Implementation of Rapid HIV Testing and Linkage to HIV Treatment or Prevention Among Vulnerable Populations in Tennessee

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Project Summary Human Immunodeficiency Virus (HIV) infection remains a significant public health problem in the United States (US). It is estimated that almost 15% of the 1.17 million people living with HIV (PLWH) in the US are unaware of their HIV status. And despite the existence of highly effective HIV treatment (antiretroviral therapy, ART), only 65% of people living with diagnosed HIV have achieved viral suppression. Similarly, among HIV-negative people eligible for PrEP, only 18% have used PrEP. These gaps between evidence and practice are deepened in the US South, where the opioid crisis has further increased the risk for acquiring HIV in this region. In order to achieve US Ending the HIV Epidemic (EHE) goals, implementation research, particularly in the US South, is needed to close the gap between evidence-based interventions and practice in the HIV neutral continuum of care. Thus, our overarching goal is to support and evaluate the implementation of a sustainable HIV health service model for rapid HIV testing and linkage to HIV treatment (ART) or prevention (PrEP) in Tennessee (TN), a state located in the US South. Our Core Project will focus on implementation and evaluation of rapid HIV testing and linkage to ART from the Shelby County Health Department, the highest volume HIV testing facility in Memphis, TN (a southern US city which ranks 4th among all US Metropolitan Statistical Areas for HIV incidence) to several nearby Ryan White-funded HIV care clinics. Our Collaborative Project will focus on implementation and evaluation of rapid HIV testing and linkage to local PrEP providers from: 1) Street Works, a Community Based Organization (CBO) providing a Syringe Service Program (SSP) to the Nashville community and 2) A Betor Way, a CBO providing a SSP to the Memphis community. We are uniquely positioned to perform the work we propose for three important reasons. First, we plan to leverage an established collaboration with implementation and community partners in Memphis and Nashville including colleagues from St. Jude Children’s Research Hospital, University of Memphis, Shelby County Health Department, Street Works, and A Betor Way. Second, we will leverage resources available at the TN Center for AIDS Research, Vanderbilt Center for Health Services Research, and the Meharry-Vanderbilt Alliance/Community Engaged Research Core. Thirdly, the investigators involved in this proposal possess the expertise in HIV clinical care and prevention, implementation science, and public health practice necessary to complete the proposed work. The proposed study will support the implementation of a contextually appropriate rapid HIV testing and linkage to HIV treatment (ART) or prevention (PrEP) in Memphis and Nashville, TN. The results will inform future scaling of these models to additional HIV testing, care, prevention sites across TN, a geographic area at the epicenter of important US HIV disparities. Importantly, our work will support the Memphis and Nashville communities in reaching their local EHE goals through leveraging of our unique academic, public health, and community-based partnerships.