2
|
Mustanski B, Queiroz A, Merle JL, Zamantakis A, Zapata JP, Li DH, Benbow N, Pyra M, Smith JD. A Systematic Review of Implementation Research on Determinants and Strategies of Effective HIV Interventions for Men Who Have Sex with Men in the United States. Annu Rev Psychol 2024; 75:55-85. [PMID: 37722749 PMCID: PMC10872355 DOI: 10.1146/annurev-psych-032620-035725] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers-particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.
Collapse
Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nanette Benbow
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Pyra
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
4
|
Goodrum NM, Lopez CM, delMas S, Davies F, Lampe B, Eckard AR, Danielson CK, Rheingold AA, Moreland AD. Moving toward transdisciplinary approaches to addressing HIV and psychological trauma: Barriers and facilitators to building collaborations. J Trauma Stress 2023; 36:884-895. [PMID: 37490311 PMCID: PMC11027063 DOI: 10.1002/jts.22959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 07/26/2023]
Abstract
Most people living with HIV have experienced potentially traumatic events (e.g., physical assault, sexual assault, intimate partner violence) and, consequently, are at risk of trauma-related mental health difficulties, including posttraumatic stress disorder (PTSD). Yet, research and clinical efforts related to HIV and psychological trauma remain siloed. Guided by the four-phase model of transdisciplinary research, the current study explored barriers and facilitators to transdisciplinary HIV/trauma clinical and research collaborations to address the overlap between HIV and psychological trauma. This exploration represents an initial step in the development and conceptualization of a transdisciplinary team known as Team REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD), which seeks to address the overlap between HIV and psychological trauma. Barriers and facilitators were explored through individual qualitative interviews with 21 research and clinical staff members across two clinics within an academic medical center (i.e., an infectious diseases clinic and a trauma-focused specialty mental health clinic). The findings revealed a number of barriers, including a lack of awareness, time and funding concerns, and a lack of clarity regarding services or the division of responsibility. The results also highlight perceived facilitators for collaborations, such as existing infrastructure and relationships, shared goals, leadership support, knowledge of other agency activities, and staff/team buy-in. Recommendations for increased collaboration included ongoing communication, needs assessment and goal development, access to partners, and role establishment. These findings will guide the next steps in further developing transdisciplinary collaboration goals and have implications for increasing collaborative approaches to patient care and targeting processes to enhance team effectiveness for transdisciplinary goals.
Collapse
Affiliation(s)
- Nada M. Goodrum
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Cristina M. Lopez
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara delMas
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Faraday Davies
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brooke Lampe
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Allison R. Eckard
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carla Kmett Danielson
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alyssa A. Rheingold
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Angela D. Moreland
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
5
|
Gandhi M, Hickey M, Imbert E, Grochowski J, Mayorga-Munoz F, Szumowski JD, Oskarsson J, Shiels M, Sauceda J, Salazar J, Dilworth S, Nguyen JQ, Glidden DV, Havlir DV, Christopoulos KA. Demonstration Project of Long-Acting Antiretroviral Therapy in a Diverse Population of People With HIV. Ann Intern Med 2023; 176:969-974. [PMID: 37399555 PMCID: PMC10771861 DOI: 10.7326/m23-0788] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Intramuscular cabotegravir (CAB) and rilpivirine (RPV) is the only long-acting antiretroviral therapy (LA-ART) regimen approved for people with HIV (PWH). Long-acting ART holds promise for improving outcomes among populations with barriers to adherence but is only approved for PWH who have virologic suppression with use of oral ART before initiating injectables. OBJECTIVE To examine LA-ART in a population of PWH that includes those with viremia. DESIGN Observational cohort study. SETTING Urban academic safety-net HIV clinic. PATIENTS Publicly insured adults living with HIV with and without viral suppression, high rates of unstable housing, mental illness, and substance use. INTERVENTION Demonstration project of long-acting injectable CAB-RPV. MEASUREMENTS Descriptive statistics summarizing cohort outcomes to date, based on pharmacy team logs and electronic medical record data. RESULTS Between June 2021 and November 2022, 133 PWH at the Ward 86 HIV Clinic were started on LA-ART, 76 of whom had virologic suppression while using oral ART and 57 of whom had viremia. The median age was 46 years (IQR, 25 to 68 years); 117 (88%) were cisgender men, 83 (62%) had non-White race, 56 (42%) were experiencing unstable housing or homelessness, and 45 (34%) had substance use. Among those with virologic suppression, 100% (95% CI, 94% to 100%) maintained suppression. Among PWH with viremia, at a median of 33 days, 54 of 57 had viral suppression, 1 showed the expected 2-log10 reduction in HIV RNA level, and 2 experienced early virologic failure. Overall, 97.5% (CI, 89.1% to 99.8%) were projected to achieve virologic suppression by a median of 33 weeks. The current virologic failure rate of 1.5% in the cohort is similar to that across registrational clinical trials at 48 weeks. LIMITATION Single-site study. CONCLUSION This project demonstrates the ability of LA-ART to achieve virologic suppression among PWH, including those with viremia and challenges to adherence. Further data on the ability of LA-ART to achieve viral suppression in people with barriers to adherence are needed. PRIMARY FUNDING SOURCE National Institutes of Health, City and County of San Francisco, and Health Resources and Services Administration.
Collapse
Affiliation(s)
- Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Matthew Hickey
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Elizabeth Imbert
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Janet Grochowski
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Francis Mayorga-Munoz
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - John D Szumowski
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Jon Oskarsson
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Mary Shiels
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - John Sauceda
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California (J. Sauceda)
| | - Jorge Salazar
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Samantha Dilworth
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Janet Q Nguyen
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - David V Glidden
- Department of Epidemiology and Biostatistics, Department of Medicine, University of California, San Francisco, San Francisco, California (D.V.G.)
| | - Diane V Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California (M.G., M.H., E.I., J.G., F.M., J.D.S., J.O., M.S., J. Salazar, S.D., J.Q.N., D.V.H., K.A.C.)
| |
Collapse
|