current aids research

• U.S. Department of Health & Human Services

• Virtual Tour
• Staff Directory
• En Español

You are here

Research & training, advances in hiv/aids research.

For an update on what medical science is doing to fight the global HIV/AIDS pandemic, read a Parade article by NIH Director Francis S. Collins and NIAID Director Anthony S. Fauci, AIDS in 2010: How We're Living with HIV .

Over the past several decades, researchers have learned a lot about the human immunodeficiency virus (HIV) and the disease it causes, acquired immunodeficiency syndrome (AIDS). But still more research is needed to help the millions of people whose health continues to be threatened by the global HIV/AIDS pandemic.

At the National Institutes of Health, the HIV/AIDS research effort is led by the National Institute of Allergy and Infectious Diseases (NIAID). A vast network of NIAID-supported scientists, located on the NIH campus in Bethesda, Maryland, and at research centers around the globe, are exploring new ways to prevent and treat HIV infection, as well as to better understand the virus with the goal of finding a cure. For example, in recent months, NIAID and its partners made progress toward finding a vaccine to prevent HIV infection. Check out other promising areas of NIAID-funded research on HIV/AIDS at http://www.niaid.nih.gov/topics/hivaids/Pages/Default.aspx .

Other NIH institutes, including the Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Institute on Alcohol Abuse and Alcoholism, also support research to better control and ultimately end the HIV/AIDS pandemic. Some of these researchers have found a simple, cost-effective way to cut HIV transmission from infected mothers to their breastfed infants. Others have developed an index to help measure the role of alcohol consumption in illness and death of people with HIV/AIDS.

Find out more about these discoveries and what they mean for improving the health of people in the United States and all around the globe.

This page last reviewed on August 20, 2015

Connect with Us

• More Social Media from NIH

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

A Review of Recent HIV Prevention Interventions and Future Considerations for Nursing Science

Author Contributions

As our knowledge of HIV evolved over the decades, so have the approaches taken to prevent its transmission. Public health scholars and practitioners have engaged in four key strategies for HIV prevention: behavioral-, technological-, biomedical-, and structural/community-level interventions. We reviewed recent literature in these areas to provide an overview of current advances in HIV prevention science in the United States. Building on classical approaches, current HIV prevention models leverage intimate partners, families, social media, emerging technologies, medication therapy, and policy modifications to effect change. Although much progress has been made, additional work is needed to achieve the national goal of ending the HIV epidemic by 2030. Nurses are in a prime position to advance HIV prevention science in partnership with transdisciplinary experts from other fields (e.g., psychology, informatics, and social work). Future considerations for nursing science include leveraging transdisciplinary collaborations and consider social and structural challenges for individual-level interventions.

Approximately 1.2 million people in the United States are currently living with HIV, and an estimated 14% are infected, yet unaware of their status ( Office of Infectious Disease and HIV/AIDS Policy, 2020 ). HIV and AIDS continue to have a disproportionate impact on certain populations, including youth—gay, bisexual, and other men who have sex with men (MSM)—racial and ethnic minorities, people who inject drugs, and residents of highly affected geographic regions such as the Southeastern United States ( Aral et al., 2020 ; Hill et al., 2018 ; Lanier & Sutton, 2013 ). Ending the HIV epidemic requires increasing engagement along the HIV prevention and care continua ( Kay et al., 2016 ; McNairy & El-Sadr, 2014 ). Early and repeat HIV testing are recommended strategies for early entry into HIV care and improved HIV-related outcomes ( DiNenno et al., 2017 ). Late and infrequent HIV testing may result in receiving an initial HIV diagnosis late in the disease trajectory, and individuals unaware they are living with HIV may be more likely to transmit HIV to others. It is essential for people living with HIV (PLWH) to receive a timely diagnosis so that they can begin combination antiretroviral therapy with the goal of achieving an undetectable viral load, a key HIV prevention strategy ( Cohen et al., 2016 ). To improve linkage and retention along the prevention and care continua, researchers have developed HIV prevention interventions in four key areas: behavioral-, technological-, biomedical-, and structural/community-level interventions.

Behavioral interventions are approaches that promote protective or risk-reduction behavior in individuals and social groups via informational, motivational, skill-building, and community-normative strategies ( Coates et al., 2008 ). HIV-specific examples include, but are not limited to, interventions promoting abstinence, condom use, sex communication, condom negotiation, HIV testing, reduction in number of sexual partners, stigma reduction, and use of clean needles among people who inject drugs. Behavioral interventions target various HIV risk behavior mediators and moderators, including symptoms of mental illness and emotion regulation ( Brawner et al., 2019 ), attitudes, beliefs, subjective norms, intentions ( Fishbein & Ajzen, 1975 ), and self-efficacy ( Bandura, 2001 ). The effectiveness of behavior-change interventions in reducing risk for HIV during the early stages of the HIV pandemic demonstrated the importance and utility of this approach ( Bekker et al., 2012 ). Classic approaches to behavioral interventions established in the early 1990s and 2000s paved the way for future research to build on, replicate, adapt, tailor, and disseminate a multitude of programs to meet the needs of various populations, such as women ( Jemmott et al., 2007 ; Wingood et al., 2004 ), MSM ( Crosby et al., 2009 ), and adolescents ( DiClemente et al., 2009 ; Jemmott et al, 1992 , 1998 , 1999 , 2010 ; Villarruel et al., 2007 ). To extend the reach of behavioral interventions, in recent years, researchers have begun leveraging technologies to promote protective and risk reduction behaviors.

The rapid expansion of the internet, mobile, and social computing technologies (e.g., text messaging, e-mail, chat, mobile phones, social media, video games, and geospatial networking applications) has provided new strategies for engaging populations who may be harder to reach through traditional venue-based HIV prevention interventions. Electronic health (eHealth) and mobile health (mHealth) have become especially popular for the delivery of technology-enabled HIV prevention interventions among populations reporting high technology ownership and use ( Barry et al., 2018 ; Conserve et al., 2016 ; Duarte et al., 2019 ; Henny et al., 2018; Hightow-Weidman & Bauermeister, 2020 ; Jongbloed et al., 2015 ; Maloney et al., 2020 ; Nadarzynski et al., 2017 ). In recent years, gamification, serious games, and virtual reality have been used in HIV prevention interventions to deliver highly engaged content and bolster interactions/behaviors in and outside of planned interventions ( Enah et al., 2013 ; Hightow-Weidman et al., 2017 , 2018 ; Liran et al., 2019 ; Muessig et al., 2015 , 2018 ). The potential role that technologies can play in increasing the scale of HIV prevention interventions, including those that aim to increase the adoption of biomedical HIV prevention methods, add to the appeal of these strategies ( Hightow-Weidman et al., 2020 ; Horvath et al., 2020 ; Maloney et al., 2020 ; Marcus et al., 2019 ; Muessig et al., 2015 ; Ramos et al., 2019 ; Threats & Bond 2021 ).

Efficacious biomedical advancements in HIV prevention, such as treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP), remain underutilized because of structural barriers and social determinants of health ( Cahill et al., 2017 ; Jaiswal et al., 2018 ; Kuhns et al., 2019 ). TasP, postexposure prophylaxis (PEP), PrEP, and pharmacologic therapy for substance abuse treatment have proven to be effective for reducing the transmission of HIV and minimizing the risk of new HIV infection ( Coffin et al., 2015 ; El-Bassel & Strathdee, 2015 ; Hosek, Green, et al., 2013 ; Page et al., 2015 ; Springer et al., 2018 ). Although biomedical prevention methods such as PEP and TasP are highly effective, we explicitly focus on PrEP because of its status as the premiere user-controlled HIV prevention medication regimen and its ability to be taken without disclosure to sexual partner(s).

In addition to behavioral, technological, and biomedical strategies that help to mitigate risk at the individual-, structural-, and community-levels, additional intervention strategies are needed to address broader social and structural factors that contribute to inequitable geobehavioral vulnerability to HIV ( Brawner, 2014 ). Such HIV prevention interventions target contextual factors (e.g., social, political–economic, policy–legal, and cultural factors) that influence transmission of and infection with HIV ( Blankenship et al., 2015 ), with an effect that diffuses out to members of key populations. Where individual-level interventions are designed to change individual beliefs, norms, and behaviors, community-level interventions aim to change the social environment (e.g., community-level norms and collective self-efficacy) and behaviors of entire populations ( Underwood et al., 2014 ). Structural- and community-level interventions are crucial to a comprehensive HIV prevention plan because they are designed to target macrolevel contextual factors (e.g., concentrated disadvantage in neighborhoods, syringe exchange policies, community-level stigma, and limited PrEP accessibility) that shape individual risk or hamper adoption of risk reduction strategies and therapeutics ( Allen et al., 2016 ; Colarossi et al., 2016 ; Gamble et al., 2017 ; Hoth et al., 2019 ; Kerr et al., 2015 ). Researchers in this space have successfully partnered with churches to decrease stigma and increase HIV testing ( Berkley-Patton et al., 2016 ; Payne-Foster et al., 2018 ), expand access to screening and prevention resources and change provider behavior ( Bagchi, 2020 ; Bernstein et al., 2017 ; Wood et al., 2018 ), and increase HIV testing in correctional facilities ( Belenko et al., 2017 ).

In this review of the literature, we explore the evolution of HIV prevention science over the past 5 years, presenting an overview of recent advances in the United States. We focused on four intervention categories—behavioral-, technological-, biomedical- (PrEP), and structural-/community-level—given the advancement of HIV prevention approaches over time. The findings highlight areas where nurses and others can advance the science of strategies to reach the national goal of ending the HIV epidemic by 2030 ( Fauci et al., 2019 ).

In our review of recent randomized controlled trials testing the efficacy of condom use and/or abstinence interventions, most targeted vulnerable populations included MSM ( Arnold et al., 2019 ; Crosby et al., 2018 ; Rhodes et al., 2017 ), adolescents ( Donenberg et al., 2018 ; Houck et al., 2016 ; Peskin et al., 2019 ), and adolescent/caregiver dyads ( Hadley et al., 2016 ; Jemmott et al., 2019 , 2020 ). Other interventions targeted incarcerated women ( Fogel et al., 2015 ) and illicit drug users ( Tobin et al., 2017 ). Many interventions were delivered in a health care or school setting, where multiple 60- to 120-min group sessions were presented. However, some interventions used a variation of frequencies and durations, such as a single 60-min one-to-one session ( Crosby et al., 2018 ) or multiple 4-hour group sessions ( Rhodes et al., 2017 ). One intervention allowed participants to attend one or two independent learning sessions, totaling 3 hours ( Hadley et al., 2016 ). About half of the reviewed studies tested the efficacy of new interventions, whereas the other half adapted previously established behavioral interventions. Crosby et al. (2018) , Fogel et al. (2015) , and Hadley et al. (2016) each adapted a different sexual health intervention. Conversely, Donenberg et al. (2018) adapted an intervention from a combination of three evidence-based programs. Instead of adapting an intervention, Peskin et al. (2019) replicated an evidence-based intervention. All interventions, except one ( Rhodes et al., 2017 ), were delivered in English.

Although several behavioral interventions led to significant increases in condom use and/or abstinence, compared with control conditions, others found no indication of intervention efficacy. For instance, Hadley et al. (2016) reported no significant group by time differences for condom use at the 3-month follow-up. These findings may be the result of delayed effects, as seen in the Fogel et al. (2015) intervention where significant group differences in condom use occurred at the 6-month follow-up, but not at the 3-month follow-up. Conversely, neither Arnold et al. (2019) nor Donenberg et al. (2018) found significant group by time differences in condom use at or beyond the 6-month follow-up, and Peskin et al. (2019) did not find differences in sexual initiation at the 24-month follow-up. These findings show that longer follow-up periods do not always have better results compared with short (i.e., 3 months) follow-up periods.

Among efficacious behavioral interventions, there was a single-session skill-building condom buffet activity ( Crosby et al., 2018 ) and multisession programs focusing on the costs and benefits of behavior change ( Fogel et al., 2015 ), emotion regulation ( Houck et al., 2016 ), cultural values ( Rhodes et al., 2017 ), environmental stressors ( Tobin et al., 2017 ), mother–son communication ( Jemmott et al., 2019 ), and scripture- and nonscripture-based abstinence ( Jemmott et al., 2020 ). Each was rooted in theoretical foundations, including those of the Theory of Planned Behavior, Social Cognitive Theory, cognitive behavioral techniques, and the AIDS Risk Reduction Model ( Azjen, 1991 ; Bandura, 1991 ; Catania et al., 1990 ). The Jemmott et al. (2019) intervention was unique in that intervention outcomes were assessed for both mothers and their sons, although the intervention was only implemented among the mothers. All other studies reported the findings of interventions that were implemented among the same participants for which outcomes were assessed.

We unexpectedly identified a nearly equal number of efficacious and nonefficacious behavioral interventions. Many studies reported increases in constructs leading to behavior change, such as self-efficacy, intentions, and attitudes, but did not find changes in actual condom use or abstinence behaviors ( Arnold et al., 2019 ; Donenberg et al., 2018 ; Hadley et al., 2016 ; Peskin et al., 2019 ). Interventions that were effective in increasing condom use and/or abstinence varied in characteristics, showing that single-session and multisession, short- and long-duration, newly created and adapted interventions can be efficacious.

Of the four interventions adapted from existing evidence-based programs, two were efficacious ( Crosby et al., 2018 ; Fogel et al., 2015 ). These interventions adapted the Focus on the Future ( Crosby et al., 2009 ) and Sexual Awareness for Everyone ( Shain et al., 1999 ) interventions. Adaptation has been long supported as an effective way to bring evidence-based interventions to new target populations and is often preferred over the creation of new interventions ( McKleroy et al., 2006 ; Solomon et al., 2006 ). However, with only half of the adapted interventions showing increased condom use among participants, it is critical that interventionists pay close attention to fidelity, proper use of theoretical foundations, and inclusion of core components during intervention adaptation and replication to maintain efficacy of the original intervention.

In accordance with previous research, the identified studies indicate the need to move away from interventions addressing a single behavior to those focusing on a combination of behavioral, biomedical, and structural approaches ( Belgrave & Abrams, 2016 ; Kurth et al., 2011 ) and those using popular technologically advanced delivery methods.

Technological Interventions

Most of the technological intervention literature we reviewed reported on studies that were at lower levels of the hierarchy of evidence ( Melnyk & Fineout-Overholt, 2011 ). Specifically, there was an imbalance in studies favoring more formative qualitative work or pilot studies compared with fewer studies reporting on randomized control trials or meta-analysis. Many studies reporting on randomized control trials also did not report on HIV-related outcomes but focused on content, protocols, or feasibility aspects of the randomized control trials. As a result, most studies reviewed were cross-sectional descriptive studies or qualitative descriptive studies using data collection strategies such as focus groups, interviews expert panels, surveys, and mixed methods ( Rodríguez Vargas et al., 2019 ; Velloza et al., 2019 ). Many of these formative studies ( Bauermeister et al., 2019 ; Cordova et al., 2018 ; Do et al., 2018 ; Enah et al., 2019 ; Erguera et al., 2019 ; Maloney et al., 2020 ; Sullivan et al., 2017 ) focused on the appeal, usability, acceptability, and feasibility of using mHealth and eHealth HIV prevention intervention across the continuum from primary prevention to disease management.

Reviewed studies show that technological interventions in HIV prevention have been studied in various target populations. These target populations include youth and young adults ( Cordova et al., 2018 ; Do et al., 2018 ; Erguera et al., 2019 ), MSM ( Alarcón Gutiérrez et al., 2018 ; Fan et al., 2020 ; Holloway et al., 2017 ), incarcerated women ( Kuo et al., 2019 ), couples ( Mitchell, 2015 ; Velloza et al., 2019 ), adults in drug recovery ( Liang et al., 2018 ), and PLWH ( Bauermeister et al., 2018 ; Schnall et al., 2019 ). These interventions vary in the technological innovations used, duration, language, format of delivery, and target outcomes.

The technology-enabled intervention studies reviewed used varying strategies to target different areas along the continuum of HIV prevention and care. In HIV testing, the focus was on synching home test results with phone counseling support ( Wray et al., 2017 ) and ordering, scheduling, and reminders associated with testing kits (e.g., Sullivan et al., 2017 ). Some studies focused on education using interactive web-based games and social media platforms ( Bauermeister et al., 2019 ; Bond & Ramos, 2019 ; Cordova et al., 2018 ; Gabarron & Wynn, 2016 ), behavioral change interventions ( Danielsonetal.,2014 ),or linkage to care and care support ( Bauermeister et al., 2018 ) targeting people who are living without HIV. Other studies focused on similar points along the care and prevention continuum targeting PLWH ( Maloney et al., 2020 ). Studies reviewed also focused on a wide range of interventions such as provision of information, self-assessments, adherence reminders, delivery of prevention information, referrals, and service from providers ( Boni et al., 2018 ; De Boni et al., 2018 ; Maloney et al., 2020 ). A number of studies included text messaging for health education, reminders, and assessments ( Dietrich et al., 2018 ; Njuguna et al., 2016 ; Ware et al., 2016 ), whereas others focused on primary behavioral preventions such as drug use ( Cordova et al., 2018 ) and engagement in care and disease management for PLWH ( Fan et al., 2020 ; Jongbloed et al., 2015 ). Reviewed studies targeting both persons living with and without HIV also used various technological-based approaches, such as interactive web-based content ( Bauermeister et al., 2019 ), smartphone geolocators near gay venues reinforcing safer sex practices ( Besoain et al., 2015 ), immersive adventure games ( Enah et al., 2019 ), and use of eye tracking technologies to monitor use ( Cho et al., 2018 , 2019 ).

Eight studies reviewed were narrative, scoping, and systematic reviews of the use and efficacy of technology-based interventions ( Bailey et al., 2015 ; Duarte et al., 2019 ; Gabarron & Wynn, 2016 ; Henny et al., 2018; Jongbloed et al., 2015 ; Maloney et al., 2020 ; Nadarzynski et al., 2017 ; Niakan et al., 2017 ). Scoping reviews of earlier digital STI prevention interventions revealed moderate effects on sexual health knowledge, small effect of behavior change, and no significant changes in biological outcomes ( Bailey et al., 2015 ; Gabarron & Wynn, 2016 ). These reviews examined studies that incorporated interventions using various designs, content, formats, target populations, and quality of content. Taken together, these reviews suggest that more research is needed to identify or develop components that can promote changes in biological outcomes. The most recent systematic review ( Maloney et al., 2020 ) found a wealth of published literature on technology-based interventions. However, findings from this systematic review suggest that most of the studies focus on educational and behavior change interventions, whereas relatively few focused on linkage to and retention in HIV prevention and care and adherence to HIV medicines, especially PrEP.

The drug combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), widely known by its brand name Truvada, used as oral PrEP in preventing HIV infections for MSM in the United States, is a well-documented, effective prevention strategy ( Grant et al., 2010 ; Mayer et al., 2020 ). However, many communities impacted by HIV are underrepresented in research trials in the United States, including transgender populations, cisgender women, and people who inject drugs. Most of the research in these groups has occurred internationally and has not had as strong an impact on HIV incidence as that of the MSM ( Baeten et al., 2012 ; Kibengo et al., 2013 ; MacLachlan & Cowie, 2015 ; Marrazzo et al., 2015 ; Martin et al., 2017 ; Mutua et al., 2012 ; Peterson et al., 2007 ; Thigpen et al., 2012 ; Van Damme et al., 2012 ).

Despite Black MSM bearing a disproportionate burden of HIV infection in comparison to MSM of other ethnicities, they are underrepresented in PrEP studies ( Hess et al., 2017 ). Most PrEP clinical trials, open-label studies, and observational studies included less than 10% Black MSM. ( Grant et al., 2010 ; Mayer et al., 2020 ). The few studies that included higher proportions of Black MSM had small numbers, including three community studies by Chan (49%, n = 109), Project PrEPare-ATN 082 (53%, n = 31), Project PrEPare-ATN 110 (47%, n = 93), and Project PrEPare-ATN 113 (29%, n = 23; Hosek et al., 2017 ; Hosek, Siberry, et al., 2013 ). Moreover, there are study gaps in sex, and the number of studies on high-risk cisgender women and transgender women is significantly smaller compared with MSM ( Kamitani et al., 2019 )

In 2019, the U.S. Food and Drug Administration (FDA) approved tenofovir alafenamide/emtricitabine (TAF/FTC), widely known as Descovy, as the first alternative medication for PrEP for MSM and transfeminine communities (FDA, 2019). TAF/FTC was shown to be noninferior to TDF/FTC. The side-effect profiles differ in that TDF/FTC has increases in renal and bone toxicities and TAF/FTC has increases in weight and lipids ( Mayer et al., 2020 ). TAF/FTC was not studied in other communities and did not gain an FDA indication for cisgender women and transmasculine communities. Some studies have found a potential link between the use of estradiol for gender-affirming care and lower tenofovir levels in the blood ( Hiransuthikul et al., 2019 ; Shieh et al., 2019 ; Yager & Anderson, 2020 ).There have been smaller studies to verify this interaction, but reported controlling for confounding variables was difficult. Further research is needed to understand whether there is effect on the efficacy of TDF and how this may impact nondaily dosing strategies.

Currently, daily oral PrEP is the only antiretroviral medication recommended for the prevention of HIV through sexual contact and drug injection use among people without HIV by the U.S. Centers for Disease Control and Prevention (CDC; U.S. Centers for Disease Control and Prevention & U.S. Public Health Service, 2018 ). In 2015, Molina et al. (2015) published a placebo-controlled trial of an “On-Demand” or 2-1-1 dosing strategy for MSM and transfeminine communities where 2 TDF/FTC pills would be taken 2 to 24 hr before sex, followed by 1 pill every 24 hr while sex continues, and ending 2 doses after the last sex act. This study found high efficacy and acceptability with an 86% reduction in HIV incidence relative to placebo on an intention to treat basis; no one acquired HIV while using 2-1-1 dosing of this nondaily dosing strategy. Furthermore, additional prospective open-label studies also showed no HIV acquisition among study participants ( Hojilla et al., 2020 ; Siguier et al., 2019 ). Despite the lack of endorsement by the CDC, many local Departments of Public Health support PrEP 2-1-1 as a way to make PrEP more attainable for the MSM community ( Los Angeles County Department of Public Health, 2019 ; New York City Department of Health and Mental Hygiene, 2019 ; San Francisco Department of Public Health, 2019 ).

Although effective, researchers and primary care providers note the need to simplify current PrEP delivery models. The CDC recommends a follow-up visit every 3 months while on PrEP, which can often be challenging for individuals to attend visits and pay laboratory costs ( U.S. Centers for Disease Control and Prevention & U.S. Public Health Service, 2018 ). A new model of care that leverages mHealth (e.g., mobile and social computing technologies) to increase initiation, retention, and adherence to PrEP, such as electronic PrEP (ePrEP), has been introduced and found to be acceptable and effective among PrEP users ( Siegler et al., 2020 ). PrEPmate is one such multicomponent mHealth intervention that uses short-message service (SMS) and youth-tailored interactive online content to enhance PrEP adherence among at-risk young MSM ( Liu et al., 2019 ). Currently, it is the only PrEP study identified as an Evidence-Based Intervention by the CDC Prevention Research Synthesis project ( CDC, 2020 ). Siegler et al. implemented the PrEP at Home Study among 50 young Black MSM in a rural area. In the study, 42% of participants received PrEP via the ePrEP system, whereas 93% preferred to use ePrEP over standard provider visit and 67% were more likely to remain on PrEP if ePrEP were available ( Siegler et al., 2019 ).

Future biomedical HIV prevention modalities such as long-acting injectable agents have the potential to prevent HIV acquisition without relying on adherence to a daily or 2-1-1 oral dosing regimen. In MSM and transfeminine communities, an injectable form of cabotegravir given intramuscularly every 2 months had an estimated 66% lower incidence of HIV, compared with daily TDF/FTC ( Landovitz, 2020 ). Additional cabotegravir studies in cisgender women are being conducted under HPTN 084 to evaluate safety and efficacy (the LIFE Study; HIV Prevention Trials Network, 2020 ). The dapivirine (DAP) vaginal ring, for use by cis-women as a flexible silicone ring that continuously releases the antiretroviral HIV drug DAP in the vagina as a long-acting option for HIV prevention is another biomedical HIV prevention modality being studied ( Psomas et al., 2017 ). A phase 2a trial of a 25-mg DAP vaginal ring has been shown to be safe and acceptable among U.S. adolescents ages 15–17 ( Psomas et al., 2017 ). The DAP vaginal ring has been approved by the European Medicines Agency for women older than 25 years, and further studies are ongoing for women ages 15–25 years in the United States ( National Institutes of Health, 2020 ).

Although there are clear benefits to the aforementioned intervention strategies, structural- and community-level interventions are distinctly different, given their focus on macrolevel factors that influence risk versus individual beliefs and behaviors. This is imperative because in many highly affected demographics (e.g., Black women and young racial and ethnic minority MSM), broader social and structural factors drive HIV risk more than individual behavior ( Bauermeister et al., 2017 ; Brawner, 2014 ). With this wider focus, changes are seen in factors such as social diffusion of safer sex messages and comfort with being gay ( Eke et al., 2019 ), better viral suppression and continuity in care ( El-Sadr et al., 2017 ; Towe et al., 2019 ; Wohl et al., 2017 ), and increased HIV testing in populations that may not have otherwise been tested ( Belenko et al., 2017 ; Berkley-Patton et al., 2019 ; Frye et al., 2019 ).

Addressing structural barriers can reduce viral load, prevent HIV infection, and increase HIV testing. In homeless populations, researchers used a rapid rehousing intervention to place participants in stable housing faster (3 months earlier than usual service clients), doubling the likelihood of achieving or maintaining viral suppression ( Towe et al., 2019 ), and worked through primary care providers in Veterans Affairs to increase PrEP access ( Gregg et al., 2020 ). Community-level interventions that used financial incentives reduced viral load and decreased self-reported stimulant use among sexual minority men who use methamphetamine ( Carrico et al., 2016 ) and increased viral suppression and continuity in care in HIV-positive patients ( El-Sadr et al., 2017 ). The latter intervention, however, did not demonstrate an effect on increasing linkage to care.

Health care access remains a concern, and novel strategies can be used to get services to those in need. Pharmacies have also been promising locations for HIV prevention work. Persons who inject drugs were more likely to report always using a sterile syringe than not when they were connected to pharmacies that received in-depth harm reduction training and provided additional services (i.e., HIV prevention/medical/social service referrals and syringe disposal containers; Lewis et al., 2015 ). Providing a PEP informational video and direct pharmacy access to PEP also increased PEP knowledge and willingness; however, this did not translate to more PEP requests ( Lewis et al., 2020 ).

In correctional facilities, researchers have used strategies such as referral to care within 5 days after release, medication text reminders, and local change teams with external coaching to maintain viral suppression post-release and increase HIV testing among inmates ( Belenko et al., 2017 ; Wohl et al., 2017 ). High fidelity to the required institutional changes needed to improve HIV services was also noted ( Pankow et al., 2017 ). With the detrimental effects of mass incarceration, including disparate HIV outcomes while incarcerated and post-release, correctional settings are prime targets for future structural intervention work.

Success is tied to meeting people where they are—engaging them through existing programs, organizations, and institutions they are already connected to. Congregation-level interventions have demonstrated success in doubling HIV testing rates and reducing HIV stigma ( Berkley-Patton et al., 2019 ; Derose et al., 2016 ; Payne-Foster et al., 2018 ); however, effects on HIV stigma varied across studies. The studies demonstrating an effect on HIV stigma only achieved this at the individual—not congregation—level ( Payne-Foster et al., 2018 ), and in Latino—but not African American—churches ( Derose et al., 2016 ). Key to these interventions was the inclusion of multilevel activities (e.g., ministry group activities, HIV testing events during services, and pastors delivered sermons on HIV-related topics) and flexibility to accommodate church schedules and levels of comfort with covering different topics. Churches were not the only setting where addressing HIV stigma beyond the individual-level was a challenge. In a community-level intervention on HIV stigma, homophobia, and HIV testing, researchers used workshops, space-based events, and bus shelter ads in a high HIV prevalence area but did not have an effect on HIV stigma or homophobia ( Frye et al., 2019 ). They did, however, increase HIV testing by 350%.

Individuals within key systems and communities can also be pivotal to share HIV-related information and increase access to services. Integration of lay health advisors (“Navegantes”) into existing social networks (i.e., recreational soccer teams) among Hispanic/Latino men led to twice the likelihood of reporting consistent condom use in the past 30 days and HIV testing at the 18-month follow-up ( Rhodes, Leichliter, et al., 2016 ). A year after the intervention ended, 2 years after their training, 84% of the Navegantes (16 of 19) continued to conduct 9 of the 10 primary health promotion activities (e.g., talking about sexual health, describing where to get condoms, and showing segments of the intervention DVD; Sun et al., 2015 ). Furthermore, using a popular opinion leader model targeting alcohol-using social networks, researchers demonstrated a decline in composite sexual risk (e.g., having sex while high or with a partner who is high and exchanging sex for drugs or money) and an increase in HIV knowledge ( Theall et al., 2015 ). An intervention developed for college students and those in the surrounding area integrated HIV testing and education, mental health, and substance abuse services and referrals and noted a preliminary effect on social norms and sexual health messages on campus ( Ali et al., 2017 ).

Culturally situated marketing and other media approaches reach a broader audience to effect change. Successful social marketing campaigns to promote HIV testing should be performed in a way that enhances well-being (rather than fear-based messages), does not represent the target community in stigmatizing ways, and acknowledges barriers to HIV testing (e.g., stigma; Colarossi et al., 2016 ). One study evaluated a city-level, culturally-tailored media intervention combined with an individual risk reduction curriculum in comparison to no city-level media and a general health curriculum ( Kerr et al., 2015 ). Study findings suggested that all media-exposed participants had greater HIV-related knowledge at 6 months, and those who received the media intervention and risk reduction content had lower stigma scores at 3 and 12 months. A community-level intervention designed to decrease HIV risk among young MSM via persuasive media communication and peer-led networking outreach reduced anal sex risk among participants who reported binge drinking and/or marijuana use; the effect was not sustained for those who used other drugs ( Lauby et al., 2017 ). Another community mobilization intervention (e.g., publicity, groups, and outreach) addressed psychosocial factors at individual, interpersonal, social, and structural levels and documented an increase in HIV testing and a reduction in condom-less sex (although not sustained at 6 months; Shelley et al., 2017 ).

Interventions targeting providers and care delivery increase risk screening, HIV testing, timely linkage to care, and PrEP access for eligible individuals. Similar to the ways lay health workers are activated internationally, Health Promotion Advocates were employed in pediatric emergency departments to survey patients (e.g., health risks, stresses, and needs; Bernstein et al., 2017 ). Positive screens triggered critical resources (e.g., brief conversation on risks and needs and treatment as indicated), and, as a result, the intervention extended emergency services beyond the scope of the presenting complaint, engaging more than 800 youth in critical services such as mental health treatment and HIV testing. By pairing intensive medical case management with formalized relationships with local health departments and resources and addressing structural barriers (e.g., ability to access HIV prevention, testing, and medical care), researchers were able to decrease the average number of days to link to care and maintain the decline over a 6-year period ( Miller et al., 2019 ). Ninety percent of those linked to care had an initial medical visit in 42 or fewer days postdiagnosis. The integration of PrEP referrals into STI partner services led to 54% of PrEP eligible men accepting a PrEP referral and a 2.5-fold increase in PrEP use after partner services among MSM ( Katz et al., 2019 ).

Another group had health professional students (e.g., medicine and pharmacy) provide education about PrEP to public health providers, contributing to an increase in PrEP prescriptions, including for PrEP-eligible at-risk groups who previously were not given prescriptions ( Bunting et al., 2020 ). An underway pilot targets training primary care providers to better understand historical influences of structural factors, assess structural vulnerability among patients, create a more integrated system of care (e.g., opioid use and HIV risk) and empathy and nonjudgement in patient interactions ( Bagchi, 2020 ). There is strong precedent for this, given that significant effects were noted in creating affirming environments for sexual and sex minority youth, including improvements in providers’ and staff’s knowledge and attitudes, clinical practices, individual practices, and perceived environmental friendliness/safety ( Jadwin-Cakmak et al., 2020 ).

Policy changes can hinder or advance HIV prevention efforts, and modeling is an effective strategy to project outcomes and identify targeted prevention strategies. In an examination of Washington, DC’s buffer zone policy—prohibition of syringe exchange program operations within 1,000 feet of schools—researchers found that adherence to this 1,000 Foot Rule reduced syringe exchange program operational space by more than 50% a year ( Allen et al., 2016 ). These restrictions on the amount of legal syringe exchange program operational space have a significant impact on service delivery among injection drug users, which in turn affects HIV transmission through syringe sharing ( Allen et al., 2016 ). Analysis of a natural policy intervention indicated that removing a ban that prohibited the use of federal funds for syringe exchange programs potentially averted 120 HIV cases ( Ruiz et al., 2016 ).

In examining which prevention approach would achieve the greatest impact on HIV transmission, in light of available resources, study findings suggested that targeted testing by venue is more cost effective than routine emergency department testing ($31,507 vs. $59,435, respectively; Holtgrave et al., 2016 ). Modeling of interventions in 6 cities indicated that HIV incidence could be reduced by up to 50% by 2030, with cost savings of $95,416 per quality-adjusted life-year, by implementing combinations of evidence-based interventions (e.g., medication for opioid use disorder, HIV testing, ART initiation, and retention; Nosyk et al., 2020 ). Of note, nurse-initiated rapid testing was included in the optimal combination that produced that greatest health benefit while remaining cost effective across all cities. An ongoing microenterprise RCT will determine the effects of multiple strategies (e.g., weekly text on job openings, educational sessions on HIV prevention, and $11,000 start-up grant) on sexual risk behaviors, employment, and HIV preventive behaviors among economically vulnerable African American young adults ( Mayo-Wilson et al., 2019 ); a paucity of reviewed studies focus in this area. A comparable holistic health demonstration project, which engaged young Black MSM, successfully achieved viral suppression, connected participants to employment opportunities, and addressed housing discrimination ( Brewer et al., 2019 ).

Discussion and Future Considerations for Nursing Science

This review of current HIV prevention interventions provides a substantial contribution to the literature by synthesizing literature on four key areas of HIV prevention science. Nursing focuses on holistic care, assessing, diagnosing, and treating all areas that influence individual and population health. As we consider where and how to develop these programs, research indicates that more people may receive HIV prevention interventions in community-based clinics than in primary care or acute care settings ( Levy et al., 2016 ). Future nursing research should aim to address the needs of underserved populations who may benefit from robust HIV prevention strategies as outlined in this discussion section.

As we continue to generate knowledge about the multidimensional nature of HIV risk, especially for marginalized and vulnerable populations, there are increasing opportunities to learn from and use previous research to design multilevel and combination intervention strategies to better overcome barriers to HIV prevention ( Brawner, 2014 ; Frew et al., 2016 ). As suggested by the identified behavioral intervention studies, classic and current prevention programs have used useful strategies, but there remains room for improvement. These studies advance the science of HIV prevention, which helps fill gaps in the current literature and offer valuable insights that can contribute toward advancing the plan of Ending the HIV Epidemic ( U.S. Department of Health and Human Services, 2019 ; Treston, 2019 ).

As behavioral interventions continue to be created, replicated, and adapted, researchers should focus on implementing and testing these interventions in real-life settings. Implementation science strategies include planning, education, finance, restructuring, quality management, and policy strategies ( Powell et al., 2012 ). These strategies include various aspects of collecting data from stakeholders and community members, assessing setting readiness, determining realistic dosing, and assessing intervention acceptability and feasibility among target populations. The translation of science from research settings to real-life settings is imperative in the sustainability of efficacious behavioral interventions.

Technological

Although there is a plethora of technological-based HIV interventions with many in the pipeline, gaps persist in the current literature. There is a lack of precise knowledge regarding the content components of these interventions that are associated with improving clinical outcomes ( Dillingham et al., 2018 ; Ramos, 2017 ). There is also limited knowledge of optimal delivery approaches for these types of digital HIV interventions ( Côté et al., 2015 ; Schnall et al., 2015 ). In addition, there is a dearth of studies evaluating the efficacy, effectiveness, and cost effectiveness of using emerging technologies in HIV prevention interventions, such as gaming, gamification, social media, and virtual interventions ( Garett et al., 2016 ; Kemp & Velloza, 2018 ; LeGrand et al., 2018 ). Furthermore, there is a lack of resource-sharing platforms that would allow for new research to build on impactful elements of technology-based HIV prevention interventions without recreation of these components. Making these components available in an open platform would substantially reduce time and costs of developing new technological interventions and prevent wasteful use of resources on elements that do lead to desired outcomes.

In all, because technology continues to evolve and potential users of these interventions gain more access and complex skills in the use of other applications in everyday life, the demand for more user-centric HIV prevention interventions will likely continue to grow. Current interventions will need to be updated to maintain relevance, and new interventions will need to be designed to be adaptable to continuing technological advances. Policymakers have a role to play in allowing for governmental sharable databases of impactful interventions so that limited resources can be used to design predictably effective components of technological interventions leading to better health outcomes.

The nurse plays a vital role in HIV prevention and PrEP care ( O’Byrne et al., 2014 ). The University of California, San Francisco School of Nursing, recently developed and validated a set of entry-level nurse practioner competencies to provide culturally appropriate comprehensive HIV care ( Portillo et al., 2016 ). Similar programs should be implemented to train nurses and further the delivery of nursing-led biomedical HIV interventions. Magnet is a nurse-led clinic in San Francisco that has successfully leveraged expanded scopes of practice to allow for nurses to practice to the full extent of their licensure and allow for the rapid expansion of PrEP services to the community ( Holjilla et al., 2018 ). Such a unique and successful community-based PrEP delivery intervention led to the development and implementation of pharmacist-led PrEP clinics ( Havens et al., 2019 ; Lopez et al., 2020 ; Tung et al., 2018 ). More community-based, nursing-led biomedical HIV interventions are needed. Furthermore, future research should explore the efficacy of biomedical HIV prevention among transmasculine and cis-women populations, especially those of color who are underrepresented in existing research efforts ( Bond & Gunn, 2016 ; Chandler et al., 2020 ; Deutsch et al., 2015 ; Golub et al., 2019 ; Rowniak et al., 2017 ; Willie et al., 2017 ). Community-based nursing-led HIV interventions may be opportune for reaching these populations.

Structural and Community

Most HIV prevention structural- and community-level interventions still focus on developing countries, with less attention in the United States ( Adimora & Auerbach, 2010 ). However, with several communities facing limited resources, large percentages of individuals living below the federal poverty level and high HIV incidence and prevalence rates, it is time to expand these international success stories to domestic work (e.g., microfinance, credit programs, and comprehensive sexual health education). There is also a paucity of these interventions targeted to women and youth. Relative to the other reviewed strategies, very few nurses are engaged in structural-/community-level interventions. If successful, the in-progress microenterprise RCT by Mayo-Wilson et al. (2019) has the potential to serve as a blueprint for integrating multiple structural approaches that have demonstrated effectiveness abroad into U.S. contexts. The work by Werb et al. (2016) can also transform approaches to structural approaches to prevent injection drug initiation—given nursing’s focus on prevention, initiation of, and/or partnership in such work could be pivotal.

An approach to consider moving forward is applying the multiphase optimization strategy (MOST) to HIV prevention strategies ( Collins et al., 2016 ). MOST uses randomized experimentation to assess the individual performance of each intervention component. This rigorous process, based on a priori optimization criteria (e.g., cost and time), identifies whether aspects of an intervention component (e.g., presence, absence, and setting) have an impact on the performance of other components. Ultimately, this knowledge is used to engineer an intervention that is effective, efficient, and readily scalable. Multilevel interventions that target more than one level can lead to the most sustainable behavior change and can be delivered in venues known to be associated with HIV risk (e.g., bars and nightclubs; Pitpitan & Kalichman, 2016 ). An ongoing study on neighborhood contexts (e.g., poverty, HIV prevalence, and access to care) and network characteristics (e.g., size and frequency of communication) among Black MSM in the deep south will generate rich data to inform interventions for this key demographic ( Duncan et al., 2019 ). There also remains a need for explicit research with transgender populations—versus only including them in other samples—to fill gaps and meet unique needs ( Mayer et al., 2016 ).

Nursing Advancements

Nurse scientists around the globe are contributing to the development of interventions along the care continuum. Jemmott et al. have created numerous behavioral interventions over the past 30 years, which have been adapted for use in new settings and with different populations ( Advancing Health Equity: ETR, 2019 ). Behavioral interventions have been implemented using technology. Nursing exemplars in technology include the development of an immersive adventure game for African American adolescents ( Enah et al., 2019 ; Enahet al., 2015). In a series of studies in the primary prevention end of the prevention and care continuum, Enah et al. studied relevant content and design elements, evaluated an existing web-based game for relevance, developed and qualitatively studied acceptability of an individually tailored adventure game, and evaluated the potential efficacy of the game among African American adolescents ( Enah et al., 2019 ; Enah, Piper & Moneyham, 2015 ). At the care end of the continuum, Schnall et al. adapted an existing intervention for MSM ( Schnall et al., 2016 ), addressing co-morbidities for PLWH using multimodal techniques ( Schnall et al., 2019 ).

Flores developed a novel sex communication video series to support parent–child communication for gay, bisexual, and queer male adolescents ( Flores et al., 2020 ). Nurses have also collaborated on telehealth interventions to identify barriers to HIV care access and adherence and address mental health, substance use, and other issues among youth and young adults living with HIV ( Wootton et al., 2019 ). Other researchers piloted HIV/STI prevention content curated from online resources (e.g., YouTube and public and private websites) and found that youth who received links to publicly accessible online prevention content had a significant improvement in HIV self-efficacy and a significant reduction in unprotected vaginal or anal sex ( Whiteley et al., 2018 ). Nurses can partner with public health experts, computer scientists, and others to leverage these resources for population health improvement because new technologies continue to emerge ( Rhodes, McCoy, et al., 2016 ; Stevens et al., 2017 ; Stevens et al., 2020 ). Nurses, including members of the Association of Nurses in AIDS Care, have also been instrumental in the All of Us Research Program, a National Institutes of Health initiative aiming to enroll one million people across the United States to increase accessibility to data on individual variability in factors including genetics, lifestyle, and socioeconomic determinants of health to speed up medical breakthroughs ( National Institutes of Health, 2020 ).

As experts in community-engaged HIV research, partnerships that are committed to engaging key communities will lead to the development of interventions—across levels—to help achieve national goals of ending the HIV epidemic by 2030 ( Fauci et al., 2019 ). Health departments, academia, and community partners can also collaborate on policy modeling to improve resource allocation and better address HIV prevention priority setting ( Holtgrave et al., 2016 ). Investigators have also called for legal reform to address state-level structural stigma (index including density of same-sex couples and state laws protecting sexual minorities) experienced by MSM, given linkages between decreased state-level stigma and reduced condomless anal intercourse and increased PEP and/or PrEP use ( Oldenburg et al., 2015 ). Geographic information systems mapping can also be used to identify areas of greatest need and allocate necessary resources ( Brawner et al., 2017 ; Brawner, Reason, Goodman, Schensul, & Guthrie, 2015 ; Eberhart et al., 2015 ).

Recommendations to Further Advance HIV Prevention Intervention Science

Based on the literature reviewed and gaps identified, we offer three recommendations to further advance HIV prevention intervention science. First, nurses should leverage transdisciplinary partnerships to lead the development and testing of comprehensive interventions. For example, nurses could develop and test a nurse-delivered intervention model that engages pharmacists for PrEP access, psychologists and social workers for mental health treatment, librarians and health communication scholars for improving health literacy, and health informaticists to program the content for virtual delivery. Second, nurse researchers are at the cutting edge of knowledge generation in multiple fields, including HIV science (as evidenced by this review), and should be highly sought after for research collaboration accordingly. Although nursing is one of the most trusted professions, nurses are often overlooked when researchers in other disciplines search for collaborators with advanced methodological skill sets, content-specific expertise, or additional perceived benefits to their research teams. Finally, regardless of the intervention type (e.g., behavioral and biomedical), future intervention work must account for social and structural challenges experienced by the intended intervention recipients (e.g., racism, homelessness, and concentrated poverty in neighborhoods). This could include activities such as adding social service linkages to research protocols (e.g., providing participants with information on stable housing programs) or implementing structural interventions to improve neighborhood conditions (e.g., hiring community members to green vacant lots).

Nurses have made tremendous strides in behavioral interventions; however, representation in biomedical-, technological-, and structural-/community-level interventions is limited. We believe this hinders possible advancements in HIV prevention science, given the uniqueness a nursing lens contributes to research endeavors. We encourage nurses to expand the scope of their intervention work, and for individuals working in fields of HIV prevention where nurses are underrepresented, to seek out nursing collaborators. Together, these transdisciplinary teams can curb the epidemic and achieve an AIDS-free generation.

Key Considerations

• Nurses should leverage transdisciplinary partnerships to lead the development and testing of comprehensive interventions.
• Future intervention work must account for social and structural challenges experienced by the intended intervention recipients.
• Nurse researchers should be used for their advanced methodological skill sets and expertise in HIV prevention science.

Disclosures

The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.

• Adimora AA, & Auerbach JD (2010). Structural interventions for HIV prevention in the United States . Journal of Acquired Immune Deficiency Syndromes , 55 ( Suppl 2 ), S132–S135. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Advancing Health Equity: ETR. (2019). Be Proud! Be Responsible! An Evidence-Based Intervention to Empower Youth to Reduce Their Risk of HIV . Retrieved from https://www.etr.org/ebi/programs/be-proud-be-responsible/
• Alarcón Gutiérrez M, Fernández Quevedo M, Martín Valle S, Jacques-Aviñó C, Díez David E, Caylà JA, & García de Olalla P (2018). Acceptability and effectiveness of using mobile applications to promote HIV and other STI testing among men who have sex with men in Barcelona , Spain. Sexually Transmitted Infections , 94 ( 6 ), 443–448. 10.1136/sextrans-2017-053348 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ali S, Al Rawwad T, Leal RM, Wilson MI, Mancillas A, Keo-Meier B, & Torres LR (2017). SMART cougars: Development and feasibility of a campus-based HIV prevention intervention . Journal of Health Care for the Poor and Underserved , 28 ( 2 ), 81–99. [ PubMed ] [ Google Scholar ]
• Allen ST, Ruiz MS, & Jones J (2016). Quantifying syringe exchange program operational space in the District of Columbia . AIDS and Behavior , 20 ( 12 ), 2933–2940. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Aral SO, O’Leary A, & Baker C (2020). Sexually transmitted infections and HIV in the southern United States: An overview . Sexually Transmitted Diseases , 33 ( 7 ), S1–S5. doi: 10.1097/01.olq.0000223249.04456.76 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Arnold EA, Kegeles SM, Pollack LM, Neilands TB, Cornwell SM, Stewart WR, Benjamin M, Weeks J, Lockett G, Smith CD, & Operario D (2019). A randomized controlled trial to reduce HIV-related risk in African American men who have sex with men and women: The Bruthas project . Prevention Science , 20 ( 1 ), 115–125. 10.1007/s11121-018-0965-7 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Azjen I (1991). The theory of planned behavior . Organizational Behavior and Human Decision Processes , 50 ( 2 ), 179–211. [ Google Scholar ]
• Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kakia A, Odoyo J, Mucunguzi A, … & Celum C. (2012). Antiretroviral prophylaxis for HIV prevention in heterosexual men and women . New England Journal of Medicine , 367 ( 5 ), 399–410. 10.1056/NEJMoa1108524 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bagchi AD (2020). A structural competency curriculum for primary care providers to address the opioid use disorder, HIV, and hepatitis C syndemic . Frontiers in Public Health , 8 , 210. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bailey J, Mann S, Wayal S, Hunter R, Free C, Abraham C, & Murray E (2015). Sexual health promotion for young people delivered via digital media: A scoping review . 10.3310/phr03130 (Public Health Research) [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bandura A (1991). Social cognitive theory of self-regulation . Organizational behavior and human decision processes , 50 ( 2 ), 248–287. [ Google Scholar ]
• Bandura A (2001). Social cognitive theory: An agentic perspective . Annual Review of Psychology , 52 ( 1 ), 1–26. 10.1146/annurev.psych.52.1.1 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Barry MC, Threats M, Blackburn NA, LeGrand S, Dong W, Pulley DV, Sallabank G, Harper GW, Hightow-Weidman LB, Bauermeister JA, & Muessig KE (2018). “Stay strong! Keep ya head up! Move on! It gets better!!!!”: Resilience processes in the healthMpowerment online intervention of young black gay, bisexual and other men who have sex with men . AIDS Care , 30 ( Suppl 5 ), S27–S38. 10.1080/09540121.2018.1510106 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bauermeister JA, Connochie D, Eaton L, Demers M, & Stephenson R (2017). Geospatial indicators of space and place: A review of multilevel studies of HIV prevention and care outcomes among young men who have sex with men in the United States . The Journal of Sex Research , 54 ( 4–5 ), 446–464. 10.1080/00224499.2016.1271862 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bauermeister JA, Golinkoff JM, Horvath KJ, Hightow-Weidman LB, Sullivan PS, & Stephenson R (2018). A multilevel tailored web app-based intervention for linking young men who have sex with men to quality care (get connected): Protocol for a randomized controlled trial . Journal of Medical Internet Research , 20 ( 8 ), 77. 10.2196/10444 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bauermeister JA, Tingler RC, Demers M, Connochie D, Gillard G, Shaver J, Chavanduka T, & Harper GW (2019). Acceptability and preliminary efficacy of an online HIV prevention intervention for single young men who have sex with men seeking partners online: The myDEx Project . AIDS and Behavior , 23 ( 11 ), 3064–3077. 10.1007/s10461-019-02426-7 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bekker L-G, Beyrer C, & Quinn TC (2012). Behavioral and biomedical combination strategies for HIV prevention . Cold Spring Harbor Perspectives in Medicine , 2 ( 8 ), a007435. 10.1101/cshperspect.a007435 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Belenko S, Visher C, Pearson F, Swan H, Pich M, O’Connell D, Dembo R, Frisman L, Hamilton L, & Willett J (2017). Efficacy of structured organizational change intervention on HIV testing in correctional facilities . AIDS Education and Prevention , 29 ( 3 ), 241–255. [ PubMed ] [ Google Scholar ]
• Belgrave FZ, & Abrams JA (2016). Reducing disparities and achieving equity in African American women’s health . American Psychologist , 71 ( 8 ), 723–733. 10.1037/amp0000081 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Berkley-Patton J, Thompson CB, Moore E, Hawes S, Simon S, Goggin K, Martinez D, Berman M, & Booker A (2016). An HIV testing intervention in African American churches: Pilot study findings . Annals of Behavioral Medicine , 50 ( 3 ), 480–485. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Berkley-Patton JY, Thompson CB, Moore E, Hawes S, Berman M, Allsworth J, Williams E, Wainright C, Bradley-Ewing A, Bauer AG, Catley D, & Goggin K (2019). Feasibility and outcomes of an HIV testing intervention in African American churches . AIDS and Behavior , 23 ( 1 ), 76–90. 10.1007/s10461-018-2240-0 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bernstein J, Dorfman D, Lunstead J, Topp D, Mamata H, Jaffer S, & Bernstein E (2017). Reaching adolescents for prevention: The role of pediatric emergency department health promotion advocates . Pediatric Emergency Care , 33 ( 4 ), 223–229. [ PubMed ] [ Google Scholar ]
• Besoain F, Perez-Navarro A, Cayl JA, Avi CJ, & de Olalla P. G. a. (2015). Prevention of sexually transmitted infections using mobile devices and ubiquitous computing [Report] . International Journal of Health Geographics . 10.1186/s12942-015-0010-z [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Blankenship KM, Reinhard E, Sherman SG, & El-Bassel N (2015). Structural interventions for HIV prevention among women who use drugs: A global perspective . JAIDS Journal of Acquired Immune Deficiency Syndromes , 69 , S140–S145. 10.1097/qai.0000000000000638 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bond KT, & Gunn AJ (2016). Perceived advantages and disadvantages of using pre-exposure prophylaxis (PrEP) among sexually active Black women: An exploratory study . Journal of Black Sexuality and Relationships , 3 ( 1 ), 1–24. 10.1353/bsr.2016.0019 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bond KT, & Ramos SR (2019). Utilization of an animated electronic health video to increase knowledge of post- and pre-exposure prophylaxis for HIV among African American women: Nationwide cross-sectional survey . JMIR Formative Research , 3 ( 2 ), e9995. 10.2196/formative.9995 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Boni RB, Lentini N, Santelli C, Barbosa A, Cruz M, Bingham T, Cota V, Correa RG, Veloso VG, & Grinsztejn B (2018). Self-testing, communication and information technology to promote HIV diagnosis among young gay and other men who have sex with men (MSM) in Brazil . Journal of the International AIDS Society , 21 ( Suppl 5 ), e25116. 10.1002/jia2.25116 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brawner BM (2014). A multilevel understanding of HIV/AIDS disease burden among African American women . Journal of Obstetric, Gynecologic, and Neonatal Nursing , 43 ( 5 ), 633–643. 10.1111/1552-6909.12481 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brawner BM, Abboud S, Reason J, Wingood G, & Jemmott LS (2019). The development of an innovative, theory-driven, psychoeducational HIV/STI prevention intervention for heterosexually active black adolescents with mental illnesses . Vulnerable Children and Youth Studies , 14 ( 2 ), 151–165. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Brawner BM, Guthrie B, Stevens R, Taylor L, Eberhart M, & Schensul JJ (2017). Place still matters: Racial/ethnic and geographic disparities in HIV transmission and disease burden . Journal of Urban Health , 94 , 716–729. 10.1007/s11524-017-0198-2 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brawner BM, Reason JL, Goodman BA, Schensul JJ, & Guthrie B (2015). Multilevel drivers of human immunodeficiency virus/acquired immune deficiency syndrome among Black Philadelphians: Exploration using community ethnography and geographic information systems . Nursing Research , 64 ( 2 ), 100–110. 10.1097/NNR.0000000000000076 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brewer R, Daunis C, Ebaady S, Wilton L, Chrestman S, Mukherjee S, Moore M, Corrigan R, & Schneider J (2019). Implementation of a socio-structural demonstration project to improve HIV outcomes among young Black men in the deep south . Journal of Racial and Ethnic Health Disparities , 6 ( 4 ), 775–789. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bunting SR, Saqueton R, & Batteson TJ (2020). Using a student-led, community-specific training module to increase PrEP uptake amongst at-risk populations: Results from an exploratory pilot implementation . AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV , 32 ( 5 ), 546–550. [ PubMed ] [ Google Scholar ]
• Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, & Mayer KH (2017). Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts . AIDS Care , 29 ( 11 ), 1351–1358. 10.1080/09540121.2017.1300633 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carrico AW, Jain J, Discepola MV, Olem D, Andrews R, Woods WJ, Neilands TB, Shoptaw S, Gómez W, Dilworth SE, & Moskowitz JT (2016). A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men . BMC Public Health , 16 , 673. 10.1186/s12889-016-3325-1 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Catania JA, Kegeles SM, & Coates TJ (1990). Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM) . Health Education Quarterly , 17 ( 1 ), 53–72. 10.1177/109019819001700107 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Centers for Disease Control and Prevention. (2020). Compendium of evidence-based interventions and best practices for HIV prevention . Retrieved from: https://www.cdc.gov/hiv/research/interventionresearch/compendium/index.html
• Chandler R, Hull S, Ross H, Guillaume D, Paul S, Dera N, & Hernandez N (2020). The pre-exposure prophylaxis (PrEP) consciousness of black college women and the perceived hesitancy of public health institutions to curtail HIV in black women . BMC Public Health , 20 ( 1 ), 1172. 10.1186/s12889-020-09248-6 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cho H, Powell D, Pichon A, Kuhns LM, Garofalo R, & Schnall R (2019). Eye-tracking retrospective think-aloud as a novel approach for a usability evaluation . International Journal of Medical Informatics , 129 , 366–373. 10.1016/j.ijmedinf.2019.07.010 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cho H, Powell D, Pichon A, Thai J, Bruce J, Kuhns LM, Garofalo R, & Schnall R (2018). A mobile health intervention for HIV prevention among racially and ethnically diverse young men: Usability evaluation . JMIR Mhealth Uhealth , 6 ( 9 ), e11450. 10.2196/11450 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Coates TJ, Richter L, & Caceres C (2008). Behavioural strategies to reduce HIV transmission: How to make them work better . Lancet , 372 ( 9639 ), 669–684. 10.1016/S0140-6736(08)60886-7 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Coffin PO, Rowe C, & Santos GM (2015). Novel interventions to prevent HIV and HCV among persons who inject drugs . Current HIV/AIDS Reports , 12 ( 1 ), 145–163. 10.1007/s11904-014-0248-2 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JHS, Godbole SV, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Cottle L, Zhang XC, Makhema J, … & Fleming TR (2016). Antiretroviral therapy for the prevention of HIV-1 transmission . New England Journal of Medicine , 375 ( 9 ), 830–839. 10.1056/NEJMoa1600693 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Colarossi LG, Hazel DS, Collier KL, Desouza S, & Pappas L (2016). Research with Latina and Black women for an HIV prevention campaign . Social Marketing Quarterly , 22 ( 3 ), 236–252. [ Google Scholar ]
• Collins LM, Kugler KC, & Gwadz MV (2016). Optimization of multicomponent behavioral and biobehavioral interventions for the prevention and treatment of HIV/AIDS . AIDS and Behavior , 20 ( 1 ), 197–214. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Conserve DF, Jennings L, Aguiar C, Shin G, Handler L, & Maman S (2016). Systematic review of mobile health behavioural interventions to improve uptake of HIV testing for vulnerable and key populations . Journal of Telemedicine and Telecare , 23 ( 2 ), 347–359. 10.1177/1357633X16639186 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cordova D, Alers-Rojas F, Lua FM, Bauermeister J, Nurenberg R, Ovadje L, Fessler K, Delva J, Salas-Wright CP, & Council YL (2018). The usability and acceptability of an adolescent mHealth HIV/STI and drug abuse preventive intervention in primary care . Behavioral Medicine , 44 ( 1 ), 36–47. 10.1080/08964289.2016.1189396 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Côté J, Rouleau G, Ramirez-Garcia P, & Bourbonnais A (2015). Virtual nursing intervention adjunctive to conventional care: The experience of persons living with HIV . JMIR Research Protocols , 4 ( 4 ), e124. 10.2196/resprot.4158 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Crosby RA, Mena L, & Smith RV (2018). Promoting positive condom use experiences among young black MSM: A randomized controlled trial of a brief, clinic-based intervention . Health Education Research , 33 ( 3 ), 197–204. 10.1093/her/cyy010 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Crosby R, DiClemente RJ, Charnigo R, Snow G, & Troutman A (2009). A brief, clinic-based, safer sex intervention for heterosexual African American men newly diagnosed with an STD: A randomized controlled trial . American Journal of Public Health , 99 ( Suppl 1 ), S96–S103. 10.2105/AJPH.2007.123893 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Danielson CK, McCauley JL, Gros KS, Jones AM, Barr SC, Borkman AL, Bryant BG, & Ruggiero KJ (2014). SiHLEWeb.com: Development and usability testing of an evidence-based HIV prevention website for female African-American adolescents . Health Informatics Journal , 22 ( 2 ), 194–208. 10.1177/1460458214544048 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• De Boni RB, Lentini N, Santelli AC, Barbosa A Jr., Cruz M, Bingham T, Cota V, Correa RG, Veloso VG, & Grinsztejn B (2018). Self-testing, communication and information technology to promote HIV diagnosis among young gay and other men who have sex with men (MSM) in Brazil . Journal of the International AIDS Society , 21 ( Suppl 5 ), e25116. 10.1002/jia2.25116 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Derose KP, Griffin BA, Kanouse DE, Bogart LM, Williams MV, Haas AC, Flórez KR, Collins DO, Hawes-Dawson J, Mata MA, Oden CW, & Stucky BD (2016). Effects of a pilot church-based intervention to reduce HIV stigma and promote HIV testing among African Americans and Latinos . AIDS and Behavior , 20 ( 8 ), 1692–1705. 10.1007/s10461-015-1280-y [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Deutsch MB, Glidden DV, Sevelius J, Keatley J, McMahan V, Guanira J, Kallas EG, Chariyalertsak S, & Grant RM (2015). HIV pre-exposure prophylaxis in transgender women: A subgroup analysis of the iPrEx trial . The Lancet HIV , 2 ( 12 ), e512–e519. 10.1016/S2352-3018(15)00206-4 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• DiClemente RJ, Wingood GM, Rose ES, Sales JM, Lang DL, Caliendo AM, Hardin JW, & Crosby RA (2009). Efficacy of sexually transmitted disease/human immunodeficiency virus sexual risk-reduction intervention for African American adolescent females seeking sexual health services: A randomized controlled trial . Archives of Pediatrics & Adolescent Medicine , 163 ( 12 ), 1112–1121. 10.1001/archpediatrics.2009.205 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dietrich JJ, Lazarus E, Andrasik M, Hornschuh S, Otwombe K, Morgan C, & Isaacs AJ (2018). Mobile phone questionnaires for sexual risk data collection among young women in Soweto, South Africa . AIDS and Behavior , 7 , 2312. 10.1007/s10461-018-2080-y [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dillingham R, Ingersoll K, Flickinger TE, Waldman AL, Grabowski M, Laurence C, Wispelwey E, Reynolds G, Conaway M, & Cohn WF (2018). PositiveLinks: A mobile health intervention for retention in HIV care and clinical outcomes with 12-month follow-up . AIDS Patient Care and STDs , 32 ( 6 ), 241–250. 10.1089/apc.2017.0303 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• DiNenno EA, Prejean J, Irwin K, Delaney KP, Bowles K, Martin T, Tailor A, Dumitru G, Mullins MM, Hutchinson AB, & Lansky A (2017). Recommendations for HIV screening of gay, bisexual, and other men who have sex with men—United States, 2017 . MMWR. Morbidity and Mortality Weekly Report , 66 ( 31 ), 830–832. 10.15585/mmwr.mm6631a3 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Do TTT, Le MD, Van Nguyen T, Tran BX, Le HT, Nguyen HD, Nguyen LH, Nguyen CT, Tran TD, Latkin CA, Ho RCM, & Zhang MWB (2018). Receptiveness and preferences of health-related smartphone applications among Vietnamese youth and young adults . BMC Public Health , 18 ( 1 ), 764. 10.1186/s12889-018-5641-0 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Donenberg G, Emerson E, & Kendall AD (2018). HIV-risk reduction intervention for juvenile offenders on probation: The PHAT Life group randomized controlled trial . Health Psychology , 37 ( 4 ), 364–374. 10.1037/hea0000582 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Duarte G, Vanegas J, Bravo G, Rada G, & Pantoja T (2019). Effectiveness of digital interventions based on mobile phones for the prevention of sexually transmitted infections: A systematic review protocol . Medwave , 19 ( 2 ), e7605. 10.5867/medwave.2019.02.7605 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Duncan DT, Hickson DA, Goedel WC, Callander D, Brooks B, Chen YT, Hanson H, Eavou R, Khanna AS, Chaix B, Regan SD, Wheeler DP, Mayer KH, Safren SA, Melvin SC, Draper C, Magee-Jackson V, Brewer R, Schneider JA, on behalf of the, N., & Network Cohort Study, T. (2019). The social context of HIV prevention and care among black men who have sex with men in three U.S. cities: The neighborhoods and networks (N2) cohort study . International Journal of Environmental Research and Public Health , 16 ( 11 ), e1922. 10.3390/ijerph16111922 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Eberhart MG, Yehia BR, Hillier A, Voytek CD, Fiore DJ, Blank M, Frank I, Metzger DS, & Brady KA (2015). Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression . Journal of Acquired Immune Deficiency Syndromes , 69 , S37–S43. 10.1097/QAI.0000000000000587 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Eke AN, Johnson WD, O’Leary A, Rebchook GM, Huebner DM, Peterson JL, & Kegeles SM (2019). Effect of a community-level HIV prevention intervention on psychosocial determinants of HIV risk behaviors among young Black men who have sex with men (YBMSM) . AIDS and Behavior , 23 ( 9 ), 2361–2374. [ PubMed ] [ Google Scholar ]
• El-Bassel N, & Strathdee SA (2015). Women who use or inject drugs: An action agenda for women-specific, multilevel, and combination HIV prevention and research . Journal of Acquired Immune Deficiency Syndromes , 69 ( Suppl 2 ), S182–S190. 10.1097/QAI.0000000000000628 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• El-Sadr WM, Donnell D, Beauchamp G, Hall HI, Torian LV, Zingman B, Lum G, Kharfen M, Elion R, Leider J, Gordin FM, Elharrar V, Burns D, Zerbe A, Gamble T, & Branson B (2017). Financial incentives for linkage to care and viral suppression among HIV-positive patients: A randomized clinical trial (HPTN 065) . JAMA Internal Medicine , 177 ( 8 ), 1083–1092. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Enah C, Lambert C, Gakumo CA, Daniel M, & Wehby PS (2019). Working with potential users to develop an HIV/STI prevention video game for rural adolescents . Clinical HIV and AIDS Journal , 2 ( 1 ), 108. [ Google Scholar ]
• Enah C, Moneyham L, Vance DE, & Childs G (2013). Digital gaming for HIV prevention with young adolescents . The Journal of the Association of Nurses in AIDS Care: JANAC , 24 ( 1 ), 71–80. 10.1016/j.jana.2012.03.005 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Enah C, Piper K, & Moneyham L (2015). Qualitative evaluation of the relevance and acceptability of a web-based HIV prevention game for rural adolescents . Journal of pediatric nursing , 30 ( 2 ), 321–328. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Erguera XA, Johnson MO, Neilands TB, Ruel T, Berrean B, Thomas S, & Saberi P (2019). WYZ: A pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV . BMJ Open , 9 ( 5 ), e030473. 10.1136/bmjopen-2019-030473 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fan X, She R, Liu C, Zhong H, Lau JTF, Hao C, Li J, Hao Y, Li L, & Gu J (2020). Evaluation of smartphone APP-based case-management services among antiretroviral treatment-naive HIV-positive men who have sex with men: A randomized controlled trial protocol . BMC Public Health , 20 ( 1 ), 1–13. 10.1186/s12889-020-8171-5 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fauci AS, Redfield RR, Sigounas G, Weahkee MD, & Giroir BP (2019). Ending the HIV epidemic: A plan for the United States . Journal of the American Medical Association , 321 ( 9 ), 844–845. [ PubMed ] [ Google Scholar ]
• Fishbein M, & Ajzen I (1975). Belief, attitude, intention and behavior: An introduction to theory and research . Addison-Wesley. [ Google Scholar ]
• Flores DD, Rosario AA, Bond KT, Villarruel AM, & Bauermeister JA (2020). Parents ASSIST (Advancing Supportive and Sexuality-Inclusive Sex Talks): Iterative development of a sex communication video series for parents of gay, bisexual, and queer male adolescents . Journal of Family Nursing , 26 ( 2 ), 90–101. 10.1177/1074840719897905 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fogel CI, Crandell JL, Neevel AM, Parker SD, Carry M, White BL, Fasula AM, Herbst JH, & Gelaude DJ (2015). Efficacy of an adapted HIV and sexually transmitted infection prevention intervention for incarcerated women: A randomized controlled trial . American Journal of Public Health , 105 ( 4 ), 802–809. 10.2105/AJPH.2014.302105 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Frew PM, Parker K, Vo L, Haley D, O’Leary A, Diallo DD, Golin CE, Kuo I, Soto-Torres L, Wang J, Adimora AA, Randall LA, del Rio C, Hodder S, & the, H. I. V. P. T. N. S. T (2016). Socioecological factors influencing women’s HIV risk in the United States: Qualitative findings from the women’s HIV SeroIncidence study (HPTN 064) . BMC Public Health , 16 ( 1 ), 803. 10.1186/s12889-016-3364-7 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Frye V, Paige MQ, Gordon S, Matthews D, Musgrave G, Greene E, Kornegay M, Farhat D, Smith PH, Usher D, Phelan JC, Koblin BA, & Taylor-Akutagawa V (2019). Impact of a community-level intervention on HIV stigma, homophobia and HIV testing in New York City: Results from project CHHANGE . Stigma and Health , 4 ( 1 ), 72–81. 10.1037/sah0000109 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gabarron E, & Wynn R (2016). Use of social media for sexual health promotion: A scoping review . Global Health Action , 9 ( 1 ), 32193. 10.3402/gha.v9.32193 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gamble T, Branson B, Donnell D, Hall HI, King G, Cutler B, Hader S, Burns D, Leider J, Wood AF, Volpp KG, Buchacz K, & El-Sadr WM (2017). Design of the HPTN 065 (TLC-Plus) study: A study to evaluate the feasibility of an enhanced test, link-to-care, plus treat approach for HIV prevention in the United States . Clinical Trials , 14 ( 4 ), 322–332. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Gardner EM, McLees MP, Steiner JF, Del Rio C, & Burman WJ (2011). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection . Clinical Infectious Diseases , 52 ( 6 ), 793–800. 10.1093/cid/ciq243 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Garett R, Smith J, & Young SD (2016). A review of social media technologies across the global HIV care continuum . Current Opinion in Psychology , 9 , 56–66. 10.1016/j.copsyc.2015.10.024 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Golub SA, Fikslin RA, Starbuck L, & Klein A (2019). High rates of PrEP eligibility but low rates of PrEP access among a national sample of transmasculine individuals . Journal of Acquired Immune Deficiency Syndromes , 82 ( 1 ), e1–e7. https://journals.lww.com/jaids/Fulltext/2019/09010/High_Rates_of_PrEP_Eligibility_but_Low_Rates_of.6.aspx [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T,Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker L-G, Mayer KH, Kallás EG, Amico KR, … & Glidden DV (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men . New England Journal of Medicine , 363 ( 27 ), 2587–2599. 10.1056/NEJMoa1011205 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gregg E, Linn C, Nace E, Gelberg L, Cowan B, & Fulcher JA (2020). Implementation of HIV preexposure prophylaxis in a homeless primary care setting at the Veterans Affairs . Journal of Primary Care & Community Health , 11 , 2510132720908370. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hadley W, Brown LK, Barker D, Warren J, Weddington P, Fortune T, & Juzang I (2016). Work It Out Together: Preliminary efficacy of a parent and adolescent DVD and workbook intervention on adolescent sexual and substance use attitudes and parenting behaviors . AIDS and Behavior , 20 ( 9 ), 1961–1972. 10.1007/s10461-016-1418-6 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Havens JP, Scarsi KK, Sayles H, Klepser DG, Swindells S, & Bares SH (2019). Acceptability and feasibility of a pharmacist-led human immunodeficiency virus pre-exposure prophylaxis program in the Midwestern United States . Open Forum Infectious Diseases , 6 ( 10 ), ofz365. 10.1093/ofid/ofz365 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Henny KD, Wilkes AL, McDonald CM, Denson DJ, & Neumann MS (2018a). A Rapid Review of eHealth Interventions Addressing the Continuum of HIV Care (2007–2017) . AIDS and Behavior , 22 ( 1 ), 43–63. 10.1007/s10461-017-1923-2 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hess KL, Hu X, Lansky A, Mermin J, & Hall HI (2017). Lifetime risk of a diagnosis of HIV infection in the United States . Annals of Epidemiology , 27 ( 4 ), 238–243. 10.1016/j.annepidem.2017.02.003 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hightow-Weidman LB, & Bauermeister JA (2020). Engagement in mHealth behavioral interventions for HIV prevention and care: Making sense of the metrics . MHealth , 6 , 7. 10.21037/mhealth.2019.10.01 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hightow-Weidman LB, Muessig KE, Bauermeister JA, LeGrand S, & Fiellin LE (2017). The future of digital games for HIV prevention and care . Current Opinion in HIV and AIDS , 12 ( 5 ), 501–507. 10.1097/COH.0000000000000399 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hightow-Weidman L, Muessig K, Claude K, Roberts J, Zlotorzynska M, & Sanchez T (2020). Maximizing digital interventions for youth in the midst of Covid-19: Lessons from the adolescent trials network for HIV interventions . AIDS and Behavior , 24 ( 8 ), 2239–2243. 10.1007/s10461-020-02870-w [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hightow-Weidman L, Muessig K, Knudtson K, Srivatsa M, Lawrence E, LeGrand S, Hotten A, & Hosek S (2018). A gamified smartphone app to support engagement in care and medication adherence for HIV-positive young men who have sex with men (AllyQuest): Development and pilot study . JMIR Public Health and Surveillance , 4 ( 2 ), e34. 10.2196/publichealth.8923 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hill MJ, Holt M, Hanscom B, Wang Z, Cardenas-Turanzas M,& Latkin C (2018). Gender and race as correlates of high risk sex behaviors among injection drug users at risk for HIV enrolled in the HPTN 037 study . Drug and Alcohol Dependence , 183 , 267–274. 10.1016/j.drugalcdep.2017.11.018 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hiransuthikul A, Janamnuaysook R, Himmad K, Kerr SJ, Thammajaruk N, Pankam T, Phanjaroen K, Mills S, Vannakit R, Phanuphak P, & Phanuphak N (2019). Drug-drug interactions between feminizing hormone therapy and pre-exposure prophylaxis among transgender women: The iFACT study . Journal of the International AIDS Society , 22 ( 7 ), e25338. 10.1002/jia2.25338 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• HIV Prevention Trials Network. (2020). A phase 3 double blind safety and efficacy study of long-acting injectable cabotegravir compared to daily oral TDF/FTC for pre-exposure prophylaxis in HIV-uninfected women . Retrieved from https://www.hptn.org/research/studies/hptn084
• Hojilla JC, Marcus JL, Silverberg MJ, Hare CB, Herbers R, Hurley L, Satre DD, & Volk JE (2020). Early adopters of event-driven human immunodeficiency virus pre-exposure prophylaxis in a large healthcare system in San Francisco . Clinical Infectious Diseases , 71 ( 10 ), 2710–2712. 10.1093/cid/ciaa474 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hojilla JC, Vlahov D, Crouch PC, Dawson-Rose C, Freeborn K, & Carrico A (2018). HIV pre-exposure prophylaxis (PrEP) uptake and retention among men who have sex with men in a community-based sexual health clinic . AIDS and Behavior , 22 ( 4 ), 1096–1099. 10.1007/s10461-017-2009-x [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Holloway IW, Winder TJ, Lea CH III, Tan D, Boyd D, & Novak D (2017). Technology use and preferences for mobile phone-based HIV prevention and treatment among Black young men who have sex with men: Exploratory research . JMIR mHealth and uHealth , 5 ( 4 ), e46. 10.2196/mhealth.6436 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Holtgrave DR, Maulsby C, Kim JJ, Cassidy-Stewart H, & Hauck H (2016). Using resource allocation modeling to inform HIV prevention priority setting for Baltimore-Towson, Maryland . Progress in Community Health Partnerships: Research, Education, and Action , 10 ( 1 ), 133–139. [ PubMed ] [ Google Scholar ]
• Horvath KJ, Walker T, Mireles L, Bauermeister JA, Hightow-Weidman L, & Stephenson R (2020). A systematic review of technology-assisted HIV testing interventions . Current HIV/AIDS Reports , 17 ( 4 ), 269–280. 10.1007/s11904-020-00506-1 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hosek SG, Green KR, Siberry G, Lally M, Balthazar C, Serrano PA, Kapogiannis B, & The Adolescent Medicine Trials Network for, H. I. V. A. I. (2013). Integrating behavioral HIV interventions into biomedical prevention trials with youth: Lessons from Chicago’s Project PrEPare . Journal of HIV/AIDS & Social Services , 12 ( 3–4 ), 333–348. 10.1080/15381501.2013.773575 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hosek SG, Rudy B, Landovitz R, Kapogiannis B, Siberry G, Rutledge B, Liu N, Brothers J, Mulligan K, Zimet G, Lally M, Mayer KH, Anderson P, Kiser J, Rooney JF, Wilson CM, & Adolescent Trials Network for, H. I. (2017). An HIV preexposure prophylaxis demonstration project and safety study for young MSM . Journal of Acquired Immune Deficiency Syndromes , 74 ( 1 ), 21–29. 10.1097/QAI.0000000000001179 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hosek SG, Siberry G, Bell M, Lally M, Kapogiannis B, Green K, Fernandez MI, Rutledge B, Martinez J, Garofalo R, Wilson CM, & Adolescent Trials Network for, H. I. (2013). The acceptability and feasibility of an HIV preexposure prophylaxis (PrEP) trial with young men who have sex with men . Journal of Acquired Immune Deficiency Syndromes , 62 ( 4 ), 447–456. 10.1097/QAI.0b013e3182801081 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hoth AB, Shafer C, Dillon DB, Mayer R, Walton G, & Ohl ME (2019). Iowa TelePrEP: A public-health-partnered telehealth model for human immunodeficiency virus preexposure prophylaxis delivery in a rural state . Sexually Transmitted Diseases , 46 ( 8 ), 507–512. [ PubMed ] [ Google Scholar ]
• Houck CD, Hadley W, Barker D, Brown LK, Hancock E, & Almy B (2016). An emotion regulation intervention to reduce risk behaviors among at-risk early adolescents . Prevention Science , 17 ( 1 ), 71–82. 10.1007/s11121-015-0597-0 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jadwin-Cakmak L, Bauermeister JA, Cutler JM, Loveluck J, Kazaleh Sirdenis T, Fessler KB, Popoff EE, Benton A, Pomerantz NF, Gotts Atkins SL, Springer T, & Harper GW (2020). The Health Access Initiative: A training and technical assistance program to improve health care for sexual and gender minority youth . Journal of Adolescent Health , 67 ( 1 ), 115–122. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Jaiswal J, Griffin M, Singer SN, Greene RE, Acosta ILZ, Kaudeyr SK, Kapadia F, & Halkitis PN (2018). Structural barriers to pre-exposure prophylaxis use among young sexual minority men: The P18 cohort study . Current HIV Research , 16 ( 3 ), 237–249. 10.2174/1570162X16666180730144455 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jemmott JB III, Jemmott LS, & Fong GT (1992). Reductions in HIV risk-associated sexual behaviors among black male adolescents: Effects of an AIDS prevention intervention . American Journal of Public Health , 82 ( 3 ), 372–377. 10.2105/AJPH.82.3.372 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jemmott JB III, Jemmott LS, & Fong GT (1998). Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: A randomized controlled trial . JAMA , 279 ( 19 ), 1529–1536. 10.1001/jama.279.19.1529 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jemmott JB III, Jemmott LS, & Fong GT (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents . Archives of Pediatrics & Adolescent Medicine , 164 ( 2 ), 152–159. 10.1001/archpediatrics.2009.267 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jemmott JB III, Jemmott LS, Fong GT, & McCaffree K (1999). Reducing HIV risk-associated sexual behavior among African American adolescents: Testing the generality of intervention effects . American Journal of Community Psychology , 27 ( 2 ), 161–187. 10.1007/BF02503158 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jemmott LS, Jemmott JB III, Chittamuru D, & Icard LD (2019). Effects of a sexual HIV risk reduction intervention for African American mothers and their adolescent sons: A randomized controlled trial . Journal of Adolescent Health , 65 ( 5 ), 643–650. 10.1016/j.jadohealth.2019.05.017 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jemmott LS, Jemmott JB III, Icard LD, & Hsu J (2020). Effects of church-based parent–child abstinence-only interventions on adolescents’ sexual behaviors . Journal of Adolescent Health , 66 ( 1 ), 107–114. 10.1016/j.jadohealth.2019.07.021 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jemmott LS, Jemmott JB III, & O’Leary A (2007). Effects on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings . American Journal of Public Health , 97 ( 6 ), 1034–1040. 10.2105/AJPH.2003.020271 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jongbloed K, Parmar S, Kop M, Spittal PM, & Lester RT (2015). Recent evidence for emerging digital technologies to support global HIV engagement in care . Current HIV/AIDS Reports , 12 ( 4 ), 451–461. 10.1007/s11904-015-0291-7 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kamitani E, Mizuno Y, Wichser M, Adegbite AH, DeLuca JB, & Higa DH (2019). Mapping the study characteristics and topics of HIV pre-exposure prophylaxis research literature: A scoping review . AIDS Education and Prevention , 31 ( 6 ), 505–522. 10.1521/aeap.2019.31.6.505 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Katz DA, Dombrowski JC, Barry M, Spellman D, Bell TR, & Golden MR (2019). STD partner services to monitor and promote HIV pre-exposure prophylaxis use among men who have sex with men . Journal of Acquired Immune Deficiency Syndromes , 80 ( 5 ), 533–541. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kay ES, Batey DS, & Mugavero MJ (2016). The HIV treatment cascade and care continuum: Updates, goals, and recommendations for the future . AIDS Research and Therapy , 13 , 35. 10.1186/s12981-016-0120-0 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kemp CG, & Velloza J (2018). Implementation of eHealth interventions across the HIV care cascade: A review of recent research . Current HIV/AIDS Reports , 15 ( 6 ), 403–413. 10.1007/s11904-018-0415-y [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kerr JC, Valois RF, Diclemente RJ, Carey MP, Stanton B, Romer D, Fletcher F, Farber N, Brown LK, Vanable PA, Salazar LF, Juzang I, & Fortune T (2015). The effects of a mass media HIV-risk reduction strategy on HIV-related stigma and knowledge among African American adolescents . AIDS Patient Care and STDs , 29 ( 3 ), 150–156. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kibengo FM, Ruzagira E, Katende D, Bwanika AN, Bahemuka U, Haberer JE, Bangsberg DR, Barin B, Rooney JF, Mark D, Chetty P, Fast P, Kamali A, & Priddy FH (2013). Safety, adherence and acceptability of intermittent tenofovir/emtricitabine as HIV pre-exposure prophylaxis (PrEP) among HIV-uninfected Ugandan volunteers living in HIV-serodiscordant relationships: A randomized, clinical trial . PLoS One , 8 ( 9 ), e74314. 10.1371/journal.pone.0074314 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kuhns LM, Hotton AL, Perloff J, Paul J, Parker C, Muldoon AL, Johnson AK, & Garofalo R (2019). Evaluation of translife care: An intervention to address social determinants of engagement in HIV care among transgender women of color . AIDS and Behavior . 10.1007/s10461-019-02548-y [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kuo CC, Rosen RK, Zlotnick C, Wechsberg WM, Peabody M, & Johnson JE (2019). Sexual health prevention for incarcerated women: Eroticising safe sex during re-entry to the community . Journal of Family Planning & Reproductive Health Care , 45 ( 1 ), 17–22. 10.1136/bmjsrh-2017-200024 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kurth AE, Celum C, Baeten JM, Vermund SH, & Wasserheit JN (2011). Combination HIV prevention: Significance, challenges, and opportunities . Current HIV/AIDS Reports , 8 ( 1 ), 62–72. 10.1007/s11904-010-0063-3 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Landovitz RJ., Donnell D, Clement M, Hanscom H, Cottle L, Coelho L, et al. (2020). HPTN083 interim results: Pre-exposure prophylaxis (PrEP) containing long-acting injectable cabotegravir (CAB-LA) is safe and highly effective for cisgender men and transgender women who have sex with men (MSM,TGW) . IAS Conference, San Francisco . 2020. [ Google Scholar ]
• Lanier Y, & Sutton MY (2013). Reframing the context of preventive health care services and prevention of HIV and other sexually transmitted infections for young men: New opportunities to reduce racial/ethnic sexual health disparities . American Journal of Public Health , 103 ( 2 ), 262–269. 10.2105/AJPH.2012.300921 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lauby J, Zhu L, Milnamow M, Batson H, Bond L, Curran-Groome W, & Carson L (2017). Get real: Evaluation of a community level HIV prevention intervention for young MSM who engage in episodic substance use . AIDS Education and Prevention , 29 ( 3 ), 191–204. [ PubMed ] [ Google Scholar ]
• LeGrand S, Knudtson K, Benkeser D, Muessig K, McGee A, Sullivan PS, & Hightow-Weidman L (2018). Testing the efficacy of a social networking gamification app to improve pre-exposure prophylaxis adherence (P3: Prepared, Protected, emPowered): Protocol for a randomized controlled trial . JMIR Research Protocols , 7 ( 12 ), e10448. 10.2196/10448 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Levy ME, Watson CC, Glick SN, Kuo I, Wilton L, Brewer RA, Fields SD, Criss V, & Magnus M (2016). Receipt of HIV prevention interventions is more common in community-based clinics than in primary care or acute care settings for Black men who have sex with men in the District of Columbia . AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV , 28 ( 5 ), 660–664. 10.1080/09540121.2015.1120266 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lewis CF, Lekas HM, Rivera A, Williams SZ, Crawford ND, Pérez-Figueroa RE, Joseph AM, & Amesty S (2020). Pharmacy PEP access intervention among persons who use drugs in New York City: iPEPcare Study—Rethinking biomedical HIV prevention strategies . AIDS and Behavior , 24 ( 7 ), 2101–2111. [ PubMed ] [ Google Scholar ]
• Lewis CF, Rivera AV, Crawford ND, DeCuir J, & Amesty S (2015). Pharmacy-randomized intervention delivering HIV prevention services during the syringe sale to people who inject drugs in New York City . Drug and Alcohol Dependence , 153 , 72–77. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Liang D, Han H, Du J, Zhao M, & Hser Y-I (2018). A pilot study of a smartphone application supporting recovery from drug addiction . Journal of Substance Abuse Treatment , 88 , 51–58. 10.1016/j.jsat.2018.02.006 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Liran O, Dasher R, & Kaeochinda K (2019). Using virtual reality to improve antiretroviral therapy adherence in the treatment of HIV: Open-label repeated measure study . Interactive Journal of Medical Research , 8 ( 2 ), e13698. 10.2196/13698 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Liu AY, Vittinghoff E, von Felten P, Rivet Amico K, Anderson PL, Lester R, Andrew E, Estes I, Serrano P, Brothers J, Buchbinder S, Hosek S, & Fuchs JD (2019). Randomized controlled trial of a mobile health intervention to promote retention and adherence to preexposure prophylaxis among young people at risk for human immunodeficiency virus: The EPIC study . Clinical Infectious Diseases , 68 ( 12 ), 2010–2017. 10.1093/cid/ciy810 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lopez MI, Cocohoba J, Cohen SE, Trainor N, Levy MM, & Dong BJ (2020). Implementation of pre-exposure prophylaxis at a community pharmacy through a collaborative practice agreement with San Francisco Department of Public Health . Journal of the American Pharmacists Association: JAPHA , 60 ( 1 ), 138–144. 10.1016/j.japh.2019.06.021 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Los Angeles County Department of Public Health. (2019). What’s new in HIV PrEP? 2-1-1 dosing and FDA advisory panel recommendation new drug for PrEP . Retrieved February 9, 2021 from. http://rx.ph.lacounty.gov/RxHIV211PrEP0919 .
• MacLachlan JH, & Cowie BC (2015). Hepatitis B virus epidemiology . Cold Spring Harbor Perspectives in Medicine , 5 ( 5 ), a021410. 10.1101/cshperspect.a021410 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Maloney KM, Bratcher A, Wilkerson R, & Sullivan PS (2020). Electronic and other new media technology interventions for HIV care and prevention: A systematic review . Journal of the International AIDS Society Electronic Resource , 23 ( 1 ), e25439. 10.1002/jia2.25439 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Marcus JL, Hurley LB, Krakower DS, Alexeeff S, Silverberg MJ, & Volk JE (2019). Use of electronic health record data and machine learning to identify candidates for HIV pre-exposure prophylaxis: A modelling study . The Lancet HIV , 6 ( 10 ), e688–e695. 10.1016/S2352-3018(19)30137-7 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, Palanee T, Nakabiito C, van der Straten A, Noguchi L, Hendrix CW, Dai JY, Ganesh S, Mkhize B, Taljaard M, Parikh UM, Piper J, Mâsse B, Grossman C, Rooney J, … & Chirenje ZM (2015). Tenofovir-based preexposure prophylaxis for HIV infection among African Women . New England Journal of Medicine , 372 ( 6 ), 509–518. 10.1056/NEJMoa1402269 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Martin M, Vanichseni S, Suntharasamai P, Sangkum U, Mock PA, Chaipung B, Worrajittanon D, Leethochawalit M, Chiamwongpaet S, Kittimunkong S, Gvetadze RJ, McNicholl JM, Paxton LA, Curlin ME, Holtz TH, Samandari T, & Choopanya K (2017). Factors associated with the uptake of and adherence to HIV pre-exposure prophylaxis in people who have injected drugs: An observational, open-label extension of the Bangkok Tenofovir Study . The Lancet HIV , 4 ( 2 ), e59–e66. 10.1016/S2352-3018(16)30207-7 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mayer KH, Grinsztejn B, & El-Sadr WM (2016). Transgender people and HIV prevention: What we know and what we need to know, a call to action . Journal of Acquired Immune Deficiency Syndromes , 72 , S207–S209. 10.1097/QAI.0000000000001086 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mayer KH, Molina JM, Thompson MA, Anderson PL, Mounzer KC, De Wet JJ, DeJesus E, Jessen H, Grant RM, Ruane PJ, Wong P, Ebrahimi R, Zhong L, Mathias A, Callebaut C, Collins SE, Das M, McCallister S, Brainard DM, Brinson C, …& Hare CB (2020). Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): Primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial . Lancet , 396 ( 10246 ), 239–254. 10.1016/S0140-6736(20)31065-5 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mayo-Wilson LJ, Glass NE, Ssewamala FM, Linnemayr S, Coleman J, Timbo F, Johnson MW, Davoust M, Labrique A, Yenokyan G, Dodge B, & Latkin C (2019). Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): Protocol for a feasibility randomized clinical trial . Trials Electronic Resource , 20 ( 1 ), 439. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• McKleroy VS, Galbraith JS, Cummings B, Jones P, Harshbarger C, Collins C, Gelaude D, Carey JW, & Team A (2006). Adapting evidence–based behavioral interventions for new settings and target populations . AIDS Education and Prevention , 18 ( Suppl ), 59–73. 10.1521/aeap.2006.18.supp.59 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McNairy ML, & El-Sadr WM (2014). A paradigm shift: Focus on the HIV prevention continuum . Clinical Infectious Diseases , 59 ( Suppl 1 ), S12–S15. 10.1093/cid/ciu251 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Melnyk BM, & Fineout-Overholt E (2011). Evidence-based practice in nursing & healthcare: A guide to best practice . Lippincott Williams & Wilkins. [ Google Scholar ]
• Miller RL, Chiaramonte D, Strzyzykowski T, Sharma D, Anderson-Carpenter K, & Fortenberry JD (2019). Improving timely linkage to care among newly diagnosed HIV-infected youth: Results of SMILE . Journal of Urban Health , 96 ( 6 ), 845–855. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Mitchell JW (2015). The use of technology to advance HIV prevention for couples . Current HIV/AIDS Reports , 12 ( 4 ), 516–522. 10.1007/s11904-015-0290-8 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Molina J-M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, Tremblay C, Le Gall J-M, Cua E, Pasquet A, Raffi F, Pintado C, Chidiac C, Chas J, Charbonneau P, Delaugerre C, Suzan-Monti M, Loze B, Fonsart J, Peytavin G, …, & Delfraissy J-F (2015). On-demand preexposure prophylaxis in men at high risk for HIV-1 infection . New England Journal of Medicine , 373 ( 23 ), 2237–2246. 10.1056/NEJMoa1506273 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Muessig KE, Knudtson KA, Soni K, Larsen MA, Traum D, Dong W, Conserve DF, Leuski A, Artstein R, & Hightow-Weidman LB (2018). “I didn’t tell you sooner because I didn’t know how to handle it myself.” Developing a virtual reality program to support HIV-status disclosure decisions . Digital Culture & Education , 10 , 22–48. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Muessig KE, Nekkanti M, Bauermeister J, Bull S, & Hightow-Weidman LB (2015). A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care . Current HIV/AIDS Reports , 12 ( 1 ), 173–190. 10.1007/s11904-014-0239-3 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mutua G, Sanders E, Mugo P, Anzala O, Haberer JE, Bangsberg D, Barin B, Rooney JF, Mark D, Chetty P, Fast P, & Priddy FH (2012). Safety and adherence to intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men and female sex workers . PLoS One , 7 ( 4 ), e33103. 10.1371/journal.pone.0033103 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nadarzynski T, Morrison L, Bayley J, & Llewellyn C (2017). The role of digital interventions in sexual health . Sexually Transmitted Infections , 93 ( 4 ), 234–235. 10.1136/sextrans-2016-052926 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• National Institutes of Health. (2020). All of us research program . www.joinallofus.org/
• New York City Department of Health and Mental Hygiene. (2019). “On-Demand” dosing for PrEP: guidance for medical providers . Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/ah/prep-on-demand-dosing-guidance.pdf .
• Niakan S, Mehraeen E, Noori T, & Gozali E (2017). Web and mobile based HIV prevention and intervention programs pros and cons: A review . Studies in Health Technology and Informatics , 236 , 319–327. https://umasslowell.idm.oclc.org/login?url5http://search.ebscohost.com/login.aspx?direct5true&db5cmedm&AN528508813&site5eds-live [ PubMed ] [ Google Scholar ]
• Njuguna N, Ngure K, Mugo N, Sambu C, Sianyo C, Gakuo S, Irungu E, Baeten J, & Heffron R (2016). The effect of human immunodeficiency virus prevention and reproductive health text messages on human immunodeficiency virus testing among young women in Rural Kenya: A pilot study . Sexually Transmitted Diseases , 43 ( 6 ), 353–359. 10.1097/OLQ.0000000000000450 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nosyk B, Zang X, Krebs E, Enns B, Min JE, Behrends CN, del Rio C, Dombrowski JC, Feaster DJ, Golden M, Marshall BDL, Mehta SH, Metsch LR, Pandya A, Schackman BR, Shoptaw S, Strathdee SA, Gebo KA, Kirk G, Montaner J, & Localized, H. I. V. M. S. G. (2020). Ending the HIV epidemic in the USA: An economic modelling study in six cities . The Lancet HIV , 7 ( 7 ), e491–e503. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• O’Byrne P, Macpherson P, Roy M, & Kitson C (2014). Overviewing a nurse-led, community-based HIV PEP program: Applying the extant literature in frontline practice . Public Health Nursing , 32 ( 3 ), 256–265. 10.1111/phn.12123 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Office of Infectious Disease and HIV/AIDS Policy. (2020). About ending the HIV epidemic: Plan for America . HIV.gov. Retrieved August 16, from https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview [ Google Scholar ]
• Oldenburg CE, Perez-Brumer AG, Hatzenbuehler ML, Krakower D, Novak DS, Mimiaga MJ, & Mayer KH (2015). State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States . AIDS , 29 ( 7 ), 837–845. 10.1097/QAD.0000000000000622 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Page K, Tsui J, Maher L, Choopanya K, Vanichseni S, Mock PA, Celum C, & Martin M (2015). Biomedical HIV prevention including pre-exposure prophylaxis and opiate agonist therapy for women who inject drugs: State of research and future directions . Journal of Acquired Immune Deficiency Syndromes , 69 ( Suppl 2 ), S169–S175. 10.1097/QAI.0000000000000641 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pankow J, Willett J, Yang Y, Swan H, Dembo R, Burdon WM, Patterson Y, Pearson FS, Belenko S, & Frisman LK (2017). Evaluating fidelity to a modified NIATx process improvement strategy for improving HIV services in correctional facilities . The Journal of Behavioral Health Services & Research , 45 ( 2 ), 187–203. https://link.springer.com/content/pdf/10.1007/s11414-017-9551-1.pdf [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Payne-Foster P, Bradley ELP, Aduloju-Ajijola N, Yang X, Gaul Z, Parton J, Sutton MY, & Gaskins S (2018). Testing our FAITHH: HIV stigma and knowledge after a faith-based HIV stigma reduction intervention in the Rural South . AIDS Care , 30 ( 2 ), 232–239. https://www.tandfonline.com/doi/pdf/10.1080/09540121.2017.1371664?needAccess5true [ PubMed ] [ Google Scholar ]
• Peskin MF, Coyle KK, Anderson PM, Laris BA, Glassman JR, Franks HM, Thiel MA, Potter SC, Unti T, Edwards S, Johnson-Baker K, Cuccaro PM, Diamond P, Markham CM, Shegog R, Baumler ER, Gabay EK, & Emery ST (2019). Replication of it’s your game… Keep it real! In Southeast Texas . The Journal of Primary Prevention , 40 ( 3 ), 297–323. 10.1007/s10935-019-00549-0 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Peterson L, Taylor D, Roddy R, Belai G, Phillips P, Nanda K, Grant R, Clarke EEK, Doh AS, Ridzon R, Jaffe HS, & Cates W (2007). Tenofovir disoproxil fumarate for prevention of HIV infection in women: A phase 2, double-blind, randomized, placebo-controlled trial . PLoS Clinical Trials , 2 ( 5 ), e27. 10.1371/journal.pctr.0020027 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pitpitan EV, & Kalichman SC (2016). Reducing HIV risks in the places where people drink: Prevention interventions in alcohol venues . AIDS and Behavior , 20 , 119–133. 10.1007/s10461-015-1116-9 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Portillo CJ, Stringari-Murray S, Fox CB, Monasterio E, & Rose CD (2016). The HIV primary care workforce of tomorrow: The UCSF integrated HIV/AIDS primary care capacity nurse practitioner program . Journal of the Association of Nurses in AIDS Care , 27 ( 3 ), 214–222. https://journals.lww.com/janac/Fulltext/2016/05000/The_HIV_Primary_Care_Workforce_of_Tomorrow__The.3.aspx [ PubMed ] [ Google Scholar ]
• Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, Glass JE, & York JL (2012). A compilation of strategies for implementing clinical innovations in health and mental health . Medical Care Research and Review , 69 ( 2 ), 123–157. 10.1177/1077558711430690 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Psomas CK, Barber TJ, Rutsaert S, & Kinloch-de Loës S (2017). Highlights from the 9th IAS Conference on HIV Science, 23–26 July 2017, Paris, France . Journal of Virus Eradication , 3 ( 4 ), 242–249. https://pubmed.ncbi.nlm.nih.gov/29057090 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ramos SR (2017). User-centered design, experience, and usability of an electronic consent user interface to facilitate informed decision-making in an HIV clinic . Computers, Informatics, Nursing: CIN , 35 ( 11 ), 556–564. 10.1097/CIN.0000000000000356 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ramos SR, Warren R, Shedlin M, Melkus G, Kershaw T, & Vorderstrasse A (2019). A framework for using ehealth interventions to overcome medical mistrust among sexual minority men of color living with chronic conditions . Behavioral Medicine , 45 ( 2 ), 166–176. 10.1080/08964289.2019.1570074 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rhodes SD, Alonzo J, Mann L, Song EY, Tanner AE, Arellano JE, Rodriguez-Celedon R, Garcia M, Freeman A, Reboussin BA, & Painter TM (2017). Small-group randomized controlled trial to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men . American Journal of Public Health , 107 ( 6 ), 969–976. 10.2105/AJPH.2017.303814 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rhodes SD, Leichliter JS, Sun CJ, & Bloom FR (2016). The HoMBReS and HoMBReS Por un Cambio interventions to reduce HIV disparities among immigrant Hispanic/Latino men . MMWR Supplements , 65 ( 1 ), 51–56. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rhodes SD, McCoy TP, Tanner AE, Stowers J, Bachmann LH, Nguyen AL, & Ross MW (2016). Using social media to increase HIV testing among gay and bisexual men, other men who have sex with men, and transgender persons: Outcomes from a randomized community trial . Clinical Infectious Diseases , 62 ( 11 ), 1450–1453. 10.1093/cid/ciw127 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rodríguez Vargas B, Sánchez-Rubio Ferrández J, Garrido Fuentes J, Velayos R, Morillo Verdugo R, Sala Piñol F, Onteniente González A, & Rodríguez Sagrado MÁ (2019). Usability and acceptability of a comprehensive HIV and other sexually transmitted infections prevention app . Journal of Medical Systems , 43 ( 6 ), 175. 10.1007/s10916-019-1323-4 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rowniak S, Ong-Flaherty C, Selix N, & Kowell N (2017). Attitudes, beliefs, and barriers to PrEP among trans men . AIDS Education and Prevention , 29 ( 4 ), 302–314. http://dx.doi.org/101521aeap2017294302 [ PubMed ] [ Google Scholar ]
• Ruiz MS, O’Rourke A, & Allen ST (2016). Impact evaluation of a policy intervention for HIV prevention in Washington, DC . AIDS and Behavior , 20 ( 1 ), 22–28. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• San Francisco Department of Public Health. (2019). San Francisco Department of Public Health (SFDPH) statement on non-daily (2-1-1) emtricitabine/tenofovir dosing for PrEP . Retrieved from http://www.gettingtozerosf.org/wp-content/uploads/2018/11/HIVUpdate_02122019_v2.pdf
• Schnall R, Bakken S, Rojas M, Travers J, & Carballo-Dieguez A (2015). mHealth technology as a persuasive tool for treatment, care and management of persons living with HIV . AIDS and Behavior , 19 ( 2 ), 81–89. 10.1007/s10461-014-0984-8 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, … & Travers J (2016). A user-centered model for designing consumer mobile health (mHealth) applications (apps) . Journal of biomedical informatics , 60 , 243–251. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Schnall R, Liu J, Mohr DC, Bakken S, Hirshfield S, Siegel K, Stonbraker S, Cho H, Iribarren S, & Voss J (2019). Multi-modal methodology for adapting digital health tools to new populations: Adaptation of the video information provider (VIP) for persons living with HIV with HIV-associated non-AIDS (HANA) conditions . Studies in Health Technology and Informatics , 264 , 1347–1351. 10.3233/SHTI190446 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Shain RN, Piper JM, Newton ER, Perdue ST, Ramos R, Champion JD, & Guerra FA (1999). A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women . New England Journal of Medicine , 340 ( 2 ), 93–100. 10.1056/NEJM199901143400203 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Shelley G, Williams W, Uhl G, Hoyte T, Eke A, Wright C, Rebchook G, Pollack L, Bell K, Wang Y, Cheng Q, & Kegeles SM (2017). An evaluation of Mpowerment on individual-level HIV risk behavior, testing, and psychosocial factors among young MSM of color: The monitoring and evaluation of MP (MEM) project . AIDS Education and Prevention , 29 ( 1 ), 24–37. [ PubMed ] [ Google Scholar ]
• Shieh E, Marzinke MA, Fuchs EJ, Hamlin A, Bakshi R, Aung W, Breakey J, Poteat T, Brown T, Bumpus NN, & Hendrix CW (2019). Transgender women on oral HIV pre-exposure prophylaxis have significantly lower tenofovir and emtricitabine concentrations when also taking oestrogen when compared to cisgender men . Journal of the International AIDS Society , 22 ( 11 ), e25405. 10.1002/jia2.25405 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Siegler AJ, Brock JB, Hurt CB, Ahlschlager L, Dominguez K, Kelley CF, & Mena LA (2019). An electronic pre-exposure prophylaxis initiation and maintenance home care system for nonurban young men who have sex with men: Protocol for a randomized controlled trial . JMIR Research Protocols , 8 ( 6 ), e13982. 10.2196/13982 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Siegler AJ, Steehler K, Sales JM, & Krakower DS (2020). A review of HIV pre-exposure prophylaxis streamlining strategies . Current HIV/AIDS Reports , 17 , 643–653. 10.1007/s11904-020-00528-9 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Siguier M, Mera R, Pialoux G, Ohayon M, Cotte L, Valin N, Ghosn J, Cua E, Pintado C, Chas J, Barriere G, Durand F, & Molina JM (2019). First year of pre-exposure prophylaxis implementation in France with daily or on-demand tenofovir disoproxil fumarate/emtricitabine . Journal of Antimicrobial Chemotherapy , 74 ( 9 ), 2752–2758. 10.1093/jac/dkz220 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Solomon J, Card JJ, & Malow RM (2006). Adapting efficacious interventions: Advancing translational research in HIV prevention . Evaluation & the Health Professions , 29 ( 2 ), 162–194. 10.1177/0163278706287344 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Springer SA, Di Paola A, Azar MM, Barbour R, Biondi BE, Desabrais M, Lincoln T, Skiest DJ, & Altice FL (2018). Extended-release naltrexone improves viral suppression among incarcerated persons living with HIV with opioid use disorders transitioning to the community: Results of a double-blind, placebo-controlled randomized trial . Journal of Acquired Immune Deficiency Syndromes , 78 ( 1 ), 43–53. 10.1097/QAI.0000000000001634 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stevens RC, Brawner BM, Kranzler E, Giorgi S, Lazarus E, Abera M, Huang S, & Ungar L (2020). Exploring substance use tweets of youth in the United States: Mixed methods study . JMIR Public Health Surveillance , 6 ( 1 ), e16191. 10.2196/16191 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stevens R, Gilliard-Matthews S, Dunaev J, Todhunter-Reid A, Brawner B, & Stewart J (2017). Social media use and sexual risk reduction behavior among minority youth: Seeking safe sex information . Nursing Research , 66 ( 5 ), 368–377. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sullivan PS, Driggers R, Stekler JD, Siegler A, Goldenberg T, McDougal SJ, Caucutt J, Jones J, & Stephenson R (2017). Usability and acceptability of a mobile comprehensive HIV prevention app for men who have sex with men: A pilot study . JMIR mHealth and uHealth , 5 ( 3 ), e26. 10.2196/mhealth.7199 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sun CJ, Mann L, Eng E, Downs M, & Rhodes SD (2015). Once a navegante, always a navegante: Latino men sustain their roles as lay health advisors to promote general and sexual health to their social network . AIDS Education and Prevention , 27 ( 5 ), 465–473. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Theall KP, Fleckman J, & Jacobs M (2015). Impact of a community popular opinion leader intervention among African American adults in a southeastern united states community . AIDS Education and Prevention , 27 ( 3 ), 275–288. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, Henderson FL, Pathak SR, Soud FA, Chillag KL, Mutanhaurwa R, Chirwa LI, Kasonde M, Abebe D, Buliva E, Gvetadze RJ, Johnson S, Sukalac T, Thomas VT, Hart C, … & Brooks JT (2012). Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana . New England Journal of Medicine , 367 ( 5 ), 423–434. 10.1056/NEJMoa1110711 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Threats M & Bond K (2021). HIV information acquisition and use among young Black men who have sex with men who use the internet: a mixed methods study . Journal of Medical Internet Research , 23 ( 5 ), e22986. https://pubmed.ncbi.nlm.nih.gov/33960953 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Tobin K, Davey-Rothwell MA, Nonyane BAS, Knowlton A, Wissow L, & Latkin CA (2017). RCT of an integrated CBT-HIV intervention on depressive symptoms and HIV risk . PLoS One , 12 ( 12 ), e0187180. 10.1371/journal.pone.0187180 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Towe VL, Wiewel EW, Zhong Y, Linnemayr S, Johnson R, & Rojas J (2019). A randomized controlled trial of a rapid re-housing intervention for homeless persons living with HIV/AIDS: Impact on housing and HIV medical outcomes . AIDS and Behavior , 23 ( 9 ), 2315–2325. 10.1007/s10461-019-02461-4 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Treston C (2019). Ending the HIV epidemic: A plan for America—Nurses needed . Journal of the Association of Nurses in AIDS Care , 30 ( 3 ), 379–380. 10.1097/JNC.0000000000000091 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tung EL, Thomas A, Eichner A, & Shalit P (2018). Implementation of a community pharmacy-based pre-exposure prophylaxis service: A novel model for pre-exposure prophylaxis care . Sexual Health , 15 ( 6 ), 556–561. 10.1071/sh18084 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Underwood C, Hendrickson Z, Van Lith LM, Lengwe Kunda JE, & Mallalieu EC (2014). Role of community-level factors across the treatment cascade: A critical review . Journal of Acquired Immune Deficiency Syndromes , 66 , S311–S318. 10.1097/qai.0000000000000234 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• U.S. Centers for Disease Control and Prevention, & U.S. Public Health Service. (2018). Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: A clinical practice guideline . https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf
• U.S. Department of Health and Human Services. (2019). Ending the HIV epidemic: a plan for America . Retrieved from: https://www.cdc.gov/endhiv/docs/ending-HIV-epidemic-overview-508.pdf
• U.S. Food & Drug Administration. (2019, October 3). FDA approves second drug to prevention HIV infection as part of ongoing efforts to end the HIV epidemic . Retrieved August 3, from https://www.fda.gov/news-events/press-announcements/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic
• Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, Malahleha M, Owino F, Manongi R, Onyango J, Temu L, Monedi MC, Mak’Oketch P, Makanda M, Reblin I, Makatu SE, Saylor L, Kiernan H, Kirkendale S, Wong C, … & Taylor D (2012). Preexposure prophylaxis for HIV infection among African women . New England Journal of Medicine , 367 ( 5 ), 411–422. 10.1056/NEJMoa1202614 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Velloza J, Ngure K, Kiptinness C, Quame-Amaglo J, Thuo N, Dew K, Kimani M, Gakuo S, Unger JA, Kolko B, Baeten JM, Celum C, Mugo N, & Heffron R (2019). A clinic-based tablet application to support safer conception among HIV serodiscordant couples in Kenya: Feasibility and acceptability study . MHealth , 5 , 4. 10.21037/mhealth.2019.01.04 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Villarruel AM, Jemmott JB, Jemmott LS, & Ronis DL (2007). Predicting condom use among sexually experienced Latino adolescents . Western Journal of Nursing Research , 29 ( 6 ), 724–738. 10.1177/0193945907303102 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ware NC, Pisarski EE, Tam M, Wyatt MA, Atukunda E, Musiimenta A, Bangsberg DR, & Haberer JE (2016). The Meanings in the messages: How SMS reminders and real-time adherence monitoring improve antiretroviral therapy adherence in rural Uganda . AIDS , 30 ( 8 ), 1287–1293. 10.1097/QAD.0000000000001035 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Werb D, Garfein R, Kerr T, Davidson P, Roux P, Jauffret-Roustide M, Auriacombe M, Small W, & Strathdee SA (2016). A socio-structural approach to preventing injection drug use initiation: Rationale for the PRIMER study . Harm Reduction Journal , 13 ( 1 ), 25. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Whiteley LB, Brown LK, Curtis V, Ryoo HJ, & Beausoleil N (2018). Publicly available internet content as a HIV/STI prevention intervention for urban youth . Journal of Primary Prevention , 39 ( 4 ), 361–370. 10.1007/s10935-018-0514-y [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Willie T, Kershaw T, Campbell JC, & Alexander KA (2017). Intimate partner violence and PrEP acceptability among low-income, young Black women: Exploring the mediating role of reproductive coercion . AIDS and Behavior , 21 ( 8 ), 2261–2269. 10.1007/s10461-017-1767-9 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wingood GM, DiClemente RJ, Mikhail I, Lang DL, McCree DH, Davies SL, Hardin JW, Hook EW, & Saag M (2004). A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: The WiLLOW Program . Journal of Acquired Immune Deficiency Syndromes , 37 ( Suppl 2 ), S58–S67. 10.1097/01.qai.0000140603.57478.a9 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wohl DA, Golin CE, Knight K, Gould M, Carda-Auten J, Groves JS, Napravnik S, Cole SR, White BL, Fogel C, Rosen DL, Mugavaro MJ, Pence BW, & Flynn PM (2017). Randomized controlled trial of an intervention to maintain suppression of HIV viremia after prison release: The imPACT Trial . Journal of Acquired Immune Deficiency Syndromes , 75 ( 1 ), 81–90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443668/pdf/nihms853764.pdf [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Wood BR, Mann MS, Martinez-Paz N, Unruh KT, Annese M, Spach DH, Scott JD, & Stekler JD (2018). Project ECHO: Telementoring to educate and support prescribing of HIV pre-exposure prophylaxis by community medical providers . Sexual Health , 15 ( 6 ), 601–605. [ PubMed ] [ Google Scholar ]
• Wootton AR, Legnitto DA, Gruber VA, Dawson-Rose C, Neilands TB, Johnson MO, & Saberi P (2019). Telehealth and texting intervention to improve HIV care engagement, mental health and substance use outcomes in youth living with HIV: A pilot feasibility and acceptability study protocol . BMJ Open , 9 ( 7 ), e028522. 10.1136/bmjopen-2018-028522 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wray T, Chan PA, Simpanen E, & Operario D (2017). eTEST: Developing a smart home HIV testing kit that enables active, real-time follow-up and referral after testing . JMIR mHealth and uHealth , 5 ( 5 ), e62. 10.2196/mhealth.6491 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Yager JL, & Anderson PL (2020). Pharmacology and drug interactions with HIV PrEP in transgender persons receiving gender affirming hormone therapy . Expert Opinion on Drug Metabolism & Toxicology , 16 ( 6 ), 463–474. 10.1080/17425255.2020.1752662 [ PubMed ] [ CrossRef ] [ Google Scholar ]

An official website of the United States government

Here's how you know

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Office of AIDS Research

• HIV Policy and Research
• Research Priorities
• NIH Strategic Plan for HIV and HIV-Related Research
• NIH HIV Research Budget
• NIH HIV Research Priority Areas
• Reduce the Incidence of HIV
• Develop Next-Generation HIV Therapies

Research Toward HIV Cure

• Address HIV-Associated Comorbidities, Coinfections, & Complications
• Cross-Cutting Areas

Viral latency and sanctuaries

Latent HIV reservoirs—small amounts of HIV that persist in people taking ART—present a significant challenge to finding a cure for HIV. Latent reservoirs remain in people with HIV when HIV becomes part of the body’s DNA in infected cells. Additionally, reservoirs of HIV can be found in certain “sanctuary” sites in the body that allow the virus to hide and be protected from both the immune system and ART. To cure HIV, the NIH supports studies to develop novel approaches and treatments that target these HIV reservoirs.

Sustained viral remission and viral eradication

Current science suggests that the path to an HIV cure involves first achieving sustained viral remission without ART. This is called sustained ART-free viral remission or a functional cure. For sustained ART-free viral remission, infectious virus must remain undetectable by sensitive testing methods for a long time without treatment. One research aim will be to prolong the time between treatments to be measured eventually not in weeks, but in months or even years. The NIH supports research into treatments leading to sustained ART-free viral remission . New cure-inducing treatments must be as safe, effective, and available for widespread use as are current-day ART regimens.

Viral eradication—eliminating the virus entirely—is the more challenging, longer-term goal.

Research Strategies

The NIH supports research to better understand how the HIV reservoir forms, persists, and reactivates, as well as investigations to develop new cure treatment strategies targeting HIV reservoirs.

A range of biomarkers and techniques, including single-cell and imaging technologies, are being studied to determine how to identify and describe the HIV reservoir. These techniques also are being used to better understand mechanisms of viral reactivation from latently infected cells.

Experimental treatments in development include therapeutic vaccines, genetically engineered immune cells that are resistant to HIV infection, drugs that reactivate latent HIV to make the virus visible to the immune system, cure-inducing immunotherapies, and interventions to permanently silence HIV in infected cells.

The search for an HIV cure involves important behavioral and social processes that complement the domains of biomedicine.  BSSR in HIV cure research is focused on important aspects such as: counseling and support interventions to address the psychosocial needs and concerns of study participants related to analytical treatment interruptions (ATIs); risk reduction in the course of ATI study participation; motivation, acceptability, and decision‐making processes of potential study participants; how cure affects the identity and social position of people with HIV; and the scalability of a proven cure strategy in the context of further advances in HIV prevention and treatment.

The NIH is leveraging resources toward an HIV cure through several public-private partnerships. NIH small business awards enable companies to help foster a diverse pipeline of experimental treatments in development. The combined support of government, industry, and nongovernmental foundations is fostering the expansion of a talented scientific workforce dedicated to advancing HIV cure research.

OAR scientist Dr. Paul Sato coordinates Research Toward an HIV Cure .

This page last reviewed on September 8, 2022

• Fact sheets

Facts in pictures

• Publications
• Questions and answers
• Tools and toolkits

HIV and AIDS

• Hypertension
• Mental disorders
• Top 10 causes of death
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases
• Feature stories
• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory
• Disease Outbreak News
• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• Data collection tools
• Global Health Observatory
• Insights and visualizations
• COVID excess deaths
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment case
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal
• Fact sheets /
• HIV remains a major global public health issue, having claimed 40.4 million [32.9–51.3 million] lives so far with ongoing transmission in all countries globally; with some countries reporting increasing trends in new infections when previously on the decline.
• There were an estimated 39.0 million [33.1–45.7 million] people living with HIV at the end of 2022, two thirds of whom (25.6 million) are in the WHO African Region.
• In 2022, 630 000 [480 000–880 000] people died from HIV-related causes and 1.3 million [1.0–1.7 million] people acquired HIV.
• There is no cure for HIV infection. However, with access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
• WHO, the Global Fund and UNAIDS all have global HIV strategies that are aligned with the SDG target 3.3 of ending the HIV epidemic by 2030.
• By 2025, 95% of all people living with HIV (PLHIV) should have a diagnosis, 95% of those should be taking lifesaving antiretroviral treatment (ART) and 95% of PLHIV on treatment should achieve a suppressed viral load for the benefit of the person’s health and for reducing onward HIV transmission. In 2022, these percentages were 86% [73–>98%], 89% 75–>98%] and 93% [79–>98%], respectively.
• When considering all people living with HIV, 86% [73–>98%] knew their status, 76% [65–89%] were receiving antiretroviral therapy and 71% [60–83%] had suppressed viral loads.

Human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system. Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of the disease.

HIV targets the body’s white blood cells, weakening the immune system. This makes it easier to get sick with diseases like tuberculosis, infections and some cancers.

HIV is spread from the body fluids of an infected person, including blood, breast milk, semen and vaginal fluids. It is not spread by kisses, hugs or sharing food. It can also spread from a mother to her baby.

HIV can be treated and prevented with antiretroviral therapy (ART). Untreated HIV can progress to AIDS, often after many years.

WHO now defines Advanced HIV Disease (AHD) as CD4 cell count less than 200cells/mm3 or WHO stage 3 or 4 in adults and adolescents. All children with HIV younger than 5 years of age are considered to have advanced HIV disease.

Signs and symptoms

The symptoms of HIV vary depending on the stage of infection.

The disease spreads more easily in the first few months after a person is infected, but many are unaware of their status until the later stages. In the first few weeks after being infected people may not experience symptoms. Others may have an influenza-like illness including:

• sore throat.

The infection progressively weakens the immune system. This can cause other signs and symptoms:

• swollen lymph nodes
• weight loss

Without treatment, people with HIV infection can also develop severe illnesses:

• tuberculosis (TB)
• cryptococcal meningitis
• severe bacterial infections
• cancers such as lymphomas and Kaposi's sarcoma.

HIV causes other infections to get worse, such as hepatitis C, hepatitis B and mpox.

Transmission

HIV can be transmitted via the exchange of a variety of body fluids from people living with HIV, such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted during pregnancy and delivery to the child. People cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water. 

It is important to note that people with HIV who are taking ART and have an undetectable viral load  do not transmit HIV to their sexual partners. Early access to ART and support to remain on treatment is therefore critical not only to improve the health of people with HIV but also to prevent HIV transmission.

Risk factors

Behaviours and conditions that put people at greater risk of contracting HIV include:

• having condomless anal or vaginal sex;
• having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis;
• engaging in harmful use of alcohol and drugs in the context of sexual behaviour;
• sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;
• receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and
• experiencing accidental needle stick injuries, including among health workers.

HIV can be diagnosed  through rapid diagnostic tests that provide same-day results. This greatly facilitates early diagnosis and linkage with treatment and prevention. People can also use HIV self-tests to test themselves. However, no single test can provide a full HIV positive diagnosis; confirmatory testing is required, conducted by a qualified and trained health or community worker at a community centre or clinic. HIV infection can be detected with great accuracy using WHO prequalified tests within a nationally approved testing strategy and algorithm.

Most widely used HIV diagnostic tests detect antibodies produced by the person as part of their immune response to fight HIV. In most cases, people develop antibodies to HIV within 28 days of infection. During this time, people are in the so-called window period when they have low levels of antibodies which cannot be detected by many rapid tests, but may transmit HIV to others. People who have had a recent high-risk exposure and test negative can have a further test after 28 days.

Following a positive diagnosis, people should be retested before they are enrolled in treatment and care to rule out any potential testing or reporting error. While testing for adolescents and adults has been made simple and efficient, this is not the case for babies born to HIV-positive mothers. For children less than 18 months of age, rapid antibody testing is not sufficient to identify HIV infection – virological testing must be provided as early as birth or at 6 weeks of age. New technologies are now available to perform this test at the point of care and enable same-day results, which will accelerate appropriate linkage with treatment and care.

HIV is a preventable disease.

Reduce the risk of HIV infection by:

• using a male or female condom during sex
• being tested for HIV and sexually transmitted infections
• having a voluntary medical male circumcision
• using harm reduction services for people who inject and use drugs.

Doctors may suggest medicines and medical devices to help prevent HIV, including:

• antiretroviral drugs (ARVs), including oral PrEP and long acting products
• dapivirine vaginal rings
• injectable long acting cabotegravir.

ARVs can also be used to prevent mothers from passing HIV to their children.

People taking antiretroviral therapy (ART) and who have no evidence of virus in the blood will not pass HIV to their sexual partners. Access to testing and ART is an important part of preventing HIV.

There is no cure for HIV infection. It is treated with antiretroviral drugs, which stop the virus from replicating in the body.

Current antiretroviral therapy (ART) does not cure HIV infection but allows a person’s immune system to get stronger. This helps them to fight other infections.

Currently, ART must be taken every day for the rest of a person’s life.

ART lowers the amount of the virus in a person’s body. This stops symptoms and allows people to live a full and healthy life. People living with HIV who are taking ART and who have no evidence of virus in the blood will not spread the virus to their sexual partners.

Pregnant women with HIV should have access to and take ART as soon as possible. This protects the health of the mother and will help prevent HIV from passing to the fetus before birth, or to the baby through breast milk.

Antiretroviral drugs given to people without HIV can prevent the disease.

When given before possible exposures to HIV it is called pre-exposure prophylaxis (PrEP) and when given after an exposure it is called post-exposure prophylaxis (PEP).  People can use PrEP or PEP when the risk of contracting HIV is high; people should seek advice from a clinician when thinking about using PrEP or PEP.

Advanced HIV disease remains a persistent problem in the HIV response. WHO is supporting countries to implement the advanced HIV disease package of care to reduce illness and death. Newer HIV medicines and short course treatments for opportunistic infections like cryptococcal meningitis are being developed that may change the way people take ART and prevention medicines, including access to injectable formulations, in the future.

More information on HIV treatments

WHO response

Global health sector strategies on, respectively, HIV, viral hepatitis, and sexually transmitted infections for the period 2022–2030  (GHSSs)  guide the health sector in implementing strategically focused responses to achieve the goals of ending AIDS, viral hepatitis B and C and sexually transmitted infections by 2030.

The GHSS recommend shared and disease-specific country actions supported by actions by WHO and partners. They consider the epidemiological, technological, and contextual shifts of previous years, foster learnings across the disease areas, and create opportunities to leverage innovations and new knowledge for effective responses to the diseases. They call for a precise focus to reach the people most affected and at risk for each disease that addresses inequities. They promote synergies under a universal health coverage and primary health care framework and contribute to achieving the goals of the 2030 Agenda for Sustainable Development.

Global HIV Programme

HIV country profiles

Global Health Sector Strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030 (GHSS)

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals

HIV infections articles from across Nature Portfolio

HIV infections (human immunodeficiency virus infections) include the spectrum of infections caused by the virus HIV that range from asymptomatic seropositivity to acquired immunodeficiency syndrome (AIDS)-related complex (ARC) and AIDS.

Latest Research and Reviews

Sustained aviraemia despite anti-retroviral therapy non-adherence in male children following in utero hiv transmission.

After early initiation of anti-retroviral therapy in infants infected with HIV-1 in utero, some children sustain undetectable virus levels, despite treatment interruption, and which associated with distinct features of the transmitted virus.

• Nomonde Bengu
• Gabriela Cromhout
• Philip Goulder

Associations between HIV stigma and health-related quality-of-life among people living with HIV: cross-sectional analysis of data from HPTN 071 (PopART)

• Katherine Davis
• Wafaa el-Sadr

Vaccination induces broadly neutralizing antibody precursors to HIV gp41

Schief and colleagues show that germline-targeting epitope scaffolds can elicit responses from rare broadly neutralizing antibody precursor B cells with predefined binding specificities and genetic features.

• Torben Schiffner
• William R. Schief

The importance of developmental assets in HIV prevention behaviors among young black men who have sex with men (MSM)

• Donte T. Boyd
• Orlando O. Harris

Population-based nanopore sequencing of the HIV-1 pangenome to identify drug resistance mutations

• Hirotaka Ode
• Masakazu Matsuda
• Yasumasa Iwatani

Immunogenicity of 2 therapeutic mosaic HIV-1 vaccine strategies in individuals with HIV-1 on antiretroviral therapy

• Kathryn E. Stephenson
• Dan H. Barouch

News and Comment

Combination treatment for immune-mediated HIV remission

In rhesus macaques, treatment with an IL-15 superagonist and broad neutralizing antibodies led to durable suppression of viremia after discontinuation of antiretroviral therapy.

• Karen O’Leary

Affinity maturation of CRISPR-engineered B cell receptors in vivo

CRISPR–Cas12a was used to directly replace mouse antibody variable chain genes with human versions in primary B cells. The edited cells underwent affinity maturation in vivo, improving the potency of HIV-1 and SARS-CoV-2 neutralizing antibodies without loss of bioavailability. Affinity maturation of edited cells also enables new vaccine models and adaptive B cell therapies.

CARD8 kills CD4 + T cells in response to HIV entry

• Alexandra Flemming

Blockbuster obesity drug leads to better health in people with HIV

Semaglutide reduces weight and fat accumulation associated with the antiretroviral regimen that keeps HIV at bay.

• Mariana Lenharo

Why have T cell-inducing vaccines for HIV failed so far?

The failure of T cell-targeted vaccines for HIV in clinical trials is likely due to impaired degranulation of low-avidity CD8 + T cells in the context of low levels of antigen presentation.

Close the gender gap in Africa’s HIV epidemic

Improving HIV interventions for men could reduce HIV acquisition in women, close the growing gender gap in HIV infections and further reduce HIV incidence in African countries.

• Bryan Tegomoh
• Boghuma K. Titanji

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

• Español (Spanish)

HIV and Specific Populations

Hiv and older people.

• According to the latest data from the   Centers for Disease Control and Prevention (CDC) ,   of the nearly 1.1 million people living with diagnosed HIV in the United States and dependent areas in 2021, over 53% were aged 50 and older.
• Many HIV risk factors are the same for people of any age, but older people are less likely to get tested for HIV.
• Treatment with HIV medicines (called antiretroviral therapy or ART ) is recommended for everyone with HIV. As for anyone with HIV, the choice of an HIV treatment regimen for an older person is based on the person’s individual needs.
• Similar to older people without HIV, many older people with HIV have health conditions such as cardiovascular disease, diabetes, renal disease, and cancer that can complicate HIV treatment.

Does HIV affect older people?

Yes, anyone can get HIV, including older people. According to the Centers for Disease Control and Prevention (CDC) , in 2021, over 53% of the people in the United States diagnosed with HIV were aged 50 and older.

Do older people have the same risk factors for HIV as younger people?

Many risk factors for HIV are the same for people of any age. But like many younger people, older people may not have the knowledge, understanding, or awareness of their HIV risk factors.

In the United States, HIV is spread mainly by:

• Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV
• Sharing injection drug equipment (works), such as needles and syringes, with someone who has HIV

Some age-related factors can put older people at risk for HIV. For example, age-related thinning and dryness of the vagina may increase the risk of HIV in older women. Thinning and dryness of the vagina can cause small tears in the vagina during sex and lead to HIV transmission . Older people may also be less likely to use condoms during sex, because they are less concerned about pregnancy.

Talk to your health care provider about your risk of HIV and ways to reduce your risk.

Should older people get tested for HIV?

The CDC recommends that everyone 13 to 64 years old get tested for HIV, at least once, as part of routine health care, and that people at higher risk of HIV get tested more often (for example, every 3 to 6 months). Your health care provider may recommend HIV testing if you are over 64 and at risk for HIV.

For several reasons, older people are less likely to get tested for HIV:

• In general, older people are often perceived as being at low risk of getting HIV. For this reason, health care providers may not always recommend testing for older people for HIV.
• Some older people may be embarrassed or afraid to be tested for HIV.
• In older people, signs of HIV may be mistaken for symptoms of aging or of age-related conditions. Consequently, testing to diagnose the condition may not include HIV testing.

For these reasons, HIV is more likely to be diagnosed at an advanced stage in many older people. According to an HIV Surveillance Report from CDC , in 2021, 34% of people aged 55 and older in the U.S. already had late-stage HIV (AIDS) when they received a diagnosis. That is, they received a diagnosis later in the course of their disease.

Diagnosing HIV at a late stage also means a late start to treatment with HIV medicines and their benefits and possibly leads to more damage to the immune system . Studies have shown that delaying treatment can increase the chances that people with HIV will develop AIDS and other serious illnesses. Late start to HIV treatment also increases the chance of getting immune reconstitution syndrome , which can cause worsening of some infections when people with HIV and low CD4 cell counts begin taking HIV medicines.

Ask your health care provider whether HIV testing is right for you. Use these questions from Health.gov to start the conversation: HIV Testing: Questions for the doctor .

Are there any issues that affect HIV treatment in older people?

Treatment with HIV medicines is recommended for everyone with HIV. As for anyone with HIV, the choice of an HIV treatment regimen  for an older person is based on the person’s individual needs.

However, the following factors can complicate HIV treatment in older people.

• Conditions, such as heart disease or cancer are more common in older people and require additional medical care.
• Side effects from HIV medicines and other medicines may occur more frequently in older people with HIV than in younger people with HIV.
• The increased risk of drug interactions in an older person taking HIV medicines and medicines for another condition.
• Age-related changes that can affect an older person’s ability to think or remember (cognitive impairment), which can make it harder to stick to an HIV treatment regimen.

This fact sheet is based on information from the following sources:

• HIV and Older Americans
• HIV Surveillance Report, 2021
• Getting Tested for HIV

From the NIH Office of AIDS Research:

• HIV and the Older Person

From the NIH National Institute on Aging:

• HIV, AIDS, and Older People

Also see the HIV Source  collection of HIV links and resources.

• Skip to main content
• Keyboard shortcuts for audio player

• Your Health
• Treatments & Tests
• Health Inc.
• Public Health

How to Thrive as You Age

Got tinnitus a device that tickles the tongue helps this musician find relief.

Allison Aubrey

After using the Lenire device for an hour each day for 12 weeks, Victoria Banks says her tinnitus is "barely noticeable." David Petrelli/Victoria Banks hide caption

After using the Lenire device for an hour each day for 12 weeks, Victoria Banks says her tinnitus is "barely noticeable."

Imagine if every moment is filled with a high-pitched buzz or ring that you can't turn off.

More than 25 million adults in the U.S., have a condition called tinnitus, according to the American Tinnitus Association. It can be stressful, even panic-inducing and difficult to manage. Dozens of factors can contribute to the onset of tinnitus, including hearing loss, exposure to loud noise or a viral illness.

There's no cure, but there are a range of strategies to reduce the symptoms and make it less bothersome, including hearing aids, mindfulness therapy , and one newer option – a device approved by the FDA to treat tinnitus using electrical stimulation of the tongue.

The device has helped Victoria Banks, a singer and songwriter in Nashville, Tenn., who developed tinnitus about three years ago.

"The noise in my head felt like a bunch of cicadas," Banks says. "It was terrifying." The buzz made it difficult for her to sing and listen to music. "It can be absolutely debilitating," she says.

Shots - Health News

Tinnitus bothers millions of americans. here's how to turn down the noise.

Banks tried taking dietary supplements , but those didn't help. She also stepped up exercise, but that didn't bring relief either. Then she read about a device called Lenire, which was approved by the FDA in March 2023. It includes a plastic mouthpiece with stainless steel electrodes that electrically stimulate the tongue. It is the first device of its kind to be approved for tinnitus.

"This had worked for other people, and I thought I'm willing to try anything at this point," Banks recalls.

She sought out audiologist Brian Fligor, who treats severe cases of tinnitus in the Boston area. Fligor was impressed by the results of a clinical trial that found 84% of participants who tried Lenire experienced a significant reduction in symptoms. He became one of the first providers in the U.S. to use the device with his patients. Fligor also served on an advisory panel assembled by the company who developed it.

"A good candidate for this device is somebody who's had tinnitus for at least three months," Fligor says, emphasizing that people should be evaluated first to make sure there's not an underlying medical issue.

Tinnitus often accompanies hearing loss, but Victoria Banks' hearing was fine and she had no other medical issue, so she was a good candidate.

Banks used the device for an hour each day for 12 weeks. During the hour-long sessions, the electrical stimulation "tickles" the tongue, she says. In addition, the device includes a set of headphones that play a series of tones and ocean-wave sounds.

The device works, in part, by shifting the brain's attention away from the buzz. We're wired to focus on important information coming into our brains, Fligor says. Think of it as a spotlight at a show pointed at the most important thing on the stage. "When you have tinnitus and you're frustrated or angry or scared by it, that spotlight gets really strong and focused on the tinnitus," Fligor says.

"It's the combination of what you're feeling through the nerves in your tongue and what you're hearing through your ears happening in synchrony that causes the spotlight in your brain to not be so stuck on the tinnitus," Fligor explains.

A clinical trial found 84% of people who used the device experienced a significant reduction in symptoms. Brian Fligor hide caption

A clinical trial found 84% of people who used the device experienced a significant reduction in symptoms.

"It unsticks your spotlight" and helps desensitize people to the perceived noise that their tinnitus creates, he says.

Banks says the ringing in her ears did not completely disappear, but now it's barely noticeable on most days.

"It's kind of like if I lived near a waterfall and the waterfall was constantly going," she says. Over time, the waterfall sound fades out of consciousness.

"My brain is now focusing on other things," and the buzz is no longer so distracting. She's back to listening to music, writing music, and performing music." I'm doing all of those things," she says.

When the buzz comes back into focus, Banks says a refresher session with the device helps.

A clinical trial found that 84% of people who tried Lenire , saw significant improvements in their condition. To measure changes, the participants took a questionnaire that asked them to rate how much tinnitus was impacting their sleep, sense of control, feelings of well-being and quality of life. After 12 weeks of using the device, participants improved by an average of 14 points.

"Where this device fits into the big picture, is that it's not a cure-all, but it's quickly become my go-to," for people who do not respond to other ways of managing tinnitus, Fligor says.

One down-side is the cost. Banks paid about $4,000 for the Lenire device, and insurance doesn't cover it. She put the expense on her credit card and paid it off gradually.

Fligor hopes that as the evidence of its effectiveness accumulates, insurers will begin to cover it. Despite the cost, more than 80% of participants in the clinical trial said they would recommend the device to a friend with tinnitus.

But, it's unclear how long the benefits last. Clinical trials have only evaluated Lenire over a 1-year period. "How durable are the effects? We don't really know yet," says audiologist Marc Fagelson, the scientific advisory committee chair of the American Tinnitus Association. He says research is promising but there's still more to learn.

Fagelson says the first step he takes with his patients is an evaluation for hearing loss. Research shows that hearing aids can be an effective treatment for tinnitus among people who have both tinnitus and hearing loss, which is much more common among older adults. An estimated one-third of adults 65 years of age and older who have hearing loss, also have tinnitus.

"We do see a lot of patients, even with very mild loss, who benefit from hearing aids," Fagelson says, but in his experience it's about 50-50 in terms of improving tinnitus. Often, he says people with tinnitus need to explore options beyond hearing aids.

Bruce Freeman , a scientist at the University of Pittsburgh Medical Center, says he's benefitted from both hearing aids and Lenire. He was fitted for the device in Ireland where it was developed, before it was available in the U.S.

Freeman agrees that the ringing never truly disappears, but the device has helped him manage the condition. He describes the sounds that play through the device headphones as very calming and "almost hypnotic" and combined with the tongue vibration, it's helped desensitize him to the ring.

Freeman – who is a research scientist – says he's impressed with the results of research, including a study published in Nature, Scientific Reports that points to significant improvements among clinical trial participants with tinnitus.

Freeman experienced a return of his symptoms when he stopped using the device. "Without it the tinnitus got worse," he says. Then, when he resumed use, it improved.

Freeman believes his long-term exposure to noisy instruments in his research laboratory may have played a role in his condition, and also a neck injury from a bicycle accident that fractured his vertebra. "All of those things converged," he says.

Freeman has developed several habits that help keep the high-pitched ring out of his consciousness and maintain good health. "One thing that does wonders is swimming," he says, pointing to the swooshing sound of water in his ears. "That's a form of mindfulness," he explains.

When it comes to the ring of tinnitus, "it comes and goes," Freeman says. For now, it has subsided into the background, he told me with a sense of relief. "The last two years have been great," he says – a combination of the device, hearing aids and the mindfulness that comes from a swim.

This story was edited by Jane Greenhalgh

• ringing in ears
• hearing loss

A .gov website belongs to an official government organization in the United States.

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• How It Spreads
• Living with HIV
• HIV Awareness Days
• Show All Home
• HIV Nexus Home
• HIV Public Health Partners
• Ending the HIV Epidemic in the U.S. (EHE)

Let's Stop HIV Together

How HIV Spreads

Getting Tested for HIV

Preventing HIV with PrEP

Preventing HIV with Condoms

Stigma and HIV

• HIV in the United States

Fast Facts: HIV in the United States

Fast Facts: HIV and Gay and Bisexual Men

Fast Facts: HIV and Transgender People

Fast Facts: HIV and Women

Fast Facts: HIV in the US by Race and Ethnicity

Fast Facts: HIV in the US by Age

More on HIV for Providers and Partners

Ending the HIV Epidemic in the US (EHE)

HIV Resources to Share

Learn about HIV and how the virus is transmitted, how to protect yourself and others, and how to live well with HIV. Also learn how HIV impact the American people.

• Resource Library
• Occupational Exposure
• Connect With Us

Research in NIAID Labs

Research conducted in niaid labs.

NIAID supports laboratories and sections that conduct peer-reviewed research as well as several branches that focus on new research technologies and animal care. Principal investigators lead research groups composed of staff scientists, physicians, fellows, technical personnel, and students.

In addition to conducting internal research, NIAID provides many laboratory and clinical research training opportunities for both pre- and post-doctoral physicians and scientists.

Division of Intramural Research

For more than 60 years the Division of Intramural Research (DIR) has supported the NIAID mission by conducting basic and clinical research in a wide range of disciplines related to immunology, allergy, and infectious diseases. Their purpose is to make scientific discoveries that promote the development of new vaccines, therapeutics, and diagnostics to improve human health.  Learn more about DIR labs and how they support the NIAID mission .

Vaccine Research Center

The mission of the Vaccine Research Center (VRC) is to conduct research that facilitates the development of effective vaccines for human disease. The primary focus of research is the development of vaccines for AIDS but the center also conducts research into the development of vaccines for many of the world’s most challenging diseases, from Ebola to influenza. Learn about the work being done at the VRC .

Intramural Scientist & Clinician Directory

Over 200 NIAID scientists and clinicians from DIR and the VRC including principal investigators (PIs), staff scientists and staff clinicians are listed in the NIAID Intramural Scientist & Clinician Directory. Search the directory to find out more about NIAID researchers .

Research Training at NIAID

To promote and develop the next generation of biomedical researchers, NIAID is committed to offering a broad spectrum of training opportunities to individuals from varying educational backgrounds, ranging from high school to postdoctoral level.  Learn more about training in NIAID laboratories . 

• Skip to main content
• Skip to FDA Search
• Skip to in this section menu
• Skip to footer links

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

U.S. Food and Drug Administration

•   Search
•   Menu
• News & Events
• Public Health Focus

FDA and Cannabis: Research and Drug Approval Process

On this page:, fda supports sound scientific research.

• Cannabis Study Drugs Controlled Under Schedule I of the CSA
• Cannabis Study Drugs Containing Hemp

Additional Resources

The FDA understands that there is increasing interest in the potential utility of cannabis for a variety of medical conditions, as well as research on the potential adverse health effects from use of cannabis.

To date, the FDA has not approved a marketing application for cannabis for the treatment of any disease or condition. The agency has, however, approved one cannabis-derived drug product: Epidiolex (cannabidiol), and three synthetic cannabis-related drug products: Marinol (dronabinol), Syndros (dronabinol), and Cesamet (nabilone). These approved drug products are only available with a prescription from a licensed healthcare provider. Importantly, the FDA has not approved any other cannabis, cannabis-derived, or cannabidiol (CBD) products currently available on the market.

• Cannabis sativa L. is a plant that contains over 80 different naturally occurring compounds called “cannabinoids”
• Cannabidiol (CBD)
• Tetrahydrocannabinol (THC)
• Plants are grown to produce varying concentrations of cannabinoids – THC or CBD
• These plant variations are called cultivars

Cannabis-derived compounds

• Compounds occurring naturally in the plant – like CBD and THC
• These compounds are extracted directly from the plant
• Can be used to manufacture drug products
• Example: highly-purified CBD extracted from the plant

Cannabis-related compounds

• These synthetic compounds are created in a laboratory
• Can be used to manufacture drug products 
• Some synthetic compounds may also occur naturally in the plant and some may not
• Examples: synthetically-derived dronabinol (also naturally occurring) and nabilone (not naturally occurring) 

FDA has approved Epidiolex, which contains a purified form of the drug substance cannabidiol (CBD) for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients 2 years of age and older. That means FDA has concluded that this particular drug product is safe and effective for its intended use.

The agency also has approved Marinol and Syndros for therapeutic uses in the United States, including for nausea associated with cancer chemotherapy and for the treatment of anorexia associated with weight loss in AIDS patients. Marinol and Syndros include the active ingredient dronabinol, a synthetic delta-9- tetrahydrocannabinol (THC) which is considered the psychoactive intoxicating component of cannabis (i.e., the component responsible for the “high” people may experience from using cannabis). Another FDA-approved drug, Cesamet, contains the active ingredient nabilone, which has a chemical structure similar to THC and is synthetically derived. Cesamet, like dronabinol-containing products, is indicated for nausea associated with cancer chemotherapy.

FDA is aware that unapproved cannabis and/or unapproved cannabis-derived products are being used to treat a number of medical conditions including, AIDS wasting, epilepsy, neuropathic pain, spasticity associated with multiple sclerosis, and cancer and chemotherapy-induced nausea. Caregivers and patients can be confident that FDA-approved drugs have been carefully evaluated for safety, efficacy, and quality, and are monitored by the FDA once they are on the market. However, the use of unapproved cannabis and cannabis-derived products can have unpredictable and unintended consequences, including serious safety risks. Also, there has been no FDA review of data from rigorous clinical trials to support that these unapproved products are safe and efficacious for the various therapeutic uses for which they are being used.

FDA understands the need to develop therapies for patients with unmet medical needs, and does everything it can to facilitate this process. FDA has programs such as Fast Track, Breakthrough Therapy, Accelerated Approval and Priority Review that are designed to facilitate the development of and expedite the approval of drug products. In addition, the FDA’s expanded access (sometimes called “compassionate use”) statutory and regulatory provisions are designed to facilitate the availability of investigational products to patients with serious diseases or conditions when there is no comparable or satisfactory alternative therapy available, either because the patients have exhausted treatment with or are intolerant of approved therapies, or when the patients are not eligible for an ongoing clinical trial. Through these programs and the drug approval process, FDA supports sound, scientifically-based research into the medicinal uses of drug products containing cannabis or cannabis-derived compounds and will continue to work with companies interested in bringing safe, effective, and quality products to market.

↑ Back to top

The FDA has an important role to play in supporting scientific research into the medical uses of cannabis and its constituents in scientifically valid investigations as part of the agency’s drug review and approval process. As a part of this role, the FDA supports those in the medical research community who intend to study cannabis by:

• Providing information on the process needed to conduct clinical research using cannabis.
• Providing information on the specific requirements needed to develop a human drug that is derived from a plant such as cannabis. In December 2016, the FDA updated its Guidance for Industry: Botanical Drug Development , which provides sponsors with guidance on submitting investigational new drug (IND) applications for botanical drug products. The FDA also has issued “ Cannabis and Cannabis-Derived Compounds: Quality Considerations for Clinical Research, Draft Guidance for Industry .”
• Providing specific support for investigators interested in conducting clinical research using cannabis and its constituents as a part of the IND or investigational new animal drug (INAD) process through meetings and regular interactions throughout the drug development process.
• Providing general support to investigators to help them understand and follow the procedures to conduct clinical research through the FDA Center for Drug Evaluation and Research (CDER) Small Business and Industry Assistance group .

To conduct clinical research that can lead to an approved new drug, including research using materials from plants such as cannabis, researchers need to work with the FDA and submit an IND application to CDER. The IND application process gives researchers a path to follow that includes regular interactions with the FDA to support efficient drug development while protecting the patients who are enrolled in the trials. An IND includes protocols describing proposed studies, the qualifications of the investigators who will conduct the clinical studies, and assurances of informed consent and protection of the rights, safety, and welfare of the human subjects. The FDA reviews the IND to ensure that the proposed studies, generally referred to as “clinical trials,” do not place human subjects at an unreasonable risk of harm. The FDA also requires obtaining the informed consent of trial subjects and human subject protection in the conduct of the clinical trials. For research intending to develop an animal drug product, researchers would establish an INAD file with the Center for Veterinary Medicine (CVM) to conduct their research, rather than an IND with CDER.

FDA is committed to encouraging the development of cannabis-related drug products, including CBD. Those interested in cannabis-derived and cannabis-related drug development are encouraged to contact the relevant CDER review division and CDER’s Botanical Review Team (BRT) to answer questions related to their specific drug development program. The BRT serves as an expert resource on botanical issues and has developed the Botanical Drug Development Guidance for Industry to assist those pursuing drug development in this area. FDA encourages researchers to request a Pre-Investigational New Drug application (PIND) meeting to discuss questions related to the development of a specific cannabis-derived and cannabis-related drug product.

Please note that certain cultivars and parts of the Cannabis sativa L. plant are controlled under the Controlled Substances Act (CSA) since 1970 under the drug class "Marihuana" (commonly referred to as "marijuana") [21 U.S.C. 802(16)]. "Marihuana" is listed in Schedule I of the CSA due to its high potential for abuse, which is attributable in large part to the psychoactive intoxicating effects of THC, and the absence of a currently accepted medical use in the United States. From 1970 until December of 2018, the definition of “marihuana” included all types of Cannabis Sativa L. , regardless of THC content.  However, in December 2018, the Agriculture Improvement Act of 2018 (also known as the Farm Bill) removed hemp, a type of cannabis that is very low in THC (cannabis or cannabis derivatives containing no more than 0.3% THC on a dry weight basis), from controls under the CSA. This change in the law may result in a more streamlined process for researchers to study cannabis and its derivatives, including CBD, that fall under the definition of hemp, a result which could speed the development of new drugs containing hemp. 

Conducting clinical research using cannabis-derived substances that are considered controlled substances under the CSA often involves interactions with several federal agencies. For example:

• Protocols to conduct research with controlled substances listed in Schedule I are required to be conducted under a site-specific DEA investigator registration. For more information, see 21 CFR 1301.18 .
• National Institute on Drug Abuse (NIDA) Drug Supply Program provides research-grade marijuana for scientific study. Through registration issued by DEA, NIDA is responsible for overseeing the cultivation of marijuana for medical research and has contracted with the University of Mississippi to grow marijuana for research at a secure facility. Marijuana of varying potencies and compositions along with marijuana-derived compounds are available. DEA also may allow additional growers to register with the DEA to produce and distribute marijuana for research purposes. DEA that, as the result of a recent amendment to federal law, certain forms of cannabis no longer require DEA registration to grow or manufacture.
• Researchers work with the FDA and submit an IND or INAD application to the appropriate CDER divisions or other center offices depending on the therapeutic indication or population. If the research is intended to support the approval of an animal drug product, an INAD file should be established with CVM. Based on the results obtained in studies conducted at the IND or INAD stage, sponsors may submit a marketing application for formal approval of the drug.

Cannabis Study Drugs Controlled Under Schedule I of the CSA (greater than 0.3% THC on a dry weight basis)

Sponsor obtains pre-IND number through CDER review division to request a pre-IND meeting. For new animal drug research, a sponsor may engage with CVM to establish an INAD file. A pre-IND meeting with CDER is optional, and an opportunity to obtain FDA guidance on sponsor research plans and required content for an IND submission .

The sponsor contacts NIDA or another DEA-registered source of cannabis and/or cannabis-derived substances to obtain information on the specific cultivars available, so that all necessary chemistry, manufacturing, and controls (CMC) and botanical raw material (BRM) information can be included in the IND. Importation of products controlled under the CSA are subject to DEA authorization.

The sponsor may contact DEA to discuss Schedule I drug research plans that may require DEA inspection for an investigator and study site Schedule I license.

Step 4: If the selected BRM or drug substance manufacturer holds a Drug Master File (DMF) , the sponsor must obtain a Letter of Authorization (LOA) to reference CMC and BRM information. Alternatively, an IND submission would need to contain all necessary CMC data characterizing their study drug and ensuring it is safe for use in humans.

The sponsor sends a copy of the IND and clinical protocol, including a LOA (if applicable), to FDA.

FDA reviews the submitted IND. The sponsor must wait 30 calendar days following IND submission before initiating any clinical trials, unless FDA notifies the sponsor that the trials may proceed sooner. During this time, FDA has an opportunity to review the submission for safety to assure that research subjects will not be subjected to unreasonable risk.

If the IND is authorized by FDA as “safe to proceed” the sponsor may then submit their clinical protocol registration application, including referenced IND number, to DEA to obtain the protocol registration. Once this is received, the sponsor contacts NIDA or another DEA-registered source to obtain the cannabis and/or cannabis-derived substances and they can then begin the study.

For nonclinical research, including research conducted under an INAD file submitted established with CVM, there is no requirement of prior authorization of the protocol by FDA before the investigators may proceed with a protocol registration application submitted to DEA. For these nonclinical protocols, investigators may immediately pursue investigator and study site licensure, and protocol registration with DEA, so they may then obtain their Schedule I cannabis-derived study drug from supplier.

Cannabis Study Drugs Containing Hemp (no more than 0.3% THC on a dry weight basis)

Sponsor provides all applicable chemistry, manufacturing, and controls (CMC) and botanical raw material (BRM) information in the IND for review by FDA, including hemp cultivars.

If the selected hemp manufacturer holds a Drug Master File (DMF) , the sponsor must obtain a Letter of Authorization (LOA) to reference CMC and BRM information. Alternatively, an IND submission would need to contain all necessary CMC data characterizing their study drug and ensuring it is safe for use in humans.

FDA’s Role in the Drug Approval Process

The FDA’s role in the regulation of drugs, including cannabis and cannabis-derived products, also includes review of applications to market drugs to determine whether proposed drug products are safe and effective for their intended indications. The FDA’s drug approval process requires that clinical trials be designed and conducted in a way that provides the agency with the necessary scientific data upon which the FDA can make its approval decisions. Without this review, the FDA cannot determine whether a drug product is safe and effective. It also cannot ensure that a drug product meets appropriate quality standards. For certain drugs that have not been approved by the FDA, the lack of FDA approval and oversight means the safety, effectiveness, and quality of the drug – including how potent it is, how pure it is, and whether the labeling is accurate or false – may vary considerably.

• Product-Specific Guidance for Generic Drug Development: Draft Guidance on Cannabidiol Oral Solution (PDF - 42KB)
• Cannabis Clinical Research: Drug Master Files (DMFs) & Quality Considerations Webinar
• Cannabis and Cannabis-Derived Compounds: Quality Considerations for Clinical Research, Draft Guidance for Industry
• FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD): Questions and Answers
• Development & Approval Process (Drugs)
• From an Idea to the Marketplace: The Journey of an Animal Drug through the Approval Process
• FDA Center for Drug Evaluation and Research Small Business and Industry Assistance group
• CVM Small Business Assistance
• National Institutes of Health (NIH): Guidance on Procedures for Provision of Marijuana for Medical Research
• National Institute on Drug Abuse's (NIDA) Role in Providing Marijuana for Research
• Drug Enforcement Administration - Registration of Manufacturers, Distributors, and Dispensers of Controlled Substances
• International Narcotics Control Board: Single Convention on Narcotic Drugs (1961)
• National Institute on Drug Abuse (NIDA): Ordering Guidelines for Marijuana and Marijuana Cigarettes

Appointments at Mayo Clinic

• Nutrition and healthy eating

Dietary fiber: Essential for a healthy diet

Eat more fiber. You've probably heard it before. But do you know why fiber is so good for your health?

Dietary fiber — found mainly in fruits, vegetables, whole grains and legumes — is probably best known for its ability to prevent or relieve constipation. But foods containing fiber can provide other health benefits as well, such as helping to maintain a healthy weight and lowering your risk of diabetes, heart disease and some types of cancer.

Selecting tasty foods that provide fiber isn't difficult. Find out how much dietary fiber you need, the foods that contain it, and how to add them to meals and snacks.

What is dietary fiber?

Dietary fiber, also known as roughage or bulk, includes the parts of plant foods your body can't digest or absorb. Unlike other food components, such as fats, proteins or carbohydrates — which your body breaks down and absorbs — fiber isn't digested by your body. Instead, it passes relatively intact through your stomach, small intestine and colon and out of your body.

Fiber is commonly classified as soluble, which dissolves in water, or insoluble, which doesn't dissolve.

• Soluble fiber. This type of fiber dissolves in water to form a gel-like material. It can help lower blood cholesterol and glucose levels. Soluble fiber is found in oats, peas, beans, apples, citrus fruits, carrots, barley and psyllium.
• Insoluble fiber. This type of fiber promotes the movement of material through your digestive system and increases stool bulk, so it can be of benefit to those who struggle with constipation or irregular stools. Whole-wheat flour, wheat bran, nuts, beans and vegetables, such as cauliflower, green beans and potatoes, are good sources of insoluble fiber.

The amount of soluble and insoluble fiber varies in different plant foods. To receive the greatest health benefit, eat a wide variety of high-fiber foods.

Benefits of a high-fiber diet

A high-fiber diet:

• Normalizes bowel movements. Dietary fiber increases the weight and size of your stool and softens it. A bulky stool is easier to pass, decreasing your chance of constipation. If you have loose, watery stools, fiber may help to solidify the stool because it absorbs water and adds bulk to stool.
• Helps maintain bowel health. A high-fiber diet may lower your risk of developing hemorrhoids and small pouches in your colon (diverticular disease). Studies have also found that a high-fiber diet likely lowers the risk of colorectal cancer. Some fiber is fermented in the colon. Researchers are looking at how this may play a role in preventing diseases of the colon.
• Lowers cholesterol levels. Soluble fiber found in beans, oats, flaxseed and oat bran may help lower total blood cholesterol levels by lowering low-density lipoprotein, or "bad," cholesterol levels. Studies also have shown that high-fiber foods may have other heart-health benefits, such as reducing blood pressure and inflammation.
• Helps control blood sugar levels. In people with diabetes, fiber — particularly soluble fiber — can slow the absorption of sugar and help improve blood sugar levels. A healthy diet that includes insoluble fiber may also reduce the risk of developing type 2 diabetes.
• Aids in achieving healthy weight. High-fiber foods tend to be more filling than low-fiber foods, so you're likely to eat less and stay satisfied longer. And high-fiber foods tend to take longer to eat and to be less "energy dense," which means they have fewer calories for the same volume of food.
• Helps you live longer. Studies suggest that increasing your dietary fiber intake — especially cereal fiber — is associated with a reduced risk of dying from cardiovascular disease and all cancers.

How much fiber do you need?

The Institute of Medicine, which provides science-based advice on matters of medicine and health, gives the following daily fiber recommendations for adults:

Fiber: Daily recommendations for adults

Your best fiber choices

If you aren't getting enough fiber each day, you may need to boost your intake. Good choices include:

• Whole-grain products
• Beans, peas and other legumes
• Nuts and seeds

Refined or processed foods — such as canned fruits and vegetables, pulp-free juices, white breads and pastas, and non-whole-grain cereals — are lower in fiber. The grain-refining process removes the outer coat (bran) from the grain, which lowers its fiber content. Enriched foods have some of the B vitamins and iron added back after processing, but not the fiber.

Fiber supplements and fortified foods

Whole foods rather than fiber supplements are generally better. Fiber supplements — such as Metamucil, Citrucel and FiberCon — don't provide the variety of fibers, vitamins, minerals and other beneficial nutrients that foods do.

Another way to get more fiber is to eat foods, such as cereal, granola bars, yogurt and ice cream, with fiber added. The added fiber usually is labeled as "inulin" or "chicory root." Some people complain of gassiness after eating foods with added fiber.

However, some people may still need a fiber supplement if dietary changes aren't sufficient or if they have certain medical conditions, such as constipation, diarrhea or irritable bowel syndrome. Check with your doctor before taking fiber supplements.

Tips for fitting in more fiber

Need ideas for adding more fiber to your meals and snacks? Try these suggestions:

• Jump-start your day. For breakfast choose a high-fiber breakfast cereal — 5 or more grams of fiber a serving. Opt for cereals with "whole grain," "bran" or "fiber" in the name. Or add a few tablespoons of unprocessed wheat bran to your favorite cereal.
• Switch to whole grains. Consume at least half of all grains as whole grains. Look for breads that list whole wheat, whole-wheat flour or another whole grain as the first ingredient on the label and have at least 2 grams of dietary fiber a serving. Experiment with brown rice, wild rice, barley, whole-wheat pasta and bulgur wheat.
• Bulk up baked goods. Substitute whole-grain flour for half or all of the white flour when baking. Try adding crushed bran cereal, unprocessed wheat bran or uncooked oatmeal to muffins, cakes and cookies.
• Lean on legumes. Beans, peas and lentils are excellent sources of fiber. Add kidney beans to canned soup or a green salad. Or make nachos with refried black beans, lots of fresh veggies, whole-wheat tortilla chips and salsa.
• Eat more fruit and vegetables. Fruits and vegetables are rich in fiber, as well as vitamins and minerals. Try to eat five or more servings daily.
• Make snacks count. Fresh fruits, raw vegetables, low-fat popcorn and whole-grain crackers are all good choices. A handful of nuts or dried fruits also is a healthy, high-fiber snack — although be aware that nuts and dried fruits are high in calories.

High-fiber foods are good for your health. But adding too much fiber too quickly can promote intestinal gas, abdominal bloating and cramping. Increase fiber in your diet gradually over a few weeks. This allows the natural bacteria in your digestive system to adjust to the change.

Also, drink plenty of water. Fiber works best when it absorbs water, making your stool soft and bulky.

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Error Email field is required

Error Include a valid email address

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

• Kim Y, et al. Dietary fibre intake and mortality from cardiovascular disease and all cancers: A meta-analysis of prospective cohort studies. Archives of Cardiovascular Disease. 2016;109:39.
• Duyff RL. Carbs: Sugars, starches, and fiber. In: Academy of Nutrition and Dietetics Complete Food and Nutrition Guide. 5th ed. New York, N.Y.: Houghton Mifflin Harcourt; 2017.
• Nutrition facts label: Dietary fiber. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/#intro. Accessed Oct. 1, 2018.
• Veronese N, et al. Dietary fiber and health outcomes: An umbrella review of systematic reviews and meta-analyses. American Journal of Clinical Nutrition. 2018;107:436.
• Song M, et al. Fiber intake and survival after colorectal cancer diagnosis. Journal of the American Medical Association: Oncology. 2018;41:71.
• Colditz GA. Healthy diet in adults. https://www.uptodate.com/contents/search. Accessed Oct. 1, 2018.
• Dietary reference intakes (DRIs): Recommended dietary allowances and adequate intakes, total water and macronutrients. Institute of Medicine. http://www.nap.edu/. Accessed Oct. 4, 2018.

Products and Services

• Available Health Products from Mayo Clinic Store
• A Book: Mayo Clinic on High Blood Pressure
• A Book: Mayo Clinic Family Health Book, 5th Edition
• A Book: Live Younger Longer
• A Book: Cook Smart, Eat Well
• A Book: The Mayo Clinic Diet Bundle
• The Mayo Clinic Diet Online
• Newsletter: Mayo Clinic Health Letter — Digital Edition
• A Book: Mayo Clinic Guide to Home Remedies
• A Book: Mayo Clinic on Digestive Health
• Health foods
• Alcohol use
• Alkaline water
• Artificial sweeteners and other sugar substitutes
• Autism spectrum disorder and digestive symptoms
• Breastfeeding nutrition: Tips for moms
• Caffeine: How much is too much?
• Is caffeine dehydrating?
• Calorie calculator
• Can whole-grain foods lower blood pressure?
• Carbohydrates
• Chart of high-fiber foods
• Cholesterol: Top foods to improve your numbers
• Coconut water: Is it super hydrating?
• Coffee and health
• Diet soda: How much is too much?
• Dietary fats
• Prickly pear cactus
• Does soy really affect breast cancer risk?
• Don't get tricked by these 3 heart-health myths
• High-protein diets
• How to track saturated fat
• Is there a special diet for Crohn's disease?
• Monosodium glutamate (MSG)
• Nuts and your heart: Eating nuts for heart health
• Omega-3 in fish
• Omega-6 fatty acids
• Phenylalanine
• Portion control
• Taurine in energy drinks
• Underweight: Add pounds healthfully
• Daily water requirement

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book
• Healthy Lifestyle
• Dietary fiber - Essential for a healthy diet

We’re transforming healthcare

Make a gift now and help create new and better solutions for more than 1.3 million patients who turn to Mayo Clinic each year.