The Village Project is an intensive case management-based intervention that harnesses peer navigation and integrated behavioral health services to improve the health outcomes of young Black gay, bisexual, and men who have sex with men. The intervention addresses social risk factors to improve health outcomes via enhanced social support systems. The Village Project uses a case manager, a peer patient navigator, a behavioral health counselor, and a client advocate to facilitate improvements in linkage to care, retention to care, access to behavioral health services, and viral suppression. This nine-month intervention was implemented by Parkland Health & Hospital System as part of a Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) initiative. The Village Project was associated with increased retention in care and viral suppression.
Dallas, TX
Linkage to care and viral suppression are lowest among young gay, bisexual, and men who have sex with men, and all HIV care and treatment outcomes are least favorable for Black males.1 Tailoring strategies that are culturally attuned and reflective of the experience of Black gay, bisexual, and men who have sex with men can reduce barriers to accessing HIV care, and ultimately improve rates of viral suppression. Drawing on both anecdotal evidence and quantitative data, Parkland Health & Hospital System decided to pair intensive case management with a peer navigator and a behavioral health counselor, along with existing primary medical care, to more effectively engage Black gay, bisexual, and men who have sex with men, and help address the stigma, depression, and anxiety that can go along with a new HIV diagnosis or seeking care at a known HIV clinic.
The enrollment process includes a comprehensive acuity scale assessment to document needs and inform care goals. Along with this acuity scale assessment that was administered every 90 days, the Substance Abuse and Mental Illness Symptoms Screener (SAMISS), and a Knowledge, Attitude & Practice (KAP) + Group Engagement Measure (GEM) assessment were used to gauge status and progress towards each client’s behavioral health goals.
Clients received weekly in-person and virtual visits from a team consisting of a dedicated case manager, a peer patient navigator, and a client advocate for the first six months of the intervention, followed by monthly contact for three additional months through the transition to standard care management. The team used various modes of communication including telephone (a Village Project-specific line), text messaging, and Zoom to best meet the needs of each client, while maintaining the protocols of a large hospital system. The case manager and the peer patient navigator scheduled and documented all upcoming appointments with clients via Parkland’s electronic medical record. This schedule noted whether the contact was in-person or virtual, as well as the purpose of the contact, which helped the frontline team manage their caseloads and assisted with maintaining client expectations.
A multi-disciplinary case conference was created to improve care coordination and to better identify and bridge gaps in care. The case conference was a weekly meeting with all care team members, during which the team discussed how to improve clients' engagement in care. This conference rotated providers to allow fresh perspectives. Comprehensive notes were shared with other care team members. The dedicated case conference enabled innovation, improved communication among the care team, and ultimately better integrated services, while reducing duplication of effort. The multidisciplinary case conferences enabled staff to coordinate care and work together to assess and support clients through their journey along the HIV care continuum.
Each client was introduced to one of the behavioral health counselors upon enrollment. This simple introduction alleviated stress and anxiety of meeting another new person on the care team. Through the assessments completed by the client, or by client self-report as well as a review of medical history, the team was able to assess whether the client had a previous mental health diagnosis or any current life stressors or past traumas that needed attention. If the client needed an alternative option for accessing behavioral health care, Parkland had long standing relationships with key community providers that provide wide-ranging behavioral health services throughout Dallas County.
The peer patient navigator also hosted a psychosocial support group, called Heart & Soul, where he facilitated discussions on HIV, care/medication adherence, stigma, racial inequities, substance use, risk reduction, and other topics. This support group nurtured growth, provided social and emotional support, and assisted in assessing clients’ behavioral health needs.
The Village Project enrolled 151 men between August 2019 and September 2020 who identified as Black gay, bisexual, and men who have sex with men, and ranged in age from 17 to 34. Of the 151 clients, 52 percent were either linked to care (if newly diagnosed) or relinked to care through access to same-day medical treatment. Retention in care and viral suppression improved for clients after 12 months post enrollment.
| Category | Information |
|---|---|
| Evaluation data |
|
| Measures |
|
| Results |
|
Source: NORC at the University of Chicago. Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men Initiative Monograph. (2022).
“When I first came into the program, I was on the verge of just starting my recovery. When I first met [peer navigator], I said, ‘I’m not about to talk to this gay man about what’s going on and… who is this lady? But they kept pressing and asking that my aunties, uncles would [be] concerned about my wellbeing. To be honest, they were the ones who kept me focused. They would check in and see about my meetings and how I was doing...And now I have a full-time job; I just got a car; I’m clean and sober; I’m in good health. Where I first started the program where I was in a hole to now—I’m soaring like an eagle and can accomplish anything.”
Intervention designed with input from Black gay, bisexual, and men who have sex with men. The Village Project collaborated with the community to build programming that resonated with Black gay, bisexual, and men who have sex with men in the service area. This group voiced the need for customized care that is culturally attuned; they want to see providers who look like them and see programs that reflect their experience. The key to building this program was a multifaceted approach that began by going to the community and listening to their concerns, while also asking staff for their ideas to engage this community in sustained care. The team created an autonomous consumer advisory board made up of Black gay, bisexual, and men who have sex with men who were in stable medical care and virally suppressed. Called the Mentors of The Village Project or MVPs, this group advised Parkland on the development of The Village Project, providing input on the creation of marketing materials, the intervention dosage, and how project staff contacted clients.
Including peers on the care team. One of the counselors was a young Black male who specialized in substance use, while the other was a queer female person of color who worked closely with The Village Project team. This was important in building trust and establishing rapport, especially with a group of people who have historically been hesitant to access mental health care services due to the layers of stigma that plague the community.
“Sometimes as a Black, gay man, when you wanna talk to someone about something, you want it to be relatable. I want to see more gay, Black men in positions like [Peer]. No one knows how it is to be Black unless you’re Black (but) I respect all the advocates.”
While originally funded through the RWHAP Part F SPNS program, The Village Project model of care is intended to be sustainable and scalable. Key elements of the program are intensive case management, peer navigation, and integrated behavioral health services, which are all covered services through the RWHAP. The Village Project also coincided with Parkland’s piloting of the rapid start protocol iSTAT Clinic, for same-day access to care and ART medication, which aimed to improve retention in HIV care by getting clients on medication sooner and keeping them out of the hospital.
- In speaking with MVPs, aspects of the clients’ lives other than their HIV status kept coming up as the main concerns/priorities for the clients. For example, clients could not come to appointments because they were dealing with housing and transportation issues, trying to find a job, or did not feel comfortable with the clinic staff.
