Collaboration among healthcare providers and community-based organizations may be a viable strategy to increase PrEP uptake among Latino MSM.
“Latino gay, bisexual, and other MSM, who are one of the groups most impacted by HIV in the United States, have unique needs and faces unique, significant barriers to getting healthcare, including HIV preventive care,” Jonathan Ross, MD, MS, says. “These include limited English proficiency, lack of health insurance, lack of experience with US healthcare, immigration-related concerns, and stigmas related to HIV and sexual orientation.”
Community-based organizations (CBOs) that work with Latino MSM “are great at addressing these types of barriers, but they haven’t often been included in designing or delivering healthcare services,” despite their expertise in working with the community, he continues.
For a study published in the Journal of Community Health, Dr. Ross and colleagues assessed how collaboration between CBOs that serve Latino MSM and health centers could facilitate PrEP distribution among this high-risk group. The study team convened an expert panel that included eight client-facing staff from three CBOs and one health center to identify strategies for collaborative delivery of PrEP.
Physician’s Weekly spoke with Dr. Ross to learn more.
PW: Can you briefly explain how the study was conducted?
Jonathan Ross, MD, MS: We set out to work with stakeholders from several CBOs and a large healthcare system in New York to figure out strategies that these organizations could implement together to help connect Latino MSM to sexual healthcare and PrEP. This group met monthly over one year to determine the barriers to PrEP for Latino MSM in New York City and identify strategies that the partnership could deliver. To reach a consensus on these issues, we used a Delphi process, which involved discussions among the group, anonymous surveys, and even a few focus groups to understand the perspectives of CBO clients.
What findings are most important to emphasize?
A major takeaway is that CBOs and healthcare organizations can and should work together to develop strategies that work for the institutions and communities they serve. Staff in CBOs and in healthcare settings have expertise to bring to the table, and working together provides an opportunity to find solutions with potential to bridge important gaps for patients.
The package of strategies that our panel identified highlight important areas to consider when delivering HIV prevention care and PrEP. One is that flexible options are critical for Latino MSM—and many other communities at risk for HIV—who often have competing priorities. Therefore, choices such as telemedicine or convenient options for lab work increase the chances of providing successful care. Another key finding is that tailored messaging that incorporates the experience of both healthcare providers and CBOs can provide essential information to communities at risk for HIV in a way that resonates with them. Finally, we found that stakeholders strongly supported approaches that would reduce communication barriers between CBOs and health centers, such as Web-based referrals and coaching sessions, to streamline the process and overcome bureaucracy and institutional inertia.
The community expert panel selected five strategies:
- A Web-based referral tool.
- Telemedicine appointments.
- Geographically convenient options for lab specimen collection.
- Tailored print and social media messaging.
- Regular coaching sessions with CBO staff.
These were highly acceptable, thought to be highly appropriate for their respective settings, and considered feasible to implement. This is important because we know that early buy-in among stakeholders is critical when trying to introduce and scale up new initiatives.
What are the implications of your findings?
Most of the time, physicians and other medical providers work entirely within the world of clinics and hospitals, even though the communities most at risk for HIV—and, among those with HIV, the communities most at risk for poor health outcomes—often have difficulty getting connected to medical care. Therefore, it is critical that healthcare organizations and CBOs work together to try to bridge this gap. For clinicians who are already engaged in this work, our findings offer several concrete strategies that we believe will improve efforts to connect Latino MSM and other groups to PrEP and keep them engaged in care. For clinicians who do not currently work with CBOs or other community representatives, our work serves as a call to explore ways in which they might be able to do so.
What would you like to see future research focus on?
A critical next step is determining whether the package of strategies our community expert panel identified is successful. We are in the midst of a 2-year study to understand which strategies are working, in which settings, and why. There is also a need to study other ways healthcare organizations and CBOs can work together. However, doing this type of collaborative work can be difficult because healthcare organizations—and the institutions that fund them, like the NIH—often have different priorities and different administrative practices than CBOs, which can sometimes lead to frustrations on both sides. We therefore will continue to advocate for regulatory and policy changes that would facilitate more cooperative approaches.
