Examining a Multicomponent Intervention to Improve HIV Health among Black Men in Southern Ending the HIV Epidemic in the U.S. Jurisdictions

Communities in the U.S. South continue to face disproportionate rates of HIV, particularly in areas identified by the Ending the HIV Epidemic in the U.S. (EHE) initiative. To respond to this, there is a critical need for scalable, community-driven interventions that enhance HIV-related health outcomes and address key barriers to health. In collaboration with a community-based organization with extensive experience in HIV service delivery, we developed NPOWER365, a multicomponent intervention that integrates individualized health education and motivation, fosters peer support, improves access to affirming healthcare services, and reduces barriers related to housing and economic stability. The intervention is guided by the Information-Motivation-Behavioral Skills model, social capital theory, and socioecological approaches to health. Pilot data suggest that NPOWER365 is feasible, well-accepted, and effective in supporting daily antiretroviral treatment (ART) adherence, as well as in reducing depressive symptoms, anxiety, and challenges with emotion regulation. The intervention is now ready for a full-scale evaluation using the RE-AIM framework, with a focus on its effectiveness, long-term use, and population reach. We propose a hybrid type 2 implementation-effectiveness trial, including a 6-month waitlist randomized controlled design with 350 participants, daily diary data collection, and longitudinal self-report assessments. The study aims are to: 1. Test the effectiveness of NPOWER365 in improving daily and longer-term (1-6 months) HIV-related behavioral health (primary outcome: ART adherence) and psychological health (e.g., secondary outcomes: lower depressive and anxiety symptoms) in a 6-month waitlist randomized controlled trial with 350 men living with HIV in the four Atlanta-area Ending the HIV Epidemic (EHE) jurisdictions. 2. Examine the moderating effect of NPOWER365 on associations between daily stress and our primary and secondary HIV outcomes. 3. Evaluate NPOWER365 maintenance and reach at the user-level (e.g., within-user changes in engagement and daily effects) and setting-level (e.g., intervention adaptations, community uptake). This research will provide critical evidence for the impact and scalability of NPOWER365 as a sustainable, community-centered intervention designed to improve HIV care in high-need, low-resource settings.