UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
School of Medicine, University of California San Francisco, San Francisco, CA, USA.
J Int AIDS Soc. 2019 Oct;22(10):e25404. doi: 10.1002/jia2.25404.
The search for an HIV cure involves important behavioural and social processes that complement the domains of biomedicine. However, the field has yet to tap into the full potential of behavioural and social sciences research (BSSR). In this article, we apply Gaist and Stirratt's BSSR Functional Framework to the field of HIV cure research.
The BSSR Functional Framework describes four key research domains: (1) basic BSSR (understanding basic behavioural and social factors), (2) elemental BSSR (advancing behavioural and social interventions), (3) supportive BSSR (strengthening biomedically focused clinical trials), and (4) integrative BSSR (building multi-disciplinary combination approaches for real-world implementation). In revisiting and applying the BSSR Functional Framework, we clarify the importance of BSSR in HIV cure research by drawing attention to such things as: how language and communication affect the meaning of "cure" to people living with HIV (PLHIV) and broader communities; how cure affects the identity and social position of PLHIV; counselling 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 related to different cure strategies; HIV care providers' perceptions and attitudes about their patients' participation in cure research; potential social harms or adverse social events associated with cure research participation; and the scalability of a proven cure strategy in the context of further advances in HIV prevention and treatment. We also discuss the BSSR Functional Framework in the context of ATIs, which involve processes at the confluence of the BSSR domains.
To move HIV cure regimens through the translational research pathway, attention will need to be paid to both biomedical and socio-behavioural elements. BSSR can contribute an improved understanding of the human and social dimensions related to HIV cure research and the eventual application of HIV cure regimens. The BSSR Functional Framework provides a way to identify advances, gaps and opportunities to craft an integrated, multi-disciplinary approach at all stages of cure research to ensure the real-world applicability of any strategy that shows promise.
寻找艾滋病治愈方法涉及到重要的行为和社会过程,这些过程补充了生物医学领域。然而,该领域尚未充分利用行为和社会科学研究(BSSR)的潜力。在本文中,我们将 Gaist 和 Stirratt 的 BSSR 功能框架应用于艾滋病治愈研究领域。
BSSR 功能框架描述了四个关键的研究领域:(1)基础 BSSR(了解基本的行为和社会因素),(2)基本 BSSR(推进行为和社会干预),(3)支持性 BSSR(加强以生物医学为重点的临床试验),以及(4)综合 BSSR(为现实世界的实施建立多学科组合方法)。在重新审视和应用 BSSR 功能框架时,我们通过关注以下方面来阐明 BSSR 在艾滋病治愈研究中的重要性:语言和沟通如何影响艾滋病病毒感染者(PLHIV)和更广泛的社区对“治愈”的理解;治愈如何影响 PLHIV 的身份和社会地位;咨询和支持干预措施,以解决研究参与者因分析性治疗中断(ATI)而产生的心理社会需求和担忧;ATI 研究参与过程中的风险降低;与不同治愈策略相关的潜在研究参与者的动机、可接受性和决策过程;艾滋病护理提供者对其患者参与治愈研究的看法和态度;与治愈研究参与相关的潜在社会危害或不良社会事件;以及在 HIV 预防和治疗进一步发展的背景下,经过验证的治愈策略的可扩展性。我们还讨论了 ATI 背景下的 BSSR 功能框架,ATI 涉及 BSSR 领域交汇的过程。
为了使艾滋病治愈方案通过转化研究途径,需要关注生物医学和社会行为因素。BSSR 可以帮助更好地了解与艾滋病治愈研究和最终应用艾滋病治愈方案相关的人类和社会层面。BSSR 功能框架提供了一种方法,可以在治愈研究的所有阶段识别进展、差距和机会,以制定综合的多学科方法,确保任何有前途的策略在现实世界中的适用性。