Young Men's Health Project Targeting HIV Risk Reduction and Substance Abuse

1. Adapt YMHP for clinic and phone delivery by existing HIV clinic staff community health
workers (CHWs), who work with YMSM ages 15-24. Investigators will conduct focus groups
with staff to obtain input on how best to implement YMHP to maximize feasibility,
acceptability, and sustainability, as well as issues with adapting the YMHP for delivery
to YMSM ages 15-18 and for phone delivery.

2. Compare the effectiveness of clinic-based versus phone-based delivery of YMHP in the
context of health care access. In order to inform future implementation, investigators
will test the effectiveness of YMHP delivered via these two modalities.

1. Assess the cost-effectiveness of both delivery formats of YMHP to enhance the
likelihood of uptake of this best evidence intervention. The hypothesis is that
phone-based will be more cost-effective than clinic-based

2. Assess the Five Components of the Self-Management Model and how these components
vary over time, are directly improved by the interventions, and mediate
intervention effects.

3. Test a sustainable model of YMHP implementation in real world adolescent clinics.
Investigators will utilize local supervisors within the clinic setting to sustain the
CHWs fidelity to delivering the motivational interviewing (MI)-based YMHP intervention.
Fidelity will be monitored throughout the trial and assessments and qualitative
interviews will be conducted with key stakeholders to determine the barriers and
facilitators of YMHP implementation utilizing the Exploration, Preparation,
Implementation, Sustainment model (EPIS).

Aims will be achieved over two phases of the study.

Phase I: Investigators will conduct research (Exploration and Preparation phases of EPIS
model) to obtain implementation feedback to best adapt YMHP for clinic-based CHWs, further
incorporate PrEP navigation services, and expand the YMHP protocol to be relevant for
Telephone-based Motivational Interviewing (TBMI). We will train a minimum of 2 CHWs at each
clinic drawing on the Implementation Science Core (ISC) to apply best-practices in training.
Once CHWs demonstrate competence according to the Motivational Interviewing Treatment
Integrity (MITI), Phase 2 will begin.

Phase II: Personnel will recruit and enroll 270 YMSM, ages 15-24, 90 at each of the three
sites. Sessions will be audio-recorded for MITI fidelity coding, and CHWs and supervisors
will be given implementation support throughout. Prior to implementation, immediately at the
conclusion of the intervention delivery phase, and one year after, the ISC will conduct
interviews with CHWs, supervisors, and clinic leaders to obtain information about the
barriers and facilitators of implementation and sustainment.

Target n: 270 YMSM across three sites (90 per site), 135 in each condition

Inclusion Criteria:

- HIV-negative test result from the past 90 days

- 15-24 years of age

- Born biologically male or currently identifying as male

- Sex with men in the past 90 days

- ≥ 5 days of illicit drug use in the past 90 days

- ≥ 1 episode of Condomless Anal Sex (CAS) in the past 90 days, or a positive STI test
result in the past 90 days.

- Able to communicate in English

Exclusion Criteria:

- Serious cognitive or psychiatric impairments

- Currently taking Truvada as Pre-Exposure Prophylaxis (PrEP)