Abstract: Over the past decade, national initiatives in the United States (U.S.) have focused HIV prevention and care programs and research to optimize the delivery of HIV prevention and treatment through implementation research. Although existing biomedical and behavioral prevention tools could end HIV in the U.S., the implementation of these tools has been uneven because of many factors, including organizational capacity, insufficient uptake by key populations, lack of success with prioritizing by geography or population growth, and inadequate scaling. To address these challenges, the federal government has funded programs, research, and evaluation projects aimed at improving health outcomes among people with HIV and people vulnerable to HIV acquisition. Increasingly, several special federal efforts are being conducted under the umbrella of “implementation science and research” that are essential components to scaling up evidence-based HIV prevention and treatment interventions in the U.S. This paper describes federal collaborations that have supported this increased focus on implementation from the perspective of 3 agencies in the U.S. Department of Health and Human Services; the Centers for Disease Control and Prevention, the National Institutes of Health, and the Health Resources and Services Administration. These federal collaborations have resulted in improved communication and coordination of efforts in the shaping and alignment of priorities in research and service delivery, increased implementation research conducted in real-world community and clinical settings and provided a feedback loop to expedite action in response to emerging evidence from such projects.

Objective. The expression of matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9) and tissue inhibitors of matrix metalloproteinases 1 (TIMP-1) and 2 (TIMP-2) in vulvar intraepithelial neoplasia (VIN I-III) and in vulvar invasive carcinoma were evaluated. Design. A retrospective study. Setting. Oulu University Hospital, Finland. Sample. The study population consisted of 68 patients with vulvar neoplasia (13 VIN I, 5 VIN II, 6 VIN III and 44 squamous cell carcinomas). Methods. Paraffin-embedded tissue samples were examined by immunohistochemistry. Main outcome measures. MMP-2, MMP-9, TIMP-1 and TIMP-2 expression in VIN compared to vulvar carcinoma. Results. In VIN I-III MMP-2 expression was positive in 13%, MMP-9 in 13%, TIMP-1 in 50% and TIMP-2 in 17% of patients. The positive expressions in patients with vulvar carcinoma were 52% for MMP-2, 36% for MMP-9, 41% for TIMP-1 and 78% for TIMP-2. Conclusions. We conclude that over-expression of MMP-2, MMP-9 and TIMP-2 may be associated with the progression from VIN to invasive vulvar squamous cell carcinoma.

We sought to integrate a brief computer and counseling support intervention into the routine practices of HIV clinics and evaluate effects on patients' viral loads. The project targeted HIV patients in care whose viral loads exceeded 1000 copies/ml at the time of recruitment. Three HIV clinics initiated the intervention immediately, and three other HIV clinics delayed onset for 16 months and served as concurrent controls for evaluating outcomes. The intervention components included a brief computer-based intervention (CBI) focused on antiretroviral therapy adherence; health coaching from project counselors for participants whose viral loads did not improve after doing the CBI; and behavioral screening and palm cards with empowering messages available to all patients at intervention clinics regardless of viral load level. The analytic cohort included 982 patients at intervention clinics and 946 patients at control clinics. Viral loads were assessed at 270 days before recruitment, at time of recruitment, and +270 days later. Results indicated that both the control and intervention groups had significant reductions in viral load, ending with approximately the same viral level at +270 days. There was no evidence that the CBI or the targeted health coaching was responsible for the viral reduction in the intervention group. Results may stem partially from statistical regression to the mean in both groups. Also, clinical providers at control and intervention clinics may have taken action (e.g., conversations with patients, referrals to case managers, adherence counselors, mental health, substance use specialists) to help their patients reduce their viral loads. In conclusion, neither a brief computer-based nor targeted health coaching intervention reduced patients' viral loads beyond levels achieved with standard of care services available to patients at well-resourced HIV clinics.

INTRODUCTION Addressing the challenges of the HIV care continuum remains a major public health priority in the United States. This is exemplified by the July 2013 Executive Order from the White House, which established the HIV Care Continuum Initiative to “mobilize and coordinate Federal efforts in response to recent advances regarding how to prevent and treat HIV infection.”1 This third and final supplemental issue developed by the Centers for AIDS Research (CFAR) HIV Continuum of Care (CoC)/Enhanced Comprehensive HIV Prevention Planning Project (ECHPP) Working Group (WG)2 for the Journal of Acquired Immune Deficiency Syndrome (JAIDS) highlights the work of academic investigators from 7 cities, 4 of which include coauthors from local public health departments, to conduct research on the HIV continuum of care. This supplemental issue describes the third series of studies to emerge from an initiative supported by the National Institutes of Health (NIH) CFAR Program designed to stimulate research among the CFARs around the HIV prevention and care continuum. This introductory article begins with a brief overview of the CFAR CoC/ECHPP Working Group; continues with synopses of NIH funding opportunities and current Centers for Disease Control and Prevention (CDC) programs that have been developed to address the continuum of care; and concludes with a synthesis of the 7 articles that are included in this supplement. CFAR HIV CONTINUUM OF CARE/ECHPP WORKING GROUP As described previously,3,4 the CFAR HIV CoC/ECHPP Working Group was initiated in 2011 to support HIV research by academic investigators in collaboration with their local Departments of Health. Building upon various models of collaboration that have been established between universities and health departments for HIV surveillance and prevention, the CoC/ECHPP WG worked to foster academic-public health partnerships throughout the CFAR network. The NIH CFAR program first provided support for this initiative in 2011 to CFAR investigators located in 9 of the 12 US cities with the highest AIDS prevalence to conduct HIV prevention and care research in support of the CDC ECHPP initiative (“ECHPP-1”). The first HIV CoC/ECHPP WG JAIDS supplement was then published in 2013 and included studies on HIV testing, prevention, and the care continuum.5–13 A second round of studies (“ECHPP-2”) was funded in 2012 to further support HIV care continuum research in these same 9 cities—and articles about this research were published in the second HIV CoC/ECHPP WG JAIDS supplement in 2015.14–23 The third and final round of projects (“ECHPP-3”) were funded in 2013 to investigators at 10 CFARs (6 of which were new to the WG) to “build on existing collaborations with their local health departments and to propose pilot interventions at one or more important junctures in the treatment cascade.”24 Thus, through the 3 rounds of ECHPP funding, 15 different CFARs (there are currently 20 CFARs) have received support through this initiative. In addition, at least 3 CFARs [the Tennessee, Third Coast (Chicago) and DC CFARs] have now included their local or state health departments as institutional partners in their CFARs.25–27 It is our hope that academic–health department partnerships for HIV prevention and research that have been promoted by the CFAR HIV CoC/ECHPP Working Group will be enduring and will continue to support national efforts to bring an end to HIV in the United States. NIMH and NIAID Research Initiatives and Activities to Address the HIV Continuum of Prevention and Care It is difficult to succinctly summarize the updated activities germane to this supplemental issue because these research and service directions have become so integral to the NIH HIV/AIDS prevention and treatment agenda. Although this agenda includes the contribution of other participating NIH entities (including the Office of AIDS Research and other NIH institutes; NICHD, NIDA, NIAAA, etc.), due to space limitations, this update will address only the NIMH/NIAID shared activities because these were the primary Institutes or Centers (IC) involved in the CFAR/ECHHP program. Academic, public health, and community partners in NIMH/NIAID efforts also receive substantial support from these other relevant ICs. Three major sets of activities have been shared by the Division of AIDS Research (DAR) at NIMH and the Division of AIDS (DAIDS) at NIAID since the previous supplemental issue of JAIDS that was a product of the CFAR/ECHPP programs.4 First, DAR and DAIDS have articulated and formalized a process and activities for an integrated biobehavioral HIV prevention and care agenda28 that includes collaboration on priority setting and funding opportunities in these domains. Importantly, the integrated agenda has also benefited from the co-location of the leadership and program staff responsible for the scientific direction of DAR and DAIDS. This integrated agenda is briefly highlighted below. Second, there are standing funding announcements, published in the NIH Guide in 2014 and 2015, that outline the unique and shared research priorities within the missions of DAR and DAIDS that directly address the types of projects in this special issue—and also call for the next iterations of this work that will evolve as a result of the expanding effective HIV prevention and treatment tools. An exemplar, but not exhaustive, list of these funding opportunities is described in this paper. Third, DAR and DAIDS have continued to broker, encourage, and fund efforts that require collaborations among scientists, clinicians, public health programs, and community partners. Notably, DAIDS and DAR leadership have used timely solicitation and funding of supplements to move quickly and target research in this area to meet the needs of affected communities. Two such calls for supplements and funded projects in 2015–2016 are outlined to conclude this brief update. The integrated bio-behavioral HIV/AIDS research agenda—spanning basic, translational, and implementation science has been outlined by NIAID leadership29 and was publicly presented by DAR/NIMH leadership at the NIAID/DAIDS AIDS Research Advisory Council (ARAC) in September 2016.30 Moving forward, it will continue to be critical for behavioral and biomedical funders and executors to assure that ongoing and planned prevention/treatment trials from phases 1–4 have the state-of-the-science in both domains, that the HIV cure agenda fosters team science, which combines discoveries from biomedical, behavioral, neuroAIDS, and participatory research to advance HIV eradication, and investments are expanded in targeted implementation research on the HIV care continuum and prevention tools (eg, PrEP) to optimize public health impact. To meet these aims, DAR and DAIDS issued collaborative funding opportunities developed to address the HIV continuum for prevention and care, which have included solicitations such as “Advancing Structural Level Interventions Through Enhanced Understanding of Social Determinants in HIV Prevention and Care”31; “Improving Delivery of HIV Prevention and Treatment through Implementation Science and Translational Research”32; “Methods for Prevention Packages Program IV”33; “Limited Interaction Targeted Epidemiology (LITE) to Advance HIV Prevention”34; and “Improving the HIV Pre-Exposure Prophylaxis (PrEP) Cascade.”35 Collectively, these highlighted funding opportunities delineate major sets of priority research directions that will continue to fuel the efforts that defined the original CFAR/ECHPP projects that were supported by NIAID, NIMH, and the other CFAR participating ICs. Finally, in addition to the above funding opportunities for multiyear large efforts to address the continuum of prevention and care, DAR and DAIDS have also used supplements to existing NIMH and NIAID grants and centers as a means to quickly stimulate and fund innovative high-priority pilot projects. Two are highlighted in this paper. In 2016, DAR and DAIDS partnered to solicit research applications to collaborate with the CDC-funded public health departments and community partners who had received demonstration project support to advance PrEP uptake in US cities with high HIV incidence: “HIV Pre-exposure Prophylaxis (PrEP) Implementation Science in CDC-funded Public Health Demonstration Projects (Admin Supp).”36 This effort resulted in the rapid funding of 8 supplemental projects that could be conducted in concert with the CDC-funded projects. In 2015, the NIAID CFAR program solicited supplement applications for high-priority innovative science to address “Advancing PrEP Delivery,” and “HIV Transmission and Microepidemics” and in 2016 funded supplements in the following topics: “Tracking HIV Transmission Phylodynamics: Leveraging Collaborations with Public Health Departments and Others to Research Methods to Analyze Phylogenetic Data in Close to Real-Time,” “Advancing PrEP Delivery among at-risk Youth and Young MSM (especially minority MSM),” and “Rapid HIV Treatment Initiation: Implementation Models, Uptake, and HIV Care Continuum Outcomes.” The responses to these solicitations were robust, and a total of 24 one-year innovative projects were funded in 2015 and 2016. DAR and DAIDS—in collaboration with their other NIH IC and DHHS partners—will continue to use all available mechanisms to support the integrated science in the HIV/AIDS prevention and care continuum. Update on CDC-Supported Programmatic Initiatives on HIV Prevention and the HIV Continuum of Care Since our previous summary of current CDC programs on the HIV continuum of care,4 the rapid pace of new activities at CDC has continued and the targeted focus on HIV outcomes related to linkage to and engagement in care and viral suppression among people living with HIV has intensified. CDC has ongoing funding relationships with all state health departments in the United States, 8 large-city health departments, and a handful of territorial or other special health departments to implement public health activities such as HIV surveillance and HIV programs. The CDC also directly funds over 100 community-based organizations (CBOs) through general and targeted efforts and provides indirect support to even more CBOs through health department funding. An important recent change for health department grantees is that CDC informed them in mid-2016 that CDC was going to combine the separate funding opportunity announcements (FOAs) for surveillance and HIV prevention programs into one FOA. Although surveillance and programmatic activities have become increasingly linked and interdependent as surveillance data are used for programmatic purposes at both the individual level (for patient tracking through the care continuum) and the jurisdictional level (for monitoring of outcomes along the care continuum),37 this combined FOA represents an important structural shift that has the promise of improving public health outcomes locally and nationally. The new funding announcement will begin in January 2018. CDC has also continued to encourage jurisdictions to have laws or regulations that support the complete reporting of all CD4 and viral load test to help monitor HIV care outcomes and to include only those states with actual complete reporting in the yearly HIV monitoring report. Over 40 states now have favorable laws or regulations requiring complete reporting, and when the monitoring report of select prevention and care outcomes was published in July 2016, 32 states and the District of Columbia had actually achieved complete reporting as defined by CDC.38 In addition, CDC has continued to provide guidance on the use of continuum of care outcomes, publishing an updated guidance in July 2016 on how to calculate the 2 main types of continua, the prevalence-based continuum and the diagnosis-based continuum.39 CDC also has implemented new demonstration projects that stand on the shoulders of earlier demonstration projects that started in 2010, 2012, and 2014 to support that National HIV/AIDS Strategy (NHAS) and CDC's high-impact prevention approach to HIV activities.4 In 2015, 2 new demonstration projects were funded. The first, Project PrIDE,40 was funded by CDC to support health departments in implementing 2 public health strategies to reduce new HIV infections in gay, bisexual, and other men who have sex with men (MSM) and in transgender persons; (1) pre-exposure prophylaxis (PrEP), a daily pill to prevent acquiring HIV, and (2) data to care (D2C) the use of HIV surveillance and other data to identify HIV-diagnosed persons not in care, and to link, engage, or re-engage them in HIV medical care.41 With over $37 million in the first year of the 3-year project, 12 health departments were funded to implement PrEP programs particularly targeting MSM and transgender persons of color, and 5 of these health departments also were funded to enhance their data-to-care activities for MSM and transgender persons. As discussed above, CDC then collaborated with NIH to try to increase and strengthen the lessons learned about PrEP implementation from Project PrIDE. NIH funded an administrative supplement of up to $175,000 per applicant that was available for CFARs, NIMH AIDS Research Centers, and other grant funded researchers working on PrEP to develop research projects around PrEP implementation in collaboration with CDC's 12 PrIDE grantees.36 Ultimately, 8 projects were funded in 6 of the 12 Project PrIDE cities. This research project followed the example of earlier NIH-funded collaborations between researchers and health departments by requiring researchers to work with health departments and propose a collaborative project. Health departments were necessary partners with researchers, but individual health departments were not required to agree to collaborate on a research project. This NIH funding provided an opportunity for health departments willing to work with researchers to address focused and public health-relevant research questions that could not be explored with CDC's nonresearch funding. A second new demonstration project led by CDC, now called Project THRIVE, was funded in 2015 by the Department of Health and Human Services (HHS), Secretary's Minority AIDS Initiative Fund (SMAIF). The purpose of this FOA is to support health departments to collaborate with CBOs, health care clinics and providers, behavioral health providers, and social services providers to develop comprehensive models of prevention, care, behavioral health, and social services models for MSM of color living with HIV or at risk for HIV acquisition.42 In contrast to Project PrIDE, which focused efforts on 2 strategies, THRIVE requires grantees to provide 13 services for MSM of color at risk for HIV acquisition and 11 services for those who are living with HIV. The FOA also is supported by a second FOA to provide training and technical assistance to support the provision of the 24 services required as part of the demonstration project. Seven state or large-city health departments were funded for this 4-year demonstration project. A few other CDC activities are notable because of their relevance to the continuum of care and work with health departments. First, in December 2015, CDC released the second “State HIV Prevention Progress Report,” which provides data, where available, across all states and the District of Columbia for 6 indicators that measure outcomes across the continuum of care.43 The third report will be published in early 2017 and will allow analysis of trends over time across states. Finally, CDC launched 2 important communication efforts in December 2015 at the National HIV Prevention Conference (NHPC) in Atlanta. A new HIV-testing campaign, called “Doing It,” was implemented targeting all groups with tailored executions for various higher-risk target populations. Part of CDC's Act against AIDS communications efforts, the campaign was developed in close partnership with community stakeholders and with extensive formative and developmental research,44 and health departments can use all parts of the campaign locally at no cost. At NHPC, CDC also released the beta version of a new online HIV risk-reduction tool.45 This tool represents the first broad update of CDC's HIV prevention messages to take into account new prevention innovations such as treatment-as-prevention and PrEP. The tool addresses prevention for the general population and those at high risk of acquiring HIV and those who are already living with HIV. One of the innovations of the tool is the “know your HIV risk” calculator that allows the user to input various behaviors and risk and protective factors to see how various actions affect overall risk. The current tool provides multiple options for users to provide input, and CDC will use this information and other research on the tool to develop and release the next version in 2017. SYNTHESIS OF ECHPP-3 MANUSCRIPTS The 7 manuscripts in this third supplemental issue of JAIDS are summarized in this section. The cities, CFARs, first author and site PI(s), and aims of each project are shown in Table 1.TABLE 1.: ECHPP-3 Manuscripts: Project State/City, CFAR, First Author and Project AimsResearchers from the University of Washington CFAR and the Seattle and King County, Idaho, Alaska, Oregon, Washington, Montana, and Wyoming State Health Departments conducted case investigations to assess the status of HIV cases that were considered, according to surveillance data, to be out of care for at least 1 year. Of 3866 cases with no CD4 count or viral load result for at least 1 year in 2012–2014, a majority were found to have moved, died, or actually be in care. The authors conclude that persons living with HIV who are classified as out of care using surveillance data may not be truly out of care, resulting in underestimates of national retention in care rates and highlighting the potential benefit of efforts to improve local surveillance data.46 Investigators from the University of North Carolina CFAR and the North Carolina Department of Health and Human Services studied the longitudinal patterns of engagement in HIV care and treatment using 10 years of HIV surveillance data in North Carolina from 2006 to 2015. Five relatively distinct care patterns emerged: consistently high clinic attendance, steadily declining attendance, consistently low attendance, weak attendance initially with early improvement, and weak attendance initially with later improvement. The authors conclude that although most care trajectories are suboptimal, there are distinct patterns of HIV care trajectories over time.47 Researchers from the District of Columbia CFAR and the DC Department of Health assessed the feasibility of geographically focused HIV testing to identify persons who needed to be linked to or engaged in care. Twenty census tracts with a high HIV prevalence were classified as either high- or low-risk areas based on viral load and in-care parameters, and rapid HIV testing and surveys were conducted for 1471 participants. The authors found that their approach was useful in identifying newly diagnosed cases of HIV and persons who were out of care, but not necessarily people residing in the targeted areas.48 An investigative team from the Johns Hopkins University CFAR and the Baltimore City Health Department developed an animated video module to address cultural barriers to HIV testing among foreign-born Latino men, and a pilot survey was then conducted to assess HIV risk and barriers to testing in 104 men. Overall, half the men were found to have never tested for HIV; and among men who had been tested, the mean time since last test was almost 3.5 years. Importantly, watching the video significantly increased men's intention to test, and thus may be used to improve testing rates in this population.49 Researchers from the Emory CFAR assessed individual and structural level barriers associated with poor retention and re-engagement in care among HIV clinic patients in Atlanta, GA. A total of 32 continuously retained patients and 27 patients with recent gaps in care were compared. Patients who were continuously retained were more likely to have social support and to have disclosed their HIV status to their families, whereas those with gaps in care were more likely to be younger and crack cocaine users, and to have food, housing, and financial instability. The authors conclude that early assessment for predictors of poor retention could help direct interventions to high-risk patients.50 Investigators from the Rochester CFAR examined the feasibility and acceptability of a peer-support text messaging intervention to increase retention and ART use in HIV-positive black MSM. A cell phone app enabled researchers to view relevant text messages from 3 trained mentors and 8 mentees. The authors found that the text messaging app was feasible and acceptable and concluded that it could be further explored as a support intervention.51 Researchers from the University of California, Los Angeles CFAR studied the use of machine-learning methods to assist in rapid identification of patterns associated with HIV using large social media data sets. They assessed various machine-learning methods for their ability to detect patterns of association between tweets and HIV, and found that logistic regression and random forest techniques were the most accurate and that logistic regression was the fastest. The authors conclude that machine-learning methods techniques could be a useful tool to augment the analysis of social big data for HIV research.52 SUMMARY In summary, the Co-Editors have greatly appreciated the opportunity to work with investigators from numerous CFARs and health departments over the past 6 years as part of the CFAR HIV Continuum of Care/ECHPP Working Group. We are grateful to the NIH for supporting this type of public-health oriented HIV research and also for supporting the documentation of the results of these projects in 2 national meetings and a trilogy of JAIDS supplements. Moving forward, this important approach could be facilitated by other funding opportunities such as those described in this article, so that academic–health department collaborations result in research that can directly inform real-world program implementation.

Open Dialogue (OD) is a Finnish approach to crisis intervention and ongoing care for young people experiencing psychosis and other psychiatric crises. OD engages the individual and family (or other supports) in meetings, with open discussions of all aspects of the clinical situation, and in decision making. Although psychiatric assessment and treatment occur, the initial emphasis is on engagement, crisis intervention, and promoting dialogue. Finnish studies are encouraging, with excellent clinical and functional outcomes after five years. The authors conducted a one-year study of the feasibility of implementing an outpatient program based on OD principles, serving 16 young people ages 14-35 experiencing psychosis-the first study of OD in the United States. Qualitative and quantitative findings suggest that this model can be successfully implemented in the United States and can achieve good clinical outcomes, high satisfaction, and shared decision making.

In summary, addressing the challenges of the HIV care continuum is critical so that the goals of the NHAS can be achieved. CDC is working closely with federal partners, public health departments, and communities throughout the United States on multiple surveillance, programmatic, and research initiatives to inform and improve outcomes along the HIV care continuum. Currently, a large number of research projects are being conducted to describe the care continuum in various populations, assess and model the impact of interventions, and monitor the quality of care. To contribute to this knowledge base, NIH is working with its academic partners to support research that will inform the optimization of HIV treatment and prevention programs. As part of this focus, the CFAR/APC HIV Continuum of Care Working Group was formed to encourage communication between academic investigators and their local DOHs and to support joint research initiatives that are both timely and relevant to their own cities and environments. Finally, the results presented in this supplement may have implications for jurisdictions beyond those in which the studies were conducted.

Background: An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART. Methods: A systematic literature search was conducted, and 6132 articles, including randomized controlled trials, observational studies with or without comparators, cross-sectional studies, and descriptive documents, met the inclusion criteria. Of these, 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents. Recommendations: Recommendations are provided for interventions to optimize the HIV care environment; increase HIV testing and linkage to care, treatment coverage, retention in care, and viral suppression; and monitor the HIV care continuum.

Epidemic modeling suggests that a major scale-up in HIV treatment could have a dramatic impact on HIV incidence. This has led both researchers and policymakers to set a goal of an "AIDS-Free Generation." One of the greatest obstacles to achieving this objective is the number of people with undiagnosed HIV infection. Despite recent innovations, new research strategies are needed to identify, engage, and successfully treat people who are unaware of their infection.

The contributions reported in this supplemental issue highlight the relevance of NIH-funded CEWG research to health department–supported HIV prevention and care activities in the 9 US cities with the highest numbers of AIDS cases. The project findings have the potential to enhance ongoing HIV treatment and care services and to advance the wider scientific agenda. The HIV testing to care continuum, while providing a framework to help track progress on national goals, also can reflect the heterogeneities of local epidemics. The collaborative research that is highlighted in this issue not only reflects a locally driven research agenda but also demonstrates research methods, data collection tools, and collaborative processes that could be encouraged across jurisdictions. Projects such as these, capitalizing on the integrated efforts of NIH, CDC, DOH, and academic institutions, have the potential to contribute to improvements in the HIV care continuum in these communities, bringing us closer to realizing the HIV prevention and treatment goals of the NHAS.

The contributions reported in this supplemental issue highlight the relevance of NIH-funded CEWG research to health department–supported HIV prevention and care activities in the 9 US cities with the highest numbers of AIDS cases. The project findings have the potential to enhance ongoing HIV treatment and care services and to advance the wider scientific agenda. The HIV testing to care continuum, while providing a framework to help track progress on national goals, also can reflect the heterogeneities of local epidemics. The collaborative research that is highlighted in this issue not only reflects a locally driven research agenda but also demonstrates research methods, data collection tools, and collaborative processes that could be encouraged across jurisdictions. Projects such as these, capitalizing on the integrated efforts of NIH, CDC, DOH, and academic institutions, have the potential to contribute to improvements in the HIV care continuum in these communities, bringing us closer to realizing the HIV prevention and treatment goals of the NHAS.

DESCRIPTIONAfter HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). Adherence to ART is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV.METHODSA systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation.RECOMMENDATIONSRecommendations are provided for monitoring entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.

HIV continues to exact an enormous toll on society and to disproportionately affect gay and bisexual men and other men who have sex with men (MSM). Innovative prevention interventions are needed to reverse this trend. In August 2009, the U.S. National Institute of Mental Health and the Centers for Disease Control and Prevention convened a meeting of scientists, community representatives, advocates, and federal partners to discuss innovative prevention-intervention science. The meeting was structured to maximize discussion of (7) healthy sex interventions, (2) community and structural interventions, (3) integrated biomedical and behavioral interventions, and (4) interventions to improve uptake of HIV testing. Presentations and discussion focused on research gaps in designing risk-reducing and sexual health-promoting interventions for MSM, including interventions to address mental health, substance use, disclosure, and stigma. This article summarizes the meeting proceedings, highlights key points, and outlines future directions.

Microwave heating enhanced the rate of three reactions typically performed in our undergraduate organic chemistry laboratory: a Diels−Alder cycloaddition, a Wittig salt formation, and a Williamson ether synthesis. Ninety-minute refluxes were shortened to 10 min using a laboratory-grade microwave oven. In addition, yields improved for the Wittig salt and ether preparations. The Diels-Alder cycloaddition of N-phenylmaleimide and 1,3-cyclohexadiene in absolute ethanol in a closed vessel and 130 °C gave 84−90% yields. Formation of the Wittig salt, benzyltriphenylphosphonium chloride, from triphenylphosphine and benzyl chloride gave yields greater than 90% when heated in acetonitrile at 200 °C Yields doubled in the Williamson ether synthesis of 2-ethoxynaphthalene, from 2-naphthol, methanolic potassium hydroxide, and iodoethane with microwave heating at 130 °C.

Biomedical approaches to HIV prevention (eg, microbicides, antiretroviral preexposure prophylaxis) are undergoing clinical trials to test their efficacy. One key consideration emerging from completed trials is the critical role of adherence to the investigational product. Suboptimal product adherence may compromise clinical trial results and ultimately undermine the effectiveness of biomedical prevention methods in any future real-world use. Efforts to strengthen biomedical HIV prevention product adherence can benefit from existing research methodologies, findings, and interventions developed for adherence to HIV treatment. Research on treatment adherence is most relevant to medication-based biomedical prevention strategies, such as antiretroviral preexposure prophylaxis and acyclovir for herpes simplex virus-2. Three areas where HIV treatment adherence literature can inform research on such biomedical prevention strategies are 1) specialized methods for assessing medication adherence, 2) research findings emphasizing social context as an adherence determinant, and 3) promising behavioral interventions to improve adherence.

Despite substantial attention in the past decade to the co-morbidity of mental health problems among people living with HIV/AIDS (PLWHA), these problems remain a significant barrier to maintaining health and secondary prevention. To address these issues, program staff from the Center for Mental Health Research on AIDS at the NIMH convened a meeting on 19th and 20th July 2007 to discuss the intersection of mental health and HIV. The conveners brought together leaders in the fields of mental illness and HIV to discuss current gaps in the research related to the prevention, diagnosis, and treatment of mental disorders among PLWHA, and how attention to mental health can affect a variety of health outcomes. Attendees were asked to discuss key questions that, if addressed through empirical investigation, could move the field toward the aim of reducing or alleviating the burden of mental illness for those living with HIV disease. The purpose of this brief report is to summarize this meeting's proceedings, overview key points of discussion, and outline areas that may be useful to consider for clinical researchers in the field.

ADVERTISEMENT RETURN TO ISSUEPREVArticleNEXTThe Laser Synthesis of Linear Polyynes: The Particle in a Box RevisitedBruce D. Anderson and Christopher M. Gordon View Author Information Department of Chemistry, Muhlenberg College, Allentown, PA 18104Cite this: J. Chem. Educ. 2008, 85, 9, 1279Publication Date (Web):September 1, 2008Publication History Received3 August 2009Published online1 September 2008Published inissue 1 September 2008https://pubs.acs.org/doi/10.1021/ed085p1279https://doi.org/10.1021/ed085p1279research-articleACS PublicationsRequest reuse permissionsArticle Views935Altmetric-Citations7LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InRedditEmail Other access optionsGet e-Alertsclose SUBJECTS:Absorption,Anode materials,Irradiation,Lasers,Quantum mechanics Get e-Alerts

Maximizing treatment adherence is essential for optimizing clinical outcomes among HIV/AIDS patients. A decade after the introduction of combination antiretroviral therapy (ART), numerous achievements and continued challenges are evident within research on HIV treatment adherence. In this paper, we illustrate some key themes within current treatment adherence research by highlighting presentations from a recent conference focused on this topic (the 2006 NIMH/IAPAC International Conference on HIV Treatment Adherence). We then discuss several ongoing challenges confronting the field, and suggest that multi-disciplinary research will be essential for overcoming these challenges and strengthening our efforts to improve and sustain adherence to HIV treatment. (C) 2007 by The Haworth Press, Inc. All rights reserved.

Maximizing treatment adherence is essential for optimizing clinical outcomes among HIV/AIDS patients. A decade after the introduction of combination antiretroviral therapy (ART), numerous achievements and continued challenges are evident within research on HIV treatment adherence. In this paper, we illustrate some key themes within current treatment adherence research by highlighting presentations from a recent conference focused on this topic (the 2006 NIMH/IAPAC International Conference on HIV Treatment Adherence). We then discuss several ongoing challenges confronting the field, and suggest that multidisciplinary research will be essential for overcoming these challenges and strengthening our efforts to improve and sustain adherence to HIV treatment.

This meta-analysis of randomized controlled trials (RCTs) of interventions for adherence to antiretroviral therapy for HIV indicates that participants who received an adherence intervention were 1.5 times as likely to report 95% adherence and 1.25 times as likely to achieve an undetectable viral load than participants in comparison conditions. The magnitude of the aggregated intervention effect is an encouraging message for HIV treatment providers, but more work is needed. For the next generation of international adherence research, there are multiple challenges that require the collaboration of providers, patients, government funders, donor agencies, and policy-makers. This commentary examines the strengths and limitations of the evidence base, identifies critical research directions, and calls for the development of a formal process to guide the rapid implementation of efficacious adherence interventions into community and clinical practice.