Enhanced Peer Navigation to Improve HIV Care for Women (EmPower Women)

In Project 2, we will employ a gender- and syndemic-responsive enhanced peer navigation intervention (EmPower Women) aimed at improving linkage to and retention in care outcomes among out of care HIV-infected women who face syndemic-related barriers, in collaboration with Christie’s Place, the only AIDS service agency for women in the county. EmPower Women will be culturally tailored to: 1) build skills to cope with syndemic-related affective distress, 2) facilitate linkages with both HIV treatment and relevant ancillary service providers (e.g., domestic violence, mental health, substance use), and 3) teach women interpersonal skills to activate social support networks (e.g., service providers, friends, family) when faced with new or ongoing barriers.

In collaboration with Christie’s Place, we will develop and test the EmPower Women intervention, a culturally tailored and gender- and syndemic-responsive program, with 100 out-of-care (newly diagnosed, never in care, or women who were linked but have fallen out of care) WLHA in San Diego County. Guided by the Theory of Triadic Influence (a multilevel social cognitive theory) and a Syndemics framework, EmPower Women will employ a 6-month Peer Navigator model aimed at improving linkage and retention among out-of-care WLHA who face syndemic-related barriers (e.g., substance use, violence , and mental health).

Utilizing a randomized, pretest, multiple posttest comparison control group design, the hypotheses are that over a 12-month follow-up period, EmPower Women (n=50) will demonstrate improvements in HIV care outcomes (i.e., linkage to care, retention in care) and syndemic-support outcomes (i.e., coping skills, activated social support networks, linkage to and receipt of ancillary support services) compared to HIV-infected women assigned to standard of care (self-guided access and use of Ryan White case management at Christie’s Place; n=50). EmPower Women will receive peer navigation support via one-on-one sessions, phone/text-based check-ins, and syndemic-responsive monthly support group sessions. If EmPower Women and iTAB are successful, they can be culturally tailored and broadly implemented for other underserved HIV-infected populations (e.g., young MSM, transgendered) in San Diego County and across California to bridge disparities observed along the HIV care continuum.

By targeting underlying syndemic factors in the context of HIV care, HIV-positive will be empowered with the skills, resources, and support needed to maintain their engagement in the HIV care continuum post-intervention. If successful, it is our hope that EmPower Women will a) function as a selfpropagating system (i.e., participants who learn how to manage their syndemic barriers will be able to later serve as Peer Navigators (PNs) to other women facing similar barriers) and b) be translatable to other HIVpositive populations facing similar syndemic barriers (e.g., MSM, sex workers).