Scaling Up Implementation Strategies to Improve the DIAGNOSE and PREVENT Pillars for Young MSM in Florida

Young men who have sex with men (YMSM) continue to experience a disproportionate burden of HIV infection and remain less likely than other populations to engage in HIV testing, prevention services, and pre-exposure prophylaxis (PrEP). Counseling, Testing, and Referral (CTR) agencies play a critical role in improving the DIAGNOSE and PREVENT pillars of the Ending the HIV Epidemic initiative by providing culturally and developmentally responsive HIV prevention services. Previous mystery shopper evaluations of CTR agencies identified important gaps in provider delivery of evidence-based practices (EBPs), including risk reduction counseling, PrEP referrals, and culturally responsive care.

The purpose of this study is to evaluate the effectiveness of the Young Adult Centered HealthForce Training (YACHT) package for improving providers' fidelity to youth-focused EBPs and increasing HIV testing among YMSM in Florida CTR agencies. The study will be conducted in 41 Florida Department of Health contracted or direct-service CTR agencies located across six Florida End the Epidemic (EHE) counties.

This is a Type 2 hybrid implementation-effectiveness, cluster stratified randomized trial involving 41 agencies distributed across three blocks. Agencies will be randomized within blocks, with 20 assigned to receive the YACHT intervention and 21 serving as the comparison group.

The YACHT package consists of two complementary implementation strategies:

Workforce Development (WD), which provides agency-tailored guided problem solving and development of quality improvement strategies based on mystery shopper feedback reports; and Quality Management (QM) using standardized mystery shopper assessments that evaluate clinic environment, provider delivery of evidence-based practices, and culturally responsive care. Mystery shoppers will visit each participating agency twice per quarter, and aggregate agency-level feedback will be used to support quality improvement.

The primary effectiveness outcome is the number of HIV tests administered to YMSM using agency-level aggregate data obtained from the Florida Department of Health. The primary implementation outcome is providers' fidelity to evidence-based practices, including risk reduction counseling and PrEP referrals, as assessed through standardized mystery shopper evaluations across multiple domains. Secondary objectives include identifying barriers and facilitators to successful implementation of youth-specific EBPs through qualitative interviews with agency representatives using a mixed-methods approach.

Both intervention and comparison agencies will receive a final mystery shopper feedback report at the conclusion of the study and will have access to ongoing voluntary virtual Tailored Motivational Interviewing (TMI) workshops. Qualitative interviews will be conducted with representatives from both intervention and comparison agencies following completion of study activities.

Inclusion criteria

Agency Eligibility

• Florida Department of Health (FDOH) contracted or direct-service Counseling, Testing, and Referral (CTR) agency.
• Located within one of the six participating Florida End the Epidemic (EHE) counties.
• Provides HIV counseling, testing, and referral services. 4 Conducted HIV testing for a minimum of 24 young men who have sex with men (YMSM) during the previous year.

Provider/Staff Eligibility

• Employed by a participating CTR agency.
• Age 18 years or older.
• Able to understand and speak English.
• Willing and able to provide informed consent.
• Selected to participate in the qualitative interview component of the study.

Exclusion criteria

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