amfAR, The Foundation for AIDS Research

Implementation Science Grants

Researchers from IMPACTA in Lima and the Fenway Institute in Boston collaborating for the Peru-based Implementation Science study.  
Researchers from IMPACTA in Lima and the Fenway Institute in Boston collaborating for the Peru-based Implementation Science study.

In an effort to address the unrelenting and disproportionate impact of HIV/AIDS on gay men, other men who have sex with men (MSM), and transgender individuals (collectively, GMT), the GMT Initiative awarded  three-year grants to three teams of researchers to study the impact of innovative HIV service delivery models for GMT in low- and middle-income countries.

GMT individuals often do not access HIV testing and treatment services due to barriers such as stigma, discrimination, and poverty. Identifying these barriers and other gaps in the continuum of HIV care—the so-called treatment cascade—and finding ways to overcome them and improve GMT individuals’ access to effective HIV prevention, testing, treatment, and care services is essential to controlling and ultimately diminishing the epidemic among them.  
  

2014–2017 Implementation Science Grants

 

Chris Beyrer, M.D., M.P.H., Johns Hopkins University, Baltimore, MD, U.S.A. – $899,887
Continuum of Care Innovations for GMT in Burma/Myanmar
January 1, 2015–December 31, 2017

Burma/Myanmar has a serious HIV epidemic, with low rates of HIV testing and treatment access and high disease burden among gay men, other men who have sex with men, and transgender (GMT) individuals. Using the framework of the HIV treatment cascade, the study team will work to measure and overcome barriers to HIV testing, diagnosis, and linkage to care. Specific innovations will include assessing the effectiveness of HIV self-testing done in the privacy of one’s home, point-of-care CD4 testing, and the use of “peer navigators” familiar with the local health system to help those who are newly diagnosed gain access to HIV treatment and care. 

In addition to The Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, the collaborative team for the implementation science research study includes the Ministry of Health, Myanmar; the University of Public Health of Myanmar; The International HIV/AIDS Alliance Myanmar; MSM Network Myanmar; and Myanmar Youthstars. This community-based implementation research aims to inform HIV-related public health initiatives for GMT in Myanmar and fill gaps in knowledge regarding the effective models to engage GMT in HIV care.

 

Javier Lama, M.D., M.P.H., Asociacion Civil Impacta Salud y Educacion, Lima, Peru – $876,684
Gender-Affirmative Transgender Care to Improve the HIV Treatment Cascade
October 1, 2014–September 30, 2017

Transgender women in Peru are at disproportionately high risk for HIV and provide an important group for assessing how new HIV prevention interventions could impact transgender individuals globally. Transgender women face violence, stigma, and discrimination that deter them from seeking HIV prevention, treatment, care, and support services. As a result, existing approaches to HIV prevention have been insufficient for controlling the HIV epidemic among transgender women.

Systems of HIV treatment and service delivery typically do not integrate gender-affirmative transgender medical services into their HIV care. This represents a missed opportunity to reach and retain individuals at high risk of, or living with, HIV in care and improve the HIV treatment cascade to curb HIV incidence. This study aims to improve access to the continuum of care among transgender women by using an innovative model that integrates HIV prevention and treatment services with transgender-affirming medical care. Working in collaboration with the Boston-based Fenway Institute and two community GMT organizations, IMPACTA and EPICENTRO, Dr. Lama and his team will integrate routine cross-sex hormone therapy into HIV and sexually transmitted infection prevention, testing, and treatment services. They will also implement health services and peer case management for 200 transgender women.

 

Nittaya Phanuphak, M.D., Ph.D., Thai Red Cross AIDS Research Centre, Bangkok, Thailand – $900,000
Innovative Strategy to Offer Online Test and Treat Services for Thai MSM
October 1, 2014–September 30, 2017

Thailand aims to end its AIDS epidemic by 2030 by increasing HIV testing rates among members of key populations to 90% and by providing all HIV-positive individuals with antiretroviral therapy, regardless of their CD4 count. Current estimates project that between 2012 and 2016, approximately 40% of new HIV diagnoses in Thailand will be among MSM; however, only 29% of Thai MSM report ever being tested, meaning that many MSM already infected with the virus likely do not know their status. Thailand urgently needs innovative strategies to engage and retain ‘hard-to-reach’ MSM in HIV testing and care. 

In this study, 600 Thai MSM will be recruited online and offered either online or offline HIV pre-test counseling. Participants who test positive will be referred to HIV treatment programs. Working in collaboration with Adam’s Love, a web-based health platform for GMT individuals, and two community-based organizations, Service Workers in Group/SWING and The Rainbow Sky Association of Thailand, the team will compare the effectiveness of online services and support interventions with traditional clinic-based HIV services and with a hybrid model that combines elements of both strategies. The results will help inform researchers on how to optimally integrate online and offline strategies to recruit and retain subgroups of Thai MSM.