Integrating HIV Cluster Analysis in Everyday Public Health Practice: Lessons Learned from a Public Health – Academic Partnership

Abstract

BACKGROUND: The use of molecular HIV cluster analysis to supplement public health contact tracing has shown promise in addressing HIV outbreaks. However, the potential of HIV cluster analysis as an adjunct to daily, person-by-person HIV prevention efforts remains unknown. We documented lessons learned within a unique public-health–academic partnership, while guiding workaday HIV prevention efforts with near-real-time molecular cluster analysis. SETTING: An academic-public health partnership in the State of Rhode Island, USA. METHODS: We recorded perceptions of our team of academicians and public-health staff that were encountered in an 18-month study evaluating integration of molecular cluster analysis with HIV contact-tracing for public-health benefit. Focus was on monthly conferences where molecular clustering of each new statewide diagnosis was discussed to facilitate targeted interventions, and on attempted re-interviews of all newly HIV-diagnosed persons statewide whose HIV sequences clustered, to increase partner naming. RESULTS: Three main themes emerged: First, multidisciplinary conferences are substantially beneficial for gleaning actionable inferences from integrating molecular cluster analysis and public-health data. Second, universal re-interviews were perceived to potentially have negative consequences but may be selectively beneficial. Third, translation of cluster analysis into public-health action is hampered by jurisdictional surveillance boundaries and within-jurisdictional data silos, across which data sharing is problematic. CONCLUSIONS: Insights from a statewide public-health–academic partnership support integration of molecular HIV cluster analyses with public-health efforts, which can guide public-health activities to prevent transmission, while identifying substantial barriers to integration, informing continued research.