Abstract
BACKGROUND: In the United States, persisting new HIV diagnoses among gay, bisexual, and other cisgender men who have sex with men (GBMSM) and transgender women make it unlikely that the United States will meet the Ending the HIV Epidemic's (EHE) goal to reduce new HIV diagnoses by 90% by 2030. Innovative strategies are needed to address this challenge, particularly in the US South, where Black and Latinx GBMSM and transgender women are disproportionately impacted by HIV. Social network approaches have led to increased HIV testing uptake. Social network interventions that are responsive to individuals' needs among disproportionately impacted groups could also increase engagement across the HIV prevention and care continuum. OBJECTIVE: This hybrid type 1 effectiveness-implementation study will evaluate an enhanced social network strategy (eSNS) intervention designed to increase engagement in HIV services (HIV testing, pre-exposure prophylaxis [PrEP] use, and HIV care) by groups disproportionately affected by HIV. From 2025 to 2027, eSNS will be delivered in the Charlotte, North Carolina (NC) region, which includes Mecklenburg County, a priority EHE jurisdiction. METHODS: The study's phase 1 was a formative period of mixed methods data collection to operationalize enhancements to the Centers for Disease Control and Prevention's social network strategy (SNS). In Phase 2, the intervention will be integrated into standard NC Partner Services for people diagnosed with HIV and their sexual or social contacts, which is routinely performed by disease intervention specialists (DISs). We will identify network recruiters (ambassadors) who are 18 years and older and are either reached by study team DIS (DIS coaches) performing partner services or referred at community sites. Over 2-6 weeks, DIS coaches will guide ambassadors to identify and refer people in their network (peers) for HIV services and will facilitate peers' referrals to HIV services. Finally, Phase 3 will evaluate the eSNS's effectiveness in increasing HIV services uptake compared to standard-of-care partner services in the Raleigh, NC region. RESULTS: This project was funded by the National Institutes of Health and initially approved by the University of North Carolina at Chapel Hill's Institutional Review Board in 2022. Phase 1 concluded in August 2024. Implementation of eSNS (Phase 2) was launched in March 2025. Based on phase 1 findings, the study was modified to include Ambassadors of any race or ethnicity and gender (originally only Black GBMSM and transgender women) and expand identification of ambassadors through community sites (in addition to partner services). CONCLUSIONS: Substantial reductions in new HIV diagnoses depend on public health approaches that effectively reach people with a higher likelihood of acquiring HIV. Our protocol proposes integrating existing strategies with an innovative intervention (eSNS) to reduce social barriers to disproportionately affected groups' engagement in the full HIV prevention and care continuum.