Testing a multicomponent intervention to improve HIV outcomes

Florida International University, Miami FL

Investigators

Abstract

The U.S. is home to a significant Caribbean population, yet little is known regarding Caribbean-born individuals living with HIV beyond what was known in the pre-TasP era. No evidence-based engagement and retention intervention strategies have been developed for this group. For Caribbean-born individuals in the U.S., the HIV care continuum frequently faces disruption. Delays in diagnosis and treatment are prevalent; disruption in care due to unmet needs is commonplace. The threat of a virus hidden from view competes with more immediate socioeconomic threats. Late entry into care further compounds stigma; intersecting forms of stigma create additional barriers to effective healthcare engagement. The recent emphasis in research prioritizes understanding the longitudinal and experiential aspects of care and tailoring engagement strategies to groups not yet benefiting from biomedical advancements. Notably absent from this current era of intervention development are Caribbean-born individuals living with HIV . Based on two decades of research in both the Caribbean region and S. Florida, we propose a study that will integrate this population into the current generation of research frameworks. This proposed R34 stems from our recent work with the first community adaptation of the Integrating Engagement and Adherence Goals upon Entry (iENGAGE) intervention for implementation in a federally qualified health center serving people living with HIV. The brief engagement intervention model is designed to address the HIV care cascade comprehensively, problem-solving unmet needs, stigma, mental health and other comorbidities within a social-ecological information-motivation-behavioral framework, that incorporates motivational interviewing components. Previous iterations have shown effectiveness in reducing internalized stigma. We propose to adapt the engagement intervention model with Caribbean-born people living with HIV in Miami. The aims of our study include: (1) utilizing mixed methods to produce multi-level formative data on barriers to engagement, retention, and viral suppression among affected individuals, stakeholders, and providers; (2) culturally adapting and evaluating a Caribbean-specific engagement intervention for preliminary efficacy in a quasi-experimental pilot among recently diagnosed or nonvirally suppressed adults; and (3) identifying multi-level implementation factors affecting outcomes using mixed methods. We will adapt photovoice techniques sensitive to sociocultural constraints within this community. The study will aim to integrate a previously overlooked group into longitudinal HIV Care Cascade research, adapting and testing a promising intervention specific to their unique and persistent poorer HIV outcomes. The study fills critical gaps for this population, responds to NIH’s recent joint publication prioritizing adaptation of interventions for stigmatized populations, and establishing a foundation for future R01-level research of national significance.