Addressing Latino MSM Health Disparities by Increasing Engagement with Behavioral and HIV-Prevention Services: An Implementation Science Approach

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PROJECT SUMMARY Miami is an HIV hotspot, driven by HIV disparities among Latino men who have sex with men (MSM). Behavioral health problems (e.g., mental health, substance use) contribute to HIV acquisition, forming synergistic disparities. Yet, Latino MSM show delayed HIV testing and underutilize pre-exposure prophylaxis (PrEP) and behavioral health services, highlighting that existing implementation efforts inadequately reach this population. My preliminary data highlight multilevel, modifiable mechanisms that drive disparities in Latino MSM’s use of PrEP, HIV testing, and behavioral health services. To advance health disparities science and achieve the Ending the HIV Epidemic goals, tailored implementation strategies that address these mechanisms to ensure the equitable delivery of PrEP, HIV testing, and behavioral health services to Latino MSM must be developed and evaluated. Research Strategy. Aim 1: Discover the key components of a culturally tailored implementation strategy that addresses the mechanisms driving Latino MSM disparities in HIV-prevention and behavioral health service use. I will leverage my preliminary data to develop a culturally tailored implementation strategy, Dime Más (“Tell Me More”) with the goal of ensuring the equitable delivery of PrEP, HIV testing, and behavioral health services to Latino MSM. From my prior work, I anticipate Dime Más will involve Latino MSM outreach workers using techniques such as motivational interviewing, problem solving, and destigmatizing narratives to engage Latino MSM in services. Results of three phases of formative research (focus groups, demonstration and feedback sessions, and a feasibility test) will be used to iteratively refine Dime Más. Aim 2: Evaluate the impact of the culturally tailored implementation strategy on Latino MSM disparities in service use. I will then conduct a pilot trial comparing Dime Más delivered by a Latino MSM outreach worker from our community partner site to standard community outreach only. Latino MSM will be randomized 1:1 to each condition (N=60, ~50% U.S. born). The trial will evaluate the impact of Dime Más on health disparities by examining PrEP, HIV testing, and behavioral health uptake across groups and exploring mechanisms of effects. We will also examine implementation outcomes (appropriateness, acceptability, feasibility, fidelity, cost) via exit interviews and surveys with participants and outreach workers. Outcomes. The proposed research and the associated training and mentoring activities will begin to elucidate the tailored strategies needed to overcome factors driving Latino MSM’s HIV and behavioral health disparities, while also building my expertise in using implementation research to advance health disparities science. With expert mentors, a strong HIV research infrastructure, solid community partnerships, and the urgent public health need to scale up PrEP, HIV testing, and behavioral health services to Latino MSM, I am well positioned to advance my research and training plan.The findings will lay the foundation for a subsequent R01 hybrid effectiveness- implementation trial, further advancing health disparities science and health equity for Latino MSM.