Building Brothers Up (2BU) is a case management intervention designed to engage and reengage Black men who have sex with men (MSM) with HIV into HIV care services. Peer case managers work closely with clients to increase HIV health literacy, troubleshoot accessibility issues to HIV care, and connect clients directly to behavioral health and support services. This three-month intervention was implemented by the Friends Research Institute as part of the Black MSM Initiative funded by the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) program. Clients who participated in 2BU had increased retention in care and viral suppression 12 months after enrollment.
Los Angeles, CA
Black MSM are disproportionally impacted by HIV, resulting in lower rates of linkage to and retention in care. The Centers for Disease Control and Prevention (CDC) reports that compared to other racial groups, Black MSM in the U.S. have a higher prevalence and incidence of HIV and are less likely to reach viral suppression.1 In response to these disparities, the Friends Research Institute implemented 2BU to provide behavioral health case management in conjunction with HIV medical and support services. 2BU was developed to increase the availability of wraparound services to Black MSM and improve rates of linkage to and retention in care.
Peer case managers worked directly with clients providing case management sessions throughout the three-month program, in addition to linking clients to HIV care, behavioral health services, and additional support services. Clients were assigned to a peer case manager with similar demographics and lived experience. Peer case managers served as trusted points of contact for clients.
2BU consisted of six sessions: four weekly sessions in the first month and one session in each of the next two months. The first session was an initial assessment that identified the client’s needs and barriers to care, developed a client-centered treatment plan, and provided immediate linkage to HIV medical care and support services. The following sessions addressed the long-term goals of the client’s HIV treatment plan and established linkage to behavioral health services and support services through a warm handoff to partner organizations.
Clients were provided wraparound HIV and support services both internally and externally. Onsite services included health education and risk reduction, hot meals, and personal hygiene supplies. 2BU facilitated warm handoffs to different partner organizations that provided clients with off-site clinical and non-clinical support services depending on need. Clients were provided a “red-carpet treatment” that directly linked clients to services, meaning they could move to the front of the line to engage in new services and receive personal introductions to staff at partner organizations to help smooth the initial enrollment process.
From October 2019 through December 2020, 69 clients who self-identified as Black MSM with HIV ages 18 to 65 years old and who were not engaged in care participated in 2BU. Of those, 40 participated in the evaluation for 12 months and had improvements in retention in HIV medical care and viral suppression during that time.
Source: Kisler KA, Fletcher JB, Reback CJ. Peer case management promoting advancement along the HIV care continuum among Black men who have sex with men living with HIV: Building Brothers Up. AIDS Patient Care STDs. 2022;36(Suppl 1): S-46-S-53
External partnerships. Within a non-clinical site, it is crucial to develop formal partnerships with medical clinics to provide HIV primary care and behavioral health services to participants. Memoranda of understanding were established with partner organizations to provide clients with seamless entry to services.
Staffing. 2BU’s core team consisted of a principal investigator and co-investigator responsible for program management and implementation, a project coordinator responsible for day-to-day operations as well as peer case managers overseeing case management for clients, an evaluator, and a data manager.
Peer case management. It is important to hire peer case managers who share similar backgrounds and lived experiences with the clients they serve. To recruit peer case managers, 2BU aimed for a large pool of applicants by advertising through job websites, local community advisory boards within the Black MSM community, and sharing within other local and professional networks.
Clinical therapist. 2BU contracted with a PhD-level professional to provide emotional support to peer case managers. Readily available clinical supervision helped to prevent burnout, as peer case managers found it challenging to support this priority population.
Training. All staff attended a six-to-eight-week training that addressed outreach safety, enrollment procedures, peer case management, and assessment delivery. The training was conducted through field observations, role plays, mock assessments, and presentations. Additional training was provided by the local AIDS Education and Training Center and the California STD/HIV Prevention Training Center.
Outreach and recruitment. 2BU used various approaches to recruit the priority populations. Recruitment strategies included online recruitment efforts directed to Black MSM, LGBTQ printed media, poster/flyer advertisements through community partners, and incentivized referrals.
- This grant, funded by a RWHAP Part F SPNS initiative, covered project staff, office space, and materials such as printing, office supplies, and risk reduction supplies. 2BU recommends funding for advertisement and a clinical therapist.
- Ongoing staffing should include a principal investigator at 25 percent time, a project coordinator at 100 percent time, and at least one peer case manager at 100 percent time.
- Although priority populations may benefit from behavioral health services, not all will be motivated to participate. It is important to tailor services based on what participants say they need and not what the providers believe they need.
- As a non-clinical program, it is very important to build strong partnerships with local organizations. This provides the opportunity to facilitate warm handoffs for participants along with referrals to HIV care, behavioral health, and additional support services.
- Although remote services may be convenient, it did not work well with older participants enrolled in 2BU. They attended in-person services at a higher rate, indicating the need for a hybrid option.