On Thursday, November 13, 2014 – Dr. Bernard Branson presented to the Los Angeles County Commission on HIV as part of the CHIPTS HIV Research and Community Colloquia Series. Dr. Branson has been a persuasive behind-the-scenes architect of public HIV prevention and testing policies in the U.S., Caribbean, and Central America for more than 30 years. He is perhaps best known as the lead author of CDC’s 2006 Recommendations for HIV screening in health care settings and, most recently, the June 2014 HIV testing recommendations that updated the U.S. laboratory testing algorithm for the first time in 25 years. He has extensive experience as a clinician, advocate, community organizer, infectious disease specialist, and clinical virologist. Since leaving his most recent position as Associate Director for Laboratory Diagnostics in CDC’s Division of HIV/AIDS Prevention in October, Bernie has devoted efforts to advancing the adoption of biomedical interventions (such as treatment for HIV viral suppression and pre-exposure prophylaxis) that hold promise for bringing an end to the scourge of HIV. His ambitious visions for prevention and treatment: 0 new transmissions of HIV, and 0 new cases of progression to AIDS among persons living with HIV.]]>
Game of Phones: A Song of Daily-reports with Missing Observations and the Models that Analyze Them
W. Scott Comulada, Dr.P.H.
UCLA Department of Psychiatry & Biobehavioral Sciences
Cell-phone based ecological momentary assessment (CEMA) is an exciting new data collection method. Illicit drug use, sexual behavior, and other HIV-transmission behaviors are reported on a daily basis and in the moment through an electronic device that is already embedded in individuals’ daily routines. The benefits of EMA are realized without the burden of an additional data collection tool. With the capacity to track behaviors at great frequency comes an unwelcome companion of traditional longitudinal studies: missing data. In particular, missing data that is dependent on data not collected by the researcher is problematic, referred to as data not missing at random (NMAR). For example, individuals may not fill out scheduled CEMA on days they are using drugs. Standard statistical models do not adjust for NMAR data and lead to incorrect conclusions. In treatment settings, NMAR patterns overlap with engagement issues and are of interest in their own right. Yet NMAR models have been underutilized due in part to the inability to implement them in standard statistical software packages. Implementation issues have been addressed with the advent of JAGS and other readily available Bayesian software that accommodates NMAR models. A greater awareness of NMAR modeling options in the research community is needed. Towards this goal, I will give an introduction to missing data issues and NMAR models for CEMA data. JAGS code will be provided. Models will be illustrated on CEMA data from pilot studies on youth in outpatient drug treatment and HIV-positive adults. This is joint work with Robert Weiss.
W. Scott Comulada is an assistant professor-in-residence in the UCLA Department of Psychiatry and Biobehavioral Sciences and a member of the CHIPTS methods core. He is part of a cross-disciplinary team of behavioral interventionists, computer scientists, and statisticians that collaborate on mobile phone-based research projects in the behavioral sciences. Dr. Comulada is also a statistician with extensive experience in the analysis of longitudinal and social network data.]]>
War is perhaps one of the most challenging situations that a human being can experience. The physical, emotional, cognitive and psychological demands of a combat environment place enormous stress on even the best-prepared military personnel. Numerous reports indicate that the incidence of post traumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. This situation has served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD and other psycho social conditions. In this regard, Virtual Reality delivered exposure therapy for PTSD is currently being used with initial reports of positive outcomes. This presentation will detail how virtual reality applications are being designed and implemented across various points in the military deployment cycle to prevent, identify and treat combat-related PTSD in OIF/OEF Service Members and Veterans. We will also present recent work being done with artificially intelligent virtual humans that serve in the role as “Virtual Patients” for clinical training of healthcare providers in both military and civilian settings and as online healthcare guides for breaking down barriers to care. The projects in these areas that will presented have been developed at the University of Southern California Institute for Creative Technologies, a U.S. Army University Affiliated Research Center, and will provide a diverse overview of how virtual reality is being used to deliver exposure therapy, assess PTSD and cognitive function, provide stress resilience training prior to deployment and its use in breaking down barriers to care. The talk will conclude with a discussion of how the urgency of war has provided the context and funding for the advancement of these technologies that will soon translate to civilian needs.
Speaker Bio: Albert “Skip” Rizzo is a Clinical and Neuro- Psychologist, and Associate Director of the University of Southern California Institute for Creative Technologies. Skip conducts research on the design, development and evaluation of VR systems targeting the areas of clinical assessment, treatment and rehabilitation. In the psychological domain, he has directed the development/implementation of the Virtual Iraq/Afghanistan VR exposure therapy system for combat-related PTSD and is involved in translating these simulation assets for PTSD assessment and prevention (stress resilience). His cognitive work has addressed the use of VR applications to test and train cognitive functioning. In the motor domain, he develops VR game-based applications to promote rehabilitation in persons with CNS dysfunction (e.g., stroke and TBI). He is also involved in the creation of artificially intelligent virtual human patients for clinical training and for creating online virtual human healthcare guides for breaking down barriers to care in psychological health and TBI.]]>
Dr. Bangsberg is the Director of the Massachusetts General Hospital Center for Global Health and a Professor at the Harvard School of Medicine, Harvard School of Public Health, and Mbarara University of Science and Technology. He completed medical school at Johns Hopkins Hospital in Balti-more, his internal medicine and chief residency at Columbia Presbyterian Hospital in New York, and Fellowships in Infectious Disease and AIDS Prevention at the University of California, San Francisco. He also holds Master’s Degrees in Public Health from the University of California, Berkeley and the History and Philosophy of Science from Kings College, London. Dr. Bangsberg’s research focuses on social behavioral factors related to HIV treatment access, treatment adherence and treatment outcomes in impoverished populations. Dr. Bangsberg has published over 250 manuscripts and raised over 50 million dollars in funding related to the study of social, behavioral, and structural determinants of HIV treatment in vulnerable populations.
For a copy of his presentation slides, click here to download (15)
The purpose of this one-day conference was to share the latest research on the impact of housing status on HIV outcomes, to discuss real-world models for integrating housing into HIV prevention and care, to foster collaborations among various stakeholders, and to develop action strategies to inform local policy, community planning, and research directions. The event included speakers such as Mayor John D’Amico of West Hollywood, City of Los Angeles Councilmember Paul Koretz, Mr. Douglas Brooks (Director of the Office of National AIDS Policy), Mr. Greg Millett (Vice President and Director of Public Policy at AmFAR), Ms. Jennifer Ho (Senior Advisor of Housing and Health to HUD Secretary), Dr. Raphael Bostic (Professor and Judith and John Bedrosian Chair in Governance and the Public Enterprise at USC Sol Price School of Public Policy), Dr. Elise Riley (Associate Professor at UCSF), Dr. Joshua Bamberger (Medical Consultant with SF Department of Public Health), Dr. Christopher Gordon of NIMH, and many others. For a complete copy of the event program, please click here. (31)
Below are videos and slides from the event.
Welcome and Opening Remarks
Douglas Brooks presentation slides (16)
Greg Millett presentation slides (13)
John Rojas presentation slides - presented by Ginny Shubert (17)
Elise Riley presentation slides (14)
Joshua Bamberger presentation slides (12)
Daniel Flaming presentation slides (14)
Marc Trotz presentation slides (18)
Shannon Legere presentation slides (12)
Shawn Kravich & Rebecca Watson presentation slides (13)
A Mississippi baby who was infected at birth appeared to remain clear of the virus for nearly two years, even though she was not taking prescribed antiretroviral drugs.
Although medical staff called it a “punch to the gut” when they learned earlier this year that the virus had returned to detectable levels, the young patient’s experience seemed to suggest a possible weakness in the virus.
Specifically, the use of a powerful three-drug cocktail very soon after birth appeared to substantially reduce HIV’s infamous hidden reservoir, and slowed its ability to gain a foothold.
On Monday, the National Institutes of Health announced the start of a global clinical trial in which newborns infected with the virus that causes AIDS will be given medication within two days of birth. (The Mississippi baby received anti-HIV therapy 30 hours after birth. The child’s mother stopped treatment after 18 months.)
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Click here to download presentation slides (19)
Implementation Science: Framework, Challenges, and Multidisciplinary Approaches
Chunqing Lin, Ph.D.
Assistant Research Epidemiologist
Center for Community Health
But a new study conducted by UCLA’s Mary Jane Rotheram-Borus, the director of the UCLA Global Center for Children and Families at the Semel Institute for Neuroscience and Human Behavior, and her colleagues from Stellenbosch University in South Africa found that community-based interventions could improve the health of children in those contexts. A paper about the randomized controlled trial appears in the current edition of the journal PLoS One.
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A landmark trial in England is to be dramatically sped up after it was found that taking a single dose of the pre-exposure prophylaxis (PrEP) Truvada provided unprecedented levels of protection for those most at risk of infection.
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Analyzing Sexual Behavior from the Healthy Living Project
Robert Weiss, Ph.D.
Department of Biostatistics
UCLA Fielding School of Public Health
Longitudinal behavioral intervention trials to reduce HIV transmission risk collect complex multilevel and multivariate data longitudinally for each subject with important correlation structures across time, level, and variables. Accurately assessing the effects of these trials are critical for determining which interventions are effective. Both numbers of partners and numbers of sex acts with each partner are reported at each time point. Sex acts with each partner are further differentiated into protected and unprotected acts with correspondingly differing risks of HIV/STD transmission. These trials generally also have eligibility criteria limiting enrollment to participants with some minimal level of risky sexual behavior tied directly to the outcome of interest. The combination of these factors makes it difficult to quantify sexual behaviors and the effects of intervention. We propose a multivariate multilevel count model that simultaneously models the number of partners, acts within partners, and accounts for recruitment eligibility. Our methods are useful in the evaluation of intervention trials and provide a more accurate and complete model for sexual behavior. This is joint work with Yuda Zhu.
Robert Weiss is professor in the department of Biostatistics in the UCLA Fielding School of Public Health and a member of the CHIPTS methods core. He is expert in analysis of longitudinal data. He develops statistical methodology for longitudinally collected univariate and multivariate psychometric data, and human behavior generally such as retention in care, self-reported substance use and sexual behaviors. He is author of the advanced introductory textbook Modeling Longitudinal Data (Springer, 2005).