Evidence map›Paper›PMID 42850979›Full record

ArticleJournal of the International AIDS Society2026

Comparative Workflow Modelling of HIV Status-Neutral Care Implementation in Six High-Burden Jurisdictions in the United States: A Qualitative Study.

Tongying Zhao, Laura K Beres, Elena P Rosenberg-Carlson, Joseph Kenny, Wilson Gomez, Alithia Zamantakis, Cathleen E Willging, Russell A Brewer, Jill S Blumenthal, Joyce L Jones and 16 more

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Journal of the International AIDS Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors.

Tongying ZhaoBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Laura K BeresBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Elena P Rosenberg-CarlsonDavid Geffen School of Medicine, University of California, Los Angeles, California, USA.ORCID https://orcid.org/0009-0008-5654-9728
Joseph KennySchool of Nursing, Yale University, New Haven, Connecticut, USA.
Wilson GomezBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Alithia ZamantakisFeinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Cathleen E WillgingPacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA.
Russell A BrewerSchool of Medicine, University of Chicago, Chicago, Illinois, USA.
Jill S BlumenthalSchool of Medicine, University of California, San Diego, California, USA.
Joyce L JonesSchool of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Uyen KaoDavid Geffen School of Medicine, University of California, Los Angeles, California, USA.
Tequetta ValerianoSchool of Nursing, Yale University, New Haven, Connecticut, USA.
Aadia I RanaHeersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.
Sung-Jae LeeDavid Geffen School of Medicine, University of California, Los Angeles, California, USA.ORCID https://orcid.org/0000-0002-7924-7430
Maile Y KarrisSchool of Medicine, University of California, San Diego, California, USA.
Ana M PachicanoFeinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Jessica KassanitsFeinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.ORCID https://orcid.org/0009-0005-0368-2953
Alison B HamiltonDavid Geffen School of Medicine, University of California, Los Angeles, California, USA.
Robin G LanziHeersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0002-5013-4141
LaRon E NelsonSchool of Nursing, Yale University, New Haven, Connecticut, USA.
Lipin LukoseBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0001-8409-3491
Donna J SmithHeersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.
Nanette D BenbowFeinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Sheree R SchwartzBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Joseph G RosenThe Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.ORCID https://orcid.org/0000-0003-4991-4033
NISH 001 Study Team

Funding

UCLA Rapid, Relevant, Rigorous Implementation Science HubP30MH058107 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Sung-Jae Lee · 1997 to 2026
$53.5M
Using Coincidence Analysis to Investigate Factors Affecting PrEP Initiation and Continuation in Southern ending the Epidemic CountiesP30MH062294 · NIMH · YALE UNIVERSITY · PI Trace S Kershaw · 2001 to 2026
$48.5M
The Brown Initiative in HIV and AIDS Clinical Research for Minority CommunitiesR25MH083620 · NIMH · MIRIAM HOSPITAL · PI NUNN, AMY STEWART · 2008 to 2025
$3.7M
The Johns Hopkins and Emory University AIDS Research Center – Center for HIV and Mental Health Stigma Elimination Strategies (CHIMES) P30MH136919 · NIMH · JOHNS HOPKINS UNIVERSITY · PI Stefan David Baral, Patrick Sean Sullivan · 2024 to 2026
$2.9M
Optimizing implementation of long-acting, injectable Cabotegravir for HIV prevention among adolescents and young adults in ZambiaK01MH130244 · NIMH · JOHNS HOPKINS UNIVERSITY · PI BERES, LAURA · 2022 to 2025
$696k
National Institute of Allergy and Infectious Diseases P30AI027767National Institute of Allergy and Infectious Diseases P30AI036214National Institute of Allergy and Infectious Diseases P30AI094189National Institute of Allergy and Infectious Diseases P30AI117943National Institute of Allergy and Infectious Diseases R24AI191821National Institute of Allergy and Infectious Diseases R24AI191842National Institute of Allergy and Infectious Diseases R24AI191865National Institute of Allergy and Infectious Diseases R24AI191868National Institute of Allergy and Infectious Diseases R24AI194681National Institute of Allergy and Infectious Diseases R24AI194905NIMH NIH HHS K01MH130244NIMH NIH HHS P30MH058107NIMH NIH HHS P30MH062294NIMH NIH HHS P30MH136919NIMH NIH HHS R25MH083620
6 · The paper itself

Abstract

introductionStatus-neutral approaches to HIV treatment and prevention, which link all individuals to tailored, comprehensive services following HIV testing, are promising strategies for reducing HIV service delivery inequities and improving clinical outcomes. However, transferable, feasible models of status-neutral service delivery are poorly understood, particularly in the United States, where implementation contexts are geographically and institutionally disparate. To guide expanded implementation, we identified difference-making attributes of status-neutral implementation workflows in a diverse sample of public sector-funded HIV clinical organizations in U.S. jurisdictions prioritized in the Ending the HIV Epidemic (EHE) Initiative.

methodsIn March-June 2024, we invited frontline HIV service providers across six EHE jurisdictions (Alabama, Baltimore, Chicago, Dallas, Los Angeles, San Diego) to participate in virtual focus group discussions (FGDs), segmented by ongoing or planned status-neutral implementation. We depicted an HIV status-neutral workflow and elicited discussants' perspectives on (in)consistencies between the illustration and their implementation practices. Applying comparative workflow modelling, we re-illustrated status-neutral implementation pathways and identified workstream features distinguishing service delivery across clinical organizations.

resultsWe facilitated eight FGDs with 56 providers across 20 organizations. Status-neutral implementation processes varied substantially across clinical organizations-distinguished by the roles and responsibilities of clinical (i.e. physicians, nurses) and non-clinical (i.e. navigators, case managers) staff as well as by the sequence and timing of activities within workflows. We identified four workflow attributes that distinguished clinical organizations: (1) the timing of health insurance review (whether insurance assessments and navigation occurred earlier vs. later in the implementation pathway); (2) the magnitude of activity integration (whether services were delivered concurrently vs. sequentially); (3) the presence of implementation partnerships (whether HIV testing was conducted in-house vs. externally); and (4) the extent of workforce task-shifting (whether services were primarily delivered by clinical vs. non-clinical staff).

conclusionsWorkflow heterogeneities reflected jurisdictional and organizational differences in funding, staffing and infrastructure. Generalizable attributes, including the degree of workflow integration and staff role delineation, can inform scalable implementation models. Enhanced cross-training and increased involvement of non-clinical staff (especially in HIV prevention workflows) are critical to enable adaptable, timely and person-centred HIV service delivery across diverse care settings.

Indexed as

Delivery of Health CareHIV InfectionsWorkflowHumansQualitative ResearchUnited StatesEnding the HIV EpidemicHIV preventionHIV treatmentimplementation scienceperson‐centred care

Identifiers

PMID42850979

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.