Highlighting Strategies for Incorporating Community Engagement in HIV Care and Prevention Programming for Black MSM Patient Communities

Transcription

1 Necessary Resilience Highlighting Strategies for Incorporating Community Engagement in HIV Care and Prevention Programming for Black MSM Patient Communities Tuesday, July 21, 2015

2 Omoro Omoighe, Associate Director, Center for Engaging Black MSM Across the Care Continuum (CEBACC), Health Equity/Health Care Access, NASTAD Byron Mason, Research Partnerships Director, Center for AIDS Prevention Studies (CAPS) - University of California, San Francisco

3 Center for Engaging Black MSM Across the Care Continuum NASTAD (CEBACC)

4 Our lives begin to end the day we become silent about what matters - MLK

5 Are public health stakeholders providing strategies for care engagement that are informed by Black MSM patient communities? I don t have a license yet. But, thanks? YOU GET A CAR!

6 Estimated HIV Incidence in the United States % of the US population/ comprise 23% of new infections *HIV and the Black Community: Do #Black (Gay) Lives Matter? AmFar Issue Brief - February 2015

7 CEBACC 2014 Literature Review Focus Interventions for HIV screening, linkage and retention for positive Black MSM less emphasis on prevention, behavioral modification Peer reviewed studies/articles published between *Multiple study designs considered Primary Study population Black MSM residing in the US

8 CEBACC 2014 Literature Review PubMed Medline Plus JSTOR Google Scholar OAJSE 1 st level Black MSM 2 nd level Black Males 3 rd level Blacks African American, Black, MSM, MSMW, Patient, Provider, Patient/Provider, Bisexual HIV Care, Intervention, Program

9 . CEBACC 2014 Literature Review Findings BMSM Interventions Disparities 8% 7% Barriers to Care Disparities 20% 65% Barriers Prevention Care Access Across the Cascade

10 U.S. Public Health Response and Addressing Social Determinants of Health Lancelet, July 2013 A systematic review of HIV interventions for black men who have sex with men (MSM) 12 completed studies of interventions for black MSM 8 out of 12 interventions aimed to reduce HIV risky behaviors among Black MSM patients 4 studies focused on care interventions for Black MSM living with HIV Many Men, Many Voices 3 MV - Behavioral Modifications - 3MV uses small group education and interaction to increase knowledge and change attitudes and behaviors related to HIV/STD risk among black MSM. Singular Approach

11 CEBACC

12 Center for Engaging Black MSM Across the Care Continuum (CEBACC)

13 Patient/Provider Relationship Bi directional opportunities to address the communication gap Black MSM patients and health care providers must be willing to educate and inform one another Successful care engagement is a partnership!

14 Behavioral Clinical Community Advisory Panel Clinicians Researchers Policy Experts NOT PICTURED Dr. Leo Moore; Dr. Quintin Robinson; Leandro Mena; Elijah Robinson; Daniel Driffin; Greg Millett; Kali Lindsey; Anton Bizzell

15 BCCAP Care Model Rating Tool

16 Care Model Inventory Care Model Institution Funded Budget Funder CRUSH (Alameda County, CA) Academic/CBOs $1,000,000 California HIV/AIDS Research Project/UCSF (State) Connect to Protect/SMILE (Memphis, TN) CBOs/Hospitals/Local Health Department $300,000 Health/NICHD ATN (Federal) Howard Brown/Broadway Youth Center (Chicago, IL) ASO $500,000 HRSA Ryan White Part D (Federal)/ Project Silk (Pittsburgh, PA) Academic/CBO $467,000 CDC (Federal) Linkage To Care (L2C) (Indianapolis, IN) ASO $400,000 AIDS United (Federal) Us Helping Us Ties that Bond CDC (Federal) (Washington, DC) CBO $300,000 Retention Through Enhanced Personal Contact (REPC) ASO/CBO (multisite) $241,565 CDC/HRSA (Federal) CLEAR Program (Norfolk, VA) $83,000 Project Healthy Living: ManDate (Washington, DC) Local host house (varies) $60,000 NASTAD, DC HAHSTA, Gilead SMILE - Fenway Institute (Boston, MA) FQHC $55,000 Adolescent Trials Network (Federal) AIDS Foundation Chicago HIV-VIP Program (Chicago, IL) NGO $14,500 CDC (Federal)

17 What s Working? Characteristics of selected care models Care is client - centered Care is client- driven Assets based vs. Deficits based Program design addresses health systems/targets multiple stakeholders Promise for maximum utilization by Black MSM Significant impact on HIV care across one or more strata of the care cascade, including prevention Program is currently ongoing.

18 What s Working? CEBACC Key Concepts Intersectionality Black, gay, male, youth Community Engagement - Designed closely with the target population e.g. CRUSH Leveraging Partnerships linking black MSM patients with support services, strong referral networks for partner services, (mental health/substance use, employment) C2P Innovations + Refreshing Traditional Strategies - recreational space AND affiliation with medical clinic, support and counseling groups: Project Silk, UHU Ties that Bond, Kaiser Speakout 25 under 25

19 What s Working? CEBACC Key Concepts Prioritizes patients immediate concerns, needs and desires Patient navigation, case management, individualized attention Not rushing patients into first appointment readiness check Assisting black MSM patients with additional structural and psycho-social barriers to care (mental health/substance use, employment) Programs meet clients where they are at

20 CRUSH Connecting Resources for Urban Sexual Health

21 CEBACC CME/CNU Development 1. Describe health care challenges for black MSM 2. Address misinformation, knowledge gaps, and ignorance among provider communities 3. Develop skills in offering high quality and nuanced culturally appropriate sexual health services

22 CME/CNU Development Dr. David Malebranche STD/STI Screenings Dr. Leo Moore Sexual Health Intake History Dr. Quintin Robinson Vaccinations

23 CME/CNU Development Dr. Theodore Hodge PrEP Access and Uptake Dr. Lisa Hightow Weidman Linkage to Care Dr. Ayana Elliott Transgender Healthcare

24 NASTAD Technical Assistance Meeting July 21-22, 2015 Byron Mason, Research Partnerships Director Center for AIDS Prevention Studies (CAPS) University of California, San Francisco

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26 Current CAPS Research Projects Drug Users Gay Men and Men Who Have Sex with Men and Women HIV+ Persons Incarcerated and Formerly-Incarcerated Persons Transgender Persons Youth International Africa Asia Methods (Quantitative & Qualitative) Policy Technical Assistance and Capacity Building Domestic International Translational and Implementation Science Traineeships Domestic International

27 CAPS Technology and Information Exchange (TIE) Core

28 Primary Objectives Science to Community: Facilitate access to and use of HIV prevention science by stakeholders (i.e., community-based organizations [CBOs], health departments, funders and policy makers); Community to Science: Support CAPS scientists use of community expertise; Foster Collaborative Research: Support communityinvolved research and ongoing collaborative research partnerships between CAPS scientists and diverse communities.

29 Community-Engaged Research Meaningful collaboration between researchers and community leaders to address communities needs CBOs/HDs/CPGs/HBCUs Interdependent, mutually beneficial relationship that pursues a common goal The process of community engaged research exists on a continuum

30 Why Community Engaged Research? There is a growing recognition that traditional research approaches, while appropriate for many research questions, have failed to solve complex health disparities. Health problems exist within the context of people s lives, and the explanations will likely be found in the messy complexity of real life. A community-engaged approach to HIV prevention and treatment can enable us to conduct research and produce results which may be directly translated to improve human health.

31 The Social-Ecological Model

32 Context in San Francisco Bay Area Well resourced/researched jurisdiction Cutting edge systems of surveillance/monitoring/data History/Activism Community response Working with diverse populations Training ground (UC System) Synergistic/community focused approach to research Shifting landscape Economic crisis vs current SF economy Current median single family home price $1 Million 36% decline of black population during the last two decades Nature of HIV prevention (biomed/social sciences) Oakland/Shadow city/south Bay Gaps with most vulnerable populations Over representation (YMSM/of color, TG) Many exist within the margins.

33 What we know SF/US HIV epidemic is fueled by social determinants of disparities, which calls for a better understanding of how these forces interact. The high rates of HIV/AIDS we see, especially among communities of color, are not the result of high-risk behavior in these communities, but social determinants/structural inequalities that make them more likely to come in contact with the disease and less likely to treat it. The intersection of race, poverty, stigma, socio-economic status and sexuality among other factors becomes the embodiment of health inequities. Many populations exist within the margins (homelessness, incarceration, commercial sex work) Outlets for social support and community capital are lacking.

34 How is CAPS responding to the current and changing demographics of the epidemic?

35 I. Technical assistance and outreach II. CAPS Community Advisory Board (CAB) III.Dissemination products and services IV.Community collaboration

36 Important Discussions How do we effect system-level change? One of the real challenges to addressing social determinants is the time for the investment: in many cases this can be 3-5 years minimum. The evidence behind community mobilization efforts must be done at the local level rather than the national, as each jurisdiction will have different characteristics that construct the social determinant. The cont d biomedicalization of HIV prevention/treatment PrEP TaSP/Test & Treat/HIV Care continuum Affordable Care Act

37 Important Discussions How do we effect system-level change? (cont d) Think differently/look over walls/break down silos/speak out Studies consistently show that low income, unemployment, food insecurity and lack of access to education and health care, among other factors, increase vulnerability to HIV. Epidemics can differ widely, learn specifics. Social determinants are a better predictor of HIV outcomes than risk behaviors. Target inequalities Addressing the structural forces that shape the spread of infectious disease represents a fundamental and necessary shift from the historic approach to the domestic HIV/AIDS epidemic. More support for community based organizations (CBOs) and the next generation leaders and collaborators Better data for providers, clinicians and health departments Use research to inform policy and practice Help reduce community viral load and community level risk

38 Successes, Challenges, Examples Highly functional and motivated infrastructure Diversity of disciplines and backgrounds Close ties to a range of communities Synergy between provider (CBO), consumer, government (local, state and federal) and corporate Engagement challenges General communication between community & science Motivating academics to engage with community Establishing a mutual beneficial relationship General lack of understanding of social context of diverse communities Alameda AIDS Research Coalition Local community building/social support efforts specifically for black MSM

39 Mpowerment Project

40 What Next? When it comes to black men who have sex with men (BMSM): High impact HIV prevention: intensifying prevention for HIV negative individuals and those at highest risk of becoming infected with HIV, and targeting resources to the interventions and areas where we can have the greatest impact. Reducing New HIV Infections Increasing Access to Care and Improving Health Outcomes for People Living with HIV Reducing HIV-Related Disparities and Health Inequities Achieving a More Coordinated National Response to the HIV Epidemic among BMSM

41 Medical advances are essential but

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43 Resources CAPS Website ( Fact Sheets Research Instruments Tool Box Working Together Manual Recommendations for Research Dissemination Social Media (Facebook, Twitter, LinkedIn)

44 Q & A Section Title

45 Thank you!!! Omoro Omoighe, Byron Mason, it