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Chair: Richard Jenkins, PhD, Health Scientist Administrator, Prevention Research Branch, National Institute on Drug Abuse
Presenters: Jacques Normand, PhD, Director of AIDS Research, National Institute on Drug Abuse
Marya V. Gwadz, PhD, Senior Research Scientist, Deputy Director, Center for Drug Use and HIV Research, New York University, College of Nursing, Jennifer Lorvick, DrPH, Associate Director, Urban Health Program, RTI International,
Toward a Comprehensive Strategy to Prevent HIV
Normand, J., National Institute on Drug Abuse
NIDA’s “seek, test, treat, and retain” strategy to reduce new HIV cases in the US reflects the evolution of HIV treatment and evidence from recent trials of new prevention tools. This presentation will review HIV epidemiology, the status of prevention tools for HIV and considerations for combination HIV prevention approaches that that include strategic use of HIV treatment as a component. Comprehensive approaches to prevention that include a variety of effective modalities in public health practice are needed to make progress in reducing the epidemic and are consistent with the National HIV/AIDS Strategy. Consistent adherence to modern antiretroviral treatment greatly reduces the likelihood of HIV being transmitted from an HIV-seropositive person. This first was evident in research on the prevention of mother to child transmission, and more recently in the HPTN052 with serodiscordant couples. Observational research where universal access to treatment has been introduced (e.g., Vancouver, San Francisco) provides another line of evidence and demonstrates how this can work as a public health strategy. Nonetheless many people, particularly at younger ages do not know their status, and among those who are HIV-seropositive, many are not linked to care or, if they have entered care, may not be retained in care. NIDA’s approach emphasizes “seeking out” those at risk for testing and prevention services, and linking those who are HIV-seropositive to care and looking for ways to insure that they are retained in care.
Heterosexuals at High Risk for HIV: Respondent-driven and Venue-based Approaches to Seek Out Vulnerable Individuals with Undiagnosed HIV Infection and Link Them to Care
Gwadz, M., Ritchie, A., Kutnick, A., Quiles, R., O’Mealy, K., Swain, Q., Martinez, B., Belkin, M., and the BCAP Collaborative Research Team, New York University, College of Nursing
There is a consensus that seeking out individuals who are unaware of their HIV infection is critical to ending the epidemic. Heterosexuals at high risk (HHR) – those that live in geographical areas with high rates of poverty and prevalent HIV - are significantly less likely to test for HIV, ae more likely to be diagnosed with HIV late, and to experience serious barriers to entering care compared to other groups. These reduced rates of HIV testing and treatment are caused by barriers at the structural (e.g., poor access), social (e.g., peer norms), and individual levels (e.g., low perceived risk, medical mistrust, fear), with African-Americans/Blacks and Latino/Hispanics experiencing the greatest impediments to timely HIV testing and treatment. Active recruitment approaches are needed to seek out HHR, test them for HIV, and link them to care if found to be HIV-infected. The present study compares two sampling frames to seek out HHR in New York City: respondent-driven sampling (RDS; N=3000), a peer-to-peer method, and venue-based sampling (VBS; N=400). RDS and VBS are both in use in the National HIV surveillance studies but have not yet been directly compared in terms of their yield of undiagnosed HIV infection. Further, to boost linkage to and retention in care among those found to be HIV-infected, the study integrates a number of peer-driven and navigation intervention components into RDS. This presentation will review the problem of HIV infection among HHR, describe the two sampling frames and the intervention components, and present preliminary findings and lessons learned. To date, 25% of the cohort has been recruited (N=690). Participants are 32 years old on average (SD=19 years), mostly male (61.8%); and primarily African-American/Black (67.4%) and Latino/Hispanic (32.6%). Over half (57.2%) had been incarcerated in their lifetimes, and half had been homeless (49.5%). About a third had used drugs in the past month (33.2%). Most had been HIV tested in their lifetimes (82.7%) but only a third had been tested in the past year (35.6%), as is recommended for this risk group. To date we have identified 11 HIV infections in the RDS study (5 newly diagnosed) and 1 newly diagnosed individual in the VBS study. We will present up-to-date findings in this presentation as well as qualitative research findings on “lessons learned” about the barriers HHR face to HIV testing.
Criminal Justice Involvement, HIV risk and HIV Care among Drug Users: Preliminary Findings from Oakland, CA
Lorvick, J., Comfort, M.L., Krebs, C.P., Kral A.H., RTI International
This presentation will provide preliminary findings from a “Seek, Test, Treat and Retain” study that focuses on reaching out in community rather than correctional settings. Oakland is a mid-size city with an African American population disproportionately affected by HIV and criminal justice (CJ) system involvement. Primary objectives of the study are (1) to ascertain whether a community-based approach can reach CJ-involved drug users at risk for HIV; and (2) to evaluate an intervention promoting continuity of medical treatment for HIV-positive drug users as they move between community and correctional settings. The effectiveness of a community-based approach to identifying and testing drug users at high risk for HIV will be examined. In addition, emerging issues regarding engagement/retention in HIV care among CJ-involved drug users will be explored, using quantitative and qualitative data.