Building Partnerships and Stakeholder Relationships for HIV Prevention: Longitudinal Cohort Study Focuses on Community Engagement

BACKGROUND

African American women bear disproportionate human immunodeficiency virus (HIV) burden in the United States, yet are often underrepresented in clinical research. Community engagement may decrease research mistrust and increase participation. We describe strategies used to engage community partners and female participants in a multisite HIV incidence study, HIV Prevention Trials Network (HPTN) 064.

OBJECTIVES

HPTN 064 assessed HIV incidence among women in 10 geographic areas chosen for both high prevalence of HIV and poverty.

METHODS

Women were recruited using venue-based sampling and followed for six to 12 months. Recruitment and engagement approaches aligned with the National Institutes of Health (NIH) Director's Council of Public Representatives (COPR) Community Engagement Framework's.

RESULTS

Results showed engagement activities increased rapport and established new partnerships with community stakeholders. Study sites engaged 56 community organizations with 2,099 women enrolled in 14 months. Final retention was 94%.

CONCLUSIONS

The COPR model maximized inclusiveness and participation of African American women impacted by HIV, supported recruitment and retention, and was the cornerstone of community engagement.

Development of a Black Caucus within the HIV Prevention Trials Network (HPTN): Representing the Perspectives of Black Men Who Have Sex with Men (MSM)

Black men who have sex with men (MSM) have disproportionate HIV disease burden in the United States. Black MSM have been underrepresented in biomedical research, including HIV clinical trials, due to a myriad of socio-structural, socio-cultural, and psychosocial factors. The HIV Prevention Trials Network (HPTN) 061, a feasibility study of a multi-component HIV prevention intervention for Black MSM in six US cities, incorporated the development and implementation of a Black Caucus as a culturally grounded model for the integration of Black MSM in clinical trials and research in HPTN. Based on a qualitative methodological approach, we describe the formation and implementation of the Black Caucus from the perspective of Black MSM key community stakeholders. Three major themes emerged from the qualitative narratives: (1) the role of the Black Caucus in shaping the HPTN, (2) how the Black Caucus addresses the needs of Black MSM communities pertaining to the influence of race and sexual identity, and (3) socio-cultural needs of Black MSM. These findings have implications for the provision of culturally congruent expertise, community engagement, cultural mistrust, recruitment and retention of Black MSM in HIV clinical trials, culturally-relevant study design and implementation, and the role of developing Black MSM prevention researchers.

Engaging Transgender People in NIH-Funded HIV/AIDS Clinical Trials Research

In 2009, the National Institutes of Health recognized the need to expand knowledge of lesbian, gay, bisexual, and transgender (LGBT) health and commissioned the Institute of Medicine to report on the health of these populations in the United States. The resulting Institute of Medicine publication called for more knowledge of the health of LGBT populations, as well as improved methodologies to reach them, more LGBT-focused research, and enhanced training programs and cultural competency of physicians and researchers. Several of the National Institutes of Health-funded HIV/AIDS clinical trials networks, including the Adolescent Medicine Trials Network for HIV/AIDS Interventions, HIV Prevention Trials Network, HIV Vaccine Trials Network, and Microbicide Trials Network, have focused attention on engaging transgender (TG) individuals in research. They have identified issues that transcend the nature of research (ie, treatment or prevention, adult or adolescent) and have adopted various approaches to effectively engage the TG community. Each network has recognized the importance of developing partnerships to build trust with and seek input from TG individuals on research plans and policies. They have established standing advisory groups and convened consultations for this purpose. To ensure that trial data are reflective of the participants they are seeking to enroll, they have reviewed and revised data collection forms to incorporate the 2-step method of collecting sex at birth and gender identity as 2 independent variables, and some have also revised research protocol templates and policies for concept development to ensure that they are appropriate for the inclusion of TG participants. The networks have also initiated trainings to enhance cultural sensitivity and developed a range of materials and resources for network and clinical research site staff. They continue to identify TG-specific research needs in an effort to be more responsive to and improve the health of TG individuals, particularly related to HIV/AIDS.

Paranoid and aggressive behavior in two obsessive-compulsive adolescents treated with clomipramine

Obsessive-compulsive disorder is increasingly recognized in patients of different age groups. Serotonergic agents, such as clomipramine, have been recently found to be useful in the management of this condition. However, unexpected side effects, such as dysphoria, aggressiveness, and paranoid ideation, may occur with therapeutic doses of this compound, as evidenced in the cases of two male adolescents presented here. Possible pathogenetic factors, involving serotonin and serotonin-receptor abnormalities are discussed. Management of these side effects is based on adequate dose reduction and monitorization.

Comparison of modified A-1 method with standard EC test for recovery of fecal coliform bacteria for shellfish

This study is one of a series in which variations of the A-1 method for the detection and enumeration of fecal coliforms and Escherichia coli in seawater and foods were evaluated. The tests were conducted jointly by the Food and Drug Administration and state and provincial laboratories that support shellfish control programs in the United States and Canada as part of the National Shellfish Sanitation Program's Microbiology Task Force activities. Results showed significantly higher recovery of fecal coliforms from naturally contaminated shellfish by the AOAC official A-1-M method than by the American Public Health Association standard method. There was no significant difference in recovery of E. coli by the 2 methods.

Cytomegalovirus infection in children undergoing open-heart surgery

A group of 124 children undergoing open-heart surgery was followed prospectively in order to estimate the risk of cytomegalovirus (CMV) infection due to transfused blood.Ninety-three patients (75%) had complement fixation (CF) titers of < 1:4 against CMV on admission. Of this seronegative subgroup, nine patients (9.7%) subsequently became infected with CMV. All nine showed seroconversion, and six were viruric 12-14 weeks after surgery. Comparative seroepidemiological studies of the hospital population showed that in the age ranges studied (3-16 yr), the infections seen in the study group represented a significant excess over expectation. This infection rate was consistent with a model of transmission by blood transfusion with a risk of 2.7% per unit but not proven.Thirty-one patients had CF antibody to CMV on admission. CMV was isolated from 14% of urines of seropositive children both before and after surgery, but only two patients showed CF antibody rises to CMV. Thus the frequency of CMV infection associated with open-heart surgery and transfusion could not be calculated in the seropositive subgroup.CMV infection was not related to the primary diagnosis or to Down's syndrome.