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      Adapting a Motivational Interviewing Intervention to Improve HIV Prevention Among Young, Black, Sexual Minority Men in Alabama: Protocol for the Development of the Kings Digital Health Intervention


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          African American or Black young men who have sex with men (BYMSM) are at a disproportionate risk for contracting HIV and have high rates of undiagnosed, and therefore untreated, HIV infection. In the southern United States, BYMSM face region-specific hurdles to HIV prevention, such as limited access to care and high levels of racism and intersectional stigma, necessitating HIV testing and pre-exposure prophylaxis interventions that address sociocultural and structural barriers while motivating BYMSM to engage in prevention. Brothers Saving Brothers (BSB) is a motivational interviewing behavioral intervention that successfully and simultaneously increased community-based HIV testing and prevention counseling and education among BYMSM in the midwestern United States.


          The aim of this protocol is to detail the process for the adaption of the BSB intervention for midwestern BYMSM to the Kings intervention for southern BYMSM. During the adaptation process, the intervention will be modernized to include rapid HIV testing, as opposed to HIV testing that requires BYMSM to return for test results, pre-exposure prophylaxis, and the provision of structural supports, and for relevance in the southern United States.


          Aim 1 is to gather qualitative data through focus groups and in-depth interviews with BYMSM aged 18 to 29 years in Alabama and in-depth interviews with prevention and outreach workers who routinely work with BYMSM in Alabama. NVivo qualitative software (QSR International) will be used for the coding and analysis of the transcripts via a thematic analysis approach. For aim 2, intervention mapping will guide the adaptation process, intervention content, components, and design. Both aims 1 and 2 will leverage the Exploration, Preparation, Implementation, Sustainment implementation science framework, with emphasis on the exploration and preparation phases of this model. By applying these frameworks, the original midwestern BSB intervention will be scientifically adapted to the southern BYMSM Kings intervention.


          This study is ongoing as of 2022 and is expected to conclude in 2024, with aims 1 and 2 being completed in 2023. Qualitative data will offer insight into the current real-world experiences and preferences of BYMSM in Alabama. Feedback will be collected through the adaptation process to inform intervention refinement. Institutional review board approvals have been received.


          The findings will inform next steps, that is, testing the Kings intervention for feasibility, acceptability, and preliminary effectiveness in a pilot hybrid type 1 effective-implementation randomized controlled trial. The study results will provide insights about important considerations for HIV prevention among BYMSM in the southern United States.

          Trial Registration

          ClinicalTrials.gov NCT03680729; https://clinicaltrials.gov/ct2/show/NCT03680729

          International Registered Report Identifier (IRRID)


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          Basics of Qualitative Research : Techniques and Procedures for Developing Grounded Theory

          The Second Edition of this best-selling textbook continues to offer immensely practical advice and technical expertise that will aid researchers in analyzing and interpreting their collected data, and ultimately build theory from it. The authors provide a step-by-step guide to the research act. Full of definitions and illustrative examples, the book presents criteria for evaluating a study as well as responses to common questions posed by students of qualitative research.
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            Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

            This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes. The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.
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                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                July 2022
                13 July 2022
                : 11
                : 7
                : e36655
                [1 ] Department of Health Policy and Organization School of Public Health University of Alabama at Birmingham Birmingham, AL United States
                [2 ] School of Medicine University of Alabama at Birmingham Birmingham, AL United States
                [3 ] Wayne State University Detroit, MI United States
                [4 ] Department of Medicine University of California San Francisco San Francisco, CA United States
                [5 ] University of North Carolina at Chapel Hill Chapel Hill, NC United States
                [6 ] College of Medicine Florida State University Tallahassee, FL United States
                Author notes
                Corresponding Author: Henna Budhwani budhwani@ 123456uab.edu
                Author information
                ©Henna Budhwani, B Matthew Kiszla, Angulique Y Outlaw, Robert A Oster, Michael J Mugavero, Mallory O Johnson, Lisa B Hightow-Weidman, Sylvie Naar, Janet M Turan. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 13.07.2022.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                : 19 January 2022
                : 2 May 2022
                : 15 May 2022
                : 21 June 2022

                hiv,men who have sex with men,pre-exposure prophylaxis,youth,implementation science,intervention,alabama,african american,sociocultural,structural barriers


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