Client-Centered Care Coordination (C4TM) for HIV/STI Prevention: a Theoretical, Conceptual, and Methodological Overview-HIV Prevention Trials Network (HPTN) 073
Abstract
Introduction: There are few culturally informed, theory-driven evidence-based strategies to support PrEP use among Black MSM. This paper describes the theoretical foundation and conceptual development of C4TM to support the prevention of HIV and other STIs.
Methods: C4TM integrates self-determination theory with comprehensive risk counseling and services using an integrative anti-racism lens. C4TM was implemented in a 52-week HIV prevention demonstration project to facilitate PrEP use and adherence among Black MSM (N = 226) in three US cities from 2014 to 2017.
Results: PrEP use was 79%, with 91% of PrEP users starting within 30 days. Twelve-month retention in C4TM was 92%.
Care coordination encounters focused primarily on clients' needs related to PrEP adherence (43%) and sexual health (19%). Over the 12-month period, a substantial proportion of the men made progress towards their PrEP adherence goals at the 8-week (83%), 26-week (75%), and 52-week (81%) study visits.
Conclusions: C4TM is a multi-level, multi-component intervention that dually targets individual-level motivations and capacities of Black MSM and the healthcare facility-level attitudes, behaviors and processes that characterize the climates where Black MSM receive services. Policy Implications.
Public health policy efforts to scale-up PrEP may consider C4TM as a tool to optimize the use of PrEP and PrEP program retention with Black MSM. C4TM is also a tool for healthcare facilities to transform their models of service delivery towards improving the implementation PrEP services, including ensuring racial equity in the prevention impact of novel PrEP formulations such as long-acting injectable and potential future long-acting oral regimens.