Robin Gaines Lanzi

Introduction: Status‐neutral approaches to HIV treatment and prevention, which link all individuals to tailored, comprehensive services following HIV testing, are promising strategies for reducing HIV service delivery inequities and improving clinical outcomes. However, transferable, feasible models of status‐neutral service delivery are poorly understood, particularly in the United States, where implementation contexts are geographically and institutionally disparate. To guide expanded implementation, we identified difference‐making attributes of status‐neutral implementation workflows in a diverse sample of public sector‐funded HIV clinical organizations in U.S. jurisdictions prioritized in the Ending the HIV Epidemic (EHE) Initiative. Methods: In March−June 2024, we invited frontline HIV service providers across six EHE jurisdictions (Alabama, Baltimore, Chicago, Dallas, Los Angeles, San Diego) to participate in virtual focus group discussions (FGDs), segmented by ongoing or planned status‐neutral implementation. We depicted an HIV status‐neutral workflow and elicited discussants’ perspectives on (in)consistencies between the illustration and their implementation practices. Applying comparative workflow modelling, we re‐illustrated status‐neutral implementation pathways and identified workstream features distinguishing service delivery across clinical organizations. Results: We facilitated eight FGDs with 56 providers across 20 organizations. Status‐neutral implementation processes varied substantially across clinical organizations—distinguished by the roles and responsibilities of clinical (i.e. physicians, nurses) and non‐clinical (i.e. navigators, case managers) staff as well as by the sequence and timing of activities within workflows. We identified four workflow attributes that distinguished clinical organizations: (1) the timing of health insurance review (whether insurance assessments and navigation occurred earlier vs. later in the implementation pathway); (2) the magnitude of activity integration (whether services were delivered concurrently vs. sequentially); (3) the presence of implementation partnerships (whether HIV testing was conducted in‐house vs. externally); and (4) the extent of workforce task‐shifting (whether services were primarily delivered by clinical vs. non‐clinical staff). Conclusions: Workflow heterogeneities reflected jurisdictional and organizational differences in funding, staffing and infrastructure. Generalizable attributes, including the degree of workflow integration and staff role delineation, can inform scalable implementation models. Enhanced cross‐training and increased involvement of non‐clinical staff (especially in HIV prevention workflows) are critical to enable adaptable, timely and person‐centred HIV service delivery across diverse care settings.

Implementation science (IS) plays a critical role in translating research into real-world health outcomes. Few studies have evaluated models that provide technical assistance and other resources to build IS capacity. The Coordinating and Capacity-Building Hubs to Enhance the Science of HIV Implementation Research (CHESHIRE) network supports US-based HIV research awardees participating in the Ending the HIV Epidemic in the US (EHE) initiative. The objective of this study is to describe the evaluation protocol for CHESHIRE and assess the effect of the implementation of hub technical assistance activities on EHE-funded research team outcomes, including IS competencies, scientific collaboration, and research productivity. This protocol describes a mixed methods evaluation using qualitative interviews with EHE project leads (n=36); social network analysis of CHESHIRE-affiliated researchers and hub members (n=265); and secondary data analysis of National Institutes of Health (NIH) RePORTER, PubMed, and NIH Implementation Science Coordination Initiative EHE Project Final Progress Report Survey data (n=248). We will use descriptive analyses, network metrics, and thematic coding to describe outcomes following CHESHIRE implementation, including IS competencies, interinstitutional partnerships, and research productivity. CHESHIRE coordinating center and hub activities were funded through NIH Center for AIDS Research and AIDS Research Center supplements beginning in 2019, with hubs funded between 2019 and 2024. Available survey data include EHE projects that completed the EHE Project Final Progress Report Survey between August 2021 and February 2025. As of January 2026, we have completed enrollment, with 265 network members in the final recruiting list. Data abstraction and analysis of the evaluation components are ongoing. Publication of findings is anticipated for December 2026. Evaluation findings will be disseminated after completion of data analysis. The findings will provide insights on whether structured IS support through CHESHIRE increases researchers' IS competencies, interinstitutional partnerships, and research productivity. This evaluation will provide empirical evidence to guide the development and optimization of technical assistance hubs in public health research and inform their future evaluation of hub-based IS capacity-building models. Findings will inform strategies to optimize IS capacity building and accelerate the translation of evidence-based interventions into practice, especially in HIV prevention and treatment. DERR1-10.2196/91374.

Background: Adolescent girls and young women (AGYW) in the U.S. Southeast are disproportionately affected by HIV. We developed and piloted PrEP-Pro, an intervention to support family medicine residents to prescribe HIV pre-exposure prophylaxis (PrEP), with a focus on AGYW. We pilot-tested the intervention, evaluating feasibility, acceptability, and appropriateness. Methods: Using intervention mapping, we developed sexual history training, PrEP curricula, and a PrEP champion program. For the 6-month pilot test, we trained PrEP champions who trained and supported residents at their sites. Participating physicians completed enrollment and exit questionnaires capturing PrEP provision experiences, attitudes/skills/barriers to completing a sexual history, and PrEP knowledge/attitudes/beliefs. Exit questionnaires assessed PrEP-Pro acceptability, feasibility, and appropriateness. We compared enrollment and exit scores on sexual history assessment, PrEP knowledge, and provider behaviors. Results: Among 46 participants (median age = 29 years), 57% were men, 59% were White, 15% were Asian, 11% were Latinx, and 7% were Black. Among 32 (70%) participants completing both enrollment and exit questionnaires, we observed significant increases in sexual history skills, PrEP knowledge, and PrEP attitudes, and non-significant increases in the proportion reporting routine sexual history assessment and HIV testing. On a 5-point scale, feasibility (mean 4.28 (SD = 0.42), acceptability (4.31 (0.53)), and appropriateness (4.25 (0.46)) scores were high with respect to the PrEP-Pro intervention. Conclusion: This multi-component intervention was feasible, acceptable, and appropriate for family medicine residents in the pilot. Pre- and post-evaluation suggest participation in the intervention increased PrEP knowledge and improved sexual history-taking. These findings suggest that the intervention could successfully enhance provider self-efficacy in delivering sexual health care.

Aim: To share insights on Implementation Science (IS) methods, challenges, solutions, and best practices derived from the second National Meeting for Research and Community Collaboration toward “Ending the HIV Epidemic (EHE) in the United States.” Methods: This 2022 hybrid, one-day conference featured presentations from 13 projects funded as NIH supplements to CFARs and ARCs between 2019 and 2022. Selected for their robust findings, projects were grouped into four topics: (1) community-based outreach strategies, (2) taking the clinic to the community, (3) strategies to improve clinical care, and (4) exploring intersectional vulnerabilities and social/structural determinants of health. Standardized presentation formats were used to ensure comparability in gathering insights on IS methodologies, challenges, solutions, and lessons learned. Structured breakout discussions advanced actionable recommendations. Rapid qualitative analysis summarized insights, emphasizing lessons transportability across diverse implementation contexts. Results: Common IS methods included rapid qualitative analysis, usability testing, surveys, engagement logs, mapping, and administrative data analysis. Recurring challenges were identified, including pandemic-related disruptions, staff turnover, recruitment barriers, communication gaps, and variations in organizational capacity. Effective solutions involved leveraging community partnerships, providing digital tools, conducting flexible training, and securing funding for sustainability. Best practices emphasized early partner engagement, iterative design, equitable power-sharing with communities, and culturally tailored approaches. Conclusions: Collaborative engagement with community partners, clinicians, and participants was pivotal to adapting and scaling interventions. Synthesizing transferable methodologies and lessons strengthens the framework for advancing HIV-related IS and achieving sustainable impact in diverse contexts.

The recent World Health Organization report on disability noted that people with disabilities (PWD) have many unmet health and rehabilitation needs, face numerous barriers to accessing healthcare and specialized services, and have overall worse health than people without disability. In view of this urgency to better identify and address health inequities systematically, we convened an expert panel of 14 stakeholders to develop a strategic plan that addresses this issue. The panel identified two major obstacles to quality healthcare services for PWD: (1) lack of coordination between the various healthcare sectors and community well-being programs and (2) substantial challenges finding and accessing healthcare services that meet their specific needs. The expert stakeholder panel noted that well-being self-management programs (both online and in person) that are easily accessible to PWD are critically needed. PWD must transition from being cared for as patients to individuals who are able to self-manage and self-advocate for their own health and well-being plans and activities. The proposed strategic plan offers providers and local communities a framework to begin addressing accessible and appropriate healthcare-to-well-being services and programs for PWD in managing their health in partnership with their healthcare providers.

Background: Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention intervention and a major strategy for reducing the HIV burden in the United States. However, PrEP provision and uptake remain lower than estimated needs, and in ways that may exacerbate HIV disparities among Black adolescent girls and young women in the southern United States. Data suggest that gaps in provider knowledge of HIV epidemiology and PrEP and skills assessing sexual health practices are important barriers to provision and uptake, with limited evidence-based interventions to address these gaps. Objective: This paper describes the “PrEP-Pro” intervention, a multicomponent intervention to train and support family medicine (FM) trainees to promote PrEP for adolescent girls and young women in Alabama. Methods: The PrEP-Pro intervention comprises 3 main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): (1) provider HIV epidemiology and PrEP education, (2) sexual history taking, and (3) PrEP Champions. In phase 1, we will work with community advisory boards (providers and clients) and then conduct focus groups with FM trainees to adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies, including provider-facing tools and client-facing educational materials. In phase 2, we will pretest and then pilot-test the initially adapted PrEP-Pro intervention with FM trainees. FM trainees will complete baseline, 3-, and 6-month questionnaires post PrEP-Pro intervention. We will also conduct in-depth interviews (IDIs) with FM pilot participants, adolescent girls and young women who accessed care after the PrEP-Pro pilot, and key stakeholders. The primary outcomes are PrEP-Pro acceptability and feasibility, which would be assessed using validated instruments at months 3 (among pretest participants) and 6 (among pilot participants). Secondary outcomes will also be assessed, including PrEP knowledge, sexual history-taking attitudes and practices, PrEP prescriptions among adolescent girls and young women encounters, and sexually transmitted infections (STIs) and HIV testing among adolescent girls and young women encounters in 6 months. Results: Study results will be disseminated to practices, state health officials, and other key stakeholders to solicit feedback on implementation opportunities and challenges to inform a hybrid effectiveness implementation trial. Our results will also be presented at local and national conferences and submitted to peer-reviewed journals. Conclusions: As PrEP grows, there is a pressing need to train FM providers and develop appropriate, contextually relevant tools to support PrEP implementation. The PrEP-Pro intervention is a multicomponent intervention to train FM residents across Alabama on sexual history-taking, PrEP provision for adolescent girls and young women, and supporting practice-based PrEP Champions. The PrEP-Pro intervention is anticipated to increase PrEP prescriptions for adolescent girls and young women and expand comprehensive sexual and reproductive health care for adolescent girls and young women in rural and urban Alabama. International Registered Report Identifier (IRRID): PRR1-10.2196/44908

The COVID-19 pandemic continues to have a global and multifaceted impact on public health. Marginalized and vulnerable populations, such as college students and postdoctoral fellows with disabilities or pre-existing conditions, are being disproportionately affected by the COVID-19 pandemic. Various barriers contribute to an individual’s intentions to seek mental health help, but with COVID-19’s unprecedented permeability, more research is needed to support this student population. This phenomenological study explored the coping strategies and help-seeking behaviors of college students and postdoctoral fellows with disabilities during the COVID-19 pandemic. Using semi-structured, in-depth interviews from fall 2020 (n = 36) and spring 2021 (n = 28), a thematic analysis was conducted. The Transactional Model of Stress and Coping was used to triangulate findings, to better understand the relationship between perceived stressors, coping mechanisms, and psychological outcomes. The findings show that (1) college students with disabilities coped in multiple ways (i.e., behavioral, relational, and mental), with some noting improvements in their coping abilities by spring, and (2) stigma prevented college students with disabilities from seeking help when needed. These findings emphasize the need for higher education to address ableism and use factors beneficial to fostering resiliency (i.e., social support, optimism, and self-advocacy) among college students with disabilities.

BACKGROUND Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention intervention and a major strategy for reducing the HIV burden in the United States. However, PrEP provision and uptake remain lower than estimated needs, and in ways that may exacerbate HIV disparities among Black adolescent girls and young women in the southern United States. Data suggest that gaps in provider knowledge of HIV epidemiology and PrEP and skills assessing sexual health practices are important barriers to provision and uptake, with limited evidence-based interventions to address these gaps. OBJECTIVE This paper describes the “PrEP-Pro” intervention, a multicomponent intervention to train and support family medicine (FM) trainees to promote PrEP for adolescent girls and young women in Alabama. METHODS The PrEP-Pro intervention comprises 3 main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): (1) provider HIV epidemiology and PrEP education, (2) sexual history taking, and (3) PrEP Champions. In phase 1, we will work with community advisory boards (providers and clients) and then conduct focus groups with FM trainees to adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies, including provider-facing tools and client-facing educational materials. In phase 2, we will pretest and then pilot-test the initially adapted PrEP-Pro intervention with FM trainees. FM trainees will complete baseline, 3-, and 6-month questionnaires post PrEP-Pro intervention. We will also conduct in-depth interviews (IDIs) with FM pilot participants, adolescent girls and young women who accessed care after the PrEP-Pro pilot, and key stakeholders. The primary outcomes are PrEP-Pro acceptability and feasibility, which would be assessed using validated instruments at months 3 (among pretest participants) and 6 (among pilot participants). Secondary outcomes will also be assessed, including PrEP knowledge, sexual history-taking attitudes and practices, PrEP prescriptions among adolescent girls and young women encounters, and sexually transmitted infections (STIs) and HIV testing among adolescent girls and young women encounters in 6 months. RESULTS Study results will be disseminated to practices, state health officials, and other key stakeholders to solicit feedback on implementation opportunities and challenges to inform a hybrid effectiveness implementation trial. Our results will also be presented at local and national conferences and submitted to peer-reviewed journals. CONCLUSIONS As PrEP grows, there is a pressing need to train FM providers and develop appropriate, contextually relevant tools to support PrEP implementation. The PrEP-Pro intervention is a multicomponent intervention to train FM residents across Alabama on sexual history-taking, PrEP provision for adolescent girls and young women, and supporting practice-based PrEP Champions. The PrEP-Pro intervention is anticipated to increase PrEP prescriptions for adolescent girls and young women and expand comprehensive sexual and reproductive health care for adolescent girls and young women in rural and urban Alabama. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/44908

The purpose of the study is to understand how undergraduate, graduate, and professional students were affected by the events of racial injustice and the COVID-19 pandemic. Data gathered from an online campus-wide survey administered during July and August 2020 indicated high levels of stress and rates of depression across all stages of training. A majority of these students also indicated that, while events around racism negatively impacted their mental health, such events did not affect students’ academic success as COVID-19 did. Although previous studies have demonstrated that student mental health has been negatively affected during COVID-19, this study shows that student mental health is also impacted by events driven by racism and racial injustice concurrent to the pandemic. In light of these findings, it is recommended that institutions adopt an intersectional approach toward addressing such contemporaneous stressors with initiatives that can adapt to multiple events simultaneously.