Evaluating the Clinical, Economic, and Social Impact of Evolving HIV Prevention and Care Strategies in Tennessee: A Multimethod Approach

HIV remains a major public health concern in the United States (US) with a disproportionate burden of disease in the US South, including Tennessee. The proportion of people with HIV (PWH) in Tennessee in 2019 who knew their HIV status (85%), were linked to care (61%), were retained in clinical care (59%), and had suppressed viral loads (65%), were well below US Ending the HIV epidemic goals (90%). The burden of HIV infection is uneven, but poor HIV continuum of care outcomes can be found throughout the state of Tennessee. Some of the poorest outcomes can be found in Memphis/Shelby County, a Phase 1 EHE Priority Jurisdiction and a Metropolitan Statistical Area (MSA) that ranks 3rd in the US for HIV incidence. In this public health context, new strategies are being employed to target, disseminate, and implement HIV testing and prevention to improve the health and well-being of those at risk of HIV acquisition and those living with HIV. Implementation of new strategies including changes to community-based outreach, target data-driven interventions, and the re-organization of integrated HIV services to deliver evidence-based delivery of HIV testing, treatment, and prevention services represents an urgent quasi-experimental event that requires evaluation. Thus, our overarching goal is to provide a near-real-time assessment of whether and how new strategies to deliver evidence-based care will impact HIV outcomes, particularly among populations highly susceptible to HIV. We are uniquely positioned to perform the work in this proposal as our study team has complementary expertise in Tennessee clinical HIV testing and prevention, HIV modeling, and qualitative research to ensure the timely initiation of the project with minimum delay. Our findings will provide clear, rigorous evidence in a near-real-time assessment of whether and how changes to implementation of HIV prevention and care in Tennessee affect HIV outcomes. Although focused on Tennessee, results are relevant to broader discussions around the direction of evidence-based strategies to improve community-based organizational capacity for public health programs already emerging across the US South. Importantly, our work will support Tennessee communities in reaching their Ending the HIV Epidemic (EHE) goals through the leveraging of our unique academic and community-based partnerships.