Refining Multilevel Barrier and Facilitator Measures for HIV Testing and PrEP Among Latino Sexual Minority Men.

Abstract

The purpose of this study is to refine and establish measures of multilevel barriers and facilitators to HIV testing and PrEP for Latino sexual minority men (LSMM). Cross-sectional measure validation. Participants from Miami, FL. 290 LSMM from the DÍMELO study. Based on prior qualitative work, we developed two measures that evaluated multiple determinants (i.e., barriers and facilitators) to (1) HIV testing and (2) PrEP use. All measures included in this analysis assessed a set of theoretically distinct barriers and facilitators. We performed 11 exploratory factor analyses (EFA) to assess the dimensionality of theoretical groupings of items informed by prior qualitative work, including: knowledge, perceived need and benefit, mistrust and concerns, stigma and normalization, cultural competence, navigation support, provider demeanor, clinic and medical system issues, privacy concerns, cost, and language and immigration barriers. Based on EFA results, we conducted two confirmatory factor analyses (CFA), one for each measure. Within each measure, the 11 EFAs extracted 10 barrier factors and 7 facilitator factors. The CFAs for HIV testing and PrEP measures were consistent, such that all models retained the structures identified in the EFAs. Findings support the use of these measures with LSMM. These measures can inform multilevel implementation strategies for health promotion professionals to scale up and disseminate HIV prevention services to LSMM.