Scaling Up Implementation Strategies to Improve the DIAGNOSE and PREVENT Pillars for Young MSM in Florida

This project will launch a Florida wide effort to promote the delivery of developmentally sensitive and evidence-based DIAGNOSE and PREVENT counseling testing and referral services (CTR) for young men who have sex with men (YMSM). The goal is to leverage implementation science strategies to improve the capacity of the HIV HealthForce to deliver evidence-based practices (risk reduction counseling, PrEP referral and motivational interviewing) within CTR services. Our recent YMSM Mystery Shoppers studies conducted at CTR sites in three cities indicated that providers are woefully unprepared or do not know how to deliver developmentally appropriate, CTR services to YMSM and miss opportunities to deliver these evidence-based practices. Mystery Shopper is a quality management strategy to monitor implementation fidelity to developmentally responsive EBPs in CTR settings. However, assessment and feedback alone are insufficient to improve fidelity; the HealthForce must be properly trained and given technical assistance. We propose integrating two implementation strategies: quality management Mystery Shoppers and HealthForce training in developmentally tailored motivational interviewing with centralized technical assistance. We will test Young Adult Centered HealthForce Training (YACHT) package in Florida’s EHE counties among the Department of Health’s 42 contracted sites who delivered CTR to at least 24 young MSM in the previous 12 months using a Stepped Wedge design. We power on both effectiveness outcomes (# of tests of YMSM) and implementation outcomes (EBP fidelity based on Mystery Shopper Assessments) consistent with a Type 2 Hybrid trial.