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Implementation Science

This initiative was designed to support HIV implementation science that have the potential to be scalable for sustained impact on the HIV epidemic in California.

Implementation Science for Ending the HIV Epidemic (2021)

Owing to decades of groundbreaking research, there is a robust toolkit of interventions documented to improve prevention, testing, and treatment outcomes for HIV. Identifying effective strategies to bring those tools to scale, for sustained and cost-effective impact, is a critical next step.

We awarded four grants to support HIV implementation science that have the potential to be scalable for sustained impact on the HIV epidemic in California.


 

Telemedicine to Improve Engagement in HIV Care and Viral Suppression in Los Angeles County

Principal Investigator: Risa Hoffman, Ph.D., UC Los Angeles
Budget: $775,849
Start Date: 2/1/2021     End Date: 1/31/2024

People living with HIV have different needs in terms of the type of health care delivery that works best for them. Adapting the standard way that HIV care is delivered can help patients who are struggling with care to overcome certain barriers, such as finding the time to come to clinic, or avoiding the stigma associated with coming to frequent medical appointments for a chronic illness. Telemedicine, or the use of telephone and/or video to perform health services, is one adaptation of standard health care delivery that has been shown to be beneficial for certain conditions, like diabetes and heart disease. While telemedicine has been used in a limited capacity for HIV care (such as for counseling), it has not been commonly used as a replacement for in-person primary care visits.

The proposed research will develop a telemedicine program within two HIV clinics in Los Angeles County. We will replace two of four in-person HIV primary care visits with a telephone or video visit that the patient can participate in from home. By reducing the frequency of in-person visits, we hope that HIV patients in these two clinics will have an easier time remaining in HIV care and taking HIV medications, and that telemedicine will be cost-saving for patients, because they won’t have to spend money on transportation to come to clinic, or spend time away from work or other household duties for clinic visits. Our study will first interview patients and providers to learn their thoughts and opinions about telemedicine, and then use this information to develop a telemedicine program that patients can participate in over ~18 months. At the end of 18 months, we will measure whether the telemedicine program helps patients have better clinical outcomes (such as undetectable viral load in the blood) and whether they miss fewer appointments over the course of the study. We will also measure how patients and providers feel about telemedicine at the end of the 18 months, to see if they liked it and what challenges they experienced, and also whether telemedicine is cost-saving for patients and for the clinics.

 

Implementing HIV PrEP among Latino men who have sex with men and transgender women

Principal Investigator: Jeffrey Klausner, Ph.D., University of Southern California
Budget: $777,994
Start Date: 2/1/2021     End Date: 1/31/2024

Telemedicine offers a great opportunity for HIV prevention, as it has the potential to increase access to pre-exposure prophylaxis (PrEP). PrEP, if used as directed, could virtually eliminate the risk of HIV acquisition among high risk populations. In addition to the brick and mortar sites, the state of California provides PrEP delivered through telemedicine (telePrEP) at no cost for those enrolled in their PrEP Assistance Program (PrEP-AP). Program participants enroll by visiting a local enrollment site once and then follow up visits, testing, and prescription filling occur remotely without visiting a clinic. However, this option is underutilized, with only a small number of people using telemedicine to get PrEP. The goal of this implementation science proposal is to develop an intervention which increases uptake of California’s telePrEP program (referred to as “Cal telePrEP” for this proposal). The study will occur in two phases. First, we will work with community based organizations, health policy stakeholders, industry stakeholders and prospective patients to identify barriers and facilitators to the uptake of telePrEP among Latinx MSM and transwomen. Data on barriers and facilitators will be collected through qualitative data collection methods (focus groups and in-depth interviews), and the development of interview/focus group guides, as well as the analysis of subsequent data, will be guided by the Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. We will then analyze the data and present our findings to a stakeholder board. This board will consist of community organizations and health policy organizations that will help us develop a set of recommendations for increasing access to telePrEP.

During the second phase, we will select local PrEP-AP enrolling sites in Los Angeles, Riverside and San Bernandino counties and we will work closely with their staff to implement the recommendations from the first phase. We will use a second framework called the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) to evaluate our intervention by monitoring telePrEP uptake on a quarterly basis.

Finally, project findings and a set of recommendations will be shared with local sites, stakeholders and PrEP providers to assist with expanding telePrEP use among Latinx populations in California.

 

Consumer Preferences for the Delivery of Prevention Services Among Individuals Leaving Jail

Principal Investigator: Janet Myers, Ph.D., UC San Francisco
Budget: $787,500
Start Date: 2/1/2021     End Date: 1/31/2024

At this time, there is little information about people’s preferences for the way they receive treatment and services for substance use disorders (SUDs) and HIV prevention. For example, there are now injectable forms of medication available for both purposes that may be preferable to pills. The purpose of this project is to understand what individuals leaving jail would like to see in terms of strategies to optimize their access to HIV prevention and SUD treatment. People leaving jail have higher rates of opiate use, SUDs and associated infections than those in the general population. Recent changes in the availability of treatments and reductions in access to prevention services due to COVID-19 have created changes in how these individuals might want to receive treatment. In this project, we hope to organize and work with a group of providers, public health officials. and people in jail themselves to advise us on: a) designing and conducting a survey to measure the best ways to deliver treatment for SUDs and HIV prevention; b) understanding the existing service delivery system to assess where we can integrate more consumer or client-friendly strategies; c) advising on the design of a pilot program able to best serve people leaving jail based on the group’s input and on the results of the survey, and, finally; d) on the development, delivery, and evaluation of this pilot program. By involving stakeholders throughout the life of the project, we expect to be able to find and integrate the best strategies for SUDs and HIV prevention for people leaving jail in San Francisco. Notably, we will be collaborating with the clinical group that provides care to people in jail in San Francisco – Jail Health Services - and with the Sheriff’s department who will work with us to provide enhanced linkage to care at release to make sure that the strategies we identify and the program that results will have the best chance at being sustainable in this setting and in others interested in a model that emerges from the preferences of the people it serves.

 

Strategies for Implementing PrEP Services in a Trans Community Center

Principal Investigator: Erik Storholm, Ph.D., San Diego State University Research Foundation
Budget:  $678,955
Start Date: 2/1/2021     End Date: 1/31/2024

PrEP or pre-exposure prophylaxis is an important HIV prevention tool for individuals with elevated risk for HIV. However, use of PrEP is lower among transgender and non-binary (TGNB) identified individuals, especially among Black and Latinx TGNB individuals who are also shown to be at higher risk for HIV. Our preliminary work with trans women in Los Angeles has found significant structural barriers to PrEP utilization including transportation difficulties, employment and housing insecurity, and frequent prior experiences of stigma in healthcare settings. In 2018, the first-of-its-kind Transgender Wellness Center (TWC) opened with the express goal of reducing structural and individual barriers to trans healthcare by creating a welcoming, safe, and affirming environment. The culmination of a decade of collaboration between Los Angeles County Department of Public Health (DPH) and numerous trans community-based organizations (CBOs), DPH-funded agencies, and community stakeholders, the TWC occupies 3,000 square feet in an accessible central location in Los Angeles. The Los Angeles LGBT Center is the lead agency overseeing and coordinating five CBOs focused on TGNB services and resources including housing, workforce development, financial literacy, economic empowerment, and HIV prevention. Although PrEP education is part of the HIV risk reduction package offered at the TWC, PrEP services are not provided onsite, resulting in a significant gap in HIV prevention services for TGNB individuals in Los Angeles. This implementation science proposal represents a collaboration with TWC leadership and key community stakeholders in response to the structural barriers that continue to impede the provision of PrEP as part of an integrated trans wellness care model that includes hormone therapy for TGNB individuals. We are proposing a 3-year project to implement and pilot test TransPrEP, a comprehensive implementation strategy that addresses structural barriers by integrating PrEP into existing services for TGNB individuals at the TWC. This application represents an academic-community partnership between the following collaborating institutions: Los Angeles LGBT Center, Los Angeles Department of Public Health, San Diego State University, RAND Corporation; Friends Research Institute; UCLA Center for HIV Identification, Prevention, and Treatment Services; and TWC.