Project Summary Despite progress in moving the needle closer to the 90-90-90 goals, the U.S experiences almost 35,000 new HIV cases each year, with persistent inequities in engagement in prevention services and along the care continuum that disproportionately impact racial, cultural and ethnic minorities in socio-economically disadvantaged communities. Missouri and Alabama are both Ending the HIV Epidemic priority states due to rates of engagement along the care cascade that are behind the 90-90-90 goals. Status-neutral approaches address two core pillars of the EHE mission, prevention and treatment. Community health workers (CHWs) are trusted members of the local community bringing unique lived experiences that align with the client population in their racial, socioeconomic and ethnic backgrounds. The overarching goal of the planned multisite implementation study is to develop a status-neutral CHW strategy for people living with HIV (PLWH) and people at risk for HIV in partnership with community-based organizations (CBOs). We will build on multiple implementation science models by using The Exploration, Preparation, Implementation and Sustainment (EPIS) framework in conjunction with the Consolidated Framework for Implementation Research (CFIR) for identifying determinants and Expert Recommendations for Implementing Change (ERIC) to identify implementation strategies. This application responds to the EHE CFAR/ARC Supplement Opportunity (FY2022) request for Strategic alliances across jurisdictions to reach EHE goals through implementation research. This proposal will strengthen capacity for multisite IS research and prioritize strategies for implementing a status-neutral CHW intervention. We have assembled an exceptional team led by Drs. Spiegelman (Yale), Humphries (Yale), Marotta (Wash U) and Lanzi (UAB) to bring together complementary expertise in the fields of implementation science, community engaged research, HIV/AIDS prevention and control and qualitative methods in implementation science. This study aims to: 1) Leverage existing community collaboratives to foster community buy-in and relationships around the status-neutral CHW concept in Alabama and Missouri, and 2) Define the components and determinants of a status-neutral CHW intervention in CBOs in Alabama and Missouri in partnership with Project RISE [PI Brewer] at three more sites. We will 2a) Assess acceptability, barriers, facilitators and preliminary readiness to implement a status-neutral CHW strategy by analyzing existing CBO data on PrEP use and the HIV care continuum; interviews with frontline staff (n=10 per site, 20 total); and a focus group with CBO leadership/management (n=10 participants per site, 20 total). We will also 2b) prioritize implementation strategies and develop supporting materials for the delivery of a status- neutral CHW strategy in partner CBOs across the two sites. The outcome of these aims will be strengthened community collaboratives that support future t...