Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE).

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PROJECT SUMMARY The goal of this research is to determine whether a CHW intervention including a mobile telehealth (M-Health) component can help achieve long term viral suppression among Black people with poorly controlled HIV. The US Government’s Ending the HIV Epidemic (EHE) initiative identified Miami-Dade County as a major epicenter of HIV. The County suffers from the Nation’s highest HIV incidence and excess AIDS-related mortality. Despite the availability of effective treatment and prevention, HIV disparities persist among certain demographic groups, especially Black communities. While Blacks comprise just 17% of the County’s population, they account for 64% of all AIDS-related deaths. This highlights a critical need for locally-designed strategies to facilitate improved access to HIV treatment and support for medication adherence. For over thirty years the University of Miami’s Center for AIDS Research (CFAR) has been dedicated to advancing HIV/AIDS research and partnering with the community to prevent, treat, and cure HIV/AIDS. This includes 12 years of research and service initiatives involving community health worker (CHW) interventions addressing disparities among Black people living with HIV (PLH). Our pilot work has already shown that Black PLH randomized to receive CHW support for 12 months had significantly improved viral suppression compared to those who received the usual standard of HIV care. More recently, our team has developed enhanced CHW interventions that combine personalized, home-based CHW support with mobile telehealth strategies to improve minority health outcomes. Building upon this research, we propose the Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE) study, a comprehensive CHW intervention to improve treatment adherence and viral suppression among Black PLH. Leveraging our established CHW network, the proposed research will integrate CHWs into HIV clinical care teams and examine the effects of a multi-level CHW and telehealth approach on viral suppression among Black people with uncontrolled HIV (viral load > 200 copies/ml). This proposal also builds upon our prior studies as well as our ongoing CHW programs providing street-based HIV outreach, education, and rapid screening in Black communities plagued by the worst HIV outcomes. Three hundred Black PLH who have not achieved viral suppression will be recruited from Miami’s public healthcare system. Participants will be randomized to a 12- month CHW intervention enhanced with mobile telehealth support versus usual HIV care. Pre and post assessments will determine intervention effects on viral load, medication adherence, hospitalizations, and self- efficacy in adhering to treatment and taking medications. The project will provide critically important research findings addressing existing knowledge gaps on the effectiveness of CHWs at improving HIV outcomes among Black PLH.