High-Impact Interventions to Eradicate AIDS

Developing new interventions to engage HIV-positive individuals in medical care and community prevention in Wisconsin

Full Project Name:High-Impact Integrated Behavioral and Biomedical Interventions to Eradicate AIDSPrincipal Investigator:Jeffrey A. Kelly, PhD, Psychiatry and Behavioral MedicineCo-Investigator:Yuri A. Amirkhanian, PhD, Psychiatry and Behavioral Medicine; Julia Dickson-Gomez, PhD, Psychiatry and Behavioral Medicine; John Fangman, MD, Medicine; Andrew Petroll, MD, MS, MedicineAward Amount:$999,395.00

Award Date

September2014

Project Duration:48 months

Project Description Narrative:

Approximately 8,500 Wisconsin residents live with HIV, with the majority residing in the Milwaukee area. A disproportionately high number of recent infections are among racial minority men who have sex with men. Reducing HIV-related morbidity, mortality, and disease transmission will require research to develop a new generation of interventions to improve early disease detection, better engage people living with HIV to enter care, and improve their long-term adherence to medications. In the first 30 years of AIDS prevention, campaigns to reduce risk and change behavior limited the growth of the HIV epidemic, but did not stop it.

Recent groundbreaking clinical trials have shown that early treatment with anti-retroviral drugs is now the best available treatment and method of prevention. This presents an unprecedented opportunity to end AIDS by treating all infected persons, achieving wide scale viral suppression, and vastly reducing downstream disease incidence. However, achieving this goal will require the development of a new integrated research agenda that brings together behavioral, biomedical, and community expertise to rapidly translate new biomedical HIV prevention advances from clinical trials to interventions that can be implemented on a public health scale. Through this award, project investigators will develop and test the efficacy of novel interventions designed to reach HIV-positive persons in the community, engage them into medical care, increase treatment adherence, and thereby reduce onward transmission of HIV disease.

Outcomes & Lessons Learned:

Formed a community advisory panel to provide input to project team and consult on interpretation of findings
Conducted in-depth interviews with HIV-positive persons in Milwaukee who were either not presently in medical care, who had attended medical appointments but did not adhere to their antiretroviral therapy regiments, or who had not been recently tested even though they reported engaging in high-risk sexual behavior in order to identify factors associated with poor care engagement
Conducted baseline assessments of HIV care engagement and laboratory test measures of all participants
Tested intervention aimed at increasing PrEP awareness and adoption using social media methods to reach and enroll nine social networks of high-risk men who have sex with men (MSM) before engaging them in baseline assessments and measures of knowledge, a five-sesssion group intervention, and follow-up assessments
Documented findings that indicated HIV medical care is closely linked with the presence of other co-existing life problems (alcohol and substance abuse, unaddressed mental health needs, housing instability, stigma, unment service needs) as well as medical mistrust, especially among African-American MSM. Identified need for strategies to maximize PrEP uptake among high-risk MSM that include addressesing concerns about PrEP's benefits, risks, reliability, and cost at the population health level
Disseminated findings through published manuscripts and shared with statewide AIDS/HIV programs and planning groups
Documented pilot test measures and intervention content to develop and receive five-year NIH funding to further work