Filtering by: HIV Prevention

Dec
12
12:00 PM12:00

Cyprian Wejnert: CDC's National HIV Behavioral Surveillance (NHBS) system

CDC's National HIV Behavioral Surveillance (NHBS) system: Methods and impact on HIV prevention among key populations

Cyprian Wejnert, Ph.D.
Centers for Disease Control and Prevention

ABSTRACT:
The National HIV Behavioral Surveillance (NHBS) system was designed to monitor risk factors for HIV infection and HIV prevalence among individuals at increased risk for HIV infection, that is, sexually active men who have sex with men who attend venues, persons who recently injected drugs, and heterosexuals of low socioeconomic status living in urban areas. These groups were selected as priorities for behavioral surveillance because they represent the major HIV transmission routes and the populations with the highest HIV burden. Accurate data on HIV risk and testing behaviors in these populations are critical for understanding trends in HIV infections and planning and evaluating effective HIV prevention activities. This presentation will provide an overview of NHBS and the methods it employs (respondent-driven sampling and venue-based sampling), and will highlight some of the impact findings from NHBS have had on HIV prevention.

 

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Nov
28
12:00 PM12:00

Daniel Almirall: Getting SMART about adaptive interventions

Getting SMART about adaptive interventions in treatment, prevention and implementation science

Daniel Almirall, Ph.D.
University of Michigan

ABSTRACT:
The effective treatment, prevention or management of a wide variety of health disorders often requires individualized, sequential decision-making. To do this, each individual’s intervention is tailored over time based on the individual’s history, e.g., changing disease or risk status, or adherence. Adaptive interventions (also known as dynamic treatment regimens in the statistical medicine literature) operationalize such individualized decision making using a sequence of decision rules that pre-specify which intervention option to offer, for whom, and when. Intervention options in this case correspond to varying doses, types or delivery modes of pharmacological, behavioral and/or psychosocial interventions. Recently, there has been a surge of interest in developing and evaluating adaptive interventions via randomized trials. Specifically, there is great interest in the use of sequential multiple assignment randomized trials (SMART), a type of multi-stage randomized trial design, to build high-quality adaptive interventions. The primary aim of this talk is to provide a brief, conceptual introduction to adaptive interventions and SMART designs. We will use various examples of adaptive interventions and SMART studies in child and adolescent mental health (e.g., ADHD, autism) to explain and illustrate ideas. If time permits, a secondary aim of this talk is to introduce the idea of adaptive implementation interventions and the use of cluster-randomized SMART designs for their development. In an adaptive implementation intervention, the intervention options—which, typically, are strategies designed to improve the uptake or delivery of evidence-based practices by a provider/site—are tailored over time based on the changing status of the provider/site. As an illustrative example, we will present the design of the AIM-Hi Study, a NIMH-funded cluster-randomized SMART which aims to develop a high-quality adaptive implementation intervention to improve the uptake/adoption of cognitive behavioral treatment in high-schools.

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Nov
7
12:00 PM12:00

Kathryn Risher: Challenges in the evaluation of interventions to improve engagement along the HIV care continuum in the United States

Challenges in the evaluation of interventions to improve engagement along the HIV care continuum in the United States

Kathryn Risher, Ph.D, M.H.S
London School of Hygiene & Tropical Medicine

ABSTRACT:
In the United States (US), a high proportion of individuals living with HIV remain unlinked to care, disengaged from care, or incompletely adherent to antiretroviral therapy (ART). We conducted a systematic review of interventions to improve linkage to care, retention in care, re-engagement among those disengaged from care, and adherence to ART in the US. We find that the bulk of evidence (117/152 included studies) addresses adherence interventions, while a very small minority address linkage or reengagement interventions (7/152 and 4/152, respectively). There was tremendous heterogeneity in measures used to evaluate interventions. We found that most (59%) of studies report significantly improved outcomes, but the effect size was variable across studies and populations. The presentation will additionally include recommendations to address the challenges identified by the systematic review.

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Oct
31
12:00 PM12:00

Sean Young: Social media for changing and predicting HIV

Social media for changing and predicting HIV

Sean Young, Ph.D.
University of California Los Angeles

ABSTRACT:
This talk will focus on how social media can be used in HIV prevention research. We'll discuss a social media-based online community for HIV prevention and ways that social media data can be used by HIV researchers.

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Oct
24
12:00 PM12:00

Emine Yaylali: Resource allocation models for HIV prevention

Resource allocation models for HIV prevention

Emine Yaylali, Ph.D.
Istanbul Technical University

ABSTRACT:
Objective: 

We will briefly explain resource allocation models, how these models could be used in improving HIV prevention and present some examples from literature. Then, we will describe HIV-RAMP, a resource allocation model to optimize health departments’ Centers for Disease Control and Prevention (CDC)–funded HIV prevention budgets to prevent the most new cases of HIV and to evaluate the model’s implementation in four health departments
Design, Settings, and Participants: 
We developed a linear programming model combined with a Bernoulli process model that allocated a fixed budget among HIV prevention interventions and risk subpopulations to maximize the number of new infections prevented. The model, which required epidemiologic, behavioral, budgetary, and programmatic data, was implemented in health departments in Philadelphia, Chicago, Alabama, and Nebraska. 
Main Outcome Measures: 
The optimal allocation of funds, the site-specific cost per case of HIV prevented rankings by intervention, and the expected number of HIV cases prevented.  
Results: 
The model suggested allocating funds to HIV testing and continuum-of-care interventions in all 4 health departments. Behavioral interventions did not receive funding in the optimal allocation for any health department. The most cost-effective intervention for all sites was HIV testing for men who have sex with men (MSM) in non-clinical settings, and the least cost-effective interventions were behavioral interventions for HIV-negative persons. The pilot sites required 3-4 months of technical assistance to develop data inputs and generate and interpret the results. Although the sites found the model easy to use in providing quantitative evidence on allocating HIV prevention resources, they criticized the exclusion of structural interventions and the use of model to allocate only CDC funds.   
Conclusions: 
Resource allocation models have potential to improve the allocation of limited HIV prevention sources and can be used as a decision-making guide for state and local health departments. Using such models may require substantial staff time and technical assistance. Model results suggesting allocating funds towards testing and continuum-of-care interventions and risk populations at highest risk of HIV transmission may lead to better health outcomes. These model results emphasize the allocation of CDC funds toward testing and continuum--of-care interventions and populations at highest risk of HIV transmission. 

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Oct
17
12:00 PM12:00

Cathy Maulsby & David Holtgrave: Economic analysis of AIDS United's access to Care Initiative

Economic analysis of AIDS United's access to Care Initiative

Cathy Maulsby, Ph.D. & David Holtgrave, Ph.D.
Johns Hopkins University

ABSTRACT:
Persons diagnosed with HIV but not retained in HIV medical care accounted for the majority of HIV transmissions in 2009 in the United States (U.S.). There is an urgent need to implement and disseminate HIV retention in care programs; however little is known about the costs associated with implementing retention in care programs. We assessed the costs and cost-utility for six Retention in Care (RiC) programs using standard methods recommended by the U.S. Panel on Cost-effectiveness in Health and Medicine.  Program costs from the societal perspective ranged from $47,919 to $423,913 per year or $594 to $2,753 per participant. The programs averted between 0.23-1.65 HIV infections per year.  QALYs gained ranged from 1.51-11.00.  Using a threshold of $163,889 USD, all of the programs were cost-effective and four were cost-saving. Across a range of program models, retention in care interventions were cost effective (and the majority were cost saving), suggesting that retention in care programs are a judicious use of resources.

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Oct
10
12:00 PM12:00

Steven Goodreau: Sources of racial disparities in HIV prevalence among men who have sex with men in Atlanta: A modeling study

Sources of racial disparities in HIV prevalence in men who have sex with men in Atlanta: A modeling study

Steven Goodreau, Ph.D.
University of Washington, Seattle

ABSTRACT:

Black men who have sex men (MSM) in the US have a substantially higher prevalence of infection than White MSM, and many proximal and distal explanations have been offered to account for pieces of this disparity.

We created a simulation model to assess the strength of existing hypotheses and data. We built a dynamic, stochastic, agent-based network model of Black and White MSM aged 18–39 years in Atlanta, that incorporated race-specific individual and dyadic-level prevention and risk behaviors, network attributes, and care patterns. We estimated parameters from two Atlanta-based studies in this population (n=1117), supplemented by other published work. We modeled the ability for racial assortativity to generate or sustain disparities in the prevalence of HIV infection, alone or in conjunction with scenarios of observed racial patterns in behavioral, care, and susceptibility parameters. 

Race-assortative mixing alone could not sustain a pre-existing disparity in prevalence of HIV between Black and White MSM. Differences in care cascade, stigma-related behaviors, and CCR5 genotype each contributed substantially to the disparity (explaining 10.0%, 12.7%, and 19.1% of the disparity, respectively), but nearly half (44.5%) could not be explained by the factors investigated. A scenario assessing race-specific reporting differences in risk behavior was the only one to yield a prevalence in black MSM (44.1%) similar to that observed (43.4%). Racial assortativity is an inadequate explanation for observed disparities. Work to close the gap in the care cascade by race is imperative, as are efforts to increase serodiscussion and strengthen relationships among Black MSM particularly. Further work is urgently needed to identify other sources of, and pathways for, this disparity, to integrate concomitant epidemics into models, and to understand reasons for racial differences in behavioral reporting.

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Oct
3
12:00 PM12:00

Anna Satcher-Johnson & Ruiguang Song: Estimating HIV incidence, prevalence, and undiagnosed infection in the United States

Estimating HIV incidence, prevalence, and undiagnosed infection in the United States

Anna Satcher-Johnson, M.P.H. & Rick Song, Ph.D.
Centers for Disease Control and Prevention

ABSTRACT:

The burden of HIV infection and health outcomes for people living with HIV varies across the United States. New methods allow for estimating national and state-level HIV incidence, prevalence, and undiagnosed infections using surveillance data and CD4 values. 

Methods: HIV surveillance data reported to the Centers for Disease Control and Prevention and the first CD4 value after diagnosis were used to estimate the distribution of delay from infection to diagnosis based on a well-characterized CD4 depletion model. This distribution was used to estimate HIV incidence, prevalence, and undiagnosed infections during 2010–2014. Estimated annual percentage changes were calculated to assess trends. 

During 2010–2014, HIV incidence decreased 10.3% (EAPC = -3.1%) and the percentage of undiagnosed infection decreased from 17.1% to 15.0% (EAPC = -3.3%) in the United States; HIV prevalence increased 9.1% (EAPC = 2.2%). In 2014, Southern states accounted for 50% of both new HIV infections and undiagnosed infections. HIV incidence and undiagnosed infection decreased in the United States during 2010–2014; however, outcomes varied by state and region. Progress in national HIV prevention is encouraging but intensified efforts for testing and treatment are needed in the South and states with high percentages of undiagnosed infection.

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Sep
19
12:00 PM12:00

Carl Latkin: Social network approaches to HIV prevention and care

Social network approaches to HIV prevention and care

Carl Latkin, Ph.D.
Johns Hopkins Bloomberg School of Public Health

ABSTRACT:
The presentation will outline how social network approach can be utilized to reach hidden populations. Embedded in social network dynamics are social influence process that can be capitalized on to promote and sustain behavior change. The presentation will briefly provide guidance on tailoring social network inventories and then focus on developing and implementing RCT of network interventions and  measuring outcomes and controlling for contamination.

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Oct
25
12:00 PM12:00

Jeffrey Parsons: Alcohol and HIV medication adherence: Taking an intervention from efficacy to effectiveness

Alcohol and HIV medication adherence: Taking an intervention from efficacy to effectiveness

Jeffrey Parsons, Ph.D.
Hunter College

ABSTRACT:
Dr. Parsons will present on his series of research projects focused on the relationship between alcohol and other drug use and HIV medication adherence. Data from an efficacy trial of an 8 session behavioral intervention utilizing motivational interviewing and cognitive behavioral skills-building will be presented, followed by how this project led to a second RCT, and a current effectiveness trial focused on implementation issues. Throughout his presentation, Dr. Parsons will highlight the mistakes he and his team made throughout the process, and how they have learned from these.

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Oct
18
12:00 PM12:00

Lisa Hightow-Weidman: Addressing the HIV epidemic among YMSM: The Care Continuum 2.0

Addressing the HIV epidemic among YMSM: The Care Continuum 2.0

Lisa Hightow-Weidman, M.D
University of North Carolina-Chapel Hill

ABSTRACT:
While the epidemic of HIV in the US has leveled off for many age groups, from 2000-2010, the annual number of new HIV diagnoses among young men who have sex with men (YMSM) more than doubled. The success of treatment as prevention in reducing the number of new HIV infections among youth, and particularly YMSM, relies on HIV testing, antiretroviral treatment (both for treatment and prevention), adherence and viral suppression among those with HIV. Technology-delivered interventions are well suited for youth given its modality, its suitability to deliver tailored content specific to each user’s HIV/AIDS risk behaviors and context, and its unique capability to diffuse HIV/AIDS prevention programs to large numbers of youth residing in numerous geographic locations. Dr. Hightow-Weidman will describe her work addressing gaps in the continuum of care for youth through novel technology-based interventions including those delivered using smartphones, applications “apps” and incorporating virtual reality avatars and game-based elements.

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Oct
11
12:00 PM12:00

Linda Beer: Trends in racial and ethnic disparities in antiretroviral therapy prescription and viral suppression in the United States, 2009-2013

Trends in racial and ethnic disparities in antiretroviral therapy prescription and viral suppression in the United States, 2009-2013

Linda Beer, Ph.D
Centers for Disease Control and Prevention

ABSTRACT:
Objectives: To examine trends in racial/ethnic disparities in antiretroviral therapy (ART) prescription and viral suppression among HIV-infected persons in care, overall and among men who have sex with men (MSM), from 2009 to 2013.
Design: The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States.
Methods: We used weighted interview and medical record data collected 06/2009-05/2014 to estimate the prevalence of ART prescription and viral suppression among racial/ethnic groups overall and among MSM. 
Results: We found significant increases in ART prescription and viral suppression among all racial/ethnic groups from 2009 to 2013, both overall and among MSM. By 2013, overall and among MSM, the Hispanic-white disparity in ART prescription was non-existent, and the black-white disparity was not significant after accounting for differences between blacks and whites in age and length of HIV diagnosis. Despite reductions in racial/ethnic disparities in viral suppression over the time period, significant disparities remained among the total population, even after adjusting for differences in racial/ethnic group characteristics. Encouragingly, however, there was no significant Hispanic-white disparity in viral suppression among MSM by 2013.
Conclusions: Despite significant improvements in ART prescription and viral suppression in recent years, racial and ethnic disparities persist, particularly for black persons. If the United States is to achieve the National HIV/AIDS Strategy goal of reducing HIV-related health disparities, continued efforts to accelerate the rate of improvement in ART prescription and viral suppression among Hispanic and black persons may need to be prioritized.

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Oct
4
12:00 PM12:00

Samuel Jenness: Mathematical models for infectious disease transmission dynamics over networks: statistical methods, software tools, and applications for HIV/STI prevention science

Mathematical models for infectious disease transmission dynamics over networks: statistical methods, software tools, and applications for HIV/STI prevention science

Samuel Jenness, Ph.D.
Emory University

ABSTRACT:
HIV and STIs are transmitted over highly structured sexual partnership networks that evolve over time. Investigating network-based drivers of epidemics and opportunities for disease prevention has required the development of statistical approaches to modeling dynamic network structures embedded within broader mathematical models of intra- and inter-host epidemiology, demography, and bio-behavioral disease risk. In this talk, I present on temporal exponential random graph models (ERGMs) to model dynamic networks using easily collected egocentric network data, the integration of these methods within our epidemic modeling software, EpiModel (www.epimodel.org), and our recent applications of these tools to investigate empirical and intervention questions for HIV/STI prevention among men who have sex with men in the United States.

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Sep
27
12:00 PM12:00

Lisa Metsch & Dan Feaster: A patient navigation/contingency management RCT for hospitalized HIV-positive substance users (CTN 0049)

A patient navigation/contingency management
RCT for hospitalized HIV-positive substance users (CTN 0049)

Lisa Metsch, Ph.D.
Columbia University

Dan Feaster, Ph.D.
University of Miami

ABSTRACT:
Importance:  Substance use is a major driver of the HIV epidemic and is 7 associated with poor HIV care outcomes. Patient navigation (care 8 coordination with case management) and the use of financial incentives for 9 achieving pre-determined outcomes are interventions increasingly promoted 10 to engage patients in substance use disorders treatment and HIV care, but 11 there is little evidence for their efficacy in improving HIV-1 viral 12 suppression rates.

Objective:  To assess the effect of a structured patient navigation 14 intervention with or without financial incentives to improve HIV-1 viral 15 suppression rates among patients with elevated HIV-1 viral loads and 16 substance use recruited as hospital inpatients.

Design, Setting, and Participants:  From July 2012 through January 2014, 18 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive either patient 1 navigation alone (n = 266), patient navigation plus financial incentives (n = 2 271), or treatment as usual (n = 264). The HIV-1 plasma viral load was 3 measured at baseline and at, 6 and 12 months.

Interventions:  Patient navigation included up to 11 sessions of care 5 coordination with case management and motivational interviewing over 6 6 months. Financial incentives (up to $1160) were provided for achieving 7 targeted behaviors aimed at reducing substance use, increasing engagement 8 in HIV care, and improving HIV outcomes. Treatment as usual was the 9 standard practice at each hospital for linking hospitalized patients to 10 outpatient HIV care and substance use disorders treatment.

Main Outcome and Measures:  The pre-specified primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral non-suppression/all-cause mortality at 12-month follow-up.

Results:  There were no differences in rates of HIV viral suppression among the three groups at 12-months (PN=89/249, 35.7%, PN+FI=98/254, 38.6%, TAU=85/249, 34.1%, χ2(2) = 0.78, p < .68).  At 6-months 120/236 (46.2%) more participants in the PN+CM group were virally suppressed compared to 89/253 (35.2%) in the TAU group (p<.04).

Conclusion and Relevance:  Time-limited patient navigation and contingency management had short-term effects but were not sufficient to achieve sustained post-intervention viral suppression among substance users with advanced HIV disease.  More sustained individual-level interventions and broader-reaching approaches that address the social determinants of health may be needed for this population.

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Sep
20
12:00 PM12:00

Joel Wertheim: HIV transmission networks and their potential public health applications

HIV transmission networks and their potential public health applications

Joel Wertheim, Ph.D.
University of California-San Diego

ABSTRACT:
Understanding the path over which viruses such as HIV have been transmitted may be crucial for directing public health resources. Contact tracing of named sexual and injection drug-use partners of people recently diagnosed with HIV is an indispensable tool for reconstructing this transmission network. In addition, viral genetic sequence data—routinely collected by public health agencies—can also be used to infer the dynamics of HIV transmission. We explore the ways in which HIV sequence data has been used to better understand both global and local HIV transmission dynamics. Further, we validate the use viral genetic sequences in reconstructing these viral transmission networks in a public health surveillance setting and demonstrate how genetic sequence data are better than partner naming data for reconstructing the viral transmission network.

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Sep
13
12:00 PM12:00

Patrick Sullivan: Use of agent-based models to inform HIV prevention for men who have sex with men

Use of agent-based models to inform HIV prevention for men who have sex with men

Patrick Sullivan, Ph.D.
Emory University

ABSTRACT: 
Agent-based models allow a virtual “laboratory” to evaluate counterfactual scenarios, evaluate the potential impact of combinations of HIV prevention, and benchmark levels of prevention services required to achieve population-level impacts of programs. We will review agent-based models of HIV prevention approaches for MSM in 5 countries, and describe how the findings of these models have been used to design combination prevention programs and guide programmatic goal setting. The results of agent-based models in different countries support the role of smart combinations of prevention interventions (e.g., PrEP, testing, treatment) and of ancillary services to increase the impact of specific modalities (e.g., adherence promotion for PrEP).

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Jan
26
12:00 PM12:00

Judith Moskowitz: Randomized trial of a positive affect skills intervention for people newly diagnosed with HIV

Randomized trial of a positive affect skills intervention for people newly diagnosed with HIV

Judith Moskowitz, Ph.D., M.P.H.
Northwestern University

ABSTRACT:
Observational studies indicate that positive affect has unique beneficial psychological and physical health effects in the context of stress. We tested whether a positive affect skills intervention in the 3 months following HIV-diagnosis was associated with improvements in coping and psychological well-being.  Participants were randomly assigned to 5 weekly in-person sessions to learn positive affect skills (n = 80) or to participate in an attention matched control condition (personal interviews; n = 79.) Follow up assessments were conducted at 5, 10, and 15 months post diagnosis.  Intent to treat analyses indicated that both groups had significant increases in positive affect and significant decreases in depressive mood. Compared to controls, intervention participants had decreases on PTSD symptoms, antidepressant use, rumination, and improvements in mindfulness.  We conclude that positive affect interventions hold promise for helping people
cope with stressful life experiences. 

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Apr
21
12:00 PM12:00

Velma McBride Murry: Technology as an alternative platform for delivering HIV risk prevention for African American youth: The Pathways for African American Success (PAAS) Program

Technology as an alternative platform for delivering HIV risk prevention for African American youth: The Pathways for African American Success (PAAS) Program

Velma McBride Murry, Ph.D.
Vanderbilt University

ABSTRACT:
While prevention scientists have increasingly recognized the potential benefits of interactive computer technology as an avenue for delivering preventive interventions to youth, there is a paucity of HIV preventive interventions that have utilized computer- based approaches. This current study was designed to test the efficacy of PAAS as an alternative delivery platform to speed up the process for moving effective HIV programs from science to practice.  PAAS, a second-generation program of the Strong African American Families (SAAF) program, is a six-week session family skill-training program designed to deter early sexual onset, risky sexual practices, and the initiation and escalation of drugs/alcohol among rural African American youths.  A total of 412 African American parents and their 6th grader from five rural counties were randomly assigned to the following: traditional didactic in-person delivery, CD-ROM, or minimal control conditions.  During the presentation a brief overview of the process of transporting and translating SAAF to PAAS will be provided, followed analyses designed to determine if technology-version of PAAS is “good enough” to establish clinically significant change in intervention targets. Implications for future research and ways to advance the field of prevention science, in addressing the need for more culturally tailored programs for use with racial/ethnic families will be discussed. 

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