1. UPTOWN HEALTH LINK HARLEM UNITED COMMUNITY AIDS CENTER STEPHEN CROWE, SHERRY ESTABROOK, EXPEDITO APONTE

2. HARLEM UNITED CAC OVERVIEW Founded at height of first phase of AIDS epidemic: 1988. Specifically to serve people living with HIV/AIDS (PLWH/As) who were homeless and/or suffering from mental illness and/or substance use. Agency of last resort for medically-underserved communities of color in Harlem. Part of community-based movement to care for PLWH/As Founded to address lack of response from established providers; Responding to the unique personal, social, and institutional barriers to care in Harlem

3. PREVENTION, EDUCATION, AND SUPPORT SERVICES DIVISION Community Focused Special Population Service Delivery Focus on increasing Access to Care and Support Systems Peer Training and Job Readiness Development Healthy People Community Outreach and Education IDU Health and Recovery Support Services Integrated HIV/HCV/STI Screenings and Coordination YMSM/TG and MSM Risk Reduction and Development Services Access to Care and Care Coordination

4. PROJECT OVERVIEW Background/Context In a 2011 review of the spectrum of engagement in care for people living with HIV infection in the U.S., Gardner, et al, estimated that only 19 percent had undetectable viral loads. Their review also estimated that 75 percent of those newly diagnosed with HIV were successfully linked to care within 6 months to a year after diagnosis. An analysis from 2009 found that 67% of Latino/as were linked to care; only 37% were retained in care, 33 percent were prescribed anti-retroviral therapy (ART) and just 26 percent were virally suppressed. What makes this project unique & innovative? Harlem United’s Demonstration Site program model will consist of innovative targeted outreach and engagement activities, a social marketing campaign encouraging access to primary care, proven retention in care activities, the expansion the agency’s extensive referral network of culturally competent providers, a local evaluation to assess the effectiveness of project activities, and the dissemination of project findings and lessons learned. Individuals will be recruited and trained as peer Health Promoters and participate in an intensive training curriculum over one month to become certified in recruiting individuals through targeted outreach and linking them into care along with a Patient Navigation team while providing them with ongoing health literacy information and activities.

5. PROJECT OVERVIEW Objectives: 1.Identify persons from the target population through culturally-competent outreach and education, and social marketing activities 2.Ensure timely entry to primary HIV care by increasing the target population’s health literacy and addressing cultural barriers to care 3.Improve overall health outcomes by increasing the target population’s access to quality HIV primary care 4.Support the target population’s retention in care and reduce HIV-related health disparities

6. PARTNERS AND COLLABORATORS Medical Providers (internal/external) Integrated Testing Services Adult Day Health Care programs (El Faro) Outreach & New Business Development Integrated Harm Reduction Program Consumer Advisory Boards Local CBOs: Hispanic AIDS Forum Latino Commission on AIDS Voces Latinas Washington Heights CORNER Project Housing Facilities/SRO’s/Shelters Day Labor Sites Restaurants/Soup Kitchens Small Businesses (bodegas/botanicas) Churches Laundromats Barbershops/Salons Methadone Clinics Outpatient Treatment Programs

7. INTERVENTION DESCRIPTION Service delivery setting: Upper Manhattan (Harlem United offices, community partner and collaborator sites, general outreach locations) Priority population: Health Promoters: HIV-positive Puerto Rican individuals with a history of substance use who are receiving health care, originated from Puerto Rico and immigrated to NY relatively recently Consumers: HIV-positive Puerto Rican individuals with a history of substance use who are out- of-care, originated from Puerto Rico and recently immigrated to NY Services and activities: 4 Cycles/Year, 12 sessions/cycle, 6-7 Health Promoters/cycles H EALTH P ROMOTER / P ROMOTORES DE S ALUD T RAINING (25 HIV+ Latino/a's In-Care) T ARGETED C ASE F INDING (40 HIV+ Latino/a's Out-of-Care) L INKAGE TO C ARE (200 ARTAS Sessions) N AVIGATION S ERVICES (2-3 follow-up Sessions per client) R ETENTION IN C ARE (3-month follow-up; 1:1 with Health Promoter; 12 Week Health Education Series)

8. INTERVENTION DESCRIPTION H EALTH P ROMOTER R ECRUITMENT (1.0 FTE P EER T RAINER / S UPERVISOR,.50 FTE O UTREACH S UPERVISOR, IN - KIND D IRECTOR OF O UTREACH ) CSP Peer Training Cylces HU Primary CareHU El FaroSocial Marketing T RAINING OF H EALTH P ROMOTERS /P ROMOTORES DE S ALUD (1.0 FTE P EER T RAINER / S UPERVISOR ) Train 4-cohorts of 6-7 HIV+ inidividuals in care (recruit 10-12 per cycle for attrition) Total of 25 Latino, HIV-positive Health Promoters 4 weeks; 12 sessions; 3 days a week; 3 hrs a day Plus Monthly Booster Trainings (group supervision) with Peer Trainer/ Supervisor T ARGETED C ASE F INDING BY H EALTH P ROMOTERS (25 P EERS, 1.0 FTE P EER T RAINER /S UPERVISOR,.50 FTE O UTREACH S UPERVISOR ) 3 times per week x 52 weeks, reach 1,200 people Health Promoters connect 2 out-of- care HIV+ each to LTC Health Promoter 1:1 supervision with Peer Trainer/ Supervisor (bi- weekly, peer development plan review) L INKAGE TO C ARE (.15 FTE PN P ROGRAM C OORDINATOR, 1/0 FTE P ATIENT N AVIGATOR ) ARTAS Intervention with 40 Out-of-Care HIV+ 5 sessions per client (200 sessions) with PN Connection to Support Services N AVIGATION S ERVICES (25 P EERS, 1.0 FTE P ATIENT N AVIGATOR ) Escorts by PN Pt. Call Center run by Peers/PN (appointment reminder/Reenga gement) Custimized Text Messaging to track medical visits R ETENTION IN C ARE (1.0 FTE P ATIENT N AVIGATOR, 25 P EERS, 1.0 FTE P EER T RAINER / S UPERVISOR ) Follow-up for a total of 4 medical visits (3-months) by Navigator Bi-monthly 1:1 engagement with Health Promoters Participation in 12-week Health Education/Social Support Series with Peer Trainer/ Supervisor (3 cycles, social activities, graduation) Internal/External Outreach LinkageRetention in Care

9. INTERVENTION DESCRIPTION Staffing: Peer Trainer/Supervisor (1 FTE), Patient Navigation Program Coordinator (.25 FTE), Outreach Supervisor (.5 FTE), Patient Navigator (1 FTE) Client incentives: Gift Cards: Health Promoter Training ($25 gift card per session), Health Promoter Booster Sessions ($10 gift card for per booster session, Linkage to care: ($10 gift card per ARTAS session), Linkage to care: $10 gift card for attending primary care appts), Health Education Sessions ($5 gift card per health education session) Health Promoter Case Finding/Targeted Outreach (2-month cycle): $400 monthly stipend payment for targeted outreach/case finding activities Metro Cards ($5/round-trip subway card): Health Promoter Training Sessions, Health Promoter Individual Sessions, Health Promoter Booster Sessions (group- level), Linkage to Care Activities, Health Promoter/Client Check-in, Health Education Sessions

10. STIGMA REDUCTION STRATEGY Conduct focus groups focused on cultural-related HIV stigma and barriers to care Develop social marketing campaign focusing on Health Promoter (peers) stigma and community-level stigma Palm cards, posters, other printed materials, online information Importance of receiving HIV services, address common myths and misunderstandings around HIV, normalize the discussion of HIV and HIV-related services Educational presentations and workshops by Health Promoters to community partners, collaborators and stakeholders during outreach/identification activities Information about HIV, how it is transmitted, who is most at risk, and how to prevent HIV, as well as information on available services and the importance of getting tested

11. LOCAL EVALUATION Goals Track service provision relative to program targets through process monitoring Ensure the fidelity of delivered interventions to the program models (ARTAS, peer training, health education series) Evaluate the efficacy of program interventions to affect changes in knowledge and attitudes around basic health literacy, specialized knowledge of HIV, HIV stigma, and outreach strategies Measure health outcomes of clients participating in ARTAS and health education interventions, and receiving peer support Ensure client and peer program satisfaction IRB protocol will be prepared by the Director of Program Evaluation, submitted through Liberty IRB

12. LOCAL EVALUATION Methods service delivery tracking through AIRS, eCW, excel sheets; staff observation; client surveys; focus groups; staff data-driven supervision (DDS), monthly CQI meetings Participants are newly identified HIV-positive Puerto Ricans with a history of substance abuse Recruitment will be conducted via peer outreach Participants will receive standard program incentives for participation Participants agree to provide information that will be used for programmatic assessment and improvement so long as they are receiving program services; participation in focus groups is voluntary

13. LOCAL EVALUATION Data collection instruments peer screener, program intake, ARTAS forms, ARTAS, peer and health training fidelity observation forms, client contact logs, standard clinic patient documentation, outreach forms, pre/post training surveys, client satisfaction surveys, potential validated instruments of stigma (Population Council; Internalized AIDS Related Stigma Scale) and health literacy/efficacy (Patient Activation Measure; HIV Treatment Adherence Self Efficacy Scale; Short Assessment of Health Literacy for Spanish Speakers) Data analysis approaches monthly review of staff DDS and program indicator dashboard, synthesis of focus group themes, paired sample t-tests of pre/post training surveys, correlation/regression analyses of predictors of health outcomes (ie intervention dosing, peer/PN support contacts, improvements in health literacy, reduction in stigma) Dissemination of findings agency newsletter, Prevention Division CAB, Annual Evaluation Report, posters and presentations to industry conferences, potential peer reviewed publications

14. PROJECT TIMELINE (YEAR 1) Start up activities: September 2013 to February 2014 – staff recruitment/onboarding, curriculum development and adaptation, develop program policies and procedures, data collection instrument development and IRB, ARTAS training, social marketing campaign planning (focus groups), Health Promoter recruitment and outreach, develop PN call center March to May 2014 – test cycle implementation, Cycle 1 Health Promoter recruitment, social marketing campaign launch, outreach activities, ARTAS intervention/linkage to care activities, health education workshops Initiation of demonstration project: June to August 2014: Cycle 1 w/ SPNS Cross-Site Evaluation, Health Promoter training, ARTAS intervention/linkage to care activities, health education workshops Evaluation planning and implementation: November 2013 to May 2014 – data collection instrument development, data collection training, policies and procedures review Key programmatic milestones: Social Marketing Campaign Launch – Spring 2014 Cycle 1 Health Promoter Cohort Implementation – Summer 2014

15. CONTACTS Stephen Crowe, Managing Director, Access to Care 212-289-2378 ext 1232, scrowe@harlemunited.orgscrowe@harlemunited.org Sherry Estabrook, Director of Program Evaluation 212-803-2850 ext 2427, sestabrook@harlemunited.orgsestabrook@harlemunited.org Expedito Aponte (Program Director/Principal Investigator) Vice President, Prevention, Education & Supportive Services 212-289-2378 ext 1211, eaponte@harlemunited.orgeaponte@harlemunited.org