Improving the reach of HIV-relevant clinical interventions using an online adjunctive intervention in South Florida HIV self-testing programs

About This Grant

Abstract. South Florida is an epicenter of the United States HIV epidemic, yet evidence-based prevention and treatment does not reach South Floridians most in need. Mental health and substance use problems fuel the HIV epidemic, yet mental health and substance use treatment reach is suboptimal in South Florida. Our team found that HIV (e.g., PrEP, PEP, ART), mental health, and substance use services in South Florida are complicated to access and not coordinated across organizations, which drives their suboptimal reach. Our partners (Care Resource, Florida Department of Health) asked our team to centralize information about local services to facilitate community reach. With these partners, we developed the “Joining Under-connected Networks To Optimize Salud” (JUNTOS) Referral Network. The JUNTOS (“together”) app and website provides information about >60 organizations to enable community members to find HIV-relevant clinical services. Our partners house HIV self-testing programs and are eager to improve client linkage to PrEP, PEP, ART, and mental health/substance use treatment, as well as new interventions such as doxyPEP. HIV self-testing provides a powerful context in which JUNTOS could function as an adjunctive intervention – one that promotes engagement in other HIV-relevant clinical interventions – to address the gap between the availability of these interventions and their community reach. We propose a three-year R01 with the following Aims: In Aim 1, we will develop a scalable implementation blueprint for integrating JUNTOS into HIV self-testing programs. The blueprint will include client-level reach strategies to promote engagement with JUNTOS and program-level adoption and implementation strategies to support our partners in integrating JUNTOS into their self-testing programs. We will use co-design workshops and service mapping to develop the blueprint. In Aim 2, we will conduct a randomized controlled trial to evaluate JUNTOS and its implementation blueprint in our partners’ HIV self-testing programs. Self-testing clients (N=210) will be randomized 1:1:1 to three different reach strategy packages from Aim 1: (a) standard (palm cards in test kits); (b) enhanced (e.g., standard strategy + consistent text/email reminders); and (c) tailored (enhanced strategy + JUNTOS usage feedback, e-coach). We will compare JUNTOS reach across the three strategies, as well as HIV-relevant clinical intervention reach (e.g., PrEP/PEP or ART, mental health or substance use treatment) and evaluate appropriateness and acceptability using mixed methods. In Aim 3, we will evaluate self-testing program staff implementation outcomes, including acceptability, appropriateness, and feasibility of JUNTOS and the blueprint, as well as adoption and implementation using mixed methods. The project responds directly to our partners’ priorities of increasing client linkage to HIV-relevant clinical interventions using an adjunctive intervention that they co-developed in service of immediate public health and organizational goals. Findings will inform refinements to JUNTOS and the blueprint in preparation for a fully powered implementation trial of JUNTOS and its implementation blueprint to achieve national EHE goals.