The Ruth M. Rothstein CORE Center launched Proyecto Promover to decrease HIV testing-related stigma, increase awareness of HIV status, and increase early linkage to and retention in care among Mexicanos with HIV. The program operates at the community level through social marketing, educational talks, networking, and testing. On the individual level, Proyecto Promover uses one-on-one conversations to identify and overcome barriers related to care engagement and retention. Evaluation showed promising rates of HIV testing, retention in care, and viral suppression.
Chicago, IL
Hispanic and Latina(o/x) people in the United States are disproportionately affected by HIV. Despite strong linkage to care among Hispanic and Latina(o/x) populations, viral suppression among these groups remains below the national average. This may be due to delays in HIV diagnosis and engagement in care, both of which have been associated with poor health outcomes.
A social marketing campaign included 1,700 strategically placed flyers and posters with the goal of reaching working-class Mexicanos. The campaign was designed to promote testing and reduce stigma: it included messages that testing was an effective preventive measure and that free and confidential testing was available at the CORE Center.
The CORE Center hosted 122 testing events with over 1,750 people, and 45 community education sessions with over 340 people. Although the CORE Center had hosted testing events in the past, they did not focus on Spanish-speaking populations. A large part of the initiative was prioritizing related neighborhoods and developing marketing materials that spoke to people with a strong Mexican identity.
The CORE Center used the following criteria to identify people eligible for Proyecto Promover:
- English or Spanish speaking,
- Self-identified as Mexican,
- 18 years of age or older,
- Diagnosis of HIV, and
- One of the following four categories:
- Had a new diagnosis of HIV within 6 months of date of referral and had never received HIV-related medical care in the past,
- Had a diagnosis of HIV more than 6 months ago and had never received HIV-related medical care in the past,
- Irregular HIV primary care—a lapse in care for more than six months in the prior two years, or
- Lost to care—received HIV medical care previously but no HIV medical appointment with in the previous 12 months.
Nine clinics implemented the individual level intervention which consisted of five ‘charlas’, defined as 60–90-minute, psychoeducational discussions, typically conducted one-on-one, but sometimes with the individual’s loved ones. Each participant completed the charlas with a patient navigator within one year of enrollment. The charlas each had a different focus designed to support people as they worked toward viral suppression and long-term HIV management. The initial charla explored the client’s personal migration and HIV narrative. In the second charla, barriers, mental health, and substance use disorder concerns were addressed. In the remaining three charlas, the clients discussed strategies to manage their relationships with others.
One hundred and seven people were enrolled in the individual level intervention, the majority of whom were male (89%). Evaluation results indicated strong retention in care and viral suppression for clients participating in Proyecto Promover from 2014 to 2016. While community events showed good turnout and participation, only a moderate number of new and lost to care clients were linked to HIV medical care through the events.
| Category | Information |
|---|---|
| Evaluation data | Survey and medical chart data served as evaluation data sources. |
| Measures | Percent of participating clients:
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| Results |
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Staffing. Proyecto Promover staff included a principal investigator, project director, local evaluator, and clinical patient navigators for each site.
Staff training. These staff received training on the prevention and treatment of sexually transmitted infections and HIV, creating and managing boundaries, conducting interpersonal interviews, motivational interviewing, trauma-informed care, and research prior to launch. Staff training was developed in partnership with the Midwest AIDS Education and Training Center and the Chicago Department of Public health.
Bilingual staff. All staff interacting with community members or clients spoke English and Spanish.
Community focus groups. Prior to client recruitment and project launch, six focus groups were conducted with community members to identify key barriers to care in the community. These focus groups provided information on clients’ needs as well as stigma in the community. Following each community event, surveys were distributed to attendees to gather feedback.
Community partnerships. Strong community partnerships were developed to host information and testing events as well as to distribute educational materials. Over 33 community partnerships were formed to facilitate the distribution of social marketing materials.
The initial Proyecto Promover was funded through the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) Latino Access Initiative. Approximately 65% of the budget was used for programmatic activities such as staffing, supplies, client transportation, and grant management costs. The remaining 35% of the budget was spent on client recruitment incentives and evaluation activities. To sustain the effort, the CORE Center needed funding for a half-time program coordinator and two clinical patient navigators.
- Project staff indicated that more than 12 months of one-on-one support was needed for some clients, particularly those returning to care. It was recommended that future iterations of the project establish longer timelines, and secure strong referral pathways ahead of time.
- Flexibility was important when planning the charlas. While one-on-one conversations were expected to occur in the clinic, many occurred in the community where the client lived. Similarly, project staff had to be flexible in determining the location of community events.
