The Culturally Responsive Intersectional Stigma Prevention Intervention


Upcoming Info Sessions

Information sessions for prospective healthcare facilities located in Dallas, TX, Montgomery, AL, Broward County, FL, and Miami-Dade County, FL, will be held in July 2024. Virtual informational sessions can be scheduled upon request. Click below to register for an in-person session or request a virtual session:

PARTICIPATING

Healthcare Facilities

PROSPECTIVE

Healthcare Facilities


Black men who have sex with men (MSM) face a unique intersection of stigmas related to race, sexuality, gender expression, and HIV risk, and these stigmas combine to create additional barriers to healthcare access. The Culturally Responsive Intersectional Stigma Prevention (CRISP) intervention is a package of training, skills building, technical assistance, and quality improvement activities aimed to increase providers’ awareness of these stigmas and to reduce health disparities through developing skills responsive to the specific needs of Black men who have sex with men (MSM).

Healthcare for Black MSM must be optimized across the entire HIV continuum, from testing to prevention to treatment.


WHY IS STIGMA PREVENTION IMPORTANT?

The US HIV epidemic is concentrated in the South. Among all MSM in the South, Black MSM in the South make up almost half of the new infections, which is a burden substantially greater than any other racial or ethnic group in any other region. HIV-related unequities persist for this group despite very effective biomedical advances which have served to reduce HIV incidence and improve health outcomes for other groups.

Increasing the use of biomedical prevention and treatment tools is imperative to curbing the epidemic among Black MSM, but will only occur if health settings and providers are culturally responsive to Black MSM needs.

The healthcare environment is key to either facilitating – or impeding – Black MSM engaging with testing, PrEP, or HIV treatment.

i.e. White people represent 65% of PrEP users while accounting for 26% of new HIV diagnoses, while Black people represent only 14% of PrEP users while accounting for 42% of new HIV diagnoses, indicating a large disparity in access and care.

Many Black MSM have had negative experiences in health care settings resulting in a feeling of judgment, rejection, shame and guilt, and ultimately medical mistrust. Negative interactions with healthcare staff discourage HIV testing and disrupt linkage to care, and the perception of stigma can cause Black MSM to avoid healthcare services due to fear of being discovered or identified, and/or fear of discriminatory treatment.

Intensive, skills-based training and quality improvement methodologies are proven ways to reduce stigma at healthcare facilities. CRISP is designed to help healthcare facilities demonstrate cultural responsiveness when providing services to Black MSM.


HOW DOES CRISP WORK?

CRISP is comprised of five integrated components that are implemented at healthcare facilities over a two-year period. Implementation of the CRISP program is designed to be adaptive and flexible, taking into consideration busy clinic schedules and multiple competing priorities.

Foundation Workshop

The CRISP intervention starts with a foundational 2-day workshop that aims to enhance cultural responsiveness in providing HIV care and prevention services for Black MSM through greater awareness and understanding of how anti-Black racism and other intersectional stigmas affect their HIV and sexual health behaviors, to improve their health outcomes along the HIV continuum. This powerful and transformative whole-facility skills-based workshop focuses on communication skills that support Black MSM in HIV PrEP and treatment linkage, retention, re-engagement, and adherence, and identifies structural interventions to increase cultural responsiveness in clinical settings and services.

CRISP ECHO

With a smaller subset of staff (referred to as a Champion team), additional training sessions are delivered in the ECHO (Extension for Community Healthcare Outcomes) model. Twelve 2-hour virtual sessions will comprise the core ECHO curriculum and explore various topics relevant to successful healthcare engagement and outcomes for Black MSM. Each session includes a short didactic presented by expert faculty, and then a case-based peer knowledge exchange related to the session theme.

Client-Instructor Coaching Sessions

Trained Black MSM “Client-Instructors” will hold one-on-one coaching sessions with providers after the Foundation training to provide an opportunity and safe space for providers to practice interpersonal communication skills around PrEP or ART initiation with Black MSM clients. Providers will complete a simulated patient interaction with the Client-Instructor and then receive coaching and feedback on specific competencies.  

Tailored Capacity Building Assistance

As needed, additional training and technical assistance (TA) will be offered to facilities, with a primary focus on navigating insurance coverage for PrEP and ART and using CRISP strategies to enhance business development. Needs may be identified and addressed throughout CRISP. 

Quality Improvement

A tailored quality improvement (QI) approach is taken to implement small tests of change and self-monitor improvement data over time, bolstered by ongoing facilitated peer-to-peer learning. QI support is provided by a matched QI coach and specialist team, tailored to the needs of each facility, and can build upon ongoing efforts. Facilities will be part of a peer learning network to help foster ideas and provide guidance throughout the QI process.

Research Data Collection Activities

CRISP healthcare facilities will support study data collection in up to three areas:

  • Provision of electronic medical record (EMR) data for assessment of study outcomes.
  • Recruitment of a small cross-sectional sample of Black MSM at three timepoints to complete questionnaires and provide limited medical record data.
  • Qualitative interviews* with Black MSM clients and healthcare facility staff (*at a subset of facilities).
Supportive Data & Graphics
Source: CDC.gov
Source: AIDSVu.org
Source: AIDSVu.org
Source: ADISVu.org

WHO CAN PARTICIPATE?

The CRISP intervention is for healthcare facilities that are serving, or have the capacity to serve, Black MSM for HIV prevention and/or treatment needs. In addition to providing these services, facilities must:

  • Be located in an HPTN 096 study community
  • Be willing and able to accept new Black MSM clients
  • Be willing to allow extraction of limited EMR data for study outcomes assessments
  • Be willing to participate in the CRISP intervention activities
  • Be willing to recruit Black MSM into the cross-sectional assessment
  • Be willing and able to incorporate PrEP into the facility practice (if prevention services are provided)

*Note: Because there is a maximum number of healthcare facilities that can be supported to participate in the study, if more facilities express interest than can be included in the study, the study team will select the facilities to participate based on information provided and interest expressed. Consideration will be given to the number and type of clients served by each facility, their location, and the type of facility, to ensure heterogeneity in the mix of participating facilities and equitable and representative coverage of healthcare facilities across the study communities.


BENEFITS OF PARTICIPATING

Improved Patient-Provider Communication

CRISP will help healthcare providers enhance their ability to communicate effectively with Black MSM patients from diverse backgrounds, leading to better understanding and trust.

Enhanced Community Trust

CRISP facilities will demonstrate a commitment to ensuring their practices align with the cultural contexts and preferences of Black MSM patients, thereby earning the trust and respect of these communities and enhancing their reputation as culturally competent healthcare providers.

Increased Patient Volume

Components of the integrated strategy will direct Black MSM clients to CRISP facilities, which will increase patient volume and revenue.

Boosting from the HPTN 096 Integrated Strategy

CRISP facilities will benefit from HPTN 096 interventions: peer support will serve as a resource and referral source to CRISP facilities; health equity coalitions will help to ensure structural barriers to healthcare are addressed; and the robust social media strategy will promote CRISP facilities and the important work they are doing to provide culturally responsive services.

Enhanced Patient Care and Satisfaction

Participating facilities will be empowered to optimize services to better meet the needs of Black MSM, which will in turn, improve patient satisfaction and engagement, and retention in care, ultimately leading to improved healthcare outcomes and reduced health disparities for this population.

Market Differentiation and Competitive Advantage

CRISP facilities will distinguish themselves in the marketplace as responsive to Black MSM’s needs, which will help them attract a broader patient base and gain a competitive advantage in an increasingly diverse healthcare landscape.

Improved EMR Data Quality for Black MSM

Participation in this study will improve every clinics’ ability to capture and track health data for Black MSM, resulting in better tools to improve their health outcomes.


Interested?

Interested facilities should complete the CRISP Prospective Facility Interest Form (see below). The form should be returned to 096crisp@fhi360.org, no later than September 15, 2024.

Once all completed forms have been received, the study team will review interested facilities and make selection decisions. All facilities will be informed of selection decisions by October 15, 2024.

For any questions, or to request an informational session, send a request to 096crisp@fhi360.org and a member of our team will be in touch.