Project Summary: The primary aim of this application is to examine the effects of a clinic-integrated community health worker (CHW) intervention on HIV outcomes among Black people with poorly managed HIV. Miami-Dade County, Florida, is an HIV epicenter where Black adults account for 17% of the population and 64% of AIDS-related deaths. A major driver of poor HIV outcomes among black persons living with HIV (PLW) are health factors such as high rates of poverty, homelessness, and unemployment that limit access to and continuity of care. These factors highlight the critical need for multi-level interventions that ameliorate the impact of HIV on. Accordingly, this application aims to examine the effects of the CHW intervention on HIV outcomes. For over 15 years, the University of Miami has supported research on CHW interventions to improve health outcomes in our community. Our earlier work found Black PLH randomized to receive community-based CHW support for 12 months improved rates of viral suppression vs. those receiving standard HIV care. Further research found clinic-based CHW support also led to improved HIV outcomes among Black PLH. Expanding this work, this application proposes to broaden CHW support to both community and clinical settings by integrating CHWs into HIV clinical teams within Miami-Dade’s largest public health system. Feasibility research (1R56NR019755-01) elicited stakeholder input on CHW clinic integration and data was used to develop a clinic-based CHW intervention that extends care to community settings. Stakeholders were also queried on perceptions of emerging healthcare challenges and potentially responsive CHW support strategies. Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE) will embed CHWs trained in motivational interviewing (MI) into HIV clinical care teams to address system and community level factors, as well as individual self-care behaviors among 300 Black PLH. Using a randomized controlled trial design, participants will receive a 12-month CHW intervention or usual HIV care. CHWs will receive robust training to utilize MI strategies. Intervention effects on viral load, medication adherence, hospitalizations, and self-efficacy in treatment adherence at 12 months will be determined from medical records, participant tracking data and pre and post assessments. Subgroup analyses will compare outcomes among women and various age groups. Results will contribute to knowledge on the utility of clinic- and community-based CHWs to improve HIV outcomes among Black PLH. If successful in optimizing HIV health outcomes, this research could make a substantive contribution towards reducing chronic disease in other communities. OMB No. 0925-0001/0002 (Rev. 01/18 Approved Through 03/31/2020) Page Continuation Format Page