Wellness web 2.0 Coastal Bend Wellness Foundation Alison Johnson & Hillary Vallejo

Outreach and Recruitment Target population Youth and young adults ages 13-34 HIV+ MSM of Color Our data shows: In Texas - African Americans and Hispanics account for 79% of new HIV infections in Texas Youth and young adults account for 57% of all new HIV infections in Texas 80% of new positives identified in 2014 reported MSM sexual activity as their primary risk

Outreach and Recruitment Target population: South Texas Area 3,309 people living with HIV (PLWH) 257 were newly diagnosed with HIV 159 reported MSM as the primary mode of exposure (64%) 61 newly diagnosed HIV+ were ages13-24 (24%) Corpus Christi HSDA: 831 PLWH (25%) 54 newly diagnosed (21%) 565 Black or Hispanic PLWH (68%) 41 PLWH were ages 13-24 (5%) 439 PLWH reported MSM (53%) Corpus Christi HSDA Counties: Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio (Web Wellness 2.0 Service Area) 2014 Texas DSHS Data

2014 Texas DSHS Data

Outreach and recruitment strategies Collaborate with separately funded CBWF Outreach programs: DSHS funded HIV testing programs targeting MSM and African American YNOT – LGBT youth advocacy program Collaborate with CBWF FQHC Clinical staff & Ryan White Case Managers Collaborate with DIS & HIV Surveillance Maintain an active presence on social media platforms and social networking apps Raise awareness about Wellness Web program Campaigns to promote HIV status awareness, care engagement and retention Peer Volunteers Collaborate with separately funded CBWF Outreach programs: identify those infected with HIV but unaware of their HIV status Project CARE – testing program that targets MSMs and African Americans Project FREE – testing program that targets MSM substance users YNOT – LGBT youth advocacy program Collaborate with CBWF FQHC Clinical staff & Ryan White Case Managers Seek referrals for patients who have been referred for HIV medical care, dropped out of care Collaborate with local Health Department: Seek referrals for individuals newly identified as HIV positive identified in partner services and public health follow-up, HIV surveillance identifies those who have are not retained in care, not had at least one visit, not achieved viral suppression, etc. Maintain an active presence on social media and social networking apps Raise awareness about Wellness Web program Encourage linkage to care and medication adherence Recruit individuals who are unaware of their status to come in for testing Peer Volunteers: “health promotora model”, recruit and train target population on WW2.0 and disseminate within their “social network”, promote HIV status awareness, promote linkage to care, train community peer volunteers to reach out to individuals within their social networks and engage in case and case management, retention

Outreach & Recruitment Settings CBWF Outreach Programs: Streets, bars, clubs, LiveChat Pass out flyers, brochures on Wellness Web Community mobilization events Example: National HIV Testing Day CBWF FQHC Clinical Staff & Ryan White Case Managers Flyer, brochures, etc. In-reach; in-person introduction by Social Media Specialist Local Health Department In-person introduction when possible by Social Media Specialist Referral made by DIS or HIV Surveillance (DSHS funded HIV testing programs) Community engagement to those they identify to be eligible for WW2.0 (newly HIV+, out of care, etc), promote the importance of community mobilization events using social media platforms In-reach, using existing databases to identify potential patients who have missed appointments, who are have seen the doctor, etc; the clinical staff and case managers can make a in-person introduction prior to establish online support to increase access to and retention in care In-reach, using existing databases to identify potential patients who have missed appointments, who are have seen the doctor, etc; the clinical staff and case managers can make a in-person introduction prior to establish online support to increase access to and retention in care (partner services and public health follow-up)

Outreach & Recruitment Settings Social Media Platforms: Facebook, Twitter, Instagram, YouTube Campaign messages: promoting linkage to care, social support, medication adherence and HIV-related health information Example campaigns targeted towards linkage to care: “Live longer. Live Stronger.” “Get connected.” “Are you in?” Managed by Social Media Coordinator & Social Media Specialists Social Networks Apps: Grindr, Growlr, Jack’d, Scruff and Adam4Adam Active presence – Passive approach Schedule HIV testing appointments Connect and retain target population at different stages of the HIV care continuum Social media platforms: Select content may be “boosted” to target a specific demographic (advertisement on FB, twitter, etc.) Media content present to community stakeholders on a frequent basis to ask for feedback, make sure it is relevant, appropriate, etc. Social Network Apps: Passive Approach-The preferred approach is more passive. This approach involves sitting in a chat room after a brief introduction or allowing online clients to initiate contact. Some apps have an exception, like Adam4Adam & GROWLr, which logs a “view” to a member’s profile once it is clicked on increasing the likelihood of further interaction. This approach may be less effective in terms of reaching significant numbers of people in a cost-effective manner; however, it creates a receptive environment of respect and trust. Active Approach-An active approach is generally more aggressive and can involve techniques that entice users to communicate in private messaging sessions. The most common techniques involves sending frequent mass communications, posting health-related messages regularly and openly in public chat sessions, and actively contacting online clients suspected of high-risk behavior based on their profile or chat conversation. Different stages of HIV care continuum: 1) unaware of HIV status, encourage/link to testing, 2) diagnosed HIV+ but out of care, promote HIV medical care/link to care/ARTAS, 3) in-care but non-compliant with treatment, provide support and encourage (mobile wellness), 4) in care but not achieved viral suppression, mobile wellness/appt reminders/support services

Outreach & Recruitment Challenges Access to Social Media Platforms and/or Social Networking Apps Internet/Smart phones with data plans and/or WiFi Frequently changing numbers, limited number of text messages Language barriers – Large Hispanic, Spanish-speaking population Cultural influences & common occurrence of individuals seeking health care only once an illness has severely progressed Peer Volunteers: Guide individuals to places where Internet is readily available, such as public libraries and local businesses with free Wi-fi Social Media Specialists and Peer Volunteers: Pop-up Internet Cafés where individuals can access Internet and health information through provided iPads and laptops Bilingual staff are available to deliver intervention in Spanish and translate social media content in English and Spanish; Bilingual and culturally competent staff members; Community stakeholders will review social media campaign messages to make sure they are relevant and appropriate; Peer volunteer program link us to communities, volunteers will be of the population Late diagnosis of HIV+, late stage AIDS

Outreach & Recruitment Challenges Mistrust of online information Frequently changing screennames on social networking apps could make follow-up difficult Social Networking Apps Guidelines & Restrictions Change the purpose of social media and social networking engagement Age Demographic-wide range 13 years to 34 years Policies in place to ensure information posted to social media is accurate, Strict privacy and confidentiality policies, Social Media staff will uphold CBWF’s professional reputation and maintain strict standards of communication Run the risk of being blocked or banned for engaging in “outreach” and soliciting purposes “entertainment”, “hook-up” vs. “health information” seeking “social support” “positive” When targeting outreach and recruitment on a large, general scale for the whole age range 13-34 the needs for the entire group are much different across the spectrum

Determining Eligibility Minority - African American/Black; Hispanic/Latino Men who have sex with Men Youth and Young Adults, ages 13 to 34 years old HIV status: Aware of their HIV status, but have never been engaged in care Aware HIV+ but have refused referral to care HIV+ ,out of care HIV+ but are unaware of their HIV status HIV+ but have not achieved viral load suppression Willing and able to access social media/social networking information

Screening & Enrollment Process Screening will take a series of questions, a dialogue of open-ended questions Demographics (DOB, Race/Ethnicity) Sexual history, sexual orientation, sexual preference, etc. Technology/device most used to access internet Social media/social networking accounts used HIV medical history First diagnosed HIV+ Last medical appointment Demographics can be collected based on profile Identify MSM This is not a exclusive or inclusive list to replace the ETAC multi-site survey Identify if the client is already using a SM platform of SN app the intervention is using or willing to create an account to access the intervention

Screening & Enrollment Process What is your screening and enrollment process? Screening In-Social Media/Social Network App engagement Eligibility Questionnaire Inform about program criteria Referral Eligible: WW2.0 Non-Eligible: Ryan White Enrollment In-person Social Media Specialists

Challenges in determining eligibility Potential challenges: Documentation/Identification of age Proof of HIV+ status Defining those “out of care” and “retained in care” Disclosure of MSM sexual risk Ages 13-34 for those who do not have documentation of their HIV+ status, it may take a while to obtain such from CBWF testing programs “retained in care” – did not have 2 episodes of HIV care & treatment in 12 month period; “out of care” – at least one HIV care & treatment MSM activity not disclosed to other partners, past experience, etc.

Discussion Alison Johnson | alisonj@cbwellness.org Hillary Vallejo | hillaryv@cbwellness.org