Culturally Appropriate Interventions of Outreach, Access, and Retention among Latino/a Populations Initiative

Latino/ETAC Site: APLA

Title of the Project/Intervention: Fuerza Positiva

PI: Jeff Bailey, MPH

Project Coordinator: Elvis Rosales

Evaluator: Jorge Montoya, Ph.D.

Intervention Characteristics:
Intervention Start Date (or expected).
Intervention Description. Brief description of intervention components (ICs). / Fuerza Positiva is a linkage to care program that is comprised of the following components :
ARTAS- a modified version of ARTAS, a strengths based case management model, will be utilized in the linkage and retention of clients in medical care. The goal of ARTAS is to identify client’s needs and, in collaboration with the linkage specialist, create service plan to assist client in accessing and remaining engaged in medical care.
Hermanos de Luna y Sol-An adapted form of Hermanos de Luna y Sol will be utilized to address issues of stigma that may be affecting the client; thus, impacting the likelihood of remaining in care or adhering to ART as prescribed.
Psychotherapy- Fuerza Positiva will provide psychotherapy to its clients in order to address social issues that may be impacting their health or their adherence to medical treatment.
What is the level of your intervention (e.g., individual, group, community)? / Fuerza Positiva is an intervention that focuses primarily on the individual; however, the program also incorporates a group level intervention, an adapted version of Hermanos de Luna y Sol
What portions of the HIV care continuum does each intervention component target? / Fuerza Positiva targets individuals who have tested HIV-positive, but have not yet engaged in care; individuals who were engaged in medical care, but have fallen out; and/or individuals that are precariously engaged in medical care and are at risk of falling out.
How have you adapted your intervention (e.g., culturally, transnational perspective)? / Modified ARTAS beyond a medical model; examining the intervention from a collectivist perspective and the cultural construct of personalismo.
How will clients be identified? / Fuerza Positiva conducts outreach/in-reach activities within Los Angeles county in an effort to indentify eligible clients.
Target Population: / Mexican men who have sex with men (MSM) or men who have sex with men and women (MSM/W)
Target N= / 150
Planned process for pilot of intervention (if applicable). Description of pilot (which components, when, how many participants, how long) / APLA piloted the ACASI tool with staff and will pilot also pilot the Hermanos curriculum (four sessions) upon the engagement of a critical mass of clients (minimum of 5).
Cross-site Evaluation Procedures:
Planned process for participant survey.
When will/did you begin administration of participant survey? / APLA received IRB approval on November 7, 2014. Enrollment of clients began on November 19, 2014.
How will clients be recruited for cross-site survey? / Clients engaged through outreach will consent to participate following the initial interview and then commence the cross-site evaluation.

Latino/ETAC Site: APLA

Title of the Project/Intervention: Fuerza Positiva

PI: Jeff Bailey, MPH

Project Coordinator: Elvis Rosales

Evaluator: Jorge Montoya, Ph.D.

Intervention Characteristics:
Who will administer the cross-site survey? / The Survey will be administered by Elvis Rosales or Carlos Reynoso.
Who will manage the cross-site survey data? / Jorge Montoya
Who will transmit data to ETAC? / Jorge Montoya
Planned process for intervention exposure data.
Who will collect the process data (intervention staff)? / Elvis Rosales, Carlos Reynoso and MH Specialist (TBH).
Who will manage the process data? / Jorge Montoya
Who will transmit process data ETAC? / Jorge Montoya
Planned process for clinical data abstraction.
To what clinics will you refer patients? / APLA Health & Wellness Northeast Valley Health Corporation, LA LGBT Center
Are any of these clinics external to your organization? / Yes
Have you established a relationship with any/all external clinics? / Yes
Have you identified technical staff who will be responsible for abstraction of clinical data? / Clinical Data will be provided by the client’s medical provider via a “Diagnosis Form”, which has already been developed by APLA
Have you established an MOU will any/all external clinics? / Yes, APLA has established Memorandum of Understandings with :
Northeast Valley Health Corporation
Los Angeles LGBT center
Local Evaluation (if applicable)
Planned process for local evaluation of ICs. Describe all components (formative, summative) of local evaluation /
  1. Data Collection Methods:
  1. ACASI
  2. Intake Forms (FamCare)
  3. Client Management/Tracking System (FameCare)
  4. EMR Request/Abstraction (entered into FamCare)
  1. These six (6) outcome objectives for Fuerza Positiva (to be achieved by August 31, 2018) are related to the following research questions:
  2. Linkage: What percentage of HIV positive clients identified through the project have been linked to primary HIV medical care within 30 days of initial identification?
  3. Obj. is min. 75% of enrolled clients
  4. Linked = Client attended initial HIV medical care visit with a primary HIV medical care provider (sole prescriber of HIV medication/treatment) no more than 30 days from initial identification.
  5. Initial identification = Fuerza Positiva staff have a verified HIV positive test result or diagnosis from lab, healthcare provider, or referring agency.
  6. Retention: What percentage of clients linked to primary HIV medical care, are retained in HIV medical care?
  7. Obj. is min. 85% of enrolled clients linked to care
  8. Retention = Client has a min. of 2 primary care visits within a 12-month period at least 2 months apart.
  9. Treatment Adherence: Is there a minimum 80% HIV medication adherence among clients retained in primary HIV medical care and prescribed ART?
  10. Obj. is min. 80% for clients enrolled and retained in care
  11. Adherence = Num. of client medication dosages taken by client (self-report) divided by prescribed dosages over a previous 7-day period.
  12. Viral Load: What percentage of clients retained primary HIV medical care, have an undetectable or reduced viral load?
  13. Obj. is min. 75% among those enrolled with treatment adherence
  14. Undetectable Viral Load = Less than 50 Copies/mL based on lab reports from most recent lab results in a six month period.
  15. Reduced Viral Load = A reduction in viral load from baseline viral load (initial lab blood work results when linked into care) to subsequent viral loads when retained in care.
  16. CD4 Counts: What percentage of clients retained primary HIV medical care, have an increase in CD4 counts?
  17. Obj. is min. 75% among those enrolled with treatment adherence
  18. Increase in CD4 Counts = An increase in CD4 count from client baseline established from initial lab available when enrolled in program and linked to care compared to subsequent CD4 counts when retained in care.
  19. HIV Stigma: What percentage of clients who complete the Hermanos de Luna y Sol intervention experience a reduction in HIV stigma?
  20. Obj. min. 75% of clients enrolled in Hermanos de Luna y Sol
  21. Reduction in HIV Stigma = Most recent scores for Internalized and Anticipated HIV Stigma (Earnshaw VA et al, 2013) show a decrease compared to initial scores for Internalized and Anticipated HIV Stigma as collected in ACASI.
  22. Depression: What percentage of clients who receive individual therapy demonstrate a reduction in depression?
  23. Obj. min. 80% of enrolled clients with depression diagnosis who are receiving counseling/psychotherapy
  24. Reduction in Depression = Most recent scores for Beck Depression Inventory show a reduction compared to initial baseline scores for Beck Depression Inventory as collected in ACASI.
  1. To what extent are client demographics dispositional factors (i.e., HIV Stigma, Depression, etc.) and multiple constructs including program dose associated with outcomes above (i.e., linkage, retention, treatment adherence, viral load, CD4 counts)?

Qualitative methods (if applicable). Describe qualitative methods to be employed [design (focus groups, key informant interviews), target population, number of groups/participants, data collection method, methods of analysis, products] / Qualitative methods were used for formative research. No current plans for qualitative methods for evaluation research.
Quantitative methods. Describe quantitative methods to be employed. [design, target population, number of participants, data collection methods, methods of analysis, products] / Primary Research Question: Does enrollment in Fuerza Positiva improve client outcomes with respect to linkage, retention, art adherence, viral load, CD4 counts, HIV stigma, and depression?
Study Design: Longitudinal with baseline, 6-month, 12-month, and 18-month follow-up measures.
Sample: HIV-positive men of Mexican origin living in Los Angeles County who consent to participate in the evaluation of Fuerza Positiva.
Data Analysis: A series of bivariate analysis will be conducted between multiple variables and key outcomes. Significantly bivariate associated variables will be included in multivariate models to assess changes in key outcomes. Some variables may be included in multivariate models even if they do not have bivariate significant association with the outcome due to theoretical considerations. Potential predictors that will be controlled for in the model include demographics, dose of intervention/program, depression, and stigma. Key outcomes include linkage and retention in care, treatment adherence, changes in viral load, and changes in CD4 counts and changes in HIV stigma and depression.
How do you plan to measure/monitor fidelity to your intervention (monitoring, supervision, etc.)? / Activity logs, program meetings, analysis of program-level data
Study Organization:
IRB approval date (or expected) / November 6, 2014
IRB expiration date / November 5, 2015

Third All-Sites Meeting. December 11-12, 2014 UC Washington DC
(One-pager form 17NOV14)