As World AIDS Day commemorations highlight historic gains and continuing challenges in the prevention and treatment of HIV globally, Yale is redoubling its efforts to curtail new infections and improve treatment outcomes in its own region. In 2014 the Center for Interdisciplinary Research on AIDS (CIRA) at the Yale School of Public Health partnered with the Lifespan/Tufts/Brown Center for AIDS Research (LTB CFAR) to form a New England HIV Implementation Science Network that is uniting the HIV research and practice communities. Despite an overall decline in the epidemic across New England, current trends show an increasing incidence of HIV among gay men, profound and persistent racial/ethnic disparities for both men and women, an aging population of persons with HIV and co-morbidities, a concentration of persons living with HIV in urban areas, and significant concern with late diagnosis of HIV and delayed entry to care. The Network was created to reverse these trends by stimulating and supporting new collaborative research programs in New England to enhance the implementation of HIV prevention and treatment interventions, and particularly within small urban areas with a high prevalence of HIV.
Dr. Paul Cleary, dean of the Yale School of Public Health and the Director of CIRA expressed optimism about the Network’s potential to impact the epidemic. “Over the past two years research scientists, service providers, public health departments, and advocates from across New England have come together under the Network umbrella to explore research priorities and new partnerships through a series of symposia, structured work groups and seminars that have generated some promising implementation research concepts and projects” said Dr. Cleary. A central tenet of the group is to facilitate community-based implementation science projects that are relevant and responsive to questions and issues identified by impacted communities and by HIV service providers, and to do this with both scientific and ethical integrity.
The UNAIDS Fast Track Strategy to end the epidemic sets out the following targets for 2020: 90 percent of people living with HIV will know their HIV status; 90 percent of people on HIV will be in treatment; 90 percent of people on HIV treatment will have suppressed viral loads and HIV related discrimination including stigma will be eliminated. The corresponding Fast Track Cities Initiative focuses on large urban centers. The National HIV/AIDS Strategy (NHAS) also calls for investing resources in places with the highest disease burden and has emphasized areas with the largest number of HIV infections, particularly major metropolitan areas. While the focus on large cities is important to the goal of eradicating HIV/AIDS, interventions developed in these jurisdictions “may not readily translate to smaller urban areas and additional research and modifications may be needed to identify optimal approaches for smaller urban areas with higher HIV prevalence, HIV disparities and limited health and social service capacity” said Dr. Cleary. The majority of HIV cases in the U.S. actually occur outside of major cities, in places that lie between rural and metropolitan areas, added Dr. Cleary, noting that “The New England Network’s unique focus on research in these smaller “in-between” areas will facilitate wider implementation and evaluation of the NHAS and the development of interventions tailored to smaller communities.”
Since its inception the Network has collectively identified priority areas and worked to develop research ideas focused on: 1) hard-to-reach/high-risk populations, 2) technology and social media, 3) modeling and cost utility analysis, and 4) mapping. Other accomplishments include a joint pilot project award to seed research collaborations within the Network; dissemination of grant opportunities and facilitated discussions to incentivize collaborations; implementation research capacity building through webinars and workshops; the creation of biographical sketches to identify Network member expertise and resources, and facilitate matchmaking; and new research grant collaborations involving multiple small cities, agencies and institutions in New England.
More information on the Network is available on the CIRA website http://cira.yale.edu/research/new-england-hiv-implementation-science-network)
Supported by NIMH (P30MH062294, Paul D. Cleary, Ph.D., and Principal Investigator) and NIAID (P30AI042853, Charles C.J. Carpenter M.D., and Principal Investigator)