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

抽象的。结束艾滋病毒流行将需要大幅扩大生物医学预防的范围 将工具提供给最需要它们的人群。尽管有可用的和有效的预防方法 包括暴露前和暴露后预防(PrEP、PEP)和作为预防的治疗，性行为的男性 随着男性感染艾滋病毒的比率继续保持在美国最高水平。拉丁裔男男性接触者(LMSM)，占其中的31% 在某些情况下，出现了明显的差异。因此，迫切需要有文化根基和有效的 实施战略，以加强循证艾滋病毒预防工具在整个预防工作中的作用 LMSM的级联。因此，我们的团队使用社区参与的方法来开发一个原型 这样的实施策略-Juntos(加入欠连接网络以优化Salud)推荐 网络--扩大PrEP、PEP和快速抗逆转录病毒疗法(ART)对LMSM的覆盖范围。这个 实施战略寻求通过以下方式提高覆盖面：(A)提高实施者导航LMSM的能力 PREP、PEP和快速ART；以及(B)LMSM对服务的需求不断增加。我们的规划工作要发展 Juntos由联邦终止艾滋病毒流行(EHE)补充方案资助，其中包括学者 (迈阿密大学、西北大学)，实施(佛罗里达州卫生部，护理资源)， 和社区合作伙伴(LMSM咨询委员会)。下一个合乎逻辑的步骤是充分开发Juntos和 进行我们提议的第三类混合有效性--实施试验，目的如下。目标1： 在艾滋病毒检测顾问一级评估与Juntos转诊有关的执行结果 网络实施策略。我们将招募迈阿密-戴德县(MDC)的艾滋病毒检测人员并将其随机化 咨询师(N=45)2：1接受Juntos或HIV检测咨询师的非定制转诊名单 目前在MDC(控制)中使用。Juntos收件人将接受培训，使用Juntos推荐他们的 LMSM测试客户端。然后，我们将评估实施和维护，并探索假设 机制(例如，知识、网络)，并评估可接受性、适当性和可行性。目标2： 在LMSM一级评价与Juntos有关的执行情况和成效结果 推荐网络。我们将跟踪由AIM 1测试顾问服务的LMSM测试客户的程度 通过以证据为基础的艾滋病毒预防和治疗服务达到。每个HIV检测最多5个LMSM测试客户端 试验中的顾问将完成简短的评估，以评估PrEP、PEP和快速ART的覆盖范围 在他们测试之前和之后。我们将探索在PrEP、PEP和快速ART覆盖方面的差异 LMSM在艾滋病毒检测顾问看到的两个手臂上的试点试验，也将探索有效性 结果。完成这项R34将提供有关Juntos的可接受性、适当性和可行性的数据， 以及关于Juntos是循证实施战略的程度的初步数据，告知 改进完全动力的混合有效性-实施试验与EHE的优先事项保持一致。

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.