Enhancing HIV Prevention and Treatment Referral and Engagement among Latino MSM: A Pilot Hybrid Effectiveness-Implementation Trial of the JUNTOS Referral Network

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Abstract. Ending the HIV epidemic will require dramatically expanding the reach of biomedical prevention tools to populations needing them most. Despite the availability and effectiveness of prevention approaches including pre- and post- exposure prophylaxis (PrEP, PEP) and treatment as prevention, men who have sex with men continue to acquire HIV at the highest rates in the US. Latino MSM (LMSM), comprising 31% of these cases, experience marked disparities. Therefore, the need is urgent for culturally grounded and effective implementation strategies to enhance the reach of evidence-based HIV prevention tools across the prevention cascade for LMSM. Accordingly, our team used community engaged methods to develop a prototype for one such implementation strategy – the JUNTOS (Joining Under-connected Networks To Optimize Salud) Referral Network – to improve the reach of PrEP, PEP, and rapid antiretroviral treatment (ART) to LMSM. The implementation strategy seeks to improve reach by (a) improving implementers' ability to navigate LMSM to PrEP, PEP, and rapid ART; and (b) increasing demand from LMSM for services. Our planning work to develop JUNTOS was funded by a federal Ending the HIV Epidemic (EHE) supplement and included academic (University of Miami, Northwestern University), implementation (Florida Department of Health, Care Resource), and community partners (LMSM Advisory Board). The next logical step is to develop JUNTOS fully and conduct our proposed type III hybrid effectiveness-implementation trial, with the following aims. Aim 1: Evaluate, at the HIV test counselor level, the implementation outcomes associated with the JUNTOS Referral Network implementation strategy. We will recruit and randomize Miami-Dade County (MDC)-based HIV test counselors (N=45) 2:1 to either receive JUNTOS or the non-tailored referral list that HIV test counselors currently use in MDC (control). JUNTOS recipients will receive training to use JUNTOS for referring their LMSM testing clients. We will then evaluate implementation and maintenance, and explore hypothesized mechanisms (e.g., knowledge, network), and also assess acceptability, appropriateness, and feasibility. Aim 2: Evaluate implementation and effectiveness outcomes, at the LMSM level, associated with the JUNTOS Referral Network. We will track the extent to which LMSM testing clients served by Aim 1 test counselors are reached by evidence-based HIV prevention and treatment services. Up to 5 LMSM testing clients per HIV test counselor in the trial will complete brief assessments to evaluate the reach of PrEP, PEP, and rapid ART before and after their testing session. We will explore differences in PrEP, PEP, and rapid ART reach between LMSM seen by HIV test counselors in the two arms of the pilot trial, and will also explore effectiveness outcomes. Completing this R34 will provide data on JUNTOS' acceptability, appropriateness, and feasibility, and preliminary data on the degree to which JUNTOS is an evidence-based implementation strategy, informing refinements for a fully powered hybrid effectiveness-implementation trial aligned with EHE priorities.