YACHT: Advancing HIV Prevention Through Implementation Science
The Young Adult Centered Healthforce Training (YACHT) Program is a collaborative effort between Eidos, Florida State University (FSU), and the Florida Department of Health (FDOH) to enhance HIV prevention strategies in Florida. By integrating mystery shopping methodologies with tailored motivational interviewing (TMI) training, YACHT aims to improve HIV counseling, testing, and referral (CTR) services for young sexual minority men. This initiative leverages implementation science to systematically evaluate and optimize CTR practices across Florida’s Ending the HIV Epidemic (EHE) jurisdictions.
The Challenge
Florida remains a focal point in the fight against HIV, with cities like Miami, Orlando, and Jacksonville experiencing some of the highest HIV incidence rates in the nation. Despite national efforts to promote HIV testing and pre-exposure prophylaxis (PrEP) referrals, many young sexual minority men in Florida do not get tested regularly and lack access to culturally responsive CTR services. Studies have identified critical gaps in HIV testing agencies’ ability to provide affirming, developmentally appropriate, and evidence-based services, leading to missed opportunities for prevention.
To address these barriers, the YACHT program was designed to systematically assess and enhance CTR service quality, ensuring that testing sites meet the unique needs of young sexual minority men in Florida.
The Client
YACHT is a multi-institutional partnership spearheaded by:
- Florida State University’s Center for Translational Behavioral Science, bringing expertise in behavioral interventions and implementation science.
- Eidos LGBTQ+ Health Initiative at Penn Nursing, a leader in action-oriented participatory research and health equity science.
- The Florida Department of Health (FDOH), ensuring statewide implementation and alignment with public health initiatives.
Together, these partners sought to leverage implementation science strategies to drive meaningful improvements in HIV testing and prevention services.
The Work
The YACHT program employs a Type 2 implementation-effectiveness hybrid trial with a stepped wedge design. The initiative consists of:
- Mystery Shopping (MS) Assessments
- Young sexual minority men trained as mystery shoppers visit HIV testing sites to evaluate service delivery.
- MS assessments focus on cultural humility, testing provider competency, PrEP referrals, and client-centeredness.
- Testing sites receive confidential feedback reports detailing their strengths and areas for improvement.
- Tailored Motivational Interviewing (TMI) Training
- Testing providers undergo specialized training in culturally competent motivational interviewing techniques.
- Training modules help staff enhance client engagement, reduce stigma, and strengthen PrEP referral strategies.
- Technical Assistance (TA) and Quality Monitoring (QM)
- Agencies receive individualized coaching to integrate best practices into their service models.
- Continuous monitoring and data feedback allow for iterative improvements over time.
By aligning these strategies with the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, YACHT systematically identifies barriers, trains providers, and ensures long-term sustainability of improved practices.
The Results
The YACHT program has already demonstrated significant impact in its early implementation phases:
- Over 250 mystery shopping visits conducted across 42 HIV testing sites in Florida.
- Improvements noted in testing providers’ privacy, confidentiality, and cultural responsiveness.
- Identified key gaps in relationship context, counseling effectiveness, and safer sex education, prompting targeted training.
- Increased engagement among HIV testing providers, with multiple sites opting for further technical assistance and workforce development.
As the study progresses, researchers will evaluate long-term trends in HIV testing rates, PrEP referrals, and CTR service quality, with results expected by 2027.
The YACHT project exemplifies the power of cross-sector collaboration and implementation science in transforming HIV prevention efforts. By integrating mystery shopping, motivational interviewing, and technical assistance, YACHT is setting a new standard for evidence-based, culturally competent HIV services.
Through this innovative partnership, Eidos, FSU, and FDOH are advancing public health equity, ensuring that young sexual minority men receive the affirming, high-quality care they deserve. If successful, YACHT’s implementation model could be scaled nationwide, serving as a blueprint for sustainable HIV prevention interventions.
For more information, check out our recent protocol paper: