Applying the Behavioural and Social Sciences Research (BSSR) Functional Framework to HIV Cure Research.

Karine Dubé,Michael J Stirratt,Judith D Auerbach,Paul Gaist

doi:10.1002/jia2.25404

Abstract

IntroductionThe 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.DiscussionThe 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.ConclusionsTo 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.

Highlights

| INTRODUCTIONA cure for HIV infection has been a hoped-for goal since the virus was first identified
The search for an HIV cure involves important behavioural and social processes that complement the domains of biomedicine
The U.S Food and Drug Administration (FDA) defines HIV cure research as “any investigation that evaluates: (1) a therapeutic intervention or approach that controls or eliminates HIV infection to the point that no further medication interventions are needed to maintain health, and (2) preliminary scientific concepts that might lead to such a therapeutic intervention” [2]

Summary

| INTRODUCTION

A cure for HIV infection has been a hoped-for goal since the virus was first identified. We apply Gaist and Stirratt’s BSSR Functional Framework [17] to the HIV cure research field. This framework describes four key domains of BSSR in HIV research, as illustrated in Figure 1: (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). BSSR can become a critical adjunct to ongoing biomedical HIV cure research efforts, as it has in the fields of HIV prevention, HIV treatment and oncology [19], by contributing methods to assess community knowledge, to improve behavioural and social approaches to risk reduction—. Determining how to prioritize these will require ongoing stakeholder engagement in diverse settings

| DISCUSSION

| CONCLUSIONS