Posts classified under: HIV -

Risk and Protective Factors for Adherence to Pre-exposure Prophylaxis (PreP) in Transwomen of Color

Abstract: Transgender women (TW) are currently the SGM population at highest risk for HIV infection in the United States, especially those who are racial/ethnic minorities. TW also report the highest levels of discrimination, victimization, traumatic life events, and other stressful experiences and are of the highest risk groups for substance abuse and mental health problems. HIV researchers have suggested resiliency may be a largely untapped resource in behavioral interventions and that it may be associated with reductions in mental health problems, substance abuse, and HIV related risk among marginalized populations. Daily pre-exposure prophylaxis (PrEP) is extremely effective in preventing HIV infection among those who are HIV-negative. While this is an exciting development for HIV prevention among minority TW, HIV prevention efforts must now shift focus to research on optimizing PrEP adherence among this high-risk population facing multiple recurring stressful life events and numerous structural barriers. In the proposed study, we will leverage an ongoing study of (N =300) racially and ethnically diverse TW enrolled in the Southern California based PrEP demonstration project, in order to conduct mixed-methods research, first using structural equation modeling (SEM) to assessing the risk and resiliency factors most associated with PrEP adherence among TW. Then using the SEM findings to inform follow-on, in-depth qualitative interviews with a sub-sample of high- to low-adherence minority TW to further explore those risk and resiliency factors and experiences most salient to PrEP adherence among high-risk minority TW. This study will provide the preliminary data to support the submission of an intervention development grant (NIDA R34) to develop a resilience-based intervention focused on improving PrEP adherence for TW.

 

 

Project Number: 5R21DA044073-02

https://reporter.nih.gov/search/eHlIDivHPECE2F8MLmltRg/project-details/9457401

 

Contact PI/ Project Leader

STORHOLM, ERIK D, ASSISTANT PROFESSOR (estorholm@sdsu.edu)

 

 

Organization

RAND CORPORATION

 

 

PUBLIC HEALTH RELEVANCE: Project Narrative The proposed 2-year mixed-methods study will have important scientific, clinical, and public health implications. a) Scientific: this study will advance our basic understanding of the risks and protectivefactors for PrEPadherence among transgender women (TW). b) Clinical: this study will provide the preliminary data to identify predictors of PrEPadherence and support development of a resilience-based intervention focused on improving PrEPadherence for TW. c) Public Health: findings from the proposed pilot study have major implications for future HIV intervention efforts to maximize PrEPadherence among those at highest risk for HIV, racial/ethnic minority TW.

 

 

 

 

Project Start Date: 01-May-2017

Project End Date: 30-April-2021

Budget Start Date: 01-May-2017

Budget End Date: 30-April-2021

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $262,330

Developing a PreP Screening Instrument for Identification/Referral of High-Risk MSM in Primary Care

Abstract: A significant public health development, pre-exposure prophylaxis (PrEP) is now being widely promoted as a prevention strategy for individuals in high-risk groups, such as men who have sex with men who report substance-use (past 6-month illegal drug use and/or heavy alcohol use). While this is an exciting development, rapid identification of these high-risk patients and the ability to provide brief consultation and prescription or referral for PrEP services by primary care staff remains a major concern. The proposed mixed methods study aims to develop and pilot-test a PrEP screening instrument for facilitating PrEP uptake among substance-using MSM that will be integrated into clinic workflow based on provider-identified barriers and facilitators to sexual-health screening. The study will take place in a single primary care clinic contained within a larger integrated healthcare delivery system, Kaiser Permanente Southern California (KPSC). Identification of both the provider- and patient-level barriers to PrEP uptake among high-risk substance-using MSM within a large integrated healthcare system will inform future intervention efforts aimed at mitigating HIV health disparities. The proposed 2-year pilot study will involve the collection of preliminary data to inform the development of a larger formal evaluation study. This project is significant in that it seeks to develop and test a screening instrument that will be administered to patients during appointment check-in and made available to their primary care provider for the rapid identification of substance-using MSM at high-risk for HIV acquisition in order to facilitate PrEP prescription/referral. This project is innovative in its focus on the identification of potential provider-, patient-, and system-level barriers to PrEP uptake among these patients.

 

 

Project Number: 1R03DA043402-01

https://reporter.nih.gov/search/o-PR-udfZUu9CeZXDB01GQ/project-details/9269815

 

 

Contact PI/ Project Leader

STORHOLM, ERIK D, ASSISTANT PROFESSOR (estorholm@sdsu.edu)

 

 

Organization

RAND CORPORATION

 

 

 

 

Project Start Date: 01-May-2017

Project End Date: 30-April-2019

Budget Start Date: 01-May-2017

Budget End Date: 30-April-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $171,422

Investigating Resiliency in Preventing Binge Drinking and Stimulant Use Among Black Men at High-Risk for HIV

Abstract: There is a profoundly disproportionate HIV burden that exists among young black men who have sex with men (YBMSM). Substance use has been inextricably linked to HIV transmission since the beginning of the epidemic. Black Americans report the highest levels of discrimination due to race/ethnicity, poverty, and substance use and these discriminatory experiences are likely to increase their risk for HIV infection. Informed by Minority Stress Theory (Meyer, 1995), the proposed 1-year study will support additional data analyses to test the minority stress model for alcohol and other drug use among 1565 YBMSM at high-risk for HIV. Aim 1: Examine the relationship between stressful experiences of racism, homophobia, and internalized homophobia and the use of alcohol and other drugs among YBMSM. Aim 2: Determine if resiliency, gay pride/self-esteem, and social support moderate the relationship between stressful experiences of racism, homophobia, and internalized homophobia and the use of alcohol and other drugs among YBMSM. Aim 3: Assess for the moderating effect of gay pride/self-esteem, resiliency and social support on the relationship between stressful experiences of racism, homophobia, and internalized homophobia and sexual risk behavior. The proposed study will have important scientific, clinical, and public health implications. a) Scientific: This study will advance our basic understanding of resiliency processes that are relevant to preventing/reducing substance use among YBMSM. b) Clinical: Findings from this study will inform our efforts to adapt substance abuse interventions so that they focus on increasing resiliency among YBMSM. c) Public Health: Resiliency factors that may combat the negative affect that arises from multiple discriminatory could inform the implementation of substance abuse prevention campaigns. Findings will also support the provision of resiliency based mental health and substance abuse treatment to address the elevated prevalence of substance use among this most vulnerable sub-group of MSM.

 

Project Number: 1R03DA042660-01A1

https://reporter.nih.gov/search/o-PR-udfZUu9CeZXDB01GQ/project-details/9269815

 

 

Contact PI/ Project Leader

STORHOLM, ERIK D, ASSISTANT PROFESSOR (estorholm@sdsu.edu)

 

 

Organization

RAND CORPORATION

 

 

 

 

Project Start Date: 15-Feburary-2017

Project End Date: 31-Janurary-2019

Budget Start Date: 15-Feburary-2017

Budget End Date: 31-Janurary-2019

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $138,653

Combating Craving with Contingency Management: Neuroplasticity and Methamphetamine Abuse in South Africa

Abstract: Methamphetamine (MA) dependence is a significant health problem in South Africa and the U.S. In South Africa, a shift in policy focus is required away from allocating health resources primarily to HIV/AIDS and TB and toward the financial, social and personal consequences of untreated stimulant addiction. In response to PAR 14-331, this application proposes to build capacity for a new linkage of productive teams of clinical researchers at UCLA and the University of Cape Town to conduct studies on the neurobiological foundation of treatment for stimulant dependence. The research direction is innovative in linking findings from neuroscience with clinical outcomes using contingency management (CM) to identify changes in brain structure and function that emerge during purely behavioral therapy. The knowledge gained may guide development of optimally effective behavioral and/or medication therapies. The application design will correlate MA-abstinence outcomes from an 8-week program of voucher-based incentives using an escalating schedule for 30 treatment-seeking, MA-dependent individuals with scores on tasks of working memory and assessments of neuropsychological and demographic status. At the beginning and end of the CM program, participants will participate in MRI scans while performing a working memory task, and will complete a battery of select neurocognitive and psychological assays to address two specific aims: (1) to determine whether changes in neural function within front striatal circuitry from baseline to end of the 8- week CM program are associated with parallel changes in measures of cognitive control and impulsivity and with MA abstinence outcomes; (2) to determine whether structural changes in front striatal circuitry over the 8-week CM intervention correspond with neurocognitive, psychological and MA abstinence measures. Findings from this study will describe associations between: (1) functional and structural indices of brain areas that support working memory, cognitive control/inhibition; (2) performance on select neurocognitive and psychological assessments; and (3) associations between these with MA abstinence outcomes. Study activities and the neuroscience data generated will provide preliminary data for a larger, adequately powered study that will test ways to optimize behavioral therapies for treating stimulant use disorder.

 

Project Number: 3R21DA040492-02S1 (2017); 5R21DA040492-02 (2016)

https://reporter.nih.gov/search/WrJtBSqGgUKo9EPZYXxZsA/project-details/9480137

 

 

Contact PI/ Project Leader

SHOPTAW, STEVEN J, PROFESSOR (SSHOPTAW@MEDNET.UCLA.EDU)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: Statement Methamphetamine addiction (MA) is a global health problem with high prevalence and great social and health costs in the United States and in the Republic of South Africa and there is a strong need for development and implementation of effective MA treatment approaches. This project will correlate outcomes from an 8-week program of contingency management with findings from pre- and post- treatment neuroimaging and neurocognitive assessments to identify structures and/or processes that may represent targets for development of novel behavioral and/or medication therapies. The public health relevance of this application is enhanced by its effort to develop capacity for a productive and impactful neuroscience research agenda between groups of strong clinical scientists in the U.S. and in the Republic of South Africa.

 

 

 

 

Project Start Date: 01-September-2015

Project End Date: 31-August-2018

Budget Start Date: 01-September-2016

Budget End Date: 31-August-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $9,353

MSM and Substances Cohort at UCLA Linking Infections Noting Effects (Masculine)

Abstract: This application in response to NIDA PAR 12-222 Cohort Studies of HIV/AIDS and Substance Use (U01) seeks to leverage extensive existing infrastructure and cohorts at the University of California, Los Angeles to launch a new cohort of substance using minority (Black or Hispanic) men who have sex with men (MMSM). The epidemic of HIV among MMSM in the US and locally in Los Angeles County (LAC) may be driven by effects of substance use on adherence to treatment regimens and bio-behavioral prevention and enhanced by high prevalence networks. Proposed investigators lead the science on studying associations between non-injection drug use, risk behaviors and infectious disease among MSM, and contribute a broad portfolio of inter-disciplinary work from immunology and basic science to epidemiology, prevention and treatment. The work proposed leverages existing cohorts including the Multicenter AIDS Cohort (MACS) and existing repositories and builds on preliminary work to guide assembly of a cohort for the study of basic and behavioral factors in younger MMSM who actively use substances and engage transmission risks. Establishing a cohort of young active substance users, particularly stimulant users, who have poor histories of antiretroviral treatment (ART) adherence as marked by measurable and clinically relevant Plasma Viral Load (PVL) will enable important tests of biological influences of substances on immune function in MMSM. This cohort is central to prevention and treatment efforts and will provide well-characterized, extensive repository samples for leveraged use with other cohorts, networks’ and individual’s studies. The MMSM will be: (i) HIV-positive with viral load >5000 copies/ml or (ii) HIV-negative at high risk for HIV infection (unprotected anal intercourse in the past 6 months). This unique cohort will facilitate studies on interactions between substance use and HIV progression and/or transmission, which are of critical public health significance. This cohort of MMSM will characterize: (i) effects substance use on behavioral and network level risk in exposed and infected MMSM on acquisition of HIV and other sexually transmitted infections (STIs: gonorrhea, Chlamydia, syphilis, Hepatitis C (HCV)); and (ii) the extent to which substance use in MMSM facilitates behaviors that transmit HIV compared to non-drug using MMSM. The application also proposes to develop and maintain a bio repository that is HIPAA-compliant, technologically-current and DAIDS Network interfaced that includes a scientific advisory committee. This cohort will comprise 620 MMSM with repeated data visits (from 1,080 MMSM). At least half of these MMSM will be active substance users and younger than age 30.

 

 

Project Number: 5U01DA036267-05

https://reporter.nih.gov/search/tyATmmCktE-kfQBMC4JEpA/project-details/9267958

 

 

Contact PI/ Project Leader

SHOPTAW, STEVEN J, PROFESSOR (SSHOPTAW@MEDNET.UCLA.EDU)

GORBACH, PAMINA MAE, PROFESSOR (PGORBACH@UCLA.EDU)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: The public health significance of the work described is very high in that the project seeks to establish a cohort of minority men who have sex with men who are active substance users who are either HIV-positive and have measurable viral load (indicating intermittent antiretroviral medication adherence) or who are HIV-negative and engage high risk sexual transmission behaviors for sexually transmitted infections, including HIV, gonorrhea, Chlamydia, syphilis and Hepatitis C. It is the composition of this cohort that confers outstanding impact. Establishing the cohort and the corresponding UCLA Bio repository for storing samples from these cohort members will provide a matchless platform to investigate basic, biological and behavioral effects of active substance use, especially stimulant use (i.e., cocaine, crack, methamphetamine, amphetamine and Ecstasy) in minority MSM who are sexually active (i.e., younger than existing cohort members) and who are inconsistent with antiretroviral medications. Findings from the proposed set of specific aims and from future research that will be made possible by establishment of the cohort and the UCLA Biorepository will enable important tests of biological influences of substances, especially stimulants, on immune function and HIV infection in very high risk MMSM, both HIV positive and HIV negative. This novel cohort will optimize our chances to clarify fundamental questions that have challenged NIDA/NIAID in curtailing infections in these populations.

 

 

FOA: PAR-12-222/ Study Section: ZDA1-NXR-B(15)S

 

Project Start Date: 30-September-2013

Project End Date: 31-May-2018

Budget Start Date: 01-June-2017

Budget End Date: 31-May-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $1,488,949

Theory-Based Text Messaging to Reduce Methamphetamine Use and HIV Risks Among MSM

Abstract: Methamphetamine use among men who have sex with men (MSM) is deeply integrated into socio-sexual networks including physical risk venues such as circuit parties, sex clubs, and bathhouses and digital spaces such as cell phone applications, websites, and digital chat rooms to “hook up” for sex. Thus, methamphetamine use is highly associated with HIV infection due specifically to concomitant high-risk sexual behaviors that occur while using the drug. Text-messaging is a novel, feasible, and sustainable approach for targeting high-risk, out-of-treatment MSM; particularly, MSM who fail to attend face-to-face or site-based interventions. A real-time text-messaging intervention capitalizes on a communication channel to which this population will attend at the exact time they are most likely to make high-risk sexual decisions. This application is in response to PA-10-012 for technologically enhanced Stage II research. Consistent with the specific research interest of the PA, this application builds on findings from an open-label Stage I study that developed and piloted a HIV prevention intervention to reduce methamphetamine use and high-risk sexual behaviors among out-of-treatment, methamphetamine-using MSM. During the pilot study, text messages – based on established behavioral change theories and specifically tailored to urban, out-of-treatment, methamphetamine-using MSM – were developed and tested. The proposed Stage II trial will assess the impact of an 8-week, gay-specific, theory-based text-messaging intervention designed to decrease methamphetamine use and HIV sexual risk behavior and, for the HIV-infected participants, simultaneously increase HIV antiretroviral treatment/adherence in out-of-treatment, methamphetamine-using MSM (N = 285). Participants will receive text messages that are personally tailored to fit their risk profile; the theory-based text messages serve as the mechanisms of behavior change. Participants will be randomized into one of three conditions: Group 1: culturally relevant theory-based text messages interactively transmitted by peer health educators (TXT-PHE); or, Group 2: the same culturally relevant theory-based text messages transmitted by automation (TXT-Auto); or, Group 3: assessment-only (AO) control with no theoretically based text messages. Participants will receive brief weekly text-message assessments on their methamphetamine use and HIV sexual behaviors in the previous seven days. The specific aims of this research are: 1) To determine differential immediate and sustained effects of transmitting theory-based text messages by PHE (TXT-PHE) versus by automation (TXT- Auto), compared to an assessment-only (AO) control condition among out-of-treatment, methamphetamine- using MSM for reductions of methamphetamine use and HIV sexual risk behaviors; and, 2) To determine the cost-effectiveness of TXT-PHE vs. TXT-Auto compared to AO for reducing methamphetamine use and HIV sexual risk behaviors. The randomized three-group design uses repeated assessments at baseline, at the end of the intervention, and at 3-, 6-, and 9-month post-randomization follow-up.

 

 

Project Number: 4R01DA035092-04

https://reporter.nih.gov/search/Qh9D4Tpmqk6QOQbxOJSWcw/project-details/9012056

 

 

Contact PI/ Project Leader

REBACK, CATHY J , (reback@friendsresearch.org)

 

Organization

FRIENDS RESEARCH INSTITUTE, INC.

 

PUBLIC HEALTH RELEVANCE: Methamphetamine use among MSM is highly associated with HIV infection due specifically to the concomitant high-risk sexual behaviors that occur while using the drug. The “real-time” theoretically based text-messaging HIV prevention intervention will reach out-of-treatment, methamphetamine-using MSM while they are in the contexts of greatest risk and interrupt both drug use and HIV sexual risk behaviors. The proposed research will determine differential immediate and sustained effects and cost effectiveness of the text-messaging intervention to reduce methamphetamine use and concomitant HIV sexual risk behaviors and, for the HIV- infected participants, increase HIV antiretroviral treatment/adherence.

 

 

 

Project Start Date: 01-Feburary-2013

Project End Date: 31-Janurary-2019

Budget Start Date: 01-Feburary-2016

Budget End Date: 31-Janurary-2019

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $464,688

The UCLA HIV/AIDS Substance Abuse, and Trauma Training Program

Abstract: The NIH Working Group on Diversity in the Biomedical Research Workforce recently released a set of recommendations to improve the diversity of the research workforce, including establishing a “system of mentorship “networks” for underrepresented minority students that will provide career guidance throughout their career development.” To that end, this R25 application responds to PAR-10-173 (NIDA Research Education Program for Clinical Researchers and Clinicians) and seeks five years of funding for the UCLA HIV/AIDS, Substance Abuse, and Trauma Training Program (hereafter, “Program”). The Program mission is to provide training and mentorship to early career clinician researchers or post-doctoral scholars who are ethnically and culturally diverse and whose focus is reducing substance abuse and HIV transmission in underserved populations at high risk for traumatic stress and health disparities. The goal is for Scholars to establish career independence, including NIH funding for their research. This program represents an evolution of our multidisciplinary, multiethnic team’s NIMH ARRA-funded HIV/AIDS Translational Training Program, which successfully provided two years of training and mentorship to five postdoctoral scholars, several of whom have received or are seeking NIDA funding. Our pilot program highlighted the need to make substance abuse and traumatic stress more central to the Program’s conceptual orientation because this link has not been the focus of training grants that target underserved populations at risk for HIV and health disparities. Our Program will provide a two-year course of training and mentorship to a total of 20 (five per year for 4 years) early career clinical researchers and post-doctoral scholars who hold funded fellowships or other academic positions but need specific training in HIV/AIDS, substance abuse, traumatic stress and health disparities. Underserved populations, particularly those racial/ethnic minority populations, are disproportionately affected by substance abuse and HIV/AIDS and typically experience a high degree of traumatic stress. To learn about the confluence of these phenomena, Scholars will attend two week-long Institutes per year for two years and will receive continual, personalized career mentoring, training, and research supervision. Each cohort of Scholars will be followed for the duration of the training grant and each cohort will present their research in Year 2, form a network of collaborative mentoring, and come together in Year 5 to share their experiences and progress in achieving Program goals. Scholars will be mentored by a core faculty mentor as well as a “home” mentor, i.e., someone regularly accessible to the Scholar who has the relevant expertise and commitment to mentoring the Scholar for the duration of the Program. Each Scholar will be expected to use pilot funding from the Program to conduct research (e.g., qualitative study, secondary analyses, etc.) that will serve as preliminary studies in their NIDA application during their two year tenure.

Project Number: 5R25DA035692-025

Mobile Technology and Incentives (Motives) for Racial and Ethnic Minorities in Los Angeles

Abstract:  HIV disproportionately affects sexual and gender minorities such as men who have sex with men (MSM) and transgender women (TGW). These individuals do not always receive the most up-to-date information on rapidly evolving guidelines in a time of new prevention technologies such as pre-exposure prophylaxis, leading to confusion in the face of recent HIV prevention developments. A lack of engagement in the traditional health care system also leads to infrequent testing for HIV. Novel ways are urgently needed to supply MSM and TGW with the most recent and accurate HIV prevention information to promote HIV health literacy and highlight the pitfalls of indirect assessments of potential infectivity rather than trimestral testing as recommended by the CDC. Mobile technologies such as text messaging present a dynamic new way to improve access to critical prevention information and care for MSM and TGW, but better ways of adapting them to the unique needs of MSM and TGW are needed, and creative ways of keeping them engaged are critical. Given the growing recognition that even if people have all necessary information and are motivated, they commonly fail to show healthy behavior, this proposal employs novel insights from behavioral economics to provide frequent feedback and incentives to keep participants engaged and support them in their intention to remain HIV negative. This proposal entails a 3-phase mobile technology based and BE supported HIV prevention intervention – called Mobile Technology and Incentives (MOTIVES) – to increase engagement with HIV prevention information and improve testing frequency. Formative Phase 1 includes 30 semi-structured interviews with MSM and TGW to finalize the planned intervention based on the insights from a preliminary study. Phase 2 will enroll 200 HIV- negative MSM and TGW in an 18-month, two-arm randomized controlled trial (RCT). Those in the intervention group will receive weekly text messages with HIV prevention information, and can win reward points for correctly answering weekly quizzes to keep them engaged and improve their retention of the HIV prevention information. Those who continue to test negative for HIV at least once every three months can enter a prize drawing to win prizes, with larger chances for those correctly answering the weekly quizzes. The control group will receive the same HIV prevention information but without the incentives. The primary outcomes include frequency of HIV testing and HIV prevention knowledge. Phase 3 includes 7 exit focus groups (with 5-8 participants per group) to evaluate areas for study improvement and estimate parameters for future scale up. The Specific Aims are to 1) develop MOTIVES and finalize the weekly text message information content and the types of incentives; 2) implement and evaluate the impact of MOTIVES; and 3) evaluate areas of improvement for MOTIVES through focus groups and estimate mission-critical design parameters with point and confidence interval estimates for a subsequent, fully-powered R01 application.

 

 

Project Number: 5R34MH109373-02

https://reporter.nih.gov/search/RSa1tMjoTkCcAib3ShEi7w/project-details/9305148

 

 

Contact PI/ Project Leader

LINNEMAYR, SEBASTIAN, ECONOMIST (slinnema@rand.org)

 

Organization

RAND CORPORATION

 

PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE For public health it is important to improve the access of populations at high risk for HIV to the most up-to-date HIV prevention information and encourage them to test for HIV at appropriate intervals. Our study will make use of HIV testing sites as an entry point to enroll study participants and send them HIV prevention information tailored to address the specific needs of men who have sex with men and transgender women along with reminders to get tested for HIV at least once every three months by mobile phone, complemented by incentives to stay engaged in the study. The insights from this R34 grant will serve as the basis for a subsequent grant application to implement such an intervention at scale.

 

 

 

 

Project Start Date: 01-July-2016

Project End Date: 30-June-2019

Budget Start Date: 01-July-2017

Budget End Date: 30-June-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $257,938

Implementation Science for Intervention Delivery in Healthcare Settings

Abstract:  Implementation science examines the efficiency of intervention implementation and to translate the existing efficacious intervention models to real world services. It could potentially enhance the effectiveness and sustainability of the behavioral intervention projects. I received my PhD in epidemiology from the University of California, Los Angeles (UCLA) in 2009. Through my involvement in several large-scale HIV behavioral intervention projects and my doctoral dissertation study, I realized the importance of implementation science in intervention delivery and determined long-term career goal to become an implementation science researcher to bridge the gap between existing knowledge and service delivery. To fill in the gap between my current skill set and the career goal, I will receive training in areas related to implementation science, including health policy, intervention adaptation, and healthcare management. The health policy training will familiarize me with the process of policy development and its influence on the intervention adaptation and implementation; the intervention adaptation courses will inform me with the general concept and framework to design the study ensuring all aspects of intervention implementation are addressed; and the health management training will provide me with analytical tools to model leadership decision making and to evaluate the implementation flow in healthcare settings. The mentor team members, Drs. Li Li, Mary-Jane Rotheram-Borus, Thomas J. Coates and Zunyou Wu, are all internationally reorganized experts in behavioral intervention implementation and adaptation. My institute, the UCLA Semel Center for Community Health (CCH) and the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), UCLA, provide me with support from a multidisciplinary team of top researchers. Collaborating with the National Center for AIDS/STD Control and Prevention (NCAIDS), China CDC, I will conduct a mentored research using an intervention trial with significant yet heterogeneous outcome to investigate multilevel factors influencing the intervention implementation and outcome, and to find the optimal approach to incorporate the intervention model into the current healthcare settings. The study will be conducted in three phases. Phase 1 will be review of related policies and in-depth interviews with healthcare administrators and hospital directors, with the aim to explore the policy barriers and facilitators in adaptation of the intervention model. Phase 2 will be conjoint analysis with hospital directors to model the decision-making in intervention adaptation and routinization in the healthcare facilities. Phase 3 will be bottleneck analysis to locate structure bottlenecks in compliance with the intervention component. The finding will provide implications for future intervention delivery in healthcare settings. Application of some analytical tools in other fields, including conjoint analysis and bottleneck analysis, will potentially contribute to the development of implementation science methodology. Based on the data achieved from the study, I will prepare for a R01 application in implementation science in Year 4 of the K award period.

Project Number: 5K01MH1021447-05

Enhancing the Role of Commune health Workers in HIV and Drug control in Vietnam

Abstract: This 5-year project aims to enhance the role of commune health workers (CHWs) in HIV and drug use prevention and treatment. We demonstrate the process of development, implementation, and evaluation of an integrated intervention for CHWs, IDUs, and their family members (FMs) in Vietnam. In Phase 1, intervention topics, format, delivery procedures, and supporting materials are developed through a series of focus group discussions. In Phase 2, implementation pilot and process evaluation are conducted to collect feedback from participating CHWs, IDUs, and their FMs by in-depth interviews in two commune health centers. In Phase 3, we conduct an intervention trial (CHW CARE intervention) in 60 commune health centers (5 CHWs, 15 IDUs and 10 FMs from each commune center), totaling 300 CHWs; 900 IDUs and 600 FMs. Randomization occurs at the commune level (30 communes assigned to the intervention group; 30 communes assigned to the control group). At each commune assigned to the intervention, the intervention is delivered to CHWs first, and the participating CHWs are required to conduct individual and group sessions with IDUs and FMs in their communes. The efficacy of the intervention is assessed at baseline, 3, 6, 9, and 12-month follow-ups by comparing outcome measures of CHWs, IDUs and FMs in the intervention group to those in the control group. Relationships between the intervention outcomes of CHWs, IDUs, and FMs are explored.

Project number: 4R01DA03360-05

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