Employment as prevention: Adapting a structural intervention to achieve HIV equity among immigrant Latino MSM. - Project Summary/Abstract Background: This fellowship application is from a second-year doctoral student seeking to establish expertise in HIV among immigrant Latino men who have sex with men (LMSM), adaptation science, and implementation science (IS). Miami-Dade County (MDC), Florida, is the project's research site, a priority jurisdiction under the Ending HIV Epidemic (EHE) plan, where the HIV burden is among the highest in the United States, particularly among LMSM.1 In MDC, unemployment, financial stress, and poverty contribute to HIV vulnerability among LMSM, especially recently arrived immigrant LMSM.2–4 Interventions are needed to address these structural barriers that impede the success of evidence-based biomedical HIV prevention and treatment tools such as pre-exposure prophylaxis (PrEP) and treatment among immigrant LMSM. Work2Prevent (W2P) is one evidence-based structural intervention which has shown to impact HIV prevention outcomes among English- speaking Black and Latino MSM and transgender women, respectively.5–8 However, W2P has yet to be adapted for immigrant LMSM populations to address their unique needs, nor for people living with HIV. Research Strategy: This fellowship would be the first to adapt an HIV-status neutral structural employment as prevention intervention (W2P) to address the structural barriers for LMSM with recent immigration histories who may be monolingual Spanish-speaking, or undocumented. This will be accomplished by obtaining feedback from immigrant LMSM (n=10) and topical experts (n=10). The research project, linked to a carefully considered training plan, will advance the candidate's trajectory of becoming an independent investigator in the science of adaptation, immigrant LMSM HIV disparities, and implementation science. The proposed project aligns with the co-primary sponsor's NIH-funded research (PI: Harkness K23MD015690, P30MH116867-03S1) to scale up and disseminate PrEP, HIV testing and behavioral health services to LMSM in South Florida. The following aims are proposed: Aim 1 will qualitatively determine key adaptations to make W2P culturally grounded for recent immigrant LMSM and status neutral via theater tests. Aim 2 will elucidate further adaptations to W2P and plan for implementation based on topical expert input through focus groups. ADAPT-ITT,9 an established framework for adapting interventions, will guide the systematic adaptation process. Training Plan: The training plan, composed of coursework, seminars, and individual meetings, will allow for developing the necessary skills to achieve the research aims and expertise in culturally adapting and enhancing the feasibility of implementing evidence-based interventions that address structural factors driving HIV disparities among immigrant LMSM. Next Steps: Study findings will inform a subsequent K01 proposal to pilot test the culturally adapted W2P program for immigrant LMSM. The subsequent K01 will fully launch PI Jaramillo to research independence. Innovative methods in adaptation and IS and focus on the unique needs of immigrant LMSM are urgently needed in geographic hotspots to achieve health equity and EHE goals.
