Building Community-Academic Research Partnerships to End the HIV Epidemic in Arizona: Findings to Inform Next Steps

Health Promotion Practice · 2025-09-27

In 2022, Arizona saw an unprecedented 20% increase in new HIV infections and viral suppression rates of 61.8% among people with HIV. Existing local efforts to address HIV should be complemented with research to identify gaps and approaches to improve outcomes. Using CBPR as a guiding framework, we explored the potential for community-academic HIV research collaborations by hosting a Community-Academic HIV Research Partnership Series. Attendance across five workshop sessions totaled 123 attendees, with representation from nonprofit community-based organizations, clinic settings, city and state government, and the university. Meeting content was guided by the following broad ideas: (a) experiences and perceptions of research; (b) successful models of community-academic research partnerships; and (c) local HIV research needs. Thematic analysis of transcribed notes identified the following overall themes and selected parenthetical subthemes: Experiences and Perceptions of Research (Responsibilities of Research and Researchers, Benefits and Barriers of Research, and Required Knowledge for Researchers); Successful Community-Academic Research Partnerships (Mechanisms to Facilitate Successful Research Partnerships); and HIV Research Needs in Arizona. Communication, trust, transparency, cultural humility, mutual benefit, diversity and inclusivity, and genuine relationship-building were regarded by community attendees as priorities for community-academic partnerships. These findings have been instructive in cultivating relationships and laying the groundwork for a formal structure for community-academic HIV and equity research partnerships. Building on early HIV/AIDS activism that set the stage for advancements in clinical, social and behavioral research, we aim to expand local collaborative efforts that will maximize the expertise of communities and researchers to effectively end the HIV epidemic.

Radiation safety: knowledge, attitudes, practices and perceived socioeconomic impact in a limited-resource radiotherapy setting

ecancermedicalscience · 2025-02-20 · 8 citations

= 0.014). The study highlights a high level of knowledge and positive attitudes towards radiation safety among healthcare workers in a limited-resource radiotherapy setting. While most participants recognized the importance of radiation safety and its shared responsibility, less than half regularly checked safety equipment. There were significant perceptions of the socioeconomic benefits of implementing safety protocols.

Exploring sexual minority men’s perspectives and benefits of long-acting injectable antiretroviral therapy in South Africa

AIDS Care · 2025-07-24 · 1 citations

In South Africa, sexual minority men (SMM) face high HIV rates and challenges with antiretroviral therapy (ART) adherence, hindering viral suppression. Factors, such as non-disclosure, stigma, and partner dynamics, complicate adherence. Long-acting ART options, like injectables, could help address these challenges; however, their acceptability among SMM in South Africa remains unclear. Between April and June 2024, qualitative interviews were conducted with 21 SMM who participated in the Speaking Out & Allying Relationships (SOAR) a video- and skills-based HIV intervention, supporting SMM's communication and coping skills for status-sharing and treatment adherence in South Africa, to explore their initial impressions of injectable ART. Interviews explored disclosure, adherence, partner dynamics, and attitudes toward injectable ART. Participants viewed injectables as a major improvement over daily pills, citing benefits, such as reduced mental burden and increased privacy and safety. They felt that injectables could give them more control over disclosure, and flexibility to manage treatment during social interactions. These findings suggest that long-acting ART could improve adherence and reduce stigma, aligning with SMMs dynamic lifestyle. Further research is necessary to evaluate the effectiveness and accessibility of injectable ART for SMM in South Africa, emphasizing supportive healthcare systems and training providers in this emerging treatment landscape.

Social isolation, social exclusion, and access to mental and tangible resources: mapping the gendered impact of tuberculosis-related stigma among men and women living with tuberculosis in Eastern Cape Province, South Africa

BMC Global and Public Health · 2025-06-05 · 10 citations

BACKGROUND: In 2022, an estimated 10.6 million people developed tuberculosis (TB) globally, with men bearing a greater burden of disease compared to women. In South Africa specifically, men experience higher risks of poor outcomes and TB-related mortality than women. Stigma and isolation among people living with tuberculosis (PLWTB) are well documented. The gendered pathways through which TB-related stigma leads to isolation or impacts access to resources during one's illness-to-health journey are poorly understood. METHODS: We interviewed PLWTB receiving treatment at government clinics in Buffalo City Metro Health District, Eastern Cape Province, South Africa. Semi-structured guides explored TB symptom experiences, access to care, treatment motivation, key supporters, and access to mental and tangible resources (MTRs) during illness. Open coding was done inductively, with MTR domains informed by the Network-Individual-Resource Model. Findings were analyzed through a cyclic, iterative, and deductive process using social isolation and exclusion as interpretive lenses. Memos and pathway mapping examined gendered differences in stigma, isolation, and access to networked MTRs. RESULTS: One hundred forty-two PLWTB (men = 86; women = 56) were interviewed. PLWTB described pervasive TB stigma and isolation. Women described self-isolating in response to enacted and anticipated stigma. Men described active exclusion by friends and family. Women's maintenance of familial ties facilitated access to MTRs while ill. Men's systematic exclusion (e.g., deliberate or forced by peers or family) reduced their agency to access resources. Men and women described regaining physical strength and recovery of social networks through treatment, but also the sustained impacts of post-treatment stigma. CONCLUSIONS: We identified gendered pathways through which TB stigma and isolation affect access to MTRs. For women, stigma led to social isolation, but familial networks helped maintain access to MTRs, fostering resilience. Men experienced social exclusion, reduced agency to access MTRs, and increased vulnerability during illness. Findings can guide gender-responsive interventions to reduce the impact of TB stigma on health outcomes.

Population-Level Trends and Determinants of HIV Testing Among U.S. Women Reporting HIV Risk Behavior From 2016 to 2020: A Repeated Cross-sectional Study

Journal of the Association of Nurses in AIDS Care · 2025-04-22 · 1 citations

ABSTRACT: Racial and ethnic disparities in HIV among women in the United States persist. Testing is a key component of HIV prevention and treatment, yet national testing rates and demographic differences among women with increased vulnerability are unclear. A secondary repeated cross-sectional analysis of Behavioral Risk Factor Surveillance System data from female respondents spanning years 2016-2020 was performed to assess HIV testing among those reporting behaviors that increase the potential for acquiring HIV. Survey weighted logistic regression was used to model the predicted probability of an HIV test in the past 12 months. Among the weighted sample ( N = 20,336), there was a 37.1% probability of an HIV test in the past 12 months. Non-Hispanic Black women had the highest probability (56.2%), and testing in the 25-34 and 35-44 years age groups was consistently below 50% in each year of the analysis. Overall, women with health care coverage (vs. without coverage) were more likely to be tested for HIV; however, no significant difference in testing by insurance status was observed for Non-Hispanic women of color in supplemental analysis. Our study underscores HIV testing gaps among U.S. women with increased HIV vulnerability, across all demographics, indicating missed opportunities and emphasizing the need for targeted, accessible, and engaging HIV prevention methods.

Hidden in Success: Gendered Patterns of Suboptimal Care Engagement Among TB Patients Who “Successfully” Completed Treatment in South Africa

medRxiv · 2025-09-07

Background: Adherence to tuberculosis (TB) treatment is key to optimal health outcomes. Programmatic definitions of treatment success may mask heterogeneity in care engagement patterns that increase risk of unfavorable outcomes. Methods: Using patient-level medication refill data, latent-class growth modelling was used to identify longitudinal trajectories of care engagement among participants who programmatically achieved treatment success. Logistic regression was conducted to investigate participant-level characteristics associated with trajectory class membership. Results: Among 548 participants, we identified three trajectories: Class 1 (consistent engagement; 84.1%), Class 2 (suboptimal engagement after 2 months; 7.7%) and Class 3 (suboptimal engagement from initiation; 8.2%). At treatment completion, Classes 1-3 accumulated 9.7 (95% CI: 7.4-11.8), 68.4 (60.4-76.9) and 55.5 (48.1-62.7) missed refill days, respectively. In gender-stratified models, men exhibited all three trajectories (83.1%, 7.4%, and 9.5%, respectively), and accumulated 10.6 [7.8-13.3], 61.0 [50.2-71.3], 53.3 [53.3-71.4] missed refill days, respectively. Women exhibited only Classes 1 and 3 (89.5% and 10.5%, respectively) and accumulated 12.1 [7.8-16.5] and 46.9 [33.3-61.6] missed refill days, respectively. Among men, prior TB (Class 2: aOR 7.44, 2.79-19.8; Class 3: aOR 2.78, 1.07-7.25) and HIV-negative status (Class 3: aOR 2.72, 1.13-6.54) were associated with suboptimal trajectories. Among women, prior TB was associated with suboptimal engagement (aOR 5.22, 1.11-24.44). Conclusion: Programmatic Treatment Success obscured suboptimal engagement trajectories. Patient-centered counseling and gender-responsive interventions are needed to address suboptimal engagement across treatment stages. Shorter treatment regimens will unlikely resolve suboptimal engagement, underscoring the importance of regimen forgiveness.

Novel lateral flow assay for point-of-care detection of Neisseria gonorrhoeae infection in syndromic management settings: a cross-sectional performance evaluation

The Lancet · 2024-02-01 · 29 citations

Implementation considerations for a point-of-care Neisseria gonorrhoeae rapid diagnostic test at primary healthcare level in South Africa: a qualitative study

BMC Health Services Research · 2024-01-09 · 10 citations

BACKGROUND: South Africa maintains an integrated health system where syndromic management of sexually transmitted infections (STI) is the standard of care. An estimated 2 million cases of Neisseria gonorrhoeae (N. gonorrhoeae) occur in South Africa every year. Point-of-care diagnostic tests (POCT) may address existing STI control limitations such as overtreatment and missed cases. Subsequently, a rapid lateral flow assay with fluorescence-based detection (NG-LFA) with a prototype reader was developed for N. gonorrhoeae detection showing excellent performance and high usability; however, a better understanding is needed for device implementation and integration into clinics. METHODS: A qualitative, time-series assessment using 66 in-depth interviews was conducted among 25 trained healthcare workers involved in the implementation of the NG-LFA. Findings were informed by the Normalization Process Theory (NPT) as per relevant contextual (strategic intentions, adaptive execution, and negotiation capacity) and procedural constructs (coherence, cognitive participation, collective action, reflexive monitoring) to examine device implementation within primary healthcare levels. Interviews were audio-recorded, transcribed, and then analyzed using a thematic approach guided by NPT to interpret results. RESULTS: Overall, healthcare workers agreed that STI POCT could guide better STI clinical decision-making, with consideration for clinic integration such as space constraints, patient flow, and workload. Perceived NG-LFA benefits included enhanced patient receptivity and STI knowledge. Further, healthcare workers reflected on the suitability of the NG-LFA given current limitations with integrated primary care. Recommendations included sufficient STI education, and appropriate departments for first points of entry for STI screening. CONCLUSIONS: The collective action and participation by healthcare workers in the implementation of the NG-LFA revealed adaptive execution within the current facility environment including team compositions, facility-staff receptivity, and STI management experiences. User experiences support future clinic service integration, highlighting the importance of further assessing patient-provider communication for STI care, organizational readiness, and identification of relevant departments for STI screening.

Tailoring a Skills-Based Serostatus Disclosure Intervention for Transgender Women in South Africa: Protocol for a Usability and Feasibility Study

JMIR Research Protocols · 2024-11-05 · 2 citations

BACKGROUND: Transgender women have few interventions to support their HIV prevention and treatment outcomes in South Africa. Further, increased focus should be on intervention development that will reduce HIV transmission within HIV-discordant partnerships, especially for transgender women who navigate gender, sexuality, and relationship stigma. The Speaking Out and Allying Relationships (SOAR) intervention has been developed for sexual minority men to address these outcomes in South Africa. It is a behavioral intervention that is delivered in groups via videoconference to develop coping skills to manage HIV-related stress, assist with disclosure to partners, and establish and maintain safer sex practices with partners. Tailoring SOAR may be feasible for transgender women to support their HIV care while reducing transmission within their relationships. OBJECTIVE: This study aims to (1) adapt SOAR for transgender women and test its usability, then (2) assess its feasibility. METHODS: To achieve aim 1, we will use a human-centered design approach to tailor the existing SOAR intervention for transgender women. Interviews and a survey will be administered to transgender women (N=15) to assess intervention preferences. Findings will be used to tailor content like roleplays, scenarios, and media to align with transgender women's lived experiences navigating HIV and relationships. Afterward, we will conduct a usability test with 7 (47%) of the 15 participants to determine intervention understanding and satisfaction. Participants will be transgender women living with HIV and in a relationship with a man who has unknown HIV status or is HIV-negative. All participants will be recruited using community-based approaches. In aim 2, we will examine SOAR feasibility using a 1-arm pilot study. Transgender women (N=20) will be recruited using aim 1 methods and eligibility criteria, with participants completing feasibility surveys and interviews, as well as behavioral and biomedical assessments. RESULTS: Intervention adaptation began in May 2023 with interviews. Feasibility pilot testing was conducted with 14 transgender women, with study completion in January 2025. CONCLUSIONS: Transgender women need more intervention options that engage their relationships since these can present barriers to HIV treatment outcomes like hindering viral suppression in South Africa. Delivering an existing yet tailored intervention via videoconference expands its reach to transgender women and allows them to engage with others and learn new skills in a secure setting like their homes. SOAR has the potential to improve relationship dynamics and reduce violence, which will in turn enhance HIV treatment and prevention engagement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52121.