CRUSH

Design

Open Cohort

Duration

Enrollment for this project will lasted approximately 12 months; the project ran for 48 months in total. Subjects were contacted at 1, 6, and 12 months post-enrollment for evaluation purposes, and additionally at 3 and 9 months for clinical purposes.

Depending on HIV status and participation in PEP or PrEP additional clinical visit will take place.

Sample Size

Approximately 342 participants

Eligibility Criteria

Eligibility criteria includes individuals 18-29 years of age and who are MSM, transgender, or who have sexual contact with HIV+ individuals.

Stratification

PrEP only pilot cohort, then a PEP/PrEP/Sexual Health Services full study cohort. Pilot participants had the ability to roll over into the full study cohort after completing the pilot study.

Intervention

All interventions were offered as opt-in services.

Regimen

PEP: Stribild-based regimen

PrEP: TDF 300mg + FTC 200mg-fixed dose combination was given orally once daily starting when a negative participant is interested and eligible for PrEP and lasting as long as the participant is enrolled and willing to continue. 

Social Network Testing

Community & Clinic Based Social Network Testing utilizing community partners deployed HIV testing with expanded reach into local communities.  Individuals within the community groups acted as informal seeds to the social network testing process.  The Wisconsin PHD SNT Protocol was used as a training guide, providing guidelines for Recruiter Enlistment, Recruiter Engagement (orientation, interview, and coaching), Recruitment of Network Associates, and Counseling, Testing and Referral (CTR).

Peer Mentoring for HIV+ Youth

Peer mentoring targeted youth newly diagnosed With HIV, youth at-risk for falling out of care, and youth currently out of care.  Mentors were stable clients in the current Downtown Youth Clinic clients in routine care ≥ 2 years).  Mentoring focuses on healthy behavior/skills and social support to improve adherence.  The intervention targeted one mentor/mentee contact per month. Contacts were event-based and/or one-on-one, and included monthly social events – at the CRUSH clinic. Mentee/Mentor matching was renewable every six months

Clinical Supervision for Staff

Clinic staff provided supervision and mentorship to overcome major challenges, including countertransference, sexual boundaries in the workplace, and guidance working with extremely challenging cases.  One-on-one focus sessions were scheduled with youth team staff twice per month, and monthly support groups for staff were conducted. This intervention employed the Maslach Burn Out Inventory twice per year.

Outcomes

Testing volume and positivity with each partner organization.

Interest in and receipt of PrEP.

Retention in care.

For HIV+ participants; adherence and viral suppression.

For HIV- participants on PrEP, adherence to medication by self-report and DBS. For all participants; retention in care, incident STI.