Posts classified under: Adults

Popular Opinion Leader HIV Intervention among Chinese Market Workers

This project is part of the NIMH Collaborative HIV/STD Prevention Trial which adopts a two-arm, randomized community-level design to test the Popular Opinion Leader (POL) HIV prevention intervention model at five international sites (China, India, Peru, Russia, and Zimbabwe). CCH is the lead on the China site.

China, representing 1/4th of the world’s population, has a rapidly emerging HIV epidemic with about 1.2 million individuals already infected, more than the total of all the Asian nations combined. Similar to Africa and India, the country’s 200-250 million labor migrants are a key to the epidemic’s future; however, HIV infection is predominantly occurring in rural settings (75% of population) and migrants transmit the virus heterosexually when moving to the cities annually.

The goals of this project are: 1) to adapt a comprehensive community-level preventive intervention – The Popular Opinion Leader – to populations in China based on data from ethnographic studies and compare the results with the other four international sites which follow the same research procedure; 2) to test the efficacy of this community-level preventive intervention in China as well as the four international sites utilizing both behavioral and biological outcomes; and, 3) to develop a manual that will permit different health care agencies and service providers to conduct rapid ethnographic studies, translate this community-level intervention to different settings and populations, and assess intervention efficacy.

The ability of CCH investigators to successfully implement the project is based on previous successful HIV prevention trials including interventions in China and participation in HIV-related cooperative agreements; support of the project from experienced Chinese collaborators, officials, and organizations; access to sites in China; collaboration with experienced Chinese investigators, several of whom have trained at UCLA; collaboration of the Qualitative Core of the UCLA-NPI with considerable cross-national and cross-site experience; and previous experience in conducting interventions and assessments that are culturally sensitive and appropriate.

Safety Counts

Drug users have a high risk of HIV infection. Because certain neighborhoods have higher levels of substance abuse, HIV risk becomes related to geography as well. Thus, there is need for local street outreach programs such as Safety Counts.

Research Methods:

In a quasi experimental, cross-over design, two Los Angeles neighborhoods were randomly assigned to receive either (1) Voluntary HIV Counseling and Testing (VCT) or (2) Safety Counts. In Phase 1, injection drug users and crack users in these neighborhoods attended the respective intervention. In Phase 2, each neighborhood and therefore its participants received the alternative intervention. Participants were reassessed at 5–9 months. Data collected included demographics, sexual risk behavior, and substance abuse.The Safety Counts intervention differed from the VCT intervention in that Safety Counts offered skill-building and goal-setting workshops, one-on-one counseling sessions to implement goals, street contacts to support other participants, and social events.

Local Significance: 

Drug users in the Safety Counts program reported significantly greater reductions in risky sex, crack and hard drug use, and risky drug injection. The more sessions of Safety Counts attended, the greater were the reductions in risky acts. Different analytic decisions result in very different findings for the same intervention. Safety Counts is an effective intervention for injection drug users and crack users.

China MMT Project: Methadone Maintenance and HIV Prevention

Abstract: The HIV/AIDS epidemic has now spread rapidly in China and is in a phase of exponential growth. Drug users have been the largest contributor to the HIV epidemic in China. In 2003, HIV prevalence among injection drug users (IDU) in Sichuan reached 27.8% in 1999 and 50% in 2003. Successful prevention of the HIV epidemic among drug users will be the key factor to blocking further spread of HIV in China.

Methadone maintenance therapy (MMT) has become a widely used harm reduction strategy to prevent HIV infection by effectively reducing drug use since methadone has been used as a substitution for heroin addiction since 1965. With the demonstrated efficacy of MMT in the treatment of drug addiction and the subsequent reduction in HIV risk behaviors, the MMT program has been scaled up. As of March 2007, 320 MMT clinics have been established in 22 provinces, autonomous regions and municipalities cumulatively treating 52,854 out-patients.

However, Chinese programmers, researchers and policy makers of MMT programs are facing special challenges. First, there is large variation in effectiveness of MMT programs. Second, patient drop-out rate is high across all sites. The proposed study aims to design a feasible MMT Plus intervention program to combine psychological and behavioral components with pharmaceutical MMT to result in effective outcome of increase in MMT retention and decrease in drug use. The specific aims of this study are: 1) To develop, prepare, and implement the MMT PLUS intervention for service providers working with MMT clients in China; 2) To assess feasibility, acceptability, and accessibility of the intervention with process evaluations and participant feedback; 3) To examine primary outcome measures of service providers in the MMT PLUS intervention group, compared to those in the standard care group; 4) To explore secondary outcome measures of clients in the MMT PLUS intervention group, compared to those in the standard care group.

The study will be conducted in Sichuan province of China in two phases. In phase 1, we will conduct two focus groups with 12 service providers and 10 clients in 2 MMT clinics respectively followed by a separate assessment survey to collect necessary information for preparation of phase 2. In phase 2, we will recruit 75 clients and 15 service providers, respectively, in 3 standard care clinics and 3 clinics with MMT PLUS intervention. Intervention will be conducted with the service providers only in 3 MMT plus intervention clinics but not in MMT standard care clinics. The results will be compared between 2 groups of MMT clinics via evaluation on primary outcome of service providers and secondary outcome of IDU by the impact of primary outcome from providers. Assessments will be measured through baseline questionnaires and follow-up questionnaires at 3, 6, 9 months from the providers and clients, as well as urine tests and medical examination of clients.

Targeted Risk Group: 

IDUs undergoing MMT treatment, MMT clinic service providers.

Intervention model: 

Cognitive Behavior, Stage of Change, and Motivational interviewing

Research Methods:

• Focus groups with 10 providers and 10 clients in two MMT clinics
• Implement MMT PLUS intervention in three MMT clinics, with 15 providers and 75 MMT clients
• Trained providers will conduct motivational interviewing sections with their clients
• Outcome assessments will be conducted at baseline, 3-, 6-, 9-month follow-ups.

Local Significance: 

Capacity building for service providers working at the MMT clinics in China; Findings from the pilot will make important contributions to the success and sustainability of MMT, and related policy making in China.

International Significance: 

Even though methadone treatment is widely used for decades, there is a lack of integrating psychosocial and behavioral components with a culturally-relevant focus. Findings from this study will provide practical implementations guidelines for agencies within and outside of China.

 

Project Number:4R01DA033130-05

https://reporter.nih.gov/search/65SM12K0A0SnlAjK1wxWrQ/project-details/9033886

 

 

Contact PI/ Project Leader

LI, LI  (lililili@ucla.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Injecting drug use is a hidden dimension of the global HIV epidemic. China‘s methadone maintenance therapy (MMT) program is expanding rapidly to address a critical link between drug abuse and HIV/AIDS. However, it faces multiple challenges, including a high dropout rate, high concurrent drug use, and a gap between clients’ needs and service providers’ skills. This project uses a combination prevention approach to respond to the urgent need for improved quality of services at clinics, provider-client interactions, and client treatment outcomes. Collected data will form the foundation of an evidence-based intervention that can be delivered to over 700 MMT clinics in China, and will potentially serve as a successful model for harm reduction programs in other countries.

 

 

Project Start Date:01-March-2012

Project End Date:28-February-2018

Budget Start Date: 01-March-2016

Budget End Date:28-February-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE/ FY Total Cost by IC: $553,968

MD for Life: Making Decisions for Life

MD for Life is a study that will help health-care professionals and researchers learn how well an intervention works with people living with HIV. Funded by the University-wide AIDS Research Program, the intervention is designed to reduce sexual risk and substance behavior by increasing motivation and intention for behavior change among individuals living with HIV. The intervention will be delivered in two different modalities. The first intervention delivery strategy will have a health care professional, trained in counseling techniques, talk with patients about their sexual and substance use risk behaviors. The second delivery strategy will have the patient receive the counseling via an interactive and engaging computer program. The counseling is based on a proven technique called motivational interviewing. This counseling technique has been successful in reducing alcohol use in multiple populations. A total of 400 patients are being recruited from four health clinics (100 patients from each clinic) that primarily serve individuals living with HIV.

While other HIV prevention programs have been successful, they have been expensive, needed multiple small group sessions, and required coordination of many schedules and extensive training for staff. This project builds on previous prevention successes and utilizes existing staff, treatment delivery settings, and new technology to deliver a brief innovative intervention that can be repeatedly delivered to a diverse population of individuals living with HIV. If successful, this program would be an inexpensive and fairly effortless program to implement in health clinics nationwide.

Links to Interventions, Training Manuals, etc. : 

Please call us, 310-794-8278, regarding the computerized based intervention.

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. : 

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

Staying healthy: Taking Antiretrovirals Regularly (STAR)

Adherence with prescribed medication regimens is critically important for patients with HIV infection, due to recent advances in HIV therapeutics. Due to the unique nature of the drugs they take (e.g., rapid development of viral resistance when only minimal doses are missed) as well as complexity of the medication regimens, there is an urgent need to develop interventions to assist patients in medication compliance. Poor adherence to antiretroviral drugs not only can result in the development of resistance by HIV to multiple drugs, but to whole classes of drugs; resistant HIV strains pose a public health danger.

In this proposal the best strategies from prior adherence and behavior change research are utilized in an intervention trial that expands previous work in that it is: (1) interdisciplinary; (2) provides sufficient “dosage” or amount of intervention; and (3) includes booster maintenance sessions.

A sample of 144 HIV-infected men and women having difficulty adhering to their antiretroviral regimen will be randomly assigned to one of two conditions: a tailored behavioral group (TBG) intervention facilitated by a behavioral psychologist and a nurse practitioner, which includes social support and patient education; or a standard care condition (SC). Extended intervention and relapse prevention are needed for long-term adherence: this intervention consists of an initial 5 sessions and 4 booster sessions. All participants will be assessed at pre- and post-intervention, and at 3, 9, 15, and 21 month follow-ups.

The aims of the study are:
1. to determine whether a tailored, behavioral intervention that includes social support and patient education components and maintenance booster sessions promotes medication adherence and effective problem-solving related to medication compliance among HIV-positive individuals over long-term follow-up;
2. to determine the level of adherence that is maintained over time in the intervention group;
3. to determine if improvement in medication adherence is associated with less evidence of emotional and behavioral distress, and better quality of life;
4. to explore how medication adherence is associated with sexual transmission risk behaviors; and
5. to explore relationships between medication adherence and potential moderating and mediating variables (including self-efficacy and outcome expectancies related to adherence, behavioral intentions, coping methods, and health care satisfaction).
The results of this study will provide empirical data urgently needed by medical providers, public health agencies, community clinics, and other organizations as they attempt to develop medication adherence interventions for HIV-infected populations.

Choosing Life: Empowerment, Action, Results! (CLEAR) for Comprehensive Risk Counseling and Services (CRCS)

CLEAR-CRCS is an evidence based HIV prevention and health promotion intervention developed for people living with HIV enrolled in Comprehensive Risk Counseling and Services (CRCS). It is a client-centered program delivered one-on-one with clients who are having difficulty initiating or sustaining behaviors that prevent HIV transmission and reinfection. The program teaches clients cognitive-behavioral strategies to cope with triggers and other stressful situations that lead to risky behaviors and unhealthy choices. The goal of CLEAR-CRCS is to help these people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. CLEAR-CRCS is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.

CLEAR-CRCS is structured such that the CRCS provider can individually tailor the program to address the unique needs of each client. The program consists of six foundational sessions that teach the core behavioral strategies of the program. Within these initial sessions, the client also develops a personal life goal and his or her prevention plan which will direct the focus of subsequent sessions. The provider then has a menu of 21 sessions to choose from in which the client can practice and apply the core strategies to realize his or her goals. The sessions in the menu address five domains: sexual behavior, substance use, treatment adherence, mental health, and successful disclosures.

Research on the original CLEAR Intervention: The original CLEAR study was conducted from 1999-2003 with an ethnically and culturally diverse group of substance using young people living with HIV/AIDS. The intervention was conducted as a multi-site trial in Los Angeles, San Francisco, and New York. The study demonstrated a significant increase in protected sexual acts, such as using condoms, with all partners and with HIV-negative partners.

Underlying Theory and Principles: The intervention was developed based on the social action theory. Social action theory stresses the importance of social interactions and environmental factors in a person’s ability to control behaviors that may endanger his or her health. It incorporates the principles that are expressed in traditional social-cognitive models of health-behavior change, including social-cognitive theory, the health belief model, and the transtheoretical model (stages of change). CLEAR-CRCS is predicated on the notion that behavior change depends both on a person’s belief that he or she can change a behavior (self-efficacy) and the beliefs that changing the behavior will result in a desired outcome (response efficacy).

Interventions, Training Manuals, etc. : 
For the most current CDC manuals please CLICK HERE visit the DEBI website.

Original RCT Protocol 1998-2002

  • Module 1
  1.   CLEAR- Mod 1, Sess 1: Identifying My Strengths: Creating A Vision for the Future. (1.5 hrs)
  2.   CLEAR- Mod 1, Sess 2: I'm HIV-Positive: Attitudes as Barriers to Future Goals. (1.5 hrs)
  3.   CLEAR- Mod 1, Sess 3: Making Commitments: Evaluating and Changing Substance Use. (1.5 hrs)
  4.   CLEAR- Mod 1, Sess 4: Seeing the Patterns: Why Do I Use Drugs and Alcohol? (1.5 hrs)
  5.   CLEAR- Mod 1, Sess 5: Beliefs: Thoughts That Influence My Substance Use Patterns. (1.5 hrs)
  6.   CLEAR- Mod 1, Sess 6: Future Goals: The Impact of Using Drugs and Alcohol. (1.5 hrs)
  • Module 2
  1.   CLEAR- Mod 2, Sess 7: Higher Self and Sexual Decisions: Facing the Challenges. (1.5 hrs)
  2.   CLEAR- Mod 2, Sess 8: Higher Self and Sexual Decisions: Changing Risk Behaviors. (1.5 hrs)
  3.   CLEAR- Mod 2, Sess 9: Making Sexual Decisions: Having Safety and Pleasure. (1.5 hrs)
  4.   CLEAR- Mod 2, Sess 10: Making Sexual Decisions: Can I Use Condoms (Correctly)? (1.5 hrs)
  5.   CLEAR- Mod 2, Sess 11: Making Sexual Decisions: Can I Influence My Partner To Use Condoms? (1.5 hrs)
  6.   CLEAR- Mod 2, Sess 12: Making Sexual Decisions: How Do I Refuse Unprotected Sex? (1.5 hrs)
  • Module 3
  1.   CLEAR- Mod 3, Sess 13: Motivation for Change: Wanting to Stay Healthy (1.5 hrs)
  2.   CLEAR- Mod 3, Sess 14: Attending Health Care Appointments (1.5 hrs)
  3.   CLEAR- Mod 3, Sess 15: Participating In Medical Care: Communication and Decision-making Skills (1.5 hrs)
  4.   CLEAR- Mod 3, Sess 16: Medication Schedules: Can I Stay on Track? (1.5 hrs.)
  5.   CLEAR- Mod 3, Sess 17: Medication Schedules: More Tools to Stay on Track (1.5 hrs)
  6.   CLEAR- Mod 3, Sess 18: Maintaining My Progress: Focus on the Future. (1.5 hrs)
  •  Workbooks
  1. CLEAR Individual Workbook I (Prevention for HIV Positive Adult and Youths)
  2. CLEAR Individual Workbook II (Prevention for HIV Positive Adult and Youths)
  3. CLEAR Individual Workbook III (Prevention for HIV Positive Adult and Youths)

Telephone Conference Call Groups

NOTE:  The original randomized controlled trial had a telephone group format that was not feasible for youth at that time.  Only the 1st module was completed, but it is in included here for reference.  The activities can be adapted and used for more current interventions.

 

Surveys and Scales Used:

 

Family-to-Family: Psychoeducation to Improve Children’s Outcomes in HIV+ Families

Abstract:HIV has a negative intergenerational impact on families, particularly children with HIV+ parents (Rotheram-Borus et al., 1997). In order to improve the social, behavioral and mental health outcomes for children affected by HIV, we have designed the Family-to-Family (F2F) intervention that includes the critical, universal, program components identified by the NIMH Intervention Workgroup (in revision). All efficacious intervention programs: frame the problem by providing information and shaping beliefs; enhance skills; establish supportive relationships; and remove environmental barriers to behavior change (e.g, HIV testing, ARV). We aim to evaluate a generic intervention approach that is culturally-tailored to families affected by HIV in a specific country, Thailand. The intervention builds on previous efficacious HIV family interventions, adapted to be sustainable in a developing country context. The F2F intervention for HIV+ parents and their family caregivers will assist families to cope with HIV-related stressors (disclosure, stigma, transmission, & custody), build skills for improving their own and their children’s adjustment, and establish supportive community relationships with other families affected by HIV. Families in Thailand need such an intervention: 1 in 4 elderly adults in Thailand will raise an AIDS orphan, even with a relatively low national seroprevalence rate (1.2%). The study will proceed in 2 phases. In Phase 1, we will pilot and finalize the intervention, assessments, and procedures with 40 families, 10 of whom are “positive models.” In Phase 2, families with HIV+ parents (400 HIV+ parents, 600 family caregivers) from 4 district hospitals in Chang Rai & Nakhon Ratchasima Provinces will be recruited to an intervention to benefit their 960 school-aged children aged 6-17 years. At their clinical care site, we will randomly assign families to either: 1) F2F, a psychoeducational intervention for HIV+ parents and family caregivers delivered in drop-in groups by healthcare providers (not including their children); or 2) a Standard Care intervention. The impact of the F2F intervention will be monitored over 24 months (baseline, 3, 6, 12, 18, & 24 months). The primary outcomes are school-age children’s social, behavioral and mental health status. HIV+ parent’s and family caregivers’ health mental health, parenting skills, and family bonds are intermediate outcomes.

Project Number: 5R01NR009922-03

https://reporter.nih.gov/search/Ur1W-rNiD0eaQlqtw2pwjQ/project-details/7255412

 

Contact PI/ Project Leader

LI, LI,  (lililili@ucla.edu)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: Unavailable

 

FOA: RFA-MH-05-008/ Study Section: ZMH1-ERB-N(03)

 

Project Start Date: 23-September-2005

Project End Date: 30-June-2010

Budget Start Date: 01-July-2007

Budget End Date: 30-June-2008

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE OF NURSING RESEARCH / FY Total Cost by IC:  $579,263

 

 

This project aims to support adults in HIV-affected families in order to improve their children’s well-being. UCLA’s Center for Community Health (CCH) , in collaboration with the Thai Ministry of Public Health, Bureau of Epidemiology, will develop the Family-to-Family (F2F) intervention in order to improve the social, behavioral and mental health outcomes for children affected by HIV.

In Phase 1, we pilot tested the current intervention contents and activities by collecting qualitative data (focus groups and in-depth qualitative interviews) from HIV+ families in the four district hospitals in Chiang Rai and Nakohn Ratchasima provinces selected for the proposed study. We tested the assessment measures with the same 40 families. The findings from Phase was used to develop intervention content, as well as the format and style of the intervention for Phase 2. In addition, the findings from Phase 1 was used to finalize the assessment measures we will use in Phase 2. Phase 1 was completed in September, 2006.

In Phase 2, 400 families with HIV+ parents from 4 district hospitals in Chiang Rai & Nakhon Ratchasima Provinces will be recruited to an intervention to benefit their school-aged children aged 6-17 years. At their clinical care site, we will randomly assign families to either: 1) F2F, a psychoeducational intervention for HIV+ parents and family caregivers delivered in drop-in groups by healthcare providers; or 2) a Standard Care condition. The impact of the F2F intervention will be monitored over 24 months.

 

Published Journal Articles :

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Interventions, Training Manuals, etc. : 

Family-to-Family: Psychoeducation to Improve Children’s Outcome in HIV+ Families in Thailand

 

Surveys and Scales Used: 

Geographical location:

Chiang Rai and Nakhon Ratchasima provinces, Thailand

 

Targeted risk group: 

HIV-affected families, including PLH, family members, and children

 

Intervention model:

Cognitive behavioral therapy consisting of 4 Modules and 12 sessions.

 

Local significance:

The intervention improved the social, behavioral and mental health outcomes for HIV-affected families over 24 months.   The intervention was successfully incorporated into the existing healthcare infrastructure.

The local teams are currently disseminating the intervention and training other healthcare workers in other district hospitals to provide the intervention.

 

International significance:

It provides a multi-level intervention model for families affected by HIV.

It provides a feasible intervention that can be implemented and incorporated into the existing healthcare infrastructure in other developing countries impacted by HIV.

 

 
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