The Juntos Referral Network: Planning an Implementation Strategy to Enhance the Reach of HIV Prevention and Treatment Services to Latino MSM and Address Intersectional Insecurities

Juntos 转诊网络：规划一项实施战略，以扩大艾滋病毒预防和治疗服务对拉丁裔男男性接触者的覆盖范围，并解决跨部门不安全问题

• 批准号: 10394554
• 负责人: Steven A Safren
• 金额: $ 30.1万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-22 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10394554
• 关键词: AIDS prevention; Access to Information; Address; Affect; Caring; Communities; Consolidated Framework for Implementation Research; County; Data; Data Collection; Drops; Economics; Epidemic; Evidence based intervention; Feedback; Florida; Focus Groups; Foundations; Fright; Goals; HIV; Healthcare; Hour; Housing; Immigrant; Immigration; Incidence; Individual; Intervention; Interview; Interviewer; Language; Latino; Legal; Maps; Mental Health; Mental Health Services; Methods; Online Systems; Outcome; Population; Prevalence; Prevention; Prophylactic treatment; Research; Resources; Services; Structure; Subgroup; Surveys; System; Testing; Translations; Transportation; Universities; Update; Viral; Work; antiretroviral therapy; base; consumer demand; design; effectiveness implementation trial; evidence base; experience; health care disparity; health equity; implementation design; implementation determinants; implementation outcomes; implementation science; implementation strategy; improved; men; men who have sex with men; online resource; peer; peer networks; peer support; pre-exposure prophylaxis; preference; prevent; prevention service; prototype; service delivery; social stigma; tool; treatment services; uptake; web site

HIV disparities among Latino men who have sex with men (LMSM) are fueled by intersectional insecurities tied to inequity. Our research with LMSM in Miami-Dade County (MDC) found that interlocking oppressive systems (e.g., intersectional stigma, immigration, structural barriers) prevent LMSM from obtaining HIV-prevention (e.g., pre-exposure prophylaxis/PrEP, non-occupational post-exposure prophylaxis/nPEP) and treatment (e.g., rapid ART). Yet, LMSM’s peers can facilitate the extended reach of services. We also found that HIV services in MDC are fragmented, creating challenges for stakeholders to navigate LMSM to existing, potentially useful HIV services that address intersectional insecurities (e.g., free transportation, drop-in services, rapid service delivery, and co-located ancillary services) and therefore block access to evidence-based interventions. Accordingly, we will employ community engaged methods to develop an implementation strategy (the Juntos referral network) to improve the reach of PrEP, nPEP, and rapid ART to LMSM. The implementation strategy will improve reach by (a) strengthening relationships and cross referrals between HIV organizations and (b) increasing consumer demand via LMSM’s access to information about HIV and ancillary services addressing intersectional insecurities and peer support for services. The planning project will be conducted in partnership with implementing and community partners (Florida Department of Health, Care Resource, LMSM advisory board). Aim 1: Identify LMSM and stakeholder priorities for the content, design, and implementation of Juntos. Interviews (based on the Consolidated Framework for Implementation Research and Health Care Disparities Framework) with LMSM (N=20-30) and stakeholder focus groups (1-2 groups) will identify priorities for Juntos’ content (e.g., information to be included about HIV organizations), design (e.g., interactive features with peers), and implementation (e.g., anticipated uses). Surveys with LMSM (N=200) and stakeholders (N=100) will further assess priorities. To expedite translation of the implementation strategy into the field, qualitative data will be analyzed via rapid qualitative analysis and surveys will be analyzed descriptively with subgroup comparisons (e.g., immigration, language). Aim 2: Identify services. Interviewer-administered surveys and web-based data extraction will identify local HIV organizations’ available services (N=30+), mapped on to priorities identified in Aim 1, informing the content of Juntos. Aim 3: Develop and pre-test prototypes. We will produce prototypes of Juntos and gather feedback via theater testing with LMSM (N=10- 15 individual tests) and stakeholders (N=1-2 group tests). Interviews and surveys will elicit feedback on the content and design of Juntos as well as implementation outcomes (acceptability, appropriateness, feasibility). The project will add value by creating an implementation strategy tailored to LMSM’s intersectional insecurities and local resources to improve the reach of PrEP, nPEP, and rapid ART, aligned with the EHE plan. This will lay the foundation for an implementation-effectiveness trial of Juntos.

与男性发生性关系（LMSM）的拉丁裔男人之间的艾滋病毒差异是由互不安全的束缚的 不平等。我们在迈阿密戴德县（MDC）与LMSM的研究发现，互锁的压迫系统 （例如，交叉污名，移民，结构障碍）防止LMSM获得预防措施（例如， 暴露前预防/预防，非占领后预防/NPEP）和治疗（例如，快速 艺术）。但是，LMSM的同龄人可以促进服务的扩展范围。我们还发现艾滋病毒服务 MDC是分散的，为利益相关者带来LMSM的挑战 解决交叉不安全感的服务（例如，免费运输，倒入服务，快速服务 交付和共同确定的辅助服务），因此阻止了对基于证据的干预措施的访问。 彼此之间，我们将采用社区参与的方法来制定实施策略（参军 推荐网络），以改善对LMSM的准备，NPEP和快速艺术的覆盖范围。实施策略 通过（a）加强艾滋病毒组织之间的关系和交叉推荐，将提高影响力 通过LMSM访问有关艾滋病毒和辅助服务的信息来增加消费者需求 交叉的不安全感和服务的同伴支持。计划项目将进行合伙 与实施和社区合作伙伴（佛罗里达州卫生部，护理资源，LMSM咨询部 木板）。目标1：确定内容，设计和实施的LMSM和利益相关者的优先级 军团。访谈（基于实施研究和医疗保健的合并框架 LMSM（n = 20-30）和利益相关者焦点小组（1-2组）的差异框架）将确定优先级 为了供Juntos的内容（例如，有关HIV组织的信息），设计（例如，交互式功能 与同行）和实现（例如，预期用途）。使用LMSM（n = 200）和利益相关者进行调查 （n = 100）将进一步评估优先级。为了加快将实施策略转换为现场的转换， 定性数据将通过快速定性分析进行分析，并将对调查进行描述性分析 亚组比较（例如移民，语言）。目标2：确定服务。面试官管理 调查和基于Web的数据提取将确定本地HIV组织的可用服务（n = 30+）， 映射到在AIM 1中确定的优先级，并告知Juntos的内容。目标3：开发和预测试 原型。我们将制作juntos的原型，并通过LMSM进行剧院测试收集反馈（n = 10- 15个个人测试）和利益相关者（n = 1-2组测试）。访谈和调查将引起有关 参数的内容和设计以及实施结果（可接受性，适当性，可行性）。 该项目将通过创建针对LMSM交叉不安全感的实施策略来增加价值 以及与EHE计划保持一致的当地资源，以改善PREP，NPEP和快速艺术的影响力。这会 为Juntos的实施效应试验奠定了基础。