San Francisco AIDS Foundation

Current standards advise starting HIV antiretroviral therapy (ART) as soon as possible with the goal of achieving viral suppression. Applying the domains of a sustainability framework as a roadmap, we examine factors and strategies impacting readiness to sustain Rapid Start ART (RS-ART) across 14 sites participating in a national initiative that successfully implemented this intervention to link people with HIV to initiate ART treatment within seven days after linkage or re-engagement in care. While sustainability entails the ongoing delivery of a previously implemented intervention, factors and strategies for sustaining RS-ART have not been well-defined or studied. We conducted one-on-one semi-structured interviews with a purposeful sample of key informants from each of the 14 sites. Data were organized using Dedoose and analyzed using thematic analysis. We conducted a total of 27 interviews with decision-makers and key staff implementing RS-ART. We identified a continuum across the sites, reflecting three different stages of readiness to sustain RS-ART. "Well-oiled machine" sites had comprehensive sustainability plans in place with RS-ART established as their current standard practice, supported by secured funding and organizational capacity. "On track" sites demonstrated a clear vision toward sustaining RS-ART, with progress contingent on securing funding and finalizing staffing plans. "To be determined" sites faced challenges, expressing uncertainty about obtaining necessary funding and determining sufficient human resources to sustain RS-ART. While feasibility and acceptability of RS-ART, driven by improved service and patient outcomes, were high across all sites, available funding and the necessary human resources were the two critical, interrelated factors impacting readiness to sustain RS-ART. Sites positioned to sustain RS-ART were able to secure funding for the necessary staff positions to effectively integrate it as standard of care. Future funding of HIV care programs must provide sufficient resources for all individuals to be offered RS-ART services to improve life expectancy, manage HIV as a chronic disease and prevent transmission to others. Given the dynamic nature of sustainability, future longitudinal studies are needed to evaluate RS-ART sustainability outcomes and its long-term effectiveness after it has been sustained.

BackgroundSuccessful retention in care of people living with HIV remains a challenge and a cornerstone of ending the epidemic. A better understanding of retention predictors could guide an evidence-based approach to target interventions. We sought to characterise HIV care retention trajectories among individuals receiving antiretroviral therapy (ART) in a rural South Africa setting, and to determine factors associated with those trajectories.MethodsWe conducted a population-based cohort study of individuals receiving ART in ten health care facilities within the Agincourt Health and Socio-Demographic Surveillance System site in Mpumalanga, South Africa, in 2015–18. We used group-based trajectory modelling to identify clusters of individuals with similar retention trajectories and assessed the association between socio-demographic factors and trajectory groups using multinomial logistic regression.ResultsAmong 1689 individuals receiving ART during the study period, five distinct trajectory groups were identified: 30.8% had gradually decreasing retention over time, 10.2% had late increasing retention, 20.7% had early increasing retention, 7.8% had early decreasing retention, and 30.5% had consistently high retention. Individuals in the consistently high retention group were more likely to be female and aged ≥40 years. In contrast, those in the early decreasing retention group were more likely to be male, aged <30 years, and with temporary resident status. Individuals in the early increasing retention group were more likely to be from villages included in a HIV Treatment as Prevention community mobilisation study. Education, marital status, and socioeconomic status were not significantly associated with group membership. Months on ART were weakly associated with group membership.ConclusionsFive distinct retention trajectories were observed and associated with specific sociodemographic factors. Our study offers a data-driven approach to inform the design of targeted interventions to improve HIV care retention. Interventions and policies addressing socioeconomic and system-level factors are essential to achieving better outcomes in high-burden areas.

Purpose Men and women of transgender experience encounter HIV-related health inequities based on race across the HIV care continua. We explored HIV prevention and care needs via focus groups, surveys, and Sexually Transmitted Infection (STI) testing experiences (N = 40); we supplemented this data via in-depth interviews with peer navigators. Methods This study was conducted from 2020 to 2022. Analyses included coding and descriptive statistics. Nearly 63% identified as Black, and 20% identified as Latinx. Nearly 90% of participants reported ever having HIV tests; 10% of participants tested positive for other STIs. Results Qualitative analyses yielded three core intervention components for men and women of transgender experience: (1) Comprehensive Trans Care; (2) Community, Mentorship, and Support; and (3) Life Skills and Professional Development. Study participants, community and scientific advisory board members agreed on the need for a peer-led, group-level intervention in English and Spanish. Conclusion These needs and priorities are conducive to future interventions which build community agency, structural approaches, and health equity centered on men and women of transgender experience of color.

Little is known about long-acting HIV treatment implementation with trans women. We piloted and evaluated the implementation of novel strategies to increase uptake and use of long-acting HIV treatment among trans women in San Francisco. In 2022, qualitative formative nominal groups (n = 8) and in-depth interviews with providers (n = 11) were conducted to elicit facilitators and barriers to long-acting HIV treatment delivery among trans women living with HIV and to inform a pilot delivery model. Between August 2023 and August 2024, participants were enrolled into the program. Sequential mixed methods were used to evaluate formative and implementation data to understand barriers to starting long-acting treatment. Barriers for trans women were concerns about side effects, fear of needles, and difficulty adhering to bi-monthly injections. They were also concerned about missed injections from lack of transportation and incarceration and medical mistrust. Providers were most concerned with participant adherence due to social determinants (e.g., housing) and behavioral health challenges (e.g., methamphetamine use, mental health disorders). Buttock fillers and implants, patient worries about interactions with hormones, clinical barriers (e.g., availability of genotyping data), insurance, and managing prescriptions were also potential barriers. A significant barrier to implementation was the burden on referring clinic providers for eligibility screening and many trans women who were referred declined participation or were not eligible due to contraindicated clinical histories. Our study identified barriers to implementing long-acting HIV treatment among trans women living with HIV and provides novel implementation insights for clinics and interventions serving this community.

Parkinson's disease is diagnosed based on motor symptoms, but non-motor symptoms of the disease, such as cognitive impairment, autonomic dysfunction, hyposmia, sleep disorders, and psychiatric disorders heavily impact patient and caregiver quality of life. It has proven challenging to faithfully reproduce and quantify these non-motor phenotypes. Indeed, many non-motor signs in animals that may phenotypically resemble features in patients may be caused by different mechanisms or may not be consistent within the same or similar models. In this review, we survey the existing literature on the assessment of non-motor signs in parkinsonian rodents and non-human primates. We highlight the gaps in our understanding and suggest how researchers might improve experimental designs to produce more meaningful results with the hope of better understanding the disease and developing better therapies.

The United States has made significant progress toward achieving the goals of its Ending the HIV Epidemic initiative. However, systematic reviews on HIV implementation research have identified problems regarding strategy specification that limit the research's transparency and replicability, and in turn limit improvements regarding HIV care in real-world practice. The strategies timeline, activities, and resources (STAResources) Table, developed as part of the substance abuse treatment to HIV Care II Project, was completed for it and 3 other HIV implementation research projects funded by the National Institute of Health. Each evaluated it in terms of the extent to which it addressed prior recommendations on strategy specification; issues related to rigor and reproducibility; and the extent to which it seemed pragmatic, simple, adaptable, relevant, helpful, useful, acceptable, appropriate, suitable, applicable, and fitting. Each was rated on a 4-point scale (0 = not at all; 1 = a little; 2 = moderately, and 3 = very much). Overall, the STAResources Table was rated favorably. It received a mean of 3.0 (SD = 0) in terms of being pragmatic, relevant, helpful, acceptable, appropriate, and applicable. The Strategies Timeline, Activities, and Rationale (STARationale) Table emerged during the process and was also rated favorably. To help the Ending the HIV Epidemic initiative achieve its goals, there is a critical need for transparent and replicable implementation research on identifying the most effective strategies for equitably implementing evidence-based practices within real-world settings. Addressing this need, the Strategies Timeline and Activities Reporting (STAReporting)Tables are pragmatic tools for helping improve the transparency and replicability of implementation strategy research.

Current trials toward an HIV cure involve combination strategies aimed at achieving durable antiretroviral treatment (ART)-free viral control or HIV elimination, many relying on analytical treatment interruptions (ATIs) to evaluate efficacy. Given the physical, psychosocial, and interpersonal risks associated with ATIs, it is critical to monitor participants' experiences so that support can be provided when needed. While qualitative approaches have been used in similar settings, we designed and implemented a series of short, closed-ended participant surveys in the University of California, San Francisco-amfAR trial, a single-arm multi-intervention HIV cure-related trial with an extended ATI. Surveys were administered at relevant trial timepoints to capture participants' (n = 10) perspectives and experiences. These included their understanding of the trial, motivations, expectations, perceived risks, benefits, and burdens of trial participation, as well as their perspectives on restarting ART and partner protections. We describe these data using descriptive statistics and summarize lessons learned from implementing quantitative surveys in this complex trial. Our data indicate that all respondents understood the scientific goals and requirements of participating in the trial. Most were motivated to help advance research but many expressed anxiety about participating. During the trial, respondents had limited side effects, discomfort, and trial burnout. Those who completed surveys at ART restart reported mixed (positive and negative) feelings and challenges (e.g., missed doses) when restarting ART. Participants offered various methods for partner protection during ATIs and at ART restart. Many respondents expressed future willingness to participate in a similar HIV cure trial. While the number of respondents was small, these findings are consistent with concerns identified in guidance regarding these types of trials as well as qualitative findings from earlier studies. Moreover, we demonstrated that it is feasible to implement quantitative evaluations of participants' experiences. Such approaches should be implemented in future HIV cure trials to optimize human-centered research implementation.

Increasing rates of sexually transmitted infections (STIs) have been associated with rises in serious morbidity. While doxycycline postexposure prophylaxis (doxyPEP), a strategy in which individuals take doxycycline, 200 mg, after condomless sex to prevent bacterial STIs, has been shown to be efficacious in randomized clinical trials, doxyPEP's potential effect on population-level STI incidence is unknown. To assess the association of citywide doxyPEP guideline release with reported chlamydia, gonorrhea, and early syphilis cases in men who have sex with men (MSM) and in transgender women in San Francisco, California. This population-level interrupted time series analysis of reported San Francisco STI cases measured monthly cases of chlamydia, gonorrhea, and early syphilis prior to (July 2021-October 2022) and after (November 2022-November 2023) release of citywide doxyPEP guidelines in October 2022. All reported chlamydia, gonorrhea, and early syphilis cases among MSM and transgender women in San Francisco during the period of analysis were included. Data were analyzed November 2023 to July 2024. Release of doxyPEP citywide guidelines. The primary outcome was the percentage change between projected and observed chlamydia, gonorrhea, and early syphilis cases in the 13-month postexposure period. Citywide, there were 6694 cases of chlamydia, 9603 cases of gonorrhea, and 2121 cases of early syphilis among MSM and transgender women during the analytic period. STI cases among MSM and transgender women decreased significantly compared with model projections for chlamydia (-6.58% per month; 95% CI, -7.99% to -5.16%) and early syphilis (-2.68% per month; 95% CI, -3.75% to -1.60%) after doxyPEP implementation. By the end of the 13-month postperiod in November 2023, chlamydia and early syphilis cases decreased -49.64% (95% CI, -59.05% to -38.06%) and -51.39% (95% CI, -58.21% to -43.46%), respectively, compared with projected cases. There was a significant increase in monthly gonorrhea cases compared with projections (1.77% per month; 95% CI, 0.87% to 2.67%). This study suggests that San Francisco's doxyPEP guideline release was associated with decreases in reported cases of chlamydia and early syphilis, but not gonorrhea, among MSM and transgender women in San Francisco. Further analyses are needed to assess whether declines are sustained and monitor for adverse consequences, including antimicrobial resistance. Supporting doxyPEP implementation for MSM and transgender women at risk for STIs could have a significant impact on the nationwide STI epidemic.

Background High levels of human HIV and tuberculosis (TB) stigma have been reported among healthcare workers (HCWs). Methods We compared HIV and TB stigma scores reported by nursing students and ward staff from hospitals across India. Transmission worry (TW) and intent to discriminate (ID) for HIV and TB were captured using a validated stigma scale. Results A total of 3733 individuals were interviewed. Nursing students and ward staff expressed higher TW while carrying out high- and low-risk tasks on patients with HIV compared to TB. Mean scores were 2.1 and 1.86 among nursing students; 1.82 and 1.79 among ward staff (all p<0.001). Both groups expressed a significantly higher ID against patients with HIV compared to TB (mean percentage: 75.6 and 70.3 among nursing students; and 81.8 and 78.8 among ward staff; all p<0.001). Conclusion TB stigma has implications for providing quality TB care. Training of HCWs regarding transmission dynamics, the importance of standard precautions during patient care, regardless of diagnosis is essential.