Refining an implementation strategy to enhance the reach of HIV-prevention and behavioral health treatments to Latino men who have sex with men

Abstract

Background: Latino men who have sex with men (LMSM) experience HIV and behavioral health disparities. Yet, evidence-based interventions, such as pre-exposure prophylaxis (PrEP) and behavioral health treatments, have not been equitably scaled up to meet LMSM needs. To address quality of life and the public health importance of HIV prevention, implementation strategies to equitably scale-up these interventions to LMSM need to be developed. This study identifies themes for developing culturally grounded implementation strategies to increase the uptake of evidence-based HIV-prevention and behavioral health treatments among LMSM. Methods: Participants included 13 LMSM and 12 stakeholders in Miami, an HIV epicenter. Feedback regarding the content, design, and format of an implementation strategy to scale-up HIV-prevention and behavioral health services to LMSM were collected via focus groups ( N = 3) and individual interviews ( N = 3). Themes were inductively identified across the Health Equity Implementation Framework (HEIF) domains. Results: Analyses revealed five higher order themes regarding the design, content, and format of the implementation strategy: cultural context, relationships and networks, navigation of health information and systems, resources and models of service delivery, and motivation to engage. Themes were applicable across HEIF domains, meaning that the same theme could have implications for both the development and implementation of the implementation strategy. Conclusions: Findings highlight the importance of addressing culturally specific factors, leveraging relational networks, facilitating navigation of health systems, tailoring to available resources, and building consumer and implementer motivation in order to refine an implementation strategy for reducing mental health burden and achieving HIV health equity among LMSM. Plain Language Summary Latino men who have sex with men (LMSM) are diagnosed with HIV and experience mental health and substance use problems more than their non-Latino/non-MSM peers. This means there is a disparity: one group is burdened by a disease more than another group. There are interventions, like pre-exposure prophylaxis and mental health/substance use treatment that can address this disparity. But, LMSM do not have enough access to these. This means there is a healthcare disparity: one group does not have as much access to healthcare as another group. The purpose of this study was to create a program to help LMSM get these services and consider how to implement it. LMSM and potential implementers talked about factors to consider in developing this program and implementation. They said the program and implementation need to (1) consider the cultural context in which LMSM are embedded, (2) leverage LMSM and implementers’ networks, (3) increase LMSM and implementers’ ability to navigate complex health systems, (4) be tailored to the resources available to consumers and implementers, and (5) build consumer and implementer motivation. These factors are important to address when developing and implementing programs to help LMSM get HIV-prevention and behavioral health treatments.

Helping Educational Leaders Mobilize Evidence (HELM): The iterative redesign of the Leadership and Organizational Change for Implementation (LOCI) intervention for use in schools

“…Ultimately, the collaborative redesign process allowed greater alignment with HELM components and school needs and priorities and should, in theory, increase adoption and implementation. These findings are consistent with recent calls for more tailorable or customizable implementation in complex settings ( Munson et al, 2022 ) and other efforts to collaboratively redesign implementation strategies outside the education sector ( Deatrick et al, 2021 ; Harkness et al, 2022 ). Given there are a number of usability challenges for implementation strategies when applied to novel settings, it is critical to ensure redesign solutions address barriers in the implementation context ( Lyon et al, 2020 ).…”

Refining Multilevel Barrier and Facilitator Measures for HIV Testing and PrEP Among Latino Sexual Minority Men

“…17,18 Provider cultural competence was also a key determinant for both measures and may relate to the stigma that LSMM encounter; it may be difficult for LSMM to find a PrEP/HIV testing provider who is a good fit for them because they may not be LGBTQ affirming and/or may not be knowledgeable about LSMM. 19 By administering the measure, stigma at the interpersonal-level and cultural competence at the structural-level may arise as factors deterring LSMM from obtaining PrEP services. As a response, a health promotion tactic may be to develop stigma reduction campaigns and/or cultural training.…”

“…In our prior qualitative work, LSMM in South Florida noted that strategies to equitably scale up HIV prevention services should be available in multiple languages, most importantly, Spanish and English. 19 Additionally, LSMM’s immigration status should be considered with regard to engagement in HIV prevention services; research has shown that a fear of deportation had an indirect effect on reduced HIV testing among Latina/o/x individuals. 20 in practice, it may be useful in some settings for health promotion professionals to determine whether higher scores on this factor are driven more by language, immigration, or both when using the findings to inform their work.…”

Applying Rapid Qualitative Analysis for Health Equity: Lessons Learned Using “EARS” With Latino Communities

“…Notably, participants shared with interviewers that they appreciated the opportunity to share about their experiences during an acutely stressful period. Our rapid research has since laid the groundwork for subsequent research examining COVID-19 vaccine engagement among LSMM (Weinstein et al, 2022) and informed our development of an implementation strategy to facilitate LSMM’s uptake of HIV-prevention and behavioral health treatment (Harkness, Weinstein, Lozano et al, 2022).…”