http://peds.med.wayne.edu/divisions.htm
This project strives to conduct innovative field and Internet outreach to encourage YCMSM to find out their HIV status and enroll, engage, and maintain in care. The investigators will use and evaluate a motivational interviewing (MI) strategy, with extensive MI training to field workers, to encourage at-risk YCMSM to be counseled and      

Intervention

• Traditional peer outreach versus traditional peer outreach plus motivational interviewing 
• Comprehensive continuum of care based on a continuous relationship model and elements of social network theory, with community and Internet outreach
• MI during outreach to use CTR and during post-testing to engage in care 
• Inter-disciplinary care using MI to promote retention in care and risk reduction 
• Healthy Choices MI support group intervention, Brother-to-Brother prevention group intervention 
• Agency outreach to capture HIV+ identified elsewhere, outreach and home visits for those lost to care 
• Peer advocacy and recreation services  

Outputs 

• 150 YMSM reached per year via 1,500 community outreach contacts, with one-half using MI
• 100 YMSM reached per year via Internet outreach, with one-half using MI
• 52 YMSM use CTR in first year, with all clients who receive CTR receiving MI with regard to post-testing
• All HIV+ receive MI regarding enrolling in care, with 100%-80% HIV+ to receive MI regarding staying in care
• 18 support groups held, 60 youth to receive case management, 80 youth to receive advocacy services
• All lost-to-care receive attempted contact

Short Term Outcomes

• Increase knowledge of HIV risks, readiness to know serostatus, knowledge of individual serostatus 
• Increase in number of clients who use CTR, enroll in care and arrive at first primary care appt 
• Increased attendance at quarterly primary care visits, adherence to treatment regimens, self-efficacy and social support, readiness to change negative behaviors, and re-enrollment of lost-to-cares  

Long Term Outcomes 

• Decrease in unmet health care needs and HIV transmission related to not knowing serostatus
• Improve health and well-being of HIV+
• Reduction in high risk sexual and substance using behaviors

Proposed Local Evaluation Strategy 

• Compare peer outreach to peer outreach plus motivational interviewing to assess the effect on readiness to accept diagnosis, receipt of HIV CTR, and return for test results; also linkage into care 
• Randomized controlled trial with pre-post test comparisons: randomization to traditional versus traditional plus motivational interviewing to assess if intervention results in the pursuit of HIV CTR 
• For field recruitment, field outreach three days per week 
• Baseline, three, and six month follow-up 
• For field: ni=50 (total N=100), for Internet: ni=75 (total N=150)