EHE Projects

FY 2023 EHE Supplemental Research Projects

For FY 2023, RAISE was assigned to work with seven EHE research projects focused on clusterdetection and response (CDR), pillar 4 of the EHE initiative. Please see below for a description of the projects.

Using Geospatial Mapping and Epidemiologic Methods to Identify and Support Persons who Inject Drugs (PWID) at risk for HIV in Alabama

University of Alabama at Birmingham CFAR
EHE Jurisdiction: Alabama
Principal Investigator: Ellen Eaton

Alabamians struggle with late HIV diagnosis and suboptimal linkage and retention in HIV care, at least in part due to poverty, rurality, and lack of public health infrastructure and Medicaid expansion. Further, historic events have impacted HIV efforts in AL in myriad ways, halting progress towards the EHE goals: the COVID-19 pandemic and the Drug Overdose Crisis. The objective of this application is to 1) leverage hospital and community-level data to identify Alabama counties at greatest risk for an HIV outbreak among people who inject drugs and 2) engage community partners to identify needs and opportunities to build community capacity. The overall goal of this proposal is to inform implementation strategies to integrate person-centered HIV, harm reduction, and addiction services for people who inject drugs in Alabama.

AIDSVu 2.0: Integrating Molecular Surveillance and HIV Reporting Data for Public Health

University of California San Diego CFAR
EHE Jurisdiction: Georgia
Principal Investigators: Susan Little & Patrick Sullivan

The current state-of-the-art web platform for national HIV prevention and treatment data is AIDSVu, an interactive online mapping tool that visualizes the state of HIV across United States. Unfortunately, neither this platform nor any other address the “Respond” pillar by integrating HIV sequence data with other EHE metrics to assist local public health efforts. We propose a proof-of-principle study to evaluate the potential benefits of incorporating regional molecular HIV surveillance data into a secure password-protected version of the existing AIDSVu platform in collaboration with the Georgia Department of Public Health (DPH). This project will develop and test concepts for a stakeholder-guided interactive online epidemiologic tool, hosted on AIDSVu, that integrates molecular HIV surveillance data with other EHE metrics and effectively guides regional prevention strategies across the state of Georgia. Custom reports and data visualizations included in the prototype design will be guided by regional stakeholders to ensure that the presented data outputs enhance regional HIV prevention strategies. Study partners will include Georgia DPH, people with lived experience, and investigators at Emory, UC San Diego, and Johns Hopkins University.

Creation of a novel Geospatial Information System (GIS)-based Reportable Diseases Mapping Tool (REDMAP) for the Cuyahoga County Board of Health to optimize EHE programming

Rustbelt CFAR
EHE Jurisdiction: Cuyahoga County, OH
Principal Investigator: Justin Yax

Real-time knowledge of HIV-related service gaps, health disparities and outbreaks in Cuyahoga County depends upon comprehensive and real-time knowledge of the HIV-related activities of all HIV-related partners in Cuyahoga County. Yet currently HIV-testing, linkage and prevention programs occur among multiple siloed settings. Though State funding and State law facilitate the sharing of some information related to HIV and sexually transmitted infection (STI) programming, significant gaps in data remain. This results in delayed reporting or incomplete analysis of outbreaks and incomplete knowledge of service gaps and health disparities within our community. The goal of our proposal is to create dynamic collaborative multi-institutional data stream of EHE-related data to the GIS department at CCBH so service gaps, health disparities and outbreaks related to HIV spread can be optimally mapped and efficiently targeted.

Adding HIV Recency Testing to Public Health Surveillance

University of North Carolina at Chapel Hill CFAR
EHE Jurisdiction: Orange County, NC & Mecklenburg County, NC
Principal Investigator: Shuntai Zhou

The objective of the project is to develop an implementation strategy to add a next gen sequencing (NGS)-based recency assay to the state HIV surveillance system in North Carolina, and use the data collected during the project period to study the factors that are associated with the transmission cluster growth. The identification of transmission networks and prompt intervention to these clusters are crucial to the HIV ending the epidemic (EHE) initiative. HIV transmission clusters with increasing member of recent infections have high priority for the public health intervention. We have initiated a pilot system with North Carolina Department of Health and Human Services (NCDHHS) to add recency testing and recency-coupled transmission network detection to a proportion of new HIV diagnoses since 2018. In the project, we will explore the feasibility and optimal procedures to expand this platform to serve the residents in the high HIV burden Mecklenburg County. We will engage stakeholders including public health departments, community organizations, providers and laboratory experts to address the barriers and facilitators for the wider implementation of the assay in the public health surveillance system.

Identifying novel data-driven partner services strategies to address the HIV and syphilis syndemic among MSM

John Hopkins University CFAR
EHE Jurisdiction: Baltimore City, MD
Principal Investigator: Christina Schumacher

The goal of this study is to develop novel network data-driven partner services strategies to address the HIV and syphilis syndemic among gay, bisexual and other men who have sex with men (MSM). Specifically, we seek to identify new approaches to contact tracing (also referred to as partner services) that could be implemented in real-world public health practice and that may improve the efficiency of identifying MSM with high transmission potential for prevention services in Baltimore City, Maryland. Through secondary data analysis of information collected during the Understanding Sexual Health in NEtworks study, a prospective cohort of 437 MSM in Baltimore City and qualitative data analyses, we will: 1) determine the sociodemographic, behavioral and geospatial characteristics of MSM that best identify those who exhibit high network connectivity; 2) compare a novel contact tracing strategy which prioritizes recently infected individuals who are highly connected to STI/HIV transmission networks to the standard of care strategy (i.e., current contact tracing methods which only prioritize recently infected individuals); and 3) identify barriers and facilitators to implementation of new partner services strategies among public health practitioners and community members. Findings will provide data on proof of concept and feasibility of alternative novel network data-driven prioritization strategies to improve the effectiveness of partner services in reducing HIV and syphilis transmission. Results also will inform a future work to implement and evaluate the effectiveness of these novel strategies.

Responding to HIV Clusters in Atlanta with Culturally Competent Linkage to Services (REACCTS)

Emory CFAR
EHE Jurisdiction: Cobb, DeKalb, Fulton, & Gwinnett Counties, GA
Principal Investigator: Jane Scott & Carlos Saldana

To improve the response to HIV clusters in Metro Atlanta, we are partnering with established CBOs that serve communities disproportionately impacted by HIV in Atlanta to design and implement training for a culturally competent cross-jurisdictional CDR expert to improve partner services, to reach associated transmission clusters and risk networks, and to offer linkage to HIV services.

Evaluating HIV testing capacity in nonclinical HSO-alternative service facilities to scale-up cluster detection and response strategies for people who inject drugs (PWID) in Philadelphia

Penn Mental Health AIDS Research Center
EHE Jurisdiction: Philadelphia County, PA
Principal Investigator: Steven Meanley

FY 2022 EHE Supplemental Research Projects

In FY22, 66 implementation science research projects were funded through Ending the HIV Epidemic initiative. These projects cross all four domains (diagnose, treat, prevent, and respond) of EHE efforts and work with community partners in EHE jurisdictions. RAISE worked in consultation with the following seven projects.

 

Addressing Missed Opportunities in Status-Neutral HIV Prevention and Treatment among Transgender Men and Transmasculine Non-Binary Individuals

Einstein-Rockefeller-CUNY CFAR
Principal Investigator: Augustus Klein

This project is designed to address the critical inequities in engagement in the diagnose, prevent, and treat pillars of EHE among transgender men and transmasculine non-binary individuals (TMNBI). Designed and implemented by a majority trans and non-binary research team, this project will collect data on how best to initiate, integrate, and sustain a status-neutral holistic sexual health delivery approach in gender-affirming community clinic settings that serve TMNBI. The adapted implementation approach and research implementation blueprint will be used to develop a large-scale implementation trial that can support multiple jurisdictions that are transitioning to status-neutral service delivery models. This proposal leverages an existing community-academic partnership with Lyon-Martin Community Health Services, a community clinic designed for and by TMNBI in San Francisco County.

Adolescent Mobile Health Unit Community Collaborative – Addressing Barriers to HIV services in Philadelphia

University of Pennsylvania CFAR
Principal Investigator: Marné Castillo

In order to expand reach of adolescent HIV services in Philadelphia, the Children’s Hospital of Philadelphia has built a mobile health unit (MHU). This MHU engages with primarily young Black and Latinx men who have sex with men and transgender women (YBLMSMTW) who are among the youth placed at highest risk for HIV infection in Philadelphia. The primary objective of this study is to evaluate the feasibility and acceptability of a status neutral HIV linkage intervention for YBLMSMTW via the MHU. The study team aims to adapt CHOP’s current model for HIV testing and linkage to care and work with the community to identify the highest yield times and locations for the MHU to deliver the intervention. The supplement project will then pilot the implementation of the adapted status neutral linkage intervention via the MHU over a six month period to assess uptake and acceptability of the services.

Advancing health equity through integration of community social and HIV services

University of Washington BIRCH
Principal Investigator: David Katz

Social determinants of health are critical factors in engagement in HIV prevention and care and contribute to inequities in HIV experienced by marginalized communities in the U.S. Yet, HIV services are often siloed from social services. This project brings together three community-based organizations serving diverse populations affected by HIV in King County, Washington, with implementation scientists. We aim to evaluate practice facilitation – an evidence-based strategy for implementing and building capacity for continuous quality improvement – as an approach for enhancing the integration of social and HIV services and thereby increasing engagement in HIV prevention and advancing health equity.

Identifying barriers and facilitators to a status neutral implementation strategy for rapid-start antiretroviral treatment for HIV prevention and care in diverse community-based care settings

Third Coast CFAR
Principal Investigators: Moira McNulty and Hale Thompson

In support of efficient and sustained care engagement, rapid initiation of ARVs for HIV treatment is quickly becoming the standard of care, supported by treatment guidelines worldwide. Furthermore, preliminary studies assessing rapid-start PrEP programs suggest that rapid-start minimizes attrition and decreases barriers to PrEP access. Howard Brown Health (HBH) is a leader in developing a status neutral approach for rapid initiation among federally qualified health centers in the nation with their Rapid-Start ARV (Rapid-Rx) programming. The Rapid-Rx program takes a status neutral approach to care engagement starting with HIV testing followed by navigation to the appropriate step in the care continuum, as well as the supportive services necessary for optimal and sustained care engagement. Despite the success of HBH’s program, it is unknown how this approach will need to be adapted to work in other high-priority settings. Therefore, this supplement aims to assess patient needs, core intervention characteristics, and multi-level contextual barriers & facilitators to inform the adaptation of Rapid-Rx to HIV prevention and care settings across three high-priority EHE jurisdictions in the Midwest: Cook Co., Illinois; Kansas City, Missouri; and Tulsa, Oklahoma.

Integrating Status-Neutral Linkage to Services in Behavioral Health Organizations

University of Washington BIRCH
Principal Investigator: Lydia Chwastiak

To reach the Ending the HIV Epidemic (EHE) targets for reducing new HIV infections by 2030, King County WA must improve its plan to reach individuals with behavioral health disorders. Most people in the US who have serious mental illness access the healthcare system through their mental health provider, but rates of HIV testing and prevention services are low in community mental health settings. The goal of this research is to increase the capacity of King County behavioral health organizations to provide rapid HIV testing and linkage to proven prevention services (pre-exposure prophylaxis and syringe services programs) to reduce HIV incidence in King County. Current EHE efforts include Learning Collaboratives to increase HIV testing and linkage to services in emergency departments and pharmacies. This one-year proposal aims to 1) describe the current HIV prevention services available in King County Behavioral Health organizations; 2) obtain input from diverse stakeholders about current barriers and facilitators to offering HIV testing and linkage to HIV prevention or care services; and 3) partner with three Provider Association member organizations to co-develop a plan for increasing access to HIV prevention services in King County Behavioral Health organizations.

Optimizing HIV testing for people who inject drugs in Suffolk County, Massachusetts

Harvard CFAR
Principal Investigator: Kevin Ard

In Suffolk County, Massachusetts, an EHE-priority area corresponding to urban Boston, a substantial proportion of new HIV infections occur among people who inject drugs. The local EHE strategy includes routine testing for HIV among people who inject drugs who seek care in emergency departments. However, uptake of HIV testing in these settings is low. In our project, we plan to assess the acceptability, feasibility, barriers, and facilitators to HIV testing in the emergency department for people who inject drugs and to further evaluate HIV testing preferences through a discrete choice experiment. Our data have the potential to directly impact EHE service delivery locally and beyond.

Status Neutral Psycho-Behavioral Capacity Building Intervention for People Who Use Drugs

Harvard CFAR
Principal Investigator: Abigail Batchelder

Untreated psycho-behavioral needs are barriers to initiation and engagement in HIV prevention and care for people who use drugs (PWUD); however, access to evidence-based psycho-behavioral services is often not accessible for PWUD due to limited availability, cost, and stigma. This project aims to bring together clinical psychology researchers, leaders and staff from a local community-based organization which serves PWUD with and vulnerable to HIV (Victory Programs, Inc.), and PWUD to collaboratively select prioritized evidence-based brief interventions, optimize them for PWUD seeking low-threshold services at Victory Programs, and make the optimized interventions available via a staff-training and website. We hypothesize that this collaborative approach with key stakeholders will result in acceptable, feasible, and accessible intervention strategies that will increase Victory Programs’ capacity to address psycho-behavioral barriers to engaging in PrEP navigation services, HIV diagnostic testing, and PrEP and antiretroviral therapy (ART) adherence.