One Step Ahead Initiative

The steps from HIV testing to confirmation of HIV diagnosis to ART initiation are often time-consuming and difficult to navigate logistically and emotionally. This study will utilize new testing technologies that have the capability to provide confirmation of HIV infection, RNA viral load, and disease staging at the time of HIV testing. Having these results will make it simpler for testing sites to move patients quickly to initiating treatment for HIV on the same day as their positive test. This approach, developed by UCSF researchers, is called RAPID (Rapid Antiretroviral Program for Individuals with new Diagnosis). RAPID patients receive immediate ART, including through ‘starter packs,’ which allows them to receive the benefits of HIV treatment as they are being linked to a provider who can oversee their longer-term care. This study will test the new testing technologies, as well as evaluate the impact of the RAPID approach on patient outcomes including linkage to and retention in care and viral suppression. The study will be implemented starting at Magnet at Strut in San Francisco and then expand to SFAF Market Street/6^th Street Clinic and Oakland’s East Bay AIDS Center (EBAC). The research team hopes the RAPID approach can be an effective method to help the Bay Area achieve the Getting to Zero goals of zero HIV-related deaths and zero new HIV infections.

Katerina Christopoulos, the principal investigator of the study commented, “Test and Be Treated” represents a powerful collaboration of community, academia and public health that will empower the San Francisco Bay area to stay a step ahead of the HIV epidemic and to get to zero new HIV infections and deaths. Thank you to the CHRP for supporting this key work and special thanks to Chris Pilcher and Bob Grant for their crucial efforts in conceiving and launching this innovative study.

Adding a new component to HIV surveillance, this study will use publicly available anonymous social media comments to inform evidence-based decision making. The multidisciplinary team of researchers (bioinformaticians, epidemiologists, computer scientists, economists, and HIV experts) will first develop a continually updated database of anonymous HIV-related social media posts and then use custom automated content analysis tools to determine the health related needs of Californians.  “We’re trying to get the ‘public’ back in public health by listening to how people’s needs are expressed on social media,” said John Ayers. “Doing so can make HIV prevention efforts in California more targeted and effective,” said Steffanie Strathdee, Associate Dean of Global Health Sciences.  For example, one project of the study will identify the most common forms of HIV-related misinformation and develop strategies to combat its spread. The researchers hope this new surveillance tool can facilitate more agile HIV control efforts.

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of morbidity in chronic treated HIV-1 infection that can slowly, silently and steadily lead to liver cirrhosis, fibrosis and cancer.  There are no known effective treatments.  In this study, researchers at UCLA will test a novel therapeutic strategy for HIV-1 related NAFLD.  The study team will combine apoA-I mimetic peptides and mitochondrial antioxidants, looking for synergistic effects, using a novel delivery system of edible tomatoes that have been engineered to express the two compounds.  If successful, these treatments have the potential to reduce HIV-related inflammation, liver fibrosis, and chronic immune dysfunction associated with HIV infection and the antiretroviral therapy, and may have application beyond HIV. Dr. Theodoros Kelesidis, the Principal Investigator, explains:  “ideally, the intervention would be included in the diet, be given safely for several years, and attenuate progression of disease. Such an intervention could be tomatoes that contain powerful antioxidants. With the support of CHRP, our translational studies will pave the way for novel therapies that may attenuate fatty liver disease in chronic treated HIV-1 infection.”

Identifying strategies to prevent HIV infections in high-risk populations is vital to California’s efforts to get to zero new HIV infections by 2021. This study will provide HIV prevention and related support services to men who have sex with men and transgender women who have substance use disorders upon release from jail. The researchers will compare the utilization of HIV prevention and other support services between individuals who receive routine case management provided upon release from jail to those who have access to GeoPassport, a GPS-based mobile app, incentives, and peer mentor support. GeoPassport provides participants with appointment and medication reminders, help finding service locations, and tracks their incentives for service utilization. Over a year-long follow up period following release from jail, the study will examine participants’ utilization of services, including: regular HIV testing; receipt of a prescription for pre-exposure prophylaxis (PrEP), the HIV-prevention pill, sexually transmitted disease screenings every 6 months, and treatment for their substance use disorders. The study team includes collaborations with Charles R. Drew University of Medicine and Science, Friends Research Institute, and Los Angeles Centers for Alcohol and Drug Abuse.  

Dr. Nina Harawa, the study’s principal investigator, commented, “whereas most people who go to jail do not experience increased HIV risk in custody, those at high-risk for HIV in the community are more likely to go to jail than those who do not.  By reaching and intervening with HIV-negative sexual and gender minorities as they leave incarceration, we hope to reduce the likelihood that the often unstable and chaotic reentry period leads to infection, relapse, or overdose.”