The Deep South has the highest rates of obesity, diabetes, and hypertension in the nation, with marked disparities by race, socioeconomic status, and rurality. The mission of the Forge AHEAD Center is to improve health outcomes and reduce the burden of cardiometabolic diseases across the Deep South, with a particular focus on the prevention and treatment of these chronic diseases. Forge AHEAD is unified thematically by its application of a precision public health approach across the care continuum, defined as delivering the right intervention to the right population at the right time. This approach acknowledges the importance of context and individual beliefs and preferences, as well as the need for multi-level and multi-domain interventions to achieve health improvements. The Center brings together an interdisciplinary team of investigators from 4 institutions in 3 contiguous states in the region, as well as non-academic partners to extend cardiometabolic research into real-world community and clinical settings. Given the high prevalence of cardiometabolic diseases in the Deep South and the strong research base of the partnering institutions, the Forge AHEAD Center is ideally situated to inform research, clinical care, and policy to improve health outcomes in a region of substantial need.

Despite substantial investment in clinical and translational research, only a small proportion of evidence-based interventions are adopted and sustained in routine practice, contributing to persistent delays between discovery and population benefit. Dissemination and implementation (D&I) science is a critical discipline for addressing this gap, and the NIH Clinical and Translational Science Award (CTSA) program (established 2006) has been strategically positioned as a national infrastructure to advance D&I capacity. We conducted a national environmental scan of publicly available websites and documents from all 66 CTSA hubs (May-July 2025), using a structured extraction tool to capture D&I-specific activities across seven domains: institution and community partnerships, formal D&I organizational structures within the CTSA, consultation services, collaborative programming, training opportunities, educational offerings, and pilot funding mechanisms. Findings reveal substantial heterogeneity in D&I science activities across CTSA hubs; 45% had a formal D&I unit, 54% offered D&I consultation services, and 37% provided collaborative programming. Structured workforce development was limited: 12% offered D&I-focused training grants, 15% offered structured educational programs, and 15% provided D&I-specific pilot funding. Consultation models varied widely in scope, access, and evaluation practices. These findings demonstrate uneven development of D&I science infrastructure across CTSAs and highlight opportunities to strengthen capacity nationally.

Background: Retention in HIV care is associated with higher rates of antiretroviral treatment adherence and viral suppression, as well as lower risk of AIDS-related morbidity and mortality. However, the multidimensional nature of retention complicates measurement standardization, limiting comparability and global evaluation. This study explored how HIV stakeholders define and assess retention, aiming to develop a patient-centred and conceptually robust understanding to inform research and practice. Methods: We conducted a qualitative study using Interpretive Description (ID) methodology, an applied qualitative approach designed to generate practice-relevant knowledge in health research. We purposively sampled 20 stakeholders representing diverse areas of expertise and geographic regions across World Bank country income classifications. We conducted, video-recorded, and transcribed in-depth, semi-structured interviews. Using constant comparative analysis (CCA), we identified recurring, convergent, and contradictory patterns. Results: The analysis identified five overarching themes. The first two, exploratory themes, included: Patient-Centred Understanding of Retention in HIV Care, which captured how stakeholders conceptualized retention in their respective contexts, and Operationalization of Retention Measures, which explored the key components used to measure retention. The next two, explanatory themes, included Purpose-Driven Definitions of Retention, which described how retention measures were selected based on their intended use; and Building Capacity through Shared Understanding and Integrated Action, which emphasized retention as a cyclical, interconnected process dependent on collaboration between patients and health systems. The final, prescriptive theme, Advancements Shaping Retention, reflected stakeholders' shared vision of improving retention through innovations in HIV treatment and technology. Conclusions: The findings suggest that stakeholders operationalize retention measures in line with specific objectives and individual health goals, while remaining attentive to contextual realities. Retention measures should remain flexible and patient-centred, rather than relying on a single rigid standard. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study has received no funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Hamilton Integrated Research Ethics Board approved this study, including all communication protocols (HiREB #16500). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The qualitative data generated during this study are not publicly available due to ethical restrictions and confidentiality agreements with participants. The interview guide is available as supplementary material.

The transition from hospital care to post-discharge follow-up is pivotal for patient health and healthcare system efficiency. While Post Discharge Clinics (PDCs) are designed to facilitate this transition, these new ventures can face challenges, such as patient adherence to appointments. Formative evaluations can provide guidelines for their effective implementation. A mixed-method formative evaluation was conducted at the University of Alabama at Birmingham Health System (UABHS)‘s PDC to evaluate the first 12 months of operation. The study combined quantitative analysis of patient characteristics, appointment status, and comorbidities with qualitative interviews of PDC staff to assess operational performance and identify areas for improvement. The quantitative analysis reported results on 2,168 PDC appointments during the study period. About half of the referred patients attended their appointment (52.1

Introduction: Gaps in care integration and coordination contribute to emergency department (ED) crowding and preventable hospitalizations, necessitating innovative solutions to improve care transitions and reduce acute care use. This study evaluates whether attendance at a nurse-led ambulatory intermediate care clinic (AICC) reduces three-month ED visits and hospitalizations compared to missed AICC appointments. Methods: This retrospective cohort study at a single academic center analyzed AICC appointments from the first three years of clinic operations using multivariable logistic regression models, controlling for demographic, socioeconomic, and clinical factors. Our primary outcome measure was an ED visit within three months of the AICC appointment; our secondary outcome measure was hospitalization within three months. Robustness was assessed using Poisson, negative binomial, and zero-inflated models. Results: Among 2,698 appointments analyzed (mean age 51.5 years; 49.7% female), patients who attended their AICC appointment had a lower absolute ED visit rate compared with those who missed it (250/2,389 [10.5%] vs 47/309 [15.2%]; risk difference, 4.75%; 95% CI, 0.56-8.93%; P = .03). Missing an AICC appointment was significantly associated with greater odds of an ED visit (OR, 1.54; 95% CI, 1.07-2.21; P = .02). Hospitalization rates were 47.3% versus 53.4% (P = .04), although missing an AICC appointment was not significantly associated with increased hospitalizations (OR, 1.28; 95% CI, 1.00-1.64; P = .05). Findings were consistent across robustness analyses. Conclusion: The ambulatory intermediate care clinic model was associated with fewer ED visits but not reduced hospitalizations, suggesting that intermediate care can improve timely access and address acute care needs but may be insufficient to influence more complex drivers of inpatient admissions. Future research should explore strategies to enhance coordination and optimize the role of intermediate care within broader health system workflows.

Guidelines recommend checking an HIV viral load (VL) within 4-8 weeks (wk) after starting or restarting anti-retroviral therapy (ART) and every 4-8 wk thereafter until virologic suppression (VS). HIV provider visits are recommended every 3-4 months until VS is reliably demonstrated. We postulate that these early lab and provider visits are proxies of early retention in care (RIC). We sought to determine if adherence to these guidelines is associated with VS at one year in patients with an elevated VL. We conducted a retrospective study of adult people with HIV (PWH) in 8 clinics in the Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) network with an HIV VL >1000c/mL in 2017 or 2018 (to avoid COVID-era changes), and a completed provider visit +/-30 days (d) of that VL, which became the anchor visit (AV) for the study. The primary outcome was VS (< 200c/mL) one year after the AV (+/-90 d). Explanatory variables in the multivariable model included having an HIV VL measured 4-8 wk after the AV, 8-16 wk after the AV and at least 1 provider visit within 120 d after the AV. Among 2345 PWH, 11.9% were new to CNICS and 88.1% were already in care. One year from AV, 47% achieved VS. Of the 53% who were unsuppressed, only 39% had confirmatory lab data, with 61% not having any lab data 1 year from AV. Compared to PWH with labs at both 4-8 wk and 8-16 wk, those with no lab visits within 4-16 wk were 0.55 (95% CI 0.49-0.62) times as likely to achieve VS, those with a lab visit 4-8 wk after AV were 0.74 (0.66-0.85) times as likely to achieve VS and those with a lab visit 8-16 wk after AV were 0.82 (0.73-0.92) times as likely to achieve VS at 1 year. A sensitivity analysis excluding PWH with missing data confirmed these results. PWH with no provider visit within 120 d of AV were 0.85 (0.74-0.98) times as likely to achieve VS at 1 year compared to those with at least 1 visit. In this large cohort of PWH in routine care across the US, adherence to guideline-recommended early lab monitoring and follow up visits after a VL >1000c/mL was associated with subsequent VS at 1 year. These metrics could serve as early markers of RIC and identify PWH at higher risk of virologic failure than most RIC measures that require 1 year of follow up, allowing for earlier intervention Katerina Christopoulos, MD, MPH, Janssen: Honoraria Kenneth H. Mayer, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Merck, Inc: Advisor/Consultant|Merck, Inc: Grant/Research Support|Moderna: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support

Introduction: Hypertension is a leading cause of Emergency Department (ED) visits, particularly among underserved populations lacking access to primary care. Timely blood pressure (BP) management following ED discharge is critical for preventing adverse cardiovascular outcomes. We conducted a pilot study evaluating the feasibility, acceptability, and preliminary effectiveness of a remote BP monitoring (RBPM) and pharmacist-led telehealth program at an ED-transition care clinic (TCC). Methods: We conducted a pilot hybrid type 2 implementation-effectiveness randomized trial at the University of Alabama at Birmingham ED TCC from July 2024 to April 2025. Adults ≥18 years with BP ≥130/80 and ≤160/100 mm Hg, with smartphone access, no established primary care provider, and English fluency were enrolled and randomized 1:1 to intervention or usual care. The 12-week intervention included: (1) RBPM using automated BP cuffs transmitting readings to the study team, (2) twice-daily BP measurements (3 readings in AM and PM), and (3) weekly pharmacist telehealth visits for medication titration and barrier discussion, with physician review and confirmation of any medication changes. Outcomes were assessed at 3-month follow-up via in-person BP measurement and standardized implementation questionnaires. Results: The 24 participants had a mean (standard deviation) age of 50(13) years; 38% were female; 71% were Black; and 42% had a high school education or less. In the intervention group, baseline BP was 155±15/102±10 mmHg, improving to 129±13/88±9 mmHg at follow-up. Of these 12 participants, 3(25%) were lost to follow up, and 6/9(67%) adhered to the complete protocol; 7/9(78%) had controlled BP(<130/80 mmHg) at 12 weeks. Reported barriers included difficulty remembering to take BP measurements due to work schedules and cost of medications. All 9 rated the intervention as highly acceptable, appropriate, and feasible. In the usual care group , baseline and follow-up BP were 154±22/96±17 mmHg and 128±23/85±15 mmHg, respectively; 4 participants(33%) were lost to follow-up, and 4/8(50%) achieved BP control at 12 weeks. Conclusion: This pilot trial demonstrates that a pharmacist-led telehealth and RBPM intervention in an ED-TCC setting is feasible, acceptable, and may improve BP control among high-risk adults lacking primary care access. These findings support the need for a larger trial to assess long-term BP outcomes, implementation scalability, and cardiovascular risk reduction.

Background: Emergency department (ED) crowding is a persistent issue in health care, resulting in increased mortality and medical errors. This challenge is particularly pronounced in underserved populations, where a higher prevalence of chronic conditions and ED utilization exacerbates gaps in care. To address this, system-level strategies, including the establishment of intermediate care clinics, are essential. This study evaluates the first three years of a nurse-led ambulatory intermediate care clinic (AICC) in the Southern US, focusing on its role in enhancing care continuity and operational challenges for expansion. Methods: This study, conducted at the University of Alabama at Birmingham Medical Center in Birmingham, Alabama, the United States, used a convergent parallel mixed-methods design, analyzing quantitative data from 3137 AICC appointment records (May 2020-June 2023) and conducting qualitative interviews with AICC staff members. Quantitative data included patient demographics and appointment characteristics. Qualitative data were thematically analyzed to identify common themes around AICC benefits and challenges. Results: Our quantitative analysis showed that the AICC managed an increasing number of patient visits with a stable appointment adherence rate. However, rising clinic-initiated cancellations indicated resource limitations. Qualitative findings provided further context for these quantitative trends. Patients from racial minority groups and those with Medicaid insurance had significantly higher odds of missing appointments. The results highlighted the AICC’s value in preventing ED visits but also revealed challenges related to patient acuity level, resource allocation, scheduling complexities, and appointment adherence barriers. Conclusions: Establishing a nurse-led AICC is feasible and beneficial in alleviating the care gap between primary and acute care and reducing ED crowding. Key considerations for sustainable success include determining patient acuity thresholds, streamlining same-day referral processes, and addressing capacity issues. These findings can guide health systems in implementing intermediate care clinics in ambulatory settings, particularly for those serving underserved communities.

Young, Black sexual minority men (YBSMM) in the South experience disproportionately high HIV incidence rates, related to experiences of intersectional stigma. Black women are often key support figures for YBSMM. This observation led to the development of "PrEP Utilization through Increasing Social Capital among YBMSM Networks with Women" (US NoW), an intervention in which Black women serve as facilitators of sexual health discussions with groups of YBSMM to enhance social capital, reduce impacts of intersectional stigma, and promote pre-exposure prophylaxis (PrEP) uptake. However, during formative qualitative interviews, numerous women selected as facilitators expressed homophobic views that could jeopardize intervention success and participant safety if left unaddressed. We therefore developed a facilitator training curriculum specifically for Black women in the South, with a goal to mitigate these risks and strengthen support offered to YBSMM. The curriculum is rooted in established cultural competence and humility educational frameworks, with training delivery informed by learner-centered teaching methods. The completed training-facilitated by a researcher who identifies as a Black sexual minority man-utilized interactive activities and discussions to teach women about bias, cultural competence and humility, HIV, and LGBTQ-focused sexual health topics. Overall, this training resource aims to equip Black women facilitators with the knowledge, skills, and attitudes necessary to effectively engage with YBSMM in a PrEP intervention. More broadly, we highlight the importance of addressing bias to provide non-stigmatizing sexual health support to LGBTQ+ individuals.

Abstract Background In the Southeastern United States, Black women are disproportionately diagnosed with HIV compared to White women. Client-centered approaches are needed to increase uptake of HIV prevention tools, including pre-exposure prophylaxis (PrEP). Gynecology (GYN) clinics are uniquely positioned to provide PrEP for women and Black women prefer receiving PrEP from GYN providers, but PrEP delivery in GYN settings has been limited. Thus, we evaluated barriers and facilitators to PrEP provision in GYN clinics. Methods From 08/2022-04/2023, we conducted dyadic focus groups and in-depth interviews with providers (i.e., physicians, nurses, and medical assistants) and clients accessing care at a university-affiliated GYN clinic in Alabama where clients face high STI burden. Interview guides grounded in the Information-Motivation-Behavioral Skills Model explored barriers to PrEP service delivery. Inductive qualitative analysis identified emergent themes from transcripts. Results 10 providers and 21 clients (100% Black, 100% female, median age 32 (range 19-44), 90.5% insured (67% with Medicaid)) were interviewed. Emergent themes included: (1) Sexual health – including STI/HIV prevention – as part of routine women’s healthcare. Providers preferred a risk-based approach to sexual healthcare while clients preferred a sex-positive approach. (2) Incorporation of PrEP services into women’s healthcare. Both clients and providers supported that PrEP is important for women’s health. Providers felt PrEP discussions should be limited to specific visits whereas clients desired regular discussions of PrEP. (3) Multi-level barriers for PrEP service delivery in GYN clinics. Barriers included limited client and provider PrEP knowledge, inadequate clinic resources, financial costs, and STI/HIV stigma. Conclusion Incorporating PrEP services into GYN clinics could increase PrEP uptake amongst Black women. Effective multi-level interventions should focus on increasing client and provider PrEP knowledge, integrating sexual health history assessment into routine care, mitigating STI/HIV stigma, and addressing structural barriers. Disclosures Latesha Elopre, MD, Merck: Grant/Research Support

Background: HIV pre-exposure prophylaxis (PrEP) use is low among Southern, Black cis-gender women (CGW). Gynecology clinics are well-positioned to integrate PrEP services as a component of sexual and reproductive healthcare for CGW. Objectives: Identify key determinants to PrEP implementation into routine gynecologic care. Design: Qualitative, in-depth interviews (IDIs). Methods: We conducted IDIs with key informants (i.e., physicians, nurses, medical assistants) and focus group discussions (FGDs) with patients accessing care in a gynecology clinic serving under- and uninsured women in Alabama. IDIs explored individual-, setting-, and process-level factors that may impact PrEP care implementation in a clinic serving approximately 3000 women yearly, 64% of whom are Black women. Results: Ten key informants participated in individual IDIs (median age 33.5, range 24–58 years, 80% female); 20 women participated in either 1 of 4 FGDs ( n = 8) or an individual IDI ( n = 12); median age 32, range 19–44. The following themes emerged: (1) patient- and provider-level stigmas related to sexuality, sexually transmitted infections (STIs), and HIV limit discussions about sexual health and HIV prevention. (2) Providers report limited knowledge about prescribing and monitoring PrEP, which is reflected in patient’s observations that providers do not routinely initiate discussions about HIV prevention or PrEP. (3) Providers utilize a more risk-based approach to PrEP counseling; patients expect non-targeted, comprehensive sexual health information. (4) Structural and social barriers will be challenges to implementing PrEP in routine gynecological care. (5) Patients and providers support a clinic-wide approach to integration of PrEP into gynecology clinics. Conclusion: Discussions around sexual health and STIs are limited in routine gynecologic care, but patients expect comprehensive counseling from knowledgeable providers. Additional provider training may increase comfort discussing and providing PrEP. These findings will inform development of implementation strategies to integrate PrEP care into gynecologic services.

AIM:To share insights on Implementation Science (IS) methods, challenges, solutions, and best practices derived from the second National Meeting for Research and Community Collaboration toward "Ending the HIV Epidemic (EHE) in the United States." METHODS:This 2022 hybrid, one-day conference featured presentations from 13 projects funded as NIH supplements to CFARs and ARCs between 2019 and 2022. Selected for their robust findings, projects were grouped into four topics: (1) community-based outreach strategies, (2) taking the clinic to the community, (3) strategies to improve clinical care, and (4) exploring intersectional vulnerabilities and social/structural determinants of health. Standardized presentation formats were used to ensure comparability in gathering insights on IS methodologies, challenges, solutions, and lessons learned. Structured breakout discussions advanced actionable recommendations. Rapid qualitative analysis summarized insights, emphasizing lessons transportability across diverse implementation contexts. RESULTS:Common IS methods included rapid qualitative analysis, usability testing, surveys, engagement logs, mapping, and administrative data analysis. Recurring challenges were identified, including pandemic-related disruptions, staff turnover, recruitment barriers, communication gaps, and variations in organizational capacity. Effective solutions involved leveraging community partnerships, providing digital tools, conducting flexible training, and securing funding for sustainability. Best practices emphasized early partner engagement, iterative design, equitable power-sharing with communities, and culturally tailored approaches. CONCLUSIONS:Collaborative engagement with community partners, clinicians, and participants was pivotal to adapting and scaling interventions. Synthesizing transferable methodologies and lessons strengthens the framework for advancing HIV-related IS and achieving sustainable impact in diverse contexts.

Young, Black sexual minority men in the Southern USA experience disproportionately high HIV incidence rates, which have been linked to intersectional stigma. Interventions centred on social capital - the sum of all resources gained through social relationships - can reduce stigma and facilitate use of HIV prevention methods, including pre-exposure prophylaxis (PrEP). We sought to understand the social capital bonds between young, Black sexual minority men and Black women to inform a social network-based PrEP intervention in the US South. We conducted 30 semi-structured, in-depth interviews with members of both groups. Interviews were thematically analysed using a team-based approach. Men described receiving support from family, friends and significant others; mothers were discussed most frequently. Men most highly valued culturally tailored emotional support. Women described providing emotional and health support to young sexual minority men, however, several also shared perspectives exhibiting homophobic biases that were consistent with men's experiences of stigma within their support systems. These findings suggest that while Black women can serve as important sources of support for young, Black sexual minority men, homonegativity among some women may weaken their social capital bonds with these men. Future interventions should address such biases with theory-informed education and other actions prior to implementation.

BACKGROUND:Canada, Mexico, and the United States are primary transit destinations for migrants in the Western Hemisphere. Migrants face barriers to accessing health services, including HIV/AIDS and STI prevention. Mobile apps may enhance public health access for these populations. OBJECTIVE:This study systematically identifies and evaluates mobile apps supporting HIV and STI prevention in Canada, Mexico, and the United States. METHODS:An environmental scan of 357 mobile applications from the Google Play and Apple App stores was conducted on June 18, 2024, following the rigorous six-step framework proposed by Fernández-Sánchez to ensure a systematic and comprehensive evaluation of apps for HIV and STI prevention. Predefined inclusion and exclusion criteria were applied, resulting in 6 eligible apps. Each app was assessed using the 29-item Mobile App Rating Scale (MARS), scored on a 5-point Likert scale (1 = inadequate, 5 = excellent), and categorized as high (3), medium (2), or low (1) based on mean scores. Internal consistency was excellent (Cronbach's α = 0.90), and inter-rater reliability demonstrated near-perfect agreement (Cohen's κ = 0.862). Data analysis was performed using SPSS version 27. RESULTS:All six apps were available in Canada, Mexico, and the United States, with 33.3% from Google Play, 16.7% from Apple, and 50.0% from both platforms. MARS evaluation revealed high quality ratings for Engagement (100%), Functionality (88.9%), Aesthetics (83.3%), and Interaction (83.0%), as well as high subjective quality (83.3%) and app-specific quality (88.9%). Life4Me+ was the highest-rated app (4.6; 3/5), while HIV-TEST received the lowest rating (3.4; 7/5). Most apps (83.3%) were only available in English, and 16.7% supported multiple languages, which may limit accessibility for non-English-speaking migrant populations. Additionally, 83.3% were updated in 2024, 33.3% were linked to non-governmental organization, 16.7% to a university, and 50.0% had no clear affiliation. Regarding their focus, 50.0% addressed STI prevention, diagnosis, and treatment, 16.7% combined HIV and STI prevention, and 33.3% provided PrEP-related resources. CONCLUSIONS:These six apps stand out for their high functionality, engagement, and accessibility, establishing themselves as effective tools for HIV and STI prevention education among migrant populations. This study highlights the critical role of digital resources in addressing public health challenges faced by vulnerable and minority groups. Integrating these apps into health promotion strategies is essential to improve health literacy and encourage preventive behaviors. Moreover, ensuring the quality, credibility, linguistic diversity, and continuous updating of these digital interventions is crucial to achieving a real and sustained impact on public health. Policies should promote clear standards that guarantee accessibility, transparency, and accuracy, thereby facilitating access to healthcare services in complex migratory contexts. CLINICALTRIAL:

INTRODUCTION:Retention in care has recently been de-emphasized as a key national HIV health metric, and its relevance in the era of more effective antiretroviral therapy regimens remains unclear. We assessed the relationship between retention in care and sustained viral suppression (SVS) over a 2-year period for newly established and previously established people with HIV (PWH). METHODS:We analyzed data from 7 Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites using modified Poisson regression with generalized estimating equations. PWH were categorized into 2 cohorts: (1) newly established: had initial CNICS visit in 2017 and antiretroviral therapy (ART)-naïve at initial CNICS visit and (2) previously established: had initial CNICS visit before January 1, 2017, or PWH who were not ART-naïve at initial CNICS visit in 2017. Retention was measured using both missed and kept visit-based metrics. The primary outcome was SVS over 2 years, defined as all viral load measurements ≤200 copies/mL. RESULTS:Among 11,994 patients, 11,573 were previously established in HIV care and 421 were newly established and ART-naive. A higher proportion of previously vs. newly established patients were retained in care and achieved SVS. In both cohorts, when controlling for age, sex, race, and risk factor of HIV acquisition, both retention measures were observed to be a predictor of SVS. CONCLUSIONS:Retention in care remains a clinically valuable metric for all PWH. Healthcare providers should emphasize consistent care engagement, and national HIV/AIDS strategies should reincorporate retention as a key indicator for improving HIV health outcomes.

Young, Black Gay, and Bisexual men who have sex with men (YBGBM) are disproportionately impacted by HIV, especially in Southern United States. We conducted a cross-sectional survey (Feb19-Mar20). Eligibility criteria were self-reported age 16-29 years, HIV-negative, Black race, and cis-gender male. We assessed associations between demographics, religiosity, intersectional stigma, and pre-exposure prophylaxis (PrEP) use (never, previous or current) among YBGBM in Alabama. Univariate and multivariable multinomial logistic regression models were fit with factors selected a priori, guided by a conceptual framework including individual-, interpersonal- and structural-level barriers to PrEP. 305 participants completed surveys (median age 24, 75% employed, 32% lacked personal transportation, and 41% reported annual incomes < $15,000). Compared to never PrEP use (n = 219), factors associated with current PrEP use (n = 51) included: ≥ college degree [AOR (95% CI): 5.48 (2.05, 14.62)], friends' social support [AOR (95% CI): 1.33 (1.00, 1.52)], perceived HIV risk [AOR (95% CI): 1.27 (1.14, 1.42)], and PrEP knowledge [AOR (95% CI): 1.42 (1.23, 1.65)] AND factors associated with previous PrEP use (n = 35) included: depression [AOR (95% CI): 3.08 (1.34, 7.09)], condom use less than all the time [AOR (95% CI): 11.98 (1.52, 94.41)], intrinsic religiosity [AOR (95% CI): 0.77 (0.68, 0.88)], stable housing [AOR (95% CI): 0.30 (0.11, 0.81)], perceived sexual stigma [AOR (95% CI): 0.84 (0.75, 0.94)], and perceived HIV risk [AOR (95% CI): 1.18 (1.05, 1.33)]. YBGBM face distinct challenges with engagement in HIV prevention services and further investigation is needed to understand individual, interpersonal as well as structural-level factors that may mediate the ability to utilize PrEP services. Tailored multilevel strategies are urgently needed to improve PrEP uptake and persistence in YBGBM.

Background Black Americans are disproportionately impacted by HIV. This disparity is more profound in the Southern United States, with the highest rates being among young, Black, sexual minority men, who are also less likely to receive state-of-the-art interventions such as pre-exposure prophylaxis (PrEP). Individual-level interventions to increase PrEP uptake do not often capitalize on the opportunity to leverage the significant effects of this group’s social networks, including Black women, on attitudes, beliefs, and behaviors around HIV prevention. Objective To increase PrEP use, an intervention, PrEP US NoW, was designed to engage young, Black, sexual minority men’s social networks in discussions with supportive Black female facilitators and ultimately enhance their social capital. Methods First, qualitative information on core health-promoting elements of social capital bonds was captured among young, Black, sexual minority men and Black women in extant social support networks. This information was then applied to adapt an existing, evidence-based mobile health app to create the PrEP US NoW pilot through an unblinded randomized controlled trial. Six social network groups (5 young, Black, sexual minority men + 1 Black woman) will participate in the intervention arm. These will be recruited through a network-based approach and will undergo tailored training (mobile-based and face-to-face) for app usage. At baseline, men will undergo HIV testing and both men and women will complete a sociodemographic survey. The groups in the intervention arm will engage in four 60-minute discussions led by Black women through the modified mobile health app. After the intervention, young, Black, sexual minority men will complete surveys electronically at 1 and 3 months (accompanied by HIV testing) on additional factors such as experiences of discrimination and PrEP stigma. The Black women will complete an electronic survey at 1 month, measuring feasibility and acceptability, and will participate in web-based qualitative interviews at 3 months to gain more knowledge on the PrEP US NoW facilitation process. Participants in the control arm will not engage in Black women–facilitated group discussions and will use a control version of the app. The baseline and follow-up surveys and HIV testing will be documented similarly to the intervention arm. Results Phase 1 (development) of PrEP US NoW research activities lasted from November 2019 to June 2024. Data collection for the phase 2 randomized controlled trial began in August 2024 and is expected to be completed in December 2025. The findings will capture the intervention’s feasibility and acceptability and changes in PrEP uptake among young, Black, sexual minority men. Conclusions The development and pilot implementation trial of the PrEP US NoW intervention is thought to leverage essential social capital among young, Black, sexual minority men, which may promote engagement in PrEP care, thus decreasing the overall number of HIV diagnoses. Trial Registration ClinicalTrials.gov NCT07024745; https://clinicaltrials.gov/study/NCT07024745 International Registered Report Identifier (IRRID) DERR1-10.2196/66326