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

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Project Summary: The primary aim of this application is to examine the effects of a clinic-integrated community health worker (CHW) intervention on HIV outcomes among Black people with poorly managed HIV. Miami-Dade County, Florida, is an HIV epicenter where Black adults account for 17% of the population and 64% of AIDS- related deaths. These health disparities arise from the Social Determinants of Health (SDOH), the modifiable circumstances in which people grow, live, work, and age. Among Black people, negative SDOH limit healthcare access and foster racial inequities. In Miami-Dade, Black people account for ~60% of the homeless, are more than twice as likely to live below the federal poverty level, and three times more likely to be unemployed compared to the non-Black population. These disparities highlight the critical need for multi-level interventions that ameliorate the impact of the SDOH on this population. Accordingly, this application aims to examine the effects of the CHW intervention on the impact of the SDOH and system-level factors on HIV outcomes. For over 15 years, the University of Miami has supported research on CHW interventions to reduce HIV disparities. Our earlier work found Black PLH randomized to receive community based CHW support for 12 months improved rates of viral suppression vs. those receiving standard HIV care. Further research found clinic based CHW support also led to improved HIV outcomes among Black PLH. Expanding this work, this application proposes to broaden CHW support to both community and clinical settings by integrating CHWs into HIV clinical teams within Miami-Dade’s largest public health system. Feasibility research (1R56NR019755-01) elicited stakeholder input on CHW clinic integration and data was used to develop a clinic-based CHW intervention that extends care to community settings. As this work occurred during the pandemic, stakeholders were also queried on perceptions of emerging healthcare challenges and potentially responsive CHW support strategies. Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE) will embed CHWs trained in motivational interviewing into HIV clinical care teams to address SDOH, system-level factors, and individual self-care behaviors among 300 Black PLH. Using a randomized controlled trial design, participants will receive a 12-month CHW intervention or usual HIV care. As 1 in 3 local Black persons emigrated from the Caribbean, CHWs will receive robust training to utilize MI strategies with Black Caribbean subpopulations. Intervention effects on viral load, medication adherence, hospitalizations, and self-efficacy in treatment adherence at 12 months will be determined from medical records, participant tracking data and pre and post assessments. Subgroup analyses will compare outcomes between African American, Caribbean- Blacks, and LGBTQ participants. Results will contribute to knowledge on the utility of clinic- and community- based CHWs to improve HIV outcomes among Black PLH. If successful in optimizing HIV health outcomes, this research could make a substantive contribution towards reducing other health disparities in this population.