Project ACCEPT is designed to improve engagement and retention in medical care for youth ages 16 to 24 years with newly diagnosed HIV. The educational and skill-building intervention was deployed at four demonstration sites and increased rates of medication use and appointment adherence in comparison to a control group. Although originally developed for cisgender youth, Project ACCEPT may be adapted for gender-diverse people.
Chicago, IL
Detroit, MI
Memphis, TN
Miami, FL
Young people face several unique challenges that affect outcomes at every stage of the HIV care continuum. For example, youth are less likely to be tested for HIV and know their status, and experience disproportionate barriers to engagement and retention in HIV medical care.1 The interpersonal and socioeconomic barriers that people with HIV experience may be higher for young people and can be particularly difficult during the first year after diagnosis. Young people may also have less experience navigating the healthcare system or communicating with clinicians. Project ACCEPT is designed for youth with newly diagnosed HIV to help them engage in the health care system, in order to improve health outcomes.
“[This was a] first opportunity for folks to learn to navigate the medical system, which is an essential life skill.”
Three individual sessions are led by a counselor or social worker who should have specific expertise in adolescent behavioral health needs. The sessions are intended to introduce the intervention, identify psychosocial barriers, and explain expectations. The individual sessions provide an opportunity to develop goals, review action plans, and make referrals to supportive services. The first individual session occurs after the client’s first HIV medical visit, and the second session occurs after the client’s follow-up medical appointment, allowing the counselor or social worker to assess concerns and explore ways to make the client more comfortable in a medical setting. The client is also introduced to a peer educator during the second session. The third and final individual session occurs after the group sessions (described below), and provides the client with an opportunity to discuss what happened during the group sessions, and develop future plans. The client is encouraged to bring a support person to this session, emphasizing the importance of developing a solid support system.
Group sessions are led by a counselor or social worker alongside a peer educator. Six weekly sessions cover a range of topics, including HIV basics, stigma, and disclosure, as well as preparing for medical appointments, substance use, and healthy living. An additional session focusing on sexuality and reproduction is separated by gender, and includes content specifically developed for cisgender men and cisgender women. Although this content has been intentionally "gendered," sites are encouraged to develop content for transgender men and women too. In these instances, sessions should be facilitated by a peer educator who shares the participants’ gender identity.
Project ACCEPT relies on the delivery of services by trained peer educators, counselors, and social workers who have the technical competencies and cultural responsiveness necessary to work with youth in their communities. Depending on the location of the implementation site, it may take some time to identify ideal candidates, particularly for the peer educator role; peer educators should be young people with HIV who have lived experience of structural and social barriers to care in the local area. Likewise, counselors and social workers should have relevant experience in mental and behavioral health services that help support youth.
Project ACCEPT was developed with the involvement of a community advisory board (CAB) composed of young people with HIV. The CAB provided input on the intervention's development and design and helped develop culturally relevant materials. Peer educators also play a central role in Project ACCEPT by using their lived experience to motivate and support clients, but also to guide the intervention and to develop content that best meets the needs of the local community.
Project ACCEPT was evaluated in a randomized controlled trial at four locations across the United States: 103 participants were randomly assigned with 57 in the intervention group and 46 in the control group. Clients in the intervention group had a significantly higher rate of self-reported medication adherence compared to the control group, and were more likely to have declining viral loads in the first 12 months.2 In addition, a qualitative analysis of a participant survey found that the intervention increased participants’ comfort with—and acceptance of—their HIV diagnosis, and helped clients to gain social support.
| Category | Information |
|---|---|
| Evaluation data | Clients’ self-reports and electronic health record medical data |
| Measures |
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| Results |
* statistically significant |
Source: Hosek SG, Harper GW, Lemos D, et al. Project ACCEPT: Evaluation of a group-based intervention to improve engagement in care for youth newly diagnosed with HIV. AIDS Behav. 2018 Aug;22(8):2650-2661.
“I’ve learned how to accept myself as an HIV-positive young adult. My counselors were caring, smart, informative men. I learned how to disclose [my status] with those I could trust and how to put on a condom. Most importantly, [I learned] ways to make myself feel better during this hard time of coping with HIV.”
- Assess population demographics. The first step is to assess the population of people with HIV in your area, including total numbers, age range, and distribution by gender and sexual orientation. This may help determine whether Project ACCEPT is feasible in your area, based on population size. It may also help you to tailor the curriculum to meet the unique needs of your community, and to plan staffing resources.
- Data systems. Ensure your site has an adequate data infrastructure to allow for ongoing evaluation of the intervention. Systems should be in place to track medication adherence, appointment frequency, and HIV viral loads.
- Staff buy-in. Secure stakeholder buy-in, especially if staff roles are likely to change or if new staff or trainings are required. This should include an assessment of existing staff resources.
- Community partnerships. Develop partnerships with community stakeholders, particularly with agencies that already serve youth. Consider the needs of the population you intend to serve and develop partnerships that may help meet those needs.
- Confidentiality laws. Know the laws in your locale, especially those pertaining to providing services to youth, consent, privacy, and mandated reporting.
Project ACCEPT was initially funded by the Adolescent Medicine Trials Network for HIV/AIDS Interventions, but was also supported with Ryan White HIV/AIDS Program (RWHAP) Parts A, C, and D funding. Most of the activities and staffing needs for Project ACCEPT are eligible for RWHAP funding, which can facilitate replication and sustainability in RWHAP-funded clinics. The intervention lends itself particularly well to RWHAP Part D-funded clinics, which are most likely to serve youth and have staff trained specifically in providing services to young people.
- Clients may be reluctant to participate in Project ACCEPT. Young people may have had negative experiences with health care providers and may feel especially vulnerable immediately after a new HIV diagnosis. It is important that clinic staff and clinicians are trained and have experience working with youth. They must be able to address the discomfort and apprehension caused by stigma, psychosocial, or other structural and cultural barriers.
- Project ACCEPT is non-inclusive. The curriculum and training materials have been developed specifically for cisgender young men and women and require adaptation for use with transgender or nonbinary youth. Recruitment strategies and session content should be tailored to meet the needs of gender-diverse people in the community, and gender-affirming services should be made available to clients either directly or via referral.
- Hosek SG, Harper GW, Lemos D, et al. Project ACCEPT: Evaluation of a group-based intervention to improve engagement in care for youth newly diagnosed with HIV. AIDS Behav. 2018;22(8):2650–2661. doi:10.1007/s10461-018-2034-4
- Hosek SG, Lemos D, Harper GW, Telander K. Evaluating the acceptability and feasibility of Project ACCEPT: an intervention for youth newly diagnosed with HIV. AIDS Educ Prev. 2011;23(2):128–144. doi:10.1521/aeap.2011.23.2.128
