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BackgroundHeavy alcohol use in people living with HIV (PLWH) has widespread negative effects on neural functioning. It remains unclear whether experimentally-induced reduction in alcohol use could reverse these effects. We sought to determine the effects of 30-days drinking cessation/reduction on resting state functional connectivity in people with and without HIV.MethodsThirty-five participants (48.6% PLWH) demonstrating heavy alcohol use attempted to stop drinking for 30 days via contingency management (CM). MRI was acquired at baseline and after thirty days, and functional connectivity across five resting-state fMRI (rsfMRI) networks was calculated with the Conn toolbox for Matlab and examined in relation to transdermal alcohol concentration (TAC) recorded by the ankle-worn secure continuous remote alcohol monitor (SCRAM) and self-reported alcohol use (timeline follow-back; TLFB). Associations between alcohol use and reduction, HIV status, functional connectivity, and change in functional connectivity across five major rsfMRI networks were determined relative to the pre- and post-CM timepoints.ResultsBaseline resting-state functional connectivity was not significantly associated with average TAC-AUC during the pre-CM period, though higher self-reported alcohol use over the preceding 30 days was significantly associated with higher baseline connectivity within the Dorsal Attention Network (DAN; p-FDR DiscussionLower resting-state functional connectivity of the Salience network significantly predicted stronger drinking reduction across all participants, suggesting a potential biomarker for reduced susceptibility to the environmental and social cues that often make alcohol use reduction attempts unsuccessful. Increased between-networks connectivity was observed in participants with higher alcohol reduction after CM, suggesting a positive benefit to brain connectivity associated with reduced drinking. PLWH with lower baseline DAN connectivity may not benefit as greatly from CM for alcohol reduction.

Transdermal alcohol biosensors measure alcohol use continuously, passively, and non-invasively. There is little field research on the Skyn biosensor, a new-generation, wrist-worn transdermal alcohol biosensor, and little evaluation of its sensitivity and specificity and the day-level correspondence between transdermal alcohol concentration (TAC) and number of self-reported drinks.Participants (N = 36; 61% male, MUsing a minimum TAC threshold of 5 μg/L plus coder review, the biosensor had sensitivity of 54.7% and specificity of 94.6% for distinguishing drinking from nondrinking days. Without coder review, the sensitivity was 78.1% and the specificity was 55.2%. Peak TAC (β = 0.92, p 0.0001) and TAC-AUC (β = 1.60, p 0.0001) were significantly associated with number of drinks. Females had significantly higher TAC levels than males for the same number of drinks.Skyn-derived TAC can be used to measure alcohol use under naturalistic drinking conditions, additional research is needed to accurately identify drinking episodes based on Skyn TAC readings.

There is a paucity of research on the prevalence of subjective cognitive complaints in people living with human immunodeficiency virus, along with the predictors and outcomes related to these complaints. We assessed demographics, substance use and psychiatric predictors, and HIV-related outcomes associated with subjective cognitive complaint items from the Cognitive Difficulties Scale. The sample consisted of 889 people living with HIV in the survey-based Florida Cohort. Results of multivariable regression models indicated that age (45-54), hazardous alcohol consumption, more frequent marijuana use and psychiatric symptoms (depression, anxiety, PTSD) were significant predictors of subjective cognitive complaints. Subjective cognitive complaints were associated with lower adherence to antiretroviral therapy in bivariate analyses, but this relationship was no longer significant after controlling for depression, race, alcohol and drug use. Further research into the relationship between depressive and subjective cognitive complaints may provide additional avenues for intervention.Existe una escasez de investigación sobre la prevalencia de quejas cognitivas subjetivas en personas que viven con el virus de la inmunodeficiencia humana (VIH), junto con los predictores y los resultados relacionados con estas quejas. Evaluamos la demografía, el uso de sustancias y los predictores psiquiátricos, y los resultados relacionados con el VIH asociados con los ítems de quejas cognitivas subjetivas de la Escala de Dificultades Cognitivas. La muestra consistió en 889 personas que viven con el VIH en la cohorte de Florida basada en la encuesta. Los resultados de los modelos de regresión multivariable indicaron que la edad (45-54), el consumo peligroso de alcohol, el uso más frecuente de marihuana y los síntomas psiquiátricos (depresión, ansiedad, trastorno de estrés postraumático) fueron predictores significativos de quejas cognitivas subjetivas. Las quejas cognitivas subjetivas se asociaron con una menor adherencia a la terapia antirretroviral en los análisis bivariados, pero esta relación dejó de ser significativa después de controlar la depresión, la raza, el alcohol y el consumo de drogas. La investigación adicional sobre la relación entre las quejas cognitivas depresivas y subjetivas puede proporcionar vías adicionales de intervención.

Author(s): Hahn, Judith A; Murnane, Pamela M; Vittinghoff, Eric; Muyindike, Winnie R; Emenyonu, Nneka I; Fatch, Robin; Chamie, Gabriel; Haberer, Jessica E; Francis, Joel M; Kapiga, Saidi; Jacobson, Karen; Myers, Bronwyn; Couture, Marie Claude; DiClemente, Ralph J; Brown, Jennifer L; So-Armah, Kaku; Sulkowski, Mark; Marcus, Gregory M; Woolf-King, Sarah; Cook, Robert L; Richards, Veronica L; Molina, Patricia; Ferguson, Tekeda; Welsh, David; Piano, Mariann R; Phillips, Shane A; Stewart, Scott; Afshar, Majid; Page, Kimberly; McGinnis, Kathleen; Fiellin, David A; Justice, Amy C; Bryant, Kendall; Saitz, Richard | Abstract: BackgroundObjective measurement of alcohol consumption is important for clinical care and research. Adjusting for self-reported alcohol use, we conducted an individual participant data (IPD) meta-analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self-reporting unhealthy alcohol consumption.MethodsWe identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1-step IPD meta-analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index-BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger-prick blood collection) variables with PEth sensitivity (PEth≥8nng/ml), adjusting for the level of self-reported alcohol use using the AUDIT-C score.ResultsOne third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8nng/ml) was 81.8%. After adjusting for AUDIT-C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables.ConclusionsAmong people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible.

BACKGROUND: Women living with HIV (WLWH) often report heavy alcohol use and may experience substantial alcohol-related problems, but it is unclear whether it is necessary to completely quit drinking to reduce such problems OBJECTIVES: To assess whether complete reduction of alcohol use produced significantly greater improvement in alcohol-related problems than a partial reduction of alcohol use (reducing alcohol use to ≤7 or ≤14 drinks per week). METHODS: We used data from a randomized clinical trial examining the effectiveness of Naltrexone in WLWH who reported heavy drinking (>7 drinks/week) at baseline. The primary outcome (alcohol-related problems) was measured using the Short Inventory of Problems. The primary predictor (drinking status: quit drinking, reduced drinking, continue heavy drinking) was measured using a 30-day timeline followback. RESULTS: The sample consisted of 163 WLWH (50% 50 years or older, 85% Black). WLWH who reported past violence had significantly greater mean SIP scores at baseline (19.9 vs. 10.5, p

BackgroundDirect biomarkers such as phosphatidylethanol (PEth) have the capability to detect heavy alcohol use, but it is unclear how strongly self-reported reduction in alcohol use correlates with reduction in PEth. We sought to explore the strength of correlation between reductions in self-reported alcohol use and change in PEth among a sample of women living with HIV (WLWH) who participated in a clinical trial to reduce heavy alcohol use. We also sought to determine whether this correlation was stronger in women with lower body mass index (BMI) and women without an alcohol use disorder (AUD).Methods81 WLWH (mean age=48.7, 80% Black) engaging in a randomized trial of naltrexone versus placebo with a positive baseline PEth (≥8ng/ml), and alcohol use data at baseline, 2, and 7months were included in this analysis. Spearman correlation coefficients were compared to measure the correlation between baseline PEth and number of drinks per week by demographic, biological, and alcohol use factors. Mini-International Neuropsychiatric Interview was used to screen for AUD. Further analyses were stratified by BMI and AUD. Spearman correlation coefficients were calculated for the change in PEth and the change in number of drinks per week over 7months, including 3 time-points: baseline, 2, and 7months.ResultsAt baseline, the correlation between baseline PEth and the number of drinks per week was significantly stronger for those with a BMI ≤25 compared to those with a BMI>25 (r=0.66; r=0.26, respectively). Similarly, the correlation between baseline PEth and number of drinks was stronger for those who did not screen positive for AUD compared with those who did (r=0.66; r=0.25, respectively). When stratifying by BMI, a low-to-moderate correlation (r=0.32, p=0.02) was present for persons with a BMI>25; when stratifying by AUD, a moderate correlation (r=0.50, p&nbsp

Understanding how perceived positive consequences are associated with drinking may help improve effectiveness of alcohol reduction interventions among people living with HIV (PLWH). We aimed to determine whether perceived positive consequence scores varied by sociodemographic, drinking, mental health or substance use variables.Perceived positive consequences of drinking were assessed using the PROMIS: Positive Consequences-Short Form. Unhealthy alcohol use was measured using a modified AUDIT-C. We used multiple linear regression to identify factors associated with perceived positive consequence.328 PLWH who consumed at least one alcoholic beverage in the last 6 months participated in the Florida Cohort study (mean age=46, 69% male, 58% Black). Perceived positive consequence scores ranged from 0 to 28 (mean=16.1, SD=6.9). Perceived positive consequence scores increased by 0.8 points for each 1-point increase in AUDIT-C score. Demographics, thoughts on reducing alcohol use, other substance use, depression, and anxiety were not significantly associated with perceived positive consequences.Our findings suggest perceived positive consequences are associated with unhealthy alcohol use. Positive consequences should be considered with negative consequences in a decisional balance when intervening on alcohol use among PLWH.Comprendre comment les conséquences positives perçues sont associées à la consommation d’alcool peut aider à améliorer l’efficacité des interventions de réduction de l’alcool chez les personnes vivant avec le VIH (PVVIH). Nous avons cherché à déterminer si les scores des conséquences positives perçues variaient selon les variables sociodémographiques, de consommation d’alcool, de santé mentale ou de consommation de substances.Les conséquences positives perçues de la consommation d’alcool ont été évaluées à l’aide du PROMIS: Positive Consquences - Short Form -conséquences positives—version abrégée. La consommation d’alcool malsaine a été mesurée à l’aide d’un AUDIT-C modifié. Nous avons utilisé une régression linéaire multiple pour identifier les facteurs associés aux conséquences positives perçues.328 PVVIH ayant consommé au moins une boisson alcoolisée au cours des 6 derniers mois ont participé à l’étude de la cohorte de Floride (âge moyen=46 ans, 69% d’hommes, 58% de noirs). Les scores des conséquences positives perçues allaient de 0 à 28 (moyenne=16.1, ET=6.9). Les scores de conséquences positives perçues ont augmenté de 0.8 point pour chaque augmentation de 1 point du score AUDIT-C.Les données démographiques, les réflexions sur la réduction de la consommation d’alcool, la consommation d’autres substances, la dépression et l’anxiété n’étaient pas associées de manière significative aux conséquences positives perçues.Nos résultats suggèrent que les conséquences positives perçues sont associées à une consommation d’alcool malsaine. Les conséquences positives doivent être considérées avec des conséquences négatives dans le processus décisionnel lors de l’intervention sur la consommation d’alcool chez les PVVIH.

BACKGROUND Alcohol misuse is highly prevalent in the U.S. and results in a great financial and public health burden. Current alcohol reduction treatments are underutilized and there is a critical need for innovation in the field. Transdermal alcohol biosensors measure alcohol use passively and continuously and may be helpful tools in alcohol interventions. To date, however, alcohol biosensors have not been widely used to directly intervene on alcohol use. There is a new wrist-worn biosensor that could be used to help people reduce their drinking, though it is unclear how to best incorporate such a device into an alcohol intervention. OBJECTIVE We aimed to identify desired features that would be acceptable and helpful in a wrist-worn biosensor-based alcohol intervention for adults with heavy drinking. METHODS Participants were recruited through an alcohol contingency management (CM) study; a contact registry; and participant referral. To qualify, participants had to be at least 40 years old; report drinking at least twice per week and indicate interest in reducing their drinking. We conducted a semi-structured interview with each participant via Zoom. The interview guide addressed general thoughts on the wrist-worn biosensor; how participants thought a wrist-worn biosensor could be used to help people quit or reduce drinking; types of information participants would want to receive from the sensor; how they would want to receive that information; and how they thought this information could be used to change their behavior. Interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS The sample was comprised of 20 adults (Mage=55.1, SDage=6.1, 55% women, 85% Black). Nine (45%) participants had previous experience with the SCRAM CAM ankle biosensor from participating in an alcohol CM study. The desirable features could be grouped into five main themes, including 1) Features that would influence willingness (the biosensor should look nice, be comfortable, and be accessible); 2) Personalized messaging (personalized biosensor-based prompts and feedback could be helpful); 3) Preference for time wearing the biosensor (for some, just wearing the biosensor could have an intervention effect); 4) Sharing data with others (this was appealing to many but not all); 5) Mental health support (many felt that mental health support could be incorporated with the biosensor). CONCLUSIONS Five main themes that would maximize desire to use a wrist-worn biosensor for alcohol intervention were identified. Taken together, the identified themes could inform a just-in-time adaptive intervention that uses a wrist-worn biosensor to help persons with heavy drinking reduce their alcohol use.

Highlights • Among PWH, cocaine use vs no-use was associated with worse HIV treatment outcomes. • Powder cocaine only users were more likely to be younger, Hispanic, and employed. • Users of powder + crack cocaine had lower viral suppression than users of either alone. • Harm reduction efforts addressing substance use should be a key component of HIV care., Introduction Cocaine (including powder and crack) use is common among people with HIV (PWH). We identified socio-demographic and behavioral factors associated with cocaine use (overall and various forms) among PWH; we also examined differences in HIV treatment outcomes across cocaine exposure groups. Methods The study sample (N = 1166) was derived from two cohorts of PWH in Florida between 2014 and 2020. Baseline data were linked to the Enhanced HIV/AIDS Reporting System (eHARS) which tracks HIV viral load. Socio-demographics and polysubstance use were compared by cocaine use and the three cocaine use groups (powder only n = 101, crack only n = 91, or both n = 65). The association between the three cocaine use groups, ART adherence, and HIV viral suppression (

BACKGROUND Transdermal alcohol biosensors can objectively monitor alcohol use by measuring transdermal alcohol concentration (TAC). However, it is unclear how sociodemographic and clinical factors that influence alcohol metabolism are associated with TAC. The main aim of this study was to examine how sociodemographic factors (sex, age, race/ethnicity) and clinical factors (body mass index, liver enzymes: alanine aminotransferase [ALT] and aspartate transaminase [AST]), alcohol use disorder, and HIV status were associated with TAC while controlling for level of alcohol use. METHODS We analyzed data from a prospective study involving contingency management for alcohol cessation among persons living with and without human immunodeficiency virus (HIV) that used the Secure Continuous Remote Alcohol Monitoring (SCRAM) biosensor. Forty-three participants (Mage = 56.6 years; 63% male; 58% people living with HIV) yielded 183 SCRAM-detected drinking days. Two indices derived from SCRAM: peak TAC (reflecting level of intoxication) and TAC area under the curve (TAC-AUC; reflecting alcohol volume)-were the main outcomes. Self-reported alcohol use (drinks/drinking day) measured by Timeline Followback was the main predictor. To examine whether factors of interest were associated with TAC, we used individual generalized estimating equations (GEE), followed by a multivariate GEE model to include all significant predictors to examine their associations with TAC beyond the effect of self-reported alcohol use. RESULTS Number of drinks per drinking day (B = 0.29, p

Background Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for many hospital-associated infections. Both MRSA-colonized and MRSA-infected patients must be isolated on contact precautions per the Centers for Disease Control and Prevention guidelines. This study evaluates the current practice for removing MRSA-colonized patients from contact precautions and proposes a new protocol to decrease inconsistencies with screening methodologies. Methods This was a retrospective chart review of MRSA screening swabs collected at an academic medical center between January 1, 2010 and December 31, 2017. Of those patients with MRSA screening swabs, extra-nasal cultures were also evaluated for MRSA infection. Screening swabs were analyzed for appropriateness of order and timing between swabs and active infections. Analysis of variance and the χ² tests were used to determine significance between groups. Results This study included 8,310 patients with a combined total of 11,601 nasal swabs. Significantly more (P = .0159) patients with 2 negative nasal swabs returned with a recurrent MRSA infection or colonization than those who had 3 consecutive negative nasal swabs (27.8% vs 17.0%, respectively). Additionally, 47.8% of patients only had 1 appropriately ordered negative nasal swab, indicating that a nurse-driven protocol may be more effective in obtaining the full series of samples required to remove contact precautions. Conclusions The current practice for removing a patient from contact precautions for MRSA is insufficient. The number of negative nasal swabs required should be increased from 2 to 3 and a decolonization protocol should be implemented.

Introduction: Among people living with HIV (PLWH), alcohol use can have negative impacts beyond HIV-related outcomes. The objectives of this study are to identify the most common alcohol-related consequences among PLWH in Florida and describe factors associated with experiencing more alcohol-related consequences. Methods: Data were collected from PLWH in the Florida Cohort study who drank at least monthly in the past year (n=397). Self-reported consequences were assessed by the 15-item Short Inventory of Problems Revised (SIP-2R). Nonparametric tests and a generalized estimating equation model with inverse probability of exposure weighting were used to evaluate associations between the total SIP-2R score and socio-demographics, mental health, and substance use while controlling for alcohol use. Results: Over half (56%) endorsed at least one consequence and 29% endorsed 5 or more consequences. The most common consequences were doing something they regretted and taking foolish risks (both endorsed by 37% of participants), both in the impulse control domain. After controlling for alcohol use and other covariates, homelessness and injection drug use remained significantly associated with greater SIP-2R scores. Conclusion: PLWH who are experiencing homelessness or injecting drugs could benefit from receiving additional screening for alcohol-related consequences if they report any alcohol use.

The microbiome-gut-brain axis, or the various interactions between the gut microbiome and the brain, has been of recent interest in the context of precision medicine research for a variety of disease states. Persons living with human immunodeficiency virus (PLWH) experience higher degrees of neurocognitive decline than the general population, correlating with a disruption of the normal gut microbiome composition (i.e. dysbiosis). While the nature of this correlation remains to be determined, there is the potential that the microbiome-gut-brain axis contributes to the progression of this disease. Previous research has established that the pathology associated with HIV induces alterations in the composition of gut microbiome, including a shift from Bacteroides to Prevotella dominance, and compromises gut barrier integrity, which may promote microbial translocation and consequent systemic inflammation and exacerbation of neuroinflammation. Further, though the use of antiretroviral therapy has been found to partially counteract HIV-related dysbiosis, it may also induce its own dysbiosis patterns, presenting a unique challenge for this research. More recent research has suggested the gut microbiome as a target for therapeutic interventions to improve symptoms associated with a variety of disease states, including HIV. Early findings are promising and warrant further research regarding the gut microbiome as a potential modifiable factor to improve health outcomes for PLWH. This review will discuss the current knowledge concerning the neuropathogenesis of HIV in the brain, role of the gut microbiome in neuroinflammation, and the relationship between HIV-status and the gut microbiome, followed by a conclusion that synthesizes this information within the context of the microbiome-gut-brain axis among PLWH. This review will also highlight the limitations of existing studies and propose future directions of this research., Highlights • The microbiome-gut-brain axis has been of recent interest as a potential novel target for precision medicine. • Individuals with HIV experience considerable neurocognitive decline and disruption of the normal gut microbiome composition. • Probiotic supplementation has been found to reduce neuroinflammation and improve neurocognition in individuals with HIV. • Future research controlling for confounders, using diverse samples, and evaluating long-term interventions is needed.

Background: Although evidence suggests HIV-related stigma directly affects health and behaviors, we have a limited understanding of stigma’s influence beyond the individual-level. We aimed to describe HIV-related stigma and strategies to reduce it in the Southeastern U.S. within the context of the social ecological model (SEM). Methods: Qualitative surveys were distributed in-person at community events, conferences, and via email to persons affected by HIV periodically over 8 months. The final sample size included 87 participants (33 persons living with HIV, 54 without HIV). A directed content analysis was used to code responses into five levels of the SEM (individual, interpersonal, community, institutional, and structural). Results: Multiple themes emerged within each level: Individual – knowledge, fear, internalization; Interpersonal – social network; Community – judgements, discrimination, community organizations, norms; Institutional – competent providers, healthcare services; and Structural – systemic barriers, language, education. Conclusions: The findings exemplify the need for a multi-level approach to intervene and reduce HIV-related stigma. Based on the experiences and suggestions of people affected by HIV, future interventions should include substantial consideration from persons affected by HIV.

Molecular HIV surveillance is a promising public health strategy for curbing the HIV epidemic. Clustering technologies used by health departments to date are limited in their ability to infer/forecast cluster growth trajectories. Resolution of the spatiotemporal dynamics of clusters, through phylodynamic and phylogeographic modelling, is one potential strategy to develop a forecasting tool, however, the projected utility of this approach needs assessment. Prior to incorporating novel phylodynamic-based molecular surveillance tools, we sought to identify possible issues related to their feasibility, acceptability, interpretation, and utility. Qualitative data were collected via focus groups among field experts (n = 17, 52.9% female) using semi-structured, open-ended questions. Data were coded using an iterative process, first through the development of provisional themes and subthemes, followed by independent line-by-line coding by two coders. Most participants routinely used molecular methods for HIV surveillance. All agreed that linking molecular sequences to epidemiological data is important for improving HIV surveillance. We found that, in addition to methodological challenges, a variety of implementation barriers are expected in relation to the uptake of phylodynamic methods for HIV surveillance. The participants identified several opportunities to enhance current methods, as well as increase the usability and utility of promising works-in-progress.

We are interested in using phylodynamics to better understand molecular clusters of HIV within the state of Florida, USA. To our knowledge, there is currently no study using such methodology to understand the epidemic in Florida. Viral sequences collected from 2007 to 2017 (about 50,000) will be linked with individual-level data (demographics—sex, race/ethnicity—and mode of transmission) accessed through the Patient Reporting Investigating Surveillance Manager (PRISM), and the Enhanced HIV/AIDS Reporting System (eHARS) via the Florida Department of Health (FDOH). Through the use of HIV-TRACE, which analyzes genetic distance matrices, we will create molecular transmission networks including data on mode of transmission, race/ethnicity, and sex. Furthermore, a maximum likelihood phylogenetic tree will be created using software (e.g. IQ-Tree, PhyML, and FastTree2) run on a high-performance cluster. Phylogenetic comparative analysis will be performed to assess the association between phylogenetic clades and demographics (including extended demographics like syphilis and other comorbidities queried from PRISM and eHARS).

Objective We aim to 1) develop and implement a novel theoretical and technical framework able to dynamically model HIV transmission clusters in near-real time; 2) validate the model with real data; and 3) host focus groups with governmental stakeholders to identify optimal strategies for precision public health interventions. Introduction Reducing HIV incidence requires a ‘precision public health’ approach encompassing prevention campaigns, targeted interventions, and ‘next-generation’ surveillance through multimodal instruments, including sequencing. Molecular epidemiology methods (phylogenetics and phylodynamics) have recently gained traction for use in identifying and tracking epidemic transmission clusters, as well as reconstructing the demographic history of viral pathogen populations. However, such methods are not equipped to identify both transmission clusters and their corresponding dynamics in real time, and transmission clusters are assumed to be unrealistically static over the course of the epidemic. We will focus on the ongoing HIV epidemic in Florida, which has one of the highest HIV incidence rates in the United States. Although key HIV transmission risk groups have been identified in Florida through classical epidemiology surveillance methods, there remains a critical need for detection and tracking of expanding transmission clusters in near-real time. Methods We propose to develop and test a new phylodynamic method, HIV Dynamic Identification of Transmission Epicenters (HIV-DYNAMITE), that will support existing HIV surveillance efforts. In collaboration with the Florida Department of Health (FDOH), we will leverage an existing dataset, which contains over 44,300 sequences, and apply HIV-DYNAMITE to identify transmission clusters and infer growth trends of these clusters within epidemics. HIV-DYNAMITE will also be used to identify and predict infection trends and virus spread by conferring with demographic data. The system will be validated using newly obtained longitudinal data. Focus group discussions with the FDOH, the Centers for Disease Control and Prevention (CDC), and other stakeholders will be conducted to confer how to employ HIV-DYNAMITE into statewide informatics systems and to design future intervention strategies. Results These methods are still under development. Conclusions In conclusion, this study aims to both complement and enhance existing efforts, such as the CDC’s HIV-TRACE, which is currently based on sequence data alone and lacks dynamic or geographic spread components. This approach has the potential to be incorporated into other settings within the US with comparable statewide surveillance and virus sequencing coverage through national reference centers.