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Molldrem S, Smith AKJ. Health policy counterpublics: Enacting collective resistances to US molecular HIV surveillance and cluster detection and response programs. SOCIAL STUDIES OF SCIENCE 2024; 54:451-477. [PMID: 38054426 PMCID: PMC11118791 DOI: 10.1177/03063127231211933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Health policies and the problems they constitute are deeply shaped by multiple publics. In this article we conceptualize health policy counterpublics: temporally bounded socio-political forms that aim to cultivate particular modes of conduct, generally to resist trajectories set by arms of the state. These counterpublics often emerge from existing social movements and involve varied forms of activism and advocacy. We examine a health policy counterpublic that has arisen in response to new forms of HIV public health surveillance by drawing on public documents and interview data from 2021 with 26 stakeholders who were critical of key policy developments. Since 2018, the national rollout of molecular HIV surveillance (MHS) and cluster detection and response (CDR) programs in the United States has produced sustained controversies among HIV stakeholders, including among organized networks of people living with HIV. This article focuses on how a health policy counterpublic formed around MHS/CDR and how constituents problematized the policy agenda set in motion by federal health agencies, including in relation to data ethics, the meaningful involvement of affected communities, informed consent, the digitization of health systems, and HIV criminalization. Although familiar problems in HIV policymaking, concerns about these issues have been reconfigured in response to the new sociotechnical milieu proffered by MHS/CDR, generating new critical positions aiming to remake public health. Critical attention to the scenes within which health policy controversies play out ought to consider how (counter)publics are made, how problems are constituted, and the broader social movement dynamics and activist resources drawn upon to contest and reimagine policymaking in public life.
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Weaver S, Dávila-Conn V, Ji D, Verdonk H, Ávila-Ríos S, Leigh Brown AJ, Wertheim JO, Kosakovsky Pond SL. AUTO-TUNE: SELECTING THE DISTANCE THRESHOLD FOR INFERRING HIV TRANSMISSION CLUSTERS. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.11.584522. [PMID: 38559140 PMCID: PMC10979987 DOI: 10.1101/2024.03.11.584522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Molecular surveillance of viral pathogens and inference of transmission networks from genomic data play an increasingly important role in public health efforts, especially for HIV-1. For many methods, the genetic distance threshold used to connect sequences in the transmission network is a key parameter informing the properties of inferred networks. Using a distance threshold that is too high can result in a network with many spurious links, making it difficult to interpret. Conversely, a distance threshold that is too low can result in a network with too few links, which may not capture key insights into clusters of public health concern. Published research using the HIV-TRACE software package frequently uses the default threshold of 0.015 substitutions/site for HIV pol gene sequences, but in many cases, investigators heuristically select other threshold parameters to better capture the underlying dynamics of the epidemic they are studying. Here, we present a general heuristic scoring approach for tuning a distance threshold adaptively, which seeks to prevent the formation of giant clusters. We prioritize the ratio of the sizes of the largest and the second largest cluster, maximizing the number of clusters present in the network. We apply our scoring heuristic to outbreaks with different characteristics, such as regional or temporal variability, and demonstrate the utility of using the scoring mechanism's suggested distance threshold to identify clusters exhibiting risk factors that would have otherwise been more difficult to identify. For example, while we found that a 0.015 substitutions/site distance threshold is typical for US-like epidemics, recent outbreaks like the CRF07_BC subtype among men who have sex with men (MSM) in China have been found to have a lower optimal threshold of 0.005 to better capture the transition from injected drug use (IDU) to MSM as the primary risk factor. Alternatively, in communities surrounding Lake Victoria in Uganda, where there has been sustained hetero-sexual transmission for many years, we found that a larger distance threshold is necessary to capture a more risk factor-diverse population with sparse sampling over a longer period of time. Such identification may allow for more informed intervention action by respective public health officials.
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Affiliation(s)
- Steven Weaver
- Center for Viral Evolution, Temple University, Philadelphia, PA, USA
| | - Vanessa Dávila-Conn
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Daniel Ji
- Department of Computer Science & Engineering, UC San Diego, La Jolla, CA 92093, USA
| | - Hannah Verdonk
- Center for Viral Evolution, Temple University, Philadelphia, PA, USA
| | - Santiago Ávila-Ríos
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Andrew J Leigh Brown
- School of Biological Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Joel O Wertheim
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
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Collura R, O'Grady T, Swain CA, Patterson W, Rajulu DT. Molecular HIV Clustering Among Individuals with Mpox and HIV Co-Morbidity in New York State, Excluding New York City. AIDS Res Hum Retroviruses 2023; 39:601-603. [PMID: 37658837 DOI: 10.1089/aid.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
The 2022 global mpox outbreak created an opportunity to test the utility of molecular HIV surveillance (MHS) to identify high-risk transmission networks. Individuals diagnosed with mpox in New York State (NYS) outside New York City-[Rest of State (ROS)] were matched to the NYS HIV and sexually transmitted infection registries. The demographic characteristics of individuals diagnosed with mpox in ROS mirror national trends. HIV-mpox comorbid individuals were more likely to be included in HIV molecular clusters compared to persons living with diagnosed HIV in ROS overall, men who have sex with men (MSM) in ROS, and age-adjusted MSM (to match individuals with mpox diagnosis) in ROS. For the 3-year 0.5% clusters, which are used to define national priority clusters, the HIV-mpox comorbid individuals clustered 2.4 times more frequently than the age/risk-adjusted control group. This study supports the use of HIV MHS to identify populations for priority public health interventions.
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Affiliation(s)
- Randall Collura
- Division of Epidemiology, Evaluation and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Thomas O'Grady
- Division of Epidemiology, Evaluation and Partner Services, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, New York, USA
| | - Carol-Ann Swain
- Division of Epidemiology, Evaluation and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Wendy Patterson
- Division of Epidemiology, Evaluation and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Deepa T Rajulu
- Division of Epidemiology, Evaluation and Partner Services, New York State Department of Health, Albany, New York, USA
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Garcia M, Devlin S, Kerman J, Fujimoto K, Hirschhorn LR, Phillips II G, Schneider J, McNulty MC. Ending the HIV Epidemic: Identifying Barriers and Facilitators to Implement Molecular HIV Surveillance to Develop Real-Time Cluster Detection and Response Interventions for Local Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3269. [PMID: 36833963 PMCID: PMC9964218 DOI: 10.3390/ijerph20043269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The rapid implementation of molecular HIV surveillance (MHS) has resulted in significant challenges for local health departments to develop real-time cluster detection and response (CDR) interventions for priority populations impacted by HIV. This study is among the first to explore professionals' strategies to implement MHS and develop CDR interventions in real-world public health settings. Methods: Semi-structured qualitative interviews were completed by 21 public health stakeholders in the United States' southern and midwestern regions throughout 2020-2022 to identify themes related to the implementation and development of MHS and CDR. Results for the thematic analysis revealed (1) strengths and limitations in utilizing HIV surveillance data for real-time CDR; (2) limitations of MHS data due to medical provider and staff concerns related to CDR; (3) divergent perspectives on the effectiveness of partner services; (4) optimism, but reluctance about the social network strategy; and (5) enhanced partnerships with community stakeholders to address MHS-related concerns. Conclusions: Enhancing MHS and CDR efforts requires a centralized system for staff to access public health data from multiple databases to develop CDR interventions; designating staff dedicated to CDR interventions; and establishing equitable meaningful partnerships with local community stakeholders to address MHS concerns and develop culturally informed CDR interventions.
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Affiliation(s)
- Moctezuma Garcia
- Department of Social Work, College of Health & Sciences, San José State University, San Jose, CA 95112, USA
| | - Samantha Devlin
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Jared Kerman
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX 77030, USA
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gregory Phillips II
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John Schneider
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Moira C. McNulty
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
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Whitfield DL, Nelson LE, Komárek A, Turner D, Ni Z, Boyd DT, Taggart T, Ramos SR, Wilton L, Beauchamp GG, Hightow-Weidman L, Shoptaw SJ, Magnus M, Mayer KH, Fields SD, Wheeler DP. Implementation of Client-Centered Care Coordination for HIV Prevention with Black Men Who Have Sex with Men: Activities, Personnel Costs, and Outcomes-HPTN 073. J Racial Ethn Health Disparities 2023; 10:183-192. [PMID: 34997550 PMCID: PMC9441015 DOI: 10.1007/s40615-021-01209-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Black men who have sex with men (MSM) experience disproportionate rates of HIV infection in the USA, despite being no more likely to engage in sexual risk behaviors than other MSM racial/ethnic groups. HIV pre-exposure prophylaxis (PrEP) has been shown to reduce risk of HIV acquisition; however, rates of PrEP use among Black MSM remain low. Clinical, psychosocial, and structural factors have been shown to impact PrEP use and adherence among Black MSM. Care coordination of HIV prevention services has the potential to improve PrEP use and adherence for Black MSM, as it has been shown to improve HIV-related care outcomes among people living with HIV. METHODS Client-centered care coordination (C4) is a multi-level intervention designed to address clinical, psychosocial, and structural barriers to HIV prevention services for Black MSM within HPTN 073, a PrEP demonstration project among Black MSM in three cities in the USA. The current study examined the implementation process of C4, specifically investigating the activities, cost, time, and outcomes associated with the C4 intervention. RESULTS On average, participants engaged in five care coordination encounters. The vast majority of care coordination activities were conducted by counselors, averaging 30 min per encounter. The cost of care coordination was relatively low with a mean cost of $8.70 per client encounter. CONCLUSION Although client-centered care coordination was initially implemented in well-resourced communities with robust HIV research and service infrastructure, our findings suggest that C4 can be successfully implemented in resource constrained communities.
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Affiliation(s)
- Darren L Whitfield
- School of Social Work, University of Maryland Baltimore, Baltimore, PA, USA.
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, CT, USA
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Arnošt Komárek
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - DeAnne Turner
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Zhao Ni
- School of Medicine, Yale University, New Haven, CT, USA
| | - Donte T Boyd
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Tamara Taggart
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington District of Columbia, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Geetha G Beauchamp
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa Hightow-Weidman
- Division of Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Steven J Shoptaw
- Division of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington District of Columbia, USA
| | | | - Sheldon D Fields
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
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