Manya Magnus

Background: The HIV Prevention Trials Network 094 INTEGRA study sought to fill the gap in implementation science literature by exploring the delivery of integrated prevention and care for HIV and opioid use dependence through mobile units to people who inject drugs (PWID). Setting: Five US INTEGRA sites with diverse implementation landscapes that were disproportionately affected by the HIV and opioid epidemics (New York; Philadelphia; WA, DC; Houston; and Los Angeles) were included. Methods: In-depth qualitative interviews from an embedded implementation science evaluation were conducted with 37 clinical and research INTEGRA staff delivering integrated care through mobile units. Pragmatic qualitative analysis was guided by the PRISM framework to identify key implementation needs, challenges, and solutions for delivering the INTEGRA intervention via mobile units in local neighborhoods. Results: Staff described how mobile delivery of INTEGRA reduced key barriers that limit PWID’s access to HIV and opioid use dependence services. Yet, they also detailed complex implementation needs, including the proactive coordination among staff to ensure sustained access to INTEGRA services, navigating internal and external spaces to deliver services, maintenance-related demands to keep the mobile unit's infrastructure operational, and interdependent efforts that bridged the mobile unit's service delivery within the extant health systems and community landscapes. Conclusions: Findings demonstrated that mobile integrated care models can reduce access barriers for PWID but require tailored implementation strategies to address operational, spatial, infrastructural, and community-level demands. Results may help inform an implementation blueprint for similar communities working to respond to the intersecting HIV and opioid epidemics affecting PWID across US settings.

Problem: Sexual violence compromises women's health and increases susceptibility to pathogens. Yet immunobiological consequences of acute sexual trauma remain incompletely understood. Methods: We conducted a cross‐sectional study among women without HIV, comparing women exposed to forced vaginal penetration in the past 4 days (Acute Cases, n = 10), within the past 12 weeks (Cases, n = 10) and never exposed (Controls, n = 12). Sixteen immune biomarkers were measured by ELISA in plasma and cervical swabs. Blood CD4 and CD8 T cells were quantified by flow cytometry. Group differences were analyzed using Kruskal‐Wallis tests followed by Dunn's test and Bonferroni correction for continuous variables and Fisher's exact test followed by pairwise Fisher's tests with Bonferroni correction for categorical variables. Results: Participants were predominantly Black (66%), publicly insured (59%) and less than 30 years of age (29%). Black women were more likely to be Acute Cases and Cases ( p = 0.02). Cervical fluid from Acute Cases showed significantly elevated inflammatory cytokines, TNF‐α ( p = 0.02), IL‐1α ( p < 0.001) and IL‐6 ( p = 0.001); chemokines, IL‐8 ( p < 0.05) and MIP‐3α ( p < 0.001); and antimicrobials, serpinA1 ( p < 0.001), SLPI ( p = 0.035) and elafin ( p = 0.001). Plasma biomarkers differed significantly for inflammatory cytokine IL‐1α ( p = 0.001), acute phase protein CRP ( p = 0.03), chemokine MCP‐1 ( p = 0.043), antimicrobials SLPI ( p = 0.001) and HBD‐2 ( p = 0.03) as well as MMP‐1 ( p = 0.004) and 9 ( p = 0.006). CD4 and CD8 T cell proportions in blood were not significantly different between groups. Conclusions: Sexual violence exposure is associated with rapid systemic and mucosal immune dysregulation that may increase susceptibility to HIV and other sexually transmitted infections.

Cisgender Black women living with HIV (BWLWH) face significant intersectional stigma, racism, and discrimination, contributing to lower adherence to antiretroviral therapy (ART). Given the role of religion and spirituality in Black communities, we explored their influence on HIV treatment. We conducted semi-structured interviews with 30 BWLWH in Washington, DC ( M age = 52.7, SD = 15.95), living with HIV for an average of 26 years ( SD = 9.72); 33% were virally suppressed. Interviews averaged 52 min and revealed intersectional stigma from multiple sources that negatively affected ART adherence. Despite stigma in religious spaces, many participants relied on spirituality to cope, stay in care, and find meaning in their diagnosis. Our findings highlight spirituality as a vital support for BWLWH. Future interventions should address both intersectional stigma and the protective role of spirituality to improve ART adherence and help reach the goals of Ending the HIV Epidemic.

Vaccination played a critical role in controlling the 2022 mpox outbreak in the United States, yet only a quarter of eligible individuals are estimated to be fully vaccinated. Using mixed methods, we analyzed cross-sectional data collected from 60 sexual and gender minority people with and without HIV (PWH and PWOH) in August 2022. We investigated willingness to receive an mpox vaccine and to participate in mpox vaccine research, as well as actual vaccine uptake and experiences, and compared results by HIV status. Two-thirds of participants (66.7%) had received at least one dose of the mpox vaccine, including 61.5% of PWH and 70.6% of PWOH. PWH and PWOH had similarly high levels of willingness to receive an mpox vaccine. In open-ended responses, participants described personal and societal benefits of vaccination and had positive attitudes towards vaccines. Despite high vaccine acceptance and uptake, satisfaction with the vaccine rollout was low. A majority of unvaccinated participants who had tried to get the vaccine reported that they were unable to access it. Willingness to participate in mpox vaccine research was lower than willingness to receive a vaccine, though still moderately high. Some participants expressed uncertainty about research participation, concerns about safety, and negative attitudes toward research in general. PWH were more willing to participate in an mpox vaccine trial than were PWOH; however, this difference was not statistically significant. These results can inform future mpox research, vaccine rollout, and community engagement for vaccine trial recruitment.

Background: The HIV Prevention Trials Network (HPTN) 083 Trial demonstrated the superiority of long-acting, injectable cabotegravir (CAB) over daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis among cisgender men (MSM) and transgender women (TGW) who have sex with men. Plasma CAB concentrations associated with HIV protection in humans are unknown. Methods: We conducted a nested case-control study to investigate the association between plasma CAB concentrations and HIV risk. Plasma CAB concentrations were estimated for participants with confirmed HIV and for HIV-negative controls, who were matched on region, gender, and race. The window of HIV acquisition for cases was defined as the time between the last HIV-negative visit and the first HIV-positive visit; this window was used to evaluate CAB exposure for cases and their matched controls. Participants were categorized by the minimum estimated CAB concentration (CABmin) during this window relative to the protein-adjusted 90% CAB inhibitory concentration (1× PA-IC90) and 4× PA-IC90. HIV risk was modeled using conditional logistic regression. Results: Plasma CABmin was ≥4× PA-IC90 in 26% of HIV-positive cases, compared with 76% of matched controls. Plasma CABmin ≥4× PA-IC90 was associated with a 93% reduction in risk of HIV acquisition compared with CABmin <1× PA-IC90 (95% CI: 76%, 98%, P < .001). CABmin between 1× and 4× PA-IC90 had an estimated risk reduction of 79% compared with CABmin <1× PA-IC90 (95% CI: −19%, 96%, P = .07). Conclusions: Consistent plasma CAB concentrations ≥4× PA-IC90 were estimated to provide 93% protection against HIV in MSM and TGW.

Background: People who inject drugs (PWID) face multilevel barriers to adhering to daily oral preexposure prophylaxis (PrEP). Long-acting injectable (LAI) PrEP may help overcome some of these barriers. Understanding willingness among PWID to take LAI PrEP and preferences for PrEP modality is important to promote LAI PrEP when it becomes available to them. Methods: We analyzed data from the 2018 National HIV Behavioral Surveillance PWID data collection cycle in Washington, DC. Respondent-driven sampling weighted proportions and correlates of willingness to take LAI PrEP and preference for LAI PrEP versus daily oral PrEP were reported, overall and stratified by gender. Results: Of 402 PWID, 69.1% reported being extremely likely/likely to take LAI PrEP; 52.4% preferred LAI PrEP over daily oral PrEP. Being female and uninsured were associated with higher odds of willingness to take LAI PrEP. Having no/low income and past-year sexual violence were associated with preferring LAI PrEP over daily oral PrEP. Men who inject drugs who were aware of PrEP had higher odds to prefer LAI PrEP over daily oral PrEP. Women who inject drugs (WWID) reporting no/low income, sexual violence, and receptive needle sharing were more likely to prefer LAI PrEP over daily oral PrEP. Conclusions: PWID in Washington, DC reported high willingness to take LAI PrEP; half reported preferring LAI PrEP. Improving education about PrEP is important for healthcare providers and PWID. Subgroups of WWID experiencing sexual violence may benefit from LAI PrEP. Human immunodeficiency virus prevention programs for PWID should consider gender differences when implementing LAI PrEP.

Background: The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI) aims to establish programs to develop pathways for successful careers in HIV science among scholars from underrepresented racial and ethnic populations. This article describes cross-site evaluation outcomes during the first 18 months (July 2021–December 2022) across 15 programs. Methods: The aims of the evaluation were to characterize participants, describe feasibility, challenges, and successes of the programs and provide a basis for the generalizability of best practices to Diversity, Equity, and Inclusion (DEI) programs in the United States. Two primary data collection methods were used: a quarterly programmatic monitoring process and a centrally managed, individual-level, participant quantitative and qualitative survey. Results: During the first year of evaluation data collection, 1085 racially and ethnically diverse scholars ranging from the high school to postdoctoral levels applied for CDEIPI programs throughout the United States. Of these, 257 (23.7%) were selected to participate based on program capacity and applicant qualifications. Participants were trained by 149 mentors, teachers, and staff. Of the N = 95 participants responding to the individual-level survey, 95.7% agreed or strongly agreed with statements of satisfaction with the program, 96.8% planned to pursue further education, and 73.7% attributed increased interest in a variety of HIV science topics to the program. Qualitative findings suggest strong associations between mentorship, exposure to scientific content, and positive outcomes. Conclusions: These data provide evidence to support the feasibility and impact of novel DEI programs in HIV research to engage and encourage racially and ethnically diverse scholars to pursue careers in HIV science.

The high incidence of HIV among US Black sexual minority men is a public health crisis that pre-exposure prophylaxis (PrEP) for HIV can help address. Public health campaigns, which often include pictures of Black sexual minority men alongside PrEP-related messaging, have been developed to encourage PrEP awareness and uptake. However, the acceptability of the messaging within these campaigns among Black sexual minority men is unclear. We conducted four focus groups with 18 HIV-negative Black sexual minority men in Washington, DC to explore their perspectives regarding promotional messaging (textual elements) in PrEP visual advertisements, including their reactions to three large-scale public health campaigns. Primary themes included: (1) the need for additional information about PrEP, (2) preference for slogan simplicity, (3) the desire to normalise PrEP use, and (4) mixed views on the inclusion of condoms. Results indicated that the messaging in current PrEP visual advertisements may not sufficiently address Black sexual minority men’s questions about PrEP. Providing basic PrEP information and methods to access more information; using simple, unambiguous language; presenting PrEP use in a destigmatising, normalising fashion; and conveying the relevance of condoms if included in the advertisement could help increase the acceptability of future PrEP advertising among Black sexual minority men.

HIV prevention with antiretroviral medication in the form of pre-exposure prophylaxis (PrEP) offers a critical tool to halt the HIV pandemic. Barriers to PrEP access across drug types, formulations, and delivery systems share remarkable commonalities and are likely to be generalizable to future novel PrEP strategies. Appreciation of these barriers allows for planning earlier in the drug-development pathway rather than waiting for the demonstration of efficacy. The purpose of this article is to propose a core set of considerations that should be included in the drug-development process for future PrEP interventions. A literature synthesis of key barriers to PrEP uptake in the United States was conducted to elucidate commonalities across PrEP agents and delivery methods. Based on the published literature, we divided challenges into three main categories of structural barriers: (1) provider and clinic characteristics; (2) cost considerations; and (3) disparities and social constructs, with potential solutions provided for each. Pragmatic strategies for examining and overcoming these barriers before future PrEP regulatory approval are recommended. If these strategies are considered well before the time of commercial availability, the potential for PrEP to interrupt the HIV pandemic will be greatly enhanced.