Using ENGAGED for CHANGE to Develop a Multicultural Intervention to Reduce Disparities among Sexual and Gender Minorities in Appalachia

Abstract: Background: Gay, bisexual, queer, and other men who have sex with men (GBQMSM) and transgender persons in Appalachia are at an increased risk for HIV, sexually transmitted infections (STIs), hepatitis C virus (HCV), mpox (formerly known as monkeypox) and are less likely to use prevention and care services. Objectives: Our community-based participatory research partnership sought to develop an intervention to increase use of HIV, STI, HCV, and mpox prevention and care services among diverse GBQMSM and transgender and nonbinary persons living in rural Appalachia. Methods: We used ENGAGED for CHANGE , a novel community-engaged participatory intervention development process, to integrate two evidence-based strategies—community-based peer navigation and mHealth—into a multi-cultural intervention. Results: The developed Appalachian Access Project intervention contains five modules to train GBQMSM and transgender and nonbinary persons to serve as peer navigators (known as “community health leaders”) within their social networks. The modules are designed to increase awareness of HIV, STIs, HCV, and mpox and their prevention and care; provide guidance on how to promote use of services, including pre-exposure prophylaxis, syringe services, and medically supervised gender-affirming hormone therapy; improve understanding of social determinants of health; and increase ability to effectively communicate and apply social support strategies in person and through mHealth social media. Conclusions: The Appalachian Access Project intervention builds on the strong, preexisting social networks of GBQMSM and transgender and nonbinary persons. It is designed to meet the needs and priorities of underserved and minoritized communities in rural Appalachia through community-based peer navigation and mHealth.