HIV+ – Page 2 – CHIPTS – Center for HIV Identification, Prevention and Treatment Services

23Jan

Mamekhaya

In South Africa, where a large portion of pregnant women are HIV positive, prevention of mother-to-child transmission of HIV (PMTCT) is an important endeavor. To improve the effectiveness of the standard PMTCT programs, the Mamekhaya program used peer mentoring and a culturally adapted cognitive behavioral intervention (CBI).

Research Methods:

HIV-positive pregnant women at the Gugulethu Midwife Obstetric Unit and at the Vanguard Community Health Center in Cape Town were invited to participate in the study. Participants at both sites received the standard PMTCT care; however, participants at the Gugulethu site received the Mamekhaya intervention.The first part of the intervention consisted of assigning a participant with a mentor mother through Mothers2mothers. The mentor mother was a woman who was HIV-positive, had recently had a child, and had received PMTCT and was doing well. Participants also attended group sessions of a cognitive-behavioral intervention. The sessions included information on living with HIV, preventing HIV transmission, parenting, social support, and mental health.

Local Significance:

Participants in the Mamekhaya intervention had increased HIV knowledge scores, significantly increased social support, and significantly decreased depression scores compared to women in the control group.

20Jan

Vietnam – Development of a Family Intervention to Address Drug Use and HIV in Vietnam

This two-year study will be conducted in Phu Tho Province, Vietnam in collaboration with the Vietnam National Institute of Hygiene & Epidemiology (NIHE). This study will develop and pilot an intervention aimed at increasing family support for IDU’s behavior change and family capacities to effectively cope with the impact of IDUs and HIV.

Targeted Risk Group:

IDUs, family members

Intervention model:

Planned behavior change, Stages of change, and Psych-education

Research Methods:

• Focus group to develop the content, format and delivery plan for the intervention
• Intervention will be delivered to 40 IDUs and 40 their family members
• Assessments will be conducted with 80 IDUs and 80 Family members at baseline, 3-month and 6-month follow-ups.

Local Significance:

The findings from the study will inform the design of the full-scale intervention trial for families coping with IDU and/or HIV in Vietnam. By addressing HIV and IDUs, this intervention could potentially reduce the psychological, physical and emotional demands of living with chronic HIV, coping with drug use, and improve the safety of society. A dissemination of the intervention design to district hospitals in Vietnam can improve the lives of families in dealing HIV and IDUs.

International Significance:

This study demonstrates a model to combine traditional drug use treatment with psychosocial and behavioral intervention. This can be applied to other countries with different cultures.

20Jan

China Stigma Project

China has 1 million Persons Living with HIV (PLH) and will have an anticipated 10 million PLH by the year 2010. With 1/5 of the world’s population (1.4 billion persons) in China, the risk of an epidemic is substantial. Recently, the Chinese government has recognized the substantial risk it faces in HIV and has allocated resources to fight HIV. Yet HIV-related stigma and discrimination continue to impede every step in mounting an effective response for prevention, treatment, and care in China.

The National Institute of Mental Health funds this 3-year project of HIV/AIDS-related stigma among health care providers in China. The specific aims of this project are: To document base rates of HIV related stigma among service providers and health administrators and its impact on health service behaviors and care for PLH; To identify socio-cultural, structural, and personal factors that are associated with HIV-related stigma towards PLH among service providers and health administrators; and To design, pilot test, and evaluate an intervention for service providers to address HIV-related stigma and its impact on health service delivery and adequate care.

A total of 105 participants have taken part in the in-depth qualitative interview in Phase I study. Among them 30 are PLH, 15 are family members of PLH, 33 are health care providers, and 27 are health care administrators. Approximately 1,000-1,400 health care providers are being recruited to participate in Phase II quantitative survey study. Using data collected from Phases I and II, the research team will design and pilot test an intervention aimed at reducing HIV/AIDS-related stigma among health care providers in China.

Geographical location:

Yunnan Province,China

Targeted group:

Service providers working at the provincial, city, county, township and village level medical facilities.

Intervention model:

Psych-education and planned behavioral change

Research methods:

In-depth qualitative interviews with PLH, family member of PLH, service providers, and health administrators.
A survey of 1,001 service providers and health administrators
Intervention pilot with baseline, 3-month and 6-month follow-ups.

Published Journal Articles :

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20Jan

Interventions for Substance-Using Youth Living with HIV

Project Name:

Interventions for Substance Using Youth Living with HIV

Project Type:

Living with HIV

Substance Abuse

Interventions for Substance Using Youth Living with HIV

Project Description:

Increasing numbers of youth are infected with HIV and are confronted with a series of challenges: stopping HIV transmission to others, maintaining health care regimens, improving their quality of life. Over the last 4 years, an intensive 31-session, 3-module intervention was designed, implemented, and evaluated to help youth living with HIV (YLH) meet these challenges. YLH significantly changed behaviors; however, a restructuring of the intervention is required based on new information from our previous study and new scientific breakthroughs: 1) only 30% of YLH continue their substance use and sex risk after learning they are seropositive 2) 30% of YLH never attended any group session, and 3) the recent scientific advances in HIV require addressing beliefs regarding post-exposure prophylaxis, life expectancies, undetectable viral loads, and the role of substance use in adhering to new medical regimens.Therefore, building on the positive results of the previous study, a secondary prevention program, CLEAR (Changing Lifestyles: Effort And Rewards) will be evaluated over 21 months for 200 substance-using YLH (aged 13-23) in Miami and LA. In addition, we will examine I) how YLH’s substance use influences seeking and adhering to combination antiretroviral therapies,and youth’s reinitiation of transmission acts based on their viral loads, beliefs regarding transmissivity of undetectableviral loads, as well as beliefs in post-exposureprophylaxis and life expectancies; 2) how well the components of the Social Action Model predict reductions insubstance use, sexual behaviors, relapse, improvements in health adherence,acquisition of knowledge of the program, and quality of life (3) the cost effectiveness of delivering the prevention program to YLH, as well as monitoring costs for health utilization for medical, nonmedical services, and differential benefits of telephone groups, individual sessions, and small groups (from previous study).

Scope:

The youth will be randomly assigned to a 3-module intervention (totaling 18 sessions)that is delivered in either a)anonymous telephone groups or b) individual sessions. Based on the Social Action Model, the intervention will 1) in Module 1, reduce substance use sexual behaviors that may transmit or enhance transmission of the HIV virus. 2) in Module 2, reduce the negative impacts of substance use on seeking and utilizing healthcare, and increase assertiveness and adherence to health regimens. 3) In Module 3, enhance quality of life and self-actualization in order to maintain behavior changes over time.

National Institute on Drug Abuse, Grant 5R01DA07903-08

20Jan

Grief Interventions for PLAs, Adolescents and Guardians

By the year two thousand, 80,000 children will be orphaned by AIDS in the U.S. and this number will continue to rise. Parental death during one’s childhood has been consistently associated with negative outcomes for children, however, there have been no prospective studies of adolescent bereavement from any type of parental death, including death from AIDS. This continuation study is aimed at delivering and evaluating an intervention to alleviate grief associated with the death of a parent. These results are likely to have implications for millions of AIDS orphans internationally and for the 550,000 US adolescents bereaved annually by parental death.

Scope:

Over the last two and a half years, 310 parents living with AIDS (PLAs) and their 498 adolescent children, age 12-18 were recruited. They were randomly assigned to receive: (1) a standard care condition in which extensive social welfare services are provided; or (2) an enhanced care condition in which three modules of coping skills intervention (Project TALC: Teens and Adults Learning to Communicate) plus social services are provided. Linked to the phases of parental illness, PLAs, their adolescents, and new custodial guardians are schedule to meet individually and jointly in over 32 sessions. Because the life span of women with AIDS extended from 14.3 months to 27 months over the last two years, about two thirds of the sample of PLAs continue to live longer than anticipated, delaying the delivery of the final intervention module. Over the next 18 months, the investigator anticipates that the PLAs will die, and the final, post-death module of the intervention will be delivered. The present continuation study will allow the investigator to complete the delivery and the evaluation of the intervention, and in addition, pursue the following activities: (1) follow youths of PLAs prospectively and longitudinally for four additional years to evaluate their mental health, behavioral, and social outcomes; (2) complete the delivery and evaluation of the enhanced coping skills intervention, particularly of Module 3 to new custodial guardians and youths; and (3) develop new measures of grief to describe the bereavement process over time.

Parents living with AIDS reported a mean of 3.3 (SD=1.3) areas of conflict with their adolescents and 1.5 (SD=1.7) stressful parenting events over the previous three months. The parents were very ill, with many physical symptoms and diseases. Simultaneously, substance use was common (17% used daily), but not injection drug use (3.3%). Half had a sexual partner (63% protected partners by using condoms consistently). Regression analysis revealed that parent-adolescent conflict was significantly associated with high parental drug use: stressful parent events were significantly related to the lifestyle (high drug use and frequent sex acts) of Latino and African-American parents, but not white parents. In contrast to parents with other illnesses, parent-adolescent conflict and stressful parenting events were not influenced by parents’ health status, but were significantly influenced by substance use and sexual lifestyles. Both mothers (87%) and fathers were significantly more likely to disclose their serostatus to adolescents (73%), compared to younger children (23%). Only 44% disclosed to all their children; 11% disclosed to none. Most PLAs (80%) discussed custody plans; however, only 30% initiated legal plans, typically for younger children. Adolescents informed of their PLA’s serostatus engaged in more sexual risk acts, smoked more cigarettes, reported more severe substance use, and greater emotional distress than did uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or followup.

National Institute of Mental Health, grant 2R01MH49958-06

20Jan

China Provider Project

China has one-fifth of the world’s population (1.4 billion people); the risk of an HIV pandemic is substantial. In 2005, AIDS surpassed hepatitis B to become the third deadliest infectious disease in China in 2005. The Chinese government has implemented a national program, “Four Frees and One Care,” which mandates access to free HIV testing and free anti-retroviral (ARV) treatment to AIDS patients in China.

As the demand for HIV treatment and care increases rapidly, service providers in China are at a critical point with growing responsibilities to deliver adequate services and care for patients living with HIV/AIDS (PLH). However, experiences of unwelcoming treatment often discourage PLH from seeking care from providers who exhibit discriminatory attitudes and behaviors. HIV-related stigma has a tremendous impact on PLH’s health outcomes, health seeking behavior, and treatment adherence. Only when patients’ fears of discrimination are reduced will they be more willing to participate in HIV testing and treatment.

The National Institute of Mental Health funds this four-year randomized controlled trial that addresses both individual and structural components to reduce HIV-related stigma among service providers in China. This intervention trial builds on a three-year pilot study that we conducted among 1,344 service providers in China from 2003 to 2006. From the pilot, we recognized the need to address HIV-related stigma by building social norms of acceptance and focusing on the well-being of all patients as well as service providers. This Popular Opinion Leader [POL] and access to universal precautions intervention integrates the behavioral level with the structural level and incorporates all core elements of the POL model with four training sessions and bi-monthly reunion sessions. We plan to train 600 POL providers in 40 county hospitals in Yunnan and Fujian, China.

The intervention trial will proceed in two phases. In Phase 1, we will develop and finalize the intervention, assessment instruments and implementation procedures. In Phase 2, we will randomly assign 40 hospitals to either: 1) an intervention group, or 2) a standard care group. The impact of the proposed intervention will be assessed over 12 months (baseline, 6 & 12 months), with 1,760 service providers and 1,000 patients. The provider outcomes are providers’ attitude and behavior changes toward patients and their universal precaution practice. The patient outcomes are patients’ perceived stigma, medical service utilization, and satisfaction and treatment adherence.

Published Journal Articles :

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20Jan

Healthy Living Project (HLP): Multi-Institutional Collaborative Research Project

The UCLA Healthy Living Project was funded by the National Institute of Mental Health (NIMH) and was designed to promote health-related behavior changes in adults living with HIV. This project aimed to reduce sexual and injection drug use risk behaviors among 1,200 HIV positive men and women in order to decrease the likelihood of secondary HIV transmission. The research study focused on four subgroups: women, heterosexual men, men who have sex with men, and injection drug users. The study was conducted at four sites: Los Angeles, Milwaukee, New York, and San Francisco.

Targeted Risk Group:

Adults living with HIV

Interventions, Training Manuals, etc. :

Surveys/Scales Used:

Intervention model:

Cognitive behavioral intervention comprised of 15 individually delivered counseling sessions covering three areas: “Stress, Coping, and Adjustment,” “Risk Behaviors,” and “Health Behavior.”

Research Methods:

In a random assignment study, individuals assigned to take part in the intervention were compared with individuals assigned to a control group, i.e. delayed intervention, on HIV-transmission behaviors, including unprotected sex and substance use. Because participants were followed over two years, longitudinal random effect regression models were used to test the efficacy of the intervention.

Local Significance:

The intervention was demonstrated to reduce risky sexual behavior and substance use.
At the end of the study, the goal was to train service provider staff to deliver the intervention to their clients. By collaborating with service providers early on in the intervention study, it was possible to learn how to tailor the intervention to the specific needs of the agencies involved and the people they serve.

International Significance:

HLP provided a behavioral intervention that can be adapted for other countries and cultures to reduce HIV-transmission risk behaviors

20Jan

Project Tech Support

Interventions, Training Manuals, etc:

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Out-of-treatment, methamphetamine-using men who have sex with men (MSM) are at extreme risk of HIV acquisition and transmission, predominantly through high-risk sexual behaviors that are facilitated by use of the drug. Project Tech Support study enrolls 50 out-of-treatment, methamphetamine-using MSM into an information technology (IT) communication intervention. Field workers conduct outreach in identified venues in the natural settings where out-of-treatment, methamphetamine-using MSM congregate. Over the course of two weeks, participants engage in a text messaging intervention and receive real-time HIV prevention messages, social support and referrals for healthier, prosocial choices regarding drug- and sexual-risk behaviors.

The study aims to:

(1) conduct formative work to assist in the development of an IT communication intervention for reducing methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM;

(2) assess the feasibility and utility of the behavioral intervention on the target population; and

(3) gather indicators of the mechanism of action for this intervention, a dose-response association will be evaluated between the extent of use of IT communication system and the degree of reduction in methamphetamine use and concomitant sexual risk behaviors.

Evaluations, including biological markers for drug use and HIV serostatus are collected at baseline and two months post-intervention. Cognitive and behavioral outcomes are measured. Findings from this study will inform the field on the feasibility of adapting an IT communication intervention for reducing sexual risk behaviors and HIV acquisition and transmission among out-of-treatment, methamphetamine-using MSM.

20Jan

Voucher-based Incentives in a Prevention Setting (VIPS)

Interventions, Training Manuals, etc. :

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Homelessness is a significant problem plaguing American cities and homeless substance abusers face increased risks. Homeless, gay and bisexual male abusers suffer approximately 80% seroprevalence and often engage in exchange sex and resist treatment for substance abuse. Contingency management interventions, which provide positive incentives for behavior change, may be particularly well suited for this disenfranchised, high-risk cohort. Specifically, voucher-based incentive therapies may be effective since they have established potency for increasing prosocial behaviors that successfully compete with taking drugs and for reducing drug use.

A randomized, controlled trial assigns 131 non-treatment seeking gay, bisexual or MSM substance users to either voucher-based incentive therapy or control groups for 24 weeks, with follow-up evaluations at 7, 9 and 12 months post randomization. The voucher-based group earns vouchers in exchange for completing prosocial and healthy behaviors, and/or submitting drug-negative urine and alcohol-negative breath samples, and/or attendance in a standard HIV prevention program, OAPP-funded The G.U.Y.S. Program. The control group receives feedback regarding behaviors performed and urinalysis and breathe alcohol tests, but does not receive voucher points for these behaviors, but does receive vouchers for attendance in a standard HIV prevention program, The G.U.Y.S. Program. Vouchers are redeemable for goods located in an onsite voucher store or purchased for the participant.

The study will assess the efficacy of the voucher-based intervention for increasing prosocial and healthy behavior and reducing substance abuse among these non-treatment seeking gay, bisexual and MSM substance users receiving standard HIV prevention services. The study will also assess the impact of the voucher-based incentive therapy on other measures of therapeutic change consistent with a harm reduction approach, including reduction of psychiatric symptoms, decreased injection drug use and high-risk sexual behavior, increased participation in The G.U.Y.S. Program, and improvement in different domains of overall functioning (medical/social/vocational). Additionally, the study will examine whether baseline participant characteristics predict voucher-based outcomes.

Applying voucher-based incentive therapy to non-treatment seeking gay, bisexual and MSM substance users as well as integrating the intervention into a county-funded HIV prevention program with a harm reduction philosophy are both highly innovative. The VIPS study has the potential to have a significant impact on the public health of the Los Angeles homeless, gay and bisexual substance-using community. If voucher-based incentive therapy is efficacious for motivating non-treatment seeking gay, bisexual and MSM substance users in a community-based HIV prevention program to increase prosocial and healthy behaviors and decrease drug/alcohol use, established prevention programs may modify their approaches to include contingency management, and use it to address the staggering public health problems non-treatment seeking homeless substance users face on a daily basis.

20Jan

Philani- Cape Town

There are four intersecting epidemics among pregnant women in South Africa: hazardous alcohol use (30%), HIV (27%), TB (60% of HIV+), and malnutrition (24% of infants). Unless the prevention programs for these epidemics are horizontally integrated, there will never be adequate resources to address these challenges and stigma will dramatically reduce program utilization. Furthermore, while clinics are the typical sites for treating each of these health problems, the NIAAA-funded Philani study is examining a home-visiting prevention program delivered by neighborhood Mentor Mothers (MM) as an alternative to clinic-based interventions to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition. The intervention encourages mothers to care for their own health, parent well, maintain their mental health, and, if the mother is living with HIV (HIV+ MAR), reduce HIV transmission and/or reduce alcohol use and abuse. The results begin to inform the optimal delivery strategy for the next generation of preventive interventions in order to be feasible and sustainable for broad dissemination immediately following an efficacy trial.

Targeted Risk Group:
Mothers at risk for hazardous alcohol use, HIV, TB, and malnutrition, as well as their infants

Published Journal Articles:

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Interventions, Training Manuals, etc:

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Surveys/Scales Used:

Intervention model:
Mothers who are thriving in the community are chosen to act as role models, i.e. mentor mothers, for mothers at risk in the same community. This is based on the positive peer deviant model. Mentor mothers conduct home visits during the course of the study.

Research Methods:
Twenty four neighborhoods were randomly assigned to the intervention (12 neighborhoods), i.e. a mentor mother home visiting program, or control condition (12 neighborhoods). There are two levels of nesting in the study. Mothers and their infants are nested within neighborhoods, and repeated observations over time are nested within individuals. Longitudinal random effect regression models will be used to account for the nesting and examine the efficacy of the intervention at improving the health of infants and their mothers over time.

Local Significance:
The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention. Preliminary results are promising and suggest the mentor mother program may be an efficient mechanism to conduct healthcare-related home visits.

International Significance:
If found to be efficacious, the home-visiting model that relies on paraprofessionals, i.e. trained mentor mothers, offers a viable alternative to clinic-based healthcare and or care that requires professional healthcare providers that may not be practical in poorer countries outside the U.S.

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