HIV and substance misuse among adolescents and young adults (AYA) remains a pressing public health prevention and treatment priority. We propose to implement Educate, Test, and Navigate (ETN), a comprehensive peer-based approach to HIV and substance misuse prevention and treatment navigation for minority youth in the country’s poorest congressional district and “hotspot” for HIV and substance misuse—the South Bronx, NYC. The evidence-based project activities are designed to (1) reduce HIV risk behavior and substance misuse; (2) increase HIV and substance misuse screening among AYA; and (3) increase the proportion of at-risk, HIV+, and/or substance misusing AYA who are engaged and retained in appropriate clinical services.
The federal Ending the HIV Epidemic initiative identified NYC’s Bronx as one of the 48 counties with the highest HIV burden in the United States. In the South Bronx, the overwhelming majority (>94%) of residents are Latino and/or Black, and 40% are younger than 25 years old. Alarmingly, the rate of new HIV diagnoses per 100,000 in the South Bronx is 29% higher than in the Bronx overall. Furthermore, the South Bronx alone accounted for more than half of new HIV diagnoses in all Bronx residents under the age of 30 in 2015. The South Bronx also represents a hotspot of substance misuse. All 5 NYC neighborhoods with the highest drug-related hospitalization rates are in the South Bronx. Research suggests substance misuse is associated with increased risk of HIV infection among HIV-negative individuals and decreased likelihood of achieving desired HIV treatment outcomes among HIV-positive individuals, namely engagement and retention in care and sustained viral suppression. Therefore, an integrated programmatic focus on both HIV and substance misuse prevention education, testing, and navigation to prevention and treatment services in geographies hardest hit by the epidemic is central to the success of the federal Ending the HIV Epidemic initiative.
Using the Educate, Test, Navigate (ETN) approach, the proposed project will implement 9 integrated activities that directly align with the projects’ programmatic goals and SMART objectives. For prevention education, we will (1) perform community outreach and engagement (2,000 households/year); (2) provide comprehensive community-based HIV and substance misuse prevention using Community PROMISE, an evidence-based intervention endorsed by the Centers for Disease Control and Prevention (CDC) (recruitment of =10 volunteer peer advocates/year); and (3) launch a community-wide public messaging and awareness campaign on HIV and substance misuse. For testing, we will (4) provide opportunities for HIV testing (150 AYA/year) and (5) HCV testing (150 AYA/year); as well as (6) substance misuse and sexual risk behavior screening and motivational interviewing-based brief interventions for AYA using SBIRT, an evidence-based program endorsed by SAMHSA (500 AYA/year). For navigation, we will (7) actively link all indicated AYA to comprehensive clinical HIV and/or substance misuse services at the Adolescent AIDS Program (AAP) at Montefiore Medical Center using STYLE, an evidence-based intervention endorsed by CDC (approximately 40 AYA/year); (8) provide comprehensive case management for retention in HIV and substance misuse services using STYLE to retain 85% of navigated AYA in services; and (9) develop and disseminate a continuing education webinar series for healthcare providers regarding testing and linkage to treatment for AYA at-risk or living with HIV, which will be made available for free Continuing Education Units through NYU’s online and continuing education division.
