Scaling Up and Out HIV Prevention and Behavioral Health Services to Latino Sexual Minority Men in South Florida: Multi-Level Implementation Barriers, Facilitators, and Strategies

Harkness, Audrey; Satyanarayana, Satyanand; Mayo, Daniel; Smith-Alvarez, Rosana; Rogers, Brooke G.; Prado, Guillermo; Safren, Steven A.

doi:10.1089/apc.2021.0018

Cited by 31 publications

(28 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, our formative research (the DÍMELO study) with LMSM and stakeholders (individuals who delivered HIV-prevention and behavioral health treatments to LMSM in South Florida) identified barriers and facilitators that need to be addressed to increase the reach of these services to LMSM. The qualitative aim of DÍMELO included LMSM (∼50% born outside the United States) and stakeholders and identified implementation determinants (Harkness et al, 2021a) using the Consolidated Framework for Implementation Research (Damschroder et al, 2009). Key determinants of HIV-prevention and behavioral health treatment use among LMSM included complexity of service access, perceived benefits of services, policies influencing service availability, patient needs and resources that could affect service use (e.g., transportation, education, immigration status, mental health/substance use), peer influence (e.g., peer stigma vs. normalization), LMSM and provider knowledge, provider/organizational relationships (e.g., stigma vs. affirmation, trust, personalism), and the availability of services.…”

mentioning

confidence: 99%

“…For example, LMSM experienced 22% of all new HIV diagnoses in 2019 (Centers for Disease Control and Prevention, 2020). Yet, evidence-based interventions, such as pre-exposure prophylaxis (PrEP), have not been sufficiently scaled up and out to LMSM (Blashill et al, 2020; Harkness et al, 2021b; Kimball et al, 2020). PrEP use in the past year was reported by only 28% of US-born LMSM (Trujillo, 2019).…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Harkness

Weinstein

Lozano

et al. 2022

Implementation Research and Practice

Self Cite

View full text Add to dashboard Cite

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.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Harkness

Weinstein

Lozano

et al. 2022

Implementation Research and Practice

Self Cite

View full text Add to dashboard Cite

show abstract

“…Many directors of MBHOs, including those who advertise services to LGBTQ+ people, perceive a high need for LGBTQ+ mental health care and report the need for more LGBTQ+ affirmative staff and related resources (Pachankis et al, 2021). In particular, mental health services and related implementation research are needed to address the needs of LGBTQ+ subpopulations such as Latino/a/x/e sexual minority men at high risk for HIV (Harkness et al, 2021), older adults (Goldhammer et al, 2019; Holman et al, 2020), persons in rural areas (Willging et al, 2016), and veterans (Valentine et al, 2021). Our results illuminate both opportunities and challenges in strategies to improving LGBTQ+ affirming care in community MBHOs.…”

Section: Discussionmentioning

confidence: 99%

What motivates community mental and behavioral health organizations to participate in LGBTQ+ cultural competency trainings?

Fish¹,

King‐Marshall²,

Williams³

et al. 2022

American Journal of Orthopsychiatry

View full text Add to dashboard Cite

The constantly evolving language, understanding, and cultural context regarding the mental health of lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse individuals (LGBTQ+) require mental health providers to obtain LGBTQ+ cultural competency training to be affirmative and effective with this population. Unfortunately, many providers are not obtaining this ongoing training and mental health disparities continue to plague LGBTQ+ populations. Guided by the Consolidation Framework for Implementation Research (CFIR), we conducted eight focus groups with community mental and behavioral health organization (MBHO) administrators (e.g., directors, clinical supervisors) and therapists to explore what factors facilitated or inhibited their adoption and implementation of a multicomponent LGBTQ+ cultural competency training program that required administrator and therapist participation in multiple learning sessions over several months (i.e., workshop, clinical consultation, and organizational technical assistance). Results from template analysis supported CFIR-aligned themes, including characteristics of individuals, inner setting, outer setting, and process, and two additional codes—marketing and other/previous training opportunities—emerged from the focus group data. Findings suggest that therapists are motivated to engage in such a program because they want to feel more efficacious, and administrators see the benefits of LGBTQ+ training programs for their clientele and marketing. Barriers to adoption and implementation include cost and personnel resistance, although participants believed these barriers were surmountable. Emphasizing therapist efficacy, clientele need, and benefits for marketing mental and behavioral health services could motivate MBHOs’ and therapists’ adoption and implementation of LGBTQ+ cultural competency training.

show abstract

“…In contrast to MITI, our study identified patients' diabetes stigma as an implementation barrier. Half (52%) of patients with type 2 diabetes report feeling stigmatized [34] and disease-related stigma has been identified as a barrier to patients signing up for health services in other contexts including HIV and mental health [35,36]. Engaging patients to develop strategies sensitive to stigma can help mitigate this barrier [36].…”

Section: Discussionmentioning

confidence: 99%

Exploring determinants and strategies for implementing self-management support text messaging interventions in safety net clinics

Nelson¹,

Roddy²,

Bergner³

et al. 2022

J. Clin. Trans. Sci.

View full text Add to dashboard Cite

show abstract

Scaling Up and Out HIV Prevention and Behavioral Health Services to Latino Sexual Minority Men in South Florida: Multi-Level Implementation Barriers, Facilitators, and Strategies

Cited by 31 publications

References 46 publications

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

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

What motivates community mental and behavioral health organizations to participate in LGBTQ+ cultural competency trainings?

Exploring determinants and strategies for implementing self-management support text messaging interventions in safety net clinics

Contact Info

Product

Resources

About