1. County Hospital in Cleveland, OH PI: Ann K. Avery, MD | Project Manager: Jen McMillen Smith, LISW-S Evaluator: Mary M. Step, PhD | Designer: Julia Briggs, Blue Star Design

2. Outreach & Recruitment Strategies Target population 13-34 year olds living with HIV/AIDS who are patients of MetroHealth, the public/county hospital in Cleveland, OH, particularly those who are not virologically suppressed or are sporadically in HIV care. Overall outreach & recruitment strategies Positive Peers will utilize 4 main recruitment strategies: 1.Fliers / brochure 2.Social media 3.Advertising 4.Optimizing the Electronic Medical Record (EMR) for “In-Reach” & Outreach

3. Fliers / Brochure Fliers Young people living with HIV can sometimes have problems managing their health due to low health literacy. Our health literacy fliers aim to educate on specific HIV care-related issues while also recruiting potential Positive Peers app users. Brochure Specifically promotes Positive Peers and will be in the clinic and with key healthcare team members (social workers, outreach and linkage to care workers, and even physicians)

8. Social: PositiveinCLE Intention is to recruit for the app and keep the Positive Peers in the consciousness of users Platforms: Twitter, Instagram, Facebook, YouTube Hashtags: #HIVCle #HIVapp #PositiveInCLE #HIV #GetTested Blog - The Plus Side: Content will be on the public-facing webpage www.positivepeers.com & search-engine optimized, so if HIV + Cleveland is Googled, it should be a top hit. There will be a form on the website to complete if a person wishes to be considered for enrollment in the app. www.positivepeers.com

9. Advertising Instagram Sponsorship Geo-targeted ad design will target heterosexuals. When an Instagram user the ad, then it will automatically pop-up in that user’s follower’s feeds. Jack’d Geo-targeted ad design for MSMs of color.

10. In-Reach & Outreach Clinic Optimize Electronic Medical Record (EMR) to produce a list of young people living with HIV who are not virologically suppressed. Project Coordinator meets with them at clinic visit. Community Outreach worker (works with out-of-care individuals) and Linkage To Care workers (work with all newly diagnosed in Cuyahoga County) will give information and encourage patients in the target population to enroll in Positive Peers. Launch Party Social event to spark interest and encourage enrollment. Heterosexual female CAB members will be present & will invite friends to attend.

11. Possible Challenges for Recruitment Disengagement It will likely be easier to recruit users who are engaged in care than those who are not. We want both on the app, so that peer mentoring occurs, but a balance of those who are only sporadically in care or are not virologically suppressed may be difficult to achieve. A person who is not engaged in care may not respond to our recruitment efforts. Math According to a 2016 CDC report, at current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime, including 1 in 2 black MSM, 1 in 4 Latino MSM, and 1 in 11 white MSM. African Americans have a lifetime HIV risk of 1 in 20 for men (compared to 1 in 132 for whites) and 1 in 48 for women (compared to 1 in 880 for whites). So it’s statistically easier to reach an out-of-care MSM living with HIV than it is an out-of-care heterosexual, even if she’s an African-American woman living with HIV.

12. Determining Eligibility Inclusion criteria 13-34 years old & living with HIV MetroHealth patient Priority given to those with viral loads / sporadically in-care (no clinic visit in 6 months) This is in line with HRSA SPNS stated target population.

13. Procedures to determine eligibility Potential participants will have an individual meeting or phone call with the Project Coordinator for eligibility screening. If the person is deemed eligible, enrollment will be offered. If not, the person will be given information about alternative resources (e.g., Secret Facebook group, Support Groups, and social events) Screening Eligible Enroll Not eligible Offer Alternative Supports

14. Enrollment process Anticipated one-hour process, one-on-one with the Project Coordinator, and will include the following elements: 1.Completing Informed Consent 2.Completing the multi-site survey (ACASI) and any other instruments 3.Downloading Positive Peers to participant’s device 4.Training on app use: functions, entering initial health data (CD4, viral load, meds, upcoming appointments) to maximize health score, customizability, data space 5.Answering questions 6.Dispensing incentive

15. Possible Challenges for enrollment Space & Time MetroHealth’s ID clinic is busy and space is tight. The Project Coordinator will need to squeeze in the exam room in between many other staff members (at minimum: physician, nurse, social worker) to screen for eligibility. The Project Coordinator’s private office is in the same building, but 6 floors up from the clinic. Those who wish to enroll can go up after completing the clinic visit.