Center for HIV Identification, Prevention and Treatment Services (CHIPTS) - EHE Supp: Implementation of an Emergency Department HIV/SUD screening and treatment referral mHealth tool for Latino patient

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Abstract This supplemental application aims to establish a new partnership in the geographic area not yet reached by current EHE efforts. This area consists of two EHE priority counties – Riverside and San Bernardino, collectively called Inland Empire. More than 14,000 individuals live with HIV in the area, and the proportion of undiagnosed infections remains relatively high (18%) and unchanged. Unrecognized HIV infection is the driving force behind the 23% increase in new HIV diagnoses between 2014-2018, as 80% of these new HIV infections can be traced to undiagnosed or out of care individuals. The HIV epidemic in the Inland Empire disproportionately impacts minority populations, as 79% of these new HIV diagnoses were among non-white individuals. Substance use disorder (SUD) is a significant driver of HIV transmission among Latino population, being the cause of one third of new HIV cases in this group. Latino patients are more likely to use health care in emergencies, which suggests a significant number of Latino patients seeking care in the emergency departments (ED) may have undiagnosed HIV infection and concurrent SUD. Loma Linda University (LLU) ED is the only Level 1 Trauma Center in the Inland Empire. It represents an ideal place to consolidate HIV and SUD services and to screen and refer Latino patients to care. Expanding HIV screening in EDs is one of the critical strategies described under the CDC PS20- 2010, supporting EHE programs in the Inland Empire. This is also a strategic priority identified by the local public health departments. In response, this study will adapt and pilot-test an existing computer-based self-screening intervention to identify Latino ED patients with HIV risk and/or SUD-related HIV risk. This screening will be facilitated by community health workers (CHWs). The CHWs, representing the target patient demographic, will be trained as HIV test counselors. They will provide rapid HIV tests to at-risk patients, required post test counseling, and linkage to appropriate care resources. This proposal will be guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) model. The study team will conduct an ED assessment during the Exploration phase to determine facilitators and barriers to implementing screening intervention. During the Preparation phase, researchers will adapt the existing screening intervention with the help of a multi- disciplinary group meeting weekly for three months. The implementation partners will train CHWs and prepare the LLU ED for a pilot test of the intervention. The Implementation phase will pilot test the intervention, focusing on its acceptability and potential to reach the at-risk Latino population. The Sustainment phase will explore the feasibility of a more extensive evaluation study and the intention to adopt this screening intervention in the LLU ED. The following implementation outcomes will be assessed: feasibility and acceptability of implementing mHealth HIV/SUD screening in the LLU ED, reach and acceptability of this intervention among patients and clinicians, intention to adopt this intervention. This data will be used to inform a more extensive evaluation study.