Increasing Access to Screening Servs for Mex Migrant Males

Alan Gilmore, Planned Parenthood Mar Monte

Background: Rising STI-HIV rates among Mexican migrant men (MMM) represent a growing challenge for California, especially for communities where employment and social factors draw greater numbers of MMM. Fresno County represents one of the most populated MMM settings in California and one of the highest rates of AIDS for Latinos in California and the USA. Statistics suggest higher STI-HIV risk for men who have sex with men (MSM) and men who use drugs (meth and IV) however, imprecise, unsystematic, and inappropriate screening methods in clinical and community settings hinder valid identification of MSM and drug use, as well as other documented risks for MMM (e.g., multiple partners and lack of condom use). Access and attendance of MMM in traditional healthcare settings is low, often due to cultural factors, such as lack of trust and dislike for western healthcare. When MMM attend traditional healthcare settings, STI-HIV screening may be missed due to poor or inappropriate screening skills, preventive services, and cultural competence.

Pilot Structural Intervention: A pilot study of a structural intervention is proposed that builds on lessons of STI-HIV prevention focusing on behavioral risk factors and culturally and linguistically appropriate methods. The proposal builds on prior history and preliminary studies of the collaborative community-research partnership. The study examines a 3- component intervention. Component 1: Community based organizations (CBOs) (e.g., employment, housing, welfare and nutrition) known to be trusted and frequented by MMM are recruited, provided staff training, environmental changes and resources, and access to case management support related to referral of MMM for STI-HIV screening. Component 2: A healthcare setting, centrally located to the recruited CBOs, is designated as a "hub" and provided staff training in preventive STI-HIV screening with special attention to cultural and linguistic factors that may hinder acceptance of and subsequent valid screening. Component 3: Case managers are trained and supported to serve as liaisons for MMM to encourage, facilitate, and follow-up on referred-MMM’s use of the healthcare hub and their completion of STI-HIV screening. Components are designed on top of existing organizational and community infrastructures in order to facilitate implementation and potential sustainability beyond funding.

Study Design: A prospective, two-group, quasi-experimental study is used to assess the pilot intervention effects, with careful attention to assess feasibility and research variables (e.g., effect size, process fidelity) necessary to plan a larger, more controlled trial. Two county health clinic sites will be selected to serve as hubs, one for the intervention and one for the comparison group of CBOs. The two healthcare hubs will be selected based on their presence in high density Latino population but far enough from each other as to not serve the same population. Four CBOs (two for each healthcare hub) will be recruited to participated based on high MMM clientele for at least two years, presence of internal supports important to the intervention (e.g., tracking and referral procedures, sufficient Spanish speaking staff), and proximity to one of the healthcare hubs. Organizations will be selected to be similar in variables known to influence amount and type of service delivery (e.g., staffing, hours of operation). One set of CBOs-healthcare hub partnership will be exposed to the 3-component intervention; the other will serve as a comparison group. The intervention will last 14 months, and be followed by 3 months of non-intervention follow-up to assess for sustainability of effects on the CBOs and healthcare agency. The primary dependent variable will be number of MMM screened at a healthcare hub for STI-HIV measured by laboratory records. Covariates at the client level (e.g., demographics, behavioral risk factors) will be assessed through case manager records and healthcare data from agency’s Information System. Process evaluation will examine implementation variables for each Component (e.g., CBO referrals to healthcare hubs; number, frequency and type of case management; STI-HIV screening variability across clinic staff).