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SPNS Initiative: Culturally Appropriate Interventions of Outreach, Access and Retention among Latino(a) Populations, 2013-2018


This Special Projects of National Significance (SPNS) Program initiative, Culturally Appropriate Interventions of Outreach, Access and Retention among Latino(a) Populations, is a multi-site demonstration and evaluation of culturally-specific service delivery models focused on improving health outcomes among Latinos/as living with HIV. The initiative currently funds ten demonstration sites for up to five years to design, implement, and evaluate innovative methods to identify Latinos/as who are at high risk or living with HIV and improve their access, timely entry, and retention in quality HIV primary care. This initiative is one of the first public health adaptations of the transnational approach, with interventions targeting HIV-infected Latino/a subpopulations living in the U.S. that are specific to their country or place of origin. The University of California at San Francisco's Center for AIDS Prevention Studies serves as the Evaluation and Technical Assistance Center (ETAC) for this initiative.  The ETAC coordinates the multi-site evaluation, provides programmatic technical assistance to the demonstration sites, and leads publication and dissemination efforts of best practices and lessons learned.

Grant Recipients

Grants for this initiative were awarded to the organizations listed below, and abstracts provide a brief description of each project. These grant recipients are funded from 2013-2018.

Gay Men's Health Crisis (GMHC), LINK II, New York, NY
GMHC's LINK II (Leaders in Networking and Knowledge) project utilizes three strategies that will effectively identify and serve Puerto Rican MSM in New York City. LINK II employs a social networking strategy that will enlist HIV-positive recruiters from the Puerto Rican MSM community to recruit their network associates for HIV tests. To link those who are HIV positive to care, a Linkage Navigation Specialist will provide customized materials and culturally-nuanced counseling and a personal escort to Mount Sinai Hospital for an initial medical visit. To help those newly-diagnosed remain engaged in medical care, GMHC will collaborate with Mount Sinai Hospital to offer an array of culturally-sensitive supportive services in a location that is widely known as being gay-friendly, sex-positive, and outside of the neighborhood where most clients live, to reduce the impact of perceived stigma on engagement in care.

Harlem United Community AIDS Center, Uptown Health Link Project, New York, NY
Harlem United's Uptown Health Link project includes: targeted outreach and engagement activities, a social marketing campaign encouraging access to primary care, proven retention in care activities, expansion of the agency's referral network of culturally competent providers, a local evaluation to assess the effectiveness of project activities, and the dissemination of project findings and lessons learned. Uptown Health Link has three components: 1) training and targeted outreach by Puerto Rican Health Promoters who will provide targeted case-finding activities to identify and recruit HIV-positive Latinos/as at venues frequented by the target population; 2) linkage to care/navigation services by Patient Navigators using ARTAS, Motivational Interviewing, and peer support to help clients overcome immediate barriers to accessing medical services; and 3) education and support by the Health Promoters who will provide individual-level support to each client to improve retention and group-level education through a 12-week educational/social support series.

New York City Health and Hospitals Corporation, Rikers Island, NY
NYC HHC Correctional Health Services (CHS) is responsible for the provision of medical and mental health care to all those held in NYC jails, offering HIV testing, care and treatment, and providing transitional care coordination for chronically ill inmates leaving jail. CHS's intervention has three components: 1) Latino cultural awareness and sensitivity training to clinicians working in NYC jails and community providers affiliated with Bronx Health and Housing Consortium, 2) tailored HIV counseling for those of Puerto Rican descent at risk of HIV, with an emphasis on testing for those who have never been tested, and 3) culturally-sensitive referrals to community-based care for those living with HIV who are released from a NYC jail. Correctional health providers will also be trained in motivational interviewing techniques to facilitate engaging clients who may be victims of sex-trafficking, providing culturally- and contextually-sensitive counseling to assist those victims in freeing themselves from the sex trade. All those admitted to a NYC jail expected to return to the community will receive a culturally-appropriate discharge plan from specially trained staff, and bilingual staff are available 24/7 to meet the needs of Spanish-speaking clients. Transitional plans will refer clients to community-based providers who are able to meet the needs of Spanish-speaking clients from different cultural backgrounds. Providers experienced with victims of sex trafficking will be identified as a resource for those clients.

Philadelphia FIGHT, Clinica Bienestar, Philadelphia, PA
Philadelphia FIGHT/Jonathan Lax Treatment Center will work in collaboration with Prevention Point Philadelphia (PPP) and Temple University for Clinica Bienestar. The project includes: 1) outreach activities to inform the community of Clinica Bienestar, 2) identification of HIV-infected persons of Puerto Rican descent through HIV testing at PPP and in outreach sites, 3) immediate (same day) connection for those newly diagnosed to Clinica Bienestar, 4) HIV Primary Care at Clinica Bienestar in three clinic sessions each week, 5) direct connection to the HIV Primary Care program at Philadelphia FIGHT for those who need it, with door-to-door transportation and patients seen by the same clinician as at Clinica Bienestar, 6) immediate connection to Case Management with ongoing case management services, 7) care navigator services, 8) a culturally-appropriate family connection initiative, 9) culturally and linguistically-appropriate education initiatives, and 10) referrals for substance abuse, behavioral health, legal services, housing, transportation, food, and emergency assistance with assistance in accessing these services for Spanish-speaking people.

University of North Carolina at Chapel Hill, NC, Enlaces Por La Salud
UNC's project is Enlaces Por La Salud: Finding, Linking and Retaining Mexican MSM and Transgender Women (TW) in HIV Care in North Carolina. To increase the number of Mexican MSM/TW who are aware of their HIV status, Enlaces Por La Salud will conduct enhanced venue-based testing, partner with health care settings traditionally accessed by the population (urgent care centers, community clinics), and target media advertising and a statewide education campaign for providers. To increase the number of Mexican MSM/TW who are linked to care within three months, rapid referrals to care will be established. Personal health navigators (PHNs) will collaborate with both Disease Intervention Specialists (DIS) and State Bridge Counselors (SBCs) to facilitate linkage of newly-diagnosed persons to HIV care within 30 days of diagnosis. To increase the number of Mexican MSM/TW who receive a minimal level of continuous care, PHNs will work with SBCs and will follow patients until at least two clinic visits more than three months apart have been attended. Enhanced and expanded clinic hours staffed with Spanish speaking providers, and culturally-appropriate support services also will be provided.

AIDS Foundation of Chicago, IL, Salud y Orgullo Mexicano
AFC's Salud y Orgullo Mexicano will identify prospective clients through three strategies: 1) a targeted Spanish language social marketing campaign, 2) in-reach through existing programs of AFC and Erie Family Health Center, and 3) outreach to agencies working with the target population and to clients at health fairs and community festivals. Promotores de salud, community health workers who are HIV-positive men of Mexican descent, will facilitate clients' timely entry, engagement, and retention in HIV primary care at Erie Family Health Center by providing culturally appropriate systems navigation, health education, medical adherence coaching, and peer counseling.

Hektoen Institute for Medical Research, Proyecto Promover, Chicago, IL
Proyecto Promover, implemented by the Ruth M. Rothstein CORE Center, will engage the growing at risk Mexican population in the Chicago EMA by recognizing the unique needs of its multiple subpopulations (women, heterosexual men, heterosexual men who engage in sex with men, but do not identify as gay or bisexual, gay men, and bisexual men and women). The intervention will foster early identification and linkage and also decrease individual and community HIV-related stigma by making HIV testing a routine practice through social marketing, community education, and community provider technical assistance. Through tailored education adapted from VOCES (a CDC-approved DEBI), community networking, and social marketing, two trained promotores will work with existing and new partners to reduce stigma and expand community-based HIV prevention education, HIV testing, counseling and referral. Community providers also will be invited to participate in a multidisciplinary HIV-testing technical assistance program aimed at increasing their knowledge of and comfort with routine testing policies and practices. The promotores will make direct linkages to a Patient Navigator (PN), and, once engaged in care, the PN will work to retain patients in care by providing culturally-tailored support through Charlas ("chats"), the Healthy Relationships DEBI, motivational interviewing, and psycho-educational groups that both address sociocultural barriers and provide support in the vein of familismo and personalismo. Taken together, these components of Proyecto Promover will foster the normalization of routine HIV testing and early diagnosis, and strengthen partnerships to increase early identification, linkages, referral and retention.

AIDS Arms, Viviendo Valiente, Dallas, TX
AIDS Arms' Viviendo Valiente project will develop, implement, and refine a Mexican Latinocentric model to engender trust and acceptance between Mexicans who are HIV positive or at-risk for HIV and service providers, in order to improve acceptance of HIV testing and treatment. The model is multi-layered, applying a combination of community-level, group-level, and individual-level interventions; integrating roles of staff and volunteers from the priority community to promote acceptance of treatment; leveraging existing AIDS Arms services; promoting delivery of culturally congruent care and services at the broader systems level; using social media and social marketing to deliver key messages; and presenting HIV education within a health and wellness perspective in the context of appealing and non-threatening events for the Mexican community. The Viviendo Valiente model design will be refined with the help of the priority population in order to achieve optimal outcomes and ensure that it is replicable, thus maximizing the impact of grant resources.

AIDS Project Los Angeles, CA, Fuerza Positiva
APLA's Fuerza Positiva will focus on HIV-infected men (especially MSM) and women of Mexican origin living in Los Angeles County, California. Using culturally appropriate models, the project will implement an intervention strategy comprised of: 1) identification and recruitment; 2) strength-based case management/patient navigation; and 3) social support. Fuerza Positiva will conduct outreach activities to reach MSM of Mexican origin in Los Angeles County and deliver strength-based case management linkage services using ARTAS model. The project will also provide culturally-specific HIV care retention and support services using an adapted version of the Hermanos de Luna y Sol intervention for approximately 45% of all HIV-positive individuals identified through the program. Fuerza Positiva will also incorporate a comprehensive array of support services and programs to address structural, financial, personal, and cultural barriers to care, including individual and group mental health services; ongoing care coordination services; client-centered information and skill-building sessions; and expansion of APLA's existing referral network to link both monolingual and bilingual persons of Mexican origin to a continuum of community-based care.

Bienestar Human Services, Proyecto Vida, Los Angeles, CA
Bienestar's Proyecto Vida will focus on Mexican MSM and work in partnership with the Los Angeles Gay and Lesbian Center, the Los Angeles County/University of Southern California Medical Center, and the Northeast Valley Health Corporation, all established providers of HIV medical care. To identify Mexican MSM living with HIV who are out of care, Proyecto Vida will employ two key strategies: Social Network Testing and Social Network Engagement (SNE), an adaptation of Social Network Testing; and strengthening of relationships with community partners who refer clients to Bienestar. To facilitate engagement and retention in care among all participating HIV-positive Mexican and other Latino MSM, Proyecto Vida will use Motivational Interviewing coupled with a linkage to care/peer navigation intervention as its primary strategy. Trained Linkage Coordinators/Peer Navigators will facilitate the initial linkage to/engagement in care, while motivational interviewing will provide clients with ongoing support, building their internal motivation and self-efficacy for remaining in care and adherent to their treatment protocol.

University of California at San Francisco, Center for AIDS Prevention Studies, San Francisco, CA - Evaluation and Technical Assistance Center (ETAC)
The Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco will serve as the ETAC for the initiative. The ETAC will provide leadership and support to demonstration sites implementing their interventions to enhance HIV testing and diagnosis among out-of-care Latina/os, and to link and retain these populations in high quality HIV care. Technical assistance will focus on the development of innovative models for providing HIV and support services; methodological (both quantitative and qualitative) research design and evaluation consultation and support; state-of-the-art data collection and management system design; ensuring patient privacy and confidentiality and, support for dissemination of study outcomes through a variety of channels. The multisite evaluation will employ mixed methods to: 1) evaluate multi-site patient outcome data using federally-approved indicators to understand intervention effectiveness, 2) conduct key informant interviews to characterize barriers and facilitators to testing and care before and after intervention implementation, and (3) collect cost data to determine the kinds of interventions that are most cost-effective. The ETAC will synthesize and disseminate findings from demonstration sites so that they have an optimum impact on the research, practices, and policies related to intervention strategies for out-of-care and sub-optimally engaged-in-care Latinos living with HIV to better inform implementation of the National HIV/AIDS Strategy.