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

拉丁裔男男性行为者(LMSM)之间的艾滋病毒差异是由跨部门的不安全感造成的 敬不平等。我们在迈阿密-戴德县(MDC)对LMSM进行的研究发现，连锁压迫系统 (例如，跨部门的耻辱、移民、结构性障碍)阻止LMSM获得艾滋病毒预防(例如， 暴露前预防/PrEP、非职业性暴露后预防/nPEP)和治疗(例如，快速 艺术)。然而，LMSM的同行可以促进服务的扩展。我们还发现，艾滋病毒服务在 MDC是分散的，这给利益相关者带来了挑战，即如何将LMSM导航到现有的、潜在有用的艾滋病毒 解决交叉不安全问题的服务(例如，免费交通、顺风车服务、快速服务 提供服务和同处一地的辅助服务)，因此阻止获得循证干预措施。 因此，我们将采用社区参与的方法来制定实施战略(Juntos 转诊网络)，以改善PrEP、nPEP和快速ART对LMSM的影响。实施策略 将通过以下方式扩大覆盖面：(A)加强艾滋病毒组织之间的关系和相互转介；(B) 通过LMSM获得有关艾滋病毒和辅助服务的信息来增加消费者需求 跨部门的不安全感和对服务的同行支持。规划项目将以伙伴关系进行。 与实施和社区合作伙伴(佛罗里达州卫生部、关怀资源、LMSM咨询 董事会)。目标1：确定LMSM和利益相关者在内容、设计和实施方面的优先事项 朱托斯。访谈(根据执行研究和保健综合框架 差异框架)和LMSM(N=20-30)和利益相关者焦点小组(1-2个小组)将确定优先事项 对于Juntos的内容(例如，要包括的关于艾滋病毒组织的信息)、设计(例如，互动功能 与对等体)和实现(例如，预期用途)。与LMSM(N=200)和利益相关者进行调查 (n=100)将进一步评估优先事项。为加快将执行战略落实到实地， 定性数据将通过快速定性分析进行分析，调查将通过描述性分析进行 分组比较(例如，移民、语言)。目标2：确定服务。面试者-管理 调查和基于网络的数据提取将确定当地艾滋病毒组织可用的服务(N=30)， 映射到目标1中确定的优先事项，告知Juntos的内容。目标3：开发和预试 原型。我们将生产Juntos的原型，并通过使用LMSM(N=10- 15项单项测试)和利益相关者(N=1-2组测试)。访谈和调查将获得关于以下方面的反馈 JUNTOS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的交叉不安全感而定制的实施战略来增加价值 以及当地资源，以扩大PrEP、nPEP和快速ART的覆盖范围，与EHE计划保持一致。这将是 为Juntos的实施效果试验奠定基础。

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.