Abstract Young Black men who have sex with men (YBMSM) are at elevated risk of contracting HIV, and are also experiencing some of the lowest health insurance coverage rates in the United States. This project seeks to systematically engage YBMSM in health insurance or Medicaid expansion in accordance with the Patient Protection and Affordable Care Act (ACA). Engagement of young otherwise healthy men in health care and in particular, YBMSM, has been a longstanding challenge. While multiple barriers to engagement have been well described, access to health care insurance is one where policies are in place in several jurisdictions, such as Chicago, where large numbers of BMSM reside. Systematic and coordinated efforts that engage these young men in health care are lacking. We propose developing and implementing a health care engagement intervention: “Insurance Coverage Expansion (ICE): A collaboration to increase and strengthen access to care among men and their networks”. The ICE intervention leverages existing HIV testing structures of the team which include three diverse organizations with longstanding community collaboration with BMSM. The specific aims of the proposed research are: (1) Develop and refine the ICE intervention to include appropriate policies, procedures and trainings to implement health insurance navigation and enrollment at the time of HIV testing; (2) Test the efficacy (insurance enrollment and linkage to care within 3 months) of the ICE intervention versus standard of care post randomization among a sample of 800 BMSM ages 18 and above; (3) Increase linkage and retention rates sufficiently to justify the cost of implementing the intervention. We will engage YBMSM in ICE building upon our expanded HIV testing programs which have conducted over 5000 HIV tests for BMSM in the past 2 years. To engage BMSM further, we will use combined network and social media approaches to recruit and retain the sample as in our current and previous work. Network recruitment (ie chain referral) as well as social media use (Facebook and hook-up apps) are key approaches to rapidly and efficiently engaging BMSM and maintaining health related contact with them. We will build upon previous and existing CDC and NIH supported projects to implement a randomized controlled trial (RCT) of ICE versus treatment as usual to achieve the aims outlined above.

Research Narrative The proposed project, Insurance Coverage Expansion (ICE): A collaboration to increase and strengthen access to care among men and their networks, seeks to engage young black men who have sex with men (YBMSM) in health insurance or Medicaid expansion in accordance with the Patient Protection and Affordable Care Act (ACA). We propose developing and implementing a health care engagement intervention that leverages existing HIV testing structures within three existing organizations that have longstanding collaborative connections with YBMSM. ICE has high likelihood of increasing health insurance coverage, linkage to care and maximization of PrEP and treatment care continuums, with concomitant reduction in population level rates of HIV infection for some of our most vulnerable community members.