Latino/ETAC Site: UNC-Chapel Hill
Culturally Appropriate Interventions of Outreach, Access, and Retention among Latino/a Populations Initiative
Latino/ETAC Site: UNC-Chapel Hill
Title of the Project/Intervention: ENLACES por la salud: Finding, linking, and retaining Mexican men and TW in HIV Care
PI: Dr. Lisa Hightow-Weidman
Project Coordinator: Christine Carcano
Evaluator: Lynne Sampson
Intervention Characteristics:Intervention Start Date (or expected). / October 20th, 2014
Intervention Description. Brief description of intervention components (ICs). / Personal Health Navigators will deliver 6 one-on-one educational modules aimed at increasing engagement in care
- Overview of ENLACES, Client Strength Assessment, Preparing for the First Appointment
- Post-appointment debrief, Communicating with Medical Provider/Team
- Social Support and Community Relationships
- Coping with Stigma, Stress, and Steps to Disclosure
- Healthy Living
- Health Self-Management and Transition to Long-term Case Management
What is the level of your intervention (e.g., individual, group, community)? /
- Individual
What portions of the HIV care continuum does each intervention component target? / Objective 1 targets HIV testing and diagnosis
- Increase number of Mexican men/TW who are aware of their status: targeted outreach, social/sexual network based testing, exploration of new testing venues, on-on-one testing.
- Increase early linkage to care among HIV+ Mexican men/TW: Established relationships with clinics by PHNs facilitate direct referrals
- Enhance retention in care for HIV+ Mexican men/TW: Intensive strengths based navigation/intervention provided by PHNs who will deliver six one-on-one educational sessions to clients for improved retention
How have you adapted your intervention (e.g., culturally, transnational perspective)? / ARTAS served as the initial model for our intervention. However, ARTAS was focused solely on linkage to care and was not developed with a transnational perspective.
We thus adapted ARTAS based on: 1) qualitative interviews with individuals from the target population who are in care and 2) literature review of cultural and transnational factors that might impact care for our patients. Each educational session has a transnational goal.
We continue to adapt our intervention in an iterative fashion.
How will clients be identified? / Newly diagnosed: outreach testing, HIV providers who have just received a new patient, connections to an individual’s first point of contact following their diagnosis such as health department staff and Disease Intervention Specialists for seamless referral to PHNs.
Out-of-care: State Bridge Counselors tasked with finding out-of-care patients, ID clinics who run out-of-care lists, word of mouth through social networks and CBO partners.
Target Population: / Mexican men and Transgender Women
Target N= / 100
Planned process for pilot of intervention (if applicable). Description of pilot (which components, when, how many participants, how long) / N/A
Cross-site Evaluation Procedures:
Planned process for participant survey.
When will/did you begin administration of participant survey? / October 20th, 2014 – first cross-site survey administered. Cross-site survey is administered at first meeting between PHN and client
How will clients be recruited for cross-site survey? / All enrollees in the ENLACES intervention are recruited for the cross-site survey. Recruitment of enrollees is described above under client identification
Who will administer the cross-site survey? / ENLACES El Centro and RAIN staff members: Maritza Chirinos, Jose Alegria, Aleida Espinal, Roberto Olmo
Who will manage the cross-site survey data? / Project Coordinator Christine Carcano and Evaluator Lynne Sampson
Who will transmit data to ETAC? / Project Coordinator Christine Carcano and Evaluator Lynne Sampson
Planned process for intervention exposure data.
Who will collect the process data (intervention staff)? / ENLACES El Centro and RAIN staff members: Maritza Chirinos, Jose Alegria, Aleida Espinal, Roberto Olmo, Project Coordinator Christine Carcano
Who will manage the process data? / Project Coordinator Christine Carcano and Evaluator Lynne Sampson
Who will transmit process data ETAC? / Project Coordinator Christine Carcano and Evaluator Lynne Sampson
Planned process for clinical data abstraction.
To what clinics will you refer patients? / UNC ID Clinic, Early Intervention Clinic of Lincoln Community Health Center, Wake County Health Department ID Clinic, CMC-Myers Park ID Clinic, and Rosedale ID
Are any of these clinics external to your organization? / Yes, all listed above are external except for the UNC ID Clinic
Have you established a relationship with any/all external clinics? / MOUs, relationships, and meetings have been established with all clinics listed above
Have you identified technical staff who will be responsible for abstraction of clinical data? / Project Coordinator Christine Carcano and Evaluator Lynne Sampson, RAIN staff member Chelsea White
Have you established an MOU will any/all external clinics? / MOUs have been established with all clinics listed above
Local Evaluation (if applicable)
Planned process for local evaluation of ICs. Describe all components (formative, summative) of local evaluation / Local evaluation components include: Enrollment form, contact form and contact log, PHN-client encounter forms, PHN session notes, ENLACES specific Testing form
Qualitative methods(if applicable). Describe qualitative methods to be employed [design (focus groups, key informant interviews), target population, number of groups/participants, data collection method, methods of analysis, products] / In-depth qualitative interviews were conducted with members of the target population who are currently in care. These were recorded, transcribed, analyzed, and used to inform the session topics, goals, and content of the intervention. We are currently conducting a more in-depth analysis of the key determinants of linkage and retention in care for a manuscript.
During the course of the intervention, we will conduct qualitative interviews with a sub-group of cohort participants (15-20). These interviews will be used to provide more in-depth and contextual understanding of the intervention experience and potential mechanisms of influence. We also plan to conduct 2-3 focus groups with cohort participants and up to 10 key informant interviews with providers at the end of the intervention to assess the experience and obtain recommendations. We will use both narrative and thematic analysis techniques to analyze the qualitative data, which will be used for dissemination in conferences and publications.
PHN observations, PHN Session Notes, client questionnaires/post engagement survey
Quantitative methods. Describe quantitative methods to be employed. [design, target population, number of participants, data collection methods, methods of analysis, products] / PHN-client Encounter forms, client medical data
How do you plan to measure/monitor fidelity to your intervention (monitoring, supervision, etc.)? /
- Currently holding weekly case conferences with staff
- PHNs use structured PHN intervention manuals developed specifically for ENLACES to deliver client sessions
- Submitted modification to IRB to videotape (randomly selected) PHN-client sessions for review by project team for fidelity
- PHNs complete structured Session Notes following all PHN-client sessions
- PHNs complete PHN-client Encounter Forms following every case of contact
- Clients will complete a survey following the close of their PHN engagement
- Project Coordinator meets with PHNs at least once every two weeks for in-person monitoring
Study Organization:
IRB approval date (or expected) / Initial Approval: 12/13/13
Modification approval for inclusion of intervention and cross-site survey: 8/20/14
IRB renewal submission: 11/24/14
IRB renewal full board agenda: 12/09/14
IRB expiration date / Currently: 12/12/14
Renewal submission approval will replace current expiration date
Third All-Sites Meeting. December 11-12, 2014 UC Washington DC
(One-pager form 17NOV14)