Simulating system dynamics of the HIV care continuum to achieve treatment as prevention.

The continuing HIV pandemic calls for broad, multi-sectoral responses that foster community control of local prevention and care services, with the goal of leveraging high quality treatment as a means of reducing HIV incidence. Service system improvements require stakeholder input from across the care continuum to identify gaps and to inform strategic plans that improve HIV service integration and delivery. System dynamics modeling offers a participatory research approach through which stakeholders learn about system complexity and about ways to achieve sustainable system-level improvements. Via an intensive group model building process with a task force of community stakeholders with diverse roles and responsibilities for HIV service implementation, delivery and surveillance, we designed and validated a multi-module system dynamics model of the HIV care continuum, in relation to local prevention and care service capacities. Multiple sources of data were used to calibrate the model for a three-county catchment area of central Connecticut. We feature a core module of the model for the purpose of illustrating its utility in understanding the dynamics of treatment as prevention at the community level. We also describe the methods used to validate the model and support its underlying assumptions to improve confidence in its use by stakeholders for systems understanding and decision making. The model's generalizability and implications of using it for future community-driven strategic planning and implementation efforts are discussed.

Managing the risk of intimacy: accounts of disclosure and responsiveness among people with HIV and intimate partners of people with HIV.

It is well known that concerns about sexual risk tend to decline among people in intimate relationships where there is established commitment and trust. In the context of relationships at increased risk for HIV transmission, interactions involving disclosure and partner responsiveness are key to maintaining intimacy and physical safety. This paper explores concepts of risk and sexual intimacy articulated by a community sample of 30 people living with HIV and their intimate relationship partners. Data revealed the shifts in intimate relationship dynamics upon the disclosure of an HIV diagnosis, the importance of intimacy in the context of managing one or both partners' HIV care and responses to new advances in HIV prophylaxis. Findings suggest that participants' experiences of self-disclosure and partner responsiveness most often resulted in an increased sense of protectiveness from and for partners. This suggests that health-promoting messaging should be adapted to be more relevant to intimate couple communication and mutual support.

A Community-Based Evaluation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for the Black Community.

Limited research evaluates substance use prevention and intervention strategies for cultural sensitivity, appropriateness of content, patient/provider interactions, and implementation for racial and ethnic minority populations. This study uses the Consolidated Framework for Implementation Research (CFIR) to examine a community-based evaluation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for implementation among the Black community in a small, urban setting. Data were gathered through four separate focus groups, one for service providers ( n = 7), one for community youth leaders ( n = 8), and two for community members ( n = 10). Findings suggest that a range of multi-level service needs and underlying mechanisms of implementation should be considered when administering SBIRT within community health settings serving Black populations. This community-involved evaluation of SBIRT responds to the call for the examination of implementation in specific settings, and suggests a need for further examinations of strategies that support engagement through SBIRT and other innovations.