Implementation and evaluation of project IN-CARE; a peer health navigation program targeting urban men who have sex with men

Issue: Targeted interventions to increase access and retention in HIV care can reduce HIV related health disparities and improve health outcomes. We describe the development, implementation and preliminary outcomes of a coordinated peer-based health navigation program targeting men who have sex with men (MSM). Description: The intervention is part of a multi-city initiative (Positive Charge) aimed at increasing access to and retention into care for vulnerable populations. From August 2010 through December 2011, we enrolled 374 HIV+ newly diagnosed and out of care adult males from 4 urban clinic and community-based settings. We used standardized surveys to collect baseline and follow-up data on factors associated with treatment outcomes. Of those enrolled, 66% were African American, 20% Latino/Hispanic and 11% White with an average age of 37 years. Lessons learned: Successful integration of peer services into existing agency operations varied based on degree of agency and staff buy-in. Recruitment of out of care clients proved more challenging than those recently diagnosed. The use of multiple outreach strategies to identify out of care clients can increase engagement. We found that clear roles and responsibilities across providers and ongoing peer supervision are needed. Self-report data suggest high rates of mental health symptoms, substance use, physical and sexual trauma, HIV-related stigma and lower rates of HIV disclosure compared to the general HIV population. Recommendations: Peer-based health navigation is a promising intervention strategy. Tailored interventions to help MSM HIV+ males manage past trauma exposure, HIV related stigma, and improve treatment self-efficacy are needed.