1. Harlem United Community AIDS Center Stephen Crowe, Tamika Howell, Expedito Aponte & John Molina

2. 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

3. 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)

4. 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 OutreachLinkageRetention in Care

5. 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

6. 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

7. HIV Care Continuum Targets of Intervention Activities Categorize intervention activities within the HIV Care Cascade by placing an “X” in the appropriate boxes below. Only include activities funded by HRSA/SPNS. Stigma reduction Identific ation LinkageRetention Intervention Activities: 1. Social marketing campaignxx 2. Health promoter recruitmentx 3. Training of health promotersxx 4. Targeted outreach by health promoters (which include educational presentations/workshops) xx 5. ARTAS Interventionx 6. Escorts by PNxx 7. Call center run by PN/peersx 8. Customized text messaging to track medical visits x 9. Follow-up activities by PNx 10. 1:1 engagement with health promotersx 11. Health Education support seriesx

8. Intervention Update Successes: Peer Training Curriculum Developed/Implemented (April): Stigma Reduction, Health Literacy/Education, Harm Reduction, Motivational Interviewing, Stages of Change Test/Pilot Cycle Implemented (April-June): 8 Peer Trainee Graduates, Pre/post tests (68% lowest/93% highest post- test averages), Post-training assessment tool (82% average) Outreach Activities (June/July): Puerto Rican Parades, Harlem Hospital, El Barrio, Upper Manhattan businesses, internal programs Social Marketing Campaign Development – outreach materials (Vaqueros) Challenges: Curriculum Revisions: improve translation, education level, exercises, guest presenters Local Evaluation Study IRB Hiring/Vacancies

9. Intervention Update Timeline for Implementation: Program Policies & Procedures Manual (April draft, June completion) Data Collection Tools & Data Entry System (June) IRB Submission (June) Hiring New Patient Navigator & Outreach Supervisor (June) Social Marketing Campaign Launch (July/August) – focus groups PN Call Center System (June/July) Cycle One Implementation (July-September) Peer Training (July 14-August 8) Peer Outreach (August/September) Linkage to Care/ARTAS (August/September) Retention in Care/Health Literacy Sessions (August/September)

10. 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

11. Stephen Crowe, Managing Director, Access to Care 212-289-2378 ext 1232, scrowe@harlemunited.orgscrowe@harlemunited.org Liza Kasmara, Director of Program Evaluation 212-860-0820 ext 1322, lkasmara@harlemunited.orglkasmara@harlemunited.org Tamika Howell, Associate Vice President of Evaluation 212-860-0820 ext 1334, thowell@harlemunited.orgthowell@harlemunited.org John Molina, Program Coordinator, Access to Care 212-289-2378 ext 1217, jmolina@harlemunited.orgjmolina@harlemunited.org Expedito Aponte (Program Director/Principal Investigator) Vice President, Prevention, Education & Supportive Services 212-289-2378 ext 1211, eaponte@harlemunited.orgeaponte@harlemunited.org Project Staff