For participating healthcare facilities:

For prospective healthcare facilities:

What is CRISP?

The CRISP (Culturally Responsive Intersectional Stigma Prevention) intervention is an integrated package of training, skills building, technical assistance, and quality improvement activities designed to help healthcare facilities optimize the healthcare experience of Black men who have sex with men (MSM) to reduce health disparities along the HIV continuum of prevention and care. CRISP increases awareness of the intersection of anti-Black racism, sexual stigma, HIV stigma, and gender non-conforming stigma, which Black MSM experience when seeking healthcare. CRISP aims to increase providers’ awareness of these stigmas and develop skills in providing services that are responsive to the specific needs of Black MSM. CRISP is one component of the HPTN 096 four-component integrated strategy.

Why is CRISP Important?

The US HIV epidemic is concentrated in the South. Among MSM in the South, Black MSM make up almost half of the new infections. Despite biomedical advances, inequities in the utilization of HIV prevention and care services by Black MSM, particularly in the South, persist. HIV biomedical prevention and treatment interventions have not had the same impact for Black MSM as they have for other groups. For example, 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.

Source: AIDSvu.org

Black MSM face a unique intersection of stigmas related to race, sexuality, gender expression, and HIV risk, and these stigmas combine to create additional barriers for Black MSM interacting with the healthcare system. Increasing the use of biomedical prevention and treatment interventions among Black MSM is imperative to meet EHE goals but will only occur if health settings and providers are culturally responsive to their needs. Healthcare for Black MSM must be optimized across the entire HIV continuum from testing through prevention through treatment.

CRISP aims to highlight the intersectional stigmas that cause barriers for Black MSM in accessing the healthcare system and interacting with providers. The healthcare environment is key to either facilitating – or impeding – Black MSM engaging with testing, PrEP, or HIV treatment. CRISP is designed to help healthcare facilities demonstrate cultural responsiveness when providing services to these men. 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 means of reducing stigma at healthcare facilities.

Who can participate in CRISP?

Participating facilities must be located in an HPTN 096 intervention community. Within these communities, participating healthcare facilities may include, but are not limited to:

  • HIV treatment clinics/providers (public and private)
  • Public health and health department clinics, including STI testing and treatment centers
  • Primary care providers (providing PrEP)
  • Community health centers and FQHCs
  • CBO-based health services including AIDS Service Organizations
  • Hospital outpatient clinics
  • College/university health services
  • Retail health hubs/pharmacies

Within HPTN 096 intervention communities, any healthcare facility that provides HIV testing, HIV PrEP/prevention, and/or HIV treatment and care services to Black men would be eligible and is invited to complete an interest form. Depending on interest, the study team may need to select a subset of interested sites, but we hope to work with as many healthcare facilities in each community as possible. Study activities may begin at different times in each community.

What is involved in CRISP?

CRISP is comprised of a bundle of six activities that are implemented with healthcare facilities over a period of two to three years. Implementation of the CRISP program is designed to be adaptive and flexible taking into consideration busy clinic schedules and multiple competing priorities. These activities include:

Client Observation Visits

As one of the first CRISP activities, trained Black MSM “Client Observers” will visit each clinic and complete simulated visits (“test patients”) to assess their general experience of the healthcare facility from the perspective of a Black MSM client. The Client Observers will provide qualitative feedback to each clinic to inform later quality improvement activities.

Foundation Workshop

The CRISP intervention starts with a foundational 2-day workshop that aims to enhance cultural responsiveness in providing HIV/STI services for Black MSM through greater awareness and understanding of how anti-Black racism and other intersectional stigmas affect their HIV/STI health behaviors, in order to improve their health outcomes along the HIV continuum. This interactive, 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.

Client Instructor 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.  

ECHO Distance & Peer Learning

With a smaller subset of staff (referred to as a Champion team), additional training sessions are held virtually focusing on a variety of topics to explore more deeply after the Foundation training. Each session includes a short didactic and then a case-based peer knowledge exchange related to the session theme.

Quality Improvement

A guided quality improvement approach is taken to implement small tests of change and self-monitor improvement data over time. Each site is paired with a quality improvement coach and will be part of a peer collaborative to help foster ideas and provide guidance throughout the QI process.

Client Surveys

Clients of the healthcare facilities will be asked to complete periodic surveys assessing the healthcare environment to see how experience of the clinic may change over time. Summary survey results by patient demographic will be provided to each clinic to inform their quality improvement approach.

What are the benefits of participating in CRISP?

Participating healthcare facilities will benefit from the following:

Training for clinic staff

  • Inclusive whole facility approach
  • One-on-one client-instructor skills application and mentoring

Peer learning network and knowledge exchange

Client survey feedback

Facilitated Quality Improvement program

  • Guided self-monitoring of clinical, patient and health worker data
  • Rapid improvement cycles
  • Coaching and technical assistance, peer-to-peer learning

Participating facilities will receive a small annual compensation package intended to offset any revenue loss or staff resource burden as a result of participating in CRISP activities. The compensation is a flat fee and not intended to directly reimburse salary or staff time, but to acknowledge the investment that facilities are putting into this program and provide some additional resources to them. The funds are unrestricted.

Ultimately, the intended outcome of the program is improved service delivery and quality outcomes for Black MSM at your facility, which will contribute to reaching EHE goals in your community.

What Healthcare Facilities are Participating in CRISP?

Participating healthcare facilities are located in HPTN 096 intervention communities.

How to Participate

Interested facilities should complete the interest form below. Completion of an interest form does NOT signify commitment of a healthcare facility to participating. A member of the study team will contact the facility representative shortly after form submission to answer any questions, provide additional information, and confirm intent to participate. As implementation preparations begin in each community, the study team representative will work with each clinic to complete the onboarding process.

Please submit the interest form online here:

To view a downloadable interest form, please click here:

Questions?

Contact CRISP@hptn.org with any questions.

Supportive Data & Graphics
Source: CDC.gov
Source: AIDSVu.org
Source: AIDSVu.org
Source: ADISVu.org