JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

Background: Adolescents and young adults (AYA) in the United States are disproportionately affected by HIV. Few interventions are designed to reduce new HIV infections for AYA populations or take AYA's developmental state into consideration.

Setting: Ending the HIV Epidemic in the US (EHE) priority areas in California, Florida, Illinois, Massachusetts, and North Carolina.

Methods: Thematic synthesis of 5 EHE projects was completed. Methodologic commonalities were identified and summarized across projects to identify key lessons learned.

Results: Engaging methods used by and accessible to AYA were central to study recruitment, and to the dissemination of health information for educational purposes. Lessons learned included use of social media and other creative methods for recruitment, retention, and dissemination of study activities; engaging AYA virtually and face-to-face; and ensuring equitable, timely monetary compensation and meaningful benefits to AYA participants.

Conclusions: Researchers and public health officials should incorporate AYA developmental context and experiences throughout the research and implementation process. This necessitates community and AYA-engaged research, intervention development, implementation, and dissemination. Future directions include expanding these efforts to communities outside of EHE areas and outside the United States, and ensuring that HIV research and interventions focus not just on individual AYA, but also on the systems and people that bear on their health and well-being (eg, health care providers, supportive adults, schools, laws, and policies).

Background: Development, implementation, and dissemination of HIV-related implementation strategies require partnerships with affected communities, government agencies, and HIV service organizations. Implementation science (IS) training for partners is needed to ensure they can benefit from, and equally contribute to, implementation research (IR). Building IS knowledge and expertise in real-world practice increases providers' ability to offer evidence-based HIV interventions and effectively implement them at scale to achieve the goals of the national Ending the HIV Epidemic (EHE) initiative.

Methods: National Institutes of Health funds the Implementation Science Coordination Initiative (ISCI) and the Sociostructural Implementation Science Coordination Initiative (SISCI) to support studies in the conduct of rigorous HIV IR through technical assistance, development of IS tools, and trainings for researchers and implementers. As part of these efforts, we created and evaluated 2 pilot IS training courses for HIV service providers: the Practitioner-Oriented Implementation Science Education (POISE) and the Implementation Practitioner Training (IPT). We discuss the importance of training for implementers, the development of our curriculum, lessons learned, and future directions for IS trainings.

Conclusions: Implementers play a critical role in IR, because they are the beneficiaries of the knowledge produced and are responsible for effectively implementing HIV interventions to achieve EHE goals. Few training courses in IS are specifically designed to meet the needs of those implementing HIV evidence-based interventions and little is known about how to design and deliver them to maximize training benefit. Both training pilots increased participants' ability to apply IS to their work. Participant input provides valuable feedback to improve future training.

Abstract: HIV continues to affect populations made socially vulnerable, including Latinx groups. For Spanish-speaking people, there are additional social factors that increase their vulnerability. How we communicate, mainly language, is fundamental to achieving expected outcomes when implementing health interventions. In this article, we address the issue of language justice and how it has been applied to meet the needs of Spanish-speaking Latinx populations in different locations in the United States when conducting HIV implementation science research. Language justice can inform HIV implementation science research to be inclusive, equitable, and reflective of the diverse populations aimed to serve, ultimately leading to a more just health care system and better health outcomes.

Abstract: The Network for Implementation Science in HIV (NISH) was established to conduct multisite research to study real-world implementation of evidence-based HIV interventions across US contexts, and to generate generalizable knowledge around implementation strategies to support the achievement of Ending the HIV Epidemic goals. NISH sites represent diverse Ending the HIV Epidemic priority jurisdictions and include participation of multiple units within those sites (eg, multiple clinics and community-based organizations) and bring together research teams from multiple backgrounds within implementation science and the HIV service sector. We argue and provide examples of how NISH studies have and can contribute to the context versus generalizability debate, generate power in numbers, and synthesize, develop, and test implementation strategies that advance both effectiveness and equity. To date, the network has conducted observational studies exploring ongoing implementation and determinants across contexts, and the identification and codesign of strategies to be leveraged in future work. The next stage of network evolution is to leverage this infrastructure to test implementation strategies through nimble study designs built for fast-changing evidence and implementation environments. We argue that the initial successes of NISH warrant future investment to efficiently capitalize on developed infrastructure and optimize science that can effectively be scaled up to address our most critical questions to end the HIV epidemic and support communities most affected.

Introduction: Little is known about the clinical status of persons with HIV who re-engage in care after an interruption. We evaluated the immunologic and clinical characteristics of individuals re-engaging in care within the Swiss HIV Cohort Study.

Methods: Participants who re-engaged in care after an interruption >14 months with a viral load ≥100 copies/mL were classified as having interrupted antiretroviral therapy (ART). We defined late re-engagement as re-engaging with a CD4 cell count of <350 cells/µL or a new Centers for Disease Control and Prevention stage C disease. Linear and logistic regression models with restricted cubic splines were used to estimate the mean CD4 cell count at re-engagement and the probability of late re-engagement as a function of care interruption duration.

Results: Of 14,864 participants with a median follow-up of 10.2 years (interquartile range 4.7-17.2 years), 2768 (18.6%) interrupted care, of whom 1489 (53.8%) re-engaged. Among those re-engaging, 62.3% had interrupted ART. For participants who interrupted ART, the mean CD4 count declined from 374 cells/µL [95% confidence interval (CI): 358 to 391 cells/µL] before the interruption to 250 cells/µL (95% CI: 221 to 281 cells/µL) among those re-engaging after 14 months, and to 185 cells/µL (95% CI: 160 to 212 cells/µL) among those re-engaging after 60 months. The estimated risk of late re-engagement in care was 68.6% (95% CI: 62.3% to 74.4%) for participants who interrupted ART for 14 months and 75.2% (95% CI: 68.9% to 80.6%) for those who interrupted ART for 60 months.

Conclusions: Although HIV care interruptions are not very common in Switzerland, most persons with HIV re-engaging after interrupting ART return with late-stage HIV.

Abstract: Communities of people living with or impacted by HIV have been at the forefront of HIV research, from identifying the health priorities to advocating for the development and implementation of interventions that benefit affected populations and individuals. Community engagement is considered fundamental for successful implementation of science projects. However, researchers have acknowledged the limited guidance on community engagement for implementation science research. Some recommendations have been made for community engagement in implementation sciences, but conducting HIV implementation research must consider the unique challenges of addressing the stigma and disenfranchisement of the populations affected. Despite the specific difficulties for community-engaged implementation science research, there are successful experiences and lessons learned that could support future fruitful experiences. This publication aims to share recommendations for community-engaged HIV implementation research based on the expertise of community-academic partnerships. These recommendations include the perspectives of academic and community partners. Community engagement in HIV implementation research will be needed beyond ending the epidemic. The future of community engagement in research may lay in embracing the constant change and securing the mechanisms to respond to it.

Abstract: Implementation science has emerged and matured as an essential field for HIV treatment and prevention, designed to bridge the gap between research and practice by identifying opportunities to overcome barriers to implementation of effective interventions, and to accelerate the replication and scale-up of HIV care innovations. In this article, we describe activities and collaborations among the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the National Institutes of Health to optimize the impact of national federal funding opportunities aimed at identifying effective and replicable HIV care and prevention interventions, improving HIV health outcomes, and reducing HIV incidence in the U.S. These activities are outlined in the context of the Ending the HIV Epidemic in the U.S. Initiative, which was enacted across U.S. Department of Health and Human Services agencies, providing new funding and outlining an operational plan to further guide federal agencies in their specific roles and funding areas.In describing these activities and opportunities, we aim to demonstrate how implementation science is being increasingly leveraged to accelerate progress towards ending HIV through scale-up and dissemination efforts. Continued collaboration through federal implementation science will be instrumental in reaching Ending the HIV Epidemic goals.

Abstract: HIV incidence is increasing among Latino/a/x individuals in the United States, especially among young Latino/x gay, bisexual, and sexual minority men. Latino/a/x populations face heightened structural and social barriers to effective interventions for HIV prevention, including pre-exposure prophylaxis, and across the HIV care continuum. Implementation science provides a timely methodology for developing, testing, and scaling effective interventions into practice. Implementation science considers a specific population's priorities and environment, which is especially relevant given the diversity of Latino/a/x populations. In this article, we present lessons learned from our group's experiences leading HIV-related implementation research with various Latino/a/x populations in the United States and Puerto Rico. We highlight the importance of structural and social determinants of health, community-engaged research, and culturally tailored interventions to address HIV disparities. Implementation researchers and institutional leaders can leverage these lessons learned to drive the multilevel change needed to end the HIV epidemic among Latino/a/x populations.

Background: Supplements were awarded under the National Institutes of Health, ending the HIV epidemic (EHE) initiative to foster implementation science through community-engaged research. The objective of this study was to synthesize lessons learned, identify areas of research sufficiently studied, and present an agenda for future research on HIV health workforce development from a collaboration across 9 EHE projects in 11 jurisdictions in the United States.

Methods: EHE supplement recipients completed a semistructured questionnaire to identify shared lessons learned about common themes of workforce development using the Consolidated Framework for Implementation Research and Expert Recommendation for Implementing Change frameworks. Data were synthesized to identify shared lessons learned, topic areas no longer in need of research, and next steps.

Results: Project teams emphasized several strategies including clarifying roles and responsibilities, the need for dynamic training, and stigma mitigation as strategies to enhance the implementation of HIV prevention and treatment services. Strengthening organizational support through supportive supervision structures, ensuring sustainable funding, preventing turnover, addressing salary constraints, and establishing clear promotion and educational pathways were identified as useful workplace development strategies. Supplements identified lessons learned about deploying community engagement strategies to ensure communities were aware of HIV prevention and treatment services. Several areas sufficiently studied that can be deprioritized were identified and discussed.

Conclusion: A research agenda for workplace development moving forward is discussed with several recommendations to improve the implementation of HIV prevention and treatment programs.

Background: Online pharmacy HIV pre- and post-exposure prophylaxis (PrEP/PEP) provision is a novel strategy to expand HIV prevention coverage. In the ePrEP pilot study, we found online pharmacy PrEP/PEP was feasible and reached populations at HIV risk in Kenya. However, program costs data are lacking.

Methods: We conducted a costing within the ePrEP pilot study in Nairobi from 11/01/2022-12/29/2023. We obtained costs from expense reports and conducted time-and-motion observations and staff interviews. We estimated total and unit costs in the first year of implementation, cost per client and per PrEP client-month (2023 US Dollars (USD)).

Results: Overall, 229 clients initiated PrEP (507 months of PrEP coverage) and 1320 initiated PEP. Based on observed program volume, annual financial cost was $109,945 USD (PrEP: $19,456; PEP: $90,489). Cost per client was higher for PrEP than PEP ($85 vs $68.6), and cost per PrEP client-month was $38 (mean duration: 2.2 months). Main drivers of financial costs were courier-delivery of HIV testing kits and drugs (PrEP: 50.6%; PEP: 40.5%), demand generation (PrEP: 25.9%; PEP: 32.1%), and equipment, system development, and utilities (PrEP: 9.3%; PEP: 9.8%). Assuming a scaled-up client volume of 2500 (PrEP: 370; PEP: 2130) reduced per-client financial costs for PrEP ($65.5) and PEP ($56) and cost per PrEP client-month ($29.6).

Conclusions: Costs of online PrEP/PEP provision is likely higher than clinic-based PrEP. Implementing cost sharing models including charging clients for HIV testing and optimizing courier delivery routes can increase program efficiencies. Our cost estimates can inform economic evaluations of online PrEP/PEP delivery.