Prioritization of Evidence-Based and Evidence-Informed Interventions for Retention in Medical Care for Persons with HIV.

Up to 50% of those diagnosed with HIV in the U.S. are not retained in medical care. Care retention provides opportunity to monitor benefits of HIV therapy and enable viral suppression. To increase retention, there is a need to prioritize best practices appropriate for translation and dissemination for real-world implementation. Eighteen interventions from CDC's Compendium of Evidence-Based Interventions were scored using the RE-AIM framework to determine those most suitable for dissemination. A CDC Division of HIV Prevention workgroup developed a RE-AIM scale with emphasis on the Implementation and Maintenance dimensions and less emphasis on the Efficacy dimension since all 18 interventions were already identified as evidence-based or evidence-informed. Raters referenced primary efficacy publications and scores were averaged for a ranked RE-AIM score for interventions. Of 18 interventions, four included care linkage and 7 included viral suppression outcomes. Interventions received between 20.6 and 35.3 points (45 maximum). Scores were converted into a percentage of the total possible with ranges between 45.8 and 78.4%. Top four interventions were ARTAS (78.4%); Routine Screening for HIV (RUSH) (73.2%); Optn4Life (67.4%) and Virology Fast Track (65.9%). All four scored high on Implementation and Maintenance dimensions. Select items within the scale were applicable to health equity, covering topics such as reaching under-served focus populations and acceptability to that population. Navigation-enhanced Case Management (NAV) scored highest on the health equity subscale. RE-AIM prioritization scores will inform dissemination and translation efforts, help clinical staff select feasible interventions for implementation, and support sustainability for those interventions.

RESUMEN: Hasta el 50% de las personas diagnosticadas con VIH en USA no son retenidos en cuidados médicos impactando su monitoreo y supresión viral. Dieciocho intervenciones de retención fueron evaluadas utilizando el marco RE-AIM para determinar su adecuación para la difusión. Evaluadores promediaron las intervenciones. Cuatro intervenciones incluyeron enlace de atención y 7 supresión viral. Las cuatro intervenciones principales fueron ARTAS, detección de rutina para el VIH, Optn4Life y Vía rápida de virología. Elementos del marco fueron usados para evaluar equidad en salud y cubrieron temas de cómo llegar a las poblaciones desatendidas y la aceptabilidad de esa población. La intervención gestión de casos para mejorar con navegación (NAV) obtuvo la puntuación más alta en la subescala de equidad. RE-AIM y los puntajes de priorización de equidad informarán los esfuerzos de difusión y traducción, ayudarán al personal clínico a seleccionar las intervenciones para la implementación y apoyarán la sostenibilidad.

A programmatic approach to address increasing HIV diagnoses among Hispanic/Latino MSM, 2010-2014.

From 2010 to 2015, young (13-24 years) Hispanic/Latino gay, bisexual and other men who have sex with men (MSM) experienced the largest increase (18%) in numbers of HIV diagnoses among all racial/ethnic groups. In 2016, the Centers for Disease Control and Prevention (CDC) assembled a team of scientists and public health analysts to develop a programmatic approach for addressing the increasing HIV diagnosis among Hispanic/Latino MSM. The team used a data driven review process, i.e., comprehensive review of surveillance, epidemiologic, and programmatic data, to explore key questions from the literature on factors associated with HIV diagnoses among Hispanic/Latino MSM and to inform the approach. This paper describes key findings from the review and discusses the approach. The approach includes the following activities: increase awareness and support testing by expanding existing campaigns targeting Hispanic/Latino MSM to jurisdictions where diagnoses are increasing; strengthen existing efforts that support treatment as prevention and increase engagement in care and viral suppression among Hispanic/Latino MSM living with HIV and promote prevention, e.g., PrEP uptake and condom use, among Hispanic/Latino MSM who are at high-risk for HIV infection.

Efficacy of a health educator-delivered HIV prevention intervention for Latina women: a randomized controlled trial.

OBJECTIVES: We developed and assessed AMIGAS (Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally congruent HIV prevention intervention for Latina women adapted from SiSTA (Sistas Informing Sistas about Topics on AIDS), an intervention for African American women. METHODS: We recruited 252 Latina women aged 18 to 35 years in Miami, Florida, in 2008 to 2009 and randomized them to the 4-session AMIGAS intervention or a 1-session health intervention. Participants completed audio computer-assisted self-interviews at baseline and follow-up. RESULTS: Over the 6-month follow-up, AMIGAS participants reported more consistent condom use during the past 90 (adjusted odds ratio [AOR] = 4.81; P < .001) and 30 (AOR = 3.14; P < .001) days and at last sexual encounter (AOR = 2.76; P < .001), and a higher mean percentage condom use during the past 90 (relative change = 55.7%; P < .001) and 30 (relative change = 43.8%; P < .001) days than did comparison participants. AMIGAS participants reported fewer traditional views of gender roles (P = .008), greater self-efficacy for negotiating safer sex (P < .001), greater feelings of power in relationships (P = .02), greater self-efficacy for using condoms (P < .001), and greater HIV knowledge (P = .009) and perceived fewer barriers to using condoms (P < .001). CONCLUSIONS: Our results support the efficacy of this linguistically and culturally adapted HIV intervention among ethnically diverse, predominantly foreign-born Latina women.

Implementing packaged HIV-prevention interventions for HIV-positive individuals: considerations for clinic-based and community-based interventions.

Providing efficacious human immunodeficiency virus (HIV) prevention services to HIV-positive individuals is an appropriate strategy to reduce new infections. The Centers for Disease Control and Prevention (CDC) has identified interventions with evidence of efficacy for prevention with positives (PwP). Through its process of disseminating evidence-based interventions (EBIs), CDC has attempted to diffuse four of these interventions into practice. One of these interventions has been diffused to community-based organizations, whereas another has been diffused to medical clinics serving HIV-positive people. A third intervention was originally developed with HIV-positive individuals using methadone, but uptake by methadone clinics has not occurred. A fourth intervention for HIV-positive adolescents and young adults has had disappointing adoption levels. Unique implementation challenges have been encountered in various intervention settings. Lessons learned in the dissemination of the first four PwP interventions will facilitate implementation of three new PwP EBIs currently being packaged for dissemination.

Prevalence and correlates of depressive symptoms among high school students in Hanover, Jamaica.

The objective of this study was to determine the prevalence of depressive symptoms in Jamaican adolescents and examine its association with individual and family factors. We used an abbreviated form of the Beck's Depression Inventory II (BDI-II) to assess depressive symptoms among 748 students, attending public high schools in the parish of Hanover Jamaica. In the analysis, we classified adolescents with scores in the upper quartile of the depressive symptom score as having depressive symptoms. Multivariate logistic regression was used to determine the predictors of depressive symptoms. 14.2% of participants reported depressive symptoms. There was association between engagement in sexual activity [Odds Ratio (OR) = 1.61, 95% Confidence Interval (CI) = 1.02-2.51], parental monitoring of adolescent activity (OR=2.04, 95%CI=1.33 -3.12), maternal affection and support (OR= 4.07, 95%CI= 2.62-6.33), and paternal affection and support (OR= 1.58, 95%CI= 1.05-2.39) with self reported depressive symptoms at the bivariate level. In the final model, depressive symptoms was associated with perceived lack of maternal affection and support (OR= 4.06, 95%CI= 2.61-6.32) and showed marginal association with being sexually experienced (OR= 1.59, 95%CI= 1.00-2.52). As most homes are female-headed, establishing support systems for the mother to take care of their adolescent children may decrease the odds of depressive symptoms. Sexually experienced adolescents may require screening for depression. Further research is required to fully explore all factors that could predispose Jamaican adolescents to depression.

The determinants of sexual intercourse before age 16 years among rural Jamaican adolescents.

Individual and family factors have been hypothesized to influence adolescent sexual behavior, but the extent to which this is true for adolescents in Jamaica as a whole and for those in rural areas in particular, has not been well studied. The objective of this study was to identify individual and family factors associated with initiation of sexual activity before the age of 16 among rural adolescents in Jamaica. We analyzed data for 469 sexually experienced adolescents attending public high schools in the rural parish of Hanover. Multivariate logistic regression was used to predict independent influences of these factors. The mean age at sexual debut was 11 years for boys and 15 years for girls. Early adolescent sexual activity was associated with liberal attitudes about negative sexual outcomes (OR = 1.96, 95%CI = 1.34-2.87) and first sexual partner not being a steady boyfriend or girlfriend (OR = 4.19, 95%CI = 1.62-10.84). Female gender (OR = 0.16, 95%CI = 0.07-0.36) and older age at time of survey were protective (OR = 0.40, 95%CI = 0.32-0.52). Girls who were early starters were more likely to have been initiated by partners who were not steady boyfriends. They also reported liberal attitude towards negative sexual outcomes. Boys were mainly influenced by liberal attitude towards negative sexual outcomes. Being older was protective for both genders. Considering the high rates of HIV and adolescent pregnancy in this population, reproductive health programs that attempt to delay age at first sex should begin early in primary school before adolescents become sexually active.

Predictors of sexual involvement among adolescents in rural Jamaica.

Early sexual activity of adolescents is associated with increased risk of teenage pregnancy, sexually transmitted infections including HIV, and higher maternal/perinatal morbidity and mortality. HIV and adolescent pregnancy are among the most serious public health problems in Jamaica. The objective of this study was to identify the potential predictors of adolescent sexual activity in Jamaica. A cross-sectional survey was conducted among 788 students 13-19 years of age in Jamaica. A questionnaire containing items on socio-demographic characteristics such as age and gender, and scales on adolescent values about sexual activity, self-efficacy for abstinence, parental love, and depression were administered to adolescents at secondary schools in the parish of Hanover. Reliability analysis of the scales, descriptive statistics, and logistic regression to determine predictors of sexual activity were conducted. Approximately 62% of adolescents who responded reported previous sexual intercourse and 38% reported never having had sex. The mean age for sexual debut was 13.6 years. Logistic regression revealed delay values (values towards delaying sexual activity) as protective (OR=0.16, CI=0.09-0.26) against involvement in sexual activity. Risk factors for sexual activity included being older (OR=1.9, CI=1.50-2.50), being male (OR=2.26, CI=1.39-3.68) and having grown-up values (OR=1.49, CI=1.05-2.12). Contrary to expectations, having higher self-efficacy skills was predictive (OR=1.47, CI=1.05-2.05) of adolescent sexual involvement. Analyses by gender revealed that delay and grownup values predicted male sexual activity, while self-efficacy, paternal love and delay values predicted female behavior. These findings show the importance of age, gender, self-efficacy, delay and grown-up values in predicting sexual activity in adolescents and indicate the need for gender-specific interventions for Jamaican adolescents.

Diffusion of Effective Behavioral Interventions and Hispanic/Latino populations.

The national HIV/AIDS prevention program, the Diffusion of Effective Behavioral Interventions (DEBI), is described in the context of addressing Hispanics/Latinos at risk for HIV/AIDS in the United States and Puerto Rico. The eight-step DEBI model is referenced in terms of the interventions and Division of HIV/AIDS Prevention/Capacity Building Branch (DHAP/CBB) Latino Diffusion Team activities. A summary of activities and examples addressing diffusion needs for the diverse Hispanic/Latino populations is discussed. Challenges and successes in diffusion and partner collaborations are also presented, with comment on future directions such as translations and trainings to serve the needs of the Hispanic/Latino-serving community-based organizations and their communities.