PROYECTO VIDA BIENESTAR HUMAN SERVICES, FRANK GALVAN, PH.D.

BACKGROUND CONTEXT AND NEED FOR PROJECT Latinos > 13 years of age diagnosed with HIV in 2010 Linked to Care in 3 months Latinos > 13 years of age living with HIV as of 2010Retained in Care in 2010 Country of Birth Total No.No.%Total No.No.% Mexico ,3443, USA ,3562, Other Latino Countries ,4102, Not specified/ unknown ,6501, Total ,7609, Los Angeles County Department of Health Services, Division of HIV & STDs Programs, personal communication, March 5, 2013

PROJECT UNIQUENESS, OBJECTIVE AND GOALS Objective: To implement a culturally innovative program designed to improve the timely entry, engagement and retention in quality HIV care for Mexican-heritage MSM living in Los Angeles County. Goals: Conduct 2,328 HIV tests; enroll 150 HIV+ MSM (70 newly diagnosed and 80 HIV+ previously diagnosed but not in care) Mexican Cultural Components Interventions with Program Participants RecruitmentTimely Entry/Engagement and Retention in Primary Medical Care Social Network HIV Testing Mobile HIV Testing Community Outreach Clinic Referrals Social Network EngagementLinkagePeer Navigation Conceptualizations of Masculinity (machismo/ caballerismo) X X X X X X X PersonalismoXXXXXXX Helping OthersX X Religiosity XX Familismo XX Personal Growth XX

MEDICAL PARTNERS Los Angeles Gay and Lesbian Center, Jeffrey Goodman Special Care Clinic Los Angeles County/University of Southern California Medical Center, Rand Schrader HIV Clinic Northeast Valley Health Corporation

INTERVENTION DESCRIPTION Service Delivery Setting: Bienestar: 8 offices in Los Angeles County; 3 mobile HIV testing vans; 25 years of serving the targeted population Priority population: Mexican-heritage MSM in Los Angeles County (either foreign- or native-born) Services and Activities: Client-focused: (1) HIV testing; (2) social network testing; (3) social network engagement; (4) linkage coordination/peer navigation (LC/PN) Provider-focused: (1) LC/PN advocacy with medical providers; (2) trainings of providers at partner medical clinics

STAFFING FOR PROGRAM Present: Principal Investigator: Robert Contreras, MBA Program Evaluator: Frank Galvan, PhD Program Interviewer: Lizbeth Rivas Program Biostatistician: Ying-Tung Chen, MS HIV Test Counselor: Albert Martinez To Be Hired: Program Manager Linkage Coordinators/Peer Navigators (2)

INTERVENTION DESCRIPTION Recruitment Strategies: Agency HIV testing (mobile vans & offices) Social Network Testing (SNT) Other: (1) community partner agencies’ referrals, (2) promotional materials Enrollment and Linkage to Care Strategy: Social Network Engagement (SNE) Linkage coordination Retention Strategy: Peer navigation Promote engagement with other Bienestar programs and services Work with medical providers to address identified barriers to care / Trainings Client Incentives: SNT & SNE recruiters: $10 gift card for every participant they successfully recruit

STIGMA REDUCTION STRATEGIES FOR ACCESS TO AND RETENTION IN HIV PRIMARY CARE Access: Use of peers in social network testing and social network engagement Retention: Use of Motivational Interviewing techniques by the Linkage Coordinators/Peer Navigators Cultural sensitivity presentations to providers that include a component on stigma

LOCAL EVALUATION Goals: (1) To evaluate the effectiveness of Proyecto VIDA in improving timely entry, engagement and retention in HIV primary care and other health indicators among Mexican-heritage HIV+ MSM; (2) To monitor Proyecto VIDA to assess the implementation of its various program components. Objectives: 1.To identify to what extent participation in the program was able to result in timely entry into care, engagement in care, high CD4 cell counts, low viral loads and high self-reported medication adherence among the participants. 2.To identify to what extent Mexican cultural values were significantly associated with our main outcome variables mentioned in #1. 3.To examine how well the program was able to meet the needs of the participants in a culturally-appropriate manner and to identify the program’s strengths and weaknesses. IRBs: (1) LACDHS IRB & (2) LAC/USC Medical Center IRB; Frank Galvan, preparer

LOCAL EVALUATION Methods: Quantitative: local evaluation domains (e.g., machismo/caballerismo, religiosity, familismo, personal growth, fatalism) Qualitative: process monitoring of the various program components Study Participants’ Role in Evaluation: 4 evaluation time points over 18 months of receiving program services (baseline and 6-, 12- and 18-months follow-ups) $10 (?) per survey administration

LOCAL EVALUATION Data Analysis Approaches: Quantitative: Descriptive, bivariate and multivariate statistical tests as the data allow for our key outcome variables mentioned in Objectives Qualitative: Use of standard content analysis techniques Dissemination of Key Findings: Local dissemination at meetings of County funding agency, HIV service providers and clients Presentations at national meetings and conferences Publications submitted to academic peer-reviewed journals

ActivityMonths Hire remaining program staffFebruary Develop qualitative data collection formsFeb-Mar In coordination with HRSA SPNS and ETAC, finalize questionnaireFeb-Apr Meet with collaborating medical clinics to finalize protocolsFeb-Mar Submit and obtain IRB approval from the Los Angeles County Department of Health Services IRB (follow up later with LAC/USC Medical Center IRB) Apr-May Initiate programJune-Aug TIME TABLE FOR YEAR 1

CONTACT INFORMATION Robert Contreras, M.B.A. Principal Investigator (323) , ext. 122 Frank Galvan, Ph.D. Program Evaluator (323) , ext. 117