The New England HIV Implementation Science Network’s third annual symposium had a clear message that was cited throughout the day: 90-90-90. Getting to zero.
The numbers refer to the UNAIDS goals that 90 percent of all people living with HIV will know their HIV status; 90 percent will receive antiretroviral therapy; and 90 percent of those who receive the therapy will have viral suppression. If the goals are achieved, many believe that the AIDS epidemic could be conquered by 2030.
Co-sponsored by the Center for Interdisciplinary Research on AIDS (CIRA) at Yale and the Lifespan/Tufts/Brown Center for AIDS Research (CFAR), Thursday’s symposium (June 2) drew nearly 125 researchers, practitioners, community organizations and public health agencies from throughout New England who are involved with HIV prevention and treatment.
“It’s unconscionable that in 2016 we’re still dealing with HIV/AIDS,” Paul Cleary, dean of the Yale School of Public Health and CIRA’s director, said as the event got underway at the Hilton Mystic in Connecticut. Cleary praised the collaborative efforts and progress of the network, which spans multiple professions, states and constituencies, all dedicated to devising and implementing new approaches to prevent and treat HIV.
Larry Brown, CFAR’s associate director, underlined the importance of using implementation science (studies that promote the uptake of research findings in HIV policy and practice) to fight the disease more effectively. “It’s the heart of what we’re trying to do,” he said.
Brown’s remarks were shared by many, who saw the integration of research findings into health care policy and practice as central to creating the approaches and collaborations necessary to reduce infections and optimize treatment outcomes for those living with HIV/AIDS, particularly in New England’s smaller cities with high HIV prevalence. .
In the past two years network members from different states, institutions and agencies have been brought together by CIRA and CFAR to develop research ideas and projects. Reaching the populations who are most impacted by HIV in the six-state region was paramount, including young gay and bisexual men of color, transgender women, women of color and people with substance-use disorders that increase their risk of HIV exposure and transmission.
The day began with a “spotlight” on nine regional network projects that have resulted from these collaborative efforts:
- The New England STD Consortium (PDF)
- ePROMISE, An Implementation Research Project to Improve the HIV Prevention and Treatment Continuum of Care in Young MSM (PDF)
- Harm Reduction Needs Assessment (PDF)
- Developing a Comprehensive Model of the HIV Care Continuum in Nine Small Cities in CT/MA/RI (PDF)
- Evaluating Alternative Strategies to Prevent Overdose Deaths and New HIV Infections (PDF)
- Examining Multilevel System Dynamics Affecting HIV Community Viral Load (PDF)
- Refining and Validating the Community Research Activity Assessment Tool (PDF)
- Project STOP: The Syphilis to PrEP Cascade (PDF)
- Implementation of HIV PrEP for MSM with and without Substance Use in Providence and New Haven(PDF)
State health departments from across the region have been part of the network from its inception and were well represented at the symposium. Tom Bertrand, of the Rhode Island Department of Health, described how his department and others have coalesced to identify more effective ways to address the rise in sexually transmitted infections.
Using social media and social networks to reach young gay and bisexual men and transgender women was a theme across several of the projects featured in the spotlight. Finding ways to expand implementation of PrEP and use novel approaches to engage at-risk individuals in HIV testing and care were also themes.
Rick Altice, Yale professor of medicine and public health, outlined a proposal developed in collaboration with HIV service agencies in Bridgeport, Hartford and New Haven that aims to combine outreach, social media and peer connections to persuade young gay and bisexual men of color and transgender women to get HIV testing, PrEP and other treatment services.
Robert Heimer, professor at the School of Public Health and director of the Emerging Infections Program at Yale, described the Harm Reduction Needs Assessment that he and colleagues conducted and told the gathering that injection drug use (one of the ways that HIV/AIDS is spread) is increasingly a suburban problem. But the suburbs are not addressing it. He drew sustained laughter from the audience when he derided the BANNA (Build Absolutely Nothing Near Anything) approach embraced by people who don’t want any drug services or programs in their communities.
As the symposium continued into the afternoon, small groups formed to allow more interactive discussion about four priority research areas: PrEP; adolescents and youth; substance use and HIV; and the HIV continuum of care. The sessions generated ideas for additional regional projects and by day’s end there was a heightened optimism that if the network stays on course and stakeholders continue working on HIV/AIDS. implementation science research projects specific to smaller New England cities, the 90-90-90 goals might be attainable.
Jim Pettinelli, CIRA’s assistant director for community research and implementation, said the network’s mission is to “advance implementation research through new collaborations and opportunities.” Noting that 70 percent of the attendees were community-based health workers and 30 percent came from academia, he said the symposium was an opportunity for people to “meet and develop relationships” that could prove fruitful in the future.
In another presentation, Professor David Fiellin and Assistant Professor Jen Edelman, both of the Yale School of Medicine, provided an overview of their multistate project, known as WHAT-IF? (PDF), to illustrate how the network can be used to develop a successful implementation science proposal. At the start of their presentation, a Shannon Burns cartoon was displayed on a screen showing a group of scientists gathered in a room. The speaker says, “The latest research shows we really should do something with all these research findings.” Attendees laughed, but the take-home message couldn’t have been more serious.
“Considerable knowledge about HIV prevention and care has been amassed through research. The findings need to be put into action, in ways that make sense for small cities, to effectively reduce new infections and improve treatment outcomes. This is the work of implementation science and our vision for the network,” said Elaine O’Keefe, CIRA’s executive director who has been working on the epidemic since the 1980s.