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Bilger A, Plenn E, Barg FK, Rendle KA, Carter WB, Lamour-Harrington A, Jones N, Peterson B, Sauceda JA, Tebas P, Mounzer K, Metzger D, Montaner LJ, Dubé K. Participant experiences in HIV cure-directed trial with an extended analytical treatment interruption in Philadelphia, United States. HIV Res Clin Pract 2023; 24:2267825. [PMID: 37837376 PMCID: PMC10634456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND A feature of HIV cure trials is the need to interrupt treatment to test the efficacy of experimental interventions-a process known as analytical treatment interruptions (ATIs). OBJECTIVES We report the experiences of participants after they completed an extended ATI. METHODS From April to November 2022, we conducted post-ATI in-depth interviews with BEAT2 clinical trial (NCT03588715) participants who stopped ART while receiving an immunotherapy regimen. We used conventional content analysis to code the data. RESULTS We conducted interviews with 11 Black/African American and three White/Caucasian participants (11 males, two females, and one transgender woman). The mean ATI was 38 weeks. Participants noted several significant experiences surrounding the interventions' side effects, ATI, and returning to medication. Some participants had positive experiences with their ATI. Other participants were nervous during the ATI. Rising viral loads led some to feel a sense of failure. Although trial experiences were heterogeneous, participants unanimously had positive interactions with the clinical trial staff which facilitated their retention in the trial. Participants shared their experiences with the trial, including changes in expectations, experiences with experimental interventions and procedures, compensation as a measure of respect, effort, transportation, and effects of COVID-19 during the trial. Based on these results, we provide considerations for the conduct of future HIV cure-directed clinical trials involving ATIs. CONCLUSIONS Managing expectations, focusing on participants' contributions, and providing support to reduce feelings of having failed the research team and/or the HIV community following viral rebound should be part of HIV cure trial design. Discussing the mental health impact of rebound during consent, distinct from risk, is needed. Continued efforts to understand how people with HIV experience ATIs will improve future designs of HIV cure clinical trials.
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Affiliation(s)
- Andrea Bilger
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Eion Plenn
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Frances K. Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - William B. Carter
- BEAT-HIV Delaney Collaboratory Community Advisory Board, Philadelphia, PA, USA
| | | | - Nora Jones
- BEAT-HIV Delaney Collaboratory Community Advisory Board, Philadelphia, PA, USA
| | | | - John A. Sauceda
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, CA, USA
| | - Pablo Tebas
- Hospital of the University of Philadelphia, University of Pennsylvania, Pennsylvania, PA, USA
| | - Karam Mounzer
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA
| | | | - Karine Dubé
- University of California San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dubé K, Barr E, Philbin M, Perez-Brumer A, Minalga B, Peterson B, Averitt D, Picou B, Martel K, Chung C, Mejía M, Cameron M, Graham G, Dee L, Diallo DD, Gordon E, Korolkova A, Dyer T, Auerbach JD, Scully E, Dong KL, Gianella S. Increasing the meaningful involvement of women in HIV cure-related research: a qualitative interview study in the United States. HIV Res Clin Pract 2023; 24:2246717. [PMID: 37608645 PMCID: PMC10454980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Cisgender women represent over half of people living with HIV globally. However, current research efforts toward a cure for HIV focus predominantly on cisgender men. The under-representation of women in HIV cure clinical studies is particularly problematic given data suggesting that sex-dependent phenotypes limit scientific discovery. OBJECTIVE We aimed to generate considerations to increase the meaningful involvement of women in HIV cure-related research. MATERIALS AND METHODS We conducted in-depth interviews with biomedical researchers and community members to better understand factors that could increase the meaningful involvement of women in HIV cure clinical trials. Participants were affiliated with academia, industry, community advisory boards, and community-based organizations, and were identified using listings from the AIDS Clinical Trials Group and the Martin Delaney Collaboratories. We used conventional content analysis to analyze the qualitative data. RESULTS We recruited 27 participants, of whom 11 were biomedical researchers and 16 were community members. Participants included 25 cisgender women, 1 transgender woman, and 1 cisgender man. Key considerations emerged, including the need to ensure that HIV cure studies reflect HIV epidemiologic trends and having accurate representation by sex and gender in HIV cure research. To increase the meaningful involvement of women, recommendations included instituting intentional enrollment goals, frequent and mandatory reporting on enrollment, and incentives for sites to enroll women. Additional themes included the need for agency and self-determination, attention to lived experiences, trauma and healing, and adequate support for women (e.g. logistical, psychosocial, mental, emotional, and physical). Participants noted that women would be willing to participate in HIV cure trials, related procedures (e.g. biopsies), and analytical treatment interruptions. They also expressed a desired for women-centered and holistic clinical trial designs that account for intersectionality. CONCLUSIONS Our empirical inquiry extends recent calls to action to increase diversity of people involved in HIV cure research. Redressing the under-inclusion of women in HIV cure research is an urgent imperative. The entire field must mobilize and reform to achieve this goal. Meaningfully involving women across the gender spectrum in HIV cure research is needed to ensure that interventions are safe, effective, scalable, and acceptable for all people with HIV.
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Affiliation(s)
- Karine Dubé
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
- University of North Carolina (UNC) Gillings School of Global Public Health, Department of Health Policy and Management, 135 Dauer Drive, Chapel Hill, NC, 27599-7411, USA
| | - Elizabeth Barr
- National Institutes of Health (NIH) Office of Research on Women’s Health (ORWH), 6707 Democracy Boulevard, Suite 400, Bethesda, MD, 20817, USA
| | - Morgan Philbin
- Center for Vulnerable Populations, Department of Medicine, University of California San Francisco (UCSF), 2789 25 Street, Suite 350, San Francisco, CA, 94110, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, Ontario, M5T 3M7, Canada
| | - Brian Minalga
- Office of HIV/AIDS Network Coordination (HANC), Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA
| | - Beth Peterson
- Wistar Institute and BEAT-HIV Delaney Collaboratory Towards an HIV-1 Cure, 3601 Spruce Street, Philadelphia, PA, 19104, USA
| | - Dawn Averitt
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Bridgette Picou
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Krista Martel
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Cecilia Chung
- Transgender Law Center, PO Box 70976, Oakland, CA, 94612-0976, USA
| | - María Mejía
- The Well Project Community Advisory Board (CAB), Nationwide, USA
| | - Martha Cameron
- International Community of Women Living with HIV (ICW), North America
| | - Gail Graham
- University of Maryland PATIENTS Program, 20 North Pine Sreet, Maryland, MD, 21201, USA
| | - Lynda Dee
- AIDS Action Baltimore, 14 East Street, Baltimore, MD, 21202, USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, 995 Potrero Avenue, San Francisco, CA, 94110, USA
| | | | - Ebony Gordon
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, 995 Potrero Avenue, San Francisco, CA, 94110, USA
- San Francisco AIDS Foundation (SFAF), 1035 Market Street, 4 Floor, San Francisco, CA, 94103, USA
| | - Anastasia Korolkova
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
| | - Typhanye Dyer
- University of Maryland, School of Public Health, 4200 Valley Drive, Suite 2242, College Park, MD, 20742-2611, USA
| | - Judith D. Auerbach
- Division of Prevention Science, Department of Medicine, UCSF, 550 16 Street, 3 Floor, San Francisco, CA, 94158, USA
| | - Eileen Scully
- Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA
| | - Krista L. Dong
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Ragon Institute of MGH, MIT and Harvard, 400 Technology Square, Cambridge, MA, 02139-3583, USA
- Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MD, 02114, USA
| | - Sara Gianella
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
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Neergaard R, Jones NL, Roebuck C, Rendle KA, Barbati Z, Peterson B, Tebas P, Mounzer K, Metzger D, Montaner LJ, Dube K, Barg FK. "I Know That I Was a Part of Making a Difference": Participant Motivations for Joining a Cure-Directed HIV Trial with an Analytical Treatment Interruption. AIDS Res Hum Retroviruses 2023; 39:414-421. [PMID: 35979886 PMCID: PMC10389247 DOI: 10.1089/aid.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Analytical treatment interruption (ATI), defined as a closely monitored clinical pause in antiretroviral therapy (ART), is a core component of many HIV cure-directed clinical studies. ATIs may cause significant physical and psychosocial risks for people living with HIV and, as a result, integrating participant and community perspectives into clinical trial designs that include an ATI is crucial to ensuring a successful and person-centered trial. We conducted semi-structured interviews with participants enrolling in the BEAT-2 cure-directed trial (NCT03588715). Interviews elicited participant motivations and decision-making processes for trial participation along with participants' perceptions of the ATI. Interviews were recorded, transcribed, and analyzed using a directed content analysis. Fourteen of 15 trial participants completed interviews. The majority were Black (79%) cisgender male (79%). Participants noted several significant motivating factors contributing to their desire to enroll in the HIV cure-directed clinical trial, the most prominent being a desire to find a cure for HIV and help others in the HIV community. HIV care teams were the most commonly identified resource for patients when making the decision to enroll in the trial, and family, friends, and romantic partners also played a significant role. Altruism was a primary motivation for participation, although participants also shared interest in learning about HIV science and research. Participants had a strong understanding of trial procedures and displayed significant trust in the study team to keep them informed and healthy during their participation. The ATI was a significant source of anxiety for participants. Their primary worry was that their prior antiretroviral therapy (ART) regimen would no longer be effective once they resumed ART. Despite these concerns, participants shared considerable excitement for continued participation in the trial and being a part of the search toward an HIV cure.
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Affiliation(s)
- Rebecca Neergaard
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nora L. Jones
- Center for Urban Bioethics, Temple University Ringgold Standard Institution, Philadelphia, Pennsylvania, USA
- BEAT-HIV Collaboratory Community Advisory Board (CAB), Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Christopher Roebuck
- BEAT-HIV Collaboratory Community Advisory Board (CAB), Wistar Institute, Philadelphia, Pennsylvania, USA
- Department of Anthropology, University of California Berkeley, Berkeley, California, USA
| | - Katharine A. Rendle
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zoe Barbati
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Beth Peterson
- BEAT-HIV Collaboratory Community Advisory Board (CAB), Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Pablo Tebas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Karam Mounzer
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Metzger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Luis J. Montaner
- BEAT-HIV Collaboratory Community Advisory Board (CAB), Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Karine Dube
- UNC Gillings School of Global Health, Chapel Hill, North Carolina, USA
| | - Frances K. Barg
- Family Medicine and Community Health, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Dubé K, Mthimkhulu D, Ngcobo W, Mindry D, Maphalala L, Pillay V, Tran W, Korolkova A, Ndung’u T, Dong K. 'With this study, we have hope that something is coming': community members' perceptions of HIV cure-related research in Durban, South Africa - a qualitative focus group study. HIV Res Clin Pract 2023; 24:2243046. [PMID: 37555592 PMCID: PMC10433450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Developing a cure for HIV remains a global scientific priority. In 2022, the Females Rising through Education, Support and Health (FRESH) cohort launched an HIV cure-related trial involving an analytical treatment interruption (ATI) in Durban, South Africa. OBJECTIVES To explore community perspectives about HIV cure-related research. METHODS Between July-August 2022, we conducted three focus groups with community members. We transcribed audio recordings verbatim and used content analysis to analyze the data. RESULTS Twenty community members (13 women and 7 men) participated in three focus groups (HIV status not included). Participants viewed HIV cure-related research as a way to address the issue of defaulting on (not taking) HIV treatment. Participants expressed hesitancy around ATIs, since these contradict longstanding treatment adherence messages. Participants shared concerns around the risk of side effects from experimental interventions balanced against potential efficacy. They advocated for trial participants to have the right to decide whether to inform their sex partners about their HIV status and ATI participation, rather than research teams making disclosure mandatory. Focus group participants also emphasized the importance of using simple language to explain HIV cure-related research. CONCLUSIONS With HIV cure trials set to launch across Africa in the future, there is a critical need to better understand and respond to local community needs and preferences and to adopt this as standard practice prior to regional trial implementation.
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Affiliation(s)
- Karine Dubé
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Deli Mthimkhulu
- Integration of Tuberculosis in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Wiseman Ngcobo
- Integration of Tuberculosis in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Deborah Mindry
- Center for Gender and Health Justice, University of California Global Health Institute, Los Angeles, CA, USA
| | - Luyanda Maphalala
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Vanessa Pillay
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Whitney Tran
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
| | - Ana Korolkova
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme (HPP), The Doris Duke Medical Research Institute, University of KwaZulu-Natal (UKZN), Durban, South Africa
- Africa Health Research Institute (AHRI), Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
| | - Krista Dong
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Cambridge, MA, USA
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Campbell DM, Cowlings PD, Tholanah M, Robinson MJ, Graham G, Aseru S, Dubé K, Cohn SE, Bar KJ, Connick E, Mngqbisa R, Scully EP, Stockman JK, Gianella S. A Community Call to Action to Prioritize Inclusion and Enrollment of Women in HIV Cure-related Research. J Acquir Immune Defic Syndr 2022; 91:e12-e14. [PMID: 36083494 PMCID: PMC9646409 DOI: 10.1097/qai.0000000000003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Danielle M. Campbell
- Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, La Jolla, CA
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA
| | - Portia D. Cowlings
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA
- Department of Education, Graduate School of Education and Psychology, Pepperdine University, Los Angeles, CA
| | - Martha Tholanah
- Milton Park Clinical Research Site, Community Advisory Board, University of Zimbabwe Clinical Trials Research Center, Milton Park
| | | | - Gail Graham
- Johns Hopkins University AIDS Clinical Trials Group Clinical Research Site, Community Advisory Board, Baltimore, MD
| | - Scovia Aseru
- Joint Clinical Research Centre (JCRC)/Kampala Clinical Research Site, Kampala, Uganda
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Susan E. Cohn
- Infectious Diseases Division, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - Rosie Mngqbisa
- Durban International Clinical Research Site, AIDS Clinical Trials Group, Durban, South Africa
| | - Eileen P. Scully
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Jamila K. Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), La Jolla, CA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), La Jolla, CA
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Roberts C, Creamer E, Boone CA, Young AT, Magnus M. Short Communication: Population Representation in HIV Cure Research: A Review of Diversity Within HIV Cure Studies Based in the United States. AIDS Res Hum Retroviruses 2022; 38:631-644. [PMID: 35018803 PMCID: PMC9464046 DOI: 10.1089/aid.2021.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV is experienced across diverse populations, with gender and racial/ethnic minority populations bearing a significant proportion of disease. With National Institutes of Health (NIH) placing a priority on the enrollment of women and racial/ethnic minorities into studies, it is important to understand the diversity of participants in research. We sought to characterize how HIV cure research studies report data on diversity. A sampling frame of publications with funding provided by the Martin Delaney Collaboratories for HIV Research in 2019 was reviewed for reporting of demographic data. Of 55 publications that included research on humans/human specimens, only 51% provided any demographic description. There often is insufficient consideration of diversity of populations in HIV cure research. Ameliorating gaps in this regard will require recruitment of diverse populations/specimens and specifications to report demographic data in articles. This will ensure inclusion of diverse participants in HIV cure research from earliest laboratory to eventual phase III studies.
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Affiliation(s)
- Carly Roberts
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, District of Columbia, USA
| | - Emma Creamer
- Community Education Group, Inc., District of Columbia, USA
| | - Cheriko A Boone
- Department of Psychological and Brain Sciences at the George Washington University and currently with Treatment Action Group, District of Columbia, USA
| | - A Toni Young
- Community Education Group, Inc., District of Columbia, USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, District of Columbia, USA
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Sylla L, Patel H, Louella M, Simoni J, Dubé K. Community HIV clinicians' perceptions about HIV cure-related research in the Northwestern United States. HIV Res Clin Pract 2022; 23:61-75. [PMID: 35904107 PMCID: PMC9836364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Research on stakeholder perspectives of HIV cure research has involved people with HIV (PWH), who generally cite the importance of HIV clinician advice in making decisions about trial participation. However, there has been little exploration of non-researcher community HIV clinician perspectives, which are clearly critical to the success of HIV cure-related research.Objective: We aimed to learn how community HIV clinicians perceive HIV cure research and identify factors that would lead them to support or discourage HIV cure trial participation by their patients.Methods: We recruited a purposive sample of 12 community HIV clinicians in metro-Seattle, WA to participate in structured interviews. We completed 11 interviews via teleconference and received one written response. We used conventional content analysis to analyze the data.Results: Overall, community HIV clinicians were supportive of patient participation in HIV cure trials. Factors affecting support included knowledge of local trials, ease of referral, patient immune function and health stability, study risks and benefits, burden of study requirements, patient characteristics, patient life stability, potential impact on engagement in care, study communication plans, and beliefs that patients should have the autonomy to decide to participate. Participants had concerns about trials requiring treatment delays or interruptions and HIV transmission risk. While their knowledge of the field was limited, they were interested in learning more about open HIV cure trials.Conclusions: It would benefit the HIV cure research community if those leading HIV cure trials make stronger efforts to engage community clinicians who care for PWH, but are not active researchers, early in the trial design process. Such engagement prior to launching HIV cure trials will improve trial designs, leading to better enrollment and retention within these important studies.
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Affiliation(s)
- Laurie Sylla
- defeatHIV Collaboratory, 1100 Fairview Avenue North, E5-110, Seattle, WA, 98109, USA,University of Washington, School of Medicine, Division of Allergy and Infectious Diseases, Mountain West AIDS Education & Training Center, Mailstop 359932, Seattle, WA 98104
| | - Hursch Patel
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA
| | - Michael Louella
- defeatHIV Collaboratory, 1100 Fairview Avenue North, E5-110, Seattle, WA, 98109, USA
| | - Jane Simoni
- University of Washington, Departments of Psychology and Global Health, 3909 Stevens Way CE, Box 351525, Seattle, WA, USA
| | - Karine Dubé
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA
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Campbell DM, Dubé K, Cowlings PD, Dionicio P, Tam RM, Agarwal H, Stockman JK, Auerbach JD, Sauceda JA, Conroy AA, Johnson MO. "It comes altogether as one:" perceptions of analytical treatment interruptions and partner protections among racial, ethnic, sex and gender diverse HIV serodifferent couples in the United States. BMC Public Health 2022; 22:1317. [PMID: 35810288 PMCID: PMC9270765 DOI: 10.1186/s12889-022-13528-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Most HIV cure-related studies involve interrupting antiretroviral treatment to assess the efficacy of pharmacologic interventions - also known as analytical treatment interruptions (ATIs). ATIs imply the risk of passing HIV to sexual partners due to the loss of undetectable HIV status. There has been a notable lack of attention paid to perceptions of ATIs among racial, ethnic, sex and gender minorities, and HIV serodifferent couples. These populations are among those most impacted by HIV in the United States. Future HIV cure research paradigms should equitably include considerations from these groups. METHODS From August - October 2020, we conducted in-depth interviews with 10 racial, ethnic, sex, and gender minority HIV serodifferent couples in geographically diverse regions of the United States to understand their perspectives about ATIs and partner protection measures to prevent secondary HIV transmissions because of participation in ATI studies. We used framework analysis to analyze the qualitative data. RESULTS Of the 10 couples recruited, four identified as a gay couple, two as a gay and bisexual couple, two as a heterosexual couple, one as a gay and queer couple, and one as a queer couple. We found that HIV serodifferent couples in our study viewed ATIs as contradicting HIV treatment adherence messages. Couples expressed discomfort around ATIs in HIV cure research. They were concerned with the return of HIV detectability and worried ATIs might result in secondary HIV transmission. Participants were strongly in favor of using a range of partner protection measures during ATIs that included PrEP, HIV risk reduction counseling, and alternatives for penetrative sex practices. Couples also recommended that sex partners be consulted or involved as part of ATI trials. CONCLUSIONS Our findings highlight new potential opportunities and strategies to mitigate risk of HIV transmission during ATIs among key groups historically under-represented in HIV cure research. Findings also underscore the relational aspects of ATI trials. We provide preliminary considerations for planning ATI trials with diverse HIV serodifferent partners. Future studies should continue to explore these issues among other types of partnerships, cultures, and socio-cultural settings.
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Affiliation(s)
- Danielle M. Campbell
- Charles R. Drew University of Medicine and Science (CDU), 1731 East 120th Street, Los Angeles, CA 90059 USA
- Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, 9500 Gilman Drive, La Jolla, CA 92093 USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599 USA
| | - Portia D. Cowlings
- Charles R. Drew University of Medicine and Science (CDU), 1731 East 120th Street, Los Angeles, CA 90059 USA
- Graduate School of Education and Psychology, Department of Education, Pepperdine University, 6100 Center Drive, Los Angeles, CA 90045 USA
| | - Patricia Dionicio
- Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Rowena M. Tam
- Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Harsh Agarwal
- UNC Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599 USA
| | - Jamila K. Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Judith D. Auerbach
- San Francisco (UCSF) Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - John A. Sauceda
- San Francisco (UCSF) Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Amy A. Conroy
- San Francisco (UCSF) Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Mallory O. Johnson
- San Francisco (UCSF) Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
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Yuan L, Tian S, Zhao Z, Liu P, Liu L, Sun J. Mean generation function model in AIDS epidemic estimation. BMC Med Inform Decis Mak 2022; 22:104. [PMID: 35429984 PMCID: PMC9013215 DOI: 10.1186/s12911-022-01825-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Since the first case of HIV infection was reported in China in 1985, the incidence and mortality of AIDS have been increasing rapidly, which has caused serious damage to the life and health of people in China and all over the world. Therefore, it is of great significance to study the technique for predicting AIDS morbidity and mortality. The purpose of this research is to explore the applicability of the mean generation function model (MGFM) in the early warning of AIDS morbidity and mortality, to predict its prevalence trend, to enrich the prediction techniques and methods of AIDS research and to provide suggestions for AIDS transmission control. Methods In this research, the MGFM was applied to predict the incidence and mortality of AIDS in China. AIDS incidence and mortality data in China from 2008 to 2019 were used to construct the prediction model. Results The MGFM can predict the annual incidence and mortality of AIDS. The model constructed in this research predicted that the incidence and mortality of AIDS in China will continue to increase from 2020 to 2023. Conclusion The mean birth function model was an effective method to monitor and predict the changing trend of AIDS incidence and mortality in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01825-6.
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Dubé K, Eskaf S, Hastie E, Agarwal H, Henley L, Roebuck C, Carter WB, Dee L, Taylor J, Mapp D, Campbell DM, Villa TJ, Peterson B, Lynn KM, Lalley-Chareczko L, Hiserodt E, Kim S, Rosenbloom D, Evans BR, Anderson M, Hazuda DJ, Shipley L, Bateman K, Howell BJ, Mounzer K, Tebas P, Montaner LJ. Preliminary Acceptability of a Home-Based Peripheral Blood Collection Device for Viral Load Testing in the Context of Analytical Treatment Interruptions in HIV Cure Trials: Results from a Nationwide Survey in the United States. J Pers Med 2022; 12:231. [PMID: 35207719 PMCID: PMC8879991 DOI: 10.3390/jpm12020231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Frequent viral load testing is necessary during analytical treatment interruptions (ATIs) in HIV cure-directed clinical trials, though such may be burdensome and inconvenient to trial participants. We implemented a national, cross-sectional survey in the United States to examine the acceptability of a novel home-based peripheral blood collection device for HIV viral load testing. Between June and August 2021, we distributed an online survey to people with HIV (PWH) and community members, biomedical HIV cure researchers and HIV care providers. We performed descriptive analyses to summarize the results. We received 73 survey responses, with 51 from community members, 12 from biomedical HIV cure researchers and 10 from HIV care providers. Of those, 51 (70%) were cisgender men and 50 (68%) reported living with HIV. Most (>80% overall) indicated that the device would be helpful during ATI trials and they would feel comfortable using it themselves or recommending it to their patients/participants. Of the 50 PWH, 42 (84%) indicated they would use the device if they were participating in an ATI trial and 27 (54%) also expressed a willingness to use the device outside of HIV cure studies. Increasing sensitivity of viral load tests and pluri-potency of the device (CD4 count, chemistries) would augment acceptability. Survey findings provide evidence that viral load home testing would be an important adjunct to ongoing HIV cure-directed trials involving ATIs. Survey findings may help inform successful implementation and uptake of the device in the context of personalized HIV care.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (H.A.); (L.H.)
| | - Shadi Eskaf
- Independent Public Health Researcher and Consultant, Chapel Hill, NC 27516, USA;
| | - Elizabeth Hastie
- School of Medicine, University of California San Diego, La Jolla, CA 92093, USA;
| | - Harsh Agarwal
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (H.A.); (L.H.)
| | - Laney Henley
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (H.A.); (L.H.)
| | - Christopher Roebuck
- Department of Science and Technology Studies, Cornell University, Ithaca, NY 14850, USA;
- Martin Delaney BEAT-HIV Collaboratory Community Advisory Board (CAB), Philadelphia, PA 19104, USA;
| | - William B. Carter
- Martin Delaney BEAT-HIV Collaboratory Community Advisory Board (CAB), Philadelphia, PA 19104, USA;
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD 21202, USA;
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA 94110, USA; (J.T.); (D.M.C.)
- AIDS Treatment Activists Coalition (ATAC), Denver, CO 80209, USA;
| | - Jeff Taylor
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA 94110, USA; (J.T.); (D.M.C.)
- AIDS Treatment Activists Coalition (ATAC), Denver, CO 80209, USA;
- HIV + Aging Research Project-Palm Springs (HARP-PS), Palm Springs, CA 92264, USA
| | - Derrick Mapp
- AIDS Treatment Activists Coalition (ATAC), Denver, CO 80209, USA;
- Shanti Project, San Francisco, CA 94109, USA
| | - Danielle M. Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA 94110, USA; (J.T.); (D.M.C.)
- AIDS Treatment Activists Coalition (ATAC), Denver, CO 80209, USA;
| | - Thomas J. Villa
- HOPE Martin Delaney Collaboratory, San Francisco, CA 94612, USA;
- BELIEVE Martin Delaney Collaboratory, Washington, DC 10021, USA
- National HIV & Aging Advocacy Network, Washington, DC 20005, USA
| | - Beth Peterson
- Wistar Institute, Martin Delaney BEAT-HIV Collaboratory, Philadelphia, PA 19104, USA; (B.P.); (L.J.M.)
| | - Kenneth M. Lynn
- Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA; (K.M.L.); (S.K.); (K.M.); (P.T.)
| | | | - Emily Hiserodt
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA 19107, USA; (L.L.-C.); (E.H.)
| | - Sukyung Kim
- Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA; (K.M.L.); (S.K.); (K.M.); (P.T.)
| | - Daniel Rosenbloom
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Brad R. Evans
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Melanie Anderson
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Daria J. Hazuda
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Lisa Shipley
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Kevin Bateman
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Bonnie J. Howell
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Karam Mounzer
- Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA; (K.M.L.); (S.K.); (K.M.); (P.T.)
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA 19107, USA; (L.L.-C.); (E.H.)
| | - Pablo Tebas
- Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA; (K.M.L.); (S.K.); (K.M.); (P.T.)
| | - Luis J. Montaner
- Wistar Institute, Martin Delaney BEAT-HIV Collaboratory, Philadelphia, PA 19104, USA; (B.P.); (L.J.M.)
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Lau JS, Smith MZ, Allan B, Dubé K, Young AT, Power J. Time for revolution? Enhancing meaningful involvement of people living with HIV and affected communities in HIV cure-focused science. J Virus Erad 2020; 6:100018. [PMID: 33251026 PMCID: PMC7646668 DOI: 10.1016/j.jve.2020.100018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Involving affected communities and people living with HIV (PLHIV) in HIV cure-focused clinical trials has ethical and practical benefits. However, there can be barriers to meaningful involvement of 'lay people' in scientific research meaning community consultation is often limited or tokenistic. This paper reports on an Australian project, the INSPIRE project (Improve, Nurture and Strengthen education, collaboration, and communication between PLHIV and Researchers), which aimed to explore barriers and enablers to enactment of the principles of meaningful involvement of PLHIV (MIPA) and affected communities in HIV cure-focused research. METHODS The project involved a workshop attended by 40 stakeholders involved in HIV care, research or advocacy including PLHIV, community organizations, basic scientists, and clinicians. The workshop involved a facilitated discussion about community involvement in a hypothetical HIV cure-focused clinical trial. Data were collected through notetaking and video recordings. Qualitative, thematic analysis was undertaken to organize the data and identify core themes related to MIPA. RESULTS Workshop discussions revealed community stakeholders often feel their involvement in HIV clinical research is undervalued, evidenced by limited financial remuneration and minimal capacity to influence the research design or processes. Building long-term, formal and informal relationships between community organizations, PLHIV, researchers and research teams or laboratories was identified as a strategy to support MIPA at all stages of a clinical trial, from design to dissemination of findings. CONCLUSIONS Enacting MIPA principles in HIV cure-focused research requires a better understanding of the potential to improve research outcomes and ensure quality in the research process.
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Affiliation(s)
| | - Miranda Z. Smith
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Brent Allan
- International Council of AIDS Service Organizations, Toronto, Canada
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - A. Toni Young
- District of Columbia Centre for AIDS Research, Community Education Group, Washington D.C., USA
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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