1. Culturally Appropriate Interventions of Outreach, Access and Retention among Latina/o Populations Initiative Evaluation and Technical Assistance Center (ETAC) University of California, San Francisco

2. Outline Goal of initiative Goal of cross-site evaluation Cross-site evaluation framework Cross-site evaluation methods –Eligibility –Global unique ID –Process evaluation –Outcomes evaluation –Economic evaluation Timeline

3. Goal of Initiative To enhance HIV testing and diagnosis among out-of-care Latino/as, and to link and retain these populations in high quality HIV care To engage intervention approaches tailored to Latino cultural beliefs as they relate to health seeking behavior

4. Goal of Cross-site Evaluation To facilitate and conduct a rigorous evaluation of innovative and effective service delivery interventions for Latino/as living with HIV across demonstration sites.

5. Evaluation Components HIV testing data Intervention exposure Participant survey Medical data abstraction Costing Local evaluation Key informant interviews Participant interviews Qualitative Quantitative

6. Cross-Site Quantitative Evaluation

7. Objectives To assess the effect of demonstration projects on: –Engagement in HIV care continuum, and –Patient health outcomes. To assess how pre-disposing factors, enabling factors and need mediate or moderate the effectiveness of demonstration projects –Identification of factors guided by Transnational Framework specific to Latino/a experiences in the US

8. Objectives To assess the cost, cost-efficiency and cost- effectiveness of demonstration projects

9. Evaluation Theory Behavioral Model (Andersen, 1968, 1995) Predisposing Factors Enabling Factors Need Health Behavior

10. Traditional Populations Predisposing FactorsEnabling FactorsNeed Demographics - Age - Gender - Relationship status Health Beliefs - Knowledge of healthcare resources - Satisfaction with HIV care - Patient/provider communication Social Structure - Education - Employment - Faith traditions Personal/Family Resources - Income - Health Insurance - Social support Community Resources - HIV healthcare resources Evaluated Health - HIV-related health status

11. Evaluation Theory Behavioral Model for Vulnerable Populations (Gelberg, Andersen, Leake 2000) Predisposing Factors Traditional populations Vulnerable populations Enabling Factors Traditional populations Vulnerable populations NeedHealth Behavior

12. Vulnerable Populations Predisposing FactorsEnabling FactorsNeed Social Structure - Transgender - Ethnicity - Skin color - Sexual orientation Lived Experience - Housing - Incarceration - HIV disclosure - Depression - Drug use -Intimate partner violence Cultural Beliefs - Racial socialization Stigma - HIV, MSM, transgender, criminal record Personal/Family Resources - Competing needs - Public benefits - Coping skills - Transportation Community Resources - Social service resources No additional factors

13. Predisposing Factors Traditional populations Vulnerable populations Transnation al Populations Enabling Factors Traditional populations Vulnerable populations Transnation al populations NeedHealth Behavior Evaluation Theory Behavioral Model for Transnational Populations (proposed)

14. Transnational Populations Predisposing FactorsEnabling FactorsNeed Health Beliefs - Knowledge of healthcare resources for immigrants Lived Experience - Country of origin - Migration - Transnational travel - Acculturation - English language literacy Cultural beliefs - Familismo, Machismo, Marianismo, Fatalismo Stigma - National origin Personal/Family Resources - Transnational social support - Economic trans- nationalism - Transnational communication - Transnational information sources Community Resources -Transnational density - Transnational HIV medical provider No additional factors

15. Evaluation Framework Predisposing Factors Enabling Factors Need Innovative Interventions Engagement in HIV Care Continuum

16. Innovative Interventions Stigma reduction –Community engagement Identification –Outreach –Social network testing Linkage –Patient navigation Retention –Case management Cross-site Evaluation

17. Primary Outcomes HIV Care Continuum –HIV positivity –Late HIV diagnosis –Linkage to HIV medical care –Retention in HIV medical care –Antiretroviral therapy –Viral suppression Cross-site Evaluation

18. Cross-site Quantitative Evaluation Methods

19. HIV Testing Aggregate data –Number tested –Number tested HIV-positive Number enrolled –Number of new HIV diagnoses Number enrolled

20. Eligibility Cross-site evaluation –HIV-infected Mexican and Puerto Rican individuals HIV-infected Latino/Hispanic race Identifies as Mexican or Puerto Rican Not fully engaged in HIV care Demonstration project participation –Sites may include HIV-infected Latino/a individuals from other places of origin in demonstration interventions. –However, these individuals will not be counted toward totals or included in the cross-site evaluation.

21. Global Unique ID (GUI) –GUI will be used to identify participants across all data collection methods –GUI components Name (first three letters of first and last name) Date of birth (month and year) Sex (on birth certificate) Gender (current) Race Ethnicity Zip code of current residence / sleeping (first three letters)

22. Participant Survey Eligible participants will be surveyed at baseline and every six months until six months before the end of the demonstration project. ETAC will be responsible for tool creation, training, technical support, maintenance of the web portal and data analysis.

23. Participant Survey Demonstration sites will be responsible for consent, data collection and weekly transfer of data to secure web portal. –Ideally, data collection staff will not be intervention staff. –If sites plan to conduct interviewer-administered surveys, these may NOT be conducted by intervention staff.

24. Intervention Exposure Routinely collected data on units of service –Community engagement –Outreach –HIV testing –Patient navigation –Case management

25. Intervention Exposure Demonstration sites will be responsible for uploading data for eligible participants every month to secure web portal. –Demonstration sites will create and use their own tools for data collection –Data must be submitted in a standardized format

26. Intervention Exposure Data elements –Date –Participant ID –Intervention provider Outreach worker, patient navigator, case manager, etc. –Provider type Peer, non-clinical provider, clinical provider –Intervention target Stigma reduction, identification, linkage, retention, etc. –Minutes

27. Data Abstraction Abstraction of routinely collected data from: –HIV testing –Patient care –HRSA Ryan White Services Report (RSR) ETAC will be responsible for tool creation, training, technical support, maintenance of the web portal and data analysis. Demonstration sites will be responsible for uploading data for eligible participants every six months to secure web portal.

28. Costing ETAC will work with demonstration sites to report the annual cost of planning and implementation of demonstration site interventions. Costing categories include: –Personnel –Recurring costs –Capital investment (one-time costs) –Infrastructure (space)

29. Costing Demonstration sites will be asked to report on costs by: –Period (pre-implementation vs. post- implementation) –Activity (community engagement, testing, patient navigation, case management) –Intervention target (identification, linkage, retention, etc.) –Source of resources (HRSA SPNS grant vs. “in- kind” costs)

30. Costing Costs associated with local and cross-site evaluation will be represented separately and are not included in the cost of demonstration site intervention implementation.

31. Timeline Participant Survey Development –Program ACASI –Pilot (est. July 14) –Finalize survey (est. August 18) IRB Approval –UCSF (est. June 30) –Sites Intervention implementation

32. Thank You Questions?