RESUMEN
The nationwide scale-up of evidence-based and evidence-informed interventions has been widely recognized as a crucial step in ending the HIV epidemic. Although the successful delivery of interventions may involve intensive expert training, technical assistance (TA), and dedicated funding, most organizations attempt to replicate interventions without access to focused expert guidance. Thus, there is a grave need for initiatives that meaningfully address HIV health disparities while addressing these inherent limitations. Here, the Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) initiative Using Evidence-Informed Interventions to Improve HIV Health Outcomes among People Living with HIV (E2i) piloted an alternative approach to implementation that de-emphasized expert training to naturalistically simulate the experience of future HIV service organizations with limited access to TA. The E2i approach combined the HAB-adapted Institute for Healthcare Improvement's Breakthrough Series Collaborative Learning Model with HRSA HAB's Implementation Science Framework, to create an innovative multi-tiered system of peer-to-peer learning that was piloted across 11 evidence-informed interventions at 25 Ryan White HIV/AIDS Program sites. Four key types of peer-to-peer learning exchanges (i.e., intervention, site, staff role, and organization specific) took place at biannual peer learning sessions, while quarterly intervention cohort calls and E2i monthly calls with site staff occurred during the action periods between learning sessions. Peer-to-peer learning fostered both experiential learning and community building and allowed site staff to formulate robust site-specific action plans for rapid cycle testing between learning sessions. Strategies that increase the effectiveness of interventions while decreasing TA could provide a blueprint for the rapid uptake and integration of HIV interventions nationwide.
RESUMEN
PURPOSE: Spontaneous cataracts have been identified in the lenses of animals across a phylogenetically wide range of species. This can be a source of insights and innovation for human health professionals, but many persons may lack awareness of it. By providing a phylogenetic survey and analysis of species with cataract vulnerability, this paper demonstrates how a broad comparative perspective can provide critical information about environmental hazards to human visual health and can spark potential innovations in the prevention and treatment of cataracts in humans. DESIGN: Perspectives. METHODS: Review and synthesis of selected literature with interpretation and perspective. RESULTS: We found 273 recorded cases of spontaneously occurring cataracts in 113 species of birds, 83 species of mammals, 30 species of actinopterygii fish, 10 species of amphibians, 6 species of reptiles, and 1 species of cephalopod. CONCLUSION: A phylogenetically wide range of species, including many living in and around human environments, are vulnerable to cataracts. These animals may serve as sentinels for human visual health. Variation in cataract vulnerability across species may also facilitate the identification of resistance-conferring physiologies, leading to accelerated innovation in the prevention and treatment of cataracts in humans.
