FY 2021 ending the HIV epidemic - primary care HIV prevention - racial and ethnic disparities in the HIV prevention continuum in the united states and specifically in new york city

Black and hispanic/latino people accounted for four in five new HIV diagnoses in NYC in 2018 and have consistently had the highest HIV diagnoses rates from 2014-2018 according to the new york city department of health. In 2021, the centers for disease control reported 17% of black people and 20% of hispanic/latino people are unaware of their HIV status. Regarding prevention medications, only 27% of black and 31% hispanic/latino people utilized prep in 2017 compared to 42% of white people. Additionally, there are higher levels of stigma experienced by black and latino people. Contributing factors to the disparity are community prevalence of housing instability, poverty and lack of access to culturally competent healthcare. This illustrates the need for targeted intervention in black and latino communities to address access barriers and stigma related to HIV testing and prevention. Healthcare choices NY, INC. (HCC) serves predominately black and latino patients in its three delivery sites with black patients representing 45% and latino patients representing 35% of the total patient population. About 70% of patients are living below the federal poverty level and have at least one additional social determinant of health. In 2020, HCC achieved a 60% HIV screening rate despite the disruption of in-person service due to the covid-19 pandemic. The number of HIV tests decreased from 1100 in 2019 to 554 in 2020 because of the lack of personal touch needed to assuage patient reluctance and stigma associated with HIV screening. Increasing HIV screening and linkage to preventative services are priorities for HCC. This funding opportunity will enhance our capacity for screening high risk patients and community members in the black and latino communities while addressing stigma, access barriers and underutilization of prep. HCC's program will implement three key interventions to engage high-risk patients into the HIV prevention continuum. 1) adapt a ryan white program service model. HCC will hire and train outreach staff to engage high-risk groups using an approach that reduces stigma and racial barriers to testing and prevention services. The outreach team will conduct information sessions/testing events in shelters, churches, and other community hubs frequented by our target populations. The events will promote the importance of HIV testing and prevention services in the health center and partnering organizations while assessing and addressing stigma and social determinants of health to ensure people are linked to resources such as assistance with transportation, insurance and prescription programs. Patients will be engaged in primary care and prevention services either through telehealth or an in-person visit at HCC or referred to collaborating providers for prep and treatment for HIV positive patients within thirty days of testing. 2)purchasing HIV testing supplies to conduct testing at the health centers and/or outreach events. The staff will track testing and results to ensure goals are met and linkage to appropriate prevention services are successful. The program will devise an outreach testing schedule to share with community stakeholders through email, websites and social media. This will help maximize the number of people who are able to receive testing through an organized community effort. 3)healthcare providers will be trained to use a status-neutral, culturally appropriate approach for HIV testing and prevention services. The training will utilize resources from the "experts" at aids institute, nysdoh and other organizations. The team will be equipped with evidence based guidance to counsel on HIV testing and prevention and feel comfortable to prescribe prep to high risk patients as the comfort level and prioritization of the program inte