The Village Project
The Village Project is an intensive case management-based intervention that harnesses peer navigation and integrated behavioral health services to improve the health outcomes of young HIV+ Black Men who have Sex with Men (BMSM). The Village Project is a culturally responsive effort to facilitate trust and better understand the social determinants of health in order to improve health outcomes. The core goals of the project are to improve linkage to care by 27%, retention in care by 15%, viral suppression by 12% and access to behavioral health/support services. The Village Project team also aims to diminish the trust deficit within the BMSM community and healthcare, while stimulating broader engagement in care. The Village Project is a three-year program with the propensity for sustainability within the standard of care in case management. How does this build trustworthiness? The Village Project, a HRSA initiative, instills trust by configuring programmatic components with community input during development and implementation. The care team utilizes a holistic approach throughout the project to better infuse social support mechanisms into care delivery, thus expanding the trust spectrum along the HIV care continuum.
How It Works
Parkland HIV Services Department in Dallas is implementing The Village Project (TVP), a nine-month intervention for 17-34 year old Black men who have sex with men (BMSM) who are living with HIV that connects patients to clinical, behavioral healthcare and supportive services. The project is funded by HRSA – Ryan White HIV/AIDS Program Part F (Special Projects of National Significance). TVP is focused on the following outcomes: increase linkage to care in less than 30 days by 27%, increase retention in care by 15%, expand behavioral health access, and increase viral load suppression by 12% of HIV+ BMSM.
TVP clients receive weekly in-person/virtual visits by a dedicated Case Manager and Peer Patient Navigator for the first six months, followed by monthly contact for the remaining three months. A customized care plan is created with the patient, with a comprehensive acuity assessment that is reevaluated every 90 days to support our guys throughout their journey of the HIV continuum of care.
The Case Manager/Peer Patient Navigator coordinates weekly contact – virtually and in-person – to assist the patients with psychosocial assessments, care plan development, referrals, ongoing monitoring, advocacy and mental health & substance use resources. The key to building this program was a multifaceted approach that began by going to the community and listening to their concerns, while also administering a professional/clinical assessment to effectually engage our demographic into sustained care. The team created an autonomous consumer advisory board made up of all Black MSM known as the MVPs (Mentors of the Village Project). This group advises the program on an ongoing basis. Additionally, a weekly psychosocial support group, known as Heart & Soul, has been created to explore and discuss topics pertaining to patient’s mental, physical, and spiritual well-being. The intent of the entire project is to help facilitate adherence to medical care and ART therapy by expanding access to care, by creating relevant and impactful programming, and by creating affirming pathways to behavioral health to support BMSM in their healthcare journey.
Skills and Competencies
The Village Project intervention relies on sustained communication, renewed engagement techniques, and disciplined holistic skills. The program builds trust by investing in the patient, not just HIV care. It is important for every member of the team to have a hands-on and personalized touch to interacting with patients. The patients don’t always want to discuss HIV solely, therefore as a supplemental support system – we must invest in their care completely and holistically. Our team focuses on their HIV care, but also carves out space for engaging with the patient on a human level. This results in trust and buy-in. It is clear that the social determinants of health can be engaged to better a patient’s HIV care journey.
Origins
This project represents an important intersectionality of needs and reveals a clear and urgent gap in health care delivery services in Texas. In 2017, the CDC reported that Blacks/African Americans accounted for 13 percent of the US population but 43 percent (16,694) of the 38,739 new HIV diagnoses in the United States and dependent areas. This project seeks to address the needs of this group of BMSM that are HIV+ in the South, in their youth and in a world filled with multiple layers of stigma and inequity.
The TVP initiative is a culturally responsive effort to engage young BMSM into HIV care to achieve viral suppression and to expand access to behavioral health in a clinical Outpatient Primary Care (OPC) setting. The team itself is diverse racially and in gender & professional expertise, which demonstrates our dedication to inclusion and representation. There is a trust deficit amongst minority communities and the healthcare system. It is vital to build inclusive and culturally humble models to meet the needs of diverse groups of people. This program is an imperfect blueprint for galvanizing trust and stimulating engagement in care.
Effectiveness
As a conduit for building genuine trust/rapport amongst our patients and staff, TVP is a safe space to explore and break down stigma barriers in areas of race, sexual orientation, socioeconomic standing, and HIV status. The demonstration style research structure allows for perpetual evolution to meet the patients where they are at in the continuum of care. TVP offers patients immediate (same day) entry/reentry into primary care via iSTAT Clinic prioritization, comprehensive peer navigation services, and supportive pathways to onsite behavioral health services.
We do have data on the preliminary impact on clinical outcomes for BMSM 17-34 six months into the program:
- Increased Linkage to Care by 40 percentage points (2018 baseline was 35%, currently 75%)
- Increased Retention in Care by 13 percentage points (2018 baseline was 52%, currently 65%)
- Increased Viral Load Suppression by 3 percentage points (2018 baseline was 68%, currently 71%)
Scalability
The Village Project model of care is sustainable and scalable. The core functions of the program are intensive case management, peer navigation and integrated behavioral health services. This research is meant to be a program that compliments the Ryan White Program structure, therefore any Ryan White funded agencies are able to implement this intervention. A comprehensive Implementation Manual & Toolkit are being developed for replication purposes. For information on replication materials, please contact Jonathan Gute at Parkland Health & Hospital System – jonathan.gute@phhs.org