PROJECT SUMMARY Older gay and bisexual men living with HIV (OGBMLH) are twice as likely to experience depression compared to heterosexual and HIV-negative counterparts. Depression is now a leading cause of morbidity and mortality among OGBMLH, exceeding that caused by HIV. Consistent with national trends, major contributing factors are elevated rates of loneliness, social isolation, and lack of social support. Innovative interventions that connect OGBMLH to services that increase social support and resilience to reduce depression and loneliness are needed to improve the health and quality of life of OGBMLH. While many socially isolated OGBMLH could benefit from community-building elder services such as congregate meal programs, bereavement groups, support groups, and social gatherings, many do not access services, in part due to fear of discrimination. Scalable efforts are needed to help OGBMLH struggling with depression and loneliness to overcome barriers to engagement in existing social services that could significantly reduce depression and loneliness. We aim to develop and refine a novel evidence-informed intervention, Bridge 2 Belonging (B2B), to reduce depression and loneliness among OGBMLH by leveraging three evidence-based intervention strategies: cognitive behavioral therapy-based friendship enrichment program (FEP), motivational interviewing (MI) communication styles, and peer mentorship (PM). Guided by the ADAPT-ITT model, we will systematically solicit feedback on these interventions from OGBMLH (n=30) and subsequently community experts (n=15) to iteratively inform an innovative peer-delivered B2B intervention to increase participation in LGBTQ+ affirmative community-building services to reduce symptoms of depression and loneliness, and secondarily improve physical health and quality of life. We will then conduct a small proof-of-concept pilot (n=15) to assess the feasibility and acceptability of the B2B intervention, including the produced manual and peer training. By systematically adapting evidence-based content informed by stakeholder feedback, this R21 will produce and pilot a critically needed intervention to increase engagement in affirmative community-building services to decrease depression and loneliness, as well as improve physical health and quality of life among OGBMLH.

PROJECT NARRATIVE To address the significant public health burden of depression and loneliness among older gay and bisexual men living with HIV (OGBMLH), evidence-informed intervention strategies that are systematically adapted based on stakeholder feedback are needed. Informed by systematically collected OGBMLH and other stakeholder feedback, the proposed Bridge to Belonging (B2B) intervention will leverage three evidence-based interventions (the cognitive behavioral therapy-based friendship enrichment program, motivational interviewing, and peer- mentoring) to reduce depression and loneliness by increasing engagement in community-building elder services. Should the B2B intervention be feasible and acceptable, we will pursue a fully powered multi-site hybrid type 1 R01 trial to concurrently assess the efficacy and the scalability of this needed intervention.