This study aimed to assess the prevalence, severity, predictors, and lived experiences of food insecurity among women enrolled in the Women’s Interagency HIV Study in the USA in 2020, at the height of the COVID-19 pandemic. We hypothesized that pre-existing socioeconomic and health-related disparities would heighten the risk of worsening food insecurity during the pandemic. The 10-item US Household Food Security Survey was administered to participants three times between June and September 2020. Multilevel mixed-effects ordered logistic regression models were used to estimate the odds of worsening food security compared to pre-pandemic baseline data. Qualitative interviews were conducted among a subset of participants to add understanding of the lived experience of food insecurity during the pandemic, beyond what quantitative measures could provide. Among 1,506 women, 28

BACKGROUND:Community-academic partnerships (C-APs) have been central to advancements in HIV research over the past 4 decades and were specifically called for in the national Ending the HIV Epidemic (EHE) initiative. Community engagement in research, particularly in HIV research, plays a critical role in prioritizing community needs in all stages of HIV research and intervention implementation. METHODS:To address the known gaps in building strong C-APs, 2 EHE Implementation Science Consultation Hubs collaboratively facilitated 2 webinars with a panel of expert community leaders. The panel discussions explored (1) what researchers need to know to create equitable C-APs and (2) best practices for navigating power in C-APs. After the webinars, we conducted a quantitative analysis of the 131 EHE research projects partnered with community-based organizations or faith-based organizations between 2019 and 2023 to examine the community engagement in research relationships between EHE academic researchers and implementation partners. RESULTS:Community panelists identified areas for academic researchers to prioritize, including building relationships with community partners, engaging equitably in partnership processes, sharing use of resources, and paying attention to community history. The quantitative analysis found 58% of EHE researchers are in new collaborations, lasting 2 years or less, with their implementation partner, and have not yet established robust partnerships. CONCLUSIONS:This study identifies strategies for strengthening community engagement in HIV research and sustaining equitable C-APs for existing EHE supplement recipients that can be integrated into future EHE research and implementation strategies to help end the HIV epidemic in the United States.

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.

Social disruptions (e.g., loss of stable housing, employment, income) during the COVID-19 pandemic have been associated with greater mental healthcare and substance use treatment needs in the general population. People with HIV (PWH) may have experienced greater social disruptions during the COVID-19 pandemic due to pre-existing social vulnerabilities and may have experienced greater interruptions in healthcare during the pandemic due to the co-management of chronic and co-morbid conditions, including mental health and substance use disorder diagnoses, which are prevalent among PWH. Between April and September 2020, surveys assessing social disruption and healthcare interruption were conducted among Multicenter AIDS Cohort Study/Women’s Interagency HIV Study Combined Cohort Study participants. Descriptive statistics and multivariable logistic regression models were used to characterize and examine the relationships between social disruptions and interruptions in general, mental health, and substance use care, adjusting for sociodemographic characteristics (age, race and ethnicity, region, income, and employment) and HIV status. Qualitative interviews were conducted to add depth and context to quantitative analysis. Among 3,665 survey participants (2,238 PWH, 1,427 PWoH), 54

Cisgender women face significant HIV risks in the United States yet retention in prevention research is challenging. The same factors that increase HIV vulnerability also create barriers to research participation. This qualitative study explored multilevel barriers and facilitators to retaining cisgender women with increased HIV prevention needs in research using the social ecological model (SEM). Semi-structured interviews were conducted from August 2023 to February 2024 with 114 participants across three groups: HIV-negative cisgender women with increased HIV prevention needs (n = 34), cisgender women living with HIV (n = 40), and HIV prevention/treatment stakeholders (n = 40). Participants were recruited nationally through convenience sampling via social media and organizations. Directed content analysis was used to identify retention factors across individual, environmental, intervention, and structural levels. Barriers included substance use affecting contact maintenance, concerns about study time commitments, frustrations with unclear study procedures, poor staff rapport, safety concerns around intimate partner violence, historical research mistrust, and systemic vulnerabilities like housing instability. Facilitators included creating affirming environments that fostered purpose, flexible scheduling with incremental compensation, clear study expectations and health education/support, authentic staff relationships, discrete communication methods, transparent study procedures and approaches, virtual visit options, and availability of multiple contact methods. Findings corroborated a key paradox: those most vulnerable to HIV acquisition may be least likely to complete longitudinal studies due to structural barriers. Successful retention requires flexible approaches that address barriers at all SEM levels. These findings provide strategies for researchers to improve retention among cisgender women with increased HIV prevention needs, strengthening research representativeness and effectiveness.

Young Black and Latino men who have sex with men are disproportionately affected by the U.S. HIV Epidemic, yet pre-exposure prophylaxis (PrEP) uptake remains low. To understand barriers and facilitators to PrEP uptake and persistence, we used a concurrent mixed methods design (quantitative: online surveys, n = 19; qualitative: individual interviews, n = 15) from providers (e.g., nurse practitioners, clinicians, and social workers) at 4 clinics providing PrEP services in Birmingham, Alabama and New York City. Although all providers were comfortable prescribing daily oral PrEP, they had concerns about on-demand PrEP (e.g., complex dosing schedule) and injectable PrEP (e.g., insurance barriers). Provider training is needed to address barriers to providing PrEP modalities beyond daily oral PrEP and increase uptake among young Black and Latino men who have sex with men. Additionally, in order to increase uptake of injectable PrEP, rising PrEP costs due to changes in the 340B Drug Pricing Program will need to be addressed.

Anal cancer, primarily caused by persistent high-risk HPV infection, is increasing worldwide. Men who have sex with men (MSM) and men with HIV (MWH) have incidence rates over ten-fold the rate among the general population. We explored health beliefs related to anal cancer, and perceived benefits, barriers, and facilitators to screening among MWH and their HIV care providers in the U.S. South, where HIV incidence remains high. We conducted in-depth interviews and thematic analyses to identify themes related to health beliefs (i.e., perceived knowledge of HPV and cancer, benefits of screening, and self-efficacy), barriers and facilitators to screening. Among MWH (N=12), benefits of screening included early detection to prevent negative outcomes and awareness about one's body. Among providers (N=4), suggestions for overcoming barriers to screening included access to standard screening guidelines, patient education, inclusion of screening into routine care, social work services, and self-collection. Among MWH that were aware of HPV-associated cancers, perceived risk of cancer and a desire to receive HPV vaccination were common. In conclusion, improving patient education about HPV-associated cancer, inclusion of screening as part of routine care, and access to self-collection kits could facilitate anal cancer screening uptake among MWH in the South.

Background: Supplements were awarded under the National Institutes of Health, ending the HIV epidemic (EHE) initiative to foster implementation science through community-engaged research. The objective of this study was to synthesize lessons learned, identify areas of research sufficiently studied, and present an agenda for future research on HIV health workforce development from a collaboration across 9 EHE projects in 11 jurisdictions in the United States. Methods: EHE supplement recipients completed a semistructured questionnaire to identify shared lessons learned about common themes of workforce development using the Consolidated Framework for Implementation Research and Expert Recommendation for Implementing Change frameworks. Data were synthesized to identify shared lessons learned, topic areas no longer in need of research, and next steps. Results: Project teams emphasized several strategies including clarifying roles and responsibilities, the need for dynamic training, and stigma mitigation as strategies to enhance the implementation of HIV prevention and treatment services. Strengthening organizational support through supportive supervision structures, ensuring sustainable funding, preventing turnover, addressing salary constraints, and establishing clear promotion and educational pathways were identified as useful workplace development strategies. Supplements identified lessons learned about deploying community engagement strategies to ensure communities were aware of HIV prevention and treatment services. Several areas sufficiently studied that can be deprioritized were identified and discussed. Conclusion: A research agenda for workplace development moving forward is discussed with several recommendations to improve the implementation of HIV prevention and treatment programs.

Abstract Adaptation of interventions to local contexts is often required for sustainable implementation. Yet maintaining and measuring fidelity to an intervention’s core components is necessary during pragmatic clinical trials. We systematically addressed this inherent tension across two studies of Montessori approaches for person-centered care in Department of Veterans Affairs (VA) nursing homes. We first conducted a 3-phase pre-implementation study (2018-2021) to adapt Montessori for VA with input from operations partners, frontline clinical teams, long-term care residents, implementation scientists, and intervention developers. We used the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to track changes in real-time using qualitative and quantitative data at eight VAs. Primary motivators for adaptation were expanding reach of the intervention and engagement with staff training/delivery. Next, the adapted Montessori intervention was tested in a pragmatic, randomized stepped-wedge clinical trial at eight additional VAs (2021-2023). Diverse frontline staff (e.g., nursing assistants, nurses, therapists) delivered the intervention to all residents. Low burden methods were used to gather reach, implementation, and fidelity data over 12-months (i.e., 15-minute weekly neighborhood check-ins, individual staff surveys, organizational-level fidelity tools completed by the clinical team). Adherence to and delivery of the intervention remained high at most sites over time across all measures. Evidence of fidelity and sustained use across sites in the trial may be attributed to the fit of the adapted Montessori intervention with the needs, resources, and clinical priorities of VA long-term care residents and staff.

OBJECTIVE:Sexually transmitted infections (STIs), including HIV, are a key contributor to psychological and physical morbidity across the United States (US). African American (AA) women are disproportionately impacted by STIs, particularly in the Deep South of the US. Strong patient-provider communication can help to increase client understanding of STI prevention and treatment options. This study aimed to explore factors influencing effective patient-provider relationships and communication around STIs (including HIV) and sexual health broadly, which will ultimately inform the refinement of a patient-provider communication tool for discussing PrEP as an HIV prevention method. METHODS:As part of a larger study focused on PrEP implementation, in-depth, semi-structured qualitative interviews were conducted among cisgender AA women who are PrEP-eligible, both with and without PrEP experience, as well as providers from three federally qualified health centers (FQHCs) and HIV service agencies in Alabama. Data were analyzed using content analysis. RESULTS:A total of 41 participants enrolled, including 21 clients (n = 6 PrEP experienced; n = 15 PrEP naïve) and 20 providers. Qualitative data were organized across the following domains: meaning of health and sexual health, factors influencing the client-provider relationship, and factors influencing sexual health discussions among clients and providers. Key factors influencing client-provider relationships were organized at client, provider, and clinic levels. Factors impacting sexual health discussions between clients and providers were organized at client, provider, and structural levels. CONCLUSION:These interviews identified key determinants of effective client-provider communication pertaining to sexual health among cisgender AA women in the US South who were receiving care at FQHCs and HIV service organizations. Individual, provider, and clinic-level factors were identified that have implications for designing sexual health interventions for cisgender AA women.

Cisgender men are diagnosed with HIV at a rate four times greater than cisgender women, with 71% of infections attributed to male-male sexual contact. Despite expanding accessibility, pre-exposure prophylaxis (PrEP) for HIV prevention is initiated by only 30% of people with PrEP indications. Five focus groups with 42 young men who have sex with men from New York and Alabama were conducted to identify key factors to PrEP initiation and persistence. Thirty focus group participants completed a survey on demographics, PrEP choices and health care attitudes. Findings suggest provider competency significantly influences PrEP use due to stigmatization in medical settings. Participants noted benefits of PrEP including HIV protection and sexual empowerment, yet barriers like cost and side effects were prevalent. Our findings outline barriers and facilitators to PrEP use among young men who have sex with men in two high priority settings that will inform PrEP care updates in participating clinics.

The onset of the COVID-19 pandemic initiated a cascade of stressors that occurred concurrently with increasing issues of racism and racial injustice events. These compounded healthcare and societal stressors significantly impacted the mental health of individuals worldwide, including university students. To address the needs of students, a survey was administered to undergraduate, graduate, and professional students at a large public university in the southeastern United States. Qualitative data were collected regarding student mental health, recommendations for institutional resources, and support needs therein. Thematic analysis of qualitative responses from 1050 university students indicated six areas students stated they wanted the university to address to support their mental health needs: (1) Communication, (2) Academic Concerns, (3) Mental Health Resources and Connections, (4) COVID-19 Safety, (5) Social Injustice, and (6) Financial Concerns. To address these areas, we propose a set of evidence-based recommendations within the Social-Ecological Framework for colleges and universities to adopt to support student mental health considering all races, backgrounds, and experiences. Additionally, we propose strategies for university and college counseling centers to provide an essential leadership role on campuses to move these recommendations forward and positively impact the mental health of students.

ObjectiveAfrican American (AA) women in the U.S. South experience significant HIV incidence, and efforts to support antiretroviral pre-exposure prophylaxis (PrEP) uptake and maintenance among this group have been insufficient. This study aimed to explore perceptions, attitudes, and implementation preferences surrounding PrEP use for AA women in the U.S. South.Methods and MeasuresThe study team conducted qualitative interviews with AA cisgender women clients (n = 21) and their providers (n = 20) in Federally Qualified Health Centers and HIV clinics in Alabama. The research team employed directed qualitative content analysis to analyze interview data.ResultsFive themes emerged: a) inconsistent access to PrEP and PrEP knowledge, b) need for improving low PrEP awareness, c) managing hesitancy to prescribe or use PrEP, d) perceived HIV vulnerability and inherent stigma, and e) normalizing PrEP as part of routine sexual healthcare to increase uptake and maintenance. Interviews revealed an openness towards PrEP as an HIV prevention strategy for AA, cisgender women in Alabama.ConclusionImproving PrEP uptake and maintenance among AA women in the U.S. South must go beyond increasing awareness to improving PrEP access and trust through visibility of AA women's PrEP use and incorporating PrEP education and services into routine sexual healthcare.

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.

The purpose of this submission to respond to a Letter to the Editor recently submitted regarding our manuscript, "Exploring COVID-19 Vaccine Hesitancy among Stakeholders in African American and Latinx Communities in the Deep South through the Lens of the Health Belief Model" published in the American Journal of Health Promotion in February, 2022. The manuscript reported on a study that had as its purpose to qualitatively explore perceptions related to COVID-19 vaccination intention among African American and Latinx participants and suggest potential intervention strategies.

Introduction African American women (AA), particularly those living in the Southeastern USA, experience disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool that may circumvent barriers to traditional HIV prevention tools, such as condom use; however, very little is known about how to improve PrEP access and uptake among AA women who may benefit from PrEP use. This project aims to understand how to increase PrEP access among AA women in the rural Southern USA, which may ultimately affect HIV incidence in this population.Methods and analysis The goal of the current study is to systematically adapt a patient–provider communication tool to increase PrEP uptake among AA women receiving care at a federally qualified health centre in Alabama. We will use an iterative implementation process, by assessing the feasibility, acceptability and preliminary impact of the tool on PrEP uptake, using a pilot preintervention/postintervention design (N=125). We will evaluate women’s reasons for declining a referral to a PrEP provider, reasons for incomplete referrals, reasons for not initiating PrEP after a successful referral and ongoing PrEP use at 3 and 12 months after PrEP initiation among our sample. The proposed work will significantly contribute to our understanding of factors impacting PrEP uptake and use among AA women, particularly in underserved areas in the Deep South that are heavily impacted by the HIV epidemic and experience worse HIV-related health outcomes relative to other areas in the USA.Ethics and dissemination This protocol has been approved by the Institutional Review Board (IRB) at University of Alabama at Birmingham (Birmingham, AL; protocol 300004276). All participants will review a detailed informed consent form approved by the IRB and will provide written or verbal informed consent prior to enrolment. Results will be disseminated through peer-reviewed manuscripts, reports, and local, national and international presentations.Trial registration number NCT04373551.

Pre-exposure prophylaxis (PrEP) is underused in the southern United States (US), a region with high HIV incidence. Clinical decision support (CDS) tools could increase PrEP prescriptions. We explored barriers to PrEP delivery and views of CDS tools to identify refinements for implementation strategies for PrEP prescribing and PrEP CDS tools. We conducted focus groups with health care providers from two federally qualified health centers in Alabama and analyzed the results using rapid qualitative methods. Barriers to PrEP included providers' lack of training in PrEP, competing priorities and time constraints during clinical visits, concerns about side effects, and intensive workload. We identified refinements to the planned implementation strategies to address the barriers, including training all clinic staff in PrEP and having CDS PrEP alerts in electronic health records sent to all staff. Development and deployment of CDS tools in collaboration with providers has potential to increase PrEP prescribing in high-priority jurisdictions.

Abstract Long-term care is a challenging environment for quality improvement due to the high resident acuity, wide variation in resident needs, and wide variation in types and backgrounds of the large staff across three daily shifts. We report results from a learning collaborative undertaken to improve care quality and staff quality improvement skills in the VA CLCs through development of high functioning relationally coordinated teams operating in accord with person-centered care principles. The collaborative included 27 CLCs. Over 9 months leadership teams completed action assignments supported by 5 workshops and regular group coaching calls. Evaluation included fidelity monitoring (attendance, mid- and final progress reports), satisfaction questionnaires, and review of the VA quality measures (CLC Compare). Pre-post participant evaluations revealed a significant increase in positive responses to the question “to what extent do you think applying these new skills/knowledge will improve quality in your CLC?” and positive responses trending toward significance in ratings of abilities to apply new skills. Open-ended survey comments were positive and indicated change in understanding and practice: “utilizing the daily huddle to facilitate real time communication afforded the team a proactive approach to providing care and reducing acute exacerbations. We are able to avert, evaluate as a real time team and make it happen in the now not as a look back.”; “definitely unified front-line staff and CLC leadership.” Some changes were achieved in CLC Compare quality scores (e.g., falls with major injury rate had a 9.6 reduction (average rate = 3.39 pre, 3.07 post)).

Background According to the American Association of Medical Colleges, women comprise 26% of full professors and 19% of medical school department chairs. African American and Latino faculty comprise 4.6% of full professors and 6.9% of department chairs. Objective Because of the lack of representation of women and racial/ethnic minority faculty at the highest levels of academic medicine, this study examines the perceptions of barriers to advancement by men and women academic medical school faculty of differing races and ethnicities to explore potential differences in perceptions by demographic group. Design Semi-structured one-on-one interviews were conducted between July and September 2017. Participants In order to give all faculty a chance to participate, faculty of all ranks and specialties were recruited from one southeastern medical school to participate in the study. Approach Interviews were audio recorded, transcribed, and analyzed by 3 members of the research team using an inductive approach to thematic analysis. Participants were organized into 4 groups for analysis-underrepresented in medicine (URiM) women, majority women, URiM men, majority men. Key Results Sixty-four faculty consented to participate in the study (56.2% women, 34.4% URiM). Subthemes were grouped under three main themes: Perceptions of Barriers to Advancement of Women Faculty, Perceptions of Barriers to Advancement of African American and Latino Faculty, and Perceptions of the Institutional Climate for Diversity. Majority men tended to voice distinctly different perspectives than the other three demographic groups, with the most notable differences between majority men and URiM women. Majority men tended to suggest that the advancement of women and URiM faculty was acceptable or getting better, the lack of URiM faculty in leadership was due mainly to pipeline issues, and women choose not to advance to leadership positions. Conclusion We found that participant gender and race/ethnicity shaped perspectives of medical school faculty advancement in distinct ways.