Yale’s Center for Methods in Implementation and Prevention Science (CMIPS) Director Donna Spiegelman, ScD, and her team have recently received a National Institutes of Health (NIH) Ending the HIV Epidemic (EHE) initiative award to continue their Rigorous, Rapid, & Relevant Evidence aDaptation & Implementation to Ending the HIV Epidemic (R3EDI) Implementation Science (IS) Hub for another two years. In addition to the R3EDI renewal, they have also been awarded support for a new EHE project, led by CMIPS associate faculty member Debbie Humphries, PhD, and Dr. Spiegelman, entitled “St. Louis Enhancing Engagement and Retention in HIV/AIDS Care” (STEER), which focuses on identifying the barriers and facilitators of engagement along the HIV care continuum. These projects exemplify CMIPS’ engagement in the national effort to end the HIV/AIDS epidemic through innovative methods, promoting ethical practices, and building the capacity of a new generation of IS researchers.
The EHE initiative backs community-led projects across the US that utilize innovative approaches to ending the HIV epidemic. As part of the initiative, NIH has funded five IS consultation hubs that offer expertise and technical support to their respective projects. In 2020, R3EDI supported projects that are leveraging faith-based partnerships, using telehealth to provide routine HIV care, utilizing health information systems to re-engage and retain people who are HIV+ in long-term care, and providing patient focused management and clinical decision support for Pre-Exposure Prophylaxis (PrEP).
For example, a R3EDI-hub affiliated project in Jefferson County, Alabama, focuses on accessing electronic health records and using predictive analytics to better ascertain who is at risk of acquiring HIV. This preventive approach is then used to increase PrEP initiation among high-risk individuals. Jefferson County’s Deputy Health Officer, David Hicks, DO, related his experience after identifying a need for the department’s epidemiologists to gain a deeper understanding of modeling, predictive analytics, and their role in population health initiatives. “To be able to empower local health department epidemiologists in using these techniques, to me,” Dr. Hicks said, “is very unique and it’s well received, and shoring up the partnerships that we have between research institutions and local health departments that are the boots on the ground.”
The renewal of the R3EDI hub ensures continued support for the work already underway, as well as new aspects including questions around public health ethics; integration of HIV testing, treatment, and prevention into other clinical care systems such as mental health and substance use; and active participation in cross-hub activities. Explaining the introduction of ethics into R3EDI hub activities, Dr. Spiegelman said, “In IS, the target of the intervention strategy might not be the patients at all. It often is the providers or facilities, so now we are finding that individual providers and facilities are feeling concerned about protection of their own identities.” The second new area will focus on integrating substance abuse, sexually transmitted infection care, and mental health care into HIV care. The third new aspect of the renewal is an effort to collaborate with the entire consortium and, as Dr. Spiegelman said, “pull together a more comprehensive joint project of EHE, looking at the most promising interventions and strategies at a larger scale.”
From the R3EDI hub’s beginning, CMIPS has supported the hub’s EHE projects through the multidisciplinary strength of the center’s faculty. Raul U. Hernandez-Ramirez, PhD, an Associate Research Scientist in Biostatistics at CMIPS, explains his role as “providing technical assistance and consultations on IS designs, frameworks, strategies, measures, and outcomes to the EHE projects.” Another R3EDI core team member, Christine Simon, ScD, an Associate Research Scientist in Public Health at CMIPS, contributes her expertise in social epidemiology and community engagement.
Missouri is one of the seven priority states identified by the EHE initiative for its higher rates of HIV infection and lags behind other states in engagement along the continuum of care, particularly for hard-to-reach populations. To address the gap in retention in HIV care access and viral suppression, Drs. Humphries and Spiegelman are conducting the STEER project, which will assess the multilevel intersectional barriers to engagement and retention in HIV care in St. Louis. In addition, the project will adapt and identify implementation strategies for a multilevel Community Health Worker (CHW) intervention to increase engagement in HIV care and prepare a hybrid implementation and effectiveness proposal to assess the adapted CHW model’s impact on engagement and retention. Looking into the future and reflecting on the project, Dr. Humphries emphasized the participatory process. “I’m excited about having a year to plan with the community and to really use an intersectionality lens to look at who the HIV care system is not working for,” she said.
By identifying priority areas where evidence-based interventions could substantially eliminate major sources of morbidity and mortality across the US and fostering a cadre of multidisciplinary and experienced researchers, CMIPS has become an integral participant in the EHE initiative and is well positioned to provide solutions as new methodological questions arise.