Blank, Michael B. PhD*,†; Metzger, David S. PhD†,‡,§; Wingood, Gina M. ScD, MPH‖; DiClemente, Ralph J. PhD‖
We are proud to be able to present a series of articles to the field that emerged from the Fifth National Scientific Meeting of the Social and Behavioral Sciences Research Network (SBSRN) hosted by Emory University in Atlanta, October 8–9, 2010. The theme of that meeting was Translational Research to Reduce Disparities in HIV. The original purpose for establishing the SBSRN was 3-fold.1 First, it was intended to foster multisite collaborations between behavioral and social scientists working within Centers for AIDS Research (CFARs). Second, it was intended to share strategies on how behavioral and social scientists could be better integrated with basic and clinical scientists. Finally, the SBSRN was explicitly organized to provide a forum for the exchange of the most recent information in the behavioral and biomedical sciences regarding HIV/AIDS and to mentor the next generation of behavioral social scientists engaged in research surrounding HIV prevention and treatment. It was hoped that combining the intellectual capital and synergies among the community of scientists engaged in this work would invigorate state-of-the-art science in this area.2 The Local Planning Group for the Atlanta meeting included Drs Patrick Sullivan, Ralph DiClemente, and Gina Wingood.
The American Psychological Society published an article about the uniqueness of the SBSRN and covered the Fifth National Scientific Meeting held in Atlanta in the December 2010 Observer.3 Up to and including that meeting, we had 79 mentees and 405 other individuals attend the 5 previous SBSRN scientific meetings. These meetings have generally been rated as outstanding in comprehensive evaluations from attendees. As in the earlier SBSRN meetings, the structure of the Atlanta meeting consisted of a mentoring day on the first day, followed by a 2-day scientific meeting, and concluded with a half a day meeting of the SBSRN Planning Committee. Scientific sessions during the 2-day meeting were interspersed with presentations by leading clinical, social, and behavioral scientists. The presentations were designed to stimulate formal discussions on how these other disciplines and core services can be more fully integrated into translational research in HIV. There was also an explicit focus on dedicated breakout sessions. In keeping with a product orientation, attendees were encouraged to pick a single breakout group and remain with that group throughout the meeting. It was expected that attendees would continue to work with their breakout group partners after the meeting concludes, toward development of articles in which they would share authorship and which would subsequently be published in the conference proceedings. This supplement contains the body of work generated at the Atlanta meeting.
This supplement begins with a brief introduction by James W. Curran and James A. Hoxie, who, respectively, direct the Emory and Penn CFARs and whose leadership and support have allowed the SBSRN to flourish. In their introduction entitled Translating Social and Behavioral Science Research to the AIDS Epidemic: A Center For AIDS Research Perspective, they note that the success of the SBSRN is because of having been intentionally engineered to bring together scientists with complementary interests and skills from across a variety of research settings and to integrate biological with behavioral and social science approaches. Increasingly, basic and clinical scientists recognize that translating success on the bench or in the laboratory into practice becomes a behavioral and social science problem when implementation of an innovation into community practice is needed. It is largely because our efforts have been so valued by basic and clinical scientists and also by social and behavioral scientists that we have been able to move the SBSRN into the forefront of AIDS research in such a brief span of time.
The first article by Dianne M. Rausch, Cynthia I. Grossman, and Emily J. Erbelding is entitled Integrating Behavioral and Biomedical Research in HIV Interventions: Challenges and Opportunities. These scientists are among the core of the National Institutes of Mental Health division of AIDS research program and who, in part, sponsored the Atlanta meeting. They make note of several advances in the prevention and treatment of HIV and highlight that the complex and sometimes contradictory results of some of the trials point out a need for more effective integration of biomedical and behavioral sciences in the design and implementation of future interventions. They call for integration of behavioral and biomedical sciences and argue convincingly that such a goal requires use of behavioral theories that can be brought to bear in clinical trials and multidisciplinary teams working from the earliest stages of the trial. They also make clear that large-scale implementation of successful intervention will require integration of behavioral science at the population level that will be needed to safeguard the health and mental health of the public.
In the second article, Sten H. Vermund, José A. Tique, Holly M. Cassell, Megan E. Johnson, Philip J. Ciampa, and Carolyn M. Audet describe Translation of Biomedical Prevention Strategies for HIV: Prospects and Pitfalls. These authors describe the evolution of HIV prevention beginning with using physical barriers such as condoms, clean injection equipment for injections, and blood and blood product safety. The article goes on to describe the more recent advances in the use of antiretroviral drug treatment as prevention and preexposure prophylaxis (PrEP). They also review the major efficacious biomedical approaches and conclude that behavioral risk reduction and adherence interventions should be integrated routinely into biomedical interventions for HIV.
Next, Russell E. Glasgow, Erin T. Eckstein, and M. Khair ElZarrad provide Implementation Science Perspectives and Opportunities for HIV/AIDS Research: Integrating Science, Practice and Policy. In this, they argue that the emerging field of implementation science is well suited to address problems of translation with its focus on context, external validity, and innovative design approaches. They hold forth a promise of perspectives that can facilitate more rapid integration of practice innovations into research, practice, and policy.
In the next article, Scott D. Rhodes, Stacy Duck, Jorge Alonzo, Jason Daniel, and Robert E. Aronson present Using Community-Based Participatory Research to Prevent HIV Disparities: Assumptions and Opportunities Identified by the Latino Partnership. They identify 7 assumptions in CBPR research and use the lens of their experiences working with immigrant Latino communities to examine them. This article presents a fine exemplar of cultural competency in implementation science.
Next, Gina M. Wingood, Ralph J. DiClemente, LaShun Robinson-Simpson, Delia L. Lang, Angela Caliendo, and James W. Hardin examine sexual risk in a sample of 848 African American women in Efficacy of an HIV Intervention in Reducing High-Risk Human Papillomavirus, Nonviral Sexually Transmitted Infections, and Concurrency Among African-American Women: A Randomized Controlled Trial. They demonstrate that an intervention developed to address HIV risk can also achieve reductions in concurrency, high-risk human papillomavirus, and nonviral sexually transmitted infections, thereby demonstrating added value for the approach they adopted.
In the next article, Michael B. Blank and Marlene M. Eisenberg describe an approach to prevention among HIV-positive persons with co-occurring severe mental illness in Tailored Treatment for HIV+ Persons With Mental Illness: The Intervention Cascade. They describe preventing AIDS through health (PATH+), an approach to prevention where the intensity and expense of services delivered by a nurse disease manager can be ratcheted up or down depending on specific person's level of adherence to treatment regimens. They describe both adherence to antiretroviral therapy and psychiatric medications as critical to the health of this population. They suggest that the intervention cascade is an alternative to one-size-fits-all interventions and holds the promise of cost effectiveness and reaching populations with complex co-occurring conditions such as mental illness.
Next, Josiah D. Rich, Ralph J. DiClemente, Judith Levy, Karen Lyda, Monica Ruiz, David L. Rosen, and Dora Dumont examine Correctional Facilities as Partners in Reducing HIV Disparities. These authors note that the United States has the highest rates of incarceration in the world and that correctional institutions provide often neglected but logical loci for HIV diagnosis, treatment, and research. They recommend a dynamic research agenda for correction populations though the CFAR Collaboration on HIV in Corrections. The CFAR Collaboration on HIV in Corrections represents the realization of the promise of collaborations through the SBSRN, and we are pleased to have helped provide a platform for its development.
The next article by Carl A. Latkin, Melissa A. Davey-Rothwell, Amy R. Knowlton, Kamila A. Alexander, Chyvette T. Williams, and Basmattee Boodram presents Social Network Approaches to Recruitment, HIV Prevention, Medical Care, and Medication Adherence. The article reviews current issues and advances in social network approaches to HIV prevention and treatment and highlights why a social network approach is a valuable tool to link social structure to individual risk behaviors. They argue convincingly that using a social network approach to behavior change for hidden populations can be a cost-effective and sustainable innovation and is critical in understating implementation of HIV prevention and treatment in communities.
In the next article, Gina M. Wingood, Priscilla Reddy, Delia L. Lang, Dorina Saleh-Onoya, Nikia Braxton, Sibusiso Sifunda, and Ralph J. DiClemente discuss adapting an effective intervention for translation and implementation in another country in Efficacy of SISTA South Africa on Sexual Behavior, HIV Stigma and Relationship Control Among isiXhosa Women in the Western Cape Province, South Africa: Results of a Randomized Controlled Trial. This is a fundamentally important contribution and holds great promise for translating innovation from the developed world to the developing world and improving global public health.
In the next article, Ralph J. DiClemente, Erin Bradley, Teaniese L. Davis, Jennifer L. Brown, Mary Ukuku, Jessica M. Sales, Eve S. Rose, and Gina M. Wingood present Adoption and Implementation of a Computer-Delivered HIV/STD Risk-Reduction Intervention for African American Adolescent Females Seeking Services at County Health Departments: Implementation Optimization Is Urgently Needed. This article presents yet another type of innovation through the use of technology and translation and implementation of a group approach of HIV and STD risk reduction to a computer-delivered intervention that can now be more widely disseminated. This is another important addition to our armamentarium to fight the HIV pandemic.
The next contribution by C. Hendricks Brown, David C. Mohr, Carlos G. Gallo, Christopher Mader, Lawrence Palinkas, Gina M. Wingood, Guillermo Prado, Sheppard G. Kellam, Hilda Pantin, Jeanne Poduska, Robert Gibbons, John McManus, Mitsunori Ogihara, Thomas Valente, Fred Wulczyn, Sara Czaja, Geoff Sutcliffe, Juan Villamar, and Christopher Jacobs is entitled A Computational Future for Preventing HIV in Minority Communities: How Advanced Technology Can Improve Implementation of Effective Programs. The authors argue that innovative approaches that use computational technologies have great promise for developing new intervention for use with minority communities, including mobile technologies and the use of systems science methods such as network analysis. The authors present 8 specific areas in the implementation process where these approaches can add value to the intervention.
The following article by Ralph J. DiClemente, Jennifer L. Brown, Jessica M. Sales, and Eve S. Rose is provided called Rate of Decay in Proportion of Condom Protected Sex Acts Among Adolescents Following Participation in an HIV Risk-Reduction Intervention. This article details the trajectories over time of condom-protected sex acts in a sample of African American adolescent women who participated in an evidence-based intervention. These authors argue that postintervention strategies need to be developed to attenuate decay of the effects of an intervention over time to maximize effectiveness.
Next, Chyvette Williams, Marlene M. Eisenberg, Julie Becher, Annet Davis-Vogel, Danielle Fiore, and David S. Metzger add Racial Disparities in HIV Prevalence and Associated Risk Behaviors Among Injection Drug Users and Members of Their Risk Networks to our collection of articles. In this, they note that observers of the racial disparities in prevalence and incidence of HIV infections and AIDS diagnoses in the United States have often concluded that these disparities exist because prevention messages, clean injection supplies, and/or interventions do not effectively reach those at greatest risk of infection. They then argue that this is a false assumption and review the data that suggest that African Americans and other groups experiencing high rates of HIV infection are as aware and often more aware of risk and protective factors than other groups. They further suggest that these disparities emerge in part because of poor access to and lower use of drug treatment and needle exchange programs by African American injectors. These authors call for an enlarged understanding of racial disparity and suggest that recognition of the scope of the problem is a critical challenge. They conclude that risk behavior rates alone do not explain observed disparities in rates of infection.
In the next article entitled Racial Differences and Correlates of Potential Adoption of Preexposure Prophylaxis: Results of a National Survey, Gina M. Wingood, Kristin Dunkle, Christina Camp, Shilpa Patel, Julia E. Painter and Ralph J. DiClemente examine barriers and facilitators to adoption of PrEP in a sample of African American and White women. They report that compared with White women, African American women were more likely to report that they would use PrEP and that they thought their female friends would use as well. African Americans also said that they use PrEP if it was recommended by a health-care provider and were also less likely to be embarrassed to ask a doctor for PrEP. Although these findings are encouraging, the potential financial cost for PrEP was identified as a barrier to adoption by both African American and White women in the study.
Next, the supplement presents an article by Patrick Sullivan, Jeremy Grey, and Simon Rosser on Emerging Technologies for HIV Prevention for MSM: What We've Learned and Ways Forward. This timely report describes the emergence of technology-enabled HIV research and intervention over the past decade, which holds the promise of reaching populations in novel ways who are most at risk for infection. They examine how innovative technologies can be harnessed to address challenges to HIV research and interventions, including improving data quality, better characterization of sampling bias, promoting compatibility between funders and research proposals, promoting consensus, and ultimately disseminating and sustaining approaches to treatment and intervention.
Finally, this collection concludes with an article by Gina M. Wingood, Anna Rubtsova, Ralph J. DiClemente, David Metzger, and Michael B. Blank entitled A New Paradigm for Optimizing HIV Intervention Synergy: The Role of Interdependence in Integrating HIV Prevention Interventions. Here the authors argue that critical to translation and implementation of interventions for addressing HIV/AIDS at the population level is consideration of what combination or combinations of interventions are needed for particular risk groups in different communities and settings and developing strategies that are theory based for how they should be sequenced. This reflects the current state of a growing number of evidence-based approaches for different populations and risk groups and how they can be applied more broadly in sustainable ways.
We would like to thank the many contributors to this fine supplement and trust that it will be well received by the field. Moreover, we would like to thank now many 100s of scientists who have embraced the SBSRN as a forum and have used it to create synergies between and among the highly diverse group of researchers, policy makers, and activists who have been drawn together to help first contain but ultimately eradicate HIV throughout the world. We remain committed to our charge and continue to be energized by continued engagement with our dedicated colleagues.
© 2013 Lippincott Williams & Wilkins, Inc.