Come As You Are - Assessing the Efficacy of a Nurse Case Management HIV Prevention and Care Intervention among Homeless Youth

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Investigator: Marguerita Lightfoot, PhD
Sponsor: Univ of Texas Health Science Ctr-Houston

Location(s): United States

Description

Few HIV prevention programs prioritize the unique HIV prevention needs of youth experiencing homelessness (YEH) including access to and engagement in the full continuum of behavioral and biomedical HIV prevention methods, particularly PrEP and nPEP. There is a critical need to test theory-based, youth-friendly HIV prevention interventions among YEH that are personalized, relevant to youth, and scalable. Guided by the Comprehensive Health Seeking and Coping Framework, the goal of this study is to conduct a randomized controlled trial of an enhanced NCM intervention, NCM4HIV, delivered to YEH 16-25 years old in collaboration with health and social service providers to assess the intervention impact on the uptake and adherence to HIV prevention strategies. If found to be efficacious, this scalable intervention will advance the field of HIV prevention among homeless youth by increasing access to behavioral and biomedical HIV prevention.

 Youth experiencing homelessness (YEH) are at high risk for HIV, with prevalence estimates as high as 13%, underscoring the need for targeted HIV prevention programs. YEH engage in more sexual risk behaviors than stably housed youth, yet underutilize existing HIV prevention programs and prevention care delivery, including low uptake of PrEP and nPEP. Nurse case management (NCM) enhanced with motivational interviewing (MI) strategies and behavioral feedback may increase engagement of youth to adopt and adhere to behavioral and biomedical HIV prevention methods. NCM is a proven public health approach that involves coordinated, individualized, comprehensive care delivered by a registered nurse that includes health assessment, care plan development, prevention education, and health and social service navigation and addresses the social determinants of health including behavioral, psychosocial, and situational factors to optimize HIV prevention in this high risk population. Guided by the Comprehensive Health Seeking and Coping Framework, we will conduct a randomized controlled trial of an enhanced NCM intervention, NCM4HIV, delivered to YEH 16-25 years old in collaboration with health and social service providers to assess the intervention?s effect on uptake of and adherence to HIV prevention strategies. NCM4HIV is an enhanced HIV prevention case management that provides direct HIV prevention services (PrEP, nPEP) and individualized HIV prevention planning using MI and behavior feedback technology. 
Aim 1 : Determine whether the enhanced NCM intervention increases uptake of HIV prevention strategies (PrEP and nPEP uptake, HIV testing, STI screening and treatment, and condom use) when compared with usual care received by YEH (N=450; aged 16-25 years). 
Aim 2 : Determine whether NCM4HIV improves mental health, substance use, and housing status when compared with control youth at baseline, immediate post and 3, 6, and 9 months.