JMIR Publications

ABSTRACT

Background:

A high proportion of Florida’s incident HIV cases are among young sexual minority men (YSMM). As testing rates are low, many are unaware of infection. Hence, counseling, testing and referral (CTR) services are essential for diagnosis and prevention as part of the Ending the HIV Epidemic (EHE) strategic plan. However, efforts to increase CTR among YSMM have not been successful.

Objective:

The Young Adult Centered HealthForce Training (YACHT) program promotes delivery of developmentally sensitive, culturally appropriate, and evidence-based CTR services for YSMM. We will test whether YACHT increases HIV testing and fidelity to evidence-based CTR practices.

Methods:

The study employs a multicomponent implementation strategy based on the Exploration, Preparation, Implementation and Sustainment (EPIS) framework. Mystery Shopper (MS) assessments are used for quality monitoring, and workforce development strategies include Tailored Motivational Interviewing (TMI) training and evidence-based technical assistance at HIV testing sites. All testing sites in seven Florida EHE counties that tested at least 24 YSMM ages 18-29 in 2021 will be invited to participate. Participating sites (n=42) will be randomized to receive the YACHT program in blocks of six, following a stepped wedge design. They will be offered TMI training for risk reduction counseling and pre-exposure prophylaxis (PrEP) referrals, along with evidence-based technical assistance for their identified areas of need, based on MS feedback. The study will evaluate whether the YACHT program leads to an increase in HIV testing by comparing the number of YSMM who test for HIV post-implementation versus pre-implementation. In addition, we will evaluate program implementation based on MS assessments of fidelity to developmentally and culturally responsive evidence-based CTR practices. Finally, we will utilize the EPIS framework to understand barriers and facilitators of program implementation and sustainment.

Results:

The YACHT project was funded in August of 2022. Data collection began in June of 2023. As of June of 2024, 194 Mystery Shopper visits have taken place at 42 sites, four sites from the first block, and one site from the second block have engaged with the study. At baseline, study sites exhibited the lowest competencies in relationship context, counseling session, and safer sex education, and the hightest completency in the privacy and confidentiality domain. Data collection will continue through May of 2027, and results are expected to be published in the Winter of 2027.

Conclusions:

To address the high rates of HIV among YSMM in Florida, the YACHT program will be implemented at HIV testing sites in EHE counties that have demonstrated capacity for testing YSMM. By supporting sites with Tailored Motivational Interviewing training and technical assistance specifically for areas of need as identified by Mystery Shoppers, the program seeks to improve the sites’ ability to deliver evidence-based CTR practices appropriate for YSMM, thereby increasing HIV testing, counseling and PrEP referrals and reducing HIV rates among this population. Clinical Trial: NCT # NCT06015581, Registered 29 August 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06015581