Intervening with Haitian Immigrants in the U.S. to Improve HIV Outcomes

干预在美国的海地移民以改善HIV治疗效果

Intervening with Haitian Immigrants in the U.S. to Improve HIV Outcomes PROJECT SUMMARY The U.S. is home to the largest population of Haitian immigrants in the world, yet little is known about Haitian immigrants living with HIV (HILWH) beyond what was known in the pre-TasP era, and no evidence-based engagement and retention intervention strategies have been developed. For Haitian immigrants and other foreign-born in the U.S., the HIV care continuum is anything but continuous. Delay in diagnosis and treatment is dominant; disruption in care due to unmet needs is commonplace. The threat of a virus hidden from view competes with more visible socioeconomic and legal threats. Lateness in care is just one more stigmatizing situation; intersecting stigmas mean a myriad of faces downturned, closed, or worse. Into this mix is the recent push to prioritize research of the longitudinal and experiential aspects of care and tailor engagement strategies to groups not yet benefiting from “getting to zero” biomedical advancements. Missing from this current era of intervention development are HILWH. Based on two decades of research in Haiti and S. Florida, which holds the largest proportion of Haitian immigrants in the U.S., we propose a study that will bring HILWH into the current generation of research. This proposed R34 in response to PA-20-141 stems from our recent work with the first community adaptation of the iENGAGE intervention for implementation with African American and Hispanic people living with HIV. The iENGAGE brief intervention model is geared to the care cascade and problem-solves unmet needs, stigma, mental health and other comorbidities within a social-ecological information-motivation- behavioral framework, utilizing motivational interviewing components, and has shown effectiveness on internalized stigma. We propose to adapt the iENGAGE model to HILWH in Miami, which is home to the full range of the Haitian diaspora experience. The aims of our study will: use mixed methods to produce multi-level formative data on barriers to engagement, retention, and viral suppression across HILWH, stakeholders, and a full spectrum of providers (Aim 1); culturally adapt and evaluate a Haitian immigrant iENGAGE for preliminary efficacy in a quasi-experimental pilot among recently diagnosed or nonvirally suppressed adults (Aim 2); and identify multi-level implementation factors affecting outcomes using mixed methods (Aim 3). We will adapt photovoice techniques sensitive to sociocultural constraints among HILWH to enhance mixed methods. The study will bring a long-neglected immigrant group into the longitudinal scope of HIV Care Cascade (HCC) research and adapt and test a promising intervention specific to their persistent HIV outcome disparities in an epicenter of both the epidemic and the Haitian immigrant diaspora. The study fills singular gaps for this population, responds to NIH’s recent joint publication prioritizing adaptation of interventions for stigmatized populations, and prepares the way for an R01 of national significance.