GOOD AFTERNOON I'M TIMOTHY
HOLTZ THE OARAC OFFICIAL.
WELCOME AND FOR YOUR
PARTICIPATION.
AS A BRIEF REMINDER TO OUR
MEMBERS OUR COUNCIL IS GOVERNED
BY THE PROVISIONS OF THE FEDERAL
ADVISORY COMMITTEE AS AMENDED
WHICH SETS FORTH STANDARDS FOR
THE FORMATION AND USE OF
ADVISORY COMMITTEES.
MY ROLE AS A DESIGNATED FEDERAL
OFFICIAL IS TO PREPARE MEETING
AGENDAS, ORGANIZE MEETINGS AND
APPROVE ALL SUBCOMMITTEE
MEETINGS AND ADJOURN ANY MEETING
WHEN IT'S IN THE PUBLIC
INTEREST.
AS A NOTE, DR. GLENSHAW WILL
FULFILL THESE DUTIES IN THE CASE
I CAN'T.
PLEASE ALWAYS STAY MUTED UNLESS
YOU ARE SPEAKING.
PLEASE KEEP YOUR CAMERA ON MOST
OF THE MEETING.
HIDE YOUR CAMERA IF YOU NEED TO
LEAVE MOMENTARILY AND RETURN.
WHEN YOU WOULD LIKE TO
PARTICIPATE IN DISCUSSION WE ASK
YOU PLEASE USE THE ZOOM RAISE
HAND FEATURE.
DR. KAPOGIANNIS AND I WILL NOTE
WHO WANT TO SPEAK AND CALL IN
TURN TO AVOID SPEAKING OVER ONE
ANOTHER.
BE AWARE YOU'LL NEED TO LOWER
THE ZOOM HAND FEATURE ONCE
YOU'VE MADE YOUR REMARKS.
FOR THIS MEETING THE ZOOM CHAT
FEATURE HAS BEEN DISABLED EXCEPT
FOR LOGISTIC MESSAGES TO THE
MEETING HOSTS.
IF YOU HAVE ISSUES OR CONCERNS
RELATED TO THE MEETING, PLEASE
CALL OR TEXT ME AND MS. MELISSA
MARA.
OUR PHONE NUMBERS ARE IN THE
MEETING E-MAIL AND CHAT.
FOR EVERYONE ON VIDEOCAST,
WELCOME.
IF YOU WOULD LIKE TO SEE THE
CLOSED CAPTION FOR THE MEETING
CLICK THE CC ICON IN THE BOUGHT
RIGHT HAND CORNER OF THE VIDEO.
I'D LIKE TO REMIND OUR MEMBERS
REGARDING CONFLICTS OF INTEREST
FORM.
COUNCIL MEMBERS MAY NOT
PARTICIPATE IN THE REVIEW OR
VOTE OF A PROGRAM OF WHICH THEY
HAVE AN INTEREST.
IF A TOPIC IS DISCUSSED THAT
POSE AS A CONFLICT REMOVE
YOURSELF AND SIGNAL ME AND WE'LL
MOVE TO YOU A SEPARATE SPACE IN
ZOOM DURING THE DISCUSSION THAT
POSES A CONFLICT.
AFTER THE MEETING KINDLY SIGN
THE COI FORM AND SEND BACK TO ME
TO CONFIRM NOTHING DISCUSSED
TODAY OPPOSED A CONFLICT FOR
YOU.
BEFORE I MOVE FORWARD ARE THERE
QUESTIONS ABOUT POTENTIAL
CONFLICTS OF INTEREST REGARDING
TODAY'S AGENDA?
HEARING NONE REMEMBER THE
MEETING IS BEING RECORDED AND
VIDEOCAST LIVE BY NIH.
I'LL TURN IT OVER THE
CHAIRPERSON OF THE 64th
DR. KAPOGIANNIS THE ACTING
DIRECTOR FOR AIDS AND THE ACTING
DIRECTOR OF AIDS RESEARCH.
DR. KAPOGIANNIS WILL NOW BRING
THE MEETING TO ORDER.
>> GOOD AFTERNOON EVERYONE.
THE 64th OFFICE OF AIDS MEETING
IS NOW IN SESSION.
WELCOME INVITED MEMBERS AND
COLLEAGUES WE'LL NOW CONDUCT A
ROLL CALL.
WHEN I CALL YOUR NAME, STATE
YOUR POSITION AND INSTITUTIONAL
AFFILIATION.
WE'LL START FIRST WITH THE OARAC
VOTING MEMBERS DR. COLLINS.
>> I'M PROFESSOR OF INTERNAL
MEDICINE IN AND INFECTIOUS
DISEASE AND APROFESSOR OF
IMMUNOLOGY AT THE UNIVERSITY OF
MICHIGAN AND ASSOCIATE DEAN OF
TRAINING IN THE DIRECTOR OF THE
MSTP.
MY RESEARCH FOCUSES ON HIV
DISEASE PATHOGENESIS.
>> THANK YOU.
DR. GALARAGA.
>> I'M A FACULTY MEMBER AT BROWN
UNIVERSITY SCHOOL OF PUBLIC
HEALTH AND ALSO SERVE AS THE
DIRECTOR OF THE HEALTH SERVICES
RESEARCH PROGRAM AND MY RESEARCH
IS ON ECONOMIC ASPECTS OF HIV
PREVENTION AND TREATMENT IN THE
U.S. AS WELL AS IN MEXICO, KENYA
AND SOUTH AFRICA.
THANK YOU.
>> DR. MEHTA.
>> MOVING ON DR. MILLER.
>> THIS IS VERONICA MILLER.
I AM IN FACULTY AT THE SCHOOL OF
PUBLIC HEATH FOR UNIVERSITY OF
CALIFORNIA BERKELEY AND ALSO THE
DIRECTOR OF THE FORUM FOR
COLLABORATIVE HIV RESEARCH.
>> I'M PROFESSOR OF IMMUNOLOGY
AT THE WORCESTER INSTITUTE AND
DIRECTOR OF SCIENTIFIC
INVESTIGATIONS AND CO-PRINCIPAL
INVESTIGATOR OF THE
COLLABORATIVE HIV.
>> DR. MONGAVI.
>> I'M A PROFESSOR AT THE
DEPARTMENT OF MICROBIOLOGY AND
IMMUNOLOGY AT NORTHWESTERN
UNIVERSITY.
I RESEARCH IN HIV SUB TYPES AND
RESULTING IN NEURODEGENERATION.
>> I'M IN A PHYSICIAN AT MASS
GENERAL HOSPITAL IN BOSTON AND
PROFESSION OF PEDIATRICS AND
PROFESSOR OF MEDICINE AT MASS
GENERAL HOSPITAL.
MY CLINICAL RESEARCH FOCUS IS ON
ADOLESCENCE AND YOUNG ADULTS
WITH HIV AND METHODS OF COST
EFFECTIVE ANALYSIS.
GREAT TO BE HERE TODAY.
>> I'M JOHN SLASMAN A PROFESSOR
AT DUKE UNIVERSITY AND WITH DUKE
UNIVERSITY HEALTH SYSTEMS AND
MEMBER OF THE LEADERSHIP GROUP
FINTAC AND LOOK AT CHILDREN AND
ADOLESCENTS WITH HIV.
>> I'M IVY TURNBULL FOR AIDS
ALLIANCE FOR INFANTS, CHILDREN,
YOUTH AND FAMILIES AND SERVE AS
THE CHAIR OF THE BOARD OF THE
NATIONAL BLACK WOMEN'S HIV AIDS
NETWORK.
>> THANK YOU.
NOW WE'LL MOVE TO OUR --
>> SORRY, I BELIEVE DR. MEHTA
JOINED US.
>> MY RESEARCH IS FOCUS ON
INTERVENTIONS TO IMPROVE UPTAKE
OF PREVENTION AND TREATMENT
INTERVENTIONS AMONG PEOPLE WHO
INJECT DRUGS.
>> THANK YOU.
NOW WE'LL MOVE TO OUR OARAC
EX-OFFICIO MEMBERS.
DR. VICKY DAVY.
>> MY POSITION IS WITH THE
OFFICE OF AND DEVELOPMENT AT
V.A.
THANK YOU.
REAR ADMIRAL JONATHAN MERMIN.
>> I REPRESENT CDC FOR VIRAL
HEPATITIS AND SEXUALLY
TRANSMITTED INFECTIONS AND IT'S
GREAT TO BE HERE.
>> NOW TO OUR ADVISORY COUNCIL
REPRESENTATIVES.
>> DR. DIEFENBACH WAS ABLE TO
JOIN US.
>> I'M THE DIRECTOR DIVISION OF
AIDS AT THE NATIONAL INSTITUTE
OF ALLERGY AND INFECTIOUS
DISEASES.
SORRY ABOUT THE CONFUSION.
I'LL BE IN AND OUT THE REST OF
THE AFTERNOON.
>> NO WORRIES, THANK YOU.
>> TO ADVISORY COUNCIL
REPRESENTATIVES.
DR. GANGNE.
DR. LIGHTFOOT.
>> I'M THE ASSOCIATE DEAN FOR
RESEARCH AND DOCTORAL PROGRAMS,
PROFESSOR IN THE OREGON HEALTH
UNIVERSITY AT PORTLAND STATE
UNIVERSITY SCHOOL OF PUBLIC
HEALTH AND ON THE MENTAL HEALTH
COUNCIL.
>> DR. OTT.
>> I'M DIRECTOR OF THE GLADSTONE
INSTITUTE OF VIROLOGY AND
PROFESSOR OF MEDICINE AT UCSF.
I CO-LEAD THE HOPE COLLABORATORY
AND MY RESEARCH IS ON HIV CURE.
GREAT TO BE HERE.
>> THANK YOU, TO OUR GUEST
SPEAKERS AND PANELISTS.
FIRST WE HAVE OUR REAR ADMIRAL
HOLTZ.
>> I'M THE DEPUTY DIRECTOR OF
THE OFFICE OF AIDS RESEARCH AND
EXECUTIVE SECRETARY OF OARAC.
>> THANK YOU.
CAPTAIN GLENSHAW.
>> IT'S WONDERFUL TO SEE YOU ALL
AGAIN AND LEAD THE SCIENCE TEAM
AT OAR AND EPIDEMIOLOGIST BY
TRAINING.
>> DR. ECLAND.
OKAY.
NOW TO DR. BARN.
DR. KENDALL BRYANT.
>> I'M CHRISTOPHER BARNHART AND
HEALTH SCIENCE POLICY ANALYST
WITH THE SEXUAL AND GENDER
MINORITY OFFICE WITHIN THE NIH
OFFICE THE DIRECTOR.
>> THANK YOU.
MS. CORETTE BYRD.
>> SHE'LL BE JOINING LATER.
>> DR. CHANDLER.
>> I'M THE DIRECTOR OF THE HIV
RESEARCH PROGRAM AND THE HEALING
COMMUNITY STUDY AT THE NATIONAL
INSTITUTES ON DRUG ABUSE.
>> THANK YOU.
>> MR. MALDONADO.
>> FOUNDER AND CEO OF TRUE
EVOLUTION A COMMUNITY-BASED
ORGANIZATION OUT OF CALIFORNIA
AND I'M A FORMER MEMBER OF THE
PRESIDENT'S ADVISORY COUNCIL ON
HIV AND AIDS IN THE OBAMA
ADMINISTRATION.
THANK YOU FOR HAVING ME.
>> THANK YOU FOR JOINING US.
>> DR. KNELTSON.
DR. ELISEO PEREZ-STABLE
>> GOOD AFTERNOON.
I'M ELISEO PEREZ-STABLE THE
DIRECTOR OF THE NATIONAL
INSTITUTE ON MINORITY HEALTH AND
HEALTH DESPAIRS AND GLAD TO BE
HERE.
>> THANK YOU.
DR. DIANNE RAUSCH.
>> I'M THE DIRECTOR OF THE
DIVISION OF AIDS RESEARCH AT THE
NATIONAL INSTITUTE OF MENTAL
HEALTH.
>> THANK YOU.
DR. WALTERS.
LASTLY OUR INVITED GUESTS
JOINING LATER DR. POWELL.
IS THERE ANYONE I DID NOT
ANNOUNCE?
OKAY.
THANK YOU, EVERYONE.
AS A REMINDER FOR OUR CHARTER
AND LEGISLATION THE OARAC
ADVISES THE OAR DIRECTOR ON
STRATEGIC PLANNING AND THE
REVIEWING OF THE AIDS PROGRAMS.
I'LL PROVIDE A BRIEF OVERVIEW OF
THE AGENDA INCLUDING A REPORT
FROM ME, A PRESENTATION FROM
DR. ELISEO PEREZ-STABLE AND
DR. NELSON FROM YALE AND GABRIEL
MALDONADO AND A PANEL DISCUSSION
ON MODELS IN HIV HEALTH
DISPARITY RESEARCH.
WE'LL HEAR UPDATES FROM NIH
COUNCILS AND FROM THE CLINICAL
GUIDELINES WORKING GROUPS.
THE AGENDA ALSO INCLUDES TIME
FOR REGISTERED PUBLIC COMMENTS.
ANYBODY LISTENING TODAY WHO
WISHES TO MAKE A PUBLIC COMMENT
SHOULD E-MAIL DR. HOLTZ.
AT OARAC INFO AT NIH.gov WITH
YOUR NAME, AFFILIATION AND
QUESTION OR COMMENT.
PLEASE VISIT THE OAR WEBSITE FOR
THE FEDERAL REGISTER NOTICE FOR
MORE DETAILS.
I'LL NOW PROVIDE THE DIRECTOR'S
REPORT.
IF SOMEONE CAN BRING UP THE
SLIDES.
WE HAVE ONE OF THE MOST PRESSING
CHALLENGES HEALTH DISPARITIES.
THE SCIENCE AROUND PREVENTING
AND TREATING HIV HAS COME A LONG
WAY IN THE LAST TWO DECADES.
ONE OF THE MOST SIGNIFICANT
ACCOMPLISHMENTS BUT NOT EVERYONE
IS BENEFITING TO THE DEGREE THEY
SHOULD BE.
WE'VE BEEN TALKING ABOUT HEALTH
DISPARITIES FOR A LONG TIME BUT
YET HERE WE ARE.
NOT HAVING A FULL IMPACT WE NEED
TO HAVE.
IT'S BECOMING INCREASINGLY CLEAR
THAT WE MUST ADDRESS BIOMEDICAL,
BEHAVIORAL AND SOCIAL SCIENCE
ASPECTS OF HEALTH DISPARITIES
SIMULTANEOUSLY IN BETTER AND
SMARTER WAYS THAN WE CURRENTLY
ARE.
I RECALL STARTING AS A FELLOW IN
INFECTIOUS DISEASE IN 2001 AND
PROSCRIBING ANTIRETROVIRAL
MEDICINE FOR MULTIPLE PILLS
MULTIPLE TIMES A DAY THAT WERE
TOXIC AND TODAY'S COMBINATIONS
HAVE FEWER SIDE EFFECTS AND
REVOLUTIONIZED HIV HEALTH CARE
BUT NOT FOR ALL.
THAT'S WHY WE'LL BE TACKLING
HEALTH DISPARITIES TODAY.
FEW PEOPLE HAVE HAD MORE
COMMITMENT THAT DR. WALLACE A
RECOGNIZED PUBLIC HEALTH AND
SOCIAL JUSTICE LEADER.
HE PASSED AWAY AUGUST 5 AND I'D
LIKE TO TAKE A MOMENT TO HONOR
HIS LEGACY.
HE WAS THE DIRECTOR OF EXTERNAL
DIRECTIONS FOR THE FRED HUTCH
INSON CANCER CENTERS TRIALS
NETWORK AND LAUNCHED THE
COMMUNITY ENGAGEMENT FOR THE
CFAR AT U-W FRED HUTCH AMONG
OTHER ACCOMPLISHMENTS.
DR. WALLACE WORKED TO INCREASE
POSITIVE HEALTH OUTCOMES AMONG
MEMBERS OF ETHIC AND SEXUAL AND
GENDER MINORITY GROUPS IN THE
UNITED STATES AND
INTERNATIONALLY.
WE HONOR HIS LIFE AS WE FOCUS ON
THOSE PERSISTENT CHALLENGE.
A BRIEF MOMENT OF SILENCE,
PLEASE.
LET'S GO TO OUR NEXT SLIDE AND
THE CHALLENGES STILL PERSIST.
IN 2021 ABOUT 70% OF NEW HIV
DIAGNOSES OCCURRED IN BLACK AND
HISPANIC POPULATIONS TOGETHER
REPRESENTING 31% OF THE
U.S. POPULATION.
THE CURRENT HIV EPIDEMIC
REFLECTS THE STAGGERING HEALTH
DISPARITIES AND THIS SLIDE IS AN
EXAMPLE OF THAT.
YOU CAN SEE IN THE TOP THREE
BARS, THE MAJORITY OF DIAGNOSES
OCCUR IN POPULATIONS OF MEN WHO
HAVE SEX WITH MEN.
BLACK AMERICAN SMM IS MOST
AFFECTED AND WITHIN THAT
POPULATION FROM 2019 INDICATE
YOUNG BLACK OR AFRICAN AMERICAN
SMM ARE THE MOST AFFECTED WITH
THREE OUT OF EVERY FOUR BEING
BETWEEN 13 TO 34 YEARS OLD.
ANOTHER EXAMPLE RELATED TO HIV
ARE PEOPLE WITH DISABILITIES.
THIS ALSO REPRESENTS AN
IMPORTANT ADVANCE IN THE HEALTH
DISPARITIES SPACE HERE.
IN SEPTEMBER, AFTER CAREFUL
CONSIDERATION OF A SERIES OF
REPORTS FROM THE ADVISORY
COUNCILS REVIEWING THE SCIENCE
AND EVIDENCE AND WITH INPUT FROM
THE DISABILITY COMMUNITY, NIH
ANNOUNCED PEOPLE WITH
DISABILITIES IS NOW AN
OFFICIALLY DESIGNATED POPULATION
EXPERIENCING HEALTH DISPARITIES
AND THIS HAS IMPLICATIONS FOR
NIH SUPPORTIVE RESEARCH.
DATA FROM THE REPORTS DEMMED
PEOPLE WITH DISABILITIES
REPRESENT MORE THAN 27% OF THE
U.S. ADULT POPULATION MAKING
THIS THE SINGLE LARGEST MINORITY
GROUP IN THE COUNTRY.
A RECENT LANCET PUBLICATION
REMINDS US THERE'S 1 BILLION WIN
DISABILITIES GLOBALLY AND AS
WITH OTHER FACTORS, THE
CO-OCCURRENCE OF DISABILITY AND
HIV COMPOUNDS HEALTH
DISPARITIES.
MODELS FROM TANZANIA AND SOUTH
AFRICA ESTIMATE THOSE DISABLED
ARE LESS LIKELY TO BE DIAGNOSED
OR RECEIVE ADEQUATE HIV CARE
COMPARED TO THE NON-DISABLED
COUNTERPARTS.
RECOGNIZING PEOPLE THE
POPULATION WITH HEALTH
DISPARITIES WILL HAVE IMPORTANT
IMPLICATIONS FOR ADDRESSING
THOSE NEEDS.
SO HEALTH OUTCOMES ARE
MULTI-FACTORIAL AND THIS IS A
SCHEMATIC I'LL WALK YOU THROUGH.
DESIRED LEVELS OF HEALTH DEPEND
ON A CONFLUENCE OF FACTORS.
DEVELOPING EFFECTIVE AND WELL
TOLERATED THERAPIES AND OTHER
TECHNOLOGY VITAL BUT NOT YET
SUFFICIENT.
WE ALSO KNOW INDIVIDUALS,
GROUPS, POPULATIONS AND
SOCIETIES LIVE AND FUNCTION
WITHIN CONTEXT SOCIAL,
STRUCTURAL AND BEHAVIORAL
REALITIES.
IT'S HARD TO ADDRESS THE FULL
SPECTRUM AND KEY FULCRUM POINTS
WITHIN THOSE REALITIES THAT ARE
SOME OF OUR KEY CHALLENGE.
I INVITE TO YOU TAKE A LOOK AT
THE GRAPHIC ON THE SCREEN BEFORE
WE WALK THROUGH IT IN GREATER
DETAIL.
IF THERE'S ONE THING YOU TAKE
WITH YOU TODAY ABOUT THE FEATURE
OF THE NIH HIV RESEARCH PROGRAM
MAKE IT THIS.
WE CONTINUE TO MAKE PROGRESS IN
ADDRESSING THE HIV PANDEMIC WE
MUST DESIGN STRATEGIES TO
ADDRESS THE MULTI-FACTORIAL
NATURE OF HEALTH OUTCOME AND TO
COUNTER ACT THE SIGNIFICANT
NUMBER OF DETRIMENTAL AND
INTERACTING FACTORS SUCH AS AND
WE'LL WALK THROUGH THE LAYERS IN
THE NEXT SLIDE.
SO MOST OFTEN EXPERIENCED BY
SOCIALLY DISADVANTAGED THE
BURDEN OF DISEASE, VIOLENCE, OR
OPPORTUNITIES TO ACHIEVE OPTIMAL
PUBLIC HEALTH AND LAYERED ON
THAT THE SOCIAL DETERMINATES OF
HEALTH ARE CONDITIONS IN THE
ENVIRONMENT WHERE PEOPLE ARE
BORN, LIVE, LEARN, WORK, PLAY,
WORSHIP AND AGE INCLUDING THE
WIDER SET OF SYSTEMS THAT AFFECT
HEALTH, FUNCTIONS AND QUALITY OF
LIFE OUTCOMES AND RISK AND THE
INTERSECTIONALITY.
THE RECOGNITION THAT THERE'S
OVERLAPPING FACTORS SUCH AS
RACE, ETHNICITY AND STRUCTURAL
RACISM WITH THAT AND INTEGRATION
STATUS AND EDUCATION, AGE,
SEXUAL ORIENTATION,
COMORBIDITIES, SUBSTANCE USE,
GEOGRAPHY AND EXPOSURE TO
EXTREME CLIMATIC EVENTS THAT
DISRUPT THE HIV CARE CONTINUUM.
WITH THAT, FOUR CONCEPTS OF
INTERSECTIONALITY INCLUDE SOCIAL
IDENTITIES AND INEQUALITIES,
INTERRELATED POWER DYNAMICS,
SOCIAL CONTEXT, RELATIONALITY
AND SOCIAL JUSTICE AND
COMPLEXITY 37 .
THE NEXT IS SYNDEMICS WHICH IS
IMPORTANT TO UNDERSTAND THIS IS
AN INTERACTING SYNERGY OF TWO OR
MORE DISEASE EPIDEMICS LEADING
TO EACH OTHER AND ACCESS BURDEN
OF DISEASE AND PERPETUATION OF
HEALTH DISPARITIES.
AND CULMINATE INTO ALL THE
FACTORS COMING TOGETHER THAT
INFLUENCE HEALTH OUTCOMES.
AND TODAY, WE WILL HEAR MORE ON
THIS FROM EXPERTS IN THE SPACE
AND REFLECT ON STRATEGIES TO
OVERCOME THE OBSTACLES STILL
STANDING IN THE WAY OF OUR
PROGRESS TO ENDING THE HIV
PANDEMIC.
FIRST I'LL INTRODUCE YOU TO SOME
OF THE WAYS THAT NIH RESEARCH IS
WORKING TO ADDRESS THE
CHALLENGES.
FIRST THROUGH THE NIH FUNDING
THE ENDING HIV EPIDEMIC IN THE
U.S. AND WHAT IS SHOWN ON THE
SLIDE IS ONLY A SMALL PROPORTION
OF THE NIH RESEARCH FOCUSES ON
POPULATIONS EXPERIENCING HEALTH
DISPARITIES.
IT'S AN IMPORTANT COMPONENT OF
THE DEPARTMENT OF HEALTH AND
HUMAN SERVICES EFFORTS TO REDUCE
THE NUMBER OF HIV INFECTIONS BY
SCALING UP PREVENTION AND
TREATMENT S IN KEY
JURISDICTIONS.
AND INCLUDES 48 COUNTIES,
WASHINGTON, D.C. AND SAN JUAN
PUERTO RICO AND STATES WHICH
HAVE A SUBSTANTIAL NUMBER OF HIV
NUMBERS IN RURAL AREAS.
NIH RECEIVES THE FUNDING TO
SUPPORT IMPLEMENTATION RESEARCH
IN THE JURISDICTIONS.
SO FAR NIH HAS AWARDED 201
PROJECTS IN 2019 TO 2022.
THIS SLIDE PROVIDES A VISUAL
OVERVIEW OF THE DISTRIBUTION OF
THOSE PROJECTS THAT INCLUDE
PRIORITY POPULATIONS WE SEE
THERE AND THE PROJECTS OF COURSE
DO INCLUDE MORE THAN ONE
PRIORITY POPULATION IN MOST OF
THEM.
SO I WILL ALSO NOTE THIS IS NOT
COINCIDENTAL THE BOXES ON THE
SLIDE RECEIVE MORE ATTENTION.
THIS IS AN EXAMPLE IN THIS
PORTFOLIO OF THE HIV RESEARCH
WHERE THE NIH INVESTMENT FOLLOWS
THE BURDEN OF DISEASE.
MORE EVERIN 2023, NIH SOLICITED
AND FUNDING SCIENCE PROJECTS IN
FOUR AREAS.
SYNDEMIC APPROACHES, LEVERAGING
PHARMACIES, LINKAGE TO CARE AND
CLUSTER DETECTION RESPONSE
TOTALLING ABOUT $25 MILLION IN
INVESTMENT.
AGAIN, THERE WAS AN INTENTIONAL
PRIORITIZATION OF MORE
INVESTMENT IN SYNDEMIC
APPROACHES.
BECAUSE AS I SHOWED WITH THE VEN
DIAGRAM, SYNDEMIC INTERACTIONS
CAN NEGATIVELY AFFECT OUTCOME
ACROSS THE HIV PREVENTION AND
CARE CONTINUUM.
IN ANOTHER EFFORT OAR HAS
ADDRESSED THE CHALLENGES OF
ENDING THE HIV PANDEMIC THROUGH
OUR NIH-WIDE MULTI-DISCIPLINARY
SIGNATURE PROGRAMS.
OUR LAST OARAC MEETING FEATURED
WOMEN'S SIGNATURE PROGRAM.
WE REMAIN CALLING FOR TECHNOLOGY
FOR RESEARCH TO SOMETHING WE
HOPE IS MORE DESCRIPTIVE AND
ACCURATE AS THE ADVANCING
TECHNOLOGIES TO IMPROVE HIV
DIAGNOSIS AND CARE IN THE
SIGNATURE PROGRAM.
FINALLY, RELATED TO THIS ON
NOVEMBER 1 AND 2, OAR AND THE
EXECUTIVE COMMITTEE WILL HOST
THE FIRST COMMUNITY-ORIENTED
WORKSHOP ON HIV DIAGNOSTICS AND
TECHNOLOGIES ENTITLED COMMUNITY
VOICES FORGING THE PATH FORWARD
FOR HIV SELF-TESTING AND
PERSONALIZED VIRAL LOAD
MONITORING.
THIS WILL BE A VISUAL WORKSHOP
AND ADDITIONAL INFORMATION IS
AVAILABLE ON THE WEBSITE.
SO, SEVERAL RECENT SUPPORTED
EVENTS ARE HELPING ADVANCE
APPROACHES TO IMPROVE CARE AND
REDUCE HEALTH DISPARITIES.
THE FIRST I'LL MENTION IS THE
PHARMACY CENTER HIV RESEARCH
INITIATIVE.
PHARMACIES PRESENT THE
GAME-CHANGING OPPORTUNITY TO
DECENTRALIZE CARE AND MAKE IT
MORE SAYS -- ACCESSIBLE AND THEY
OFFER MORE CONVENIENT ACCESS
THROUGH LONGER HOURS AND MORE
LOCATIONS.
WE KNOW THAT ONE OF THE
CHALLENGES IN IMPROVING HEALTH
OUTCOMES IS PEOPLE CAN'T ALWAYS
GET TO THE DOCTOR OR ACCESS THE
RIGHT SERVICES ONCE THEY ARE
THERE.
WE NEED SCENES OPTIONS AS
POSSIBLE TO INCREASE ACCESS TO
CARE AND EXPANDING OUR APPROACH
BRINGING PREVENTION AND
TREATMENT SERVICES INTO
PHARMACIES ENABLES US TO DO
THAT.
IN JUNE, NIH OFFICE OF AIDS
RESEARCH AND NATIONAL INSTITUTE
OF MENTAL HEALTH WITH OTHER
INSTITUTES CENTERS AND OFFICES
HELD A MEETING WITH SEVERAL
OTHER ATTENDEES AND SPEAKERS TO
DISCUSS PHARMACY DISCHARGE.
FULL INFORMATION IS AVAILABLE ON
THE OAR WEBSITE.
EXPERTS FROM MANY SECTOR HIGHLY
MOTIVATED TO ADVANCE THIS
CONCEPT.
I WILL NOT HIGHLIGHT ANOTHER
IMPORTANT EVENT THE OAR HELD IN
PARTNERSHIP WITH OTHER NIH
INSTITUTES AS THE CDC AND HRSA.
IN EARLY SEPTEMBER, OARAC LED
THE AGING WORKSHOP WITH HIV AND
AIDS AND THEN HELD A PANEL
DISCUSSION INCLUDING COMMUNITY.
AN IMPORTANT TAKE HOME MESSAGE
WAS THAT AGING WITH HIV NOT JUST
ABOUT OLDER ADULTS BUT ABOUT
LIVING AND HAVING CUMULATIVE
EXPOSURE TO THE VIRUS AS WE
HEARD FROM THE COMMUNITY AT
USCHA AND WORTH NOTING ARE THE
CHILDREN BORN WITH HIV AND LIVE
LONG TERM WITH THE VIRUS AND ONE
OF MY ADOLESCENT PATIENT
ACQUIRED HIV PERINATALLY AND
STILL TALK TO HIM AND ASKS THE
QUESTIONS ABOUT THE SIDE EFFECTS
OF THE DRUGS AND WHAT I HAVE TO
DEAL WITH.
AND FROM AN ALL-INCLUSIVE
PERSPECTIVE WE CAN REFER TO THIS
PROGRAM AS NIH AND AGING ACROSS
THE LIFE SPAN.
THE NEXT EVENT TOOK PLACE IN
CONJUNCTION WITH THE OFFICE OF
RESEARCH ON WOMEN'S HEALTH
CO-HOSTED A WOMEN'S WORKSHOP
THAT EXPLORED THE WAYS TO LOOK
AT PRIORITIES AT THE
INTERSECTION OF HIV IN WOMEN'S
HEALTH AND GATHER INPUT FROM THE
COMMUNITY.
PRESENTATIONS WERE FOLLOWED BY A
LIVELY AND INTERACTIVE LISTENING
SESSION.
THEY REITERATED HIV IS NOT THE
DEFINING FEATURE BUT CALLED FOR
MORE MEANINGFUL ENGAGEMENT
WITH THAT CENTER ON THE
COMPLEXITY OF BLACK WOMEN'S
EXPERIENCE.
THE RESEARCH IS CRITICAL TO
REMEMBER BASIC DISCOVERIES ARE
STILL PROGRESSING.
THERE WAS THE FIRST INNOVATION
AND RESEARCH SYMPOSIUM AS PART
OF THE FESTIVAL HELD ON CAMPUS.
WE HOPE IT MAKE IT AN ANNUAL
EVENT AND SUPPORTED BY THE
INNOVATION FUND.
THE PROGRAM PROVIDES ONE-YEAR
FUNDING FOR MERITORIOUS PROJECT
USE INNOVATIVE APPROACHES TO
ADDRESS HIGH PRIORITIES IN HIV
RESEARCH THERE WAS A BROAD RANGE
OF TOPICS INCLUDING THOSE
HIGHLIGHTED ON THE SCREEN FOR
YOU TO READ.
CHANGING GEARS TO SIGNIFICANT
UPCOMING HIV RELATED EVENTS.
THIS IS THE LAST OARAC MEETING
BEFORE WORLD AIDS DAY DECEMBER
1.
THIS MARKS THE 35th ANNIVERSARY
OF THAT DAY AND THE CREATION OF
THE OFFICE OAR.
IT WILL ALIGN WITH THE
U.S. GOVERNMENT'S THEME OF
REMEMBER AND COMMITTEE AND THE
WILL RELEASE THE ACTION REPORT
ON THAT DAY.
THE UPDATE WILL HIGHLIGHT
PROGRESS MADE FOR ADVANCING THE
NATIONAL STRATEGY RELEASED IN
2021.
STAY TUNED TO OUR WEBSITE FOR
MORE DETAILS.
I ALSO WANTED TO REMEMBER
COUNCIL MEMBERS THE NEXT MEETING
IS THURSDAY FEBRUARY 22 OF 2024
AND IT WILL BE A VIRTUAL EVENT.
THANK YOU FOR MAKING THESE
MEETINGS A PRIORITY IN YOUR VERY
BUSY SCHEDULES.
I'LL SHARE A FEW IMPORTANT
ADMINISTRATIVE UPDATES.
SEPTEMBER 1, OAR TRANSITIONED
THE FEDERAL OFFICER TO ADMIRAL
HOLTZ THE DEPUTY DIRECTOR.
THIS TRANSITION ALIGNS WITH THE
LEADERSHIP STRUCTURE AND
STANDARD NIH PRACTICES AND
ENABLED CAPTAIN GLENSHAH TO
FOCUS ON THE STRATEGIC PLAN.
THANK YOU FOR YOUR EXCELLENT
WORK OVER THE PAST FOUR YEARS
AND WELCOME TO YOUR FIRST
MEETING IN THE NEW ROLE.
ADDITIONAL TRANSITIONS I'D LIKE
TO NOTE FOR THE COUNCIL, FIRST
THE CHANGE IN THE NATIONAL
CANCER ADVISORY BOARD
REPRESENTATIVE TO OARAC.
WE THANK DR. FRANCIS OSMOND FOR
HIS SERVICE AND WARMLY WELCOME
DR. TRIESE AND WE THANK YOU
THOSE FOR THEIR TIME AND
COMMITMENT TO OARAC
AND I'D LIKE TO EXPRESS MY
GRATITUDE TO DIRECTORS, COLLINS,
MILLER, RIVERA AND SLICEMAN FOR
RENEWING THEIR TERMS.
AND THERE'S UPDATES REGARDING
THE NIH.
FIRST SIGNIFICANT FOR THE HIV
RESEARCH PROGRAM A NEW DIRECTOR
FOR OAR'S LARGEST PARTNER NIAID
AND SHE COMES TO US FROM THE
UNIVERSITY OF ALABAMA BIRMINGHAM
AND HAS BEEN AN ADVOCATE FOR
MINORITIZED POPULATIONS AFFECT
AED BY HIV AND STDs AND IS A
CHAMPION IN THIS ARENA.
SHE BRINGS A WEALTH OF
LEADERSHIP EXPERIENCE FROM
LEADING INTERNATIONAL CLINICAL
TRIAL AND TRANSLATIONAL
RESEARCH.
WE AT OAR LOOK FORWARD TO WORK
WITH HER AND LOOK FORWARD TO
ENDING THE HIV PANDEMIC.
THERE'S NUMEROUS LEADERSHIP
UPDATES WITHIN THE OFFICE OF THE
DIRECTOR'S VISION OF PROGRAM
COORDINATION, PLANNING AND
STRATEGIC INITIATIVES.
THIS IS THE DIVISION IN WHICH
OAR ALSO SITS.
JUST THIS MORNING DR. SCHWETZ
WAS NAME AS THE NIH DEPUTY
DIRECTOR FOR PROGRAM
COORDINATION, PLANNING AND
STRATEGIC INITIATIVES AND
DIRECTOR.
SHE HAS BEEN SERVING AS THE
ACTING PRINCIPLE DEPUTY DIRECTOR
SINCE SEPTEMBER OF 2021 AND
REMAIN IN THAT POSITION UNTIL
NEW NIH DIRECTOR IS CONFIRMED BY
THE SENATE AND A TRANSITION
OCCURS.
DR. ICINGER WILL CONTINUE AS THE
DIRECTOR UNTIL THAT TIME.
AND THERE'S A FEW ADDITIONAL
UPDATES.
DR. WALTERS IS THE NEW DIRECTOR
OF THE NIH TRIBAL HEALTH
RESEARCH OFFICE AND A MEMBER OF
OUR PANEL TODAY.
WE LOOK FORWARD TO HEARING FROM.
AND THEN DR. JANE SIMONI THE
DIRECTOR OF THE OFFICE OF
BEHAVIORAL AND SCIENCE RESEARCH
AND DR. BREMER IS THE NEW
DIRECTOR OF THE OFFICE OF
NUTRITION RESEARCH.
FINALLY, THE SEARCH FOR THE NEXT
PERMANENT OAR DIRECTOR IS
ONGOING.
I'D LIKE TO TAKE A FEW MINUTES
TO TALK ABOUT HOW WE'LL SHAPE
THE FUTURE OF THE NIH RESEARCH
PROGRAM TO ENHANCE HOW WE WILL
ADDRESS THE MULTI-FACETED
COMPLEX CHALLENGES.
OAR WILL COORDINATE THE
STRATEGIC PLAN FOR HIV RESEARCH.
WE'RE TAKING PRELIMINARY STEPS
TO PREPARE FOR THE UPDATE.
WE PLAN TO VET IDEAS THROUGH
INTERNAL CHANNELS WITH THE HIV
AIDS COMMITTEE AND ALL OFFICES
AND CENTER WITH FUNDING.
WE PLAN TO LAUNCH AN OARAC
WORKING GROUP TO INCORPORATE
INPUT.
WE ANTICIPATE A MORE IN DEPTH
PRESENTATION ON THE TOPIC THE
FIRST OARAC MEETING IN 2024.
LET ME SHOW YOU HERE THE
REMAINDER OF OUR MEETING TODAY
THE SCHEDULE AND I'LL GIVE YOU A
MOMENT TO READ THROUGH THIS.
SHORTLY WELL HEAR MUCH MORE
ABOUT HEALTH DISPARITIES IN THE
CONTEXT OF HIV FROM A SERIES OF
EXPERTS AS I MENTIONED BEFORE.
FOLLOWED BY EYE LIVELY
DISCUSSION AND REPRESENTATIVES
FROM NIH INSTITUTES, CENTER AND
OFFICES AND OAR.
BEFORE I TAKE SOME OF YOUR
QUESTIONS TODAY, I WANT TO COME
BACK TO THIS IMPORTANT POINT.
TODAY AS NEVER BEFORE WE
RECOGNIZE THE CHALLENGES OPPOSED
BY HEALTH DISPARITIES, SOCIAL
DETERMINATE NATES OF HEALTH AND
THIS IS A RECOMMITMENT TO WORK
TOGETHER IN THE LAYERS OF THIS
CHALLENGE.
I TRUST TOGETHER WE'LL GET
THROUGH TO THE FINISH LINE.
THANK YOU AND I WILL NOW OPEN
THE FLOOR TO QUESTIONS.
>> THANK YOU.
WE HAVE TWO MINUTES FOR COMMENTS
AND QUESTIONS.
RAISE YOUR HAND ON ZOOM IF YOU
HAVE A QUESTION.
>> THANK YOU AND GRAN
CONGRATULATIONS AND GO BACK TO
HEALTH DISPARITY RESEARCH.
A WHILE BACK IT WAS A WHILE BACK
THE FORUM AND THE SUCCESS WAS
THAT THE CLINICAL RESEARCH HIV
FUNDING STREAM FUNDED ALL THREE
CALIFORNIA CFARs TO CONTINUE AND
LOOK AT HEALTH DISPARITIES
RESEARCH IN THE IN THE OWN
BACKWARD AND I KNOW WHAT YOU'RE
TALKING ABOUT BUT IF THE C FARs
ARE CONTINUING WITH THE EFFORT
ON HEALTH DISPARITIES RESEARCH
IN THE COMMUNITY BECAUSE A LOT
OF THE RESEARCH HAS TO BE REALLY
SPECIFIC TO THE LOCAL
COMMUNITIES OTHERWISE YOU JUST
COME UP WITH VERY GENERALIZED
MESSAGES ABOUT HEALTH
DISPARITIES AND HOW THEY'RE BAD
AND NEED TO BE OVERCOME.
>> THEY'VE CONTINUED TO DO THE
WORK.
WE'RE WORKING TOGETHER TO COME
UP WITH NEW FOAs AND WE EXPANDED
TO INCLUDE OTHER INSTITUTES.
WE HIGHLIGHTED THE WORK BEING
DONE UNDER THE EHE RUBRIC IS
CONTINUING AND ONGOING.
AND WE'RE IN THE PROCESS OF
DEVELOPING 2026 INITIATIVES.
SO YOU'LL SEE A LOT OF THOSE
COMING UP WITH ONGOING EFFORTS.
>> THANK YOU.
>> THANK YOU, I THINK WE'LL HEAR
MORE ABOUT THIS IN THE PANEL
DISCUSSION.
DR. MONTNERA.
I BELIEVE YOU'RE ON MUTE.
>> THANK YOU, WITH PREP UPDATES
AND THE DYNAMIC OF PREVENTION
AND WITHIN THE POPULATION ARE
DISTINCT AND THOUGH THE LESSON
HIGHLIGHTED I WAS WONDERING
WHERE THE AGING POPULATION WAS
INTERSECTING WITH THESE PROJECTS
IF IT'S A PARTICULAR EMPHASIS
AREA.
>> I'M NOT AWARE THERE'S
ANYTHING AGING AND OLD OR ADULTS
IN THE PROJECT AND WHETHER
THEY'RE CALLED OUT I MIGHT HAVE
TO REFER BACK TO DR. CARL OR
DIEFENBACH ABOUT THIS.
>> WHILE THEY'RE NOT ALWAYS
CALLED OUT SPECIFICALLY IT
INCLUDED WHEN WE WRITE THE
INITIATIVES AND THE AGING
POPULATION HAS ALWAYS BEEN A
TARGET AND CONTINUES TO BE.
THERE ARE A LOT OF EFFORTS BEING
DEVELOPED RIGHT NOW ABOUT THE
AGING POPULATION AND THE EHE
INCLUDES IT.
I DON'T THINK THERE WAS A
SPECIFIC CALL UP LIKE BILL SAID
BUT IT'S DEFINITELY EMBEDDED IN
THERE.
>> AND PRIORITY OF MINE EFFORTS
TO TRY TO BRING FOCUS INTO THE
HIV AND AGING SPACE AND TRYING
TO FIGURE OUT WHAT OTHERS MIGHT
BE ABLE TO DO IN ADDITION TO
SOME WE HAVE ALREADY IMPLEMENTED
IN THE FIELD WITH ADMINISTRATIVE
SUPPLEMENTS AND COLLABORATIONS
WITH OTHER INSTITUTES LIKE NIA
AND OTHERS.
THOSE ARE ADDITIONAL WAYS TO
ADDRESS THIS AND I THINK LOOKING
FORWARD TO MORE SOON.
JOHN, I THINK YOU HAVE A
QUESTION.
>> THAT WAS A GREAT
PRESENTATION.
AS YOU KNOW, IMPACT IS MEETING
THIS WEEK AND THE ISSUES OF
HEALTH CARE DISPARITIES,
IMPLEMENTATION SCIENCES AND ARE
WE BRINGING INITIATIVES ON
BOARD?
>> AS I ARTICULATED, I THINK WE
FULLY INTEND TO ENGAGE WITH ALL
SECTORS OF THIS EFFORT AND THE
STRATEGIC PLANNING AND LOOKING
AT THE PRIORITIES.
AND THAT INCLUDES OBVIOUSLY THE
INTERNAL WORK HERE THAT WE HAVE
TO DO WITHIN ALL THE COLLEAGUES
AND PARTNERS ACROSS NIH AND IT
WILL INCLUDE THE COMMUNITY AND
THE FULL SWATH OF ACADEMICIANS
AND A CHANCE TO LOOK AT ALL
THESE THINGS THAT GO TO THAT
VERSION OF THE STRATEGIC PLAN.
AGAIN, MORE TO COME AS THAT GETS
FLUSHED OUT BY THE NEXT OARAC
MEETING YOU'LL HAVE A MUCH MORE
THOROUGH PRESENTATION.
SHORT ANSWER, YES.
>> WOULD YOU LIKE TO INTRODUCE
ELISEO PEREZ-STABLE.
>> THANK YOU.
SO WE'LL NOW SWITCH GEARS AND GO
INTO OUR NEXT PRESENTER,
DR. ELISEO PEREZ-STABLE DIRECTOR
OF THE NATIONAL INSTITUTE ON
HEALTH AND HEALTH DISPARITY AND
OVERSEES THE BUDGET TO ADVANCE
THE BUDGET OF MINORITY HEALTH
AND HEALTH DISPARITIES RESEARCH.
SINCE JOINING NIMHD HAS BEEN ON
THE CUTTING EDGE AND ENDING THE
HIV EPIDEMIC STARTS WITH
ADDRESSING THE HEALTH
DISPARITIES.
BEGIN WHEN YOU'RE READY.
>> THANK YOU VERY MUCH.
THANK YOU, BILL AND TIM FOR ALL
THE EFFORTS YOU ARE DOING.
I WANT TO START BY SHARING THAT
MY BACKGROUND AS A GENERAL
INTERNIST AND WAS IN SAN
FRANCISCO IN JUNE OF 1979 WHEN
THE FIRST PATIENT WITH
INTERSTITIAL LUNG DISEASE WAS
ADMITTED TO THE ICU AND OVER THE
OF THAT DECADE THAT FOLLOWED AS
A PRIMARY CARE GENERAL INTERNIST
I SAW A LOT OF PATIENTS WITH
HIV-AIDS WHO PROGRESSED AND DIED
WITH MULTIPLE COMPLICATIONS.
SO OBSERVING FROM A LITTLE BIT
MORE DISTANCE THE EVOLUTION OF
HOW WE ARE NOW IN 2023 AT WITH
THE EPIDEMIC WITH TOOLS THAT CAN
LEAD TO A NORMAL LIFE EXPECTANCY
FOR SOMEONE INFECTED AT AGE 25
IS REALLY AMAZING.
AND OUR COMMITMENT AT NIMHD FOR
ADDRESSING THE HIV IN GENERAL
AND PARTICULARLY IN THE HEALTH
DISPARITIES AREA IS REALLY A
VERY IMPORTANT PART OF OUR
MISSION.
I'LL START WITH A BIG PICTURE
THAT YOU ALL HEARD ALREADY WHO.
WE HAVE THE TOOLS.
WE HAVE PREP.
WE HAVE EFFECTIVE MEDICINES.
WE HAVE EASY DIAGNOSIS TO DO
EARLY WITH HOME TESTING AND
TREATING.
YET 20% OF NEW INFECTIONS OCCUR
IN PEOPLE WHO ARE ALREADY
TREATED AND NOT SUPPRESSED SO
THAT'S CLEARLY AN AREA WE CAN DO
BETTER.
AND 63% OF PERSONS WITH HIV SHOW
VIRAL SUPPRESSION BUT AMONG
BLACK AND LATINO INDIVIDUALS
YOUNGER IT'S 50% YES.
THE MULTI-LEVEL APPROACHES ARE
REALLY NECESSARY IN A FOCUSSED
WAY.
SO IT IS A PRIORITY TO END HIV
EPIDEMIC.
IT HAS TO START WITH DISPARITIES
AS BILL OUTLINED IN TERMS OF
WHERE THE INFECTIONS ARE.
I DON'T HAVE A SLIDE TO FOCUS ON
THE GEOGRAPHY BUT IT CLEARLY
ALSO IS IN CERTAIN PARTS OF THE
COUNTRY THAT DO MUCH WORSE WITH
KNEW INFECTIONS THAN OTHERS.
A
AND SET SOME STANDARDS YEARS AGO
AND IS AN ABSOLUTE REQUIREMENT
TO DO GOOD SCIENCE AND ADDRESS
ENDING THE HIV EPIDEMIC.
WE NEED TO IMPLEMENT WHAT WE
KNOW.
WE SHOULD GET WELL OVER 80% OF
INDIVIDUALS WHO ARE INFECTED
WITH HIV SHOULD BE SUPPRESSED.
THERE ARE MODELS AT WORK.
AND DISSEMINATING THE MODELS
SEEING WHAT ARE TE BARRIERS FOR
NON-PARLI
NO
NON-IMPLEMENTING THEM IS WHERE
THE SCIENCE OF ENDING THE HIV
EPIDEMIC ON THE IMPLEMENTATION
SIDE SHOULD BE.
WE SHOULD BE MORE OF AN ENGINE
FOR INCREASING THE SCIENTIFIC
AND CLINICAL WORKFORCE AND OUR
CLINICAL WORKFORCE DIDN'T
REFLECT THOSE OBTAINING HIV AND
NEED TO DIVERSIFY THE WORKFORCE.
I HAVE THE AUTHORITY ACCORDING
TO CONGRESSIONAL STATUTE AND THE
FIRST THREE BULLETS WERE
INCLUDED IN THE ORIGINAL
LEGISLATION IN 2000.
IN 2016 WE DECLARED SEXUAL ACOR
GENDER MINORITIES OR LGBTQ AS A
POPULATION WITH HEALTH
DISPATRIOTS AND WE DECLARED
PERSONS WITH DISABILITIES TO BE
IN THE CATEGORY.
A UNIFYING CHARACTERISTIC IS THE
SOCIAL DISADVANTAGE THAT RESULTS
IN PART BEING SUBJECT TO
DISCRIMINATION OR RACISM.
AND FROM BEING UNDER SERVED IN
HEALTH CARE.
SOCIAL CLASS ARE FACTOR
INFLUENCE FACT.
THEY PREDICT SO MUCH THAT WE
DON'T FULLY UNDERSTAND THAT OUR
POSITION IS IT SHOULD ALWAYS BE
MEASURED IN STANDARDIZED WAYS
AND CONSIDER NOT NECESSARILY AS
CAUSAL BUT CONSIDERED IN THE
CAUSAL PATHWAY IN ANY HEALTH
OUTCOME IN HUMANS.
EXAMPLES INCLUDE RACE AND
ETHNICITY PREDICT LIFE
EXPECTANCY NOT FULLY EXPLAINED.
ASTHMA DISPROPORTIONATELY
AFFECTS AFRICAN AMERICANS AND
PUERTO RICANS FOR EXAMPLE AND
NOT MEXICANS FOR EXAMPLE AND
MOST COMMON IN THE POOR AND FOR
EXAMPLE, MODERATE OR SEVERE
OBESITY AND IT'S NOT BECAUSE OF
POOR BEHAVIOR IT RELATE TO
STRUCTURAL FACTORS AND A
COMPLEXITY OF OTHER THINGS AND
AMONG PERSONS WITH DIABETES WE
OBSERVE ALL MINORITIZED
POPULATIONS 30% LESS AND TWICE
AS MANY RENAL DISEASE COMPARED
TO WHITE COUNTERPARTS ACCORDING
TO THE DIABETES REGISTRY OF
NORTHERN CAROLINA KAISER.
SAME DISEASE AND HEALTH SYSTEM
AND THE CRUDE FACTOR WE CALL
RACE AND ETHNICITY PREDICTS
DIFFERENCES IN OUTCOMES WE CARE
ABOUT AND CAN CAUSE MAJOR
MORBIDITY AND MORTALITY.
THIS IS AN EXAMPLE OF DATA FROM
A DECADE AGO SHOWING A GRADIENT
OF SOCIO ECONOMIC STATUS WITH
MORTAL
MORTALITY.
IF YOU'RE POOR, $25,000 IS THE
LEVEL OF INCOME FOR A FAMILY OF
FOUR TWICE AS MUCH LIKELY TO DIE
AND YET HOW OFTEN DO OUR
CLINICIANS OR OUR SCIENTISTS
KNOW THE SOCIO ECONOMIC STATUS
OR SOCIAL CLASS OF THEIR
PARTICIPANTS?
THIS IS THE KIND OF RELATIONSHIP
THAT IS ALMOST AS ROBUST AS ONE
WOULD SEE WITH SMOKING
INTENSITY, CIGARETTE SMOKING
INTENSITY, SYSTOLIC BLOOD
PRESSURE OR BMI.
AND EARLIER THIS YEAR, IN A
CONTRACT FROM NIMHD A GROUP OF
HEALTH ECONOMISTS WE DID WITH
ANALYSIS OF 10 YEARS AGO THAT IN
A GIVEN YEAR AN EXAMPLE OF 2018,
RACIAL AND ETHNIC DISPARITIES
ACCOUNTED FOR $450 BILLION IN
EXCESS COSTS TO THE UNITED
STATES.
AND IN THROUGH EDUCATIONAL
ATT
ATTAINMENT AND A COLLEGE DEGREE
IS A DIVIDING LINE IN HEALTH
OUTCOMES IN THE U.S. POPULATION.
AND COSTS A TRILLION DOLLARS.
THIS IS ON AN ANNUAL BASIS.
$451 BILLION IS ALMOST TEN TIMES
THE NIH BUDGET AND YET WE
CONTINUE TO TOLERATE AND LIVE
WITH THESE DISPARITIES.
SO NIMHD HAS FOCUSSED ON RACE
AND ETHNICITY AND SOCIO ECONOMIC
STATUS AS THE FUNDAMENTAL
PILLARS OF HEALTH DISPARITY
SCIENCE AND WE ARE REITERATING
OUR PRIORITY IN THIS CASE.
REMEMBER THAT POPULATIONS LIVING
WITH HEALTH DISPARITIES IS
DECLARATION AND DESIGNATION WE
MAKE FOR THE ENTIRE AGENCY.
THIS IS NOT TO SAY NIMHD IS
GOING TO TAKE CARE OF IT.
WE REALLY CAN'T.
WE ACCOUNT FOR MAYBE 15% OF
DISPARITIES BUDGET OF THE AGENCY
AND SO REALLY DEPENDENT ON OUR
SISTER INSTITUTES ESPECIALLY THE
LARGE ONES TO MAKE THIS A
PRIORITY.
WE HAVEN'T REALLY MADE
SUFFICIENT PROGRESS IN RACIAL
AND ETHNIC DISPARITIES FOR
IMPORTANT SOCIAL CLASS TO SAY WE
CAN MOVE ON TO ANOTHER TOPIC OR
MAKE THESE ALL SIMILAR
PRIORITIES.
THIS IS OUR PRIORITY.
AND THIS IS OUR PRIORITY AND
INTERSECTIONALITY IS A CRITICAL
CONCEPT AS YOU SAW BILL OUTLINE.
RACE, ETHNICITY AND SOCIAL CLASS
INTERACT AND RURAL POPULATIONS
AND PEOPLE WHO IDENTIFY AS
SEXUAL AND GENDER MINORITIES.
PEOPLE LIVING WITH DISABILITIES
AND CLINICAL CONDITION OR OTHER
DEMOGRAPHIC FACTORS SUCH AS AGE
OR LANGUAGE.
AND WE SEE DISPARITY INS PORTALS
AND ONE WOULD EXPECT THE
WEALTHIEST SEGMENT OF RACE AND
ETHNIC POPULATION TO HAVE THE
BEST OUTCOMES WHICH ISN'T ALWAYS
THE CASE.
WHITE AMERICANS CONTINUE TO BE
THE MAJORITY ABOUT 60% IN THE
2020 CENSUS.
AND INSTEAD TRY TO MOVE THE
FIELD TOWARDS CREATING
ASPIRATIONAL GOALS BASED ON
NATIONAL METRICS WHERE WE CAN
COMPARE ANY POPULATION.
SOME IS SUMMARIZED IN OUR
WEBSITE ON THE LINK THERE.
WE'VE ALSO FOCUSSED IN THE LAST
FIVE YEARS OR SO ON STANDARDIZED
MEASUREMENTS PARTICULARLY AROUND
SOCIAL DETERMINATES OF HEALTH.
MANY ARE PROBABLY FAMILIAR WITH
THE PHOENIX TOOLKIT INITIALLY
STARTED WE THE NATIONAL HUMAN
GENOME INSTITUTE AND FOLLOWED
THEIR METHODOLOGY AND THIS
REQUIRES WHAT WE PROPOSE
CERTAINLY CONSTRUCTS AND
CONCEPTS TO BE CONSIDERED.
AN EXPERT COMMITTEE IS NAMED AND
THEY TAKE ABOUT A YEAR OR SO AND
I'LL SAY YES THESE MEASURES ARE
VETTED BY THE LITERATURE.
WE DON'T INVENT MEASURES OR
CREATE MEASURES BUT VET WHAT HAS
BEEN PUBLISHED AND LOOK AT
POPULATION-BASED SAMPLES.
IN DECEMBER OF LAST YEAR WE HAD
TOOLS ADDED TO OUR TOOLKIT THE
LINK ON THE SLIDE HOPEFULLY
AVAILABLE TO YOU.
THE COLLECTIONS WILL REFER OUR
APPLICANTS TO OUR INSTITUTE FOR
GRANTS TO THE WEBSITE TO
CONSIDER.
WE'RE NOW REVIEWING AND TRYING
TO MAKE SURE THAT THE ONES WE
HAVE FOR INDIVIDUAL SOCIAL
DETERMINATES ARE DEMOGRAPHICS
ARE ONES WE ARE CONTINUING TO
SUPPORT AND AS YOU MAY HAVE
HEARD, THE OFFICE OF MANAGEMENT,
BUDGET, CENSUS CATEGORIES ARE
UNDER REVIEW AND WILL LIKELY BE
CHANGED IN MID 2024.
IT HAS CLEARED THROUGH HHS IS IT
IS NOW IN ITS FINAL PHASE OF
CLEARANCE IN THE EXECUTIVE
BRANCH.
HIV AND HEALTH DISPARITIES, TO
RETURN TO THIS AND HOUSING
INSTABILITY INTERSECT
SIGNIFICANTLY.
BLACKS OR AFRICAN AMERICANS MAKE
UP 40% OF AMERICANS FACING
HOMELESSNESS AND NEW HIV
DIAGNOSES AND WITH LATINOS YOU
SEE A SIMILAR CHALLENGE, 22%
EXPERIENCE HOMELESSNESS OF
PERSONS EXPERIENCING
HOMELESSNESS AND 27% OF NEW HIV
DIAGNOSES.
YOUTH AND YOUNG ADULTS THAT
CONTINUE INTO THE EARLY 20s WHO
EXPERIENCE HOMELESSNESS ARE
LIKELY TO BE INFECTED WITH DRUG
USE OR SEX WORK AND OVER
REPRESENTED IN THE HOMELESS
POPULATION.
IN SOME WORK FUNDED THROUGH
NIMHD IN A K AWARD THE
RELATIONSHIP BETWEEN HOUSING
CHARACTERISTICS AND OUTCOMES IN
WOMEN LIVING WITH HIV SHOWN HERE
AND THE IMPORTANCE OF ASSESSING
HOUSING STATUS AND
CHARACTERISTICS THAT IDENTIFY
WOMEN LIVING WITH HIV AND WILL
BENEFIT FROM TARGETED
INVENTIONS.
THIS IS DATA FROM MIAMI-DADE
COUNTY WOMEN HOMELESS, UNSTABLY
HOUSED, NO OTHER ADULT AND
REPORTED NOT DISCLOSING THEIR
HIV STATUS WERE AT RISK OF POOR
HIV CARE.
THESE KINDS OF EMPIRICAL
EVIDENCE WOULD SUPPORT TARGETED
INTERVENTIONS IN LOCAL AREAS AND
WE ARE AT THE POINT WHERE WE
NEED LOCAL EPIDEMIOLOGY AND
LOCAL SOLUTIONS AND STRATEGIES
TO ADDRESS THIS PANDEMIC.
AND WE SEE A NUMBER OF YEARS AGO
ADULT RESEARCH FRAMEWORK THAT WE
HAVE USED AGAIN ONE OF MY GOALS
IS IS TO REVISIT THIS.
THIS WAS IN PART INSPIRED BY
WORK I DID WITH THE NATIONAL
INSTITUTE ON AGING WHILE I WAS
ON THE COUNCIL AND DEVELOPED A
RESEARCH FRAMEWORK FOR AGING
DISPARITIES.
AND PART OF THE THING I LIKE
ABOUT OUR FRAMEWORK DEVELOPED BY
STAFF AND INPUT IS THE
SIMPLICITY.
IT'S NOT INTENDED TO BE CAUSAL.
IT'S NOT COMPLICATED.
AND IT DOESN'T INTEND TO BE
COMPREHENSIVE BUT HIGHLIGHT THE
LEVELS OF INFLUENCE.
THINGS WE'RE ALL AWARE OF AND
LAY THEM OUT AND SEE WHERE IS MY
RESEARCH LOCATED HERE WHETHER
BIOLOGICAL, BEHAVIORAL OR AROUND
THE BUILT ENVIRONMENT OR SOCIAL
CULTURAL ENVIRONMENT.
OF COURSE, BEING A FORMER
PRIMARY CARE DOC I VALUE AND
CONSIDER THE HEALTH CARE SYSTEM
AN ESSENTIAL PLACE TO ENHANCE OR
WORSEN DISPARITIES OR WORK TO
DIMINISH OR DECREASE
DISPARITIES.
YOU SEE THE DIFFERENT LEVELS OF
INFLUENCE AS ILLUSTRATED EARLIER
BY BILL AS WELL AND EMPHASIZE
THE FACT THAT MOST OF US
INVESTIGATORS REALLY GRAVITATE
TOWARDS THE INDIVIDUAL COMPONENT
AND IT'S MUCH HARDER TO SEE GOOD
SCIENTIFIC APPLICATIONS OVER TO
THE RIGHT SIDE, MY RIGHT SIDE OF
THE FRAMEWORK.
SO IN THE COMMUNITY OR SOCIETAL
FRAME AND WE NEED TO DO MORE OF
THAT.
DATA ON NEW HIV STATUS.
BLACK AND LATINO 70% AND THE
MAJORITY ARE MEN WHO HAVE SEX
WITH MEN AN HETEROSEXUAL WOMEN
ARE THERE MEN WHO HAVE SEX WITH
WOMEN AND YOU CAN SEE THE DA
DARKENED STATES IN APPALACHIA
AND NEW MEXICO HAVE A
DISPROPORTIONATELY HIGHER RATE
OF THE PERSONS LIVING WITH
DIAGNOSED HIV INFECTION.
WHERE THE HIV EPIDEMIC BEGAN IN
THE COUNTRY THE TWO COASTS,
PARTICULARLY CALIFORNIA AND NEW
YORK, WE SEE BETTER OUTCOMES AND
I THINK THIS IS WHERE WE NEED TO
GO IS THE FOCUS ON THESE STATES.
THESE ARE NOT RESEARCH --
THERE'S NOT TOO MANY RESEARCH
INTENSIVE INSTITUTIONS IN MOST
THOSE STATES.
SOME HAVE THEM.
THERE ARE CFARs LOCATED IN SOME
STATES AS MENTIONED EARLIER AND
WE AT NIMHD HAVE BEEN WORKING
WITH THEM SINCE I'VE BEEN AT NIH
AND WILL CONTINUE TO COLLABORATE
AND LOOK FOR SYNERGY WITH OUR
NETWORK.
NEXT SLOID.
-- NEXT SLIDE.
NOW, AGING WAS BROUGHT UP
EARLIER.
I THINK APPROPRIATE TO THAT IS
TO SEE WHAT COMORBIDITIES HIV
STATUS.
I WAS TAKING CARE OF SOME
PATIENTS WITH HIV UNTIL I
STOPPED SEEING PATIENTS AT UCSF
AND TOWARDS THE END MY PATIENTS
WITH HIV WERE PRETTY
STRAIGHTFORWARD IN TERMS OF
THEIR HIV BUT THEY WERE GETTING
HYPERTENSION, KIDNEY DISEASE OR
OTHER PROBLEMS AND THAT WAS THE
MAIN TOPIC OF OUR VISITS.
YOU CAN SEE HERE THE PERCENT OF
PEOPLE WITH CHRONIC KIDNEY
DISEASE IS HIGHER IN THE DATA
SET OF BENEFICIARIES OVER A
FIVE-YEAR COURSE.
LINKING HIV TO MEDICAL CARE
WITHIN ONE MONTH DIAGNOSIS
VARIES BY RACE AND ETHNICITY.
WE WERE AROUND THE 80% LEVEL,
OVER ALL WE COULD SAY WE COULD
DO BETTER.
GETTING TO 80 IS A BIG STEP IN
MOST THE PUBLIC HEALTH
INITIATIVE BUT HOW DO WE PUSH IT
UP TO THE 95% LEVEL TO COME AT A
QUALITY STANDARD AND THERE'S
MANY OF THESE QUALITY STANDARDS
ONE CAN RELATE TO WHETHER IT BE
EVALUATION OF AN ABNORMAL
MAMMOGRAM IN CANCER SCREENING OR
A PROPORTION OF THOSE WITH
HYPERTENSION WITH BLOOD PRESSURE
CONTROL.
TURNING TO THE ISSUE OF RACISM.
NOT NECESSARILY POLITE
CONVERSATION AT THE DINNER TABLE
BUT AN IMPORTANT PROBLEM THAT
CAME UNDER A LOT OF EMPHASIS IN
2020 WITH THE MURDER OF GEORGE
FLOYD.
HOWEVER, THIS IS AN ISSUE WE
HAVE BEEN LIVING WITH SINCE THE
FOUNDING OF OUR COUNTRY REALLY.
THESE ARE DATA FROM 2015 AS YOU
SEE DONE BY THE KAISER FAMILY
FOUNDATION SURVEY OF AMERICANS
ON RACE AND THEY ASKED HAVE YOU
EXPERIENCED UNFAIR TREATMENT
BECAUSE OF RACE OR ETHNIC
BACKGROUND IN A VARIETY OF
SETTINGS IN THE PAST 30 DAYS.
NOT LIFE TIME OR YEAR BUT 30
DAYS AND OVER HALF OF AFRICAN
AMERICANS SAY YES AND ABOUT OVER
A THIRD OF LATINOS SAY YES TO
THIS.
THIS IS IS ASTOUNDING.
I WOULDN'T GUESS THESE NUMBERS
HAVE REALLY DECREASED SINCE
2015.
IF ANYTHING THEY MAY HAVE GOTTEN
WORSE AS A RESULT OF 2020 AND
THE PANDEMIC.
AND YES WE NEED TO ADDRESS THIS.
NOW, WE'RE SCIENTISTS SO WE NEED
TO THINK HOW DISCRIMINATION
PERHAPS CONTRIBUTE TO
INEQUITIES.
THIS IS AN EXAMPLE OF A STUDY
FUNDED BY NIMHD LOOKING AT BLACK
ADULTS WITH HIV WHO ARE
RECRUITED AND LOOK AT THE ISSUE
OF MEDICAL MISTRUST AND
PERCEIVED DISCRIMINATION AT THE
INTERSECTIONALITY OF HIV, RACE,
SEXUAL AND GENDER MINORITY
ORIENTATION AND POOR ADHERENCE
TO ANTIVIRAL THERAPY LEADING TO
LOWER CARE ENGAGEMENT AMONG
BLACK ADULT WITH HIV.
THE ROLE THAT PERCEIVED
DISCRIMINATION OR STRUCTURAL
DISCRIMINATION MAY LED TO HEALTH
OUTCOMES IS SOMETHING WE NEED TO
STUDY MORE.
WE HAVE LAUNCHED INITIATIVES IN
THIS ENDORSED BY THE MAJORITY OR
ALL THE NIH INSTITUTES.
AND THIS IS NOT A SHORT-TERME
EFFORT.
WE NEED TO CONTINUE THE EFFORT.
AT NIMHD WE THOUGHT ABOUT
RACISM.
INTERPERSONAL IS WHAT THE VAST
MAJORITY OF LITERATURE YOU HEARD
ABOUT OR READ IS BASED ON.
IT'S GOOD WORK, GOOD SCALES.
IT'S ON THE TOOLKIT.
OTHERS HAVE DEVELOPED THESE
EVERYDAY DISCRIMINATION SCALES.
A
AND STRUCTURAL RACISM AND WE
TRIED TO EMPHASIZE EFFORTS AND
IT'S NOT INDIVIDUAL BEHAVIORS
BUT WHAT THIS ORGANIZATION HAS
AND THINK ABOUT EVERYONE
PROBABLY HAS AT LEAST HEARD OF
OR PLAYED MONOPOLY AT SOME TIME
UP THEIR LIFE AND A CERTAIN YOU
CAN'T START TO PLAY AND THE
PEOPLE PLAYING FOR AN HOUR HAVE
GONE AROUND THE BLOCK A FEW
TIMES, BOUGHT SOME PROPERTY AND
PUTTING UP HOUSES AN HOTELS AND
NOW YOU CAN JOIN AT A
DISADVANTAGE.
THIS IS STRUCTURAL RACISM AND
THIS IS WHAT AMERICAN INDIANS
AND ALASKA NATIVES OR HISPANICS
HAVE EXPERIENCED IN THE UNITED
STATES TO DIFFERENT DEGREES.
WE'RE NOT HERE ABOUT CAUSING
BLAME.
WE'RE HERE ABOUT ADDRESSING THIS
IN A SYSTEMATIC WAY AND STUDYING
IT BECAUSE WE'RE NIH AND WE
THESE TO DO THE RESEARCH.
THERE'S OTHER CATEGORIES OF
RACISM YOU SEE LISTS HERE
CONCEPTUALLY IMPORTANT TO
CONSIDER.
I WOULD SPECIFICALLY CALL OUT
THE PERCEIVED SOCIETAL
DISCRIMINATION AS A USEFUL
CONCEPT OR CONSTRUCT WITH YOUTH.
RATHER THAN WHAT'S YOUR LIVED
EXPERIENCE IS MORE WHAT DO YOU
SEE SOCIETY OUT THERE LIKE.
SO THINKING ABOUT HOW DOES
RACIAL INEQUITY POTENTIALLY
HARM?
WE TALKED ABOUT MEASURES MUCH OF
THE DATA RELATES TO PHYSICAL AND
MENTAL HEALTH STATUS OF THE
STUDIES LED BY JAMES JENSON FROM
THE UNIVERSITY OF MICHIGAN AND
BLACK AMERICANS COHORT STUDY AS
CUMULATIVE CHRONIC STRESS AND
THE CHILDHOOD EVENTS AND THINGS
THAT HAPPEN EARLY IN LIFE
AFFECTING YOU 30, 40 MARKED
POTATOES.
THERE'S DATA ON RACISM AND
PHYSIOLOGIC MEASURES AND
HYPERTENSION OR INFLAMMATORY
MARKERS AND CARDIOVASCULAR RISK
FACTOR AND THEN I MENTIONED
BEFORE ABOUT THE SMOKING AND
DRINKING AND SUBSTANCE USE.
AND THERE'S A HISTORY WE HAVE
THAT OCCURRED IN THE 1930s.
IT WAS SYSTEMATICALLY
INCORPORATED IN U.S. CITIES IN
THE 1930s.
THE IDEA A BANK WOULD LOAN MONEY
TO THE HIGHEST PROPERTY AND
RESTRICT AND THIS IS TAKEN FROM
DOCUMENTS AND LOWEST GRADE AND
WHAT WE SEE IS SEGREGATION IN
THE DISTRICT OF COLUMBIA AND
WHAT WE SEE IS DIFFERENCES IN
LIFE EXPECTANCY EXCEEDING 10
YEARS FROM EAST OF THE RIVER TO
THE NORTHWEST.
DIFFERENCES IN CARDIOVASCULAR
OUTCOMES, FOR EXAMPLE, AND ALSO
WITH MEDIATORS OF CARDIOVASCULAR
OUTCOMES.
TO A LESSER OR GREATER EXTENT
THIS OCCURRED IN ALMOST EVERY
CITY IN THE UNITED STATES AND
FOLLOWING THE BEGINNING OF THE
ECONOMIC BOOM THE UNITED STATES
EXPERIENCE AFTER WORLD WAR II
THROUGH THE MID 1960s, THE
BUILDING UP OF EQUITY FOR
FAMILIES WAS DISPROPORTIONATELY
FOR BLACKS AND LATINOS WHO CAME
LATER.
THIS IS THE MONOPOLY ANALOGY I
GAVE YOU EARLIER IS ABOUT.
SO HOW DO WE MITIGATE THIS?
THERE'S LESS ROBUST DATA ON THIS
HOPEFULLY THROUGH INITIATIVES AT
NIH WE BEGAN TO GENERATE MORE
DATA ON THE TOPIC.
AND LOOK AT THE ONES PROVIDING
THE CARE AND PROMOTING PHYSICAL
ACTIVITY AND THESE ARE PROMISING
THE SO-CALLED INTEGRATION OR
RACIAL SOCIALIZATION WHICH KIND
OF ENDED IN 1980 FROM POLICIES
IN THE UNITED STATES AROUND THE
BUSING ISSUE.
PROBABLY WAS WORKING.
THERE'S MULTIPLE LINES OF
EVIDENCE COMMUNITIES THAT HAVE A
SPECTRUM OF RESIDENTS AND
ECONOMIC SPECTRUM AND THE
WEALTHY WILL NOT LIVE WITH
EVERYONE BUT NOT EVERYONE OF A
PARTICULAR STRATA IS GOOD FOR
THE GENERAL POPULATION IN THE
COMMUNITY.
MORE SOCIAL COHESION.
HAVING MORE PEOPLE INTERACTIONS
IS A BIG CHALLENGE AREA OF
VIRTUAL MEETINGS AND THE CONCEPT
OF RELIGIOUSNESS AND CULTURAL
COMPETENCE AND ACCESSIBLE CARE
PERHAPS CAPTURED IN THE
PATIENT-CENTERED MEDICAL HOME
AND ULTIMATELY WE NEED TO
REFLECT ON THE POWER OF
INSTITUTIONS TO HAVE THE
POLICIES THAT NEED TO BE
ADDRESSED.
AND I'M SURE YOU'RE AWARE NIH
WENT THROUGH SOME REFLECTION AN
LAUNCH THE UNITE INITIATIVE I
WON'T DWELL ON BUT THIS IS NOT A
SHORT TERM INVESTMENT.
THIS IS REALLY A LONG TERM
EFFORT.
PROMOTING HEALTH EQUITY IN
HEALTH CARE IS CRITICAL.
IT STARTS WITH EXPANDING ACCESS.
WE'VE SEEN THE ACA EXPERIMENT
SURVIVE HEALTH INSURANCE.
IN UNSURED RATES HAVE BEEN
DECREASED FROM 30% TO 50%.
LATINO OR HISPANICS HAVE THE
HIGHEST RATES OF UNINSURED FROM
A RACIAL AND ETHNIC GROUP AND
BLACK AMERICANS ARE HIGHER THAN
WHITES AND NEEDS TO BE MORE
IMPLEMENTATION SCIENCE AND
THERE'S NO EXCUSE WHERE
HYPERTENSION SHOULD NOT BE HIGH
PRIORITY AND MEASURE IT WITH HOW
WE'RE DOING IT IN EXPRESSING HIV
AND THE MOST DISADVANTAGED
POPULATION.
THERE'S THE COMMUNITY HEALTH
WORKER MODEL INTO THE SYSTEM
WITH NAVIGATORS AND TARGETING
CONDITIONS AND WE TALKED ABOUT
PRIMARY CARE AND MAKING SURE THE
ELECTRONIC HEALTH WORKER DOESN'T
MAKE EQUITY WORSE.
DIDN'T INCREASE DISPARITIES WITH
VIDEOS AND NO LONGER OWN
COMPUTERS BUT PHONES.
WHATEVER WE DO AND IT CONSUMES
DATA SO WHATEVER WE'RE DOING
WITH PORTALS WHICH ARE GREAT WAY
TO EMPOWER PATIENTS WE NEED TO
ADDRESS EQUITY IN THOSE SYSTEMS.
HAVING PERFORMANCE MEASUREMENTS
NOT JUST ON VALUE-BASED CARE BUT
EQUITY.
IF WE DECREASE READMISSIONS TO
THE HOSPITAL TO 15% FOR HEART
FAILURE, LET'S SAY, HOW GOOD ARE
WE DOING WITH AFRICAN AMERICANS
WHO HAVE THE HIGHEST RATES OF
HEART FAILURE COMPARED TO THE
REST OF THE POPULATION.
AND WITH COVID THE PANDEMIC
BROUGHT THEM HOME TO US AT NIH
AND I CO-CHAIRED THE RADX FOR
UNDER REPRESENTED POPULATIONS.
AND THIS SAY MODEL THAT I -- IS
A MODEL THAT IS IMPORTANT.
I'D LIKE A CONTINUUM FOR A
COMMUNITY-ENGAGED NETWORK WE
FUND AND HAVE THE
COMMUNITY-ENGAGED ALLIANCE.
WE CO-LEAD WITH NATIONAL HEART,
LUNG AND BLOOD INSTITUTE.
WE SEE THIS AS AN ESSENTIAL
RESEARCH PLATFORM AS WELL AS A
WAY TO ADDRESS A MULTITUDE OF
PROBLEMS IN COMMUNITIES AND I'LL
END NOW WITH JUST THESE GENERAL
GUIDANCES FROM NIMHD
PERSPECTIVE, MULTI-LEVEL
INTERVENTIONS ARE CRITICAL AND
EMPHASIS ON INTERSECTIONALITY AS
MENTIONED MORE THAN ONCE.
THE IDENTIFYING MECHANISMS AND
BUILDING TRUST AND STRUCTURAL
CHANGE TO MODIFY BEHAVIORS.
THANK YOU FOR YOUR ATTENTION.
THE LAST SLIDE IS OUR CONTACT
AND LOOK FORWARD TO THE PANEL
DISCUSSION.
>> THAT WAS A GREAT
COMPREHENSIVE OVERVIEW.
MR. MALDONADO AND LET'S HOLD
QUESTIONS UNTIL THE NEXT
PRESENTATION.
I'M GOING TO BRING US TO THIS
DR. LA RON NELSON PROFESSOR
AT -- SORRY, I'M LOSING MY
PLACE.
THE PROFESSOR AND ASSOCIATE DEAN
OF GLOBAL AFFAIRS AND PLANETARY
HEALTH AT THE YALE SCHOOL OF
PUBLIC HEALTH AND HIS RESEARCH
FOCUSES ON DEVELOPING AND
TESTING STRATEGY TO OPTIMIZE THE
EQUITABLE IMPLEMENTATION OF HIV
PREP AND HIV MSDI TREATMENT IN
BLACK COMMUNITIES IN THE
U.S. AND CANADA AND SEXUAL
MINORITIES IN AFRICA.
HE'LL PRESENT HIS TALK THE
EPISTEMOLOGY OF IGNORANCE NORMAL
SCIENCE INEVITABLE INEQUITIES
AND AUDACIOUS ANTIDOTES FOR THE
HIV EPIDEMIC.
>> I WAS ASKED HOW NIH CAN
INTEGRATE HIV RESEARCH IN
SYNDEMICS AND YOU'RE IN LUCK
BECAUSE I'LL TALK TO YOU NOT
ONLY FROM A RESEARCHER'S
PERSPECTIVE BUT FROM THE
PERSPECTIVE OF MENTAL HEALTH
NURSE, A BLACK PERSON, A GAY
PERSON AND TEACHER WHO SPENDS A
LOT OF TIME THINKING ABOUT THIS.
SO THE INEQUITIES WE OBSERVE IN
HIV ARE ALARMING.
BUT THEY'RE NOT UNUSUAL.
WE SEE THE SAME PATTERNS ACROSS
MULTIPLE SOCIO ECONOMIC AND
HEALTH BURDENS.
THIS MAP YOU SEE HERE WAS
PRODUCED BY NFAR I PUBLISHED
WITH ABOUT THE OBSERVED
INEQUITIES IN COVID-19.
WHAT YOU SEE HERE IS A
GEOGRAPHIC PATTERN WITH SOME KEY
SOCIAL AND HEALTH PROBLEMS ARE
CONCENTRATED.
THAT'S POVERTY, UNEMPLOYMENT,
BEING UNINSURED.
THERE'S INFECTIOUS DISEASE LIKE
SYPHILIS AND DIABETES AND HEART
DECEASE.
-- DISEASE.
I DON'T HAVE A MAP TO SHOW THE
NEW DISTRIBUTION OF HIV
INFECTIONS BUT IT LOOKS LIKE ONE
OF THE MAPS ON THE SCREEN.
THE PATTERNS OF DISEASE WE SEE
ARE MORE SOCIALLY AND
POLITIC
POLITICALLY DETERMINED.
IF WE LOOK DEEPLY IN THE COLORS
THE GREEN, ORANGE AND RED YOU'LL
FIND ALL TYPES OF PEOPLE BUT
MOSTLY MINORITIZED BASED ON
RACIAL, GENDER, SOCIAL, INCOME
AND STATSES.
THEY'RE NOT MINORITIZED NUMBERS
BUT WITHIN THE PLACEMENT OF THE
SOCIAL HIERARCHY.
THIS REFLECTS THE SOCIAL OH OF
U.S. COMMUNITY AND THE
DEVALUIZATION OF POPULATIONS
ASSIGNED UNDER ADVANTAGED AND
EXPOSED TO RISK.
THIS SHOWS THE WIDENING GAP WITH
THE INTRODUCTION OF NEW
BIOMEDICAL DISCOVERIES AND THE
IMPLEMENTATION OF PUBLIC HEALTH
PRACTICE AND YOU SEE THE AFDA
APPROVAL OF PREP.
THERE'S OTHER ADVANCES SCIENCE
HAS DELIVERED TO US DURING THE
SAME TIME PERIOD.
FOR EXAMPLE, RAPID POINT OF CARE
TESTING FOR HIV OR SELF-TESTING
OR HOME-BASED TESTING AND
TREATMENT AS PREVENTION.
IN THEORY THEY'LL CONTRIBUTE TO
EVENTS AND WHITE MSM.
THIS IS NORMAL.
IT'S NORMAL BECAUSE OUR SOCIETY
ORGANIZED IN A TWHA PROMISES
BENEFITS TO PEOPLE WHOSE STATUS
IS PRIVILEGED.
THIS ALSO PROVES THE HEALTH
BENEFITS OF SCIENCE.
IN THE GRAPH OF INCIDENTS AMONG
SMM THERE ALMOST NO IMPACT ON
BLACK MSM.
THE BENEFITS FROM THE ADVANCES
STAYED THERE AND DISPARITIES
BECAUSE OF THE BENEFITS DO NOT
TRICKLE DOWN.
TO DO THIS WE NEED TO REDESIGN
SCIENCE TO BENEFITS FLOW MORE
EQUITABLY OTHERWISE THIS WILL
CONTINUE TO HAPPEN.
NORMAL SCIENCE IS THE WAY WE
CONDUCT RESEARCH.
THIS INCLUDES EMBEDDED BLIND
SPOTS.
BLIND SPOTS FOR UNDER
MINORITIZED GROUPS SOME I NAMED
AND OTHERS YOU HEARD ABOUT AND
ARE EASY TO MISS.
IT'S A NICE WAY TO SAY EASY TO
MISS AND EASY TO IGNORE.
THESE BLIND SPOTS ARE NOT
INCID
INCIDENTAL.
SCIENCE REENFORCES THE DOMINANT
PARADIGM OF HOW -- AND IT ALSO
REINFORCES DOMINANT SOCIAL
ORGANIZATION.
IT ALL FITS.
RACISM IS EMBEDDED IN SCIENTIFIC
INFRASTRUCTURE AND SOME NIH WORK
HAS EMPHASIZED THIS AND EMBEDDED
EVEN IN SCIENTIFIC PROCESSES.
IT FEELS NORMAL BECAUSE IT ALL
GOES BUT THAT SUPPORTS THE
STATUS QUO AND THIGHS Y-- THESE
INEQUITIES HAPPEN.
NORMAL SCIENCE WORKS AND WE'RE
TRYING TO FIND OUT IF WE'RE
CONDUCTING SCIENCE AIMED AT
IMPACTING ACADEMIC INEQUITIES
WHAT WE NEED IS A REVOLUTIONARY
SCIENCE TO DISRUPT THE INEQUITY
PATTE
PATTERNS.
A BOOK CALLED THE STRUCTURE OF
SCIENTIFIC REVOLUTIONS.
IT WAS LOOK AGENT SCIENTIFIC
PROGRESS OVER A LONG PERIOD OF
TIME AND TRYING TO TRACK HOW WE
GOT HERE AND WHAT DID WE DO
BEFORE THAT GOT US HERE AND HE
REALIZED AND FOUND THAT THERE
WERE BREAKS THAT SOME MAJOR
ADVANCES DIDN'T SEEM CONNECTED
TO THE WORK THAT HAD BEEN DONE
BEFORE.
THINGS HAD CHANGED.
SO WHEN THERE'S TALK OF NORMAL
SCIENCE IT'S REFERRED TO WHEN
SCIENCE IS LESS AND LESS ABLE TO
ADDRESS THE QUESTIONS OF THE
TODAY.
THE PRESSING PROBLEMS OF THE DAY
AND THIS REPRESENTS WHAT YOU
CALL THE DRIFT.
AND THAT AT THE SOME POINT
SCIENCE REACHES CRISIS.
WHAT ARE WE GOING TO DO?
THIS NOT WORKING.
THIS LEADS TO A NEW WAY OF
THINKING THAT DEPARTS SHARPLY
FROM APPROACHES THINGS AT THE
TIME CONSIDERED REVOLUTIONARY OR
UNHEARD OF AND THE REVOLUTIONS
LEAD TO PARADIGM SHIFT AFTER A
WHILE BECOME THE NEW NORMAL.
FROM A RESEARCHER'S PERSPECTIVE
WE'RE ALREADY IN A SCIENTIFIC
CRISIS IN HIV.
WE ARE TRYING THINGS THAT ARE
NOT WORKING.
I THINK IT'S BECAUSE OF THE WAY
WE'RE TRYING IT AND WE MIGHT BE
NEARING THE CUSP OF A REVOLUTION
IN HIV SCIENCE.
MAYBE WE'RE NOT ACKNOWLEDGING
THAT BUT WE HAVE TO BE THERE AND
WHEN I SAY REVOLUTIONARY SCIENCE
I'M NOT COMING UP WITH WHAT IT
MEANS FOR US TODAY BUT I THINK
IT MEANS EVIDENCE IN ACTION OR
EVIDENCE THAT ACTS.
IT HAS TO BE MORE THAN
GENERATING NEW KNOWLEDGE.
THAT DOES NOT AFFECT THE SYSTEMS
WE JUST HEARD ABOUT FROM OUR
NIMHD LEADERSHIP.
ONE WAY TO CHARACTERIZE THE
SCIENTIFIC CRISIS IS THINKING OF
US BEING IN A NEW ERA OF HIV
EPIDEMIC DRIVEN BY BEHAVIOR.
THE MARKETS AND SYSTEMS, HEALTH
SYSTEMS, SOCIO CULTURAL SYSTEMS
AND POLITICAL SYSTEMS.
THAT'S WHAT'S HAPPENING.
IF SCIENCE IS TO ADDRESS HIV, WE
HAVE TO ALSO FIGURE HOW TO
ADDRESS OTHER BEHAVIORS THAT ARE
RELEVANT.
THINK OF AN EXAMPLE OF BLACK
MSM.
YOU HEARD FROM THE CDC SOME
YEARS AGO THAT IF THINGS DIDN'T
CHANGE ONE AND TWO WOULD HAVE A
CHANCE OF ACQUIRING HIV AND
WHERE THERE'S HIGH PREVALENCE IN
THE HIV COMMUNITY THE ODDS OF
BEING EXPOSED OR HAVING SEX WITH
SOMEBODY WHO HAS HIV IS GOING TO
BE HIGH REGARDLESS OF THE NUMBER
OF PARTNERS YOU HAVE OR THE
FREQUENCY OF SEX.
SO THE BEHAVIOR WON'T BE THE
DRIVER, THE DRIVER WILL BE OTHER
BEHAVIORS IS TREATMENT AND
PREVENTION AVAILABLE IN YOUR
COMMUNITY AND IS YOUR PROVIDER
ABLE TO DISCUSS PREP WITH YOU?
ARE THERE IMPEDIMENTS FOR YOUR
PROVIDER DISCUSSING SEX AND
SEXUALITY AMONG YOUNG MSM AND
DOES THE MANUFACTURE OF THE DRUG
MAKE IT EASIER FOR YOU TO GET.
WILL THE INSURANCE COMPANY PAY
FOR THE DRUG?
ARE THERE STRONG POLITICAL
IMPEDIMENT TO HAVING AUTHORITY
TO PRESCRIBE THIS OR POLITICAL
IMPEDIMENTS TO NURSE
PRACTITIONERS BEING ABLE TO
CLAIM FULL REIMBURSEMENT FOR THE
CARE THEY PROVIDER BECAUSE IF
THEY DON'T THE HEALTH CARE
SYSTEM WON'T MAKE IT POSSIBLE
BECAUSE IT'S A FINANCIAL
DISINCENTIVES.
NONE OF THESE ARE BY PATIENT
BEHAVIOR BUT MARKET, SYSTEMS,
CULTURAL AND POLITICAL SYSTEMS
WILL AFFECT INDIVIDUAL AND
POPULATION-LEVEL OUTCOME IN HIV.
OUR RESEARCH HAS TO GO THERE.
IF WE'RE GOING TO BE
REVOLUTIONARY SCIENCE TO IMPACT
THE EPIDEMIC WE HAVE TO GO
THERE.
THERE'S WAYS TO DO IT.
WE NEED TO UNDERSTAND THE
DRIVERS OF THE HIV INEQUITIES.
STUDIES THAT COMBINE MULTIPLE
STRATEGIES AND LEVELS AND
STUDIES THAT INTEGRATE
STRATEGIES THAT IMPACT MORE THAN
ONE TARGET AT A TIME.
THIS DIAGRAM IS FROM A PAPER
FROM BRIAN WIENER CALLED THE
CONVERGENCE FRAMEWORK AND AN
EXAMPLE OF INTERVENING WITH
THREE TARGETS AT THREE LEVELS
NEEDED TO IMPROVE THE ACCEPTANCE
OF CHEMOTHERAPY.
WON'T DO IT BY JUST TALKING TO
THE PATIENTS AND NOT ENGAGING IS
THE PEER NETWORK.
YOU HAVE TO DO ALL THREE AND IN
HIV WE HAVE TO LOOK AT
MULTI-LEVEL DRIVERS AND WHAT CAN
BE DONE TO ADDRESS THEM TO
REDUCE THE INEQUITIES.
AND I THINK NEW TECHNOLOGIES
LIKE LEVERAGING BLOCK CHAIN
TECHNOLOGY AND ARTIFICIAL
INTELLIGENCE WHICH I DON'T KNOW
A LOT ABOUT HAVE BEEN SHOWN IN
MANAGEMENT SECTORS TO HAVE
IMPROVEMENTS ON SERVICE OUTCOMES
BUT HEALTH SYSTEMS ALSO SERVICE
SYSTEMS TO USE THE TECHNOLOGY TO
THINK HOW TO TO IMPROVE BUSINESS
OUTCOMES IN HEALTH SYSTEMS AND
SERVICE OUTCOMES AND ULTIMATELY
PATIENT OUTCOMES.
THEY NEED TO BE ABLE TO --
NORMAL SCIENCE YOU DESIGN
INTERVENTION WITH FIXED
COMPONENTS AND YOU TEST IT.
WITHOUT ANY RESPECT TO WHAT'S
HAPPENING AROUND YOU OR AROUND
US AND THESE EPIDEMICS THESE
THINGS ARE EVOLVE.
SO INTERVENTIONS HAVE TO BE ABLE
TO EVOLVE OR BE FLEXIBLE IN SOME
WAY SO I WROTE HERE BEND TO
AVOID BREAKING.
IF THE EPIDEMIC HAS CHANGED AND
THE INDIVIDUAL HAS NOT, I THINK
THERE'S A HIGH RISK IT WILL FAIL
AND THERE'S POTENTIALLY TO
EVOLVE IN WAYS THAT SHOW IMPACT
AND NOT FOR NORMAL SCIENCE.
WE HAVE TO THINK ABOUT HOW WE DO
THAT.
IT HAS TO MAINTAIN LOCAL
RELEVANCE AND HAS TO BE
IMPORTANT IN THE EPIDEMIC AND
MAY MEAN TESTING WHAT YOU DESIGN
BUT ALLOW IS TO CHANGE BASED ON
WHAT'S HAPPENING IN THE
ENVIRONMENT AROUND WHAT IS BEING
IMPLEMENTED AND MAY INCLUDE
BENDING SOME OF THE NORMAL RULES
WITHOUT SACRIFICING SCIENTIFIC
RIGOR.
I PUT UP THIS AS AN EXAMPLE.
THE STUDY CO-LEAD AND DESIGN
WITH CHRIS AND BOB AND IS A MULE
LEVEL INTERVENTION STUDY DONE
ACROSS THE SOUTH.
THE FIGURE ON THE RIGHT IS
CIRCULAR FIGURE WAS SUPPOSED TO
SHOW THE INTEGRATED STRATEGY
THAT TAKES STRUCTURAL
INTERVENTIONS AND BEHAVIORAL
INTERVENTIONS TO SUPPORT THE
IMPLEMENTATION OF PREP TREATMENT
AND TESTING AND CIRCULAR FOR
ANOTHER REASON.
WE COULD HAVE MADE IT A STRAIGHT
LINE BUT WE NEED THE
INTERVENTION STRATEGY TO BE
FLUID WHILE STILL BE FUNCTIONAL
AND RIGOROUS BUT RESPONSIVE.
IT WAS A DIFFERENT TYPE OF STUDY
THEY THINK THE NETWORK HAD SEEN
BUT REALIZED IT WAS NECESSARY IF
WE'RE GOING TO DO WORK THAT
IMPACT THE EPIDEMIC.
IF WE DO STUDIES LIKE HPTN096
AND OTHER STUDIES THAT ARE NOVEL
AND UNUSUAL WE NEED METHODS TO
ACCOMMODATE THE NEW COMPLEXITIES
AND PART OF WHAT HAPPENS IS YOU
HAVE SCIENTISTS THAT WORK
TOGETHER TO COME UP WITH THINGS
AND STATISTICIANS SAYING WE
DON'T HAVE A WAY TO TEST THAT OR
METHODS TO EVALUATE THAT.
WE -- NIH, WE SHOULD INVEST IN
THE DEVELOP.
NEW METHODS OR TESTING NEW
METHODS THAT CAN HANDLE THE
POTENTIAL NEW WAYS OF DOING
THINGS.
HERE'S EXAMPLE OF THINGS THAT
HAVE BEEN DONE MORE RECENTLY.
THE MOST DESIGN MULTI-FACED
OPTIMIZATION STRATEGY AND SMART
DESIGNS, IMPLEMENTATIONAL
DESIGNS AND WE NEED MORE OF THAT
AND NOVEL IDEAS TO HOW WE DO
THIS AND NOVEL DESIGN AND
STRATEGY.
THE NEXT EXAMPLE IS CALLED LEARN
AS YOU GO.
THIS IS A STRATEGY -- AN
ANIMATED STRATEGY THAT TAKES
DATA AND COLLECTS DATA BEING
DESIGN AND ING OUT
MATHEMATICALLY WHERE IT MIGHT
NEED TO CHANGE AND NEEDS TO BE
INFORMED BY HOW RACE, RACISM
MIGHT INFORM UNDER LIE THE
LOGIC.
I REMEMBER HAVING A STATISTICIAN
WHO DEVELOPED THIS COME TALK TO
PEOPLE BLACK RESEARCHERS IN
DALLAS WHO COULD APPRECIATE IT
BUT CRITIQUED IT AND THERE ARE
WAYS THAT MATH CAN SUPPORT --
HOW DO I WANT TO SAY THIS?
THIS CAN SUPPORT STATUS QUO SO
WE DON'T JUST NEED NEW METHODS
BUT METHODS INFORMED BY PEOPLE
WHO HAVE DIFFERENTLY LIVED
SOCIAL EXPERIENCES.
THE NEXT SLIDE GETS AT THAT.
ANOTHER AUDACIOUS WAY TO ADDRESS
THIS IS DEVELOPING SUPPORTING
RESEARCH INFRASTRUCTURE
DEVELOPMENT PARTICULARLY IN
HBCUs, HISTORICALLY HISPANIC AND
INDIGENOUS INSTITUTIONS.
I LIKE THE PIONEER AWARD NIH
DOES.
BECAUSE IT'S DIFFERENT.
IT DOESN'T FOLLOW THE USUAL
STRUCTURE.
WHEN I HEAR ABOUT THEM, THE
RESEARCH SEEMS TO BE VERY
EXCITING OUT THE BOX RESEARCH
AND THE PROCESS SEEMS
STREAMLINED.
AND I THINK FOR TRAINING GRANTS,
P30s OR RESEARCH CENTERS, R25,
ALL THOSE THINGS, WE NEED TO
FIGURE OUT WAYS TO GET THEM TO
PLACES WHERE THE PEOPLE WHO HAVE
SIMILAR SOCIAL EXPERIENCES LIVE
AND THE FOLKS TRYING TO IMPACT
ARE GETTING AN EDUCATION.
WE NEED TO MAKE IT EASIER FOR
THAT TO HAPPEN.
WE NEED IT TO HAPPEN QUICKLY AND
I EMPHASIZE QUICKLY BECAUSE I
THINK WE HAVE TO TREAT -- THIS
IS GOING TO SOUND WEIRD TO SAY,
WE HAVE TO TREAT HIV LIKE IT'S
AN EMERGENCY.
I REMEMBER THE COVID PANDEMIC
AND I SAW THE BEHAVIORS OF
POLITICAL PEOPLE AND FEDERAL
AGENCIES WHEN IT TREATED AN
EPIDEMIC LIKE AN URGENT
EMERGENCY.
I THINK SOME OF THOSE THOUGHT WE
COULD NEVER DO THIS BUT WE DID
IT WE SHOULD APPLY IT TO HIV.
IT'S A LONG STANDING EMERGENCY.
THERE ARE WAYS WE CAN FIGURE OUT
TO MAKE THE PROCESSES BEING
BETTER RESPONSIVE TO THE
EPIDEMIC.
I THINK THIS IS ONE OF THOSE AND
DIVERSITY SUPPLEMENTS HAVE
WORKED WELL.
FINDING WAYS TO INCREASE THE
VOLUME OF THOSE AND MAKE IT
EASIER FOR THOSE TO BE AWARDED.
INCENTIVIZE COLLABORATION AND
REWARD COLLABORATION AND
COMPETITION IS HEALTHY AND LEADS
TO INNOVATION AND IN OTHER WAYS
TO MAKE THE MOST WITH LIMITED
RESOURCES I THINK COOPERATING
ACROSS FEDERAL GRANTEES IS ONE
WAY TO DO THAT.
I SAW SOME OF THAT WORK WITH ONR
AND NIMHD AND THE PRISM PROGRAM
WHERE THEY BROUGHT GRANTEES
TOGETHER TO TALK ABOUT SOME
THINGS AND I EVEN WORKED WITH
LISA BOLLEG WHO HAD AN R21 TO
DEVELOP A MEASURE AND I WAS
LEADING A STUDY THAT NEEDED A
MEASURE OF STIGMA BUT DIDN'T
HAVE TIME TO DEVELOP ONE AND
THEY DEVELOPED THE MEASURE AND
WE USED OUR RESOURCE TO PUT IT
INTO THE FIELD.
SO THAT WAS WE GOT MORE OUT OF
THAT TOGETHER THAN ANY ONE OF US
COULD HAVE DONE.
SO MODELS THAT ENCOURAGE THAT
TYPE OF COLLABORATION I THINK IS
IMPORTANT AND COOPERATION ACROSS
FEDERAL AGENCIES IS ALSO
IMPORTANT BECAUSE CDC, NIH ALL
HAVE DIFFERENT FOSI BUT THE
PROBLEMS ARE NOT SILOED SO
COOPERATION ACROSS FEDERAL
AGENCIES IS ALSO KEY.
THE LAST SLIDE REALLY IS THE
EPISTEMOLOGY OF IGNORANCE ABOUT
WHAT WE KNOW AND DON'T KNOW.
DO WE PASSIVELY NOT KNOW OR ARE
WE ACTIVELY NOT KNOWING?
IT'S NOT A RIDDLE.
IT'S A REAL QUESTION.
THE PART OF UNDERSTANDING OF
IGNORANCE IS A GAP OF KNOWLEDGE.
INSUFFICIENT INFORMATION AND WE
CAN EASILY FIX THAT IF WE
PROVIDE SOME DATA.
I DON'T KNOW IF THAT'S IT.
I THINK WE'VE HAD A LOT OF
INFORMATION FOR A VERY LONG TIME
AND I THINK IT REQUIRES A
CRITICAL UNDERSTANDING OF WHAT
IS IGNORANCE AND HOW WE DEAL
WITH IT BECAUSE IN THE
EPISTEMOLOGY OF IGNORANCE AND
UNDERSTAND IT IS AND HOW IT
FUNCTIONS, WHAT PRODUCES IT IN
SOME WAY IT COULD BE A REFUSAL
OF KNOWLEDGE.
ACTIVE RESISTANCE TO KNOWLEDGE
OR ONLY ACCEPTING CERTAIN TYPES
OF KNOWLEDGE WHICH ALLOWS US TO
IGNORE CERTAIN THINGS FOR
MINORITIZED PEOPLE INEQUITIES
FOR MISS IT AND THINK WHETHER WE
ERECT THE ADMINISTRATIVE AND
ACADEMIC STRUCTURES TO MAKE IT
UNATTAINABLE OR LE SS ATTAINABLE
AND CAN MAKE IT MORE DIFFICULT
FOR ACADEMIC BREAKS THROUGHS,
THE KINDS WE NEED.
WE DO KNOW SOME THINGS.
THE FIRST SLIDE IS THE LAST
SLIDE.
WE DO KNOW THAT THERE'S A
WIDENING GAP IN HIV INCIDENTS
NOT JUST IN MSM BUT WE KNOW WE
MUST DO SOMETHING DIFFERENTLY
AND I WOULD SAY DRAMATICALLY
DIFFERENTLY TO ADDRESS THESE
INEQUITIES.
THANK YOU.
>> THANK YOU, DR. NELSON FOR A
GREAT PRESENTATION.
IN THE INTEREST OF TIME I'LL TRY
TO KEEP US GOING WITH THE NEXT
DISCUSSION AND TAKE QUESTIONS
AFTER THAT.
SO WHY DON'T WE GO AHEAD THEN
AND HEAR FROM TRUE EVOLUTION
CHIEF EXECUTIVE OFFICER GABRIEL
MALDONADO CEO OF THE
ORGANIZATION SERVING THE LGBTQ
YOUTH IN SAN BERNARDINO AND
RIVERSIDE COUNTIES AND FORMER
MEMBER OF THE PRESIDENTIAL
ADVISORY COUNCIL AND UNDER
PRESIDENT OBAMA AND SERVED ON
THE NATIONAL ADVISORY BOARD FOR
ADVISORY GROUPS FOR MERCK AND
GILEAD AND HIS TALK IS DEFEATING
STIGMA AND ADVANCING HEALTH
EQUITY.
>> I'VE BEEN A COMMUNITY
ORGANIZER FOR THE MAJORITY OF MY
CAREER AND A BIG PART OF THE
WORK I DO FOCUSSED ON THE
INTERSECTION OF HEALTH EQUITY
AND RACIAL JUSTICE.
I'M PRESENTING TRUE EVOLUTION
AND OUR SPECIFIC PROJECT I WANT
TO THANK DR. NELSON BECAUSE I
HAVE NOTES FROM HIS PRESENTATION
AND TEED UP THE MODEL MY
ORGANIZATION HAS BEEN WORK ON
THE LAST THREE YEARS.
A LITTLE BIT ABOUT US.
WE WERE FOUNDED IN 2007.
WE'RE CELEBRATING 16 YEARS.
IT HAS BEEN EVOLUTION.
WE STARTED OFF AS AN ADVOCACY
ORGANIZATION WORKING IN OUR
LOCAL COMMUNITIES.
YOU'LL BE SURPRISED AT THE TIME
EVEN OUR LOCAL CITY CHARTER
STILL USE TERMS LIKE AMERICAN
NEGRO AND ORIENTAL DURING 2007.
WE WERE AS AN ADVOCACY GROUP
CUTTING AT FUNDAMENTAL BASIC
LANGUAGES IN OUR COMMUNITIES.
IN 2007 WHEN I FOUNDED THE
ORGANIZATION FOR THOSE THAT KNOW
CALIFORNIA HISTORY POLITICS IT
WAS IN RIVERSIDE ACCOUNT WE HAD
OVER 85% THAT VOTED YES ON PROP
8 AND I WAS MET WITH SIGNS UPON
MY FIRST DAY OF UNDERGRAD IN
2007 THAT SAYS GOD HATES FAGOTS
THAT'S WHAT I SAW ON THE CORNER
OF MARTIN LUTHER KING AND CREST
AND THAT HAS BEEN MY GOAL AND WE
BEGAN PROVIDING DIRECT SERVICES
AND YOU'LL SEE THE LIST OF
SERVICES ALONG WITH THE
POPULATIONS WE SERVE.
WE HAVE GROWN FROM SERVING YOUTH
IN OUR ITERATION AND OVER THE
LAST 10 YEARS TO AN AGING
POPULATION FOR 65 AND OLDER.
AND WHAT I WANT TO SHOW YOU IS
OUR HOUSING PROGRAM.
TRUE EVOLUTION BECAME EMERGENCY
SUPPORTIVE HOUSING PROVIDERS IN
2017 AND THAT TEED US UP FOR
PROVIDING HOUSING DURING THE
COVID-19 PANDEMIC WHEN WE WERE
ASKED TO HOUSE A HOMELESS
POPULATION AND WE WERE ASKED TO
SERVE PEOPLE LIVING WITH HIV.
WE WERE TOLD WE'D ONLY GET 20
AND IN THE FIRST TWO WEEKS WE
RECEIVED 60.
AND WE HAD ABOUT 85 FOR THE LIFE
TIME OF THIS PROGRAM.
ALL PEOPLE LIVING WITH HIV.
ALL INDIVIDUALS MISSED IN THE
MOST RECENT POINT IN TIME
HOMELESS COUNT.
IT GAVE AN OPPORTUNITY FOR US TO
THINK OF AN AWARD ALONGSIDE
RIVERSIDE COUNTY AND OUR
PARTNERS SECURED PROJECT HOME
KEY.
THIS WAS CALIFORNIA GOVERNOR
NEWSOM'S PROGRAM TO DO EMERGENCY
HOUSING AND NOW THIS WAS ABOUT
CREATING PERMANENT AND
TRANSITIONAL HOUSING FOR THE
ONGOING.
WE WERE INAUGURAL RECIPIENTS OF
THE PROGRAM AND WERE GIVEN AN
INNOVATIVE OPPORTUNITIES.
I'M LOOKING AT MY NOTES AND
DR. NELSON SAID SO MANY THINGS I
WANTED TO QUOTE FROM AND THIS IS
AN EMERGENCY OF HOW WE SHOULD
LOOK AT HIV.
WE DID IT DURING COVID AND WE
ARE AN EXAMPLE OF WE DID IT
DURING COVID AND THE GOVERNMENT
DIDN'T PLACE ITS BURDENSOME VERY
BUREAUCRATIC PROCESS AND ALLOWED
US TO BE INNOVATIVE AND COME UP
WITH A DIFFERENT MODEL IN
ADDRESSING PEOPLE LIVING WITH
HIV IN A 360 COMPREHENSIVE WAY.
THIS IS A SNAPSHOT OF OUR
PROGRAM AND I HAVE A VIDEO FOR
YOU TO SHOW YOU THE CAMPUS
BECAUSE IT HAS OPENED.
AND SO OUR PROGRAM IS AN UP TO
24-MONTH TRANSITIONAL HOUSING
PROGRAM BECAUSE IT WAS FUNDED
UNDER COVID-19 WE DO FOCUS ON
THOSE THAT ARE PARTICULARLY AT
HIGHEST RISK FOR COVID-19 AS
WELL AS HIV ACQUISITION.
SO OBVIOUSLY THAT'S A BIG
MAJORITY OF THE POPULATION WE
SERVE AND THE POPULATION
DR. NELSON SPOKE OF BUT WE WANT
TO FOCUS 80% ON LGBTQ.
WE'RE VERY INCLUSIVE AND HAVE
PEOPLE LGBTQ NOT LGBTQ BUT
MISSED TO SEVEN THIS POPULATION
AND AS THE PROGRAM WAS CREATED
IN ADDRESSING PEOPLE LIVING WITH
HIV AT MINIMUM THREE-QUART ERS
OF OUR PROGRAM GIVES SPACE FOR
PEOPLE LIVING WITH HIV AND WE
ARE AT 100% OF PEOPLE LIVING
WITH HIV AND WE HAVE A BED FOR
THE PROPERTY MANAGER WHO LIVES
ON SITE AND SENIORS NOW MAKE UP
50% OF OUR PROGRAM.
THAT 25% HAS DOUBLED AND IT'S
BECAUSE OF WHERE THE NEED IS.
NOW I WANT TO SHOW YOU THE
CAMPUS.
IT TOOK US THREE YEARS AND
NEARLY $23 MILLION LATER.
IF YOU WERE ON THE CAMPUS AND
WERE DOING A TOUR I'D SAY
WELCOME TO PROJECT LEGACY.
YOU'LL SEE HERE A ONE-ACRE
NEIGHBORHOOD BLOCK THAT SITS IN
DOWNTOWN RIVER WITH FIVE
RESIDENTIAL SINGLE FAMILY HOMES
AS WELL AS THE 5,000 SQUARE FEET
COMMERCIAL BUILDING WITH OPEN
RECREATIONAL SPACE.
EACH HOMES WERE NAMED AF A
DIFFERENT FIGURE IN THE LGBTQ
COMMUNITY.
IT'S A BEACON TO LET OUR
COMMUNITY KNOW IN A SUBTLE BUT
DIRECT WAY WE'RE HERE FOR THE
PEOPLE.
THIS IS ACTUAL COMPLETED
CAMPUSES INCLUDING THE GEORGEON
JOHNSON HOUSE WITH SIX BEDS AND
ANOTHER BED AND THEY'RE
HISTORICAL NAMES PAST AND
PRESENT AND ONE OF THE PIONEERS
IN THE EARLY DAYS AND STILL WITH
US TODAY OF UNITY FELLOWSHIP
CHURCH.
AND OUR COMMERCIAL BUILDING IS
DEDICATED TO WHAT WE CALL THE
INLAND EMPIRE LGBTQ COMMUNITY
CENTER.
IN ADDITION WE'LL HAVE A HOST OF
RECREATIONAL AND WELLNESS
PROGRAMS FOR A STATE OF THE ART
FITNESS CENTER BUILT TO PROMOTE
FOOD AND NUTRITION AND THIS IS
THE 40,000 SQUARE FOOT OPEN
SPACE TO THE RESIDENTS AND
COMMUNITY AND WE CONSIDER
OURSELVES A COMMUNITY
NEIGHBORHOOD PROVIDER NOT JUST
FOR RESIDENTS THERE BUT THE
NEIGHBORHOOD ASSOCIATION WAS AN
ACTUAL BIG PROPONENT AND
SUPPORTER OF THIS PROGRAM AND SO
MANY OF THE FEATURED ELEMENTS OF
THE PUBLIC SPACING AND OPEN
GROUNDS AND COMMUNITY GYM, THE
WELLNESS PROGRAMS, THEY'LL ALL
BE AVAILABLE TO THE COMMUNITY
INTO OUR NON-RESIDENTIAL
CLIENTS.
IF YOU GO TO THE NEXT SLIDE,
I'LL SHOW YOU SOME VERY SPECIFIC
STRATEGIES WE'RE HOPING TO
IMPLEMENT AND OPPORTUNITIES FOR
SCIENCE TO LOOK AT FOR FUTURE
REPLICATION.
AND OUR MODEL WORKS WOULD BE
GREAT TO SHOW.
WE WANT TO ENSURE OUR PROGRAM IS
FOCUSSED ON LOW BARRIER
SERVICES.
THIS IS EXPLORING ALL THE
RESTRICTIONS AROUND ELIGIBILITY
REQUIREMENTS SOMETIMES PROGRAMS
RESTRICTIONS LIKE YOU CAN'T LIVE
IN A HOUSING PROGRAM IF YOU MAKE
INCOME.
THINGS THAT ARE COUNTERINTUITIVE
TO WHAT WE'RE TRYING TO ACHIEVE
WITH CLIENTS.
WE WANT TO EXAMINE OUR INTERNAL
POLICIES CONSISTENTLY AND
REGULATORY POLICIES WITHIN THE
STATE WE WORK IN AND THE
COMPLEXITIES OF BEING IN A
CALIFORNIA HEALTH CARE SYSTEM.
HOW DO WE SIMPLIFY ACCESS TO
SOCIAL, MEDICAL AND HOUSING
SERVICES FOR OUR CLIENTS.
THAT'S ONE OF OUR GOALS.
THE SECOND IS A COMPLETE 360
COMPREHENSIVE SERVICE DELIVERY
INCLUDING HOUSING, MEDICAL,
SOCIAL SERVICES WHICH INCLUDES
WORKFORCE DEVELOPMENT, SUBSTANCE
ABUSE TREATMENT SERVICES,
WELLNESS PROGRAMS AND
RECREATIONAL.
I WOULD SAY ABOUT 70% OF THESE
PROGRAMS OUTSIDE OF MEDICAL HAVE
BEEN OPERATING AND FUNCTIONING
EITHER EN OUR HISTORY OR BEGAN
WE FIRST STARTED HOUSING
RESIDENTS IN FEBRUARY OF THIS
YEAR.
SO ABOUT 75% OF THOSE SERVICES I
MENTIONED ARE ALREADY MOVING
ACTIVELY FLOWING, PROVIDING
SERVICES TO CLIENTS.
WE ARE GOING TO BE BUILDING A
FUTURE MEDICAL CENTER ON THE
PROPERTY AND SO THAT WILL THEN
BE IN 2025 WHERE WE WILL LAUNCH
OUR CORE MEDICAL SERVICES.
THE THIRD SERVICE A THIRD
STRATEGY IS HOUSING AS THE NEXUS
FOR ALL SERVICE DELIVERY.
IF THEY'RE NOT HOUSED WITH A
QUALITY OF LIFE NOTHING ELSE
WILL MATTER AND I HAVE FOUND
HOUSING PROVIDERS HAVE MOST
INFLUENCE OVER THE CLIENT AND
WHEN YOU'RE RESPONSIBLE WHERE
THEY SLEEP EVERY DAY YOU'RE A
DRIVING FORCE TO ENSURE THEY
STAY IN TREATMENT AND CARE AND
ADDRESS THEIR MENTAL HEALTH
PARTICULARLY WHEN IT'S RENT FREE
YOU CAN PLACE PROGRAMMATIC
REQUIREMENTS FOR SHOWING UP TO
SUPPORT GROUP AND ENGAGING IN
FOOD AND NUTRITION AND THEY'RE
MORE WILLING AND EXCITED AND
ACTIVE TO PARTICIPATE BECAUSE
THEY'RE CORE FUNCTION OF HOUSING
AND SURVIVAL IS ADDRESSED.
OUR FOURTH STRATEGY IS THE
INTEGRATION OF WELLNESS AND
NON-CLINICAL HEALTH SERVICES.
THIS IS CALLED OUR PHYSICAL
FITNESS AND BOXING, TAI CHI,
YOGA AND THE SENIORS WANTED TAI
CHI AND THE YOUNGER PEOPLE
WANTED BOXING.
AND FINALLY IT'S IMPORTANT TO ME
AND I'VE INFUSED THIS IN MY
STAFF WE NEED TO HAVE A BALANCE
BETWEEN A GUIDED EXPERIENCE AND
SELF-DETERMINATION.
WE CANNOT JUST PIGEON THESE
CLIENTS TO DOING EXACTLY WHAT WE
WANT ROBOTICALLY STEPPING.
WE NEED THEM TO BE INSPIRED TO
BE DREAM AND LOWER THEIR
ANXIETIES FROM SURVIVORHOOD AND
TAP INTO THE PURPOSE THE INNER
TRUTH OF WHERE THEY ARE GOING
AND WHERE THEY WANT THEIR LIVES
TO GO AND WE SPEND TWO YEARS
FIGURING THAT OUT AND WE
IMPLEMENT A RENT SAVINGS PROGRAM
IF YOU'RE EMPLOYED AND EMPLOY
TECHNOLOGY AND HAVE A STATE OF
THE ART SECURITY SYSTEM THAT
ALLOWS FOR FLUIDITY AND
FLEXIBILITY AND FREEDOM FOR
CLIENTS TO MOVE IN AND OUT OF
THE FACILITY, HAVE DIFFERENT
TYPES OF ACTIVITIES, BEING ABLE
TO WORK AT DIFFERENT HOURS OF
THE DAY.
BASIC THINGS OFTEN NOT FEASIBLE
IN MOST HOUSING PROGRAMS AND HOW
DO YOU USE TECHNOLOGY TO ACCOUNT
FOR THINGS LIKE SAFETY AND
ACCOUNTABILITY?
THINGS LIKE THAT.
AND REPLACEMENT OF NOT GIVING
THEM THEIR FREEDOM AND FINAL
SLIDE.
SOME RECOMMENDATIONS I HAVE FOR
THE SCIENCE COMMUNITY AND FOR
NIH, THIS IS FUN STUFF.
NOT EVERYTHING HERE WILL BE
WONKY SCIENCE RECOMMENDATIONS
BUT ALSO BUILDING TRUST AND
SOLIDARITY AND CONNECTION WITH
YOUR COMMUNITY.
I JUST SAW ON LINKED IN A VIDEO
FROM APPLE WHERE THEY SHOWED
THEIR SUSTAINABILITY REPORT IN
THIS COOL INTERACTIVE SCRIPTED
VIDEO THAT WAS SO MUCH FUN AND
EVEN WHEN YOU SEE IN POLITICAL
POLLING YOU SEE WHEN THE PUBLIC
TRIES TO VOTE ON WHETHER THEY
TRUST CORPORATIONS MORE OR THE
GOVERNMENT IT'S ALWAYS
CORPORATIONS.
SOMETIMES IT'S THINGS LIKE A
FOCUS ON YOUR BRAND AND
CONNECTION WITH THE PEOPLE.
PEOPLE TRUST PEOPLE NOT SYSTEMS.
SO WHO ARE ALL OF YOU AND LET'S
HEAR YOU FROM AND HOW DO YOU PUT
YOU ALL IN FRONT OF THE CAMERA
MORE SO EVERYDAY PUBLIC CAN SEE
YOU?
EXPANSION OF COMMUNITY-BASED
RESEARCH INITIATIVES.
DEVELOP MORE INNOVATIVE WAYS FOR
EVALUATING THE RESEARCH
OPPORTUNITIES.
MY ORGANIZATION HAS TRIED
MULTIPLE OCCASION TO GET IN
RESEARCH AND CAN'T SEEM TO LAND
ON THE RIGHT LANGUAGE THAT
SPEAKS TO REVIEWERS OR SPEAKS TO
PROJECT OFFICERS.
WE CAN'T SEEM TO SPEAK THE
LANGUAGE THAT LANDS THE
OPPORTUNITY.
AND SO MAYBE THERE'S ALSO
OPPORTUNITY IN EXAMINING OTHER
WAYS AND WAYS OF SCOPING SO
COMMUNITIES LIKE OURS DON'T GET
MISSED WHEN WE JUST MAY NOT KNOW
HOW TO SPEAK THE LANGUAGE ALL
THE WAY FOR SCIENCE TO
UNDERSTAND WHAT WE'RE TRYING TO
COMMUNICATE.
FURTHER IMPLEMENTATION SCIENCE.
I'M A BIG FAN OF THE STATE OF
CALIFORNIA'S PROGRAM WHICH IS IN
OUR MEDICAL PROGRAM TO TRY AND
PROMOTE SOCIAL SERVICES AS PART
OF THE INTEGRATED MEDICAL
PROGRAM.
IT'S GIVEN US AN OPPORTUNITY TO
BILL FOR OUR SOCIAL SERVICES AND
WOULD BE INTERESTED IN WHAT THE
EFFECTIVENESS THIS IS FOR THE
IMPLICATIONS OF POLICY AND
FINALLY DISMANTLING THE SILOS.
THERE'S SO MANY OPPORTUNITIES
ENCOURAGING BLENDED FUNDING AND
ADDRESSING THIS IN MORE OF A
SYNDEMIC APPROACH AND HOW DO YOU
BRING IN DIFFERENT FUNDING
OPPORTUNITIES TO FULFILL THE
PROGRAM BUT IT WOULD BE GREAT IF
THE FEDERAL GOVERNMENT DID THAT
TOO AND LOOKED ACROSS DEPARTMENT
AND DIVISIONS TO COME UP WITH
WAYS TO CREATE PRIVATE LEGACIES
IN FUTURE USING INNOVATIVE
DOLLARS AND I'M SURE THERE'S
LIMITATIONS BUT IF YOU CAN JOIN
FORCES WITH DIFFERENT AREAS OF
RESEARCH THAT LOOKS AT DIFFERENT
DEPARTMENTS AND DIFFERENT TYPES
OF STATES THAT WOULD BE GREAT.
THAT'S MY PRESENTATION AND THANK
YOU FOR YOUR TIME.
>> THANK YOU.
THANK YOU SO MUCH FOR ALL THE
GREAT WORK YOU'VE DONE SO FAR.
WE ARE ACTUALLY A MINUTE SHY OF
THE BREAK TIME BUT WHAT WILL
SUGGEST WE TAKE 10 MINUTES OF
QUESTIONS AND MAYBE TRY TO DO
FIVE MINUTES OF BREAK INSTEAD OF
15 FOR WHATEVER PEOPLE NEED TO
DO.
SO LET'S GO AHEAD AND OPEN THE
FLOOR UP.
PLEASE RAISE YOUR HAND YOUR
VIRTUAL HANDS AND WE'LL START
TRYING TO GO IN ORDER FOR ALL
THREE PRESENTATIONS
DR. PEREZ-STABLE AND
DR. NELSON'S AND
MR. MALDONADO'S.
LUIS.
>> I HAVE TWO POINTS I'D LIKE
TO.
I BRING EXPERIENCE OF MENTORED
FACULTY FOR OVER 15 YEARS AND
THE LISTENING SESSION WITH OAR
IN THE UNIVERSITY OF PUERTO RICO
AND MY FIRST POINT IS REGARDING
THE GUIDELINES FOR STUDY SECTION
IN TRYING TO IDENTIFY WHAT IS
SIGNIFICANT REGARDING HEALTH
DISPARITIES.
A LOT OF THE PARTICIPANTS THAT
TRY TO ADVANCE THIS WORK FACE A
CHALLENGE WHEN IT COMES TO
TRYING TO ADDRESS THIS ONE SIZE
FITS ALL ANSWER RELATIVE TO
IMPACT AND THE NEEDS OF THE
COMMUNITY THAT THEY'RE TRYING TO
MAKE A DIFFERENCE IN.
I THINK WE NEED I THINK NIMHD
CAN COME UP WITH GUIDELINE TO
DEFINE WHAT IS SIGNIFICANT IN
COMMUNITIES EITHER ECONOMIC
IMPACT, PERCENT OF INDIVIDUALS
AFFECTED AND WE NEED TO EMPOWER
THE APPLICANT AND STUDY SECTION
TO EVALUATE THESE APPLICATIONS
IF WASN'T TO MOVE FORWARD.
-- WANT TO MOVE FORWARD AND
REDUCING THE GUIDELINES TO THREE
SCORES.
ONE IS FACTOR ONE, IMPORTANCE OF
THE RESEARCH AND PERHAPS THERE'S
OPPORTUNITY TO INFUSE THIS POINT
IN TO WHAT ARE NEW GUIDELINES
FOR EVALUATION BECAUSE I THINK
UNLESS WE DO THAT, UNLESS WE ACT
IN THIS AREA WE'RE NOT GOING TO
CHANGE THE PARADIGMS DR. NELSON
RAISED OR MR. MALDONADO LANGUAGE
THAT TELLS THE STUDY WHAT'S
SIGNIFICANT AND GUIDELINES FOR
HEALTH DISPARITIES WOULD BE AN
IMPORTANT ACTIVITY.
THE SECOND POINT IS REGARDING
WHETHER NIMHD OR OAR WOULD HELP
DEFINE A COMMON DEFINITION OF
HEALTH DISPARITIES RESEARCH THAT
COULD BE USED TO ACCOUNT FOR ALL
THE PORTFOLIOS OF THE INSTITUTES
THAT MEET THIS CRITERIA ACROSS
THE NIH.
BECAUSE WE TALKED ABOUT THE
INSTITUTE AND WE TALKED ABOUT
THE MAJORITY OF MONEY GOING TO
OTHER INSTITUTES THAT HAVE
BIGGER BUDGETS THAT ADDRESS
THESE AREAS.
ACTUALLY COALESCING THE ACTUAL
TOTAL INVESTMENT OF NIH IN
HEALTH DISPARITY AND WHAT
PERCENTAGE OF EACH INSTITUTE IS
GOING IN THIS AREA WITHIN THE
DEFINITION WE'LL AGREE WITH AND
EMPOWER US TO SEE THE GROWTH IN
INVESTMENT AS WELL AS MAKING
SURE THEIR PORTFOLIOS MEET A
MINIMUM OF INVESTMENT IN THIS
AREA.
THOSE ARE MY TWO POINTS.
THANK YOU.
>> THANK YOU.
OMAR.
>> THANK YOU.
A VERY BRIEF REMARK.
I REALLY LIKE THE PRESENTATION
OF DR. NELSON ABOUT
REVOLUTIONARY SCIENCE BUT IT
SEEMS A LOT OF IT WOULD FIT IN
THE CONTEXT OF IMPLEMENTATION
SCIENCE IN THE SENSE THAT WHAT
SEEMS TO BE NEEDED JUST AN
EXAMPLE IS ASTOUNDING IN TERMS
OF THE DECLINE OF HIV INCIDENTS
AMONG WHITE MSM AFTER PREP AND
BLACK INCIDENTS SEEMS TO BE
STAGNANT.
TO ME THAT'S THE FAILURE OF
IMPLEMENTATION SCIENCE
APPROACHES WE HAVEN'T BEEN ABLE
TO DO MORE.
BUT I DON'T UNDERSTAND AND
PERHAPS SOME CLARIFICATION WOULD
BE GREAT.
WHY DO WE NEED DIFFERENT METHODS
IN THE SENSE THAT THE SAME
METHODS WE HAVE WOULD BE GREAT.
LIKE WE HAVE A NEW TECHNOLOGY
SAY mRNA VACCINES AND WE HAVE
NEW IMPLEMENTATION APPROACHES TO
MAKE SURE PREP GETS TO THOSE WHO
NEED IT MOST AND EVALUATE THEM
WITH THE BEST TOOLS WE HAVE
ALREADY IT SEEMS TO ME.
BUT I WOULD LOVE TO HEAR
DR. NELSON'S COMMENTS ON THAT.
THANK YOU.
>> YES, THANK YOU FOR THAT
QUESTION.
AS I THINK OF HOW TO RESPOND TO
IT.
I AGREE, I DON'T THINK WE
NEED -- SO IN MY EXAMPLE WE KNOW
THE EFFICACY OF PREP.
THAT'S NOT IN QUESTION.
IMPLEMENTATION METHODS HAVE
WORKED BUT NOT FOR EVERYONE.
IS THERE A DIFFERENT
IMPLEMENTATION STRATEGY --
>> SORRY TO INTERRUPT.
THE METHOD TO ME SEEMS FINE IT'S
AN RCT WHAT SEEMS TO HAVE FAILED
IS THE IMPLEMENTATION OF PERHAPS
A NOVEL PACKAGE OF
INTERVENTION -- MAYBE I'M
NITPICKING HERE BUT AS A PERSON
THAT CARES DEEPLY ABOUT METHODS
I THINK THE METHOD'S FINE.
WE WOULD NEED AN RCT OR MORE
INNOVATIVE OR REVOLUTIONARY
INTERVENTION.
THAT'S ALL.
I ADMIRE WHAT YOU'RE TRYING TO
DO AND I AM TRYING TO DO THE
SAME I'M JUST SAYING THE METHODS
WE HAVE SEEM FINE AND HAVE
BETTER IDEAS TO DO WHAT NEED TO
BE DONE.
>> AND MAYBE THAT'S THE POINT
ABOUT THE DIFFERENCE BETWEEN
EFFICACY AND IMPACT.
I THINK THEY'RE NOT DOING AS
WELL FOR IMPACT AND FINDING HOUT
TO YOU TO DO EQUITABLE IMPACT.
I DO APPRECIATE YOUR QUESTION.
THANK YOU.
>> I FULLY AGREE.
I WOULD ADD REAL WORLD, WHAT THE
INTERVENTIONS DO IN THE REAL
WORLD IS KIND OF WHAT YOU'RE
GETTING AT AND I THINK BEING
ABLE TO DO THAT IN THE MOST
RIGOROUS WAY IS WHAT WE'RE AFTER
HERE AND WHAT METHODOLOGIES MAY
BE APPLICABLE TO HELP GET US
THERE.
>> I'M FROM NICHD I WAS STRUCK
BY GABRIEL'S COMMENT HOW HARD IT
IS FOR COMMUNITY BASES TO GET
RESEARCH FUNDING AND PART OF THE
IMPROVE BENEFIT TO ADDRESS THE
MORBIDITY OR MORTALITY CRISIS IN
THE COUNTRY WE LAUNCHED A
COMPETITION TO ENCOURAGE SUCH
ORGANIZATION TO DEVELOP THE
INFRASTRUCTURE TO DEVELOP THE
RESEARCH WE NEED AND IF WE'RE
GOING TO ADDRESS THE MATERNAL
HEALTH CRISIS IT'S GOT TO BE IN
THE COMMUNITIES WHERE THAT IS
HAPPENING AND THAT'S OFTEN NOT
THE ACADEMIC MEDICAL CENTER.
AS PART OF THE CHALLENGE THESE
ORGANIZATIONS WERE ABLE TO
COMPETE FOR CASH PRIZES THAT
ALSO THEN GAVE THEM THE
RESOURCES TO START DEVELOPING
THE CAPACITY AND DO THE TRAINING
TO BETTER ENGAGE IN RESEARCH.
AGAIN, WITH I THINK THE
FINALISTS WILL GET ANNOUNCED
NEXT YEAR BUT SOMETHING WE HEAR
CLEARLY THE PROBLEM YOU
IDENTIFIED AND ARE TRYING TO
ADDRESS IT IN SOME NOVEL WAYS.
>> JOHN.
>> I WANTED TO REITERATE THE
APPLICATION OF IMPLEMENTATION
SCIENCE AND LOOK AT WAYS TO LOOK
AT OUTCOMES WHERE WE COMPARE
WHAT I WOULD SAY TRADITIONAL
NIH-FUNDED SCIENCE LIKE
DEVELOPMENT OF AN HIV VACCINE
VERSUS UTILIZING PREP WHICH HAS
AN AFFECT SIMILAR TO A VACCINE
IN TERMS OF ELIMINATING NEW
CASES.
I THINK WE HAVE THOSE ANALYTICS
AN CAN SHOW THAT EVIDENCES IT
WILL ENHANCE OUR OBJECTIVES
AROUND HEALTH CARE DISPARITIES.
>> DR. PEREZ-STABLE.
>> ANSWERING THE FIRST TWO
COMMENTS, NIMHD IS CHARGED WITH
MONITORING AND ASSESSING THE
INVESTMENTS ACROSS THE AGENCY IN
MINORITY HEALTH AND HEALTH
DISPARITIES.
THERE ARE TECHNICAL CHALLENGES
OF WHAT COUNTS.
WE HAVE COME METHODOLOGICALLY
AND THERE'S AN ALGORITHM AND
HOPEFULLY IN 2024 WE'LL HAVE A
GOOD HANDLE ON THAT.
IT'S IN THE BALLPARK OF ABOUT $5
BILLION.
YOU COULD DO THE MATH.
THIS IS SCIENCE NOT CAPACITY
BUILDING OR INCLUSION OR
DIVERSITY OF THE WORKFORCE.
THIS IS ACTUAL RESEARCH.
AND LOOKING AT IT BY INSTITUTE
IS GOING TO BE PART OF MY
RESPONSIBILITY WHICH I'LL
PRESENT TO MY COLLEAGUES AT ONE
POINT.
THE ISSUE RAISED ABOUT THE
METHODS, I WOULD SAY, YES, YOU
NEED A CLINICAL TRIAL BUT HOW DO
YOU GET PEOPLE TO IT?
WHAT WE PHASE WITH THE COVID-19
TRIAL IF YOU LOOK AT WHAT
HAPPENED IN THE FIRST TWO
MONTHS, 90% OF THE VOLUNTEERS
WERE WHITE AND THE PANDEMIC WAS
DISPROPORTIONATELY IMPACTING
AFRICAN AMERICAN, LATINO,
AMERICAN INDIAN AND ALASKAN
NATIVE COMMUNITY AND IT'S HOW WE
ENGAGE PEOPLE THAT HAS TO BE
TAILORED AND DIFFERENT AND THOSE
ARE METHODS TOO.
I'LL LEAVE IT AT THAT.
THANKS.
>> THANK YOU.
>> I'M INTRIGUED BY THE
CONVERSATION.
STARTED BY OMAR AND I THINK IT
WOULD BE HELPFUL FOR MORE
ENGAGEMENT BY NIH, OAR TO THINK
ABOUT THE CROSS-SECTION BETWEEN
METHODOLOGY AND HOW ARE WE
ANSWERING QUESTIONS, WHAT
QUESTIONS WE'RE ANSWERING WHICH
OFTEN COMES FROM THE OBSTACLES.
AND MAYBE MORE IN MY INSTITUTION
THAN NIH WHERE PEOPLE IDENTIFY
DISPARITIES AT INEQUITIES.
USUALLY RACIAL AND ETHNIC BUT
CAN BE OTHERS AS WELL AND THEY
DON'T SPEND TIME ON
INTERVENTIONS.
SOMETIMES THE INTERVENTIONS CAN
BE A DAILY PILL FOR PREP INSTEAD
OF REDUCING SEXUAL PARTNERS OR
SOMETIMES LONG ACTING AGENTS BUT
THINKING CAREFULLY WHAT ARE THE
MOST CRITICALLY APPLIED RESEARCH
QUESTION AND SOMETIMES
OPERATIONAL ONES AND SEEING WHAT
METHODS WOULD ABUT US -- ALLOW
US TO IMPLEMENT THEM KNOWING WHO
IS INCLUDED IS ONE OF THE MOST
ESSENTIAL ASPECTS OF A STUDY TO
KNOW THE ANSWER YOU WANT IF NOT
IT'S NOT ASKING THE QUESTION
FROM THE POPULATIONS MOST
AFFECTED.
ALL OF THAT TOGETHER I THINK
COULD HELP AND WON'T BE DECIDED
IN THIS MEETING BUT PROBABLY ONE
OF THE MOST IMPORTANT QUESTIONS
FOR US IN GOVERNMENT AND
RESEARCH IS TO SAY WHEN WE LOOK
BACK WHAT MADE THE BIGGEST
DIFFERENCE AND WHAT WOULD WE
HAVE KNOWN ENOUGH THEN TO HAVE
NOT DONE OR WISH WE HAD KNOWN
ENOUGH NOT TO HAVE SPEND THE
MONEY AND FOR ALL OF US IT'S A
LARGE AMOUNT OF MONEY.
>> THANK YOU.
VERY GOOD POINTS.
I APPRECIATE THAT.
AND DR. COLLINS IS NEXT.
>> THANK YOU FOR TAKING MY
QUESTION/COMMENT.
SO ONE OF MY ROLES IS TO SERVE
AS THE MSTP DIRECTOR AND IN THAT
ROLE WE TRY TO RECRUIT A DIVERSE
GROUP OF M.D. Ph.D. TRAINEES WHO
OFTEN PLAY A BIG AND IMPORTANT
ROLE IN ALL KINDS OF ASPECTS OF
THIS AND ONE OF THE THINGS THAT
WE FACE IS A VERY SMALL PIPELINE
OF DIVERSE APPLICANTS AND IN
PARTICULAR AFRICAN AMERICAN
APPLICANTS.
OUR INSTITUTION COMMITS TO A
PIPELINE PROGRAM TO BRING IN
DIVERSE APPLICANTS EVERY SUMMER
AND DO WHAT WE CAN TO INTEREST
THEM IN OUR PATHWAYS AND HELP
THEM WITH THEIR APPLICATIONS SO
THEY'RE AS EXPRESSIVE AS
POSSIBLE THIS IS A FOCUS A LONG
TIME FOR DIRECTORS OF THESE
PROGRAMS AND WE'VE NOT REALLY
BEEN ABLE TO ACHIEVE AN
EXPANSION OF THE APPLICANT POOL.
THERE'S A RELATIVE DEARTH OF
SCARCITY OF FUNDS FROM THE NIH
FOR THESE KINDS OF PROGRAMS.
THERE'S PREP AND THINGS LIKE
THAT BUT THE NUMBER OF SLOTS
WERE LIMITED AND I GUESS I JUST
WANTED TO PUT MY TWO CENTS IN
FOR GETTING THE NIH PERHAPS
PERHAPS MORE PROGRAMS TO EXPAND
THE WORKFORCE OF DIFFERS
APPLICANTS GETTING INTO SCIENCE
AND MEDICINE AND PHYSICIAN
SCIENTIST TRAINING PROGRAMS AND
MOTIVATING THEM TO DO SO.
WE CAN'T DO TOO MUCH OF THAT AS
THESE THEY REPRESENT THE GROUPS
OF PEOPLE AND MAY HAVE THE BEST
WAYS OF UNDERSTANDING HOW TO
REACH THEM AND SOLVE SOME
PROBLEMS.
>> I APPRECIATE THAT.
ALL VALID POINTS.
WE HAVE TIME FOR ONE MORE
QUESTION AND THEN I'M GOING TO
TRY AND SEE IF I CAN GIVE US 10
MINUTES FOR BREAK.
>> LET ME COMMENT ON
DR. COLLINS' LAST STATEMENT.
I MENTIONED THE NIH PIONEER
AWARDS I WAS THINKING ABOUT
APPLYING THAT LOGIC TO TRAINING
PROGRAMS.
SO YOU CAN DO WHAT YOU TALKED
ABOUT.
IT SEEMED LIKE A VERY
AVANT-GARDE WAY TO GET AT THINGS
THAT OTHERWISE I THINK SUFFER
DUE TO NORMAL -- THESE REGULAR
REVIEW PROCESS.
I JUST WANTED TO ACKNOWLEDGE
WHAT YOU SAID AND I AGREE.
>> THANK YOU, LA RON.
WORD TO DR. OTT AND GO FOR
BREAK.
>> THANK YOU.
I DON'T WANT TO KEEP ANYONE FROM
THE BREAK BUT I WOULD LIKE IT
HEAR MORE ABOUT THE METHODS HOW
TO REACH OR ADDRESS THE MISTRUST
IN MEDICAL INTERVENTIONS IN
CERTAIN COMMUNITIES BECAUSE
ESPECIALLY FOR THE MBC
COLLABORATORIES WE HAVE A LARGE
COMMUNITY OUTREACH PROGRAM ALSO
WHERE WE'RE TRYING TO DO THIS,
REACHING COMMUNITIES WHO NEED IT
THE MOST BUT ENCOUNTER A LOT OF
MISTRUST AND IF THERE'S POINT
FOR HIV I WOULD LIKE TO HEAR
MORE IN THE PANEL DISCUSSION
ABOUT METHODS HOW TO BEST
ADDRESS THIS.
>> YES.
YOU ALMOST READ OUR MINDS.
THAT'S WHAT WE GET TO.
LET'S TAKE A 10-MINUTE BREAK AND
COME BACK AT 2:35 EASTERN TIME
AND IN THE INTERIM, I BELIEVE
THERE'S OTHER INSTRUCTIONS.
DON'T LOG OUT OF THE ZOOM BUT
MUTE YOUR LINE AND HIDE YOUR
CAMERA.
WELCOME BACK, EVERYONE.
WE'LL NOW RESUME THE OARAC
MEETING WITH AN NIH PANEL ON
INTEGRATING SYNDEMIC MODELS IN
HIV HEALTH DISPARITIES RESEARCH.
I'M TIMOTHY HOLTZ AND
DR. KAPOGIANNIS WILL CO-MODERATE
AND WE'LL HAVE REPRESENTATION OF
SEVEN INSTITUTES WITH PORTFOLIOS
THAT ADDRESS HIV HEALTH
DISPARITIES.
A MODERATED DISCUSSION AMONG
PANELIST AND WITH OARAC MEMBERS.
WE'LL AIM TO END AT 3:55 EASTERN
TIME.
WELCOME AND THANK YOU FOR
JOINING US.
TO GET STARTED I'LL CALL ON YOU
IN ALPHABETICAL ORDER TO
INTRODUCE YOURSELVES TO GIVE A
BRIEF DISCUSSION OF YOUR TITLE,
AFFILIATION AND WHAT YOUR
INSTITUTE OR OFFICE FOCUSES ON
REGARDING HIV AND HIV-RELATED
RESEARCH.
>> CALLING ON THE PANELISTS IN
ALPHABETICAL ORDER, DR. AKLIN.
>> GOOD AFTERNOON AND THANK YOU
FOR ALLOWING ME TO PARTICIPATE
TODAY.
I'M CURRENTLY SERVING AS THE
DEPUTY DIRECTOR OF THE NATIONAL
INSTITUTE OF NURSING RESEARCH.
EXCITED TO BE HERE.
JUST TO SHARE A LITTLE BIT ABOUT
WHAT WE DO AS WE MOVED INTO A
NEW ERA FOR THE WORK WE'RE
SUPPORTING OUR MISSION SO TO
HELP INFORM PRACTICE AND POLICY
TO OPTIMIZE HEALTH AND ADVANCE
HEALTH EQUITY IN THE FUTURE.
SINCE 1985 WE HAVE BEEN DOING
THE WORK NECESSARY TO SUPPORT
THE DEVELOPMENT OF A LIFE COURSE
PERSPECTIVE AND TYPICALLY WHAT A
MEAN BY THAT IS AT THE CORE WE
HAVE THE ABILITY TO COME UP WITH
SOLUTIONS AND POWER TO HAVE A
BROAD REACH BECAUSE NURSES ARE
EVERYWHERE.
IN OUR CLINICS AND HOSPITALS AND
WORKPLACES AND HOMES AND THAT
GIVES US THE OPPORTUNITY TO
BRIDGE AND ASK QUESTIONS AND WE
NOW HAVE AN IN PLACE A 2022-2026
STRATEGIC PLAN.
WE HAVE FIVE RESEARCH LENSES TO
GIVE A PERSPECTIVE TO LOOK AT
HEALTH EQUITY, SOCIAL
DETERMINATES OF HEALTH,
POPULATION AND COMMUNITY HEALTH,
PREVENTION, HEALTH PROMOTION AND
SYSTEMS OF MODELS OF CARE.
WE'RE ENCOURAGING INVESTIGATORS
TO LOOK AT THE LENSES BECAUSE OF
THIS WE'RE ABLE TO HARNESS
RESEARCH IN DIFFERENT AREAS NOT
NECESSARILY FOCUS ON ONE
PARTICULAR DISEASE BUT IN
PARTICULAR TO THE WORK LOOKING
AT HIV/AIDS RESEARCH AND I'LL
PAUSE THERE BECAUSE I RECOGNIZE
WE WANT TO BE BRIEF.
THANK YOU.
>> DR. CHRISTOPHER BARNHART.
>> I'M CHRISTOPHER.
I'M A HEALTH SCIENCE POLICY
ANALYST.
OUR OFFICE COORDINATES RESEARCH
WITH THE HEALTH AND WELL-BEINGLY
WORKING WITH THE NIH INSTITUTES
AND OFFICE AND PROVIDE SUBJECT
MATTER EXPERTISE ACROSS THE NIH
AND LIAISE TO ENSURE POPULATION
CONSIDERED AND REPRESENTED
ACROSS THE AGENCY.
WE DON'T HAVE OUR OWN RESEARCH
PORTFOLIO BUT WE REGULARLY FUND
GRANTS AND CONTRIBUTE TO
ACTIVITIES RELATED TO HIV AND
MONITOR AND PERFORM ANALYSES ON
IN HEALTH RESEARCH.
THE HIV/AIDS AS A SUBJECT HAS
ALWAYS ACCOUNTED FOR AND
CONTINUES TO ACCOUNT FOR A
SIGNIFICANT PORTION OF THE
PORTFOLIO AND LOOK AT LGBTQ
COMMUNITIES GAY, BISEXUAL AND
MEN HAVING SEX WITH MEN AND
TRANSGENDER WOMEN WHO ARE BLACK,
AFRICAN AMERICAN, LATINO,
AMERICAN INDIAN AND ALASKAN
NATIVE AND THOSE WHO INJECT
DRUGS OR ENGAGE IN SEX WORK OR
SOCIO ECONOMICALLY DISADVANTAGED
AND LOOKING AT INTERVENTIONS TO
HALT THE SPREAD OF HIV AND
MEASURES FOR SGM FOLKS AND LOOK
AT THE CONTINUUM FOR ALL SGM
PEOPLE.
IT'S MY PLEASURE TO BE HERE AND
LOOKING FORWARD TO A RICH AND
INTERACTIVE DISCUSSION.
>> DR. BRYANT.
>> I'M THE DIRECTOR OF HIV/AIDS
AND ALCOHOL RESEARCH FOR NIAAA.
I'VE BEEN INVOLVED IN THE
PORTFOLIO SINCE THE 1990s.
WE HAVE LOOKED AT COHORT
STUDIES, ALTERNATIVE CENTRAL
APPROACHES TO LOOKING AT HEALTH
CARE SYSTEMS AND THE ROLE OF
ALCOHOL USING ELECTRONIC MEDICAL
RECORDS, APPLICATION OF BIG
DATA, ARTIFICIAL INTELLIGENCE.
WE NOW HAVE ENCODED OVER 11
MILLION V.A. RECORDS WITH
PATIENTS WE LOOKED AT IN
MULTIPLE WAYS BROADLY SPEAKING
WE EMPHASIZED PERSON BY
ENVIRONMENT APPROACHES RELEVANT
TO BEHAVIORAL AND
PATHOPHYSIOLOGICAL AFFECTS FOR
PATTERNS OF ALCOHOL CONSUMPTION
AND ACCESS AVAILABILITY OVER THE
ENVIRONMENT OVER THE LIFE SPAN
INCLUDING HEALTH CARE AND OTHER
ASPECTS AND POLICY ISSUES.
AND LOOKS AT THE ROLE OF WHICH
IS USE AND ALCOHOL-RELATED
DISEASES IN THE CONTEXT OF
PREVENTION AND TREATMENT FOR
HIV/AIDS.
ALCOHOL USE DISORDER AND
INCLUDING HEAVY EPISODIC
DRINKING DIRECTLY IMPACTS
INCREASES IN HIV INFECTION,
FAILURE IN THE TREATMENT CASCADE
TO IMPAIR ADHERENCE TO
MEDICATIONS AND TOXICITY AND
INTERACTIONS WITH MEDICATIONS
AND OTHER MULTIPLE MEDICATIONS
PARTICULARLY PSYCHOTROPIC
MEDICATIONS AND ONES PRESCRIBED
WITH AGING AND OTHER COMORBID
ILLNESSES SUCH AS COMPLICATIONS
AND CO-INFECTIONS LIKE T.B. AND
FALLS AND FRACTURES AND
INSUFFICIENT HOUSING AND OTHER
ENVIRONMENTAL FACTORS.
NIAAA HAS FOUR DIVISIONS LOOKING
AT HEALTH EFFECTS, METABOLISM
AND TREATMENT AND NEUROSCIENCE
AND THEY ALL INCLUDE LARGE
COHORT ACTIVITIES ALSO IN
COLLABORATION WITH OTHER I.C.s.
RELEVANT TO THE CURRENT
DISCUSSION, NIAAA SPECIFICALLY
FINDS INTERSECTIONAL APPROACHES
WITH POPULATION-LEVEL RESEARCH
AND THE ROLE OF HIV RISK
RESEARCH AND ALCOHOL IN
DISPARITIES AND DIVERSE SEXUAL
MINORITY YOUTH AND OTHER HIGH
RISK POPULATIONS.
THANK YOU.
>> THANK YOU.
DR. REDONNA CHANDLER.
>> GOOD AFTERNOON, EVERYONE.
I'M THE DIRECTOR OF THE HIV
RESEARCH PROGRAM AT NIDA AND THE
HEALING COMMUNITY STUDY.
NIDA SUPPORTS A WIDE PORTFOLIO
ACROSS A RANGE OF SCIENCE
EVERYTHING FROM BASIC SCIENCE TO
PREVENTION, TREATMENT
DEVELOPMENT, EPIDEMIOLOGY AND WE
HAVE HAD FOR OVER TWO DECADES
NOW A LARGE IMPLEMENTATION
SCIENCE PORTFOLIO THAT LOOKS AT
TRYING TO ENSURE THAT EFFECTIVE
TREATMENT, INTERVENTIONS AND
PRACTICES REACH THOSE WHO ARE
MOST AT NEED AND THAT BREADTH OF
SCIENCE FOCUSSED ON SUBSTANCE
USE AND ADDICTION INCLUDES THE
INTERSECTION AT HIV.
WE'RE THE SECOND LARGEST FUNDER
OF HIV RESEARCH NIH BEHIND NYE
ADD THAT RECOGNIZE THE NATURAL
OF SUBSTANCE USE ADDICTION AND
HIV WITH OTHER CO-OCCURRING
DISORDERS AND HAVE A QUESTION
AROUND SYNDEMIC APPROACHES WE'LL
ADDRESS LATER.
IN PART OF WHAT'S BEEN PERTINENT
TODAY, NIDA HAS ALWAYS
RECOGNIZED A DISPROPORTIONATELY
BURDEN OF SUBSTANCE USE DISORDER
AND HIV ON AMERICAN INDIAN,
NATIVE ALASKANS AND BLACKS AND
HISPANICS.
WHILE SUBSTANCE USE INITIATION
AMONG THOSE MINORITY INDIVIDUALS
BEGINS AT A LATER AGE IN
ADOLESCENCE, THEY BEAR
DISPROPORTIONATELY CONSEQUENCES,
SOCIALLY, LEGALLY, MEDICALLY WE
HAVE HAD A FOCUS ON THOSE GROUPS
AND I'M ABLE TO DEVELOP AND
SUPPORT RESEARCH IN THREE KEY
AREAS.
ONE IS WITH WITHIN COMMUNITY
ENGAGED RESEARCH AND WE'RE
SUPPORTING ONE OF THE LARGEST
COMMUNITY-ENGAGED RESEARCH
INITIATIVES IN 67 COMMUNITIES
ACROSS THE COUNTRY RIGHT NOW
THAT HAVE BEEN IMPACTED BY THE
AND HAVE AN EFFORT TO ENHANCE
WELLNESS OR IMPROVE.
IT'S A LARGE RESEARCH NETWORK
THAT PARTNERS WITH TRIBES ACROSS
THE COUNTRY.
IT'S INTENDED TO HELP INDIGENOUS
PEOPLES AND TRIBES TO
BUILD CAPACITY AND FOR THEM TO
BE ABLE TO IDENTIFY AND
PRIORITIZE RESEARCH WITHIN THE
SPACE OF HEALTH AND SUBSTANCE
USE.
WITHIN THE GOAL OF BEING ABLE TO
IMPROVE ACCESS TO SUBSTANCE USE
PAIN, TREATMENT AND OTHER
RELATED HEALTH CONDITIONS.
WE'VE ALSO HAD A LONG STANDING
COMMITMENT TO SCIENCE INCLUDING
HIV WORK WITH INDIVIDUALS
INVOLVED IN THE JUSTICE
POPULATION WHICH AGAIN ARE
MOSTLY MINORITY INDIVIDUALS.
AND WE HAVE JUST RECENT LY AND
HAVE A LARGE NETWORK LOOKING AT
PROVIDING EFFECTIVE HIV CARE AS
PART OF ENDING THE HIV EPIDEMIC
IN THE UNITED STATES FOR THOSE
INVOLVED IN CRIMINAL JUSTICE.
SO OUR INSTITUTE DIRECTOR HAS A
HUGE COMMITMENT TO THE AREA OF
HIV RESEARCH AND MAKING SURE
THAT IT'S WELL INTEGRATED INTO
ALL THE INITIATIVES WE SUPPORT.
>> THANK YOU.
DR. ELISEO PEREZ-STABLE.
>> YOU ALREADY HEARD ABOUT ME.
I THINK AT NIMHD'S FOCUS
RECENTLY HAS BEEN ON
INTERVENTIONS ALONG THE LINES OF
OUR PRIORITIES WITH THE CLINICAL
SETTING, SUPPRESSING VIRAL LOAD
AND PROMOTING THE UPTAKE OF PREP
IN THE POPULATIONS WE DISCUSSED.
I WOULD COMMENT THAT WE HAVEN'T
BEEN GETTING AS COMPETITIVE RO1
APPLICATIONS IN THE LAST TWO OR
THREE YEARS ON HIV.
WE DID A LITTLE BIT BETTER THE
LAST FISCAL YEAR BUT IN HIV I
THINK THE TARGET POPULATIONS ARE
CLEAR.
THANKS.
>> DR. DINANNE ROUSH.
>> WE LOOK TO ALLEVIATE
CONSEQUENCES OF HIV IN THE
ANNIVERSARY SYSTEM AND
PREVENTING HIV TRANSMISSION AND
MORBIDITY AND MORTALITY AMONG
THOSE LIVING WITH HIV.
THE HIGH EMPHASIS ON MENTAL
HEALTH AND THE ROLE IT PLAYS
ACROSS ALL THE AREAS.
WE LOOK ACROSS MULTIPLE
POPULATIONS WITH STRONG
ATTENTION TO THE DIVERSITY,
EQUITY, INCLUSION AND ACC
ACCESSIBILITY OVER THE LIFE SPAN
AND LOOK AT THE TREATMENT
CASCADE AND HAVE A STRONG
IMPLEMENTATION SCIENCE PROGRAM
ON RESEARCH TO ENHANCE
DISSEMINATION STRATEGIES AND THE
IMPACT OF EFFECTIVE
INTERVENTIONS UNDERSTANDING THE
PHYSIOLOGY WITH CNS PATH OL WITH
THE GOAL OF EFFECTIVE TREATMENT
AND CHARACTERIZING PERSISTENCE
IN THE CNS AND ERADICATION
STRATEGIES AND USING NOVEL DATA
SCIENCE TO ENHANCE PREVENTION,
TREATMENT AND CURE EFFORTS.
WE PARTNER IN OUR WORK AND LOOK
FORWARD TO THE DISCUSSION
BECAUSE WE ALSO HAVE A STRONG
PROGRAM IN INTERSECTIONALITY.
THANKS.
I'LL STOP THERE.
>> THANK YOU.
OUR FINAL PANELIST DR. WALTERS.
>> CAN YOU HEAR ME OKAY?
>> QUESTION.
>> GREAT.
IT'S GREAT TO BE HERE.
I'M KARINA WALTERS ENROLLED IN
THE FOUNDATION OKLAHOMA AND
DIRECT THE TRIBAL HEALTH
RESEARCH OFFICE HERE AT THE
NATIONAL INSTITUTES OF HEALTH
STARTED FIVE MONTHS AGO SO I'M
STILL GETTING FAMILIAR.
IT'S A VIBRANT HUB STRATEGICALLY
COORDINATING AND COLLABORATING
WITH PARTNERS AND NATIVE SERVING
ORGANIZATIONS TO BUILD THE
WORKFORCE FOR LIVES AND
COMMUNITIES PRIMARILY FOR
BUILDING AND COLLABORATING ON
DEVELOPING INNOVATIVE INDIGENOUS
RESEARCH AND THAT INCLUDES
PREVENTION RESEARCH IN THE
HIV/AIDS PREVENTION RESEARCH AND
DEVELOPING A NATIVE RESEARCH
WORKFORCE AND ALSO INTRAMURALLY
PROVIDING TECHNICAL ADVISING FOR
BUILDING COMPETENCY FOR OUR NIH
WORKFORCE TO PARTNER WITH
TRIBAL ENGAGEMENT IN COMMUNITIES
AN LOOK FORWARD IN THAT
EXTERNALLY FACING OFFICE OF THE
DIRECTOR AND FINALLY
COORDINATING AND COLLABORATING
BOTH WITHIN NIH AND ACROSS THE
I.C.s TO CONSIDER INNOVATIONS IN
PROGRAM AND RESEARCH AND
PARTNERING WITH OTHER HHS TRIBAL
OPTIVES ON STRATEGIC INITIATIVE
AND POLICY DEVELOPMENT.
WE DON'T DEVELOP GRANTS BUT
PARTNER AND ON A PERSONAL NOTE
PRIOR TO MY ARRIVAL HERE I WAS
AN AMERICAN INDIAN HIV
RESEARCHER.
EXCITED TO BE HERE AND BE ABLE
TO ALSO TALK ABOUT OPPORTUNITIES
FOR COLLABORATING ACROSS THE
I.C.s TO DEVELOP BETTER HIV
PREVENTION COMMUNITIES.
WE TEND TO BE REALLY INVISIBLE
AND RACIALLY MISCLASSIFIED IN
DATA SYSTEMS.
WE HAVE HIGH NEED IN THIS AREA.
GLAD TO BE HERE.
>> THANK YOU ALL.
I'M EXCITED TO GET STARTED.
WE'RE GOING TO START WITH
DR. PEREZ-STABLE I KNOW YOU HAVE
A 3:00 P.M. HARD STOP AND WE'LL
START BY SPEAKING ABOUT
INTEGRATION OF METHODS AND BEST
PRACTICE AND CONTINUE THE
DISCUSSION BEFORE THE BREAK.
GIVEN WHAT WE HEARD FROM YOU
ABOUT THE NEED TO ADDRESS HIV
HEALTH DISPARITIES RESEARCH
USING SYNDEMIC MODELS AND LOOK
AT RESEARCH AND WHAT WILL YIELD
OUTCOMES ON MINORITIZED
POPULATIONS?
>> THANK YOU.
I'M OPTIMISTIC BUT IT'S YET TO
BE GET ESPECIALLY AFTER
DR. NELSON'S PRESENTATION.
THERE'S TWO BIG CATEGORIES.
ONE IS A COMMUNITY-ENGAGED
RESEARCH METHOD TO LOOK AT A
COMMUNITY WHATEVER WAY WE DEFINE
IT AND CREATE A SUSTAINABLE
PARTNERSHIP LOOKING AT MUTUAL
REPRESENTATION -- RESPECT AND
TRUST.
PEOPLE HAVE BEEN IMPLEMENTING
THESE METHODS FOUR DECADE.
IT'S ON AND OFF ACCORDING TO THE
GRANT CYCLE.
I THINK WE'RE AT THE POINT WE
THINK IT'S TIME TO GENERICALLY
SUSTAIN A NETWORK TO BE ADAPTED.
THE SECOND IS IMPLEMENTATION
SCIENCE.
THERE'S EFFICACY FOR A DIFFERENT
DRUG, BEHAVIORAL APPROACH OR
VACCINE AND GETTING IT TO PEOPLE
MOST IN NEED.
WIFE NOT INSTEAD OF INTO THAT
WHETHER IT'S VIRAL PREVENTION
AND LOOKING AT SUB-SAHARAN
AFRICA AND PREP AND BEHAVIOR
MODIFICATION IN TERMS OF CONDOM
USE OR OTHER APPROACHES I THINK
WERE IMPORTANT.
THE FINAL POINT IS THE
STANDARDIZED MEASURES.
AS WE COLLECT MORE DATA IN
COMMUNITY SETTINGS, NOT
MEASURING THINGS DIFFERENTLY ON
THE DEMOGRAPHIC OR SOCIAL
DETERMINATES OF HEALTH AND OTHER
VARIABLES IS CRITICAL FOR OUR
SCIENTIFIC COMMUNITY TO DO.
AND DURING THE PANDEMIC WE
IMPLEMENTED THAT IN THE RADXUP
INITIATIVE AND THERE'S
CHALLENGES THOUGH WE GOT GOOD
UPTAKE ACROSS THE COUNTRY IN A
LARGE PROGRAM.
THANK YOU.
>> THANK YOU SO MUCH, ELISEO AND
THANK YOU AGAIN FOR JOINING US
TODAY.
I'D LIKE TO TURN TO DR. RAUSCH
AND DR. BARNHART.
AS INTERSECTIONALITY LOOKS AT
CAUSES OF HEALTH INEQUITIES WHAT
DO YOU LOOK TO ADVANCE
INTERVENTIONALITY RESEARCH AND
START WITH DR. RAUSCH.
>> WE CONSIDER IT CRITICAL TO
ADDRESS THE ISSUE OF
INTERSECTIONALITY IN THE CONTEXT
OF HIV.
OUR APPROACH HAS BEEN TO SUPPORT
RESEARCH THAT EMPHASIZES BASIC
BEHAVIORAL AND SOCIAL SCIENCE
PRIORITIES AIMED AT ENDING THE
PANDEMIC AND ENDING THE HEALTH
OUTCOME FOR PEOPLE WITH HIV
ACROSS ALL POPULATIONS.
AND OUR ADVANCEMENT OF THE
INTERACTIONALITY BASED RESEARCH
HAS INCLUDED RESEARCH PROGRAMS
AND INITIATIVES AND WORKSHOPS
AND RFAs AND PARs AND NOSIs AND
PUBLISHED MANUSCRIPTS.
AND RECENTLY A SPONSORED JOURNAL
IN THE APAH.
AND SOME EXAMPLES INCLUDED IN
WHAT WE HAVE DONE AND CONTINUE
TO DO, IN 2020, NIMHD AND OAR
SPONSORED A STIGMA AND
DISCRIMINATION WORKSHOP TO MO
MODELS LOOKING AT DISCRIMINATION
TO INFORM HIV AND HIV PREVENTION
AND RESEARCH BROADLY.
THE OPENING AND CLOSING SESSIONS
OF THE WEBINARS ARE PUBLICLY
AVAILABLE AS WELL AS A SUMMARY
OF THE WORKSHOP.
SEVERAL IMPORTANT OUTCOME FROM
THAT WORKSHOP INCLUDE RESEARCH
TO APPLY MICROLONGITUDINAL
DESIGNS TO IDENTIFYING
MECHANISMS AN PATHWAYS THAT
UNDER LIE STIGMA AND PROMOTE
MULTI-LEVEL AND STRUCTURAL
INVENTIONS THAT MOVE BEYOND THE
INDIVIDUAL LEVEL OF
UNDERSTANDING.
ALSO WE ADDRESSED
INTERSECTIONAL STIGMA TO IMPROVE
HIV OUTCOMES.
THIS FOCUSSED ON MEASUREMENTS,
HOW TO MEASURE IT AND ONCE YOU
UNDERSTAND HOW TO MEASURE IT,
YOU CAN BEGIN TO UNDERSTAND
OPPORTUNITIES TO INTERVENE AMONG
MULTIPLE LEVELS.
ALSO IN 2023, ALONG WITH NIAD WE
LOOKED AT THE NIMHD RESEARCH
CENTERS WHICH INCLUDED THE EHE
SCIENTIFIC PRIORITIES, SYNDEMIC
APPROACHES TO HIV PREVENTION AND
TREATMENT AND APPROACHES TO
INCREASE FOCUS ON INTERSECTING
DISEASES AND SOCIAL CONDITIONS
THAT ACERBATE HEALTH INEQUITIES.
ALSO TO ENHANCE THE
EVIDENCE-BASED APPROACHES TO
ASSESS, MONITOR AND INTERVENE
WITH RESPECT TO THESE
INTERSECTIONS FOR OPTIMAL
OUTCOMES AND PREVENTION AND
TREATMENT.
WE RECENTLY IN '23 PUBLISHED A
NOTICE OF SPECIAL INTEREST WITH
STIGMA AND DISCRIMINATION AND
OTHER SOCIAL AND STRUCTURAL
DETERMINATES OF HEALTH IN HIV
TREATMENT TO EXPAND THE RESEARCH
BASE TO UNDERSTAND BETTER AND
DEVELOP NEW INTERVENTIONS.
THIS NOSI SOLICITS THEORETICALLY
AND EMPIRICALLY DRIVEN RESEARCH
APPLICATIONS TO ADVANCE
MEASUREMENT AND UNDERSTANDING
FOR STRUCTURAL FACTORS TO
EXAMINE THE MECHANISMS AND
PATHWAYS BY WHICH THEY ARE
BARRIERS SO THEY CAN BE USED TO
DEVELOP AND TEST INTERVENTIONS
TO ADDRESS SPECIFICALLY WHAT
THEY ARE AND HAVE AN IMPACT TO
IMPROVE THE PREVENTION AND
TREATMENT OUTCOMES.
ALSO WE'VE BEEN SUPPORTING
IMPLEMENTATION SCIENCE AND
ENCOURAGE EVIDENCE-BASED
INTERVENTIONS.
AND FINALLY, THIS CALLS FOR A
SPECIAL ATTENTION TO KEY
POPULATIONS SUCH AS MINORITY
WOMEN LIVING WITH HIV AS WELL AS
MEN WHO HAVE SEX WITH MEN AND
OTHER SEXUAL AND GENDER MINORITY
GROUPS PARTICULARLY THOSE YOUNG,
MINORITY AND LIVING IN THE
SOUTHERN REGION OF THE U.S.
>> DR. BARNHART.
>> I THINK THE PLACE TO START IS
IMPROVING MEASURES OF
INTERSECTIONALITY AND
OPPRESSION, DISADVANTAGE, POWER
DYNAMICS,ETS PERHAP THIS WILL
ABUT US TO MORE CLEARLY AND
DEFINITIVELY LINK THEM TO
HEALTH.
VALIDATION SHOULD BE PERFORMED
WITH THE INTENDED AUDIENCE AND
MEASURES OF DISADVANTAGE SHOULD
BE VALIDATE WITH SGM YOUTH AND
VALIDATION MEASURES AND A PLACE
WHERE MORE QUALITATIVE MEASURES
MAY CAPTURE DIMENSION AND
INTERSECTIONALITY.
AND WE NEED TO DEVELOP
STATISTICAL METHODOLOGY AND
TOOLS TO ALLOW ANALYSIS OF
COMPLEX DATA.
WE HAVE AN NOFO TO DEVELOP AND
IMPROVE METHODS, MEASURES AND
ANALYTICAL TECHNIQUES WHICH
WOULD BE RELEVANT AND I'LL SAR
SHARE THEM LATER.
I RECOMMEND LOOKING AT SEX
CHARACTERISTIC DATA AS
DEMOGRAPHIC DATA IN STUDIES THAT
DON'T NECESSARILY FOCUS ON THESE
BUT INCLUDE MEMBERS OF OTHER
MARGINALIZED COMMUNITIES AND
VICE VERSA COLLECTION OF SGM
STUDIES WOULD BE IMPORTANT AND
INFORMATIVE.
I THINK WE NEED TO INVESTIGATE A
BROADER RANGE OF HEALTH DRIVERS
AND ACCOUNT FOR SOCIAL
IDENTITIES AND STRUCTURAL AND
SOCIAL DETERMINATES OF HEALTH TO
APPROXIMATE A PERSON'S
CIRCUMSTANCES.
FOR EXAMPLE, PUBLIC HEALTH
POLICY, CAREERS, SOCIAL CAPITAL
AND ACCESS TO THESE.
WE SHOULD ADVANCE INTERVENTIONS
THAT ADDRESS A PERSON'S NEED
MORE HOLISTICALLY OPPOSED TO
INDIVIDUAL CONDITIONS OR
CIRCUMSTANCES.
FOR EXAMPLE, ADDRESSING MENTAL,
SOCIAL AND ENVIRONMENTAL AND
PHYSICAL HEALTH MAY BE MORE
PREVENTIVE THAN ADDRESSING
PERHAPS ISOLATION.
FOR RESEARCH ENGAGE THE FOCAL
COMMUNITIES IN ALL PHASES OF
RESEARCH INVESTIGATING
INTERSECTIONAL ISSUES THROUGH
REFINEMENT AND DISSEMINATION.
MAKE THESE PEOPLE TRUE PARTNERS
IN RESEARCH ENDEAVORS AS THEY
MAY BE THE BEST INFORMATION
AVAILABLE FOR ISSUES AND HOW TO
MITIGATE THEM.
WE SHOULD ENSURE THEIR INPUT AND
VIEW POINT ARE CONSIDERED AND
INCORPORATED AND ADEQUATELY
COMPENSATE FORD THEIR
CONTRIBUTION AND NEEDS AND NEED
TO CULTIVATE GENUINE BONDS WITH
MEMBERS OF THE COMMUNITY.
I THINK WE NEED A SPECIAL EYE
TOWARDS I MPLEMENTATION RESEARC
AND POPULATION-SPECIFIC BARRIERS
AND THE MOST BASIC INTERVENTIONS
DON'T WORK WELL IN THEORITHEORI.
WE SHOULD ENCOURAGE RESEARCH
SILOS AND CROSS-POLLINATION
AMONG RESEARCHERS WHO STUDY
INTERVENTIONED AND TRY TO AVOID
PUTTING INFORMATION BEHIND
PAYWALLS TO ENCOURAGE PEOPLE TO
USE THE INFORMATION WE GENERATE
AND SHOULD EMBRACE PRINCIPLES OF
TRANSPARENCY AND
COMPREHENSIBILITY IN OUR
COMMUNICATIONS.
>> THANK YOU.
LET'S DISCUSS ISSUES OF
SUBSTANCE ABUSE AND HIV SYND
SYNDEMICS.
HOW IS YOUR INSTITUTION LOOKING
AT THE INTERSECTION OF SUBSTANCE
USE DISORDERS AND MENTAL HEALTH
DISORDERS AND HIV?
>> SO NIDA HAS ALWAYS RECOGNIZED
THE SYNDEMIC NATURE OF HIV AND
SUBSTANCE ABUSE.
YOU MUST LOOK AT HIV, SUBSTANCE
USE AND OTHER TYPES OF RELATED
CONTINUES OR ISSUES DEPENDING ON
THE FOCUS OF THE STUDY WHETHER
IT IS MENTAL HEALTH, HEPATITIS,
SOFT TISSUE INFECTIONS, SOCIAL
DETERMINATES OF HEALTH,
ETCETERA, IF YOU'RE GOING TO BE
COMPETITIVE AND GET FUNDING.
IT'S PEAT A PART OF WHAT WE
TALK ABOUT BECAUSE EACH OF THESE
AMPLIFY THE OTHER IN TERMS OF
THE IMPACT OF BURDEN AND DISEASE
AND HEALTH OUTCOMES.
AND YOU KNOW IT HAS ALWAYS BEEN
EVIDENT AND VERY EVIDENT AGAIN
THE SYNDEMIC NATURE AT PLAY WITH
THE CRISIS THAT WE ARE FACING IN
THE AREA OF ADDICTION AND
OVERDOSE CRISIS.
WE HAVE SO MANY PEOPLE DYING
ANNUALLY FROM DRUG OVERDOSES AND
THERE ARE A COUPLE OF FINDINGS I
CAN HIGHLIGHT THAT I PRESENTED
TO OUR NATIONAL ADVISORY COUNCIL
LAST MONTH THAT SORT OF SPEAK TO
THIS.
THE NON-MEDICAL USE OF OPIOIDS
IS THREE TIMES HIGHER AMONG
PEOPLE LIVING WITH HIV.
THIS WAS WITHIN THE HIV REGISTRY
IN NEW YORK CITY.
IN NEW YORK CITY, THEY FOUND
PEOPLE LIVING WITH HIV HAD
DOUBLE THE RATE OF OVERDOSE
DEATHS OF OVER ALL INDIVIDUALS
IN NEW YORK CITY.
AND IN FACT, WITHIN HIV CLINICS
THERE WAS A PERFECT OPPORTUNITY
TO BE ABLE TO NOT ONLY FOCUS ON
HIV OUTCOMES BUT SUBSTANCE USE
OUTCOMES WHICH TYPICALLY IS NOT
INTEGRATED IN THIS NATION.
SOMETHING LIKE PROVIDING
EDUCATION AND DISTRIBUTING
NALOXONE COULD HAVE SAVED LIVES
AND ALLOWED PEOPLE THE
OPPORTUNITY TO MOVE TO SUBSTANCE
ABUSE CARE AND HAVE BEEN ABLE TO
CONTINUE IN THEIR CARE FOR HIV.
FROM A BASIC SCIENCE PERSPECTIVE
WE LEARNED FENTANYL INCREASES
REPCATION IN VITRO IN EXPRESSING
CELL LINES AND NALOXONE THAT
TREATS OPIOID USE DISORDER MAY
BLOCK THE FENTANYL REPLICATION
AND YOU SEE THE SYNDEMIC NATURE
AND YOU HAVE TO ADDRESS THE
ISSUES SIMULTANEOUSLY.
WE WILL NOT BE SUCCESSFUL IF
WE'RE GOING TO TRY AND PIECE AND
PARS THEM OFF.
WHEN YOU TALK ABOUT SYNDEMICS
THAT WE DON'T TALK ABOUT AT ALL
AT NIH AROUND THE HIV PORTFOLIO.
WE HAVE TO BEGIN TO CONSIDER AS
THE IMPACT OF CLIMATE CHANGE.
I'M NOT EVEN TALKING ABOUT
EXTREME WEATHER BUT TEMPERATURE
AND WHAT IT DOES TO FOOD
INSECURITY AND WATER
AVAILABILITY AND INFECTIOUS
DISEASES, MIGRATION, ETCETERA.
WE HAVE TO BEGIN TO CONSIDER
THAT AND IF YOU WANT TO TALK
ABOUT HEALTH INEQUITIES AND
DISPARITIES, THE PARTS OF OUR
WORLD AND OUR COUNTRY MOST
DISPROPORTIONATELY IMPACTED BY
EXTREME HEAT ARE THOSE WHY YOU
SEE THE GREATEST DISPARITY.
SUB SAHARA AFRICA THEY'RE
DISPROPORTIONATELY IMPACTED BY
CLIMATE CHANGE AND WHERE THERE'S
MODELLING AND DATA THAT TALKS
ABOUT THE INCREASE IN INCIDENTS
OF HIV AS A RESULT OF THAT.
AND SO WE HAVE TO BEGIN TO THINK
MORE BROADLY ABOUT HOW TO KEEP
TRACK OF THE BIG PICTURE AS WELL
AS THE CONTEXT WITHIN WHICH ALL
OF THESE THINGS ARE HAPPENING IF
WE'RE GOING TO BE ABLE TO HAVE
ANY SUBSTANTIAL GAINS.
>> THANK YOU.
COULD NOT AGREE MORE ABOUT THE
IMPORTANCE OF CLIMATE CHANGE ON
HEALTH.
DOCTORS, WALTERS AND BARNHART
ARE THIS DETERMINATES THAT MAY
YIELD HIGH IMPACT ON HIV HEALTH
OUTCOMES AND FOCUS ON
INTEGRATING INTO HIV RESEARCH?
DR. WALTERS?
>> FIRST, I CONCUR WITH A LOT OF
THINGS ALREADY DISCUSSED AND TO
HIGHLIGHT FOR AMERICAN INDIAN
ALASKAN NATIVE COMMUNITIES WHAT
WE ENCOUNTER IN HIV PREVENTION
RESEARCH PUSHBACK BECAUSE HIV IS
NOT THE MOST PRESSING ISSUE BUT
THE SOCIAL DETERMINATES OF
HEALTH AND ACCESS TO CLEAN AND
HEALTHFUL WATER AND CLIMATE
CHANGE IMPACTS ARE
DISPROPORTIONATELY IMPACTING
NATIVE COMMUNITIES HAVING TO
RELOCATE IN VILLAGES IN ALASKA
TO GETTING HIT WITH ASTHMA
BECAUSE OF THE DROUGHT
CONDITIONS IN CALIFORNIA.
THERE'S A LOT OF IMPACTS
HAPPENING.
SOMETIMES HIV IS NOT ON THE
MIND.
THOUGH IT'S AN ISSUE AND IT'S A
BIG ISSUE AND IN TERMS OF THE
INNOVATIONS AND INTERVENTIONS,
ONE THING I KNOW THERE'S NOT A
LOT OF EFFICACY STUDIES ON
INTERVENTIONS WITHIN AMERICAN
INDIAN AND ALASKAN NATIVE
COMMUNITIES AND FROM RELATED
WORK WE'RE STILL WAITING TO SEE
DATA COME OUT FROM ARE
INNOVATIONS IN USING LAND-BASED
HEALING APPROACHES TO GET
OUTSIDE THE BEHAVIORAL FRAME
WORKS OR PREVENTION SETTINGS AND
GET OUT IN THE ENVIRONMENT AND
INTO THE COMMUNITIES AND GET
THEM RECONNECTED TO LAND AND
PLACE AS A WAY TO DELIVER
INTERVENTIONS AND NATURE-BASED
SOLUTIONS AND THINGS THAT NOT
ONLY LINK US BACK TO ORIGINAL
INSTRUCTIONS IN HELPFUL WAYS OF
BEING IN THE WORLD BUT GETTING
OUT OF THE CLINICAL SETTINGS AND
BEGIN TO SHIFT THE CONVERSATION
TO COMMUNITY-LEVEL CHANGE AND
COMMUNITY CHANGE THAT NEEDS TO
HAPPEN TO BECOME A HEALTHIER
COMMUNITY AND PEOPLE.
IT'S LESS INDIVIDUALIZED AND
MORE FOCUSSED ON CONNECTING TO
COMMUNITY FOR EXAMPLE IN ONE
STUDY THE QUESTION IS WHAT KIND
OF ANCESTOR DO MY ANCESTORS
DREAM ME TO BE AND WHAT DO I
DREAM FUTURE GENERATIONS TO BE
THROUGH MY HEALTHFUL ACTIONS
TODAY.
TAKING CARING OF MYSELF YOU'LL
HEALTH AND DECISION MAKING, I'M
NOT ONLY HELPING MYSELF AND
PARTNERS AND FAMILY BUT HAVING
AN IMPACT FOR A WORLDLY
COMMUNITY.
MAKING THOSE LANGUAGES
CONCEPTUALLY GETS AT MORE THE
PATHOLOGY ORIENTED WORK THAT
NATIVE COMMUNITIES ARE DEALING
WITH STIGMATIZATION AND BACK TO
RELATIONAL WAYS OF BEING IN THE
WORD AND CONNECTING TO SOCIAL
CONNECTEDNESS AND DEVELOPING A
SENSE OF BELONGING IS CRITICAL.
PARTLY BECAUSE OF SO MUCH OF HIV
IS PART OF, LGBTQ AND RELATED TO
OTHER KINDS OF ISSUES THAT MIGHT
BE POTENTIALLY INITIALLY
STIGMATIZED.
IT'S VERY IMPORTANT THAT SENSE
OF BELONGING IS ANOTHER FACTOR
AND INCREASING CONNECTEDNESS,
INCREASED SENSE OF BELONGING.
HAVING THAT ONE PERSON WHO SEES
YOU AS PART OF THE LARGER
COMMUNITY.
A LOT OF OUR INTERVENTIONS THAT
ARE SUCCESSFUL DON'T NECESSARILY
PASS THROUGH THE COMMUNITY BUT
THROUGH THE AMERICAN INDIAN
ALASKAN COMMUNITIES AND THEY
LINK TO LGBTQ EVENTS AND WE NEED
TO FIGURE OUT CREATIVE
INNOVATIONS AN IT'S COMPLEX
BECAUSE WHEN I ASK OUR COMMUNITY
WHAT'S IT LIKE BEING FOR
EXAMPLE, GAY IN OKLAHOMA AND HE
SAID I DON'T KNOW I'M ONLY GAI
IN TULSA.
IDENTITY AND THE INTERSECTION OF
BEHAVIOR NEED TO BE CONSIDERED.
I WANTED TO PUT A PLUG IN FOR
ONE OTHER APPROACH I DON'T THINK
IS UNDER UTILIZED.
SOME OF THE WORK STARTING TO BE
DONE AROUND TELEHEALTH AND
VIRTUAL INTERVENTIONS WHERE
PEOPLE PRACTICE BEHAVIORS, IT'S
A SAFE PLACE TO ACCESS SUPPORT
AND NETWORKING IN RURAL
COMMUNITIES WHERE YOU DON'T
NECESSARILY HAVE THAT IN PLACE
AND IT GETS YOU CONNECTED TO
OTHER FOLKS ON A VIRTUAL
PLATFORM TO BEGIN TO ENGAGE IN
INTERVENTIONS IN THAT AREA AND
SO WE'VE DONE WORK IN THE
AMERICAN ALASKAN COMMUNITIES
WHERE WE'RE INTERESTED IN
ACCESSING THAT BECAUSE IT
DECREASE THE CHANCE OF BEING
OUTED IN THE COMMUNITY BUT AN
OPPORTUNITY TO CONNECT WITH
OTHERS ACROSS THE UNITED STATES
NOT JUST IN THE LOCAL COMMUNITY.
SO I'LL STOP THERE BECAUSE I
KNOW WE'RE LIMITED IN TIME.
THANK YOU.
>> DR. BARNHART ABOUT
INTERVENTIONAL STUDIES
ADDRESSING SPECIFIC DRIVERS?
>> BEING FROM NIAAA I THINK
YOU'LL GET MY SPECIFIC DRIVER.
ALCOHOL USE DISORDERS ARE THE
MOST PREVALENT SUBSTANCE USE
DISORDER AMONG PEOPLE LIVING
WITH HIV AND UNDER IDENTIFIED
AND UNDER ADDRESSED AND THOUGH
WE HAVE APPROPRIATE
INTERVENTIONS I'LL SKIP ON SOME
INFORMATION FROM MORBIDITY AND
MORTALITY BUT THERE'S CHANGES IN
THE BIOMEDICAL HAVE BEEN
DEVELOPED FOR MEASURING RISK FOR
INFECTION, PROGRESSION AND
FRAILTY.
A NUMBER OF MULTIPLE
META-ANALYSES HAVE RECENTLY
CONCLUDED THIS CALLS FOR MORE
ACTIVE ENGAGEMENT IN GOVERNMENT
AND IMPLEMENTING
ALCOHOL-FOCUSSED INTERVENTIONS
AS WELL AS COLLABORATION AND
KNOWLEDGE TRANSFER FROM
HIGH-INCOME COUNTRIES TO DEV
DEVELOPING COUNTERPARTS TO
EFFECTIVELY ADDRESS
ALCOHOL-RELATED ISSUES IN PEOPLE
LIVING WITH HIV/AIDS AND
EFFECTIVELY MOVING TOWARDS
HIV/AIDS ERADICATION.
NOW, THERE ARE A WHOLE BURCHL OF
ISSUES AROUND MEASUREMENT AND
SCREENING AND HOW THESE HAVE
BEEN DEVELOPED BUT WE HAVE
TESTED MODELS KSAR ADAPTIVE
MODELS CONJOINED SCREENING FOR
ALCOHOL, ANXIETY, PAIN, TRAUMA,
TOBACCO AND OTHER MEDICATIONS
AND OTHER APPROPRIATE SUBSTANCE
USE WITHIN THE CONTEXT OF PEOPLE
ACQUIRING AND LIVING WITH
HIV/AIDS.
AND WE'VE LOOKED AT THE
FEASIBILITY OF THE RANGE OF
INTERVENTIONS AND INCLUDING
ADAPTIVE MODELS FOR MIXED
BEHAVIORAL AND THERAPEUTICS.
THIS IS A STEP CARE FRAMEWORK.
MULTI-LEVEL INDIVIDUAL GROUP
MODELS.
IT CHANGES SOCIAL NORMS.
E-HEALTH DELIVERY IN RURAL
SETTINGS AND MODELLING THE
IMPACTS OF COMPREHENSIVE HIV
PREVENTION, TREATMENT IN SYSTEMS
LIKE THE V.A. AND KAISER
PERMANENTE.
THESE ARE AT THE NATIONAL LEVEL
AND OTHER COUNTRIES.
THIS INCLUDES ADVANCES IN NEW
BIO SENSOR TECHNOLOGY,
BIOMARKERS TO DETECT AND
VALIDATE THESE ALCOHOL-RELATED
MEASURES.
I WON'T GO ON BUT THERE'S A
NUMBER OF OTHER ISSUES AROUND
THINGS LIKE PARTNER VIOLENCE,
DOMESTIC AND INTERNATIONAL
SETTINGS THAT ARE IMPORTANT AND
WE ARE ISSUING A NUMBER OF
ANNOUNCEMENTS AROUND
COMPREHENSIVE CENTERS AND
PROGRAM PROJECTS BUT THE MOST
RECENT CONCEPT CLEARANCE THAT'S
COMING UP THAT'S RELEVANT TO
THIS IS REALLY LOOKING AT
ADVANCING BIOMARKER RESEARCH FOR
IMPROVING CLINICAL RESEARCH AND
MANAGEMENT OF ALCOHOL RELATED
MEDICAL CONDITIONS AND HOW TO DO
THIS AND WE HAVE A MEETING
AROUND PREVENTION.
WE ISSUED OVER 12 GRANTS ON
ALCOHOL PREVENTION AND USE AND
PLAN TO LOOK AT THIS AMONG
WOMEN, LGBTQ AND SETTINGS WHERE
THEY MIGHT BE APPLIED.
THIS IS COMING UP AND SPONSORING
A MEETING DIRECTLY RELATED TO
THIS.
THANK YOU.
>> THANK YOU, KENDALL AND THANK
YOU ALL FOR THE RICH DISCUSSION
AND WOULD LIKE TO TURN IT OVER
TO DR. KAPOGIANNIS FOR OUR NEXT
SECTION.
>> JUST TRYING TO SOAK THIS ALL
IN AS A RICH DISCUSSION AND
THINKING LOOKING AT THIS FROM A
POPULATION PERSPECTIVE AND
SPECIFICALLY TO MINORITIZED
POPULATIONS WE'VE BEEN
DISCUSSING TODAY AS WE SAW
EARLIER THERE'S DISPARITIES
ACROSS RACIAL AND ETHNIC AND
SEXUAL GENDER POPULATIONS AND
THINKING ABOUT IT I REMEMBER
SEEING A DISPARITY AND LOOKING
ACROSS THE AGE GROUPS AND THE
ONE GROUP THE AMERICAN INDIAN
AND ALASKAN NATIVES AT THE TOP
OF THAT AS WE GET OLDER THE
DISABILITY PREVALENCE INCREASING
AND YOU PROBABLY KNOW THE DATA
BETTER THAN I BUT WONDERING,
DR. WALTERS, IF YOU CAN ADD TO
THE CONTEXT OF METHODS AND
APPROACHES THAT WITHIN YOUR
COMMUNITY AND WITHIN THE MISSION
OF THROW THAT COULD GET TO
ADDRESSING YOUR POPULATIONS AND
METHODOLOGIES DISCUSSED BY FOLKS
ON THIS PANEL, DIANNE AND
KENDALL, FOR EXAMPLE, THE
INTERVENTION AND HOW TO GET AT
THE POPULATIONS THAT MAY NOT BE
EASILY ACCESSIBLE LIKE LGBTQ.
>> THAT'S A GREAT QUESTION AND
PROBABLY DESERVES MORE THAN A
TWO TO THREE MINUTES RESPONSE.
LET ME HIGHLIGHT THINGS I WANT
TO EMPHASIZE.
ONE IS THE MAJORITY OF AMERICAN
INDIAN AND ALASKAN NATIVES ARE
IN URBAN SETTINGS AND OUR
COMMUNITIES WHO END UP IN URBAN
AREAS A LOT AS WELL THERE'S
STRONG POCKETS IN OUR RURAL
COMMUNITIES.
BUT FINDING LGBT NATIVE SECTIONS
IS LIKE FINDING A RED NEEDLE IN
A HAYSTACK AND THERE'S UNIQUE
DEMANDS AROUND SAMPLING OR
TRYING TO ESTABLISH PREVALENCE
IN A POPULATION.
WE'RE NOT CLUSTERED BY COMMUNITY
THE RELOCATION PROGRAMS IN THE
'50s THROUGH '70s DISPERSED
NATIVE PEOPLE SO WE WOULDN'T
BUNCH BY NEIGHBORHOOD.
IT'S VERY DIFFICULT DOING THIS
RESEARCH.
THERE'S INNOVATION IN RDS
APPROACH THAT HAVE BEEN TESTED
WITH COMMUNITIES THAT WORK.
AND GET AN EXTENT OF THE ISSUES
AND RELATION TO SOME OUTCOMES
AND SAMPLING IS A BIG FACTOR AND
ANOTHER ONE WAS MEASUREMENT AND
ADEQUATELY CAPTURING SOME OF THE
CONSTRUCTS THAT ARE MEANINGFUL
TO OUR COMMUNITY.
AND ALSO THINGS THAT WE NEED TO
FOCUS MORE ON WELL BEING AND
WHO'S DOING WELL AND WHY AND HOW
WE BUILD PROGRAMS AN
INTERVENTIONS THAT NURTURE THAT
AND TO GET AT THAT WE NEED
CONSTRUCTS MEASURED.
BELONGING AND CONNECTEDNESS AN
THOSE KINDS OF THINGS BECOME
MORE IMPORTANT AND IDENTITY AND
MAKING SURE WE HAVE THE
COMPLEXITY IN OUR IDENTITIES
ENABLED IN THE PROCESS IS
CRITICAL.
SO I THINK THOSE ARE TWO HUGE
ISSUES, MEASUREMENT, SAMPLING
AND REPRESENTATIVE POPULATION
AND IN TERMS OF LOOKING AT MORE
INTERSECTIONALITY ISSUES AND
TRAUMA AND VIOLENCE AND LOOKING
AT THAT IN RELATION TO SUBSTANCE
USE.
I'M WORRIED THE OPIOID EPIDEMIC
HAS EXPLODED INDIAN COUNTRY AND
PEOPLE ARE DYING FROM OTHER
KINDS OF THINGS, OVERDOSE AND NO
ONE IS KNOWING IF THEY'RE LIVING
WITH HIV OR EXPOSED.
I THINK WE HAVE SERIOUS ISSUES
THAT'S COMING DOWN THE PIKE.
WE NEED TO LOOK AT THAT AND
FINALLY CULTURAL RELEVANCE IN
PULLING COMMUNITIES IN TO LOOK
AT THIS MORE WE NEED TO LOOK AT
THINGS LIKE STIs AND RELATION TO
HIV AND POSITIVE SEXUAL HEALTH
AND WORKING WITH YOUTH ON
DEVELOPING POSITIVE
COMMUNICATION AND POSITIVE
SEXUAL HEALTH EXPERIENCES.
PART OF THE TRAUMA FROM BOARDING
SCHOOL TRAUMA IN OUR COMMUNITIES
WAS AN ABSOLUTE ERASURE OF
HEALTHY SEXUAL SPIRIT AND WAYS
OF NAVIGATING AND NEGOTIATING
THOSE KINDS OF THINGS AND LOTS
OF EXPOSURE TO SEXUAL TRAUMA
INFORMALLY.
WE HAVE A LOT OF WORK TO DO TO
ADDRESS SIMULTANEOUSLY SOME
ISSUES AROUND SEXUAL VIOLENCE
AND TRAUMA AND
INTERGENERATIONALITY OF TRAUMA
AND THAT'S OFF THE TOP OF MY
HEAD I THINK WOULD BE IMPORTANT
AND FINALLY GETTING AT BUILDING
INTERVENTIONING -- CULTURALLY
DERIVED IN THE INTERVENTIONS AND
TEACHINGS OF THIS PEOPLE AROUND
HEALTHFUL BEHAVIORS AND WE HAVE
STORIES AND SAYINGS AND PROVERBS
THAT HELP UNDERSTAND WHAT'S
HAPPENING IN OUR BEHAVIOR OUR
WAYS OF BEING IN THE WORLD
INCLUDING HOW YOU UNDERSTAND
YOUR BODY AND YOUR PARTNER'S AND
OTHER DECISION MAKING AND WE'RE
WORKING WITH AMERICAN INDIAN
ALASKAN COMMUNITIES AND TALKING
ABOUT THE CONNECTEDNESS AND
BELONGING AS WELL.
I'LL STOP THERE.
>> AND FOR LGBTQA PEOPLE I THINK
I HAVE A NUMBER OF THINGS I
WANTED TO HIGHLIGHT.
WE NEED TO INCREASE POLICY
RESEARCH IN LIGHT OF THE CURRENT
DRAFT AGAINST HEALTH AND
RESEARCH PARTICULARLY FOR TRANS
PEOPLE AND HEALTH IS LACKING IN
THE PORTFOLIO AND THERE'S ONE OR
TWO PROJECT.
WE ALL KNOW IT'S AN IMPORTANT
ASPECT THAT INFLUENCES HEALTH
AND THERE'S A SEVERE DEARTH OF
IT.
WE NEED TO INCORPORATE MORE
QUALITATIVE AND MIXED METHODS
STRATEGY TO LOOK AT THE
INEQUITIES FACED BY LGBTQ
PEOPLE.
I WOULD FOCUS LOOKING AT SOCIAL
DRIVERS AND INTERVENTION TARGETS
AND LOOKING AT PREVENTION
STRATEGIES AN TREATMENT
REGIMENTS.
WE NEED TO ENSURE THEY ARE HEARD
AND WHAT THEY HAVE TO SAY IS
APPROPRIATELY INCORPORATED INTO
RESEARCH PLANS AND STRATEGY.
HHS AS A CENTER TO HELP CONNECT
WITH PEOPLE WITH LIVED
EXPERIENCE AND FOLLOW BEST
PRACTICES AND DOING SO.
AND ENGAGE PRACTITIONERS ACROSS
THE CARE CONTINUUM AND SUBSTANCE
USE AND MENTAL HEALTH PROGRAMS
TO ASCERTAIN WHAT THEY DEEM ARE
THE MOST SALIENT ISSUES RELATED
TO UPTAKE FOR LGBTQIA PEOPLE AND
ACCESS TO SERVICES THERE ARE
LGBTQIA SPECIFIC BARRIERS AND
CHALLENGE.
WE NEED TO TAILOR RESEARCH TO
SPECIFIC POPULATION OF FOCUS
INCORPORATING SOCIAL, CULTURAL,
ENVIRONMENTAL AND POLITICAL
CONTEXT IN WHICH OUR RESEARCH
TAKES PLACE.
WE NEED TO USE WHAT WE HAVE,
LEVERAGE EXISTING STRATEGY
DEVELOPMENT AND ALL OF US HAS A
MASSIVE DATA SET WITH A
SUBSTANTIAL NUMBER OF LGBTQ AI
PARTICIPANTS AND LOOK AT HIV
BURDENS, WORK WITH OTHER
INVESTIGATORS WHO ENGAGED IN
COMMUNITIES OF INTEREST AND TEAM
UP WITH HEALTH CARE INSTITUTION
HAVE LGBTQ CLIENTS IF WE AN AND
NEED TO FACILITATE PARTICIPATION
IN RESEARCH FOR EVERYBODY
POTENTIALLY THROUGH FOR EXAMPLE
REIMBURSEMENTS FOR TIME OR
INCLUSION AND EXCLUSION CRITERIA
AND LOOKING AT THE FOCAL
POPULATION.
PEOPLE MAY WANT TO BE A PART OF
RESEARCH BUT WE HAVEN'T MADE
THAT EASY SO WE NEED TO FIX
THAT.
>> WITHIN THE MINORITIZED
POPULATION I'D LIKE TO GO TO
DR. COURTNEY AKLIN.
TO GET AT THE QUESTION OF HOW IS
NIH ENCOURAGING RESEARCH
SPECIFICALLY INVESTIGATING
SOCIAL DETERMINATES OF HEALTH
AND SOME EXAMPLE ARE FOOD AND
HOUSING INSECURITY AND EFFORTS
TO ADVANCE RACIAL EQUITY IN THE
HIV RESEARCH PORTFOLIO.
>> THANK YOU FOR ASKING THAT
QUESTION.
IT'S AN EXCITING TO HAVE THIS
CONVERSATION BECAUSE THERE'S
BEEN AN ENORMOUS UNDERSTANDING
OF UTILIZIZATION -- UTILIZATION
OF SOCIAL DETERMINATES OF HEALTH
AND SO MUCH SO IT'S ONE OF THE
LENSES OF OUR FRAMEWORK AS WE
PUT TOGETHER OUR STRATEGY PLAN
AND IT'S NEXT TO IMPOSSIBLE IF
YOU'RE DEALING WITH ANY CLINICAL
OR RESEARCH WORK TO BE ABLE TO
ADDRESS THE QUESTIONS WITHOUT
LOOKING AT THE VARIOUS LEVELS
AND LOOKING AT IT FROM A SOCIAL
DETERMINATE OF HEALTH LENS
ALLOWS US TO DO THAT.
IN SPITE OF THERAPIES WE KNOW WE
CURRENTLY USE TO REDUCE THE
VIRAL LOADS TO NEAR ZERO AND
PREVENTIVE MEASURES SUCH AS PREP
AND USE OF CONDOMS WE SEE THESE
DISPARITIES AND THE QUESTION IS
ALWAYS WHY.
WHAT CAN WE DO DIFFERENTLY IN
TERMS OF TEASING A PART WHAT IS
THERE FOR NINR ONE THING WE WANT
TO DO IN TALKING ABOUT SOCIAL
DETERMINATES OF HEALTH AND BREAK
DOWN THE NOMENCLATURE.
AT NIH BOTH NIMHD AND NINR HAVE
TAKEN THE LEADERSHIP ROLE BY
ESTABLISHING A COORDINATING
COMMITTEE FOR ALL OF NIH TO
REALLY HARNESS IN ON WHAT WE
MEAN WHEN WE TALK ABOUT SOCIAL
DETERMINATES OF HEALTH IF YOU
LOOK AT CDC AND WORLD HEALTH
ORGANIZATION YOU'LL HEAR PLACES
WHERE PEOPLE WORK, PLAY,
WORSHIP.
IT'S BIGGER THAN THAT AND TRYING
TO UNDERSTAND IT LEADS TO BETTER
QUESTIONS WHEN YOU THINK OF IT
IN MATERIALS OF THAT FRAMEWORK.
THE OTHER FRAMEWORK AND RIGHT
NOW WE HAVE A NOTICE OF INTENT
TO PLAY TO ESTABLISH AWARENESS
ACROSS THE NURSING DISCIPLINES
AND DISCIPLINES THAT ARE
COMPLIMENTARY TO IT IN TERMS OF
BEING ABLE IT'S A ONE-YEAR
COURSE AND BEING ABLE TO LEARN
HOW TO ALIGN THE FIELDS WITH THE
FULL UNDERSTANDING OF HOW TO
CONDUCT AND EVALUATION RESEARCH
LOOKING AT IT FROM A SOCIAL
DETERMINATES OF HEALTH LENS AND
ONE EXAMPLE I WANT TO POINT TO
WE FUNDED RECENTLY IS LOOKING AT
YOUTH.
WE'VE HAD CONVERSATION ABOUT THE
DIFFICULTY OF HAVING YOUTH TO
FOLLOW THE PREVENTIVE MEASURES
WE KNOW WORK AND TRYING TO
UNDERSTAND HOW TO DO THAT AND
TAKING INTO CONSIDERATION THE
CONTEXT.
WE HAVE STUDIES THAT LOOK AT
HOMELESS YOUTH AND TRY TO
DETERMINE NOT ONLY ACCESS TO
CARE BUT ALSO THE OPPORTUNITY OF
LEVERAGING PLACES WHERE THEY
ARE, EXAMPLE SCHOOL AND SCHOOL
SETTING IS ONE OF THE STUDIES WE
RECENTLY FUNDED TO TRY TO
DETERMINE AN EXAMPLE IF UP TAKE
IS MORE REASONABLE WHEN BROUGHT
TO A SCHOOL SETTING TO HAVE A
CONVERSATION OF WHAT IT IS AND
PUTTING IT IN THE LARGER
CONTEXT.
THERE'S THE IS AVAILABILITY OF
TREATMENT AND SCREENING THERE.
WE LOOKED AT A STUDY WITH UNMET
NEEDS AND ANTIVIRAL THERAPY AND
ADHERENCE AMONG BLACK
INDIVIDUALS LIVING WITH HIV IN
LOS ANGELES.
THE MAIN FOCUS IS TO USE A
COMMUNITY-ENGAGED APPROACH WHERE
WE'VE TAKEN TO NURSE
PRACTITIONERS OR PRIMARY CARE
SETTINGS TO BE ABLE TO ASK THE
QUESTIONS BUT MAKING SURE WHEN
WE POSE THE QUESTIONS WE'RE
DOING IT IN A WAY THAT GETS AT
NOT JUST THE RESEARCH QUESTIONS
BUT THE ACCEPTABILITY OF THE
QUESTIONS WE'RE ASKING.
>> THANK YOU.
THAT'S WHAT I WAS LOOKING FOR
AND I KNOW WE HAVE LIMITED TIME
AND AN AMBITIOUS QUESTIONS AND A
WOULD LIKE TO MOVE TO OPEN IT UP
TO MEMBERS TO COME IN WITH THEIR
QUESTIONS.
I WOULD SAY DEPENDING ON HOW
THAT GOES IF THERE'S ADDITIONAL
TIME WE'LL GO BACK TO OUR OTHER
SLATE OF QUESTIONS.
LET'S INVITE FOLKS TO RAISE
HANDS.
I SAW DR. NILLAND FIRST.
>> THANK YOU FOR THE SPEAKERS.
IT'S A RICH AND
THOUGHT-PROVOKING DISCUSSION
TODAY.
ONE THING THAT STRUCK ME IN
DISPARITIES AS SOMEONE WHO
TRANSITIONED TO RESEARCH
INDEPENDENCE ONE THE I DO AS AN
EARLY STAGE INVESTIGATOR WHEN I
LOOK AT THE O ARDF AND WE LOOK
AT DISPARITY RESEARCH AND WONDER
IF THAT'S SOMETHING OAR CAN
ADVOCATE FOR MAKING THOSE DATA
AVAILABLE AND TRANSPARENT
BECAUSE THE WORK GOING ON AND
SECOND REFLECTS ON WHAT
DR. ELISEO PEREZ-STABLE
ESTABLISHED ABOUT THE DEARTH OF
POPULATI
POPULATIONS THINKING ABOUT THE
COMMUNITY-ENGAGED RESEARCH BEING
DIFFICULT TO PITCH AND GET
FUNDED.
DR. NELSON TALKING ABOUT NORMAL
SCIENCE AND DR. MALDONADO
TALKING ABOUT THE NEW CRITERIA
FOR A REVIEW PANEL TO GUIDE
REVIEW PANELS.
NIH HAS TERRIFIC TOOLS FOR
INVESTIGATORS TO FIGURE OUT AND
NAVIGATE THIS COMPLEX SYSTEM
LIKE AN ASSISTIVE REFERRAL TOOL.
FOR THE IPOs OR OTHERS, THERE'S
A MECHANISM WHERE YOU CAN
REQUEST ADDITIONAL EXPERTISE TO
BE ON THE REVIEW PANEL BUT I
WONDER WHAT OPPORTUNITIES MIGHT
BE TO ENHANCE THE MEMBERSHIP OF
THE REVIEW PANEL TO REFLECT
BETTER THE APPLICATIONS COMING
IN IN ADDITION TO
[INDISCERNIBLE].
THERE'S BEEN SUBSTANTIAL
INVESTMENT IN THE SPACE OF
HEALTH DISPARITIES AND TERMS OF
WHAT WE CALL THINGS AT NIH.
I REMEMBER OVER THE LAST THREE
OR FOUR YEARS ANNUALLY SOMEWHERE
AROUND A FIGURE OF $450 TO $500
MILLION GOING TO THE TOPICAL
AREA.
I CAN TELL YOU THAT.
MORE DETAIL AND GETTING GRANULAR
DATA THAT CAN BE PART OF THIS IS
IMPORTANT TO DO AND I'LL LEAVE
THAT TO OUR DATA GURUS AND GOING
BACK AND FOLLOW UP WITH YOU AND
BLANKING ON YOUR OTHER COMMENT
RELATED TO REVIEW.
I THINK AGAIN, THERE'S A LOT OF
OPPORTUNITIES TO BE ABLE TO
ADDRESS THAT FROM A PROGRAMMING
PERSPECTIVE VIA INITIATIVES AND
RFAs AND SPECIAL PANELS.
YOU'RE REFERRING MORE TO THE
INVESTIGATOR SUBMITTED AWARDS
AND HOW THINGS COME IN FOR NEW
INVESTIGATORS, ETCETERA.
AND I THINK AGAIN I KNOW OUR
REVIEW IS UNDERGOING A NEW
PROCESS IN LOOKING AT PROCEDURES
AND IT'S A UNIQUE OPPORTUNITY TO
PROVIDE THAT FEEDBACK AND SEE
WHAT WE CAN DO TO ADVANCE THE
CAUSE FURTHER TO MAKE SURE WE'RE
ALIGNED.
WE'LL HAVE TO GET BACK TO YOU ON
THAT AS WELL.
>> LULU -- LUIS.
>> I HAVE BEEN HEARING ABOUT THE
PROPOSALS COME FROM MINORITY
INSTITUTIONS AND THE INABILITY
TO COMPETE WITH HIGHER INCOME
INSTITUTIONS.
AS IT BEEN TALKED ABOUT TODAY,
WE TO PROPOSE A WHOLE NEW
PARADIGM.
WE KNOW WHAT WE'RE DOING DOESN'T
WORK.
WE'VE BEEN TALKING ABOUT IT FOR
20 YEARS.
SO I THINK IT'S TIME FOR SOME
NEW IDEAS IF YOU SEARCH HEALTH
DISPARITIES ONE THING THAT SAYS
COMMUNITY-BASED ISSUES BUT MAYBE
WE NEED TO KIND OF PROPOSE THAT
THESE STUDY SECTIONS NEED TO BE
TAILORED IN FUNDING LEVELS FOR
INSTITUTIONS.
AND TRYING TO HAVE STUDY
SECTIONS THAT REFLECT THE
COMMUNITIES AND INSTITUTIONS
THAT ARE TRYING TO BREAK INTO A
FIELD.
OTHERWISE WE REFER BACK TO THE
HIGH-INCOME INSTITUTION AND
INVESTIGATORS NEED TO GET
GRANDFATHER APPLICATIONS WITH
OTHER INSTITUTION TO GET THEM
THROUGH STUDY SECTION.
THE POINT I WANTED TO BRING
BECAUSE IT'S AN OUTSTANDING
GROUP OF INDIVIDUALS IN MULTIPLE
INSTITUTES IS TO ENCOURAGE
EXISTING NETWORKS.
WE HAVE MINORITY INSTITUTIONS
THAT KNOW THEIR CANDIDATES VERY
WELL AND HAVE BEEN WORKING IN
THE COMMUNITIES 25 YEARS OR
MORE.
THE CCFARs DO THIS SUCCESSFULLY
AND THERE'S AN EXAMPLE WHERE WE
RECOGNIZE WE NEED MORE
REPRESENTATION IN RESEARCH FROM
INSTITUTIONS AND THEY'RE USING
THE CFAR NETWORK TO PROMOTE.
THE NCI DOES THIS ACROSS
NETWORKS.
MAYBE WE COULD EXPLORE HOW TO
SPARK INITIATIVES WITHIN THE
EXISTING NETWORKS THAT ALREADY
REACH THE POPULATIONS OPPOSED TO
TRY TO EACH INSTITUTE CREATE
SOMETHING AN MAYBE SYNERGIZING
WITH THEM WOULD BE MORE
SUCCESSFUL.
>> POINTS TAKEN.
DR. MERMIN.
>> THANK YOU.
I APPRECIATE IT THE CONFERENCE.
I AM -- I WANTED TO PROPOSE OAR
THINK ABOUT WHAT ARE WE FUNDING.
ARE WE GOING THE MOST STRATEGIC
SCIENTIFIC WORK THAT WOULD END
UP IF IMPLEMENTED REDUCE THE
DISPARITIES IN HIV.
THE ISSUE WE FIND OURSELVES
GOING BACK DOWN THE PATHWAY OF
SMALL DEMONSTRATION PROJECTS OR
INTENSE NICHE RESEARCH THAT IS
NOT AS USEFUL AS SOME OF THE
OTHER RESEARCH THAT COULD BE
MORE DIRECTLY APPLICABLE.
WE WANT TO DO WELL.
I GUESS ONE QUESTION IS HOW DO
YOU LOOK BACK AT THE RESEARCH
THAT WAS CONNECTED OVER THE PAST
10 YEARS FUNDED THROUGH THE HIV
RESEARCH AND THEY DIDN'T
SUCCESS.
I GUESS WE'D HAVE DIFFERENT
DEFINITIONS.
WERE THEY BROUGHT TO SCALE?
DID THEY END UP BEING A LINCHPIN
TO SOME NEW INTERVENTION OR NEW
APPROACH THAT REALLY WAS
FUNDAMENTAL TO CHANGING THE
WORLD OF NIH IN A WAY THAT WE
THINK IS GOING TO MAKE A
DIFFERENCE BECAUSE THAT PROCESS
IF WE DON'T DO WE END UP KIND OF
HAVING A LOT OF TANGLED WEB OF
MULTIPLE DIFFERENT PROJECTS
AND STUDIES AND I THINK SOME OF
THE RESEARCHERS WHO WANT TO
APPLY WON'T SEE THEMSELVES OR
THEIR RESEARCH BUT WE CAN DIRECT
THAT MORE BY THINKING WHAT WE'RE
FUNDING AND THE DESIGN OF THE
RFAs AND GRANTS AND I THINK
WE'RE MISSING SOME OF THAT IN
SOME OF THE RESEARCH THAT WE ARE
FUNDING THAT THEY WEREN'T THE
STUDIES THAT WOULD HAVE GONE IN
THE LOGIC MODEL TOWARDS GREATEST
PUBLIC HEALTH SUCCESS.
>> WHEN THEY PUT TOGETHER THE
PROGRAMS AND INITIATIVES AND
DEVELOPING THEM, I THINK
EVERYBODY AND I DID THIS WHEN I
WAS AT ONE OF THOSE, YOU CONDUCT
A PROGRAMMATIC ANALYSIS AND LOOK
AT JUICE FOR SQUEEZE AND WHAT'S
HAPPENED AND WHERE THE GAPS ARE
AND WHERE THEY NEED TO GO.
I THINK THAT IS PART OF THE
PROCESS BUT I THINK THE OTHER
PART THAT'S INTEGRAL IS AT THAT
STRATEGIC PLANNING AND NIH-WIDE
PRIORITY SETTING WE WERE TALKING
ABOUT BRIEFLY I MENTIONED
EARLIER, I THINK IT DOES REQUIRE
A LITTLE BIT OF THAT ANALYSIS,
THAT PROGRAMMATIC ANALYSIS
ACROSS AND SEEING WHAT JUICE
SQUEEZED LOOKS LIKE.
GOOD POINTS.
VERY GOOD POINTS.
ALL RIGHT.
ANYBODY ELSE FROM PANELIST HAVE
TO LEAVE AN COUPLE MINUTES?
I DON'T SEE OTHER HANDS UP.
TIM, DO YOU WANT TO GO INTO
ANOTHER QUESTION?
>> LET'S MOVE INTO DISCUSSION OF
IMPLEMENTATION RESEARCH.
WE KNOW INFLAMMATION RESEARCH
APPROACHES CAN LOOK AT DIRECT OR
INDIRECT FACTORS AND THAT
MITIGATE STRUCTURING AND SOCIAL
DETERMINATES OF HEALTH AND
INTERSECTIONAL ISSUES AND
THERE'S A LARGE PORTFOLIO.
WOULD YOU BRIEFLY TALK TO US
ABOUT THE BEST PRACTICES OR
SUCCESSFUL APPROACHES THAT COULD
BE EXPANDED OR POTENTIALLY
ADAPTED IN NEW SETTINGS.
>> SO IMPLEMENTATION SCIENCE IS
A COMPLICATE ADD APPROACH AND
NOT A SINGLE -- IT'S GOT TO BE
AN INTEGRATED THING.
ONE THING LARON BROUGHT UP YEAR
IS IT'S NOT A -- IN ORDER TO BE
EFFECTIVE IT HAS TO BE
MULTI-DISCIPLINARY.
ONE OF THE FIRST THINGS THAT HAS
TO BE MULTI-DISCIPLINARY BUT AND
THERE'S DIFFERENT ISSUES THAT
WILL BE IMPORTANT.
SO THE REAL -- THE GOAL OF THE
IMPLEMENTATION SCIENCE AGENDA IS
TO STRENGTHEN THE EVIDENCE WITH
IMPLEMENTATION STRATEGY TARGET
THE SOCIAL DETERMINATES OF
HEALTH AND ULTIMATELY APPROVE
OUTCOMES AND REDUCE INEQUITIES.
AND ONE OF THE FIRST CRITICAL
THINGS ABOUT THAT IS TO ENGAGE
COMMUNITY PARTNERS TO
CONDUCTIVELY IDENTIFY WHICH
SOCIAL DETERMINATES OF HEALTH
AND WHICH OUTCOMES ARE CRITICAL
TO ANSWERING THE QUESTION YOU
WANT TO ANSWER IN THAT
PARTICULAR COMMUNITY AND THE
RESEARCH QUESTIONS AND METHODS
ARE DEVELOPED AROUND THAT.
AND THEN INTERDISCIPLINARY
RESEARCH TEAM AND STRONG
INTERACTION WITH THE COMMUNITY
BECAUSE THE INTERVENTION MAY
HAVE EVIDENT BASE BUT HAS TO BE
TAILORED TO THE COMMUNITY YOU'RE
TRYING TO WORK WITH.
SOMETIMES A HYBRID EFFECTIVENESS
AND IMPLEMENTATION APPROACH IS
GOOD BECAUSE IT AND USING AN
IMPLEMENTATION SCIENCE FRAME
WORK YOU CAN BUILD IN CHECK
POINTS AND PIVOT WITH THE
APPROACH IF YOU'RE SEEING THAT
YOU'RE -- THOSE THINGS ARE NOT
WORKING PARTICULARLY AS YOU HAD
EXPECTED.
THE OTHER THING I THINK THAT'S
REALLY IMPORTANT THAT WE'RE
GETTING MORE AND MORE INVOLVED
IN IS USING DATA SCIENCE TO
BETTER UNDERSTAND AND DEVELOP
COMPLEX MODEL SYSTEMS TO
UNDERSTAND THE PARTICULAR SOCIAL
STRUCTURAL DETERMINATES WITHIN
THE POPULATION AND YOU CAN
IDENTIFY MORE TARGETED
PREVENTION, TREATMENT AND CARE
OPPORTUNITIES.
AND THE OTHER THING IN
COLLABORATION WITH DATA AND
IMPLEMENTATION SCIENCE IS
COMMUNITY AND IMPLEMENTING
PARTNERS AND OTHER INTERESTED
EFFECTIVE PARTIES CAN CLEARLY
DEFINE THE PROBLEM AND THEN
DEFINE AND PRIORITY PRIORITIZE
THE KEY VARIABLES AND THEN
DEVELOP THE APPROACH THAT HAS
LIKELY THE OPPORTUNITY TO BE
EFFECTIVE.
SO THAT'S KIND OF HOW WE'VE BEEN
WORKING ON IT.
THERE ARE LOTS OF LOGIC MODELS
FOR IMPLEMENTATION SCIENCE AND
DEPENDING ON THE QUESTION YOU
WANT TO ASK YOU PICK THE BEST
ONE THAT ALLOWS YOU TO MOVE
FORWARD AND PUT THE BEST TEAM
TOGETHER.
THOSE ARE MY SUGGESTIONS.
I'M SURE THERE'S OTHERS.
CATALYZING WHAT PEOPLE HAVE SAID
IN THIS MEETING.
ALL THE POINTS ARE VERY VALID.
IF YOU WANT TO ENGAGE THE
COMMUNITY YOU HAVE TO ENGAGE THE
COMMUNITY THAT YOU WANT TO WORK
WITH SO YOU ARE TALKING THEIR
TALK AND APPROACHING MEETING
THEIR NEEDS.
>> THANK YOU.
I'D LIKE TO GET IN THE NEXT 10
MINUTES I'D LIKE TO GIVE A
CHANCE TO DOCTORS, BRYANT,
CHANDLER AND AKLIN TO ANSWER ONE
MORE QUESTION SPECIFICALLY TO
DOCTORS, BRYANT AND CHANDLER
FIRST WHAT DEMONSTRATES EFFICACY
TO REDUCE TRANSMISSION IN REAL
WORLD CONTEXT.
FOR EXAMPLE, SOMETHING WE NEED
TO DO WITH SYRINGE EXCHANGE
PROGRAMS OR PREP FOR PEOPLE
USING SUBSTANCES?
DR. BRYANT.
>> WHEN I WAS AT YALE UNIVERSITY
30 YEARS AGO WE STARTED THE
FIRST NEEDLE EXCHANGE PROGRAM.
SO I'M ALL FOR IT.
OUR FOCUS HAS BEEN ON TRYING TO
LOOK AT THE PREVENTION ASPECT
MORE CAREFULLY IN TERM OF THE
WHOLE BEHAVIORAL ATTITUDES AND
BEHAVIOR CHARACTERISTIC OF THE
POPULATIONS THAT WE'RE LOOKING
AT AND THEY'RE PRIMARILY ALCOHOL
DEPRESSED POPULATIONS WITH OTHER
COMORBIDITIES.
IT'S A CHALLENGE.
THE ISSUE IS WHAT WAS MENTIONED
BEFORE IS HOW DO YOU INTEGRATE
THE SUBSTANCE USE AND THIS IS
TRUE OF OTHER SUBSTANCES INTO
THESE SETTINGS PARTICULARLY
HOUSING SETTINGS AND WHO HAS
UPTAKE OF THESE THINGS.
SO WE'RE REALLY LOOKING
DIFFERENTLY AT THE
CHARACTERISTICS OF PREP AND PREP
AND CAP AVAILABILITY AND THE ONE
THING I WILL SAY IS THE NIAAA
HAS DONE A LOT OF WITH POLICY
RESEARCH AND THE CDC HAS DONE
SOME OF THIS BUT YOU LOOK AT
THINGS LIKE DENSITY OF LIQUOR
OUTLETS AND GEOMAPING,
GEOFENCING, ALL THESE THINGS
MORE RELATED TO GEOSPATIAL TYPE
OF INTEGRATION OF INTERVENTIONS.
HOW DO YOU FACILITATE
INTERVENTIONS.
IT'S NOT EVEN THE IMPLEMENTATION
BUT HOW DO YOU LAY THESE THINGS
OUT IN THE REAL WORLD AND HOW DO
PEOPLE DEVELOP THE COGNITIVE
REPRESENTATIONS OF THE
EFFECTIVENESS OF THESE
INTERVENTIONS.
SO IT'S REALLY MORE OF A RISK
MANAGEMENT APPROACH.
SO WE'RE ACTUALLY DOING QUITE A
BIT AROUND RISK MANAGEMENT AND
TRYING TO TRAIN HEALTH
PROFESSIONALS INCLUDING
PHARMACISTS IN TERMS OF BRIEF
MESSAGING INTERVENTIONS THEY CAN
DELIVER IN A VARIETY OF
SETTINGS.
>> THANK YOU, DR. CHANDLER, SAME
QUESTION.
>> THERE'S A MOUNTAIN OF
EVIDENCE TO DEMONSTRATE THE
EFFECTIVENESS OF SYRINGE SERVICE
PROGRAMS FOR TRANSMISSION OF HIV
AND GETTING PEOPLE TO ENTIRE
INTO SUBSTANCE ABUSE TREATMENT.
LOWERING OTHER REALLY EXPENSIVE
MEDICAL CONDITIONS LIKE ENDO
ENDOCARDITIS INFECTION AND WHAT
WE SEE ACROSS SOME PARTS OF THE
COUNTRY IS THAT SYRINGE SERVICE
PROGRAMS ARE UNDER SIEGE AND WE
HAD A LARGE HIV OUTBREAK COUNTRY
AND THE SYRINGE SERVICE PROGRAMS
WERE STOOD UP AND A COUPLE YEARS
AGO THEY'VE BEEN SHUT DOWN.
WE'RE SEEING THEM SHUT DOWN
ACROSS THE STATE OF WEST
VIRGINIA WHICH IS HAVING TWO
COUNTIES HAVE EXPERIENCING A BIG
HIV OUTBREAK.
YOU HAVE TO CHANGE THE HEARTS
AND MINDS OF PEOPLE WITHIN
COMMUNITIES.
WE CAN DEVELOP ALL THESE
WONDERFUL FANTASTIC
INTERVENTIONS AND APPROACHES BUT
IF YOU WANT UPTAKE AND WANT
PEOPLE TO USE IT YOU HAVE TO
THINK HOW TO DO THIS AND PART OF
THE THINGS WE'VE DONE IS STARTED
LOOKING AT HEALTH COMMUNICATIONS
CAMPAIGNS AND HOW BEGIN TO
FIGURE OUT HOW TO EFFECTIVELY
TAILOR MESSAGING TO COMMUNITIES
THAT MEETS COMMUNITY MEMBERS
WHERE THEY ARE WITH THEIR LEVEL
OF SCIENTIFIC EXPERTISE OR NOT
WITH THEIR FAITH BASED IDEAS AND
CULTURE AND LANGUAGE.
I THINK WE CAN ALL AGREE THAT WE
LEARNED A LOT ABOUT HOW FAR WE
NEED TO GO WITH HEALTH
COMMUNICATIONS WITH THE COVID
PANDEMIC AND ISSUES AROUND THAT
AND THAT REMAINS TO BE A
CRITICAL AND IMPORTANT THING IN
AND AN IMPORTANT AREA OF SCIENCE
TO CONSIDER NIDA AND NIMHD
PARTNERED A YEAR OR SO AGO AT AN
INITIATIVE LOOKING AT HEALTH
COMMUNICATIONS CAMPAIGN AND HOW
TO EFFECTIVELY GET MESSAGING OUT
TO COMMUNITIES SO THERE'S A
GREATER RECEPTIVITY AND WI
WILLINGNESS AND THESE PROGRAMS
GRATE EXAMPLE, IT'S NOT JUST THE
PATIENT POPULATION YOU HAVE TO
CONVINCE BUT THE BROADER
COMMUNITY WITH WHICH THE
INTERVENTION WILL SIT YOU HAVE
TO CONVINCE TO SUPPORT IT AND
LET IT BE THERE.
THERE ARE PLACES MORE OR LESS
SUCCESSFUL AND HAVE TO GALVANIZE
LESSONS LEARNED AND OFTEN THINGS
WE DON'T CONSIDER AND THE OTHER
THING WE HAVE TO REALIZE IS THAT
MORE PEOPLE AT RISK LIFK WITH
HIV AND USING AND FOR PEOPLE
INJECT BEING -- INJECTING DRUGS
AND MINORITIES FACE
DISCRIMINATION WITHIN THE HEALTH
CARE SYSTEM.
IT BECOMES A MATTER OF HOW DO
YOU IMPACT THAT AND WE LOOKED AT
A SURVEY OF PRIMARY CARE
PROVIDERS AND 45% THAT
VOLUNTARILY PARTICIPATED IN THE
SURVEY SAID SUBSTANCE USE WAYS
MORAL FAILURE.
22% SAID THEY WERE ANGRY WITH
THEIR PATIENTS INJECTING DRUGS
AND 20% AGREED WITH THE
STATEMENT PEOPLE WHO INJECT
DRUGS ARE DISHONEST AND THESE
ARE THE INDIVIDUALS WE'RE TRYING
TO HAVE PROVIDE MEDICATION FOR
OPIOID USE DISORDER AND TRYING
TO GET THEM TO PROSCRIBE PREP.
TRYING TO GET THEM TO BE ABLE TO
PROVIDE THE CARE NECESSARY AND I
DON'T WANT TO JUST BLAME THEM
BECAUSE WE DON'T KNOW HOW TO
HAVE HEALTH CARE SYSTEMS THAT
ARE DISCRIMINATION FREE.
WE DON'T KNOW HOW TO INTERVENE
IN AN EFFECTIVE WAY TO CREATE
THE KINDS OF ENVIRONMENTS WHERE
YOU SEE THE RIGHT KINDS OF
INTERVENTIONS HAPPENING FOR THE
RIGHT KINDS OF PEOPLE AND
ENGAGING IN THE CHANGING OF
HEARTS AND MINDS AND PROVIDING
BETTER CARE.
>> I WANTED TO GET TO DR. AKLIN
FOR THE LAST QUESTION BEFORE WE
END AT 4:00 EASTERN.
WHAT DID YOUR INSTITUTE TO DO TO
FOSTER COMMUNITY-BASED RESEARCH.
>> WHERE WE ARE IS UNDERSTANDING
A NEW AND INNOVATIVE APPROACH
ENGAGING WITH COMMUNITIES
GETTING TO UNDERSTANDING HOW TO
PARTNER WITH THE COMMUNITY.
BUT FOR US TAKING IT A STEP
FURTHER AND HAVING THE COMMUNITY
DRIVE THE RESEARCH QUESTIONS AND
SUPPORTING THE COMMUNITIES
SPECIFICALLY WHO HAVE THE
ABILITY TO BE ABLE TO TAKE THE
INTERVENTIONS AND TAKE THE
INFORMATION IN TERMS OF
PREVENTIVE MEASURES WE HAVE AND
NOT ONLY LOOK AT ADAPTABILITY OF
THAT BUT THE ACCEPTABILITY TO
THEN SEE UPTAKE.
ONE OF THE THINGS WE DO AND
PARTNERED WITH COMPOS AN NIH
WIDE PROGRAM TO ADVANCE SCIENCE
FOR SOCIETY.
WE HAVE THE OPPORTUNITY TO
SUPPORT THE COMMUNITY
ORGANIZATION AND ASK COMMUNITY
ORGANIZATION TO LEAD THE
RESEARCH AND ENCOURAGE THAT
COMMUNITY ORGANIZATION TO
PARTNER WITH RESEARCHERS.
ESSENTIALLY LOOKING AT IT FROM
THE OTHER WAY WHERE MOST
INTERVENTIONS ARE LED BY
RESEARCHERS ASKING TO INVOLVE
COMMUNITY-BASED ORGANIZATIONS.
SO NINR TAKES A STRONG
LEADERSHIP ROLE IN BEING ABLE TO
DO THIS SPECIFICALLY WHEN WE
TALK ABOUT THE PROGRAMS WE HAVE
SPONSORED AND SUPPORTED FOR HIV.
WE'RE FOCUSSING ON THE AFRICAN
AMERICAN COMMUNITY AND MEN
HAVING SEX WITH MEN AND MAKING
SURE WE HAVE AN OPPORTUNITY TO
BE IN A SPACE TO HEAR AND
LISTEN, OBSERVE AND UNDERSTAND
SPECIFICALLY THOSE BARRIERS SO
WE CAN THEN DRESS IT FROM THE
COMMUNITY UP -- ADDRESS IT FROM
THE COMMUNITY UP.
WE SOUPPORTED AN RO1 INTERVENTIN
BEING MORE NEUTRAL IN OUR
QUESTIONS AND ASKING SPECIFIC
FOR THE ENVIRONMENT AND COUNTY
WHERE THEY ARE, HOW BEST TO BE
ABLE TO UNDERSTAND WHAT'S
AVAILABLE.
WHETHER WE'RE LOOKING AT THE
NEED TO TALK ABOUT EDUCATION AND
MESSAGING OR LOOKING AT THE NEED
OF PROVIDING ACCESS TO MAKE SURE
THEY HAVE THE AVAILABILITY OF
BEING ABLE TO USE THAT IS
ESSENTIALLY WHERE WE ARE WITH
OUR COMMUNITY-ENGAGED WORK.
>> THANK YOU.
THIS HAS BEEN TERRIFIC.
THANK YOU TO ALL OF OUR
PANELISTS AND OARAC MEMBERS FOR
ENGAGING IN THIS THOUGHTFUL
CONVERSATION.
WE'LL JUST TAKE A FIVE-MINUTE
BREAK SO THAT WE WILL BE BACK AT
4:05 EASTERN TIME AND COME BACK
TO THE HOME STRETCH SO PLEASE DO
NOT LOG OUT OF ZOOM.
MUTE YOUR LINE AND HIDE YOUR
CAMERA AND BE RIGHT BACK.
>> WE'LL HERE FROM OUR NIH
ADVISORY COUNCIL AND EXECUTIVE
COMMITTEES TO PROVIDE BRIEF
SUMMARIES OF THE MEETINGS.
I BELIEVE WE'RE GOING TO HAVE A
SLIGHT SHIFT FROM THE ORDER OF
THE AGENDA AND GO FIRST WITH
DR. LIGHTFOOT SERVING ON THE
MENTAL HEALTH COUNCIL AND
ASSOCIATE DEAN FOR RESEARCH AND
THE PORTLAND STATE UNIVERSITY
SCHOOL OF PUBLIC HEALTH.
DR. LIGHTFOOT OVER TO YOU TO
PROVIDE UPDATES.
>> THANKS VERY MUCH.
>> THANK YOU.
HAPPY TO PROVIDE UPDATES.
THERE WAS AN EVENT ENTITLED THE
EVOLUTION OF MENTAL RESEARCH.
THERE'S A BIG INITIATIVE
HAPPENING IN NIMHD I THOUGHT
MIGHT BE OF INTEREST TO THIS
GROUP IS ADVANCING PRECISION
MEDICINE IN PSYCHIATRY AND
TAILORING THE TREATMENTS FOR
INDIVIDUAL OFTEN TRIAL AND ERROR
AND BECAUSE OF THAT IT LEADS TO
UNACCESSIBLE DELAYS IN RECEIVING
IVE TREATMENT.
THE INITIATIVE HAS BEEN LAUNCHED
TO ADDRESS THIS AND INTENDED TO
LAUNCH WITH TWO PARALLEL AREAS
OF NEED.
THE PRECISION DIAGNOSTICS AND TO
THE RFAs WERE RELEASED IN THOSE
AREAS AND HOPE FOLKS IN DOING
HIV WORK ARE THOUGHTFUL AND
INTENTIONAL LOOKING AT
OPPORTUNITIES.
I'M PLEASED TO ANNOUNCE LISA
BOLE WAS NAMED THE THIRD JAMES
JACKSON MEMORIAL AWARD WINNER IN
JULY OF THIS PAST YEAR.
SHE'S KNOWN VERY WELL TO THE HIV
COMMUNITY AND IN THE DEPARTMENT
OF PSYCHOLOGICAL AND BRAIN
SCIENCES AT THE GEORGE
WASHINGTON UNIVERSITY AND
CO-DIRECT THE CORE OF THE D.C. P
IT IS --PFAR AND LOOKED AT
ECONOMIC STATUS AND SEXUALITY.
THE AWARD'S NAMESAKE FOCUSSED ON
RACISM AND MENTAL HEALTH AND HAD
FAR REACHING IMPACT IN DISPARITY
RESEARCH AND MINORITY HEALTH.
GIVEN THE TOPIC BOTH THESE FOLKS
ARE REALLY KEY CONTRIBUTORS TO
OUR KNOWLEDGE IN THIS AREA.
ALSO NOTE THERE'S BEEN A COUPLE
OF CHANGES IN NIMHD LEADERSHIP
WE'VE HAD A NEW DIRECTOR OF THE
DIVISION OF SERVICES AND
INTERVENTION DR. YOUNG HAD A
CAREER IN INTERVENTIONS RESEARCH
AND KNOWN TO MANY OF US IN HIV
PIM BROUWERS AND THE DIVISION OF
AIDS RESEARCH IN 2004 HE HELD
VARIOUS ROLES IN HIS TENURE.
AND HE'S BEEN INSTRUMENTAL IN
PROGRAM DEVELOPMENT, TRAINING
ACROSS ALL PRIORITIES IN THE
DIVISION OF AIDS RESEARCH.
AND THEN YOU'LL SEE HERE THE NEW
DEPUTY FOR THE DIVISION OF AIDS
RESEARCH IS NOW GREG GREENWOOD.
QUICKLY WANTED TO SHARE NIMHD IS
GOING THROUGH A PROCESS TO
CHANGE ITS MISSION STATEMENT.
HERE IN BOLD YOU CAN SEE SOME
PROPOSED CHANGES IN THE MISSION
STATEMENT TO SEEK THE
FUNDAMENTAL KNOWLEDGE ABOUT THE
NATURE AND BEHAVIOR AND LIVING
SYSTEMS AND TO APPLY THAT
KNOWLEDGE TO OPTIMIZE HEALTH AN
PREVENT OR REDUCE ILLNESS FOR
ALL PEOPLE.
WE'RE LOOKING FOR INPUT AROUND
THE NEW PROPOSED MISSION
STATEMENT.
RESPOND BY NOVEMBER 24.
I LISTED THERE THE N-O-T TO PUT
THAT RESPONSE IN.
HERE'S SOME OF THE HIV SPECIFIC
FUNDING OPPORTUNITIES NIMHD HAS
AVAILABLE RIGHT NOW.
THE FIRST IS NOT NIH SPECIFIC
BUT GIVEN WHAT WE TALKED ABOUT
EARLIER AND THE COMMENTS AROUND
FOLKS AGING WITH HIV, I THINK
THIS IS AN APPROPRIATE P-A-R FOR
FOLKS INTERESTED IN THE AREA
PARTICULARLY AROUND MENTAL
HEALTH AND HOW THAT'S RELATING
TO SUICIDE RISK LATER IN LIFE
AND YOU CAN SEE HERE N-O-Ts
AROUND CARE AND TREATMENT FOR
ADOLESCENTS AS WELL AS MENTAL
HEALTH COMORBIDITIES, STIGMA AND
SCIENCE AROUND HIV AND GLOBAL
HIV TREATMENT TARGETS.
SO PLEASE JUST TAKE A NOTE OF
THOSE AND I HOPE THERE'S FOLKS
WATCHING LOOKING TO RESPOND TO
THESE.
THERE'S ALSO TWO CONCEPT
CLEARANCES APPROVED AT THE LAST
NIMHD COUNCIL MEETING.
-- TWO RELATED TO HIV AT LEAST.
THE FIRST IS AN ANTI-HIV TESTING
CARE THROUGH PHARMACIES AND THIS
TO ENCOURAGE DESIGNS TO FURTHER
CAPACITATE AND SCALE THE ROUTINE
DELIVERY OF HIV TESTING,
PREVENTION AND CARE SERVICES
THROUGHOUT PHARMACIES AND
PHARMACY SETTINGS AND ENABLING
STUDENTS AND PHARMACIES TO
EFFECTIVELY DELIVER HIV
SERVICES.
AND TOPICS TO FIT THERE ARE THE
CONCEPT CLEARANCE AND SHORT LIST
NOT COMPREHENSIVE BUT ANYTHING
RELATED TO PHARMACY BASED
SCREENINGS FOR HIV AND COMMON
COMORBID CONDITIONS AND PREP
DELIVERY INCLUDING INJECTABLES.
PHARMACY-BASED MONITORING
SUPPORT FOR TREATMENT AND
ADHERENCE AND TRAINING STUDENTS
AND TECHNICIANS TO SUPPORT HIV
PREVENTION AND CARE.
THE LAST WAS STREAMLINING
INTERVENTION FOR YOUTH LIVING
WITH HIV IN LOW-AND
MIDDLE-INCOME COUNTRIES AND HOW
TO BEST ADDRESS THE NEEDS OF
YOUTH LIVING WITH HIV IN LOW AND
MIDDLE INCOME COUNTRIES.
THAT'S TWO MAIN GOALS OF THE
CONCEPT.
FIRST WAS TO INCREASE THE NUMBER
OF MENTAL HEALTH INTERVENTIONS
TAILORED TO THIS POPULATION BOTH
IN TERMS OF THEIR DEVELOPMENT
NEEDS AS WELL AS ISSUES RELATED
TO LIVING WITH A CHRONIC
STIGMATIZED DISEASE AND TO
ENSURE INTERVENTIONS ARE
STREAMLINED FOR IMPLEMENTATION
AND TOPIC APPROPRIATE WOULD BE
DETERMINING THE OPTIMAL POINTS
OR INTENSITY TO LESSEN THE
INTERVENTION FOR YOUTH LIVING
WITH HIV AND DETERMINING THE
MINIMAL DOSE OR CRITICAL
COMPONENTS NEEDED TO ACHIEVE
CLINICALLY SIGNIFICANT
IMPROVEMENTS.
MATCHING THE MOST EFFECTIVE
INTERVENTION TO THE APPROPRIATE
PERSON AND TESTING
IMPLEMENTATION STRATEGIES TO
LESSEN PROVIDER BURDEN WHILE
DETERMINING THE QUALITY OF
INTERVENTION DELIVERY.
NIMHD HELPED SPONSOR TWO
MEETINGS IN THE YEAR HIV
RELATED.
FIRST WAS VIOLENCE IN THE HIV
CARE CONTINUUM AND SECOND WAS
PHARMACY-CENTERED HIV RESEARCH.
THE RECORDINGS AND PROCEEDINGS
ARE AVAILABLE SO PLEASE I
COURAGE YOU TO TAKE A LOOK..
-- I ENCOURAGE YOU TO TAKE A
LOOK.
WE HAD A RESEARCH HIGHLIGHT.
WE HEARD ABOUT THIS PARTICULAR
STUDY AND PAPER.
SO THE BRAIN MICROGLIA MAY SERVE
AS AN HIV RESERVOIR.
IN THE STUDY THEY ISOLATED IS
THE CELLS FROM NON-HUMAN
PRIMATES AND SOUGHT EVIDENCE TO
WHAT THIS PERSISTENT VIRAL
INFECTION LOOKED LIKE AND SAW
LACK OF DIVERSITY AND THEY
COLONIZE REGIONS AND THIS AREA
OF THE BRAIN DOES HARBOR HIV AND
SERVE AS SYSTEM RESERVOIR IN THE
BRAIN.
THERE'LL BE ADDITIONAL RESEARCH
IN THE AREA.
WE HEARD ABOUT NIMHD'S
INVESTMENT AND THERE'S THE
COMMUNITY PARTNERSHIP TO ADVANCE
SCIENCE FOR SOCIETY.
I THINK THIS IS ALSO
PARTICULARLY OF INTEREST FOR HIV
RELATED RESEARCHERS.
THERE ARE HIV RELATED STUDIES
THAT HAVE BEEN FUNDED UNDER THE
COMPASS PROGRAM SO IT'S
SOMETHING WE ALL NEED TO BE
AWARE OF AND IT WAS INTERESTING
TO HEAR ABOUT THIS PROGRAM.
S TO GIVE YOU ALL A SENSE.
THIS PROGRAM IS SUPPORTED BY THE
NIH COMMON FUND.
IT'S FOCUSSING ON HEALTH EQUITY
SO APPROPRIATE TO OUR
CONVERSATION TODAY.
IT'S INTENDED TO LEVERAGE
STRUCTURAL INTERVENTIONS AND
MULTI-SECTORIAL PARTNERSHIPS.
ONE OF NIHs STRATEGIES AND
THINKING ABOUT ADDRESSING THESE
ISSUES AROUND SOCIAL
DETERMINATES OF HEALTH AND
HEALTH OUTCOME.
SO IT'S ALLOWING FOR REALLY
EXPANSIVE WAYS TO LOOK AT SOME
OF THESE ISSUES AND SO FAR HAS
BEEN A SUCCESSFUL PROGRAM AND
I'M BIAS BECAUSE THEY'RE ALSO
FUNDING ONE OF MY PROJECTS BUT I
THINK WE'RE GOING SEE SOME
REALLY IMPACTFUL SCIENCE COMING
OUTIVE THIS PROGRAM.
-- COMING OUT OF THIS PROGRAM.
IN TERMS OF THE FISCAL YEAR '23
BUDGET JUST WANTED FOLKS TO KNOW
THAT THERE WAS A $2.3 ALLOCATION
FOR NIMHD AND IT ANTICIPATES
WARDING NEW AND COMPETING
PROJECT GRANTS IN FISCAL YEAR
'23 AND HAS AN ESTIMATED SUCCESS
RATE OF 23%.
IN ACCORDANCE WITH THE NEXT
GENERATION INITIATIVE EFFORTS
THEY'RE ANTICIPATING AWARDING TO
86 EARLY STAGE INVESTIGATORS AND
172 AT-RISK INVESTIGATORS AND
FOR FISCAL '24 AND THE HOUSE
APPROPRIATIONS COMMITTEE THEY
PROVIDED A $2.2 MILLION FOR
NIMHD A REDUCTION FROM FISCAL
YEAR '23 ENACTED LEVELS AND THE
SENATE APPROPRIATIONS COMMITTEE
THEIR BUDGET WOULD PROVIDER $2.4
MILLION AN INCREASE OF $100
MILLION ABOVE THE ENACTED LEVEL.
I BELIEVE THAT MIGHT HAVE BEEN
IT FOR ME.
YES, THANK YOU VERY MUCH.
>> THANK YOU.
LET'S MOVE TO DR. OTT.
I WILL SAY A FEW WORDS.
DR. OTT SERVES AS THE MEMBER OF
THE NATIONAL ADVISORY COUNCIL ON
DRUG ABUSE AND SENIOR
INVESTIGATOR FOR THE GLASGOW
TECHNOLOGY AND PROFESSOR OF
MEDICINE AT UCSF.
TAKE AWAY THE UPDATES ON NACDA.
>> I'M DELIGHTED TO PROVIDE AN
UPDATE ON THE NATIONAL INSTITUTE
ON DRUG ABUSE FROM OUR LAST
COUNCIL MEETING.
>> THE RESEARCH PORTFOLIO IS
VERY BROAD AND INTERTWINED WITH
HIV RESEARCH AND SUPPORTS BASIC
AND CLINICAL AND IMPLEMENTATION
SCIENCE RESEARCH AND THERE'S
SELECT AREAS OF FOCUS AS WE
UNDERSTAND THE SYNERGISTIC AREA
OF HIV AND SUBSTANCE USE AND
EXAMINING CONTRIBUTIONS OF
SUBSTANCE USE TO HIV AND
HIV-ASSOCIATED COMORBIDITIES AND
INTEREST IN COMORBIDITIES AND
PATHWAYS AND ETIOLOGY AND
TREATMENT AND DISCRIMINATION AND
HEALTH CARE DELIVERY ALL
SUBJECTS WE ALREADY DISCUSSED
TODAY.
WE HEARD FROM THE DIRECTOR OF
THE WHITE HOUSE OFFICE OF
NATIONAL AIDS POLICY AN UPDATE
ON FEDERAL EFFORTS TO ADDRESS
THE NATIONAL EPIDEMIC OF HIV AND
HE HIGHLIGHTED THAT 1 IN 10
INFECTIONS STILL CONTINUE TO BE
IN PEOPLE WITH INJECTION DRUG
USE AND THAT MANY OF THE FACTORS
THAT WE DISCUSSED INCLUDING
HOMELESSNESS AND ALSO OPIOID USE
AND OVERDOSE AND METH USE
CONTINUE TO BE DRIVING FACTORS
OF NEW NIH INFECTIONS AND POORER
HEALTH OUTCOMES IN PEOPLE WITH
HIV.
AND PLACE -- AND LOOKING AT
SUBSTANCE USE RESEARCH THAT
CENTERS OUTCOMES THAT'S
IMPORTANT TO INFORMING EFFORTS
TO ADDRESS HIV STEMMING FROM
SUBSTANCE USE.
ANOTHER THING WE WANTED TO
HIGHLIGHT IS THAT PREP IS
WORKING IN PEOPLE WHO INJECT
DRUGS AND THE FINAL
RECOMMENDATION THE
U.S. PREVENTIVE SERVICES TASK
FORCE GIVES PREP AN A-GRADE FOR
EFFECTIVENESS IN PREVENTIVE CARE
AND RECOMMENDS THE CLINICIANS
PRESCRIBE PREP AND FOR FURTHER
INFORMATION CAN BE FOUND BUT
EMPHASIZES PEOPLE WHO INJECT
DRUG SHOULD NOT BE INCLUDED FROM
THESE EFFECTIVE MEASURES.
HOWEVER, AS DR. CHANDLER
MENTIONED THERE IS QUITE A BIT
OF IMPLICIT BIAS TOWARDS PEOPLE
WHO INJECT DRUGS AND THE PRIMARY
CARE PROVIDER SPACE.
ONE THIRD OF THE PARTICIPANTS OF
THIS STUDY DISPLAYED HIGH LEVELS
OF STIGMA TOWARDS PEOPLE WHO
INJECT DRUGS.
AND LOOKING AT STATEMENTS FOR
THOSE WHO INJECT DRUGS ARE
DISHONEST AND SO THERE'S A LOT
OF WORK HERE AND I THINK IF THIS
IS NOT CHANGING I THINK
RECOMMENDATIONS LIKE PRESCRIBING
DRUGS.
AND WE NEED TO LOOK AT
DISCRIMINATION AND
INTERSECTIONAL STIGMA LOOKING AT
THE PROVISION OF GUIDELINE ON
CONCORDANT CARE FOR THOSE USING
DRUGS OUR LIVING WITH HIV AND
IT'S A RELEVANT SUBJECT FOR
PEOPLE WHO INJECT DRUGS AND FOR
THE MISSION.
THIS IS THE LAST SLIDE WHERE WE
WANTED TO EMPHASIZE THE CURRENT
FUNDING OPPORTUNITIES THAT ARE
VERY MUCH GEARED TO BE INTEGRATE
ED RESEARCH WHEN PROVIDING CARE
AND HIGHLIGHTS HERE SPECIFICALLY
RESEARCH INTO MICROGLIAL PA
PATHOLOGY AND STUDIES AT THE
INTERSECTION OF HIV AND POLY
SUBSTANCE USE.
SO WITH THIS, I'LL TURN IT BACK.
>> I'LL BACK TO CORETTE BYRD IN
TERMS OF OUR HEALTH POLICY
ANALYST AND CLINICAL GUIDELINES
ACTIVITIES AS WELL AS OTHER
CROSS-CUTTING ACTIVITIES.
>> TODAY I'D PROVIDE A BRIEF
OVERVIEW OF A FEW ADDITIONAL
RECENTLY CLEARED CONCEPTS BY
INSTITUTES, CENTERS AND OFFICES
AT NIH RELATED TO HIV.
THIS SAY -- IS A SUMMARY AND
THERE'S REISSUED CONCEPT FOR A
TOTAL OF 15 THIS PERIOD.
FIRST THE NATIONAL INSTITUTE OF
ALLERGY AND INFECTIOUS DISEASE
HAS NEW CONCEPTS.
THE STRATEGIES FOR ELIMINATING
HIV PROTEINS SUPPORTS BASIC
RESEARCH GRANTS THAT DEVELOP
NOVEL THERAPEUTICS DIRECTED TO
INTRACELLULAR HIV TARGETS BY
VARIOUS MECHANISMS SUCH AS
PROTEIN DEGRADATION AND
TARGETING OF VIRAL RNA THROUGH
INHIBITING RNA PROCESSING.
THE LIMITED INTERACTION TARGETED
EPIDEMIOLOGY NEW CONCEPT
SUPPORTS A LARGE ELECTRONICALLY
GENERATED COHORTS OF MEN WHO
HAVE SEX WITH MEN AND
TRANSGENDER WOMEN WHO ARE HIV
NEGATIVE AND FOLLOW THEM TO
STUDY THE EPIDEMIOLOGY OF HIV
INCIDENTS IN LATIN AMERICA.
GENDER AFFIRMING HORMONE
THERAPY, RESILIENCE, PHARMACO
KINETICS STUDIED FOR INFECTION
IN TRANSGENDER PEOPLE.
VACCINE RESPONSES ALSO KNOWN AS
INDOR INTEGRATES BIO ENGINEERING
AND IMMUNOLOGY.
THIS INITIATIVE HAS SEVERAL
OBJECTIVES.
ONE, TO IDENTIFY SIGNATURES AND
MARKERS OF DURABLE HIV VACCINE
RESPONSES.
TO IDENTIFY EARLY IMMUNE SIGNALS
FOR PROGRAMMING DURABLE HIV
VACCINE RESPONSES AND TO APPLY
THIS KNOWLEDGE TO THE
DEVELOPMENT OF MORE DURABLE HIV
VACCINES.
STRATEGIES FOR CONTROLLED
RELEASE OF HIV VACCINES ALSO
CALLED SCORE H ADVANCES
EFFECTIVE AND PRACTICAL ANTIGEN
AND IMMUNOGEN DELIVERY PLATFORMS
TO MANIPULATE AND CONTROL
SPATIAL AND TEMPORAL RELEASE OF
HIV VACCINES TO IMPROVE IMMUNE
RESPONSES AND TO DELIVER COMPLEX
IMMUNIZATION REGIMENTS IN A
SINGLE FORMULATION.
NIAID HAS NOTICE OF SPECIAL
INTEREST TO SOLICIT RESEARCH
PROPOSE THE GOALS OF ENDING THE
HIV EPIDEMIC AND THE CENTERS FOR
AIDS RESEARCH WHICH IS ALSO
KNOWN AS CFAR AND DEVELOPMENTAL
CENTERS GRANTS SUPPORT PROGRAMS
THAT EXPAND THE ROLE OF THE CFAR
DEVELOPMENT CORE TO INCLUDE
ADDITIONAL SUPPORT AND
INFRASTRUCTURE TO DIVERSIFY
APPROACHES, INVESTIGATORS AND
RESEARCH INTO HIV RELATED HEALTH
DISPARITIES.
ON THIS SLIDE YOU'LL SEE THE
NATIONAL INSTITUTE OF CHILD
HEALTH AND DEVELOPMENT HAS ONE
NEW CLEAR CONCEPT AND THE
NATIONAL INSTITUTE OF MINORITY
HEALTH AND HEALTH DISPARITIES
HAS TWO NEW CLEARED CONCEPTS.
FOR NICHD THE OPTIMIZING HEALTH
OF CHILDREN WITH PERINATAL
EXPOSURE SEEKS TO UNDERSTAND THE
SOCIAL ENVIRONMENT FACTORS THAT
CONTRIBUTE TO THE HEALTH
OUTCOMES OF POPULATIONS WHO ARE
EXPOSED TO HIV AND ART IN UTERO
AND BREAST FEEDING UNINFECTED AN
LOOKING AT STRUCTURAL STIGMA AND
INEQUALITIES.
FOR HOUSING STABILITY AMONG
PEOPLE LIVING WITH HIV/AIDS FROM
POPULATIONS THAT EXPERIENCE
HEALTH DISPARITIES SUPPORTS
MULTI-LEVEL AND
MULTI-DISCIPLINARY RESEARCH THAT
ADDRESS THE INTERSECTIONS
BETWEEN HOUSING, CARE SEEKING
AND TREATMENT BEHAVIORS OF
PEOPLE LIVING WITH HIV AND
EXPERIENCING HOUSING
INSTABILITY.
AND THE SECOND CONCEPT
MECHANISMS AND INTERVENTIONS TO
ADDRESS COMORBIDITIES IN
POPULATIONS THAT EXPERIENCE
HEALTH DISPARITIES HAS A TWOFOLD
PURPOSE.
FIRST TO SUPPORT INTERVENTION
RESEARCH.
TO IMPROVE QUALITY OF LIFE AND
PROMOTE SUCCESSFUL AGING AMONG
PEOPLE LIVING WITH HIV FROM
RACIAL, ETHNIC AND LOWER SOCIO
ECONOMIC LEVELS AND COMORBI
COMORBIDITIES ACROSS THE LIFE
COURSE.
THE SECOND IS TO SUPPORT STUDIES
TO UNDERSTAND THE MECHANISMS
UNDERLYING HIV RELATED
COMORBIDITIES THAT CONTRIBUTE TO
EXCESS MORBIDITY AND MORTALITY
IN HIV INFECTED POPULATIONS.
PARTICULARLY IN THOSE THAT
EXPERIENCE HEALTH DISPARITIES
AND MAY HAVE INTERSECTING
IDENTITIES.
BOTH THE NATIONAL CANCER
INSTITUTE AND NATIONAL INSTITUTE
OF AGING ISSUED ONE CONCEPT THE
FUNDING OPPORTUNITIES SEEKS A
CONTINUATION OF THE AIDS CANCER
SPECIMEN RESOURCE AND THE
PRIMARY OBJECTIVE THE ACSR IS
TOE ACQUIRE AND STORE AND
EQUITABLY DISTRIBUTE SAYS
SPECIMENS AND DATA WITH
HIV-RELATED MALIGNANCIES.
THE NIA IMPACT OF COMORBIDITIES
AND COINFECTIONS OF HIV
RESERVOIRS SEEKS APPLICATIONS BY
TWO OVERARCHING OBJECTIVES.
TO IMPROVE THE UNDERSTANDING OF
BIOLOGICAL AND SOCIO BEHAVIORAL
ASPECTS OF AGING THROUGH
INFECTION AND TREATMENT OF HIV
AND IMPROVE APPROACHES FOR
TESTING, PREVENTION AND
TREATMENT OF HIV INFECTION AND
MANAGEMENT OF HIV-RELATED
COMORBIDITIES, CO-INFECTIONS AND
COMPLICATIONS IN DIFFERENT
POPULATIONS AND CULTURAL
SETTINGS BY APPLYING THE CURRENT
UNDERSTANDING OF AGING SCIENCE.
TO CONCLUDE THE CONCEPTS FOR
REISSUANCE.
THE LONG ACTING DRUG DELIVERY
SYSTEMS FOR ART OPTIMIZATION IN
HIV-INFECTED CHILDREN SUPPORTS
DEVELOPMENT OF A LONG-ACTING
DRUG DELIVERY FOR TREATMENT OF
HIV 1 IN CHILDREN.
THE U.S.-BRAZIL COLLABORATIVE
BIOMEDICAL RESEARCH PROGRAM
SUPPORTS U.S. INVESTIGATORS
WORKING IN BRAZILIAN COLLEAGUES.
THE FOCUS ON IMMUNOLOGY AND HIV
AND AIDS AND COMORBIDITIES AND
THE FINAL REISSUED CONCEPT IS
SOUTH AFRICA BIOMEDICAL RESEARCH
PROGRAM TO RENEW THE U.S. SOUTH
AFRICA COLLABORATIVE PROGRAM FOR
ANOTHER FIVE YEARS AND PROVIDE
SUPPORT FOR U.S. AND SOUTH
AFRICAN SCIENTIST TO COLLABORATE
WITH MEMBERS IN BOTH COUNTRIES
AND SUPPORTS EARLY CAREER
INVESTIGATORS AND INNOVATIVE
IDEAS.
WITH THAT, THANK YOU FOR YOUR
TIME.
OVER TO YOU, BILL.
>> THANK YOU.
NOW WE'LL GO BACK TO OUR
ORIGINAL ORDER AND START WITH
DR. GANDHI WELL KNOWN TO OARAC
AS THE PRIOR CHAIR SHE'S SERVES
AS THE MEMBER OF THE AID
RESEARCH ADVISORY COUNCIL AND
ASSOCIATE CHIEF OF THE DIVISION
OF HIV AND INFECTIOUS DISEASES
AND GLOBAL MEDICINE AT UCSF
GENERAL MEDICAL HOSPITAL AND
SERVESS THE MEDICAL DIRECT OF TE
WARD 6.
TAKE IT AWAY.
>> THANK YOU SO MUCH.
I'M SORRY THEY GOT US OUT OF
ORDER.
I HAD A PATIENT ISSUE ACTUALLY.
THANK YOU SO MUCH.
THIS IS AN UPDATE FROM THE
COUNCIL SEPTEMBER 11th AND THE
IT WAS AN INTERESTING MEETING.
AND REGRETFULLY MY SECOND TO
LAST ON COUNCIL.
THIS WAS EXTREMELY EXCITING TO
HEAR ABOUT THE NEW DIRECTOR NOW
THERE.
THAT WAS EXCITING TO HEAR AND WE
HEARD ABOUT FROM THE DIRECTOR ON
THE REPORT AND HEARD THE LAST
UPDATE FROM THE FORMER ACTING
DIRECTOR OF NIAID.
AND NIAID RELATIVE TO OTHER
INSTITUTES LOOKING AT FY22 AND
FY23 HAS DONE EQUALLY AS WELL.
THERE WAS AN INCREASE HIGHER FOR
NCI OTHERWISE WE'RE THERE IN
TERMS OF SMALL INCREASES FROM
2022 TO 2023.
SO I DO HAVE TO MENTION THOUGH
THAT THERE WAS DISCUSSION AT THE
NIAID ADVISORY COUNCIL AND
BROUGHT TO US BY THE DIRECTOR
AND PROGRAM ABOUT THIS MOMENT IN
TIME THAT WE'RE HAVING AROUND
POLARIZATION.
AROUND ATTACKS ON NIAID AND
INFECTIOUS DISEASE AND
UNFORTUNATELY SOMETHING
PARTICULAR A PROPOSED FUNDING
CUT IN THE HOUSE OF THE FULL ON
23% COMPARED TO THE SENATE
BUDGET PROPOSED WHICH WAS
LEAVING NIAID FLAT LIKE THE
OTHER INSTITUTES.
OF COURSE WE ALL KNOW WHAT'S
HAPPENED AND THIS DID NOT END UP
GOING THROUGH THE HOUSE AND THE
HOUSE GOT A SPEAKER DECLARED
TODAY.
IT SPEAKS TO THE DECISIONS IN
THE UPCOMING FINANCIAL
MANAGEMENT PLAN AND THE
ANNOUNCED PAY LINES USUALLY
THESE ARE HIGHER AND THE
ESTABLISHED P.I. THE PAY LINE IS
8 PERCENTILE AND NEW ONE COMING
DOWN FROM 16 AND 12
RESPECTIVELY.
AND SO THAT IS SOMETHING THAT'S
HAPPENED AND TWO DAYS AGO NIAID
ANNOUNCED THE R21 AND R3 PAY
LINES 23 INSTEAD OF 29 AND SOME
ACROSS THE BOARD CUTS.
HOPEFULLY BEING CONSERVATIVE AND
CAUTIOUS AND HEOPEFULLY IT WILL
GET BER AND WE HAD TO HAVE
DISCUSSIONS ATHET MEETING
SPEAKING TO THIS DIFFICULT TIME
FOR US AT NIAID AND WITH ALL THE
POLITICALIZATION AND I THINK IT
WILL GET BETTER.
SO THERE WERE SUCCESSES AND ARE
SUCCESSES AND IT'S BEEN AN
INCREDIBLE YEAR IN TERMS OF
ADVANCING IN HIV MEDICINE AND IN
THE ADVANCES NIAID DROVE IN
TERMS OF THE COVID-19 PANDEMIC.
SO THE STUDIES FUNDED BY NIAID
THAT REALLY WERE AND BY THE NIH
EXCITING LED TO NOT ONLY THE
APPROVAL OF THIS EVERY EIGHT
WEEKS AS A PREVENTIVE AGENT BUT
THE U.S. PREVENTIVE SERVICES ASK
FOR GAVE IT AS PREP AN A GRADE
THIS YEAR WHICH MEANS IT WILL
PAVE THE WAY FOR INSURANCE
COVERAGE AS A SUPERIOR FORM OF
PREP AT LEAST IN BOTH TRIALS AND
WOMEN AND TRANSGENDER WOMEN AND
CISGENDER MEN.
IT WAS INCREDIBLE TO SEE THE
ADVANCES THROUGH THE PLATFORM
AND ACTIVE PLATFORM IN NOT ONLY
COVID VACCINES BUT IN TREATMENT
AND INVESTIGATIONAL THERAPIES
FOR MILD TO MODERATE COVID AND
NOW WORK IS ONGOING.
THEN WE DISCUSSED THE END HIV
EPIDEMIC MONIES AND THE FUNNELS
OF THOSE FUNDS TO EXCITING
PROJECTS ACROSS THE INSTITUTES
FOR STRATEGIES THAT WILL HELP
END THE HIV EPIDEMIC AND
COMMUNITY-FOCUSSED AND
SCIENTIFIC ADVANCES IN
DIAGNOSIS, TREATMENT, PREVENTION
AND OUTBREAK PREVENTION.
SO ACTUALLY CORETTE WENT OVER
THESE SO I WON'T DWELL ON THE
BUT CONCEPTS WERE BROUGHT TO THE
NIAID COUNCIL FOR APPROVAL.
ALL WERE VERY IMPACTFUL AND ALL
WERE APPROVED BY COUNCIL BECAUSE
THEY WERE REALLY EXCITING.
I THOUGHT THE FIRST WAS
INTERESTING BECAUSE WE FOCUS ON
THE TRANSCRIPTIONAL PATHWAY FOR
HIV BUT WHAT ABOUT AFTER
TRANSLATION HAS OCCURRED AND
THERE'S HIV PROTEIN AROUND.
WHAT ABOUT DRUGS THAT TARGET HIV
PROTEINS AN IT'S INTERESTING TO
THINK WITH THE NOVEL POTENTIAL
TARGET FOR TREATMENT AND CURE OF
ELIMINATING HIV PROTEINS AND RF
AND R 126 -- R21 WAS APPROVED
AND IF YOU LOOK AT PATTERNS
AROUND THE WORLD WITH HOW HIV
INCIDENTS HAVE BEEN GOING,
GLOBALLY IT'S DECREASED FROM
2010 TO 2020 FROM 2.1 TO 1.5
MILLION BUT THERE'S INCREASES IN
CERTAIN REGIONS INCLUDING
EASTERN EUROPE AND LATIN
AMERICA.
AND THERE WAS A SUCCESSFUL
PROGRAM ALREADY FUNDED IN THE
U.S. OF THESE LIMITED TARGETED
EPIDEMIOLOGY INITIATIVES AND
FOCUSSED ON LATIN AMERICA AND
AMONG VULNERABLE POPULATIONS IN
LATIN AMERICA TO LOOK AT PREP
FOR THOSE WHO HAVE REASON TO
NEED IT AND INCREASING RATES OF
VIROLOGIC EXPRESSION AND THIS
SAY UG3 MECHANISM AND ALSO
APPROVED.
TWO OTHER CONCEPTS.
CONTROLLED RELIEF OF HIV
VACCINES.
CONCEPT NUMBER 3.
TO HELP IMPROVE THE IMMUNE
RESPONSE PREVENTION OR
THERAPEUTIC VACCINE OR CURE TO
HELP CONTROL THAT IN THE HOPES
IT WILL INCREASE IMMUNOGENICITY
AND VACCINES THAT WILL MAKE
VACCINES -- STRATEGIES TO
ENGINEER VACCINES TO MAKE THE
RESPONSES MORE DURABLE.
AND REALLY LOOKING AT BASIC
SCIENCE AND APPLIED RESEARCH
ASPECTS OF FORMULATED VACCINES
THAT HOPEFULLY WILL LEAD TO MORE
DURABLE IMMUNE RESPONSES.
AND THEN KWON SENTS NUMBER FIVE
AND SIX AGAIN WE DISCUSSED BUT I
THINK IT'S TERRIBLY IMPORTANT
THAT THE NIAID DECIDED TO REALLY
LOOK INTO GENDER-AFFIRMING
HORMONE THERAPY AND ITS IMPACT
ON IMMUNOLOGY AND PHARMACO
KINE
KINETICS.
THERE'S INTEREST BETWEEN THESE
AND ANTIVIRALS THAT HAVE SMALLER
STUDIES AND NEED LARGER STUDIES
TO LOOK AT THE DRUG IMMUNOLOGY
AND ARE THERE THINGS WE CAN DO
TO IMPROVE THE IMMUNOLOGY OF HIV
PREVENTION OR TREATMENT.
THIS IS AN EXCITING AN IMPORTANT
INITIATIVE IN LIGHT OF CURRENT
SITUATIONS.
AND THEN THE OTHER IS THE ADULT
WORLD WE'RE VERY INTERESTED IN
LONG ACTING DRUG DELIVERY AND SO
MUCH MORE LIMITED OPTIONS FOR
CHILDREN FOR LONG-ACTING AN
ANTIRETROVIRAL THERAPY AND
THINKING OF ONES THAT ARE
PATCHES THAT DON'T INVOLVE PAIN
AND DON'T INVOLVE NEEDLES.
THINGS TO HELP CHILDREN GET
ADVANCES IN LONG-ACTING ARVs.
AND I'LL END WITH THE FACT THAT
THESE ALSO WERE TWO APPROVED
CONCEPTS IN ONE.
THERE'S ESSENTIALLY A PROPOSING
COLLABORATIVE SCIENCE BETWEEN
THE U.S. AND BRAZIL IN A
BIOMEDICAL RESEARCH PROGRAM
DOVETAILING WITH THE INITIATIVE
AND IMPORTANT FOR OUR GOOD WORK
WITH COLLABORATIONS IN THAT
REGION WITH THE INCREASING RATES
OF TRANSMISSION AND HIGH
PREVALENCE OF HIV AND ANOTHER
COLLABORATIVE MISSION BETWEEN
THE U.S. AND SOUTH AFRICA ACROSS
INSTITUTES WITH DIFFERENT
ASPECTS OF RESEARCH.
EXTREMELY IMPORTANT AND SOBERING
MOMENT AND THANK YOU FOR
ALLOWING ME TO PRESENT.
>> NOW A RAISE OF HANDS FOR ANY
DISCUSSION?
I DON'T SEE HANDS TO LET'S MOVE
AHEAD AND OUR FINAL UPDATES WILL
COME FROM THE HIV CLINICAL
GUIDELINES WORKING GROUP OF
OARAC INCLUDING GUIDELINES AND
PANEL UPDATES.
ONE PRESENTER TODAY DR. ALICE
PAU THE PRINCIPLE INVESTIGATOR
FOR EVALUATING PATIENTS WITH HIV
TREATMENT FAILURE AND AN
ASSOCIATE INVESTIGATOR FOR HIV
MANAGEMENT AND DRUG INTERACTION
CLINICAL TRIALS.
THE FOCUS OF RESEARCH IS IN HIV
TREATMENT FAILURE AND DRUG
RESISTANCE AND BECAME THE
EXECUTIVE SECRETARY OF THE PANEL
IN 2004.
CO-EDITOR OF THE HHS PANEL AND
TREATMENT OF INFECTIONS AND THE
LEADER OF THE PHARMACOLOGY TEAM
FOR THE GUIDELINES.
DR. PAU, OVER TO YOU TO PRESENT
YOUR UPDATES.
>> THANK YOU, BILL.
I'M GOING TO MAKE IT SHORT.
SO I'M GOING PROVIDE YOU WITH
SOME UPDATES OF WHAT WE HAVE
DONE SINCE THE LAST TIME.
APOLOGIES FOR THE DATES BEING
WRONG OVER THERE.
NEXT SLIDE.
IT'S BEEN 25 YEARS SINCE THE
FIRST GUIDELINE PUBLISHED IN
MMWR.
I WAS FIRST PUBLISHED IN APRIL
24, 1998.
AT FIRST WHEN THE GROUP WAS
FORMED IT WAS THOUGHT IT WOULD
BE DISMANTLED IN THREE YEARS AND
25 YEARS LATER WE'RE STILL HERE.
YOU CAN IMAGINE IN THIS
PARTICULAR SLIDE ON THE LEFT
SIDE WE HAVE THE NNRTIs AND
P.I.s.
AT THE TIME THE GROUP WAS FORMED
WE ONLY HAVE THESE THERAPIES.
HERE WE ARE WITH MULTIPLE DRUG
CLASSES AND WE'RE ABLE TO SAY
THE LANDSCAPE OF HIV TREATMENT
IS DIFFERENT FROM WHAT HAD BEEN
25 YEARS AGO.
SO WITH THAT WE HAD OUR FIRST
RETREAT OF THE FULL PANEL SINCE
2019.
WE'RE GOING HAVE A MEETING IN
2020 THAT HAD TO BE CANCELED
BECAUSE OF COVID AND WE BROUGHT
BACK OUR FIRST GUIDELINES
CO-CHAIR, DR. FAUCI TO COME
BACK.
HE WAS ABLE TO COME BACK AND
SHARE WITH US SOME OF THE
HISTORY.
HE CALLED HIMSELF THE GRAND
FATHER OF ANTIRETROVIRAL THERAPY
AND TALKED ABOUT WHAT CHANGED IN
THE LAST FIVE YEARS.
WE CELEBRATED OUTGOING MEMBERS.
SIM HERE.
DR. GANDHI AND JORDANO AND HUNT,
KELLER, LENNOX AND TOBASS.
THEY EXTENDED THEIR TERM BECAUSE
OF THE COVID-19 PANDEMIC.
WE APPRECIATED THEIR WORK THEY
HAD DONE AND CONTINUED TO DO AND
WE WERE SAD TO SEE THEM GO
BECAUSE THEY PUT IN A LOT OF
WORK OVER THE YEARS FOR THE
PANEL.
SO WHAT DID WE DISCUSS AT THE
MEETING?
IT WAS A JAM-PACKED MEETING
OTHER THAN SOCIALIZING, GET
TOITO
ING -- GETTING TO KNOW EACH
OTHER AGAIN AND WE TALKED ABOUT
WHERE WE ARE COMPARED WITH ALL
THE DIFFERENT GUIDELINES ALL
OVER THE WORLD.
AN IT WAS INTERESTING TO SEE
THAT WE CONVERGED NOW FROM 10
YEARS AGO AND THE INHIBITERS
WERE NOWHERE FOR FOUND IN MANY
COUNTRIES AND NOW AROUND THE
WORLD GLOBALLY EVERYONE USES THE
INHIBITER AND THE NEXT TOPIC OF
DISCUSSION WAS WEIGHT CHANGE AND
ADISPOS TI CHANGES WITH THE USE
OF ANTIRET RET RETROVIRALS AND
DISCUSSED THE STUDY AND HOW IT
INFLUENCED THE GUIDELINES.
WE STARTED IN 2019 AND PUT A
STOP TO IT AFTER THE PANDEMIC
WAS GOING TO WRITE A SECTION ON
HIV AND TRANSPLANT THAT WAS SOON
OUT AND INDIVIDUALS WITH HIV ARE
LIVING LONGER BUT SUFFERING FROM
END STAGE KIDNEY DISEASE AND
LIVER DISEASE AS WELL AS
MALIGNANCY WHERE IT REQUIRES
TRANSPLANTS AND THOUGHT IT WOULD
BE IMPORTANT TO WRITE A NEW
SECTION.
WE GROUPED THIS IN 2023.
HOPEFULLY WE'LL HAVE A NEWS
SECTION ON HIV AND TRANSPLANT.
WE TALKED ABOUT DRUG
INTERACTIONS AND HOW MUCH
CHALLENGE WE HAVE IN WRITING
GUIDANCE ON DRUG INTERACTION AND
SHOWING YOU SOME DATA IN THE
NEXT COUPLE OF SLIDES TO SHARE
WITH YOU THE REASON WHY WE SAY
THAT.
AND LASTLY WE HAD SOME
DISCUSSIONS ABOUT WHAT ARE THE
NEW DRUGS IN THE PIPELINE AND
MELANIE THOMPSON ALWAYS PRESENTS
SOME OF THE DATA SO WE KNOW WHAT
WE'LL BE EXPECTING IN THE COMING
YEARS.
SO THIS IS WHAT WE HAVE OVER THE
LAST FIVE YEARS OR SO.
YOU CAN SEE THAT FROM 2019 TO
2022, 2021 THERE WAS A DIP AND
THAT CORRESPONDS WITH THE
PANDEMIC BUT NOW WHAT YOU SEE IS
AN INCREASE IN THE USE OF THE
GUIDELINES IN 2022 AS WELL AS
2023.
WE ALSO TRY TO FIGURE OUT WHO
ARE READING THE GUIDELINES AND
WHAT THE SECTIONS MOST BEING
VIEWED AND WHAT HAS BEEN NUMBER
ONE AS LONG AS I CAN REMEMBER
AND ONE THING PEOPLE DON'T
REALLY RECOGNIZE AND DON'T
APPRECIATE IS THE FACT THAT THE
DRUG INTERACTION SECTION ISLY
NUMBER TWO ON THE LIST.
AND IT'S BEING VIEWED BY MANY
PEOPLE FROM AROUND THE WORLD.
EVEN THOUGH THERE'S THE
LIVERPOOL GUIDELINES THAT IS
AVAILABLE.
THE REST ARE LISTED THERE WHICH
IS NOT SURPRISING WHEN TO START
WITH THE THERAPY AND SO FORTH.
AND WE TALKED ABOUT THE
GUIDANCE.
YOU CAN SEE WE LOOK AT THE
INCREASE IN NUMBER OF DRUGS THAT
WE HAVE TO REPORT ON DRUG
INTERACTION BETWEEN 2013 AND
2023.
THOUGH WE HAD MORE NUMBER OF
DRUGS AVAILABLE, THE NUMBER OF
DRUGS THAT WE REPORTED ON IN
2013 WAS 23 AND 26 IN 2023.
AND THAT'S MAINLY BECAUSE WE
ELIMINATED A NUMBER OF DRUGS NO
LONGER IN USE.
IT'S NOT THAT WE ONLY HAD THREE
THANK YOU DRUGS AVAILABLE BUT
BECAUSE OF THE FACT THAT WE TOOK
AWAY SOME DRUGS.
THE NUMBER OF INTERACTIONS WENT
FROM 213 TO 691.
AND THE NUMBER OF TABLES HAD
GONE UP BUT MORE IMPORTANTLY IS
THE NUMBER OF PAGES.
THE WHOLE GUIDELINES IS ABOUT
490 PAGES, 116 OF THEM ARE
DRUG-DRUG INTERACTIONS.
AND THAT'S REALLY DIFFICULT
BECAUSE WE HAVE A VERY SMALL
NUMBER OF ONCOLOGISTS THAT WORK
ON THESE AND YOU CAN IMAGINE
TRYING TO GO THROUGH EVERY
SINGLE DRUG AND LOOK AT THE NEW
INTERACTI
INTERACTIONS AND NOW WE'RE IN
CATCH UP MODE AND WE HAVE TO
THINK OF THE COMPLICATIONS WITH
OTHER DRUGS AND THERE ARE FEW
STUDIES THAT HAVE BEEN DONE FOR
THESE AGENTS WITH THE STUDIES
AND THE ABILITY OF THEM STAY FOR
A LONG TIME IN THE BODY AND
DIFFICULT TO ANTICIPATE THE
INTERACTIONS TO PROVIDE GUIDANCE
FOR THE CLINICIANS.
AND WHAT ELSE HAVE WE DONE SINCE
THE LAST TIME I REPORTED TO
OARAC?
WE HAVE DECIDED COVID-19 AND HIV
SECTION NEEDS TO BE RETIRED
BECAUSE WE DIDN'T HAVE THE TIME
TO UPDATE AND THERE IS ALREADY
THE COVID-19 TREATMENT
GUIDELINES AS A SECTION OF
COVID-19 AND WE REFERRED
CLINICIANS TO THIS PARTICULAR
SECTION.
AS I MENTIONED THE NEW SECTIONS
BEING WORKED ON.
ONE IS THE HIV IN TRANSPLANT AND
ADIPOSITY AND LOOKING AT EXPERTS
AND WORKING WITH A PANEL TO
DEVELOP RECOMMENDATIONS ON THE
USE OF STATINS IN PEOPLE WITH
HIV.
AND THERE'S BEEN DISCUSSION
ABOUT THIS BECAUSE OUR
GUIDELINES IS ANTIRETROVIRAL AND
THE QUESTION IS DOES IT BELONG
TO US OR DOES IT BELONG TO THE
PRIMARY CARE GUIDELINES WHICH IS
THE HIV MA THAT SPONSORS IT.
WE'RE LIKELY GOING TO COME UP
WITH A ONE-PAGE RECOMMENDATION
BUT WE NEED THE EXPERTISE FROM
OUTSIDE THE PANEL TO HELP US TO
PUT TOGETHER GUIDANCE THAT IS
CREDIBLE FOR THE CLINICIANS TO
USE.
LASTLY, THERE ARE A NUMBER OF
UPDATES COMING IN THE EARLY
SPRING.
WE'LL HAVE UPDATES ON WHAT TO
START EARLY IN THE RECENT HIV IN
OLDER PEOPLE AND WOMEN AND
SUBSTANCE USE AND DRUG
INTERACTION AND THEN NEW
INFORMATION ABOUT RENAL DOSING.
WITH THAT I'LL PASS IT BACK TO
DR. KAPOGIANNIS.
>> VERY IMPRESSIVE AND AMAZING
THANK YOU.
ANY QUESTIONS, COLLEAGUES?
DON'T SEE ANY HANDS UP.
IF THERE'S ANY QUESTIONS PLEASE
RAISE YOUR HAND.
GOING ONCE, GOING AND GONE.
OKAY.
THANK YOU, ALICE, ONCE AGAIN.
AS WE BEGIN TO CLOSE A REMINDER
THAT THIS TIME WE HAVE A FEW
MINUTES ALLOTTED FOR PUBLIC
COMMENT.
DR. HOLTZ HAVE YOU RECEIVED ANY
COMMENTS FOR TODAY'S MEET?
>> NO, WE HAVE NOT RECEIVED ANY
PUBLIC COMMENT FOR TODAY'S
MEETING.
I HAVE A COUPLE NOTES FOR OARAC
MEMBERS TO KINDLY SIGN AND
RETURN THE CONFLICT OF INTEREST
FORM AT THE CLOSE OF THE MEETING
AND THEY WERE SENT TO YOU THIS
AFTERNOON.
ONE HOUSEKEEPING ITEM, THE
MINUTES FROM THE 63rd MEETING
WERE APPROVED IN ADVANCE OF
TODAY'S MEETING.
WE'LL FOLLOW THE SAME PROCESS
FOR THE NOTES OF TODAY'S MEETING
OVER E-MAIL IN ADVANCE OF THE
NEXT VIRTUAL OARAC MEETING.
PLEASE NOTE THE NEXT PUBLIC
MEETING WILL BE VIRTUAL AND
SCHEDULED FOR THURSDAY, FEBRUARY
22, 2024.
DR. KAPOGIANNIS OVER TO YOU FOR
CLOSING REMARKS.
>> THANK YOU.
THANK YOU, DR. HOLTZ.
I WANT TO EXTEND MY SINCEREST
GRATITUDE FOR AN INFORMATIVE
MEETING.
WE APPRECIATE YOUR DEDICATION
AND CONTINUED FEEDBACK AND THE
GREAT DIVERSITY OF PERSPECTIVES
AND INPUT YOU HAVE TO PROVIDE.
I LOOK FORWARD TO OUR ONGOING
DIALOGUE AND CONTINUED WORK
TOGETHER AS WE USE HIV RESEARCH
TO COMPREHENSIVELY ADDRESS THE
MULTI-FACTORIAL INFLUENCES ON
HEALTH DISPARITY AND BRING THEM
INTO THE HIV PANDEMIC.
TODAY'S MEETING IS NOW
ADJOURNED.
THANK YOU.