S.M.A.R.T.E.E Social Media App for Retention Treatment Engagement and Education Howard Brown Health, Chicago James Zuniga, Gregory Phillips II, PhD, MS

Target Population YMSM and TWOC Ages 13-34 And fit one of the following criteria: Newly diagnosed Never engaged in care Not retained in care - no HIV medical visit for at least 6 months Not virally suppressed Site-specific criteria: All clients must receive their primary HIV medical care at an HBH site or be willing to transfer their care to HBH One of the site-specific criteria is the clients must be receiving HIV medical care at one of our 5 sites. Those who have been out of care for longer than 12 months will be contacted by our LTC teams, as we have a specific team who works with these individuals. Those clients who already have case managers will continue to work with their CM, and the advocate will only be collecting assessment information as opposed to short term case management. Advocates will attend at least 3 medical appointments with clients, and work with each eligible client for 6 months or more until the client is virally suppressed or transferred to long-term case management.

Outreach and Recruitment Strategies Strategies include: -Direct outreach -Staff referral -Self-referral Flyers, palm cards, posters Social Media accounts will post information on the program and the app to boost community awareness Advocates will make direct calls and emails from generated reports Staff will be trained on what the program is and the requirements for the study, and will be able to refer any clients they have to SPNS staff. Clients can also call and ask about their eligibility, from flyers, posters, palm cards and social media posts. The information on the flyer will give a general description of the app and what the program can help the client with. These same materials will also be available to clients on our information tables. Some direct outreach may also include attending venue events and different outreach events when appropriate. Reports will be pulled directly from our EMR database to help us identify which clients are out of care. Direct outreach will involve advocates directly contacting the pt to sched a med appt, during this time staff will attempt to introduce the program and gauge the clients interest. EMR orders were created to document interactions w/pts. Periodically HBH will post advertisements on our social media accounts for the app and the program.

Location HBH has six locations that offer various medical and behavioral health services Retention Advocates will be assigned laptops for travel to each site Recruitment will be done at all 5 of HBH medical sites. Laptops will be assigned to advocates allowing them to work from every site. Occasionally, HBH social media accounts will give exerts about the program or the app, to help boost community awareness. It’s important to note the client does not have to live in Chicago to be eligible for the study, as HBH sees clients from all over the Midwest. Surveys will be conducted at each medical site, in private when it is most convenient for the Advocate.

Challenges in Conducting Outreach Client’s fear of being “outed” Monitoring multiple locations for continuity of outreach Outdated client contact information Community knowledge of study Outreach events Once clients become aware that a staff member only works with HIV positive clients, trans clients are less likely to engage with that particular staff member during drop in nights and t-time etc. This limits our ability to conduct direct outreach. Another challenge will be creating a plan that works best for a staff of three to monitor five locations, difficult to monitor flyer supplies, if staff are presenting the program correctly, or if interested clients are being linked to SPNS staff correctly. Community knowledge of study may lead to an influx of false data/clients who are not trans or msm gaining entry into the study. The contact information we have for the client is outdated, limiting ability to contact the client. Working in tandem with staff who have TWOC clients will be vital for recruiting trans participants. When attending direct outreach events or venues it will be difficult to engage the client, and it may not be possible to verify if they are a client of HBH, or if they meet the requirements.

Determining Eligibility Reports are pulled from EMRs to identify clients who are lost to care or at risk of being lost to care Access to the client’s EMR allows for the Advocate to verify client eligibility To avoid confusion, only SPNS staff will validate client’s eligibility While the app will be available to all clients, only those fitting the criteria will be selected for inclusion in the study. Using this master list we can directly contact clients who fall within the set parameters. Collaborations with staff who work closely with transgender clients is underway to devise plans on how recruit while protecting clients’ privacy. Only SPNS staff will confirm eligibility with clients so that little confusion occurs, and

Direct Outreach Staff Referral Self-referral Advocate initiates contact Client consents to medical appointment Client meets with Advocate to complete or set date for survey Staff Referral HBH staff advise client to contact Advocate HBH staff advises Advocate to contact client Advocate confirms eligibility, and date to complete survey set Self-referral Client contacts Advocate Advocate determines eligibility Date to complete survey set or Direct outreach will involve advocates directly contacting clients who are identified as not in care that is, not having had an HIV related medical appointment within the last 6 months. During the attempt to contact the client, staff will introduce the client to the program and record their interest. Clients will then ask to give consent for SPNS staff to attend their next medical appointment. This will allow the advocate, physician and client to create a short-term treatment plan, this is where the program will be explained more in depth. After the appointment the client will complete the initial consent and assessment, during this time the client and the advocate will go over the client’s goals, and create a care plan. During this time the client will either complete the survey at that time or schedule a time to come back. Staff such as case managers, mental health providers and physicians will also be able to provide the client with information about the program.

Important things to note Clients who have case managers at HBH or elsewhere will be asked to defer to their existing case managers for care plans Not every participant will need a medical appointment upon enrollment Consent to Advocate attending medical appointment is not required for enrollment One potential challenge is clients who have larger healthcare teams. In order to best serve client’s effectively and efficiently clients with existing case managers will referring to their case manager for care plans, and Advocates will only administer the survey. The Advocate will refer to the case manager should any issues or concerns arise. This will lesson confusion between staff members and clients. While it is not required for clients to consent to Advocates attending medical appointments, it will be highly encouraged when an advocate is able.

Challenges in Eligibility Possible Solutions Client does not transfer over medical records Clients who may fall into the grey lines of eligibility guidelines Outreach events Clients who struggle with keeping appointments Enter client as new patient Ensure client fits at least one criterion Provide outreach team with sufficient supplies Avoid multiple sessions or obtain transportation assistance We may have clients who want to engage with the program but may not want to transfer care, or who agree but then no records are transferred over. We can enter the client as a new patient but it would then take time for lab results to come back. Many clients, will be considered out of care because they have not had a medical appointment within the last 6 mon, however their labs indicate they are virally suppressed, and have bee. Those clients who struggle with maintaining their medical appointments, they may have a genuine interest in the program but struggle with actually coming into the clinic. As participants must be clients of HBH or willing to transfer care, it will be difficult to verify that information at an outreach event that was not hosted at HBH.

Discussion Liz Weck Kristin Keglovitz Baker kristink@howardbrown.org James Zuniga 773.388.8935 Jamesz@howardbrown.org Gregory Phillips II 312.503.3447 glp2@northwestern.edu Liz Weck 773.388.8666 lizw@howardbrown.org Kristin Keglovitz Baker kristink@howardbrown.org