Fuerza Positiva Jeff Bailey MPH AIDS Project Los Angeles Jorge Montoya Ph. D Sentient Research

Spectrum of Engagement in Care: US vs. Los Angeles County (MMP Data 2011) USALos Angeles County Los Angeles County HIV Surveillance Data 2011 Gardner et al. CID 2011

AIDS Project Los Angeles Fuerza Positiva Organizational Chart Local Health, Behavioral Health, and Social Service Referral Sites HIV-Positive MSM of Latino Heritage Served by APLA T.H.E. Clinic (Clinical Site) T.H.E. Clinic (Clinical Site) Mexico and Border Health Organizations and Officials Local Public & Private Agencies, Businesses, Health Providers, & Community Organizations Project Administrator Jeffrey Bailey, MPH Project Administrator Jeffrey Bailey, MPH Fuerza Positiva Leadership Council  Project Staff  Representatives of Three Clinical Sites  HIV-Infected Consumers  Reps. of Local Public and Private Latino Organizations and Businesses Fuerza Positiva Leadership Council  Project Staff  Representatives of Three Clinical Sites  HIV-Infected Consumers  Reps. of Local Public and Private Latino Organizations and Businesses Out-of Care or Precariously in Care HIV-Positive Latino MSM of Mexican Heritage Living in Los Angeles County Rand Schrader Clinic at LAC/USC Medical Center (Clinical Site) Rand Schrader Clinic at LAC/USC Medical Center (Clinical Site) Northeast Valley Community Health Corporation (Clinical Site) Northeast Valley Community Health Corporation (Clinical Site) Mental Health Specialist – 1.0 FTE Cecilia Dominguez PsyD Mental Health Specialist – 1.0 FTE Cecilia Dominguez PsyD Project Coordinator / Linkage Specialist 1.0 FTE Elvis Rosales Project Coordinator / Linkage Specialist 1.0 FTE Elvis Rosales Linkage Specialist – 1.0 FTE TBH Linkage Specialist – 1.0 FTE TBH Project Specialist George Ayala, PsyD Project Specialist George Ayala, PsyD Evaluation Consulting Firm Sentient Research Jorge Montoya, PhD, Lead Investigator Evaluation Consulting Firm Sentient Research Jorge Montoya, PhD, Lead Investigator National Evaluation & Technical Assistance Center

General Framework for Fuerza Positiva Engagement in Care Model Outreach Patient Navigation Emotional Support Initial Contact - Encounter Enrollment Individual Service Plan Linkage to care Retention in care  Identify and recruit eligible clients through social networks of APLA clients  Conduct project outreach campaign, including expanded HIV testing and identification of clients precariously or tenuously involved in care  Enroll HIV-positive patients of Mexican origin in program and obtain necessary consent  Utilize ARTAS framework for intensive care linkage case management, including collaborative development of individualized client action plans  Collaboratively identify and place client in appropriate HIV primary care medical home based on factors that include accessibility, range of services, and consumer preference  Provide additional intensive peer navigation support and psychosocial case management for patients facing specific barriers to care engagement  Provide initial retention support using the Hermanos de Luna Y Sol model  Provide a range of additional retention support services include individual and group counseling, extended case management, peer events, and community coalitions

Intervention Design Fuerza Positiva  Year I: MSM  Year II: Women and Transgender  Incentive-based design (Time I, II & III)  Contingency management  Linkage to supportive services (food & nutrition, housing, public benefits)  Treatment education/adherence counseling  Risk reduction counseling

Evaluation Design Data Collection  Baseline at enrollment  Follow-up measures  3-Months  6-Months  12-months Measures  Enrollment Data & Demographics  HIV Care Continuum Outcomes  Support & Referral Outcomes  Moderators & Mediators  Intervention Exposure (Dose)  Individual  Emotional Support  Group Activities

Evaluation Design Data Sources

Program Timeline ACTIVITYTIMELINE Formative Planning Process  Recruit/hire/train staff  Conduct focus groups  Clinical partnerships  Community partnerships  Evaluation plan/tools  Local evaluation measures  IRB  Refine intervention design  Develop/pilot outreach campaign 2013 through June 2014

Program Timeline ACTIVITYTIMELINE Program Implementation 1.Identify /recruit MSM for intervention  Newly diagnosed  Not in care  Suboptimal/tenuous care 2.Enroll MSM in modified ARTAS  Linkage to care  Supportive Services  Treatment Education 3.Emotional Support Services  Individual  Group (Hermanos de Luna y Sol) June 2014

Stigma Reduction Plan Fuerza Positiva 1.Social support  Individual/group counseling  Group focused activities 2.Treatment education/adherence counseling 3.Disclosure assistance  Risk reduction counseling 4.Focus on health & wellness

Program Contact NameRolePhone Jeff BaileyProject Jorge Elvis RosalesProject Cecilia DominguezMH