This content originally appeared on FDA News Release. View the full article here.
[On December 22, 2022], the U.S. Food and Drug Administration approved Sunlenca (lenacapavir), a new type of antiretroviral medication for adult patients living with human immunodeficiency virus type 1 (HIV-1), whose HIV infections cannot be successfully treated with other available treatments due to resistance, intolerance, or safety considerations. After the starting dose is completed, Sunlenca is administered as subcutaneous (under the skin) injections once every six months, allowing convenient dosing for patients.
“Today’s approval ushers in a new class of antiretroviral drugs that may help patients with HIV who have run out of treatment options,” said Debra Birnkrant, M.D., director of the Division of Antivirals in the FDA’s Center for Drug Evaluation and Research. “The availability of new classes of antiretroviral medications may possibly help these patients live longer, healthier lives.”
Sunlenca is the first of a new class of drugs called capsid inhibitors to be FDA-approved for treating HIV-1. Sunlenca works by blocking the HIV-1 virus’ protein shell (the capsid), thereby interfering with multiple essential steps of the viral lifecycle. Sunlenca’s starting dose is given as oral tablets and subcutaneous injections, followed by maintenance injections every six months; Sunlenca is given in combination with other antiretroviral(s).
The safety and efficacy of Sunlenca were established through a multicenter clinical trial with 72 patients whose HIV infections were resistant to multiple classes of HIV medications. These patients had to have high levels of virus in their blood despite being on antiretroviral drugs. Patients were enrolled into one of two study groups. One group was randomized to receive either Sunlenca or placebo in a double-blind fashion, and the other group received open-label Sunlenca. The primary measure of efficacy was the proportion of patients in the randomized study group who achieved a certain level of reduction in virus during the initial 14 days compared to baseline. In this group, 87.5% of patients who received Sunlenca achieved such a decrease in virus compared to 16.7% of patients who received a placebo. After 26 weeks of Sunlenca plus other antiretrovial drugs, 81% of participants in the first group achieved HIV RNA suppression, where levels of HIV were low enough to be considered undetectable. After 52 weeks, 83% of participants continued to have HIV RNA suppression.
The most common adverse reactions with Sunlenca were injection site reactions and nausea. Most injection site reactions were described as swelling, pain or redness. Sunlenca comes with certain warnings and precautions. Injection site reactions described as nodules or indurations may be persistent in some patients. Additional warnings and precautions include the risk of developing immune reconstitution syndrome, which is when the immune system overreacts after starting HIV treatment. Also, small (residual) amounts of Sunlenca can remain in the body for up to a year or longer; low levels of drug caused by missing doses of Sunlenca or failing to maintain a fully suppressive HIV treatment regimen after stopping Sunlenca could lead to an increased risk of developing viral resistance. Residual amounts of Sunlenca could also lead to potential drug interactions.
Patients should not receive Sunlenca if they also take certain drugs that cause reduced levels of Sunlenca. This may result in losing virologic response and developing viral resistance.
CHIPTS Combination Prevention Core Director Dr. Cathy Reback was recently recognized for her work developing an impactful text messaging intervention – Text Me, Girl! – that improves antiretroviral therapy (ART) uptake and adherence and self-reported viral suppression among transgender women ages 18–34 years. As of November 2022, Text Me, Girl! is live on TargetHIV.org as part of the Ryan White HIV/AIDS Program (RWHAP) Best Practices Compilation. As described on TargetHIV.org:
Text Me, Girl! is a text messaging intervention that aims to improve linkage to and retention in HIV care, increase adherence to HIV medications, and improve viral suppression and other health outcomes among transgender women ages 18–34 years. Text Me, Girl! delivers automated text messages grounded in behavioral change theory and associated with all stages of the HIV care continuum. The intervention supports young transgender women with HIV, particularly those experiencing barriers to care such as periods of homelessness and/or incarceration, substance misuse, or engaging in sex work.
Text Me, Girl! was developed and evaluated as part of Use of Social Media to Improve Engagement, Retention, and Health Outcomes along the HIV Care Continuum, an initiative funded by the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) program. Text Me, Girl! participation was associated with statistically significant improvements in ART uptake and adherence, and self-reported viral suppression.
Check out these resources to learn more about the Text Me, Girl! Intervention and evidence-base:
The 2022 HIV Next Generation Conference hosted by CHIPTS welcomed 130 attendees for a day of presentations, discussions, and networking. The conference facilitated by Dallas Swendeman, CHIPTS Development Core Co-Director, welcomed attendees and participants from academic institutions, community-based organizations, health care institutions, and other organizations working to end the HIV epidemic. The day also provided a unique opportunity for cross-collaboration and mentorship.
The conference theme, “Implementation Science for HIV Prevention and Treatment to End the Epidemics” was emphasized throughout the day’s program. Steve Shoptaw, CHIPTS Director and Norweeta Milburn, CHIPTS Development Core Director gave opening remarks to lay the groundwork for the conference. Amaya Perez-Brumer, Assistant Professor at the University of Toronto offered an engaging and informative opening plenary.
The program proceeded with the first set of sessions featuring presentations and panel discussion that occurred concurrently. One set of sessions, moderated by Laura Bogart, CHIPTS Combination Prevention Core Scientist centered on mental health and HIV prevention. The first session featured Jasmine Lucero Lopez, she discussed the impact of a virtual platform to mitigate the effects of isolation among older people living with HIV using Discord.Katherine Lewis highlighted mental health strengths among youth at-risk for and living with HIV. Curtis Wong & Alice Ma shared sexual health promotion methods and decision-making strategies among youth at-risk for HIV in Los Angeles and New Orleans.
The second session running concurrently, facilitated by Dilara K. Üsküp, CHIPTS Policy Impact Core Scientistcentered on HIV prevention. The second set featured David Mosqueda & Dino Selders who addressed PrEP/ PEP use disparities amongst marginalized communities by way of a peer-led collaborative initiatives. Lori Zomback described medical student-ran telehealth for HIV testing and counseling among sexual minority men. Pablo Zapata discussed factors associated with HIV testing among Spanish and English speaking Latinx youth.
A second set of two concurrent sessions followed, this set included a session focused on substance use and HIV that was facilitated by Pamina M. Gorbach, CHIPTS Global HIV Director. Boram Kim & Cheng-Shi Shiu began the first session, discussing factors influencing betel nut chewing behavior in people living with HIV in Myanmar. Amanda P. Miller presentation examined substance use and associated intimate partner violence risk among MSM In Los Angeles, California.
A concurrent session facilitated by Jesse Clark, CHIPTS Combination Prevention Scientist Core was the first of the EHE Implementation Science panels. Alison Hamilton discussed the UCLA Rapid, Rigorous, Relevant (3R) implementation science hub and its supporting EHE Initiatives. Wei-Ti Chen addressed intersectional oppression in Asian Pacific Americans with HIV in Southern CA through a implementation science framework. Laura Hoyt D’Anna, Everardo Alvizo & Jaelen Owens collaborated to present on implementing a community-engaged equity approach to identify barriers and facilitators to the PrEP care continuum in Long Beach, CA.
The first panel in the final set focused on policy impact and was facilitated by Ayako Miyashita Ochoa, CHIPTS Policy Impact Core Co-Director. Felipe Findley & Vanessa Warri led an engaging discussion focused on HIV and the carceral state describing the effects of research on health outcomes. The second panel led by Dallas Swendeman, CHIPTS Development Core Co-Director closed the second part of the EHE Implementation Science panels. Ronald A. Brookspresented on implementation strategies that promoted equitable dissemination of LAI and PrEP to Black/Latino MSM and Transgender women in Los Angeles. Raiza M. Beltran & Tam Phan discussed pharmacist delivered PrEP and PEP in three high priority EHE counties in CA. Carl Highshaw & Sung-Jae Lee provided an overview of Haus of C.H.O.P (Choosing Healthy Options for Prevention/PrEP). Corrina Moucheraud & Raphael Landovitz described their project focused on financially incentivizing strategies for HIV prevention in high-incidence populations in LA County.
Finally, CHIPTS Co-Director Raphael J. Landovitzgave the closing remarks, reminding attendees of the conference’s purpose and highlighting the need for innovative interventions to end the HIV Epidemic.
See below for oral presentation PDFs and available recorded presentations.
WELCOME AND OPENING REMARKS
Opening Remarks by:
Norweeta Milburn, PhD, Director, CHIPTS Development Core
Steve Shoptaw, PhD, Director, CHIPTS
Conference Facilitator and Announcements by:
Dallas Swendeman,PHD, Co-Director, CHIPTS Development Core
OPENING PLENARY
Amaya Perez-Brumer, PhD, MSC, Assistant Professor, Dalla Lana School of Public Health, Division of Social and Behavioural Health Science
Presentation Title: Who Benefits from Global HIV Prevention Science? A Call for Researcher Accountability
Presentation Summary: To imagine and reimagine a more just praxis for HIV research globally, we, as scholars and practitioners, must grapple with the extreme privilege at the center of who gets to do global HIV health research, who are its beneficiaries, and who are its subjects. To begin to think through these provocations, this talk will discuss three ongoing paradoxes rooted in data politics and the extractive logics at the center of global HIV prevention science.
Presentation Summary: This presentation will discuss the perspectives of a Community Advisory Board (CAB) on the usability of Discord as a virtual village. We will explore the benefits and drawbacks of this platform for the purpose of this study, based on the opinions expressed by the CAB. Lessons learned from this experience and how to improve future studies will be shared.
Presentation Summary: Youth enrolled in several linked HIV prevention and treatment continua studies who participated in a telehealth coaching intervention completed a strengths assessment, and qualitative data on mental health strengths was analyzed using thematic analysis and a resilience lens. Youth self-described mental health strengths included intrapersonal resilience assets (protective traits, stress management activities, feeling positive despite current mental health challenges, and no current mental health challenges) and external resilience resources (social/emotional support, therapy/counseling, and use of mental health medication). These results highlight the utility of strengths-based intervention methods and resilience for youth at-risk for and living with HIV.
Presentation Summary:A strengths-based telehealth coaching intervention was delivered to youth at-risk for or living with HIV in Los Angeles and New Orleans within the context of several linked HIV prevention and treatment continua studies. We used a choice-based framework and qualitative methods to analyize strengths assessment data, which revealed intrapersonal, interpersonal, and structural factors that influenced participants’ sexual health decision-making, including decisions regarding PrEP use, condom use, and other strategies. These results demonstrate the utility of self-determination and choice-based frameworks in sexual health promotion efforts for youth.
Presentation Summary: PrEP Furnishing shows promise of assisting marginalized peoples living in primary care healthcare shortage areas. Altamed fast tracks furnishing initiatives by placing PrEP navigators in the lead when it comes to Patient initial care and retention.
Presentation Summary: A group of medical students conducted tele-health HIV testing using OraQuick and provided education and risk-reduction counseling during the turnaround time. There was high participant satisfaction and educational benefit for the students, demonstrating benefits to both public health and medical education.
Presentation Summary: Data for the current project were collected as part of SMART, an ongoing pragmatic trial of an online HIV prevention intervention for adolescent sexual minority youth. Despite higher risk, few Latino youth reported ever having received an HIV test. Results suggest sexual health education and pediatricians are an important, but largely untapped, source of testing and could be further supported with familial support to end the epidemic
Presentation Summary: Despite the WHO classifying betel nuts as a carcinogen with a high risk of oral and laryngeal cancer, Myanmar is one of the world’s largest consumers of betel nuts because chewing betel nuts is socially and culturally influenced in Myanmar. The study aimed to examine factors that influence betel nut chewing in people living with HIV (PLWH) in Myanmar. From a secondary analysis of 2020 Myanmar PLWH data, physiological hyperarousal symptoms and loneliness were associated with increased betel nut chewing among PLWH in Myanmar.
Presentation Summary: Prior work suggests substance use is a risk factor for intimate partner violence but limited research exploring this association among MSM exists. We explored associations between substance use and experiences of IPV among MSM participating in the mSTUDY cohort in Los Angeles. Stimulant use was associated with increased odds of experiencing IPV relative to those reporting no stimulant use and the magnitude of this association was greater among MSM living with HIV.
Set 2 – Panel 2: EHE Implementation Science (PT. 1)
Presentation Summary: The UCLA 3R Hub, a supplement to CHIPTS, is one of eight hubs funded by the NIMH to support EHE pilot Implementation studies. Tis presentation will briefly address the critical role of Implementation science in ending the HIV Epidemic and will describe services and supports that are available to the Southern California community and beyond.
Presentation Summary: The purpose of this study is to collaborate with the local Asian Pacific American With HIV (APAWH) community to adapt and evaluate the appropriateness, acceptability, and feasibility of a 4-session, 4-week Social-justice Oriented, Family Informed self-management intervention to promote health among APAWH in Southern California, particularly Orange counties (SOFIAA). The scientific premise is that APAWH experience systematic barriers in healthcare delivery and policies, resulting in poor health outcomes. Additionally, regardless of ethnicity, APAs often prioritize their responsibilities to their families over their own individual needs. Our hypothesis is that APAWH will perceive SOFIAA as acceptable, feasible, and appropriate and a future study will demonstrate SOFIAA may be used to promote family support, decrease the effects of structural racism and HIV-related stigma, and achieve better outcomes in APAWH. This study addresses the critical need to optimize an intervention to promote self-management skills among APAWH by simultaneously addressing the reality and effects of structural racism and discrimination against APAWH from both the mainstream U.S. society and the APA communities.
3. Laura Hoyt D’Anna, MPA, DrPH & Everardo Alvizo, LCSW & Jaelen Owens, BA
Presentation Summary: The study aims to address the HIV epidemic by improving PrEP linkage, uptake, and retention among Black and Latinx same-gender loving men, transgender women, and other gender-diverse persons in Long Beach, CA. This is a mixed methods study designed to explore barriers and facilitators to engagement along the PrEP care continuum from the viewpoints of community members and current and potential PrEP providers. Findings will inform the following: 1) the Long Beach HIV/STI Strategic Plan, 2) a culturally appropriate PrEP readiness and facilitation tool, and 3) intervention opportunities to be studied in future research.
Set 3 – Panel 1: Policy Impact
1. Felipe Findley, PA-C, MAPS, AAHIVS & Vanessa Warri, MSW
Presentation Summary: This panel will share broad perspectives of CHIPTS Community Advisory Board member and community partners engaged in CHIPTS PIC work to address disproportionate health outcomes across communities engaged by carceral systems. Panelists will elucidate pathways for researchers to better capture the effects of criminalization on health outcomes.
Set 3 – Panel 2: EHE Implementation Science (PT. 2)
Presentation Summary: The project will host 7 informational/educational community workshops to provide up-to-date and relevant information on LAI-PrEP to providers (medical and non-medical) that serve Black/Latino/a MSM and transgender women and potential consumers. Additionally, the project will develop a community-derived and culturally appropriate strategic messaging guide to facilitate ongoing dissemination of LAI PrEP information to our focused populations of providers and consumers.
2. Raiza M. Beltran, PhD, MPH & Tam Phan, PharmD, AAHIVP
Presentation Summary: For this presentation, we will provide a short overview of our proposed project that builds community capacity to better examine the facilitators and barriers to pharmacists-furnished HIV services in select priority areas of Southern California.
Presentation Summary: For this study, we provide a plan on the equity-focused approaches aimed at optimizing engagement of young Black LGBTQ+ individuals across the PrEP care continuum by partnering with House & Ball Community (H&BC) members using social work guiding principles.
Presentation Summary: TIPS is a recently-funded project (an Ending the HIV Epidemic supplement to CHIPTS) that is using a mixed methods approach to understand how best to design an investigational financial incentives program for PrEP use and HIV prevention among young, Latino, Black and African American, cisgender men who have sex with men in South Los Angeles. This represents a collaborative research endeavor between investigators at UCLA, APLA Health & Wellness, and DHSP; and aims to generate policy- and program-relevant insights.
Since 1988, communities around the world have come together annually on December 1 to observe World AIDS Day. World AIDS Day offers an opportunity to unite in demonstrating support for those living with HIV, remembering those lost, and redoubling its commitment to ending the HIV epidemic. The U.S. government’s theme for World AIDS Day 2022 was “Putting Ourselves to the Test: Achieving Equity to End HIV,” highlighting the importance of providing equitable access to HIV testing, prevention, care, treatment, and research. CHIPTS commemorated this important day with a social media series highlighting why our CHIPTS community members wear red for World AIDS Day, and by participating as a partner in the Charles R. Drew University of Medicine and Sciences World AIDS Day 2022 event.
CHIPTS Social Media Series: Why I Wear Red for World AIDS Day
“I #WearRed for #WorldAIDSDay because it reminds me and others that we must continue working to End the HIV Epidemic.” – Dr. Steve Shoptaw, CHIPTS Director“I #WearRed for #WorldAIDSDay to honor and cherish the people we have lost, celebrate how far we have come in preventing and treating HIV, and remember we still have work to do to reach people who continue to be marginalized in our prevention and treatment efforts.” – Dr. Norweeta Milburn, CHIPTS Development Core Director“I #WearRed for #WorldAIDSDay because I want to be part of the collective voice to end HIV/AIDS!” – Eddie Sanders, CHIPTS Community Advisory Board Co-Chair“I #WearRed for #WorldAIDSDay because I fight against stigma and inequities associated with HIV.” – Dr. Chunqing Lin, CHIPTS Methods Core Associate Director“I #WearRed for #WorldAIDSDay because there is still so much work to do. And we will not rest until we have ended the HIV pandemic.” – Dr. Raphael Landovitz, CHIPTS Co-Director and Combination Prevention Core Co-Director
“I #WearRed for #WorldAIDSDay to remember all our friends, family members, and colleagues who died in the 1980s and 1990s just months following a diagnosis. I wear red for #WAD2022 to honor those living with HIV. I wear red for #WAD to do my part to End the HIV Epidemic.” – Dr. Cathy Reback, CHIPTS Combination Prevention Core Director“I #WearRed for #WorldAIDSDay because transmasculine people are left out of the HIV/AIDS conversation and I want to ensure that those in my community have access and want to bring awareness to the overall human community.” – Luckie Alexander, CHIPTS Community Advisory Board Member
“I #WearRed for #WorldAIDSDay until we have found a cure.” – Dr. Christina Ramirez, CHIPTS Methods Core Scientist“I #WearRed on #WorldAIDSDay because it shows that I stand in solidarity with those who are infected as well as those who are affected by HIV/AIDS.” – Chandi Moore, CHIPTS Community Advisory Board Member“I #WearRed for #WorldAIDSDay to remember the many people who lost their lives to HIV. It is in their honor and memory that I work to help advance research to ensure there is equitable access to services for all. Only together will we end HIV.” – Uyen Kao, CHIPTS Executive Director
Drew CARES World AIDS Day 2022 Event
CHIPTS participated in the World AIDS Day event at Charles R. Drew University of Medicine and Science on Monday, December 5, 2022, from 11:00 AM to 3:00 PM. The event was hosted by the Drew Center for AIDS Research, Education, and Services (Drew CARES). Students, staff, faculty, and community members visited the CHIPTS table to learn more about the work we do to address inequities and end the HIV epidemic. CHIPTS staff engaged with attendees and offered HIV-related educational resources and promotional materials.
Check out our mini-gallery featuring event photos.
This content originally appeared on NIDA. View the full article here.
On World AIDS Day, December 1, we remember those lost to the HIV epidemic, take stock of how far we have come, and map the way forward. In the past decades, scientific and community leadership have achieved great things in helping people with HIV live long, healthy lives, as well as reducing HIV transmission through prevention. Yet as the United States grapples with the dual epidemics of HIV and drug overdose, people who use drugs continue to be left behind—especially sexual and gender minorities who are disproportionately impacted by HIV.
But even with multiple forms of HIV prevention now available, including pre-exposure prophylaxis (PrEP) pills for people who are HIV-negative and antiretroviral therapy that can help people with HIV maintain an undetectable viral load and thus not transmit the virus, HIV transmission rates remain frustratingly elevated. Increased methamphetamine use over the past decade may play an overlooked role. A 2020 study in the Journal of Acquired Immune Deficiency Syndromes (JAIDS) showed that a third of new HIV transmissions among sexual and gender minorities who have sex with men were in people who regularly use methamphetamine.
Methamphetamine use is more prevalent among gay and bisexual men than among other men, and it often accompanies sex (sometimes called “partying and playing” or “chemsex”). While in previous decades the mixing of methamphetamine and sex was mainly associated with White gay men, Black and Hispanic men who have sex with men are increasingly using methamphetamine too.
The disinhibiting effects of methamphetamine can increase certain sexual behaviors that make transmission of HIV more likely. There is also evidence that methamphetamine may make the body more vulnerable to HIV acquisition and contribute to HIV disease progression. Methamphetamine use can also lead to other serious health concerns, including addiction and fatal overdose.
In a new NIDA video, “Sex, Meth and HIV,” we highlight that to end the HIV epidemic with the effective tools at our disposal requires that we first recognize and respect the complexity and needs of sexual and gender minorities who use drugs. Like other drugs, methamphetamine may help individuals cope with mental health challenges like depression, anxiety, and trauma. Some gay and bisexual men use methamphetamine to enhance sexual experience and sense of connectedness. It can also temporarily boost self-confidence among individuals who may experience stigma and shame surrounding sexuality or other aspects of their lives.
For clinicians working to educate patients about health at the intersection of HIV and drug use, understanding the role that methamphetamine plays in an individual’s life is critical to providing quality care.
As Sarit Golub, a City University of New York (CUNY) Hunter College psychologist researching HIV and stigma, says in a companion video for clinicians, “Trust, Stigma and Patient Care,” telling gay and bisexual men about risks of combining drugs and sex can come across as instilling fear and shame, and may alienate rather than empower. As Dr. Golub notes, such communication can disregard the totality of an individual’s needs—for connection, for pleasure, and for confidence in a world that judges and shames.
Even in healthcare settings, people commonly experience stigma around drug use and sexuality, as well as racism and other forms of discrimination. A history of encountering stigma and discrimination in these settings often leads people to avoid disclosing their substance use and sexual practices with their providers. Clinicians must work with patients to rebuild that lost trust by listening to patients’ concerns rather than imposing their own.
“Meeting people where they are”—that is, providing care regardless of substance use or other behaviors that confer some health risk—has become the guiding philosophy of harm reduction. But it should also apply to prevention and treatment of both HIV and substance use disorders. We cannot hope to reach communities with effective prevention measures such as PrEP without recognizing and accepting the totality of people’s experiences, wants, and needs. Listening and acceptance from others help people take control of their own health. Equally important is to ensure that access and coverage for HIV prevention and treatment are accessible to all who can benefit from them.
Research to find better ways to reach people who use drugs with HIV prevention tools like PrEP, as well as to guide policymakers and insurance providers in ensuring the coverage of these tools, is a key focus area in NIDA’s 2022-2026 Strategic Plan. Expanding education regarding drugs and HIV, reducing stigma, and overcoming other barriers to care are also crucial. Carrico and CUNY School of Public Health researcher Christian Grov (lead author of the JAIDS study) are currently conducting NIDA-funded research on strategies to increase the use of PrEP among sexual minority men who use stimulants, including use of telehealth and incentives (contingency management) to facilitate adherence.
As NIH honors World AIDS Day, we particularly remember the people lost to the dual epidemics of HIV and overdose. For those grieving loved ones, NIDA stands among you. Through scientific advancement, NIDA is committed to saving lives. Recovery and healthy, long lives are possible through the use of evidence-based treatments alongside social support.
The 2022 CHIPTS HIV Next Generation Virtual Conference is this upcoming Friday, December 2, 2022 from 9:00 AM – 12:15 PM PT! The conference is VIRTUAL and FREE to attend.
The goal of this conference is to support the next generation of HIV researchers, HIV prevention and treatment practitioners, and service providers working towards an end to HIV/AIDS through networking and sharing visions for future priorities. The theme of this year’s conference is “Implementation Science for HIV Prevention and Treatment to End the Epidemics.” The conference will feature oral and poster presentations by faculty, student and emerging researchers from various institutions.
CEU credits: Attend the conference, and sign in and out using the form that will be provided to receive credits. The PAETC will follow up post-conference.
The Pacific AIDS Education and Training Center – Los Angeles Area is accredited to provide the following: Continuing LCSW and MFT Education Credit. Courses meet the qualification for a maximum 3.5 hour of continuing education credit for LMFTs, LCSWs, LPCCs, and LEPs as required by the California Board of Behavioral Sciences. Provider #PCE 128280. Continuing Nursing Education Credit. Course is approved for a maximum of 3.5 contact hour by the California Board of Registered Nursing. Provider #15484.
We invite you to take a look at the poster presentations below which will be featured at the 2022 Next Generation Virtual Conference.
POSTER PRESENTATION 1
Presenter(s):
Gabriel Edwards, MD, MPH, Associate Project Scientist, Department of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine
Presentation Title: Mobile Enhanced Prevention Support: App Design for People Leaving Jail
Summary: This is a project which received funding as part of the CHIPTS 2022 Mentored Pilot Grant Program. It focuses on a population at high risk for HIV -sexual and gender minorities with a recent history of incarceration and substance use, and aims to gather qualitative data on the way the population engages with mobile technology to address health and social needs. We use an implementation science framework centering around health equity to guide data collection.
Presentation Title: A ‘Think Aloud’ Qualitative Study to Improve Coping with Discrimination and Reduce Health Disparities among Black Sexual Minority Men
Summary: ‘Think Aloud’ is a processes can add depth to the quantitative and qualitative research and gives dimension to thought processes and behavioral responses. There are a variety of studies looking at Black sexual minority men and intersectionality’s impact on mental health and stigma; however, they do not combine ‘Think Aloud’ with self-reported discrimination for a better understanding of the impact of discrimination and stigma on mental health and coping mechanisms.
POSTER PRESENTATION 3
Presenter(s):
Aliaa Ibnidris, PhD, Postdoctoral Research Fellow, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town
Presentation Title: Association of combined antiretroviral therapy with altered brain function and cognition dysfunction in people with HIV
Summary: Neurocognitive impairment in later stages of HIV is common ad still occurs even in controlled HIV infections with combined antiretroviral therapy (cART). This project aims to look at the association between being on cART with brain function as well as with cognitive performance in people with HIV.
POSTER PRESENTATION 4
Presenter(s):
Ricardo Mendoza Lepe, PhD, Bilingual Research Coordinator, Bienestar Human Services
Presentation Title: Desde su Persectiva: Inclusivity and Research Community Advisory Boards in Transgender Research
Summary: Meetings to improve research about their communities, learn and be part of their research, learn about research development, and create inclusive and trusted programs for the transgender community.
POSTER PRESENTATION 5
Presenter(s):
Amanda P. Miller, MS, PhD, Postdoctoral Fellow, San Diego State University & University of California San Diego (Joint T32 program)
Presentation Title: Evaluating the relationship between hazardous alcohol use andintimate partner violence and PrEP use in pregnant and breastfeeding women at high risk of HIV in Cape Town, South Africa
Summary: HIV, perinatal alcohol use and intimate partner violence (IPV) represent a syndemic that produces a tremendous public health burden for both mother and fetus in South Africa. Contextualizing drivers of alcohol use and risk factors for IPV among pregnant and breastfeeding women and how alcohol use, IPV victimization and other social determinants of health experienced by South African women influence decision making around PrEP use will provide critical insight into potential points of intervention to address these intersecting health issues. We qualitatively explored these themes among pregnant women at high risk of HIV infection who report using alcohol and/or experiencing intimate partner violence during pregnancy.
POSTER PRESENTATION 6
Presenter(s):
Bret Moulton, MPH, Supervising Epidemiologist, Los Angeles County Department of Public Health, Division of HIV and STD Programs
Presentation Title: “Ending the HIV Epidemic” in Los Angeles County: HIV Diagnoses Among Clients Utilizing Free, Mailed HIV Self-Test Kits
Summary: As an emerging strategy to expand HIV testing availability, self-testing can expand screening access to persons who might experience barriers to accessing health care. Since 2020, Los Angeles County has provided free HIV self-test kits through the mail to targeted residents. One-third of people who ordered a kit reported never testing for HIV before, and 1.1% of participants had an HIV diagnosis within one year
POSTER PRESENTATION 7
Presenter(s):
Jada Williams, BS, Graduate Student, UCLA Division of Population Behavioral Health
Presentation Title: Experiences of the COVID-19 Pandemic Among Queer Black Men in Los Angeles: Reflections from a Virtual Listening Session
Summary: The CFAR Health Disparities Core convened a virtual listening session with queer Black men living in Los Angeles to describe the meanings of a shared lived experience, as well as the situations, conditions, and contexts that are part of the lived experience of participants. The current study was designed to better understand the experiences of queer Black men, including experiences associated with their sexual minority and race or racialized identities during the COVID-19 pandemic.
POSTER PRESENTATION 8
Presenter(s):
Jocelyn Limas, BSc, Graduate Student Researcher, UCLA Fielding School of Public Health – Epidemiology, UCLA Semel Institute Center for Community Health
Presentation Title: Barriers to PrEP initiation among at-risk youth in Los Angeles and New Orleans
Summary: HIV PrEP uptake among adolescents and young adults remains low, prompting research and interventions to address barriers to PrEP initiation with a focus on expanding PrEP awareness and knowledge. In this analysis, data from a study of the Adolescents HIV Medicines Trial Network (ATN 149) was used to identify other underlying and often overlooked barriers to PrEP initiation amongst this population and how these barriers changed over time.
POSTER PRESENTATION 9
Presenter(s):
Reshmi Mukerji, MPH, Graduate Student, University College London, Institute for Global Health
Presentation Title: Qualitative study of intersectional stigma of HIV and other marginalized identities among women living with HIV in India
Summary: Women living with HIV carry a disproportionate burden of HIV stigma, especially in countries where gender discrimination is rampant. Women who have additional marginalized identities often experience worsened violence as a result of multiple stigmas. The nature of this violence can be temporal in nature, as there is a reduction in enacted and internalized stigma over time.
POSTER PRESENTATION 10
Presenter(s):
Ali Mhungu, PhD Student, School of Health Sciences University of Dundee
Presentation Title: Adult Girls and Young Women’s experiences of HIV in the context of patriarchal culture in Murewa, Zimbabwe
Summary: This presentation presents the personal, relational and social experiences of living with HIV amongst the adolescent girls and young women (AGYW). The results of this study indicated that despite being disfranchised by HIV, AGYW demonstrated agency and resilience.
POSTER PRESENTATION 11
Presenter(s):
Antwan De’Sean Matthews, BSc, Director Of Youth Programs, Code Tenderloin
Presentation Title: Code Tenderloin Empowering Black Youth Program Provides Incentives And Resources to Address Health Disparities in San Francisco, CA.
Summary: Throughout this workshop, the audience will learn how Nonprofits can effectively provide resources and solutions for the communities they serve through program implementation. Through the EBY program process, students are incentivized to participate in the development of the program by providing financial opportunities throughout the 16 weeks. With a diverse funding source, EBY 2022 cohort funded ten interns at $8,000 per student and three fellows at $10,500 per student. Audience members will have learned by the end of the presentation how to develop effective programs through advocacy and program development and implementation to help address health disparities in their communities.
POSTER PRESENTATION 12
Presenter(s):
Vanessa R. Warri, MSW, PhD Student, UCLA Department of Social Welfare, Luskin School of Public Affairs, Center for the Study of Women
Presentation Title: Towards Justice-Centered Futures in Transgender Research: Community-Driven Insights for Repairing and Forging Stronger Academic and Community Relations
Summary: : Robust safeguards against exploitative or harmful research practices related to transgender, gender-expansive, and intersex (TGI) communities have not yet fully been articulated, much less systematically implemented in institutional settings. This presentation offers reflective insights from phase one qualitative interviews of an ongoing collaboration between research universities and TGI communities in California to examine research priorities, ethical considerations, and opportunities to foster greater relationships among TGI and academic research communities
This content originally appeared on HIV.Gov. View the full article here.
Each year on December 1st, we commemorate World AIDS Day. This important awareness day remains a time to reflect on our worldwide response to HIV/AIDS while honoring the lives of those lost to AIDS-related illnesses. On this day, we also renew our commitment to supporting the wellbeing of those with HIV, as well as those at risk for infection.
The U.S. Government (USG) theme for World AIDS Day 2022— Putting Ourselves to the Test: Achieving Equity to End HIV— emphasizes accountability and action, affirming the Biden-Harris Administration’s dedication to ending HIV, both in the United States and around the globe, through an approach that centers on communities disproportionately affected by the pandemic. This year, we observe World AIDS Day in the context of two other infectious disease threats—COVID-19 and monkeypox—which have heavily impacted many of those same communities. These epidemics have further highlighted that our public health response to HIV will require us to address health disparities holistically.
The theme also highlights the importance of HIV testing. “Everyone should get tested for HIV and know their status. We are advancing a status-neutral approach to HIV testing that puts equity at the forefront. Under this approach, no matter what the outcome of the test, people should be connected with the necessary HIV prevention and treatment services, including strategies to address social determinants of health and barriers to access,” said Kaye Hayes, HHS Deputy Assistant Secretary for Infectious Disease and the Director of the Office of Infectious Disease and HIV/AIDS Policy.
We have made remarkable strides since the first World AIDS Day commemoration 34 years ago. Scientific research has yielded innovations in HIV care, treatment, and prevention so that individuals with HIV can enjoy longer, healthier lives. Robust scientific studies have also shown that people who are on HIV medication and achieve and maintain viral suppression cannot spread HIV to others, which means that successful treatment further drives down new transmissions. These advances have been possible due to strategic collaborations between governments, public-sector partners, multilateral institutions, nongovernment and philanthropic organizations, private companies, and research institutions. People with HIV have been central to this progress, and community-based organizations working in areas most affected by HIV are at the forefront of ensuring that the advances we have made translate into real improvements in the health and lives of the people they serve.
Yet despite our tremendous progress, our work is not finished. Globally, there are approximately 1.5 million new cases of HIV every year, including over 35,000 new infections in the United States. Due to stigma, discrimination, and other structural factors, certain populations and geographic areas continue to bear most of the burden of this disease. We remain deeply committed to ending HIV everywhere by engaging and empowering communities, and by ensuring that our programs, research, and policies are informed by the voices of those populations most impacted by HIV.
Globally, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest commitment by any nation to address a single disease in history. Led by the U.S. Department of State in collaboration with seven other USG partner agencies, PEPFAR has worked for the past 19 years with more than 50 countries across the globe to address HIV/AIDS. In collaboration with partnerships across multiple sectors, PEPFAR’s programs have saved more than 21 million lives, prevented millions of HIV infections, and helped countries build a strong foundation to prevent, detect, and respond to other health threats, including COVID-19. “The greatest public health asset and the greatest public health response is PEPFAR. Through collaboration and partnership, we have made considerable progress toward ending the HIV/AIDS pandemic, but the last mile of the response is the greatest challenge. We are working with our multisectoral partners to focus on areas where gaps still exist among key and vulnerable populations to end HIV/AIDS as a public health threat by 2030,” said Ambassador Dr. John Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy, who leads PEPFAR.
Here in the United States, the Ending the HIV Epidemic in the U.S. (EHE) initiative continues to provide a bold vision for dramatically reducing the number of new HIV cases over the next several years, while the updated National HIV/AIDS Strategy (NHAS), released by President Biden during World AIDS Day last year, provides stakeholders across the nation with a complementary framework for addressing HIV among the populations and communities most impacted. The NHAS Federal Implementation Plan (PDF, 707 KB), released in August 2022, outlines specific actions and activities that various federal agencies will take to achieve the goals set forth in the Strategy.
“This World AIDS Day, we acknowledge the role equity plays in either the success or failure of our Nation’s HIV response. Providing equitable access to HIV testing, prevention, care, treatment, and research is key to ending the HIV epidemic,” said Harold Phillips, Director of the White House Office of National AIDS Policy. “The COVID-19 pandemic has tested our resolve and our ability to focus on ending the HIV epidemic. This World AIDS Day, we must recommit and re-energize all sectors of society to center equity within our HIV response by ensuring that everyone with HIV and those at-risk for infection have access to appropriate HIV testing, treatment, and prevention services. We encourage everyone to get an HIV test and to help us combat HIV-related stigma. As we work to implement the National HIV AIDS Strategy, this year’s theme reminds us that the time has come to act, and for all of us to put ourselves to the test of ending HIV.”
This content originally appeared on the NIAID Newsroom website. View the full article here.
Starting antiretroviral treatment (ART) early in the course of HIV infection when the immune system is stronger results in better long-term health outcomes compared with delaying ART, according to findings presented at the IDWeek Conference in Washington, D.C.
The findings are based on an extended follow-up of participants in the National Institutes of Health-funded Strategic Timing of Antiretroviral Treatment (START) study. In 2015, START demonstrated Exit Disclaimera 57% reduced risk of AIDS and serious non-AIDS health outcomes among participants who began ART when their CD4+ T-cell counts—a key indicator of immune system health—were greater than 500 cells per cubic millimeter (mm³) compared with those who did not begin ART until either their CD4+ counts fell below 350 cells/mm³ or they developed AIDS. Following the 2015 report of these findings, the participants in the deferred treatment arm were advised to begin ART.
Approximately, 1.2 million people in the United States are living with HIV, and roughly 13% do not know they are infected, according to the Centers for Disease Control and Prevention. When HIV diagnosis and treatment are delayed, HIV continues to replicate. This can negatively impact the infected individual’s health and increase the risk of transmitting the virus to others.
The international START study proved the benefit of early ART initiation, but longer-term follow-up of 4,446 participants was undertaken to determine whether the health benefits of early ART compared with deferred ART increased, remained constant, or declined after the participants in the deferred arm were advised to begin ART. The primary study endpoints included the number of participants who developed AIDS; those who developed serious non-AIDS health conditions, such as major cardiovascular disease, kidney failure, liver disease and cancer; and those who died.
For participants who began ART before the end of 2015, the median CD4+ cell count at the time of ART initiation was 648 cells/mm³ for the immediate arm and 460 cells/mm³ for the deferred arm. The analysis presented [on 10/21/22] compared the primary study endpoints before the end of 2015, with those in the extended follow-up period, from Jan. 1, 2016, to Dec. 31, 2021. In the latter period, most deferred-arm participants were taking ART. During the second period, people initiating ART in the deferred group had rapid and sustained declines in HIV viral load (less than or equal to 200 copies/mL); however, CD4+ cell counts remained, on average, 155 cells lower compared with that of individuals in the immediate ART group. While the risk of serious health outcomes was substantially diminished soon after ART was initiated in the deferred treatment group, some excess risk remained compared with the immediate treatment group. The deferred ART group continued to have a somewhat greater risk (21%) of serious health consequences or death in comparison to the immediate treatment group. Twenty-seven cases of AIDS occurred in the five-year follow-up period in the deferred treatment group compared with 15 cases in the early treatment group. Similarly, 88 cases of serious non-AIDS health issues occurred in the deferred treatment arm compared with 76 cases in the immediate treatment arm. Lastly, there were 57 deaths in the deferred treatment group compared to 47 in the immediate treatment arm.
These findings confirm that ART significantly improves the health of an individual with HIV and reduce the person’s risk of developing AIDS and serious health issues, and that early diagnosis and treatment are key to maximizing these benefits and reducing risk, according to the presenters.
The START study and its extended follow up was conducted by the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT), funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH. It was led by principal investigator James D. Neaton, Ph.D., of the University of Minnesota, Minneapolis, and START study co-chairs Abdel Babiker, Ph.D., of the University College London, and Jens Lundgren, M.D., of the University of Copenhagen.
This content originally appeared on the Fogarty International Center website. View the full article here.
CHIPTS Combination Core Affiliate Dr. Wei-Ti Chen was recognized by the Fogarty International Center for her recently funded project, “Buddhism and HIV Stigma in Thailand: An Intervention Study.” This project is supported by the NIH Climate Change and Health Initiative, which aims to reduce health threats from climate change across the lifespan and build health resilience in individuals, communities, and nations worldwide. Learn more about the NIH Climate Change and Health Initiative and Dr. Chen’s project below.
Scientists internationally agree that climate change threatens human health; the complexity of its impact is enormous. In an effort to include new researchers from multiple disciplines in climate change and health (CCH) research from both the U.S. and low- and middle-income countries, NIH has awarded supplemental funds to fourteen Fogarty projects. All of the awarded projects address at least one of the CCH Initiative’s core pillars—health effects research, health equity, intervention research, and training and capacity building—or one of the priority areas of science identified by the initiative, which include behavioral and social science research, disaster research response, and adaptation research.
Dr. Wei-Ti Chen’s project on “Buddhism and HIV Stigma in Thailand: An Intervention Study” is included in these awarded supplement grants. Thailand remains one of the countries with the largest population of people living with HIV (PLWH) in the Asian-Pacific region. In Thailand, as in other middle-income Asian countries, HIV stigma is a pressing health concern. The purpose of this study is to culturally adapt and evaluate the feasibility of a four-week, two-hour, group-based stigma reduction intervention to promote health engagement.
The scientific premise is that Buddhist-Thai culture provides a unique cultural context for Thai PLWH to understand HIV stigma and suffering. The study hypothesizes that Thai PLWH will display lower internal stigma and more care engagement following the intervention. This study addresses the critical need to optimize care engagement through addressing HIV stigma within local cultural contexts. Its long-term goal is to help establish a comprehensive, culturally-sensitive stigma reduction intervention for Thai PLWH.
In September 2022, CHIPTS and the UCLA-Charles Drew University Center for AIDS Research (UCLA-CDU CFAR) received funding for a total of seven new Ending the HIV Epidemic supplement awards from the National Institutes of Health. These awards support one- and two-year implementation research projects as part of a national effort to enhance the implementation science knowledge base needed for the Ending the HIV Epidemic in the U.S. (EHE) initiative. CHIPTS also received renewal funding for our EHE implementation science hub, the UCLA Rapid, Rigorous, Relevant (3R) Implementation Science Hub.
Learn more about the seven innovative projects that were awarded funding this year below.
CHIPTS
“Financially incentivizing HIV prevention among high-incidence populations in LA County: Preparing for implementation”: This project aims to collect pre-implementation data in order to design an HIV prevention conditional cash transfers (CCT) intervention and implementation strategy for young Black and Latino cisgender men who have sex with men in Los Angeles County. This includes (A) collecting qualitative data about acceptability, appropriateness, and feasibility of this proposed CCT from consumers and key stakeholders (policymakers, service providers, community members, etc.); and (B) conducting a discrete choice experiment to identify the most-preferred attributes of such a CCT. (PIs: Corrina Moucheraud/Raphael Landovitz)
“Implementation Strategies to Promote Equitable Dissemination of Long-Acting injectable PrEP to Black/Latino MSM and Transgender Women in Los Angeles”: This project will use a community-engaged approach to promote the equitable dissemination of long-acting injectable pre-exposure prophylaxis (LAI PrEP) among Black and Latino men who have sex with men and transgender women (BLMSM/TGW) in Los Angeles County (LAC) through informational/educational community workshops and community-derived, culturally appropriate LAI PrEP messaging. The project has three specific aims. Aims 1 and 2 are to increase awareness and knowledge of, and trust and confidence in LAI PrEP as a new HIV prevention option among BLMSM/TGW and providers serving them. Aim 3 is to develop a LAI PrEP strategic messaging guide to support ongoing diffusion of LAI PrEP information by the LAC Public Health Department’s Division of HIV and STD Programs and BLMSM/TGW service providers to facilitate greater community awareness and stimulate community discourse about the use of this new HIV prevention tool among BLMSM/TGW in LAC. (PI: Ronald Brooks)
“De-Medicalizing PrEP by Partnering with House and Ball Community Using Social Work and Guiding Principles: Prioritizing Young Black LGBTQ+ Individuals”: This study will facilitate the involvement of a locally trusted social work provider agency and a community health center to develop and evaluate the effectiveness of non-medicalized social work and community engagement strategies. The study will proceed in 3 phases over 2 years. The Specific Aims of the proposed study are: Aim 1: Examine barriers and challenges affecting the PrEP care continuum among young Black LGBTQ+ members of the House & Ball Community (H&BC); Aim 2: Formalize H&BC empowerment services that facilitate linkages to support and retention services provided at a comprehensive social work and grassroots engagement agency; and Aim 3: Pilot test equity-focused, community-engaged grassroots model approaches that can support the PrEP care continuum for young Black LGBTQ+ members of the H&BC. (PI: Sung-Jae Lee)
“Applying Behavioral Economic Incentives to Support Implementation of PrEP in a Trans Community Center”: This study will be the first test three discrete behavioral economic strategies for implementing PrEP services in a Trans Community Center (TWC). The proposed supplement will leverage the parent study PrEP Well, a 3-year California HIV/AIDS Research Program-funded implementation science grant to bring comprehensive and gender-affirming PrEP services to scale in a first-of-its-kind transgender community center. Aim 1 will assess the acceptability, appropriateness, feasibility, and preliminary effects of the individual identity behavioral economic incentives (IBEI) approach to support the implementation of the PrEP Well program along with overall self-care at TWC. Aim 2 will assess the acceptability, appropriateness, feasibility, and preliminary effects of offering the community-based identity behavioral economics incentives (CBEI) approach to support the implementation of the PrEP Well program at TWC. Aim 3 will assess the acceptability, appropriateness, feasibility, and preliminary effects of offering the staff-based identity behavioral economic incentives (SBEI) approach to support the implementation of the PrEP Well program at TWC. (PI: Erik Storholm)
UCLA-CDU CFAR
“Understanding the implementation of SB 159: Pharmacist delivered pre- and post-exposure prophylaxis in three high priority EHE counties in CA (Los Angeles, Riverside and San Bernardino Counties)”: Pharmacist-delivered PrEP/PEP has the potential to expand access to key biomedical prevention strategies under the EHE Prevention Pillar. This study will inform best practices for pharmacies seeking to expand service delivery to include PrEP/PEP and help to identify what changes in law, policy, and/or funding, if any, will be required to propel pharmacist-delivered PrEP/PEP in California. Tithe aims of this study include: 1) build a coalition of key regional stakeholders to understand implementation barriers and facilitators to pharmacist-delivered PrEP/PEP among key populations; 2) determine differential barriers and facilitators to implementation of pharmacist-delivered PrEP/PEP, targeting geographic areas of vulnerability to HIV and reduced access to PrEP (“PrEP deserts”) compared to “non-PrEP deserts;” and 3) engage a key regional stakeholder coalition to identify locally-based strategies to reduce barriers and enhance facilitators to implementing pharmacist-delivered PrEP/PEP. (PI: Ian Holloway)
“Addressing intersectional oppression in Asian Pacific Americans with HIV in Southern CA: An Implementation Science Framework”: The purpose of this study is to collaborate with the local Asian and Pacific Americans with HIV (APAWH) community to adapt and evaluate the appropriateness, acceptability, feasibility, and preliminary efficacy of a 4-session, 4-week Social justice Oriented, Family Informed self-management intervention to promote health among APAWH in Los Angeles and Orange counties (SOFIAA). The aims include: 1) adapt an evidence-based intervention (the SOFIAA) to address intersectional oppression experienced by APAWH in Southern California, and 2) evaluate the SOFIAA’s implementation outcomes and preliminary effectiveness on APAWH’s mental and physical health. (PI: Wei-Ti Chen)
“Implementing a Community-Engaged Equity Approach to Identify Barriers and Facilitators to the PrEP Care Continuum in Long Beach, CA”: This study is designed to identify individual and structural barriers and facilitators affecting engagement in the PrEP care continuum among BLMSM and transwomen in Long Beach, CA. The aims include: 1) to explore, using qualitative methods, contextually specific barriers to and facilitators of PrEP engagement among BLMSM and transwomen and PrEP services among providers; 2) to obtain, using survey methods, locally relevant estimates of the scope and magnitude of PrEP experiences, barriers and facilitators, and services; and 3) to disseminate and implement study results to increase PrEP care continuum engagement in ways that are meaningful for the Long Beach community. (PI: Laura D’Anna)
If you have any questions about these projects or would like to be connected to a project PI, please contact chipts@mednet.ucla.edu.
CHIPTS participated in the World AIDS Day event at Charles R. Drew University of Medicine and Science on Monday, December 5, 2022, from 11:00 AM to 3:00 PM. The event was hosted by the Drew Center for AIDS Research, Education, and Services (Drew CARES). Students, staff, faculty, and community members visited the CHIPTS table to learn more about the work we do to address inequities and end the HIV epidemic. CHIPTS staff engaged with attendees and offered HIV-related educational resources and promotional materials.
