JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

Aim: To share insights on Implementation Science (IS) methods, challenges, solutions, and best practices derived from the second National Meeting for Research and Community Collaboration toward "Ending the HIV Epidemic (EHE) in the United States."

Methods: This 2022 hybrid, one-day conference featured presentations from 13 projects funded as NIH supplements to CFARs and ARCs between 2019 and 2022. Selected for their robust findings, projects were grouped into four topics: (1) community-based outreach strategies, (2) taking the clinic to the community, (3) strategies to improve clinical care, and (4) exploring intersectional vulnerabilities and social/structural determinants of health. Standardized presentation formats were used to ensure comparability in gathering insights on IS methodologies, challenges, solutions, and lessons learned. Structured breakout discussions advanced actionable recommendations. Rapid qualitative analysis summarized insights, emphasizing lessons transportability across diverse implementation contexts.

Results: Common IS methods included rapid qualitative analysis, usability testing, surveys, engagement logs, mapping, and administrative data analysis. Recurring challenges were identified, including pandemic-related disruptions, staff turnover, recruitment barriers, communication gaps, and variations in organizational capacity. Effective solutions involved leveraging community partnerships, providing digital tools, conducting flexible training, and securing funding for sustainability. Best practices emphasized early partner engagement, iterative design, equitable power-sharing with communities, and culturally tailored approaches.

Conclusions: Collaborative engagement with community partners, clinicians, and participants was pivotal to adapting and scaling interventions. Synthesizing transferable methodologies and lessons strengthens the framework for advancing HIV-related IS and achieving sustainable impact in diverse contexts.

Background: Because implementation remains the biggest challenge to Ending the HIV Epidemic in the United States (EHE), since 2019, the National Institutes of Health (NIH) has funded 248 supplements to identify best practices for delivering evidence-based HIV interventions. NIH also funded a coordination center [Implementation Science (IS) Coordination Initiative "ISCI"] and 9 consultation hubs ("Hubs") to provide technical assistance and cross-project information sharing, measure harmonization, and data synthesis. This article describes this unique capacity-building model, lessons learned from the first 5 years, and opportunities created by this infrastructure.

Methods: Beginning in FY20, Hubs were assigned 7-9 funded supplement projects in EHE priority jurisdictions. Primary Hub services included direct coaching, multiproject meetings, communities of practice, and technical webinars. ISCI and the Hubs met monthly to reflect on project support, discuss ways to enhance HIV IS broadly, and assess projects' use of Hub services.

Findings: Hub engagement strategies included grouping projects by HIV intervention type, setting data reporting expectations early, and tailoring engagement based on EHE team IS expertise. Support and coordination provided by the Hubs and ISCI have developed generalizable IS knowledge from local knowledge (e.g., publications and tools). The network of ISCI, the Hubs, and EHE projects have also led to infrastructure for conducting multisite HIV implementation research.

Implications for di science: The Hub model is a novel, systemwide approach for rapidly improving IS capacity in a field. Implementation of this model will continue to be refined through an ongoing evaluation and as the funding transitions to regular, nonsupplement NIH funding mechanisms.

Background: Community-engaged research (CEnR) is fundamental to effective HIV prevention and treatment implementation, although limited in practice. We describe CEnR lessons learned by researchers in HIV-related implementation science to improve future CEnR.

Setting: Academic-community research partnerships funded by the 2019-2021 National Institutes of Health Ending the HIV Epidemic (EHE) supplement awards.

Methods: Seven individual awardees representing 8 EHE awards documented partnership characteristics and key CEnR experiences in an online form. Three semi-structured reflection sessions subsequently discussed experiences, identifying opportunities and barriers using qualitative thematic analysis, iterative dialogue, and illustrative case studies.

Results: Awardees identified both partnerships newly established for the grant (60%) and preexisting collaborations (40%). Key perceived CEnR benefits included: new and better project ideas; improved project implementation; and priorities to guide future research. Prominent barriers included: administrative burdens resulting in delayed funding access that constrained partner engagement; limited grant timelines and funding for essential preimplementation partnership building; and limited recognition of key CEnR activities in academic success metrics. Adaptive responses to barriers included focusing short award periods on exploratory aims and building on extant community activities.

Conclusions: Systems-level redesign at the funder and university levels could improve CEnR equity, including accepting financial risk between grant award and funding receipt to facilitate completion of essential prework such as Institutional Review Board approvals and prevent the exclusion of the more financially constrained community partners or forcing unfunded effort provision and establishing appropriate support and promotion criteria for CEnR-engaged faculty. Thus, enabling CEnR good practices can improve future HIV-related implementation research and EHE goal achievement.

Background: Embedding implementation science (IS) research into health departments can foster relevant and robust research that is responsive to health department needs. However, few health department evaluators have formal IS training. Building internal health department capacity to conduct rigorous evaluation has the potential to catalyze improvements in Ending the HIV Epidemic (EHE) service delivery.

Setting: In-person IS workshop for EHE evaluators held in Seattle, WA, May 2024.

Methods: We conducted a needs assessment with EHE jurisdictions to identify their capacity and expertise in IS, and desire for additional training. Based on this assessment, we developed a 2.5-day workshop to equip health department epidemiologists/data managers/program coordinators with the background and tools needed to conduct evaluations of activities within their EHE programs. The workshop covered 9 core IS competencies.

Results: There were 14 workshop participants, representing 25% of the 57 EHE jurisdictions. Participants felt that the workshop increased their IS technical skills [IS knowledge rating (0 to 5 scale) increased from a mean of 2.5 (day 1) to 4.2 (day 3)] and that the workshop helped them understand how implementation outcomes can strengthen their evaluation. They also noted that the workshop provided them with a useful framework to contextualize and evaluate EHE activities, with 83% of participants strongly agreeing that the content learned could be applied to their health department work.

Conclusions: IS short-courses are a promising strategy to increase health department evaluators' understanding of IS and to gain confidence in how to apply IS methods to their own EHE evaluations.

Background: Meaningful community engagement in research is critical yet challenging in traditional academic models. To inform engagement efforts, we characterized community-academic partnerships funded through the Ending the HIV Epidemic (EHE) Initiative.

Methods: From July to December 2023, community and academic partner recipients of 2021 or 2022 EHE implementation science awards were invited to independently complete an online survey assessing partnership experience, anticipated and experienced levels of community engagement, and community engagement throughout the research process. Level of community engagement measures was guided by the Continuum of Community Engagement model. Data were descriptively analyzed.

Findings: Of 102 invited projects, we received 82 responses, 29 community (35%) and 53 academic (65%) awardees, representing 54 projects (53%). We received responses from community and academic representatives of the same project (ie, paired responses) for 22 of 54 (41%) participating projects. One-third (27/82) of participants reported collaborating with their EHE partner for ≤2 years. Overall, 41 of 53 (77%) academic representatives anticipated higher engagement than they experienced. Conversely, 20 of 28 (71%) community partners anticipated lower levels of community engagement than they experienced. Community and academic partners reported active engagement of community partners during recruitment (71/81, 88%) and data collection (54/81, 67%) activities most frequently. They reported active engagement of community partners during data analysis (18/81, 22%) and grant writing (22/81, 27%) activities least frequently.

Conclusions: EHE implementation science awards largely resulted in active collaborations with varied experiential perspectives from both academic and community partners. Strategies for improved shared understanding of how partners envision their engagement throughout the research may strengthen collaborations.

Background: Loss to follow-up to HIV care after delivery puts birthing parents with HIV at higher risk of loss of viral suppression, disease progression, and HIV partner transmission. This study assessed factors associated with retention in postpartum HIV care.

Methods: This is a retrospective cohort study at a single academic medical center and included patients followed from January 2014 to December 2022. The primary outcome was retention in postpartum HIV care (any health care encounter discussing HIV medication adherence or viral load within 12 months postpartum). Data were analyzed using χ 2 and student t test for discrete and continuous variables. Univariate and multivariable log regressions were used to measure independent associations on care retention and health care utilization outcomes.

Results: Of the 111 patients with planned follow-up at our facility, 93 (83.8%) participants had ≥1 HIV care encounter within 12 months of delivery. Participants had a mean age of 31.2 (±5.84) years, were predominantly Black (79.3%), non-Hispanic (91%), and non-U.S. born (57.5%) with substantial exposure of prior IPV (29.6%). Participants retained in care were more likely to use ART during pregnancy (92/99% vs 16/94.2%, P = 0.01) and have viral suppression at delivery (n = 83/90% vs 12/67%, P = 0.02). Retention in care was negatively associated with substance use during pregnancy (aOR 0.29, 95% CI: 0.09 to 0.95) after adjustment for social health covariates.

Conclusions: Although almost 84% of participants were retained in HIV care within 12 months of delivery, substance use during pregnancy was a significant risk factor for HIV care attrition postpartum.

Background: Most infants born to women living with HIV are HIV exposed but uninfected exposed infants have poorer growth than HIV-unexposed uninfected children. Few large studies have compared children who are exposed (CHEU) and unexposed (CHUU) in the era of dolutegravir (DTG)-based antiretroviral treatment (ART).

Setting: Longitudinal study of mother-infant CHEU and CHUU pairs in Nairobi and Western Kenya.

Methods: Mother-infant pairs were enrolled at 6 weeks postpartum with 6-monthly growth assessments. We compared longitudinal growth between CHEU and CHUU infants during the first year and assessed biologic and social factors affecting growth [length- and weight-for-age z-scores (LAZ, WAZ) and weight-for-length z-scores (WLZ)] and stunting (LAZ <-2), underweight (WAZ <-2), and wasting (WLZ <-2) from birth to 1 year.

Results: Among 2000 infants (1000 CHEU and 1000 CHUU), CHEU infants had significantly lower LAZ at 6 months {-0.165 [95% confidence interval (CI): -0.274 to -0.056], P -value = 0.003} and 12 months (-0.195, 95% CI: -0.294 to -0.095, P -value = 0.0001; n = 1616). CHEU infants had a higher prevalence of stunting at 6 months compared with CHUU infants (prevalence ratio: 1.45, 95% CI: 1.14 to 1.85). Among all children, greater maternal BMI, education, and caregiver-perceived social support were positively associated with growth. Higher maternal and infant comorbidities were associated with growth deficits for CHEU infants. Among CHEU, ART timing (before versus during pregnancy), and ART regimen (dolutegravir -based, efavirenz-based, and protease inhibitor/other) did not affect growth.

Conclusions: Growth deficits among CHEU persist, despite DTG-based ART. Addressing comorbidities, amplifying social support, and education may improve growth outcomes.

Introduction: We assessed the risk of adverse pregnancy and birth outcomes and birth defects among women living with HIV (WLHIV) on antiretroviral therapy (ART) and HIV-negative women.

Methods: We analyzed data on live births, stillbirths, and spontaneous abortions during 2015-2021 from a hospital-based birth defects surveillance system in Kampala, Uganda. ART regimens were recorded from hospital records and maternal self-reports. Using a log-binomial regression model, we compared the prevalence of 16 major external birth defects and other adverse birth outcomes among WLHIV on ART and HIV-negative women.

Results: A total of 203,092 births were included from 196,373 women of whom 15,020 (7.6%) were WLHIV on ART. During pregnancy, 15,566 infants were primarily exposed to non-nucleoside reverse transcriptase inhibitor-based ART (n = 13,614; 87.5%). After adjusting for maternal age, parity, and number of antenatal care visits, WLHIV on non-nucleoside reverse transcriptase inhibitor were more likely than HIV-negative women to deliver preterm (adjusted prevalence ratio [aPR] = 1.27, 95% confidence interval: 1.21 to 1.32), post-term (aPR = 1.23, 95% CI: 1.16 to 1.32), or small for gestational age infants (aPR = 1.35, 95% CI: 1.30 to 1.40). Spina bifida was more prevalent among infants born to WLHIV on ART periconceptionally compared with HIV-negative women (aPR = 2.45, 95% CI: 1.27 to 4.33). The prevalence of the other selected birth defects was similar between infants from WLHIV on ART and HIV-negative women.

Conclusions: In Uganda, WLHIV on ART were more likely than HIV-negative women to experience selected adverse birth outcomes. Further surveillance of maternal ART exposure, including by drug class and ART regimen, is needed to monitor and prevent adverse birth outcomes in WLHIV.

Background: Community-level social vulnerabilities may affect HIV outcomes. This analysis assessed the association between county-level social vulnerability and Centers for Disease Control and Prevention (CDC)-funded HIV testing program outcomes.

Setting: HIV testing data from 60 state and local health departments and 119 community-based organizations were submitted to CDC during 2020-2022.

Methods: HIV testing data were combined with the county-level Minority Health Social Vulnerability Index, which measures economic, medical, and social vulnerability. We calculated absolute and relative disparity measures for HIV testing program outcomes (ie, HIV positivity, linkage to HIV medical care, interview for partner services, referral to preexposure prophylaxis providers) between high and low social vulnerability counties. We compared differences in HIV testing program outcomes by demographic factors and test site type.

Results: The majority (85.8%) of the 4.9 million tests were conducted in high social vulnerability counties. HIV positivity (1.1%) and linkage to medical care after a new diagnosis (77.5%) were higher in high social vulnerability counties. However, interview for partner services after a new diagnosis (72.1%) and referrals to preexposure prophylaxis providers among eligible HIV-negative persons (48.1%) were lower in high social vulnerability counties. Additionally, the relative disparity in HIV testing program outcomes varied by demographic factors and test site type.

Conclusions: CDC-funded HIV testing programs reach the most vulnerable communities. However, testing outcomes vary by community vulnerability, demographic factors, and test site type. Continued monitoring of the relationship between county-level social vulnerability and HIV testing program outcomes would guide HIV testing efforts and allocate resources effectively to achieve the national goal of ending the HIV epidemic.

Abstract: Five years into the US national Ending the HIV Epidemic (EHE) plan, it is a critical time to examine what has been learned and what still needs to be studied to achieve its 2030 goals of reducing new HIV infections by 90%. While much has already been gained from the 250+ individual National Institutes of Health-funded implementation research projects and the capacity building provided by the Implementation Science Coordination Initiative (ISCI) and 9 regional consultation hubs (RCHs), identifying generalizable implementation science lessons requires the synthesis of findings across multiple sites, studies, and/or contexts. This supplemental issue of JAIDS emphasizes collaborative papers that summarize shared HIV implementation knowledge from multiple EHE-funded research projects. The 24 papers herein represent work from 111 EHE supplement projects and 7 R01s happening in 40 EHE priority jurisdictions, as well as from ISCI, all RCHs, and federal partners. We identified the following 4 overarching themes: infrastructure for HIV implementation research, methods for conducting HIV implementation research with specific communities, implementation strategies to help deliver HIV-related interventions, and training in implementation science for the HIV workforce. Insights shared in this issue provide a clear pathway for the next phase of EHE, in which research infrastructure must remain robust, workforce investments must prioritize sustainability, and partnerships must continue to bridge local innovation with systemic change.