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Open Access Publications from the University of California

Recent Work

Since its founding in 1983 by California State Legislature, the California HIV/AIDS Research Program (CHRP) has supported excellent, timely, and innovative research that is attentive to the needs of California, accelerating progress towards prevention, care and treatment for HIV/AIDS. During this time over $250M has been awarded for over 2,000 research projects.

CHRP provides start-up funds for the development of cutting edge research in California, providing critical leverage to bring in federal and private dollars to the state. A 2006 survey of California investigators found that more than five dollars in federal and other grant support was generated for every dollar invested by CHRP in California-based research.

Cover page of Documenting best practices for maintaining access to HIV prevention, care and treatment in an era of shifting immigration policy and discourse

Documenting best practices for maintaining access to HIV prevention, care and treatment in an era of shifting immigration policy and discourse

(2020)

Changes in the United States federal-level political landscape have been felt within immi- grant communities, and the public health clinics that serve them. We sought to document how HIV prevention and care clinics are reaching and retaining their immigrant community patients during a period of retrenchment of accessible public resources and immigrant rights. From May 2018 through January 2019, we conducted 20 in-depth interviews with cli- nicians, case workers, advocates, legal experts, and peer navigators in Northern and Cen- tral California. Interviews were recorded and transcribed. Several themes emerged which can be grouped into three primary areas: changes post-election, challenges meeting the needs of patients, and best practices for maintaining access to prevention and care ser- vices. Post-election, providers reported some of their patients skipping clinic appointments due to fear of Immigration and Customs Enforcement (ICE) raids and deportation while other patients had moved to locations that they felt were less policed. Challenges emerged around linguistic competency, meeting basic needs such as housing stability and employ- ment, and treating mental health sequelae resulting from trauma experienced in home coun- tries or during migration itself. Best practices included hiring bi-lingual and bi-cultural staff, linking to legal services to assist with immigration status, holding trainings around immigrant rights and responses to ICE raids, and building trust with immigrant patients by assuring them that their status would not be collected or reported. In light of adverse policy changes affecting immigrants, agencies have begun to institute best practices to mitigate the nega- tive impact of those policies on their clients and patients.

Medical-Legal Partnerships to Support Continuity of Care for Immigrants Impacted by HIV: Lessons Learned from California

(2019)

The United States (US) has experienced a surge of anti-immigrant policies and rhetoric, raising concerns about the influence on health outcomes for immigrants living in the US. We conducted qualitative interviews (n = 20) with health care and social service providers, attorneys, and legal/policy experts in California to understand how agencies were maintaining access to HIV care and prevention for immigrant clients. We conducted a thematic analysis to describe the role of medical–legal part- nerships (MLPs) and document best practices. Informants reported high demand for legal services. Referrals were facilitated by case managers, medical providers, and pre-existing relationships between clinics and legal agencies. Informants identified a need for additional funding and further guidance on screening for and supporting patients with legal needs. MLPs have the capacity to create sustainable, efficient, comprehensive structural changes that minimize barriers to HIV prevention and treatment and improve health outcomes among immigrant populations.

Shaping the Patient-Centered Medical Home to the Needs of HIV Safety Net Patients: The Impact of Stigma and the Need for Trust

(2018)

The patient-centered medical home (PCMH) is a promising model for increasing the efficiency and quality of HIV care. We evaluated the implementation of PCMH-related demonstration projects in HIV care settings serving safety net populations. We conducted 113 qualitative interviews with key informants and patients to understand which PCMH components were perceived as best meeting patient medical and support service needs. Our results demonstrate the value and limitations of the PCMH, as currently conceived, for HIV care settings. Clinics focused on modifying workflows and improving care coordination. Patients welcomed such changes because they reinforced existing trust in the providers. Clinics dedicated less attention to promoting patient activation, such as building self-management skills, because such changes were seen as duplicative or undermined existing practices to meet patient social support needs. Research should explore how components of the PCMH could be modified to more fully meet the needs of this patient population.

Cover page of The Impact Of Medicaid Expansion On People Living With HIV And Seeking Behavioral Health Services

The Impact Of Medicaid Expansion On People Living With HIV And Seeking Behavioral Health Services

(2018)

While Medicaid expansion created healthcare access for millions in California, its impact on people living with HIV (PLWH) is more nuanced. Newly covered PLWH with behavioral health needs had to navigate separate mental health and substance use care systems, rather than receiving them in integrated care settings as they had under the Ryan HIV/AIDS White Program (RWHAP). We conducted 47 interviews to examine the impact of Medicaid expansion on PLWH with behavioral health needs in California. California’s historical division in its Medicaid funding streams created challenges in determining which payer should cover clients’ behavioral healthcare. Compounding these challenges was a perceived lack of cultural competence for serving PLWH, insufficient infrastructure to facilitate continuity of care, and unmet need for non-medical supportive services. The multi-payer model under health reform has compromised the administrative simplicity and integrated delivery of HIV and behavioral health services previously available to uninsured patients through the RWHAP.

Cover page of ImmPort, toward repurposing of open access immunological assay data for translational and clinical research.

ImmPort, toward repurposing of open access immunological assay data for translational and clinical research.

(2018)

Immunology researchers are beginning to explore the possibilities of reproducibility, reuse and secondary analyses of immunology data. Open-access datasets are being applied in the validation of the methods used in the original studies, leveraging studies for meta-analysis, or generating new hypotheses. To promote these goals, the ImmPort data repository was created for the broader research community to explore the wide spectrum of clinical and basic research data and associated findings. The ImmPort ecosystem consists of four components-Private Data, Shared Data, Data Analysis, and Resources-for data archiving, dissemination, analyses, and reuse. To date, more than 300 studies have been made freely available through the Shared Data portal (www.immport.org/immport-open), which allows research data to be repurposed to accelerate the translation of new insights into discoveries.

Cover page of A comparison of HIV testing protocols with Latino day laborers

A comparison of HIV testing protocols with Latino day laborers

(2016)

This project compared two HIV testing protocols, an HIV test alone or as part of a bundled package with other tests, to examine which resulted in a higher test uptake in a sample of 725 Latino day laborers. The testing uptake was 29.1% for the HIV-only protocol and 13.6% for the HIV-bundled protocol (p < 0.001). Thus higher levels of testing among day laborers may occur when the HIV test is offered alone. However, no HIV-positive tests were found and few risk behaviors reported. This would argue against the need for routine HIV screening with this population as a whole. HIV testing among Latino day laborers should target those involved in actual high HIV risk behaviors, such as unprotected sex with men or injection drug use.