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）的艾滋病毒差异是由交叉的不安全感引起的

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.