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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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Ragonnet-Cronin M, Hayford C, D’Aquila R, Ma F, Ward C, Benbow N, Wertheim JO. Forecasting HIV-1 Genetic Cluster Growth in Illinois,United States. J Acquir Immune Defic Syndr 2022; 89:49-55. [PMID: 34878434 PMCID: PMC8667185 DOI: 10.1097/qai.0000000000002821] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND HIV intervention activities directed toward both those most likely to transmit and their HIV-negative partners have the potential to substantially disrupt HIV transmission. Using HIV sequence data to construct molecular transmission clusters can reveal individuals whose viruses are connected. The utility of various cluster prioritization schemes measuring cluster growth have been demonstrated using surveillance data in New York City and across the United States, by the Centers for Disease Control and Prevention (CDC). METHODS We examined clustering and cluster growth prioritization schemes using Illinois HIV sequence data that include cases from Chicago, a large urban center with high HIV prevalence, to compare their ability to predict future cluster growth. RESULTS We found that past cluster growth was a far better predictor of future cluster growth than cluster membership alone but found no substantive difference between the schemes used by CDC and the relative cluster growth scheme previously used in New York City (NYC). Focusing on individuals selected simultaneously by both the CDC and the NYC schemes did not provide additional improvements. CONCLUSION Growth-based prioritization schemes can easily be automated in HIV surveillance tools and can be used by health departments to identify and respond to clusters where HIV transmission may be actively occurring.
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Affiliation(s)
- Manon Ragonnet-Cronin
- Department of Medicine, University of California San Diego, San Diego, USA
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Christina Hayford
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Richard D’Aquila
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Fangchao Ma
- Illinois Department of Public Health, Chicago, USA
| | - Cheryl Ward
- Illinois Department of Public Health, Chicago, USA
| | - Nanette Benbow
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Joel O. Wertheim
- Department of Medicine, University of California San Diego, San Diego, USA
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Dawson L, Benbow N, Fletcher FE, Kassaye S, Killelea A, Latham SR, Lee LM, Leitner T, Little SJ, Mehta SR, Martinez O, Minalga B, Poon A, Rennie S, Sugarman J, Sweeney P, Torian LV, Wertheim JO. Addressing Ethical Challenges in US-Based HIV Phylogenetic Research. J Infect Dis 2020; 222:1997-2006. [PMID: 32525980 PMCID: PMC7661760 DOI: 10.1093/infdis/jiaa107] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/06/2020] [Indexed: 12/29/2022] Open
Abstract
In recent years, phylogenetic analysis of HIV sequence data has been used in research studies to investigate transmission patterns between individuals and groups, including analysis of data from HIV prevention clinical trials, in molecular epidemiology, and in public health surveillance programs. Phylogenetic analysis can provide valuable information to inform HIV prevention efforts, but it also has risks, including stigma and marginalization of groups, or potential identification of HIV transmission between individuals. In response to these concerns, an interdisciplinary working group was assembled to address ethical challenges in US-based HIV phylogenetic research. The working group developed recommendations regarding (1) study design; (2) data security, access, and sharing; (3) legal issues; (4) community engagement; and (5) communication and dissemination. The working group also identified areas for future research and scholarship to promote ethical conduct of HIV phylogenetic research.
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Affiliation(s)
- Liza Dawson
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Nanette Benbow
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Faith E Fletcher
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Amy Killelea
- National Alliance of State and Territorial AIDS Directors, Washington, District of Columbia, USA
| | - Stephen R Latham
- Yale Interdisciplinary Center for Bioethics, New Haven, Connecticut, USA
| | - Lisa M Lee
- Virginia Tech, Blacksburg, Virginia, USA
| | - Thomas Leitner
- Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Susan J Little
- University of California at San Diego, San Diego, California, USA
| | - Sanjay R Mehta
- University of California at San Diego, San Diego, California, USA
| | | | - Brian Minalga
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Art Poon
- University of Western Ontario, London, Ontario, Canada
| | - Stuart Rennie
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Patricia Sweeney
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucia V Torian
- New York City Department of Health, New York, New York, USA
| | - Joel O Wertheim
- University of California at San Diego, San Diego, California, USA
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Molecular network-based intervention brings us closer to ending the HIV pandemic. Front Med 2020; 14:136-148. [PMID: 32206964 DOI: 10.1007/s11684-020-0756-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/13/2020] [Indexed: 01/08/2023]
Abstract
Precise identification of HIV transmission among populations is a key step in public health responses. However, the HIV transmission network is usually difficult to determine. HIV molecular networks can be determined by phylogenetic approach, genetic distance-based approach, and a combination of both approaches. These approaches are increasingly used to identify transmission networks among populations, reconstruct the history of HIV spread, monitor the dynamics of HIV transmission, guide targeted intervention on key subpopulations, and assess the effects of interventions. Simulation and retrospective studies have demonstrated that these molecular network-based interventions are more cost-effective than random or traditional interventions. However, we still need to address several challenges to improve the practice of molecular network-guided targeting interventions to finally end the HIV epidemic. The data remain limited or difficult to obtain, and more automatic real-time tools are required. In addition, molecular and social networks must be combined, and technical parameters and ethnic issues warrant further studies.
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