1. Digital HIV Care Navigation San Francisco Department of Public Health Erin Wilson, Sean Arayasirikul and Dillon Trujillo June 16-17, 2016

2. Brief Project Overview

3. Project Overview  Health eNav is a digital HIV care navigation project to improve retention and engagement in HIV care in San Francisco.  Four main components:  Integrate social media platforms to locate and retain participants in care;  Provide short-term mobile phone access;  Deliver asynchronous, non-traditional digital navigation through text messaging  Collecting ecological momentary assessment (EMA) data and integrating that into the digital HIV care navigation system in real-time  Our target population includes newly diagnosed and out of care MSM and transwomen, ages 18-34.

4. Outreach and Recruitment Strategies

5. Use of Social Media Platforms  We will use social media platforms for two strategies:  Social Marketing (public-facing)  Look and Retain (direct messaging, location status/OOJ) [Digital Navigation intervention component]  Platforms  Social Media Home – Facebook Account, Fan Page, Secret Group  Engagement – Twitter, Instagram, Snapchat  Dating Apps – Grindr, Scruff, Tindr, Jack’d  Messaging Apps - Kik, Line, WhatsApp  Other  Health eNav website

6. Approach to outreach and recruitment – Providers and Partnership Network SF DPH HIV testing Sites SF DPH System Navigation Data to Care Initiative Community System Navigation Web and social media presence to reach NIC patients Text “12345” to Health eNav 617- 826-9932 Digital Navigators will be mobile for in person enrollments Digital Navigation will extend care beyond the walls of the clinic and outside of the traditional 9-5 weekday work schedule

7. Providers and Partnership Network Reach  Map of all agencies in SF

8. Additional Outreach and Recruitment Strategies  Referral from large population based HIV behavioral surveillance efforts with MSM and transwomen  TransNational (n=900) and the SHINE study (n=300)  National HIV Behavioral Surveillance Study (n=500)  Self-referrals from increased social media and website presence

9. Anticipated Challenges in Recruitment and Outreach  Turnover at HIV testing, clinic sites and among navigators  Keeping recruitment at top of priority list among staff in our network  Timely data to care report acquisition

10. Strategies to Address Recruitment Challenges  Co-location of Digital Navigators at clinics  Understanding how Health eNav fits in the mix of navigation and engagement in care services  Providing longer term (1 year) navigation and retention support  Create continuous caring relationships that extend outside the clinic via digital technologies and outside the traditional weekday 9-5pm  Short-term mobile phone access  Clearly communicating Health eNav benefits  Regular discussions with partners about panel management, focused on new diagnoses, out of care patients and patients not virally suppressed

11. Eligibility & Inclusion

12. Eligibility Criteria for Inclusion  Identify as MSM or transwoman;  Are18-34 years old;  Are infected with HIV; and  Meet one of the following criterion:  Are aware of their HIV infection status, but have never been engaged in care;  Are aware of their status, but have refused referral to care;  Have dropped out of HIV care;  Have not achieved viral load suppression; or  Are newly diagnosed with HIV.

13. Determining Eligibility  Referrals from Health eNav’s Providers and Partnership Network  Providers will screen for eligibility and upon referral, Digital Navigators will confirm eligibility criteria  Self-Referrals  Digital Navigators will screen for eligibility and confirm eligibility through eCW, ARIES or re-engagement with their care team prior to enrollment

14. Anticipated Challenges in Determining Eligibility  Gaining access and training to appropriate data infrastructures that will aid in confirming eligibility  We currently have access to eCW and ARIES  Ensuring that the Providers and Partnership Network is knowledgeable of eligibility criteria and accurately screens potential participants  We will provide our partners with flyers and small “cheat” cards with Health eNav’s eligibility criteria  Digital Navigators will maintain a presence at clinics’ panel management meetings to raise the visibility of Health eNav and confirm eligibility criteria

15. THANK YOU!!!

16. Providers and Partnership Network  Health eNav Leadership Committee  San Francisco City Clinic  Ward 86, and Positive Health Program, San Francisco General Hospital and UCSF  Applied Research, Community Health Epidemiology & Surveillance (ARCHES)  Data to Care Initiative  Linkage, Integration, Navigation, and Comprehensive Services (LINCS)

17. Providers and Partnership Network  SFDPH Linkage, Integration, Navigation, and Comprehensive Services (LINCS)  Embedded Navigators at:  San Francisco City Clinic  San Francisco General Hospital Ward 86  SFDPH Tom Waddell Urban Health Clinic  SFDPH Castro Mission Health Center  San Francisco City Clinic

18. Providers and Partnership Network  San Francisco Navigator Network  San Francisco AIDS Foundation  Magnet/Strut Clinic  Glide HIV Services  Shanti  St. James Infirmary  UCSF 360 Clinic  Mission Neighborhood Health Center  Jail Health Services  Alliance Health Project  Community Health Promotion and Prevention

19. Providers and Partnership Network  SFDPH Funded HIV Testing Sites  Asian & Pacific Islander Wellness Center  Tenderloin Area Center of Excellence Health Clinic  Larkin Street Youth Services  Youth Clinic HIV testing site  Assisted Care/Aftercare (ACAC)