HIV PROJECTS
PIs: Julia Marcus, PhD, MPH, Douglas Krakower, MD
The primary research focus of the HIV portfolio is to improve the implementation of preexposure prophylaxis (PrEP) for HIV prevention and sexual health promotion in the US. The team is led by Julia Marcus, PhD, MPH, an infectious disease epidemiologist, and Douglas Krakower, MD, an infectious disease physician, both Associate Professors in the Department and Adjunct Faculty at The Fenway Institute, with Dr. Krakower also a practicing physician at Beth Israel Deaconess Medical Center. Together, they have extensive experience leading quantitative and qualitative studies on PrEP implementation across a variety of health care delivery settings. This research is primarily funded through the National Institutes of Health.
The faculty’s HIV-related projects have used electronic health record (EHR), survey, and qualitative data to identify patients who may benefit from PrEP, quantify clinical outcomes among PrEP users, and characterize gaps and inequities in the PrEP continuum of care. The faculty’s work is cited by the Centers for Disease Control and Prevention in clinical guidelines for PrEP provision and as key evidence of the effectiveness of PrEP, and has been implemented in diverse clinical settings across the US to improve PrEP provision for patients likely to benefit.
Examples of current HIV-related projects include studies to 1) test whether an EHR-based decision support tool can improve PrEP discussions and prescribing safety-net clinics, 2) evaluate real-world use and impact of long-acting injectable PrEP, 3) implement and evaluate a strategy for linking people to PrEP in the Dallas County jail, 4) determine the prevalence and patterns of use of antibiotic prophylaxis for sexually transmitted infections, and 5) evaluate the extent to which a telehealth platform is reaching populations who are at increased risk of HIV and underrepresented in clinic-based PrEP programs.
Recent Publications
Prevention
Sewak A, Lodi S, Li X, Shu D, Wen L, Mayer KH, Krakower DS, Young JG, Marcus JL. Causal effects of stochastic PrEP interventions on HIV incidence among men who have sex with men. Am J Epidemiol. 2023 Apr 19;. doi: 10.1093/aje/kwad097. [Epub ahead of print] PubMed PMID: 37073419.
Burns CM, Pung L, Witt D, Gao M, Sendak M, Balu S, Krakower D, Marcus JL, Okeke NL, Clement ME. Development of a Human Immunodeficiency Virus Risk Prediction Model Using Electronic Health Record Data From an Academic Health System in the Southern United States. Clin Infect Dis. 2023 Jan 13;76(2):299-306. doi: 10.1093/cid/ciac775. PubMed PMID: 36125084; PubMed Central PMCID: PMC10202432.
Marcus JL, Killelea A, Krakower DS. Perverse Incentives - HIV Prevention and the 340B Drug Pricing Program. N Engl J Med. 2022 Jun 2;386(22):2064-2066. doi: 10.1056/NEJMp2200601. Epub 2022 May 28. PubMed PMID: 35621521.
& Marcus JL, Killelea A, Krakower DS. HIV Prevention and the 340B Drug Pricing Program. Reply. N Engl J Med. 2022 Aug 11;387(6):576. doi: 10.1056/NEJMc2208621. PubMed PMID: 35947725.
Marcus JL, Krakower DS. Making PrEP easy. Lancet HIV. 2022 Apr;9(4):e226-e228. doi: 10.1016/S2352-3018(22)00036-4. PubMed PMID: 35364024.
Humphries DL, Rhodes EC, Simon CL, Wang V, Spiegelman D, Ott C, Hicks D, Marcus JL, Krakower D, Rana A. Using Health Care Professionals' Perspectives to Refine a Clinical Decision Support Implementation Strategy for Increasing the Prescribing of HIV Preexposure Prophylaxis (PrEP) in Alabama. J Int Assoc Provid AIDS Care. 2022 Jan-Dec;21:23259582221144451. doi: 10.1177/23259582221144451. PubMed PMID: 36537589; PubMed Central PMCID: PMC9772965.
COVID-19
Baral S, Rao A, Rwema JOT, Lyons C, Cevik M, Kågesten AE, Diouf D, Sohn AH, Phaswana-Mafuya RN, Kamarulzaman A, Millett G, Marcus JL, Mishra S. Competing health risks associated with the COVID-19 pandemic and early response: A scoping review. PLoS One. 2022;17(8):e0273389. doi: 10.1371/journal.pone.0273389. eCollection 2022. Review. PubMed PMID: 36037216; PubMed Central PMCID: PMC9423636.
Kruse GR, Pelton-Cairns L, Taveras EM, Dargon-Hart S, Gundersen DA, Lee RM, Bierer BE, Lawlor E, LaRocque RC, Marcus JL, Davies ME, Emmons KM. Implementing expanded COVID-19 testing in Massachusetts community health centers through community partnerships: Protocol for an interrupted time series and stepped wedge study design. Contemp Clin Trials. 2022 Jul;118:106783. doi: 10.1016/j.cct.2022.106783. Epub 2022 May 6. PubMed PMID: 35533978; PubMed Central PMCID: PMC9076025.
Rao A, Rucinski K, Jarrett BA, Ackerman B, Wallach S, Marcus J, Adamson T, Garner A, Santos GM, Beyrer C, Howell S, Baral S. Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries. J Acquir Immune Defic Syndr. 2021 May 1;87(1):644-651. doi: 10.1097/QAI.0000000000002620. PubMed PMID: 33443963; PubMed Central PMCID: PMC8276834.
Jenness SM, Le Guillou A, Chandra C, Mann LM, Sanchez T, Westreich D, Marcus JL. Projected HIV and Bacterial Sexually Transmitted Infection Incidence Following COVID-19-Related Sexual Distancing and Clinical Service Interruption. J Infect Dis. 2021 Mar 29;223(6):1019-1028. doi: 10.1093/infdis/jiab051. PubMed PMID: 33507308; PubMed Central PMCID: PMC7928867.