The D.C. Partnership for HIV/AIDS Progress is laying groundwork necessary to stem the rate of new HIV infections in the city, improve the health of district residents living with HIV and strengthen the city's response to the HIV/AIDS epidemic. The D.C. Partnership for HIV/AIDS Progress, launched in 2010, is a collaboration between the National Institutes of Health (NIH) and the Washington, D.C., Department of Health.
"Over the past several years, our nation's capital has experienced a decline in the number of new cases of HIV infection and AIDS. However, the District of Columbia still has one of the highest HIV prevalence rates in the country, with roughly 2.7 percent of adults and adolescents infected with the virus," said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH. "Our ongoing research collaboration with the District is a commitment to find and improve the methods that work on a community level by funding studies designed to ease the HIV/AIDS burden for the residents of this city and potentially other communities in the United States and abroad."
Working with the D.C. Department of Health, NIAID, along with the NIH Clinical Center, co-leads the D.C. Partnership for HIV/AIDS Progress, with additional funding provided by the NIH Office of AIDS Research. To date, NIH has spent $11.6 million on the initiative, which is anticipated to be in place until at least 2015.
Speaking at today's XIX International AIDS Conference (AIDS 2012) in Washington, D.C., Carl W. Dieffenbach, Ph.D., director of NIAID's Division of AIDS, highlighted the work the Partnership has completed around its central research efforts.
Identifying and Helping At-Risk Populations
Recognizing that African-Americans continue to represent the largest segment of the district's HIV/AIDS cases, a key focus of the D.C. Partnership is to better understand the factors that place blacks at risk for HIV infection and to develop effective interventions for reducing risk, said Dr. Dieffenbach. NIAID has conducted two observational studies to examine risk factors and interventions among segments of the African-American population particularly vulnerable to HIV infection
The HPTN 061 study, which involved 1,553 black men who have sex with men living in the District, as well as in Atlanta, Boston, Los Angeles, New York City and San Francisco, was designed to assess whether community-level interventions intended to prevent HIV infection would be used by the study population. The study also was designed to assess if a larger clinical trial using community-level prevention interventions among black gay and bisexual men in the United States was feasible.
"Early results from the study indicate, not surprisingly, that there are indeed high rates of new HIV infections among black men who have sex with men, particularly younger men," noted Dr. Dieffenbach. "Although this is concerning, the study did show that black gay and bisexual men are willing to receive regular testing for HIV and STIs and to participate in HIV prevention research. It paves the way for designing future studies to test other interventions that may be more acceptable and effective among these men."
A separate study, known as HPTN 064, was designed to estimate HIV incidence among African-American women from areas with high rates of HIV and poverty. The study, which concluded in 2011, enrolled 2,099 women from Washington, D.C., as well as Atlanta; Raleigh-Durham, N.C.; Baltimore; Newark, N.J., and New York City. Preliminary results found the HIV incidence rate among black women in these hard hit areas during the study period to be higher (0.24 percent) than HIV incidence among black women overall in the United States. Also, 32 participants (1.5 percent) discovered they were HIV-infected when they enrolled in the study. The findings confirm the more severe impact of HIV among black women in many urban areas and suggest the need to raise HIV risk awareness and expand HIV testing and prevention efforts in highly affected areas of the United States, Dr. Dieffenbach noted.
Tracking HIV Care, Measuring Success
The second key component of the D.C. Partnership involves monitoring HIV-associated health issues and outcomes by electronically collecting information on HIV-infected residents receiving care at 12 of the city's outpatient health clinics. These clinics provide care for as many as 12,000 HIV-infected patients.
Enhanced Subspecialty Care and Research Access
The D.C. Partnership has also helped expand access to hepatitis treatment and psychiatric services for the District's HIV-infected patients. Led by the NIH Clinical Center, NIH physician specialists are providing care to HIV patients at three clinics throughout the city.
"To date, we have seen more than 400 hepatitis C-infected patients, many co-infected with HIV, who are potential candidates for hepatitis C treatment," said program director Henry Masur, M.D., chief of the Critical Care Medicine Department in the NIH Clinical Center. "These patients not only had the benefit of receiving medical care, but were also given the opportunity to participate in research studies for new hepatitis treatments. There are many new, exciting drugs for hepatitis C that offer the potential for more effective and better tolerated therapy with shorter regimens."
In addition to the partnership's work to provide hepatitis care, the National Institute of Mental Health, also part of NIH, is working with District-based academic leaders and clinics to assess the mental health needs of HIV patients and build an interdisciplinary approach to HIV and mental health. NIMH is developing research studies to better address patient needs and examine the neurological effects of HIV. In collaboration with the National Institute of Neurological Disorders and Stroke, NIMH and NIAID have launched a major initiative investigating HIV-related cognitive brain disorders, which are a clinical challenge and threat to the long-term health of people infected with HIV.
Piloting Test and Treat
The fourth research cornerstone of the D.C. Partnership is the Test, Link-to-Care Plus Treat (TLC-Plus) pilot study, or HPTN 065. The study is designed to examine whether a multi-component, community-level approach to expanded HIV testing, linking patients to care, promoting adherence to antiretroviral therapy, and helping infected patients adopt HIV prevention behaviors might be feasible if implemented widely across the United States.
The study is being conducted in the District of Columbia and the borough of the Bronx in New York City, at 77 sites (39 in D.C.) that conduct HIV testing or provide medical care to people with HIV, and at 16 hospitals (seven D.C. hospitals). It is supported by NIAID, NIMH and the CDC. Its features include a campaign promoting frequent HIV testing among men who have sex with men and HIV tests offered in hospital emergency rooms and through in-patient admissions. Additionally, HIV-infected study participants are offered financial incentives, such as gift cards and coupons for reduced-cost medications, to encourage them to receive medical care and reward patients who maintain low blood levels of HIV by adhering to their antiretroviral drug regimens. Computer-based counseling is provided to HIV patients to assess and modify behaviors that could increase their risk of passing the virus to others.
Results from the TLC-Plus study are expected in 2014, and may inform the design of a larger U.S. clinical trial.
Enhancing, Building Research Capacity
The D.C. initiative has also helped to foster a community of HIV/AIDS researchers within the city through the District of Columbia Developmental Center for AIDS Research (DC-D-CFAR). Launched in June 2010, the DC-D-CFAR is a multi-institutional collaboration that includes 138 clinical investigators at American University, Children's National Medical Center, Georgetown University, The George Washington University, Howard University, the Veterans Affairs Medical Center, Washington Hospital Center, Unity Health Care, Whitman Walker Clinic, La Clinica Del Pueblo and Family Medical Services.
"The DC-D-CFAR will provide the scientific leadership and institutional infrastructure to promote HIV/AIDS research in the District, while also helping to develop the next generation of HIV/AIDS researchers," said Dr. Dieffenbach. "This is an excellent opportunity to bring NIH scientists into close partnership with community partners, especially minority partners while providing an opportunity for District patients to get access to cutting-edge research."