Yale University

St. Louis Enhancing Engagement and Retention in HIV/AIDS Care (STEER)

Funder: National Institute of Mental Health
Project period: 09/30/2021 - 02/28/2023
Grant Type: Research
Further Detail

Abstract Text:

Missouri is one of seven priority states identified by the Ending the HIV Epidemic Initiative as it has higher rates of HIV infection and lags behind other states in engagement along the continuum of care, particularly for hard-to-reach populations. Hard-to-reach populations face intersecting stigma and discrimination that lead them to distrust health care providers and researchers and experience lapses in engagement in treatment. There is a critical need to identify barriers and facilitators of engagement along the HIV care continuum to inform the development of novel implementation strategies to end the HIV epidemic in St. Louis, MO. To address the gap in retention in HIV care access, retention, and viral suppression in hard-to- reach population in the St. Louis area, the St. Louis Enhancing Engagement and Retention in HIV/AIDS Care (STEER) Project proposes to: Aim 1. Assess the multilevel intersectional barriers to engagement and retention in HIV care in St. Louis; Aim 2. (1) Adapt and (2) identify implementation strategies for a multilevel CHW intervention to increase engagement in HIV care for hard-to-reach populations of people living with HIV in St. Louis; and Aim 3. Prepare a hybrid implementation/effectiveness proposal to assess the adapted CHW model on engagement and retention in HIV care. Research design and methods. The following planning supplement is a partnership between the Center for Interdisciplinary Research on AIDS at Yale University, The Brown School and School of Medicine at Washington University, Vivent Health, a Community-Based Organization in St. Louis, and the Bureau of STDs, HIV and AIDS in Missouri. The following study will draw on intervention and implementation mapping processes utilizing the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change domains. The planning process will be used to apply an intersectional framework to understanding the complex needs facing people who are living with HIV who are not engaged in care. We will conduct secondary data analysis on program and state-level data to conduct a needs assessment to define the problem of engagement in care in St. Louis. We will gather data qualitative data from 1) Patients, 2) Frontline lay health workers engaging with PLHIV in St. Louis, 3) Key Informants, and 4) existing CHWs. Qualitative data will inform each step of the intervention and implementation mapping approach including the development of a logic model of change. The planning grant will develop an adapted intervention and identify implementation strategies to be tested in a future study.