Research Priorities to End the Adolescent HIV Epidemic in the United States: Viewpoint

Abstract

Youth represent 21% of new HIV diagnoses in the United States. Gay, bisexual, and transgender (GBT) youth, particularly those from communities of color, and youth who are homeless, incarcerated, in institutional settings, or engaging in transactional sex are most greatly impacted. Compared with adults, youth have lower levels of HIV serostatus awareness, uptake of antiretroviral therapy (ART), and adherence. Widespread availability of ART has revolutionized prevention and treatment for both youth at high risk for HIV acquisition and youth living with HIV, increasing the need to integrate behavioral interventions with biomedical strategies. The investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) completed a research prioritization process in 2019, focusing on research gaps to be addressed to effectively control HIV spread among American youth. The investigators prioritized research in the following areas: (1) innovative interventions for youth to increase screening, uptake, engagement, and retention in HIV prevention (eg, pre-exposure prophylaxis) and treatment services; (2) structural changes in health systems to facilitate routine delivery of HIV services; (3) biomedical strategies to increase ART impact, prevent HIV transmission, and cure HIV; (4) mobile technologies to reduce implementation costs and increase acceptability of HIV interventions; and (5) data-informed policies to reduce HIV-related disparities and increase support and services for GBT youth and youth living with HIV. ATN's research priorities provide a roadmap for addressing the HIV epidemic among youth. To reach this goal, researchers, policy makers, and health care providers must work together to develop, test, and disseminate novel biobehavioral interventions for youth.

Patients, Social Workers, and Pharmacists’ Perceptions of Barriers to Providing HIV Care in Community Pharmacies in the United States

“…Another patient barrier that participants believed pharmacists are unaware of includes cost barriers associated with HIV and patient insurance options. Cost of medication and HIV services has been a well-studied barrier to retention in HIV care [ 8 , 48 , 49 , 50 ]. In one study, people living with HIV specified insurance as one of their most common barriers to care [ 49 ].…”

“…For pharmacists to be able to connect with patients similarly to social workers, they need to develop close relationships with their patients. Patients that have a better relationship with their healthcare service providers are more likely to be retained in HIV care [ 8 , 53 ]. Previous studies show that social workers have very close bonds with their patients [ 53 ].…”

“…In the United States, people living with the human immunodeficiency virus (HIV) do not consistently utilize care [ 1 , 2 , 3 ], resulting in poor health outcomes including death [ 4 ]. People living with HIV move along a continuum of care [ 5 , 6 , 7 ] from not knowing their status to becoming retained in HIV and then virally suppressed [ 8 , 9 ]. The care people with HIV receive is examined on a continuum, where a person moves from not knowing their HIV status to becoming virally suppressed [ 5 , 6 , 7 ].…”

“…The care people with HIV receive is examined on a continuum, where a person moves from not knowing their HIV status to becoming virally suppressed [ 5 , 6 , 7 ]. Retention in HIV care occurs when patients utilize HIV care services to move along the HIV continuum of care [ 8 , 9 ]. More than 80% of the individuals who are retained in HIV care achieve viral suppression [ 10 ].…”

Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men

“…HIV prevention and care interventions for GBMSM have most often been provided through in-person sessions with behavior change interventions, are often focused on specific subgroups of GBMSM (eg, high-risk HIV-negative episodic substance-using GBMSM, Black GBMSM with HIV-negative or unknown HIV serostatus, HIV-positive clinic patients) [ 23 ] and often target only 1 element of comprehensive prevention—for example, condom use, medication adherence, or PrEP uptake [ 4 ]. In a serostatus-neutral framework [ 24 ], we must evaluate interventions that address multiple prevention behaviors (eg, HIV testing, sexually transmitted infection [STI] testing, condom use, PrEP uptake, and medication adherence), many of which are relevant to GBMSM with HIV and those at risk for HIV infection.…”