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Proyecto Compadre: Using Implementation Science to Tailor Peer Navigation for Latino Men in the US–Mexico Border Region

Tsuyuki, Kiyomi PhD, MPHa; Stockman, Jamila K. PhD, MPHa; Stadnick, Nicole A. PhD, MPHb; Moore, Veronica MPAc; Zhu, Helena; Torres, Vicente MPHc; Cano, Rosalindac; Penninga, Katherine MSWc; Aldous, Jeannette L. MDc

Author Information
JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1, 2022 - Volume 90 - Issue S1 - p S98-S104
doi: 10.1097/QAI.0000000000002985

Abstract

  • Evidence-based innovation: HIV testing and care linkage.
  • Innovation recipients: Spanish-speaking Latino men who have sex with men (MSM).
  • Setting: San Diego County, California.
  • Implementation gap: There is a need for expanded linguistically, culturally appropriate, and representative HIV outreach and information to address the stigma and medical mistrust that prevent Latino MSM from accessing HIV testing, prevention, and care linkage.
  • Primary research goal: Select/pilot implementation strategies.
  • Implementation strategies: Peer navigation, others.

INTRODUCTION

Latino gay, bisexual, and other men who have sex with men (MSM) in the United States experience HIV prevention disparities. HIV testing is a critical entry point into prevention and linkage to care, yet an estimated 17% of Latinos are unaware of their HIV infection1 and are at the greatest risk for late HIV diagnosis (AIDS within 1 year of diagnosis).2 Implementation barriers related to engaging Latino MSM with HIV prevention (testing) and care include stigmatized use of HIV services and pre-exposure prophylaxis (PrEP), Latino MSM readiness along the change continuum, concerns about negative consequences of service use (ie, confidentiality), and Latino MSM and provider knowledge about services.3,4 Strategies are needed to address these persistent sociostructural barriers (ie, language, insurance, and stigma) and facilitate successful engagement in HIV prevention practices for Latino MSM.5,6

Peer-led implementation strategies, such as peer navigation (PN), enlist members of a specific group to influence and support members to change behaviors and norms conducive to a healthier lifestyle.7 Peers have access to hidden populations that may lack access to conventional health programs.8 Peer-driven messaging is effective in engaging MSM in intervention content by using peers' established rapport and trust to disseminate information about HIV testing and prevention, while offering social support9 and reducing the negative effects of medical mistrust and stigma.10,11 Peer-led strategies among MSM have an increased uptake of HIV testing,12–18 improved HIV knowledge, and reduced condomless anal sex acts.19,20 The utilization of peers as leaders in patient navigation programs has been identified with improved engagement/linkage of HIV-infected individuals with care.21 There is a paucity of peer-led HIV testing strategies for Latino MSM, but Latino MSM who report social support from peers report frequent and less delayed HIV testing, less unrecognized HIV infection, and less risky sexual behaviors.22,23

We conducted an implementation research study in San Diego (SD) County that engaged Latino MSM, HIV staff at various points of the service delivery chain, and an academic–community partnership between a large state university and a large Federally Qualified Health Center (FQHC). The community collaborator is a federally funded, multisite, nonprofit organization providing accessible health services across SD County. We used the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework24 in the study design, measurement, and analysis of barriers and facilitators to accessing and providing HIV testing and care to develop a PN implementation strategy called Proyecto Compadre (Project Good Friend). This article aimed to present preliminary findings from the collaborative development of Proyecto Compadre, a peer-mediated, social media, social network, patient-focused implementation strategy aimed to promote HIV testing and PrEP/HIV care linkage for Spanish-speaking, Latino MSM in SD County.

METHODS

Design and Data Collection

We conducted a pilot Ending the HIV Epidemic mixed-methods implementation research study with Latino MSM and staff divided into 2 phases. Phase I focused on understanding the relevant inner and outer contexts, innovation, and bridging determinants of the EPIS Framework24 associated with the effective implementation of HIV testing and PrEP/HIV care linkage among Latino MSM. We conducted 7 focus groups (FGs) with organizational staff, 15 key informant interviews (KIIs) with Latino men (data saturation was reached), and 4 KIIs with peer navigators. Phase I specifically mapped the current HIV prevention services (provided or used), community and mobile outreach efforts, peer-led services, and care coordination/wraparound services. Before the qualitative assessments, we administered brief, 20-minute paper-based surveys on sociodemographics, comorbidities and HIV prevention and treatment (Latino men only), and work experience (staff only). In phase II, we conducted 31 brief, web-based surveys with both Latino men and staff to rank the full list of implementation strategies from each group based on qualitative data from phase I. They ranked each strategy on a Likert scale (strongly agree to strongly disagree) separately for feasibility (staff only) and acceptability, and from 1 to 10 for importance of implementation. Feasibility was defined as the extent to which the implementation strategy is practical or possible to use and measured if the strategy was perceived to be implementable, possible, doable, and easy to manage.25,26 Acceptability was defined as the extent to which the implementation strategy is attractive, agreeable, or palatable and measured if they approved the strategy, found it appealing, liked the idea, and welcomed it. Strategies were ranked in the order of importance, and acceptability and feasibility (staff only) were considered in the ranking. The research team (organizational leadership and investigators) then considered the prioritized rankings from each group within the implementation context. Finally, we conducted web-based FGs (2 with Latino MSM and 2 with organizational staff) to tailor the prioritized Proyecto Compadre implementation strategies for Latino MSM and the organizational context. Academic–community partnership meetings reviewed findings and informed the development of the logic model informed by the EPIS framework in response to local and organizational needs (see Supplemental Digital Contents 1–4, https://links.lww.com/QAI/B886, https://links.lww.com/QAI/B887, https://links.lww.com/QAI/B888, https://links.lww.com/QAI/B889).

Recruitment

Latino men were recruited through direct community-based recruitment, provider referral, and clinic-based recruitment in South and Southeast SD County. Eligibility criteria included self-identifying as Latino/Hispanic, age 18 years or older, and either: (1) HIV+ and engaged in HIV care, (2) HIV- and engaged in PrEP care, or (3) HIV− (or status unknown) and not engaged in HIV testing or PrEP. Organizational staff were recruited through email invitation and were provided protected time to participate. Staff eligible to be included consisted of HIV frontline staff, peer navigators, managers, supervisors, and care providers.

Data Analysis

Quantitative data from phase I were analyzed descriptively using STATA 15.1.27 Phase II survey data of implementation strategy feasibility (Staff only), acceptability, and importance rankings were then averaged within groups (Latino MSM/Staff) and compared, and a final list of strategies was devised. Findings were presented to organizational leadership, and top ranking strategies within each group and those that overlapped between groups were assessed for inclusion in the multifaceted implementation strategy based on the organizational implementation context.

Qualitative data from phases I and II were preliminarily analyzed by creating templated summaries28 in which: (1) neutral domains were created from each FG/KII question, (2) the team of investigators applied and revised the domains with 2 FG/KII each, and (3) then applied the revised domains to all the FG/KIIs. Templated summaries were revised for key themes around barriers and facilitators to HIV testing and care linkage and ways to tailor evidence-based practices and implementation strategies for Latino men. Using preliminary findings, the academic–community partnership of the Proyecto Compadre team convened to discuss appropriate health behavior theory, evidence-based interventions, and implementation inputs to inform the logic model.

RESULTS

Table 1 summarizes the sociodemographic and other characteristics of Latino men and organizational staff. Latino men (N = 15) were at an average age of 39 years, 67% were at least high school–educated, 81% had an annual income at or below $29,000, 94% preferred to speak Spanish, 27% were US born, 67% identified as gay, and 53% were HIV-negative. Staff (N = 26) were mainly Latinx (69%) and spoke Spanish (77%). Staff were well trained in cultural competency, serving transgender populations, motivational interviewing, trauma-informed care, and HIV prevention and care.

TABLE 1. - Characteristics of Latino Men and Organizational Staff
Latino Men (n = 15), n (%) Staff (n = 26), n (%)
Sociodemographics
 Age, yrs, mean (SD) 39.47 (10.53) 39.32 (10.75)
  25–34 6 (40) 11 (42)
  35–44 4 (27) 8 (31)
  45–54 3 (20) 4 (15)
  55–61 2 (13) 2 (8)
  Missing 1 (4)
 ≥High school diploma 10 (67) 26 (100)
 Annual income
  ≤$29,000 12 (81)
  Missing 3 (20)
 Sex
  Male 15 (100) 14 (54)
  Female 12 (46)
 Ethnicity
  Hispanic/Latinx 15 (100) 18 (69)
  Non-Hispanic White 5 (19)
  Asian/Pacific Islander; Black/African American; other 3 (12)
 Speaks Spanish 14 (94) 20 (77)
 US born 4 (27) 19 (73)
 Sexual orientation
  Gay or lesbian 10 (67) 9 (35)
  Straight or heterosexual 4 (27) 17 (65)
  Bisexual 1 (7)
 HIV status
  Positive 6 (40) 4 (15)
  Negative 8 (53) 21 (81)
  Do not know 1 (7) 0 (0)
  Prefer not to say 0 (0) 1 (4)
 No medical insurance 7 (47)
 Lived in the street (in the previous 12 mo) 5 (33)
 Food insecure (in the previous 12 mo) 4 (27)
Staff characteristics
 Staff category
  Clinic staff 16 (61)
  Health care provider 3 (12)
  Management 3 (12)
  Other 4 (15)
 Received training in
  Cultural competency 25 (96)
  Working with transgender patients 19 (73)
  Professional development skills 18 (69)
  Motivational interviewing 17 (65)
  Trauma-informed care 17 (65)
  Medications for HIV 16 (62)
  Treatment adherence counseling 15 (58)
  PrEP 13 (50)
Rankings [ranking from 1 to 6]
 Referral to social and ancillary services (ie, MH) [1]
 PN program [2] [4]
 PN recruitment through social media [3]
 PN recruitment through in-person network [4]
 Culturally tailored HIV material [5] [1]
 Community HIV campaign [6] [2]
 PN training program [5]
 Recruiting logistics (social media; in-person; incentivized) [6]
 Train all staff re: HIV referral [3]
Source: Proyecto Compadre (2019–2020).

Regarding feasibility (staff only), acceptability, and importance of implementation strategies, Latino men and staff both positively ranked a formal PN program (2 and 4, respectively), culturally tailored HIV material (5 and 1, respectively), and a community HIV campaign around South SD County (6 and 2, respectively). Latino men also positively ranked referrals to social and ancillary services (ie, mental health [MH] care; 1) and peer recruitment through social media and in-person networks (3 and 4, respectively). Staff also positively ranked training all staff in HIV referral, PN training program, and establishing a comprehensive recruitment strategy to include social media, in-person, and incentivized recruitment methods (ranked 3, 5, and 6, respectively).

Table 2 summarizes the rankings of the implementation strategies and highlights the strategies that were retained, organized by EPIS factors. Outer context strategy suggestions included the following: PN program and information dissemination. Latino men described a PN implementation strategy that leverages peer trust and referral to address intersectional stigma, medical mistrust, and discrimination in accessing HIV services and uses the Latino social network to expand reach. Latino men emphasized the need for a community HIV campaign with tailored, publicly accessible, and discreet HIV messaging to disseminate information. Latino men also recommended a social media intervention to leverage facilitators to testing in the outer context of EPIS. This strategy would create and strengthen social networks to disseminate information around HIV testing and prevention. Key suggestions identified culturally competent HIV educational material as an innovation factor. Staff described the need for culturally tailored HIV educational materials in Spanish, at a sixth-grade reading level, and sexual orientation neutral, given significant stigma in the Latino community. Inner context factor suggestions consisted of a formalized PN program structure. Staff described the need for an organizationally integrated PN program with a supervisorial structure, PN training, and fair PN compensation and team integration.

TABLE 2. - Recommended Components for a Community-Vetted PN Implementation Strategy for Latino MSM in San Diego, CA
Implementation Strategies Barrier/Facilitator Addressed or Leveraged and Example Quotations
Peer-led intervention Barriers addressed: intersectional stigma, medical mistrust, discrimination (outer context: service environment/policies)
 Peer recruitment and referral If…a flyer or something reached us by a relative or acquaintance who is already going to the clinic, then we feel secure that it is well-established and a place with open doors where we trust to go and ask questions (Latino male, phase I)
 Peers build trust and reduce stigma Diffusion of information is important because people are scared to go to a clinic or they feel shame because they don't speak English, they don't have documents [(legal status)], or don't know what will happen…[we] need to let people know not to worry about it (Latino male, phase I)
 Peers use Latino social network [Have] other Latinos referring them so that they know it's safe and confidential. Using the Latino social network (Latino male, phase I)
Disseminate information Barriers addressed: lack of HIV prevention and care information (outer context: availability and accessibility of public health information)
 Community HIV campaign All the information that I have seen about HIV [and] PrEP [is] in the clinics…I have not seen any ads on the street or in transportation (Latino male, phase I)
 Tailored messaging Creating a viral message, an attractive campaign…using language that is easy to understand…Staff who are in the field are used to using big words and people sometimes are not at that level, and they get scared (Latino male, phase II)
 Public and discrete messaging Use something that is informative, and that offers…anonymity; like a QR code…I see it in public transportation, on the street…I take it without no one seeing me and [without] feeling judged (Latino male, phase II)
Social media platforms Barriers addressed: expanded reach and diffusion of innovation (bridging factor: network/communication channels)
 Social media recruitment and intervention Creating the Facebook page…from men to men…the administrator will input prevention messages, it could be a good way to engage clients with services…an informal platform to make friends and talk to clients like if they were friends (Latino male, phase II)
 Dating apps recruitment and intervention I suggest using…[the] Grindr app or other dating [with] an announcement like “the virus doesn't kill, but your fear of getting tested does,”…it is a reality, the virus doesn't kill us, but the fear of receiving care is what leads people not to treat HIV on time (Latino male, phase II)
Tailored HIV educational material Barriers addressed: need for linguistically and culturally appropriate material (innovation factor: culturally, linguistically competent; relevant intervention content)
 Spanish language The vast majority of clients that we see, especially in South Bay, are mono-lingual Spanish speakers who obviously feel more comfortable with any type of service in Spanish (Staff, phase I)
 Reading level It's best that the material is set at like a sixth grade level…and it's a lot of phrasing…that even some native English speakers get confused with before even translating it into Spanish (Staff, phase I)
 Sexual orientation stigma They want the services but they do not want it to be openly homosexual, to have even more confidentiality. There's a stigma attached to just being openly gay with a lot of Latinos. So that's a very big issue (Staff, phase II)
PN program structure Barriers addressed: need for PN management, PN representation, and team integration (inner context: staffing, organizational characteristics)
 Dedicated PN manager We don't have a dedicated staff position to run our peer navigation program…so talking about organizational structure, if we had resources…that could fund a dedicated staff position or even a small team to actively recruit,…navigate, and train, and make sure none of our [PNs] are falling through the cracks (Staff, phase I)
 PN reflect population If…they don't have a social security number, then that limits them from being a peer volunteer and stipends and all that…But maybe…include peers that actually reflect our population (Staff, phase II)
 PN pay and team integration If we were to get a volunteer with incentives or hire a peer navigator, having benefits and…ideally, paying them and keeping them as part of the team (Staff, phase II)
Source: Proyecto Compadre (2019–2020).

Figure 1 presents the EPIS-based logic model that aided the development of the Proyecto Compadre components. Determinants to HIV testing and prevention for Latino men within the outer context included29 the public charge law (a regulation endangering immigration status based on using social benefits). Barriers to testing included the lack of HIV information, intersectional stigma, medical mistrust, being uninsured, untreated MH problems, Spanish monolingual status, and lack of reach of Latino men.30–32 Facilitators included social support (check-in calls, birthday parties, and support groups), word of mouth (peer referral) that gave men trust in the referral, culturally competent care, dissemination of information, and using social media to enhance reach and access to care. In the inner context, the organization developed a COVID-19 home-based testing program but still lacks a PN model and case management for HIV-negative clients and a strategy for social media recruitment and faces workforce difficulties retaining trained PNs. Bridging factors included strong community–academic partnerships for implementation.

F1
FIGURE 1.:
Proyecto Compadre peer-led social media, social network implementation science logic model. The current report focuses on the exploration and preparation phases (first two columns). PN = Peer Navigation; HIVST = HIV self-testing; MH = Mental Health.

Implementation Strategy Bundle

Proyecto Compadre is a multifaceted PN implementation strategy that comprises the following: (1) peer-led intervention strategy, (2) social media recruitment and dissemination strategy, (3) tailored HIV educational material, and (4) PN program structure.33

Mechanisms

Organizational coordination includes managing a PN program, hiring and training PNs and PN Coordinator, optimizing HIV self-testing and referrals to care, and community stakeholder buy-in. PN and peer influence is hypothesized to increase perceptions of social support, reduce stigma, reduce medical mistrust, and enhance HIV prevention norms. Proyecto Compadre is hypothesized to increase accessibility to HIV and MH information and linkage to care and reduce sociostructural barriers.

Outcomes

Implementation outcomes include reach (characteristics of tested vs. nontested, recruitment rate of Latino MSM and PNs, and qualitative measures), effectiveness (HIV testing productivity and qualitative measures), and implementation (acceptability and fidelity). Clinical and services outcomes include HIV testing (% repeat/testers), unmet MH need (access to MH provider with MH need), and linkage to care (PrEP, HIV, and MH).

DISCUSSION

Using the EPIS framework, we identified outer, inner, bridging, and innovation determinants to inform selection of a multifacted PN implementation strategy. Findings have 3 key implications for ending the HIV epidemic among Latino MSM in SD County. First, our PN implementation strategy for Spanish-speaking Latino MSM included key elements that address outer context determinants identified in our phase 1 assessment of being peer-led, using Latino social networks and social media for enhanced reach and information dissemination and culturally tailoring intervention material. The ranking system used in phase 2 identified important, acceptable, and feasible implementation strategies. The PN program was selected as the primary strategy based on the ranking system but is a multifaceted implementation strategy that requires additional implementation strategies to address the multilevel barriers to HIV testing and care for Latino MSM (ie, language barriers, stigma, etc). In addition, the ranking system enabled us to identify potential synergies among organizational staff, Latino MSM, and organizational implementation context. The PN implementation strategy will engage navigators in disseminating intervention content about HIV testing and prevention to their peers by leveraging their established rapport and trust, while offering social support and reducing the negative effects of medical mistrust and stigma. The PN strategy can serve as a liaison service to identify and address other needs, such as MH (in this case), in addition to HIV-specific services. Referral to these social and ancillary services was identified as a priority for Latino men, and addressing these sociostructural barriers to testing can increase the number of individuals reached and retained by HIV services. The PN strategy centers individuals who need the most support to access HIV testing and be linked to care. Peers are more likely than professionals to influence health behaviors of fellow group members and have better access to hidden populations who may lack access to conventional health programs.7,8 Findings from this study are specific to Spanish-speaking Latino MSM in SD County who are regular social media users, especially because Latino subgroups in other US regions experience variable barriers to testing and care utilization.34–36 However, if efficacious, Proyecto Compadre can be modified for other Latino subgroups paying attention to the unique cultural (Puerto Ricans, Dominicans, etc.) and implementation contexts. One limitation is that participant recruitment was through referral by peers and agencies, potentially limiting transferability of findings to those reachable by traditional referral mechanisms. However, we offset this limitation by including Latino MSM not currently engaged in HIV prevention/care.

Second, we selected critical implementation strategies at the organizational level (inner context), including creating PN jobs, developing a PN training certificate program, and systematizing a social media recruitment and intervention approach. Staff specified the need to include an administrative/supervisorial structure for PNs and social media recruitment, which would allow for consistent PN recruitment, integration, and retention. In addition, engaging trainings for PNs are imperative to address ethical/confidentiality issues and support PN implementation fidelity. Finally, staff stated that they needed culturally appropriate Spanish-language HIV educational materials because most clients prefer to access services in Spanish (innovation factors). These strategies align with EPIS inner context and innovation factor considerations by managing organizational coordination to facilitate key implementation outcomes such as HIV testing and care linkage reach and effectiveness.

Third, our community–academic partnership (bridging factor) highlighted critical facets for a continued and successful collaboration to ending the HIV epidemic for Latino MSM. These partnerships are the basis of providing infrastructure and a common goal between researchers at academic institutions and CBOs. Proyecto Compadre is the first of its kind to leverage the power of peer influence, social media, and social networks to address HIV testing and MH, advancing HIV prevention science and addressing care disparities among Spanish-speaking Latino MSM. In conclusion, we developed and adapted a PN implementation strategy to mitigate key barriers and leverage key facilitators to HIV testing and PrEP/HIV care linkage for Latino MSM.

REFERENCES

1. Centers for Disease Control and Prevention. HIV and Hispanics/Latinos. Atlanta, GA: CDC; 2020. Available at: https://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/index.html. Accessed June 15, 2021.
2. Wohl AR, Tejero J, Frye DM. Factors associated with late HIV testing for Latinos diagnosed with AIDS in Los Angeles. AIDS Care. 2009;21:1203–1210.
3. Pinto RM, Berringer KR, Melendez R, et al. Improving PrEP implementation through multilevel interventions: a synthesis of the literature. AIDS Behav. 2018;22:3681–3691.
4. Harkness A, Satyanarayana S, Mayo D, et al. Scaling up and out HIV prevention and behavioral health services to Latino sexual minority men in South Florida: multi-level implementation barriers, facilitators, and strategies. AIDS Patient Care STDs. 2021;35:167–179.
5. Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A, et al. The invisible US Hispanic/Latino HIV crisis: addressing gaps in the national response. Am J Public Health. 2020;110:27–31.
6. Horvath KJ, Walker T, Mireles L, et al. A systematic review of technology-assisted HIV testing interventions. Curr HIV/AIDS Rep. 2020;17:269–280.
7. Webel A. Testing a peer-based symptom management intervention for women living with HIV/AIDS. AIDS Care. 2010;22:1029–1040.
8. Simoni JM, Nelson KM, Franks JC, et al. Are peer interventions for HIV efficacious? A systematic review. AIDS Behav. 2011;15:1589–1595.
9. Simoni JM, Franks JC, Lehavot K, et al. Peer interventions to promote health: conceptual considerations. Am J Orthopsychiatry. 2011;81:351.
10. Best Practices for Integrating Peer Navigators into HIV Models of Care. Washington, DC: AIDS United; 2015. Available at: https://www.aidsunited.org/data/files/Site_18/PeerNav_v8.pdf. Accessed May 30, 2021.
11. Brooks RA, Landrian A, Nieto O, et al. Experiences of anticipated and enacted pre-exposure prophylaxis (PrEP) stigma among Latino MSM in Los Angeles. AIDS Behav. 2019;23:1964–1973.
12. Elford J, Bolding G, Sherr L. Peer education has no significant impact on HIV risk behaviours among gay men in London. AIDS. 2001;15:535–538.
13. Erausquin JT, Duan N, Grusky O, et al. Increasing the reach of HIV testing to young Latino MSM: results of a pilot study integrating outreach and services. J Health Care Poor Underserved. 2009;20:756.
14. Golden MR, Stekler J, Hughes JP, et al. HIV serosorting in men who have sex with men: is it safe? J Acquir Immune Defic Syndr. 2008;49:212–218.
15. Wilton L, Herbst JH, Coury-Doniger P, et al. Efficacy of an HIV/STI prevention intervention for Black men who have sex with men: findings from the many men, many voices (3MV) project. AIDS Behav. 2009;13:532–544.
16. Geibel S, King'ola N, Temmerman M, et al. The impact of peer outreach on HIV knowledge and prevention behaviours of male sex workers in Mombasa, Kenya. Sex Transm Infect. 2012;88:357–362.
17. Ko NY, Hsieh CH, Wang MC, et al. Effects of Internet popular opinion leaders (iPOL) among Internet-using men who have sex with men. J Med Internet Res. 2013;15:e40.
18. Young SD, Cumberland WG, Nianogo R, et al. The HOPE social media intervention for global HIV prevention in Peru: a cluster randomised controlled trial. Lancet HIV. 2015;2:e27–e32.
19. Medley A, Kennedy C, O'Reilly K, et al. Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev. 2009;21:181–206.
20. Ye S, Yin L, Amico R, et al. Efficacy of peer-led interventions to reduce unprotected anal intercourse among men who have sex with men: a meta-analysis. PLoS One. 2014;9:e90788.
21. Bradford JB, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care STDs. 2007;21(supp 1):S49–S58.
22. Lauby JL, Marks G, Bingham T, et al. Having supportive social relationships is associated with reduced risk of unrecognized HIV infection among Black and Latino men who have sex with men. AIDS Behav. 2012;16:508–515.
23. Carlos JA, Bingham TA, Stueve A, et al. The role of peer support on condom use among Black and Latino MSM in three urban areas. AIDS Educ Prev. 2010;22:430–444.
24. Moullin JC, Dickson KS, Stadnick NA, et al. Systematic review of the exploration, preparation, implementation, sustainment (EPIS) framework. Implement Sci. 2019;14:1.
25. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38:65–76.
26. Lewis CC, Weiner BJ, Stanick C, et al. Advancing implementation science through measure development and evaluation: a study protocol. Implement Sci. 2015;10:102.
27. StataCorp. Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC; 2017.
28. Palinkas LA, Mendon SJ, Hamilton AB. Innovations in mixed methods evaluations. Annu Rev Public Health. 2019;40:423–442.
29. Tsuyuki K. Proyecto Compadre Ending the HIV Epidemic Among Racial and Ethnic Minorities in the US. Bethesda, MD: NIAID/CFAR Implementation Science Pilot; 2020.
30. Galvan FH, Bogart LM, Wagner GJ, et al. Conceptualisations of masculinity and self-reported medication adherence among HIV-positive Latino men in Los Angeles, California, USA. Cult Health Sex. 2014;16:697–709.
31. Spadafino JT, Martinez O, Levine EC, et al. Correlates of HIV and STI testing among Latino men who have sex with men in New York City. AIDS Care. 2016;28:695–698.
32. Taylor BS, Garduño LS, Reyes EV, et al. HIV care for geographically mobile populations. Mt Sinai J Med. 2011;78:342–351.
33. Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:21.
34. Lopez-Quintero C, Shtarkshall R, Neumark YD. Barriers to HIV-testing among Hispanics in the United States: analysis of the National Health Interview Survey, 2000. AIDS Patient Care STDs. 2005;19:672–683.
35. Reynoso-Vallejo H, Chassler D, Witas J, et al. Patterns of drug treatment entry by Latino male injection drug users from different national/geographical backgrounds. Eval Program Plann. 2008;31:92–101.
36. Levy V, Prentiss D, Balmas G, et al. Factors in the delayed HIV presentation of immigrants in Northern California: implications for voluntary counseling and testing programs. J Immigr Minor Health. 2007;9:49–54.
Keywords:

HIV testing; peer navigation; PrEP; implementation science; Latino MSM; EPIS framework

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