Current Research
The Center for Latino Adolescent and Family Health (CLAFH)
Project Confianza
Pronounced inequities in the impact of HIV among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) represent a discernible challenge for advancing progress toward the national Ending the HIV Epidemic (EHE) initiative’s 2030 goals. Medical mistrust (MMT) and trustworthiness have been identified in previous HIV services research as influential drivers in shaping individual-level health-related decision-making, agency, and behavior toward HIV service use among HLMSM. Thus, research to understand and address factors that shape MM and HIV service MMT in key geographies of elevated HIV incidence among HLMSM represents a public health priority to enable progress toward meeting national EHE goals. Throughout the project, the HLMSM-led investigative team will partner with a steering committee consisting of HLMSM, community leaders with strong community ties to the Hispanic/Latino (H/L) community and HLMSM, healthcare providers who serve HLMSM, academic partners with subject expertise relevant to the proposed study activities and methods, media and communication partners with strong connections to the HLMSM community, and other key stakeholders. The project consists of two integrated study phases focusing on five geographic areas — Los Angeles County, CA; Bronx County, NY; Bexar County, TX; Miami-Dade County, FL; and San Juan Municipio, PR — that align with EHE priority jurisdictions and account for a significant burden of HIV incidence among HLMSM across the US.
During Phase I, we will conduct formative research to inform the development of a community-designed, multilevel intervention, including: Activity 1: Semi-structured In-depth Interviews with approximately N=100 HLMSM (20 HLMSM per geography) will explore individual definitions of mistrust and trustworthiness and their root causes at multiple levels, and how mistrust and trustworthiness shape engagement in prevention and treatment. Activity 2: Semi-structured In-depth Interviews with N= 75 Key Informants (e.g., HIV service providers; 15 Key Informants per geography) will characterize their experiences with MMT among HLMSM and elicit perspectives on local and organizational laws/policies that contribute to MMT. Activity 3: Focus Groups with approximately N=50 HLMSM (10 per geography) and N=50 Key Informants (10 per geography) will draw upon the definition and root causes of multilevel mistrust and trustworthiness elicited from activities 1 and 2 to explore perceptions of potential solutions for addressing their root causes. Activity 4: Cross-Sectional Online Surveys of N=1,625 HLMSM (325 HLMSM per geography) will elicit information from HLMSM about the relative weight/importance of the root causes and specific, changeable pathways shaping MMT and HIV service use among HLMSM, which can be targeted for intervention in Phase II.
In Phase II, we will conduct a three-arm (1:1:1) parallel explanatory randomized control trial to evaluate the efficacy of a community-designed, multi-level intervention in addressing MMT and improving use of status-neutral HIV services among HLMSM. N=336 HLMSM will be recruited from each of the five project geographies (N=1,680 total) and will be randomly assigned to receive either the community-designed, multi-level intervention alone, or the community-designed, multilevel intervention plus peer navigation, or the standard of care (referral to existing local HIV prevention/treatment services). Together, this study has significance for advancing national EHE goals.
Community Screening and Linkage to Substance Use Services
This SAMHSA-sponsored research is evaluating the efficacy of a nurse-driven, multi-level, Community Screening and Linkage to Substance Use Services program in Mott Haven, NYC. Mott Haven—one of the hardest hit localities by the overdose epidemic and the poorest congressional district in the continental US—representing a high-need community and the catchment area for the current project. With substance use-related emergency room visits and hospitalizations about three times as high as the New York City-wide average, Mott Haven residents face substantial challenges with the adverse consequences of untreated alcohol and drug misuse in their community. The right to access high-quality and affordable substance use and mental health-specific treatment and prevention services are core components of behavioral health (substance misuse + mental health) equity. This access is too often not a reality for Mott Haven families. The project addresses this gap head on through a community-based screening, brief intervention, and referral to services (SBIRT) model, combined with multi-sectoral collective action among families, health, and social service providers to enhance substance use outcomes and care integration.