PROJECT SUMMARY
In the US, Black women living with HIV/AIDS (WLHA) are less likely to be engaged in care, adherent to
antiretroviral therapy (ART), and virally suppressed compared to White WLHA. Concurrently, Black women are
also disproportionately affected by interpersonal violence – physical, sexual, and/or psychological abuse by a
current or former intimate partner or non-intimate partner – which may co-occur with poor mental health and/or
substance use disorders, further contributing to ART non-adherence, lower CD4 counts, and reduced viral
suppression. Peer Navigation, while highlighted as a successful model of care in improving HIV care
outcomes, requires resources that HIV service agencies often lack. A scalable and sustainable solution is the
use of mobile health (mHealth) smartphone applications (“apps”). Although there has been an increase in
mHealth interventions developed for HIV prevention and care among at-risk and HIV-positive MSM and youth,
we are unaware of any to improve retention in care, ART adherence, and viral suppression among Black
WLHA, nor any mHealth interventions that are responsive to Black women’s experiences with interpersonal
violence. To address this gap, we will develop and pilot test a culturally tailored, trauma-informed smartphone
app, called LinkPositively, for Black WLHA affected by interpersonal violence. Core components of
LinkPositively include: a) Virtual Peer Navigation that includes phone and text check-ins and 4 weekly one-on-
one video sessions to build skills to cope with barriers and navigate care; b) Social Networking platform to
receive peer support; c) Educational and Self-care database with healthy living and self-care tips; d) GPS-
enabled Resource Locator for HIV care and ancillary support service agencies; and e) ART self-monitoring and
reminder system. Guided by the Theory of Triadic Influences and Syndemic Theory, the study will be
conducted in 2 phases with corresponding aims. In Aim 1, 4 focus groups with Black WLHA with experiences
of interpersonal violence, one focus group with peer navigators, and 4-6 key informant interviews with
providers will be conducted to determine which app features, content, and functions are most likely to support
downloading, initiating use, and sustaining engagement over time. Aim 1 will culminate in usability testing by
Black WLHA affected by interpersonal violence (n=5), to finalize intervention components and procedures. In
Aim 2, we will pilot test LinkPositively to assess feasibility and acceptability and determine preliminary effects
of the intervention on HIV care outcomes (i.e., retention in care, ART adherence, viral suppression) and
mechanism of change variables (i.e., social support, self-efficacy). Participants will be randomly assigned to
either the intervention (n=40) or control (Ryan White standard of care, n=40) arm, with follow-up at 3- and 6-
months. This study will benefit the advancement of HIV prevention science by harnessing technology to
promote engagement in HIV care, while improving social support through peers and social networking – all
under the auspices of being trauma-informed for Black WLHA with experiences of interpersonal violence.
