Since 2008, new HIV diagnoses in the US have been reduced by about half; however, progress is not equally distributed. In 2022, only about 65% of people diagnosed with HIV in the US—and North Carolina—were virally suppressed, falling short of the national target of 95% viral suppression. Southern states, including North Carolina and neighboring South Carolina, continue to bear a disproportionate share of the HIV burden, especially in rural and urban communities of color. A multidisciplinary research team from the UNC Institute for Global Health and Infectious Diseases and UNC Charlotte recently launched Respond Carolinas, an innovative, community‑centered initiative to improve HIV prevention, testing, and care engagement among Black and Latino men and transgender women in Mecklenburg County.
Respond Carolinas is guided by a collaborative leadership team that includes Ann Dennis, MD, MS, principal investigator and an associate professor of infectious diseases, and Meagan Zarwell, PhD, co-investigator and associate professor of epidemiology and community health at UNC Charlotte, who introduced the project at a recent Friday Conference. They are supported by a diverse team of co‑investigators from both institutions, whose expertise spans epidemiology, social network methods, molecular analysis, and community engagement. The project enhances the CDC’s Social Network Strategy (SNS) to reach communities experiencing rapid and recent HIV transmission.
“Despite major progress in HIV prevention and treatment, the epidemic remains fragile—especially in the South,” said Dennis. “Respond Carolinas is about strengthening our response by working directly with the communities most affected and leveraging trusted peer relationships to improve access to testing, prevention tools, and care.”
New Approach to HIV Prevention and Care
Respond Carolinas brings together three core components. First, enhanced SNS uses community members known as Respond Ambassadors, trained and supported by disease intervention specialists to encourage HIV testing and connect peers to prevention and treatment services. Second, integrated molecular epidemiology helps the team identify and respond to transmission “hot spots.” Genetic cluster analyses of HIV cases in North Carolina have revealed much broader connection webs than standard partner services alone (with contact tracing finding approximately 24% positivity among located partners). Third, a Community Advisory Group (CAG), facilitated by Alicia Diggs, has played a pivotal role in guiding recruitment strategies to reflect the priorities and realities of affected populations. As a result, extensive interviews and focus groups with HIV service providers, public health staff, and priority community members, have given researchers new insights on how information and resources travel.
Formative Findings Shape HIV Prevention and Care Interventions
Findings to date show that trust and readiness are more important than monetary rewards, indicating the need for creative and supportive engagement. Findings also show a crucial need for both ambassadors and peer educators to receive strong training and support. While most participants value peer endorsement, they also want reliable, expert information.
“People trust people they know,” said Zarwell. “By equipping community members with knowledge, support, and resources, we’re creating a model that feels authentic, empowering, and responsive to real needs.”
Respond Carolinas is one of the few US projects adapting SNS specifically for transmission networks and embedding it within partner services. As a result, interventions are becoming more culturally aligned, community‑driven, and practical for both ambassadors and staff. Mecklenburg County Public Health and regional teams are also able to guide public health practice in real time. Meanwhile, the CAG has become a central decision‑making partner, guiding the program to invest in transparent communication, including videos, testimonials, and community‑led messaging. And because Respond Carolinas integrates molecular epidemiology with social network approaches, recent transmission networks are being identified more precisely, guiding where resources should be deployed–including testing, PrEP outreach and re‑engagement in care.
“This work is about partnership,” said Dennis. “Public health staff, community organizations, and community members themselves are all essential to building a stronger, more equitable HIV response.”
The CDC’s “Ending the HIV Epidemic” initiative aims to reduce new HIV infections by 90% by 2030. Nationally, the project’s early results are contributing to broader conversations about modernizing social network strategies and ethically integrating molecular data into HIV response efforts. Finally, the findings will lay the groundwork for ongoing evaluation of the intervention and its potential for future scale‑up.
UNC Institute for Global Health and Infectious Diseases
Established in 2007, the UNC Institute for Global Health & Infectious Diseases at the UNC School of Medicine started over 30 years ago with infectious disease physician researchers studying HIV in China and Malawi. Through the years, our work has expanded to include emerging pathogens, cancer, women’s health and vector-borne disease like malaria–shaping policy through evidence-based research around the world. At UNC-Chapel Hill, the Institute facilitates research excellence while nurturing emerging scientists to advance patient care and practice, addressing the most important global health issues of our time–through research, training and service.