1
|
MOLLDREM STEPHEN, SMITH ANTHONYKJ, McCLELLAND ALEXANDER. Advancing Dialogue About Consent and Molecular HIV Surveillance in the United States: Four Proposals Following a Federal Advisory Panel's Call for Major Reforms. Milbank Q 2023; 101:1033-1046. [PMID: 37380617 PMCID: PMC10726778 DOI: 10.1111/1468-0009.12663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Policy Points Molecular HIV surveillance and cluster detection and response (MHS/CDR) programs have been a core public health activity in the United States since 2018 and are the "fourth pillar" of the Ending the HIV Epidemic initiative launched in 2019. MHS/CDR has caused controversy, including calls for a moratorium from networks of people living with HIV. In October 2022, the Presidential Advisory Council on HIV/AIDS (PACHA) adopted a resolution calling for major reforms. We analyze the policy landscape and present four proposals to federal stakeholders pertaining to PACHA's recommendations about incorporating opt-outs and plain-language notifications into MHS/CDR programs.
Collapse
Affiliation(s)
- STEPHEN MOLLDREM
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch
| | | | | |
Collapse
|
2
|
Hallmark CJ, Luswata C, Del Vecchio N, Hayford C, Mora R, Carr M, McNeese M, Benbow N, Schneider JA, Wertheim JO, Fujimoto K. Predictors of HIV Molecular Cluster Membership and Implications for Partner Services. AIDS Res Hum Retroviruses 2023; 39:241-252. [PMID: 36785940 PMCID: PMC10171944 DOI: 10.1089/aid.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Public health surveillance data used in HIV molecular cluster analyses lack contextual information that is available from partner services (PS) data. Integrating these data sources in retrospective analyses can enrich understanding of the risk profile of people in clusters. In this study, HIV molecular clusters were identified and matched to information on partners and other information gleaned at the time of diagnosis, including coinfection with syphilis. We aimed to produce a more complete understanding of molecular cluster membership in Houston, Texas, a city ranking ninth nationally in rate of new HIV diagnoses that may benefit from retrospective matched analyses between molecular and PS data to inform future intervention. Data from PS were matched to molecular HIV records of people newly diagnosed from 2012 to 2018. By conducting analyses in HIV-TRACE (TRAnsmission Cluster Engine) using viral genetic sequences, molecular clusters were detected. Multivariable logistic regression models were used to estimate the association between molecular cluster membership and completion of a PS interview, number of named partners, and syphilis coinfection. Using data from 4,035 people who had a viral genetic sequence and matched PS records, molecular cluster membership was not significantly associated with completion of a PS interview. Among those with sequences who completed a PS interview (n = 3,869), 45.3% (n = 1,753) clustered. Molecular cluster membership was significantly associated with naming 1 or 3+ partners compared with not naming any partners [adjusted odds ratio, aOR: 1.27 (95% confidence interval, CI: 1.08-1.50), p = .003 and aOR: 1.38 (95% CI: 1.06-1.81), p = .02]. Alone, coinfection with syphilis was not significantly associated with molecular cluster membership. Syphilis coinfection was associated with molecular cluster membership when coupled with incarceration [aOR: 1.91 (95% CI: 1.08-3.38), p = .03], a risk for treatment interruption. Enhanced intervention among those with similar profiles, such as people coinfected with other risks, may be warranted.
Collapse
Affiliation(s)
- Camden J. Hallmark
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Houston Health Department, Houston, Texas, USA
| | - Charles Luswata
- Houston Health Department, Houston, Texas, USA
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Natascha Del Vecchio
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Christina Hayford
- Third Coast Center for AIDS Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | | | - Nanette Benbow
- Third Coast Center for AIDS Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John A. Schneider
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Joel O. Wertheim
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
3
|
Garcia M, Devlin S, Kerman J, Fujimoto K, Hirschhorn LR, Phillips II G, Schneider J, McNulty MC. Ending the HIV Epidemic: Identifying Barriers and Facilitators to Implement Molecular HIV Surveillance to Develop Real-Time Cluster Detection and Response Interventions for Local Communities. Int J Environ Res Public Health 2023; 20:3269. [PMID: 36833963 PMCID: PMC9964218 DOI: 10.3390/ijerph20043269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The rapid implementation of molecular HIV surveillance (MHS) has resulted in significant challenges for local health departments to develop real-time cluster detection and response (CDR) interventions for priority populations impacted by HIV. This study is among the first to explore professionals' strategies to implement MHS and develop CDR interventions in real-world public health settings. Methods: Semi-structured qualitative interviews were completed by 21 public health stakeholders in the United States' southern and midwestern regions throughout 2020-2022 to identify themes related to the implementation and development of MHS and CDR. Results for the thematic analysis revealed (1) strengths and limitations in utilizing HIV surveillance data for real-time CDR; (2) limitations of MHS data due to medical provider and staff concerns related to CDR; (3) divergent perspectives on the effectiveness of partner services; (4) optimism, but reluctance about the social network strategy; and (5) enhanced partnerships with community stakeholders to address MHS-related concerns. Conclusions: Enhancing MHS and CDR efforts requires a centralized system for staff to access public health data from multiple databases to develop CDR interventions; designating staff dedicated to CDR interventions; and establishing equitable meaningful partnerships with local community stakeholders to address MHS concerns and develop culturally informed CDR interventions.
Collapse
Affiliation(s)
- Moctezuma Garcia
- Department of Social Work, College of Health & Sciences, San José State University, San Jose, CA 95112, USA
| | - Samantha Devlin
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Jared Kerman
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX 77030, USA
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gregory Phillips II
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John Schneider
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Moira C. McNulty
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| |
Collapse
|
4
|
Shook AG, Buskin SE, Golden M, Dombrowski JC, Herbeck J, Lechtenberg RJ, Kerani R. Community and Provider Perspectives on Molecular HIV Surveillance and Cluster Detection and Response for HIV Prevention: Qualitative Findings From King County, Washington. J Assoc Nurses AIDS Care 2022; 33:270-282. [PMID: 35500058 PMCID: PMC9062191 DOI: 10.1097/jnc.0000000000000308] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Responding quickly to HIV outbreaks is one of four pillars of the U.S. Ending the HIV Epidemic (EHE) initiative. Inclusion of cluster detection and response in the fourth pillar of EHE has led to public discussion concerning bioethical implications of cluster detection and response and molecular HIV surveillance (MHS) among public health authorities, researchers, and community members. This study reports on findings from a qualitative analysis of interviews with community members and providers regarding their knowledge and perspectives of MHS. We identified five key themes: (a) context matters, (b) making sense of MHS, (c) messaging, equity, and resource prioritization, (d) operationalizing confidentiality, and (e) stigma, vulnerability, and power. Inclusion of community perspectives in generating innovative approaches that address bioethical concerns related to the use of MHS data is integral to ensure that widely accessible information about the use of these data is available to a diversity of community members and providers.
Collapse
Affiliation(s)
- Alic G. Shook
- College of Nursing, Seattle University Seattle, Washington, USA
| | - Susan E. Buskin
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Epidemiologist, Public Health – Seattle & King County, Seattle, Washington, USA
| | - Matthew Golden
- Public Health – Seattle King County HIV/STD Program
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Julia C. Dombrowski
- Public Health-Seattle & King County HIV/STD Program
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joshua Herbeck
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Roxanne Kerani
- Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|