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.

与男性发生性关系的拉丁裔男性（LMSM）之间的艾滋病毒差异受到交叉不安全感的推动 不平等。我们对迈阿密戴德县（MDC）的LMSM进行的研究发现， (e.g.,交叉污名，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 ART）。然而，LMSM的同行可以促进服务的扩展。我们还发现， MDC是分散的，给利益相关者带来了挑战，使他们能够将LMSM引导到现有的、可能有用的艾滋病毒中。 解决交叉不安全性的服务（例如，免费交通，上门服务，快速服务 提供服务和合用同一地点的辅助服务），因此阻碍了循证干预措施的获得。 因此，我们将采用社区参与的方法来制定实施战略（Juntos 转介网络），以提高预防性接触、非预防性接触和快速抗逆转录病毒疗法对LMSM的覆盖率。执行战略 将通过（a）加强艾滋病毒组织之间的关系和交叉转诊，以及（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， 交叉的不安全感和对服务的同伴支持。该规划项目将与 与执行和社区合作伙伴（佛罗里达卫生部、护理资源部、LMSM咨询部） 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（基于实施研究和卫生保健综合框架） 与LMSM（N=20-30）和利益相关者焦点小组（1-2个小组）的差异框架）将确定优先事项 对于Juntos的内容（例如，包括有关艾滋病毒组织的信息），设计（例如，互动功能 与对等体），以及实现（例如，预期用途）。对LMSM（N=200）和利益相关者的调查 （N=100）将进一步评估优先事项。为加快将执行战略落实到外地， 定性数据将通过快速定性分析进行分析，调查将通过 子组比较（例如，移民、语言）。目标2：确定服务。访谈者管理 调查和基于网络的数据提取将确定当地艾滋病毒组织的可用服务（N=30+）， 映射到目标1中确定的优先事项，为Juntos的内容提供信息。目标3：开发和预测试 原型。我们将生产Juntos的原型，并通过LMSM（N=10- 15个单独测试）和利益相关者（N=1-2组测试）。访谈和调查将收集关于 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交叉不安全性的实施策略来增加价值 和当地资源，以改善PrEP，nPEP和快速ART的覆盖范围，与EHE计划保持一致。这将 为Juntos的实施效果试验奠定基础。