Trajectories of socially regulated gene expression, methamphetamine use, and viral load among HIV-positive men who have sex with men (MSM) receiving contingency management

Abstract: he K01 Mentored Research Scientist Development Award will provide Dr. Michael Li with invaluable research experience, mentored training from interdisciplinary faculty, and training activities in a combination of behavioral and basic sciences, which will prepare him well in his career as a biobehavioral researcher in addiction medicine and HIV treatment/prevention. This K01 mechanism will support Dr. Li’s research and training efforts to develop expertise in the following areas: (1) neurally regulated “stress” gene expression markers and links to addiction and HIV disease progression; (2) cultural competence and ethical conduct; (3) technical assay and substantive analytic methods in gene expression research; (4) clinical trial methods; and (5) professional development. Dr. Li has assembled an interdisciplinary mentorship team who will support key aspects of his training and research. Dr. Steven Shoptaw is a highly productive and influential researcher in addiction medicine, and he has an extensive track-record mentoring people who later became successful independent researchers. Co-mentor Dr. Steven Cole has pioneered the field of social genomics, and will direct Dr. Li’s training in transcriptomic methods. Dr. Jesse Clark will guide Dr. Li in clinical trial operations and safety procedures, and Dr. Thomas Belin will provide extensive mentoring in advanced statistical methods and inferential frameworks in clinical trials. Dr. Li proposes to investigate whether a neurally regulated “stress” gene expression pattern can serve as a clinically meaningful, non-abstinence-based endpoint for contingency management for methamphetamine (METH) use disorder (MUD) in MSM living with HIV. Abstinence determined by urine testing has been the only standard clinical outcome for MUD treatment, but provides an incomplete picture of patient recovery. The gene expression pattern called the conserved transcription response to adversity (CTRA) may provide insight into changes in both psychosocial health and pathogenesis over the course of MUD treatment. The CTRA is marked by upregulated expression of pro-inflammatory genes and downregulated expression of Type I interferon genes in response to negative psychosocial experiences such as depression, anxiety, and violence, problems also comorbid with METH use. The CTRA also involves some of same gene regulatory pathways that contribute to METH-related pathogenesis, such as those involving inflammation and innate antiviral responses (relevant to PLWH). My proposed research will use a two-arm clinical trial design (N=55) with 35 HIV-positive MSM with MUD receiving contingency management for METH reduction, and 20 HIV-positive MSM who qualify as a non-substance-using control to accomplish the following aims: 1) to investigate whether CTRA gene expression coincides with METH use and viral load; 2) to investigate whether psychosocial indicators of addiction are associated with CTRA; and 3) to conduct an exploratory pilot investigation to determine the degree to which CTRA mediates the association between METH use and viral load. Together, this K01 research project and training plan will play a fundamental role in my early success as an independent substance use and HIV researcher.

Project Number: 1K01DA051329-01A1

https://reporter.nih.gov/search/P51IV4WiG0m3UfJ8wdV_1w/project-details/10161548

 

Contact PI/ Project Leader

LI, MICHAEL JONATHAN, POSTDOCTORAL SCHOLAR (mjli@mednet.ucla.edu)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: Determining whether a patient is both feeling better and improving physiologically when treating people living with HIV (PLWH) for methamphetamine use disorder (MUD) requires identification of a clinically significant measure separate from abstinence. My proposed K01 activities open the exciting opportunity to address this challenge by testing a gene expression pattern identified by the field of social genomics, which may provide insight into both psychosocial health and biological processes that impact chronic disease risk in PLWH receiving MUD treatment. Support from this K01 will facilitate my training in transcriptomics, clinical trial methods, and ethical/culturally competent practices, all of which will help me achieve my long-term career goal—to be a leading researcher of biomarker assessment tools for PLWH receiving addiction treatment.

 

 

Project Start Date: 01-April-2021

Project End Date: 31-March-2026

Budget Start Date: 01-April-2021

Budget End Date:31-March-2022

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE ON DRUG ABUSE/ FY Total Cost by IC: $189,401

Evaluating the PrEP cascade in HIV-negative pregnant and breastfeeding women in South Africa (PrEP-PP)

Abstract: HIV-negative pregnant and breastfeeding women in South Africa are at extremely high risk of HIV acquisition despite increased access to and initiation of antiretroviral therapy (ART) in South Africa. We urgently need effective interventions to reduce HIV incidence in pregnant and breastfeeding women. Currently PrEP is one of the only female controlled methods that is effective for preventing HIV acquisition. PrEP-PP is a study of pre-exposure prophylaxis (PrEP) among HIV-1 seronegative Pregnant and Postpartum women in two South African urban primary health care facilities. Effective use of PrEP could contribute to eliminating maternal HIV acquisition, and hence eliminating mother to child HIV transmission (MTCT). However, PrEP efficacy requires adherence during periods of sexual activity and adherence requires PrEP access, awareness and counseling. Currently, a major obstacle in the field is the lack of knowledge of women’s initiation, retention and adherence to PrEP during pregnancy and breastfeeding periods in Africa. Now is the time to evaluate how best to provide PrEP to vulnerable pregnant and breastfeeding women as WHO recently developed guidelines for providing PrEP in pregnancy and breastfeeding women but there are limited data on acceptability, initiation and adherence in pregnant and breastfeeding women in Africa where the burden of HIV is greatest. Our study will focus on the following specific aims: 1. Determine the distribution of women across the PrEP cascade (initiation, retention, and adherence) and outcomes (HIV acquisition, transmission, and adverse events) in a cohort of pregnant and breastfeeding women in Cape Town, South Africa 2. Evaluate patient and provider-level factors associated with the PrEP cascade (initiation, retention and adherence) using quantitative and qualitative approaches 3. Apply an established mathematical model to simulate the impact of improvement in the PrEP cascade on HIV infections averted (maternal and perinatal) Our PrEP-PP study is urgent and essential to understand the PrEP cascade in pregnant and breastfeeding women in South Africa and to identify factors associated with PrEP initiation and adherence to develop interventions to ensure that everyone in this at-risk population can benefit from PrEP. The results from the PrEP-PP study will provide a model for the South African Government, and other Governments in the region, to scale up PrEP delivery among pregnant and breastfeeding women at risk of HIV acquisition and perinatal transmission and contribute to the elimination of perinatal HIV transmission.

Project Number: 1R01MH116771-01A1

https://reporter.nih.gov/search/dkK25PIoW0KfsaDd4N5FHw/project-details/9623865

 

Contact PI/ Project Leader

COATES, THOMAS J., PROFESSOR IN RESIDENCE (tcoates@mednet.ucla.edu)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: HIV-negative pregnant and breastfeeding women in South Africa (SA) are populations at very high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP) is one of the only female controlled methods that can prevent HIV acquisition. Our study, PrEP-PP, will evaluate the PrEP cascade ( PrEP initiation, retention, adherence) and patient and provider-level factors associated with the PrEP cascade to inform future PrEP programs.

 

 

Project Start Date: 15-September-2018

Project End Date: 30-June-2023

Budget Start Date: 15-September-2018

Budget End Date: 30-June-2019

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $579,553

Bringing South African Men into HIV Counseling and Testing (HCT) and Care

Abstract: The ultimate objective of this research is to provide evidence-based strategies to improve treatment of HIV+ men. Treatment as prevention (TasP) can only work through a three step process: (1) Testing a significant proportion of the population, (2) linkage to care and (3) maintaining in care a significant proportion of HIV+ individuals to the point of viral suppression. The benefits of increased testing, linkage to and maintenance in care for men would be enormous. We propose a study that combines structural and individual level interventions and integrates the results to address our overall objective of maintenance in care to the point of viral suppression. Aim 1: In a cluster-randomized study, we will investigate whether male-centered mobilization and testing increases the population-level percentage of men who have been tested (within the last 12 months) by more than 10 absolute percentage points. Aim 2: In the individually-randomized design, we will investigate whether POC CD4 testing and individualized case management improves linkage to care (immediately following diagnosis) and viral suppression (12 months later) over POC CD4 testing alone and standard of care. Aim 3: Integrate the results of the two trial components (Aims 1 and 2) to evaluate the joint effect of the interventions on the percentage of HIV+ men who are effectively tested, linked to care and maintained with undetectable VL. The benefits of increased testing, linkage to and maintenance in care for men would be enormous. Men would remain healthier longer, could work and support their families, contribute to rather than deplete household economic resources, raise their children, and they would be less likely to transmit HIV to female partners

 

Project Number: 5R01MH105534-05

https://reporter.nih.gov/search/VniB9auLBEWQm8hAmLPNVg/project-details/9728038

 

 

Contact PI/ Project Leader

COATES, THOMAS J., PROFESSOR IN RESIDENCE (tcoates@mednet.ucla.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, moe likely to have detectable viral load (VL), more likely to transmit HIV with unprotected intercourse and more likely to progress to AIDS and die sooner from HIV. As such, community-based HIV counseling and testing strategies that are responsive and attractive to men are urgently required. This research will evaluate innovative strategies to test for HIV and diagnose black African men and successfully link them to care and maintain them in care, which may reduce their likelihood of transmitting HIV and have a beneficial impact on their individual health, as wel as the well-being of their partners, children, families, and communities.

 

 

Project Start Date: 07-July-2015

Project End Date: 30-April-2022

Budget Start Date: 01-May-2019

Budget End Date: 30-April-2022

 

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $511,341

Understanding and Engaging Families in HIV Biomedical Prevention for Latino Men Who Have Sex with Men

Abstract: This K01 is submitted by Dr. del Pino, Associate Professor, from Charles R. Drew University of Medicine and Science (CDU). This proposal is the next step in his transition from philosophy to public health research. He seeks to reduce HIV disparities among Latino men who have sex with men (MSM) by analyzing family support data from three prospective cohort studies in Los Angeles and Chicago and by conducting formative research to leverage the siblings of Latino MSM in an HIV biomedical prevention intervention. He has published qualitative and quantitative papers on family support, substance use, and HIV. He is currently supported by the CDU Emerging Scholars Award and CRECD. Career Development and Training Plan: Dr. del Pino’s mentoring team includes Dr. Steve Shoptaw (expert in substance use and biomedical interventions), Dr. Nina Harawa (expert in the development of culturally responsive HIV-prevention interventions for MSM of color), and Dr. Arun Karlamangla (expert in complex biostatistical data analysis and longitudinal clinical epidemiology research). The training goals (advanced biostatistics, families and stigma, and intervention development) will be achieved through coursework and individual tutorials with each mentor. He will have access to the UCLA CTSI (NCATS); UCLA CHIPTS (NIMH); and to AXIS, CDU’s center for clinical and translational research resources and trainings (NIMHD). Research Plan: Despite the prevention and treatment efforts of the past 30 years, Latino MSM continue to be disproportionately impacted by HIV. Yet a powerful cultural source of motivation has been underutilized: the family. This project seeks to address HIV disparities by addressing gaps in our knowledge of (a) how family support affects the behaviors and health of Latino MSM over time and (b) how to engage siblings in the development and delivery of PrEP-use messages. Aim 1: Determine how family support and mental health affect the HIV-related behaviors (e.g., substance use, sexual risk) and HIV-related health (e.g., STI, HIV viral load) of Latino MSM over time. Hypothesis: Latino MSM with greater family support over time will report better HIV-related risk behaviors and health outcomes than Latino MSM who report little to no family support. Aim 2: Identify barriers and facilitators to engaging Latino MSM and siblings in HIV biomedical interventions. Aim 3: Develop and pilot test sibling-delivered messages to increase PrEP use in high-risk Latino MSM to gather feasibility and acceptability data and to refine the intervention processes and messages. Summary: The Career Development and Training Plan and the Research Plan will prepare Dr. del Pino to submit an R01 to test the efficacy and effectiveness of a culturally-specific, sibling-based intervention to reduce HIV disparities among Latino MSM. His mentorship team has the required expertise and established record of mentoring junior researchers to ensure that he becomes an independently-funded investigator.

 

Project Number: 1K01MD015002-01

https://reporter.nih.gov/search/XxIAVWiEEUW3kw7szt9ZIg/project-details/9926760

 

 

Contact PI/ Project Leader

HARAWA, NINA THAWATA , PROFESSOR (NHarawa@mednet.ucla.edu)

 

 

Organization

CHARLES R. DREW UNIVERSITY OF MED & SCI

 

 

PUBLIC HEALTH RELEVANCE: Despite the prevention and treatment efforts of the past 30 years, Latino men who have sex with men (MSM) continue to be disproportionately impacted by HIV nationally, and is particularly a problem in Los Angeles, which is a predominantly Latino minority city. Yet a powerful cultural source of motivation for behavior change has been underutilized: the family. The long-term goal of this K01 is for Dr. del Pino to become an independent investigator and national thought leader (1) to expand our understanding of the impact of family relationships on Latino MSM and how to include them in the development and testing of HIV biomedical interventions and (2) to address HIV and other health disparities in diverse sexual and gender minority communities.

 

 

Project Start Date: 29-January-2020

Project End Date: 30-November-2024

Budget Start Date: 29-January-2020

Budget End Date: 30-November-2020

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES / FY Total Cost by IC:$129,465

Evaluation of the Implementation of PrEP Provision for Ugandan Fisherfolk

Abstract: In Ugandan fisherfolk communities, HIV prevalence is an order of magnitude higher than in the Ugandan general population, and high HIV prevalence among fisherfolk helps to drive the general epidemic. In a prior R21 study, we demonstrated that bringing HIV testing to fisherfolk communities, where healthcare facilities are scarce, can identify a large number of high-risk HIV-negative fisherfolk. To have a significant impact on the HIV epidemic among fisherfolk, a key next step in this research program would be to offer pre-exposure prophylaxis (PrEP; a highly effective and safe daily pill containing tenofovir and emtricitabine to prevent HIV) to high-risk HIV-negative fisherfolk following HIV testing. Although the 2016 Ugandan HIV prevention and treatment guidelines recommend PrEP for HIV prevention in fisherfolk, there is currently no governmental support for PrEP implementation in fisherfolk communities. Pilot data are urgently needed to demonstrate to the Ugandan Ministry of Health that PrEP can be feasibly delivered to fisherfolk, in order to secure government support for PrEP for fisherfolk. The Specific Aims are: (1) To conduct formative qualitative research to examine barriers to and facilitators of PrEP uptake, and to obtain input on acceptable PrEP messaging and provision, for fisherfolk communities on Lake Victoria, Uganda; and (2) To conduct a mixed-methods analysis comparing the implementation of community-based vs. healthcare facility-based PrEP provision for fisherfolk communities on Lake Victoria, Uganda. For both PrEP interventions, we will conduct monthly HIV testing and PrEP and antiretroviral treatment provision events, using messages developed from the formative work to raise awareness about PrEP. PrEP will be offered to 100 fisherfolk in two Lake Victoria landing sites during testing events on specified days of the month: In one site, PrEP will be distributed in a nearby healthcare facility during monthly events, and in the other site, PrEP will be distributed in a temporary community space. Among those who are non-adherent (based on refill data), PrEP provision will be supplemented via PrEP delivery by community health workers or at community PrEP pick-up points, based on strategies elicited in the formative work. To evaluate implementation, we will conduct semi-structured interviews with healthcare providers and fisherfolk who do and do not decide to initiate PrEP, and obtain medical records data to compare the proportion of fisherfolk: identified as PrEP-eligible, who initiate PrEP, who adhere to PrEP (i.e., refills over 6 mos.), who seroconvert, and who discontinue PrEP, overall and by socio-demographic characteristics (e.g., gender). We will engage with Ugandan Ministry of Health policymakers throughout the research, to keep them apprised of results and to determine directions for future policy around PrEP for fisherfolk. To realize the 90- 90-90 goals, it is critical to seek out the hardest to reach, most at-risk populations such as fisherfolk, who reside and work in areas without easy access to healthcare.

 

Project Number: 5R34MH119924-02

https://reporter.nih.gov/search/ZZ4mAxmcFEuQAaU8pv87Bw/project-details/10136099

 

 

Contact PI/ Project Leader

BOGART, LAURA M, SENIOR BEHAVIORAL SCIENTIST (LBOGART@RAND.ORG)

 

Organization

RAND CORPORATION

 

 

PUBLIC HEALTH RELEVANCE: Among Ugandan fisherfolk, HIV prevalence is very high and is likely a driver of the general epidemic in the country. To have a significant impact on HIV among fisherfolk, it is essential to offer pre-exposure prophylaxis (PrEP) to high-risk HIV-negative fisherfolk in tandem with treating HIV-positive fisherfolk with antiretroviral therapy. We will evaluate the feasibility, acceptability, and preliminary effects of PrEP delivery interventions in two separate fisherfolk communities.

 

 

Project Start Date: 01-April-2020

Project End Date: 31-March-2023

Budget Start Date:01-April-2021

Budget End Date:31-March-2022

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH/ FY Total Cost by IC:$298,735

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

Enhancing the Role of Commune Health Workers in HIV and Drug Control in Vietnam

Abstract: We propose a 5-year implementation science project in Vietnam, aiming to enhance the role of commune health workers (CHWs) in HIV and drug use prevention and treatment. We plan to 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 will be developed through a series of focus group discussions. In Phase 2, implementation pilot and process evaluation will be conducted to collect feedback from participating CHWs, IDUs and their FMs by in- depth interviews in two commune health centers. In Phase 3, we will 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 will occur 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 will be delivered to CHWs first, and the participating CHWs will be required to conduct individual and group sessions with IDUs and FMs in their communes. The efficacy of the intervention will be 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 will also be explored.

 

Project Number: 4R01DA033609-05

https://reporter.nih.gov/search/zNyDE3OylEm46WcjsXk3TQ/project-details/9060912

 

 

Contact PI/ Project Leader

LI, LI,  (lililili@ucla.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Globally, HIV burden is growing among drug using populations. To effectively deliver PEPFAR and other programs to prevent HIV/AIDS, there is an urgent need to translate and integrate behavioral interventions into routine healthcare practices. This proposed project responds to this urgent need by focusing on the important role of commune health workers in HIV and drug use prevention and treatment in Vietnam. This project can potentially demonstrate a successful model that can be implemented in primary care systems in other countries to address the HIV epidemic and drug use prevention, which remains a global public health priority.

 

FOA: RFA-DA-12-002/ Study Section: ZDA1-NXR-B(06)R

 

Project Start Date: 15-June-2012

Project End Date:31-May-2018

Budget Start Date: 01-June-2016

Budget End Date: 31-May-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE/ FY Total Cost by IC: $489,658

China TEA (Together for Empowerment Activities)- Intervention for HIV Affected Families

Abstract: This 5-year project is a randomized controlled trial of the TEA (Together for Empowerment Activities) intervention. TEA intervention is an innovative, theoretically-based, culturally sensitive family intervention for HIV-affected families in rural China. The intervention will have six sessions (plus a preparation session) delivered at three levels simultaneously: 1) TEA Gathering (small group for parents living with HIV (PLH) and their family members), 2) TEA Time (home-based family activities with children), and 3) TEA Garden (community events). Built on the extensive pilot work by the collaborative team in the past 5 years, we propose to conduct the randomized controlled trial of TEA intervention with 480 HIV-affected families in 24 villages in Anhui, China, including 480 PLH, 480 sero-negative family members, and 720 children aged 6-18. We will randomly assign villages to either: 1) TEA intervention group (with all three levels of activity), or 2) a control group (with limited activities). The efficacy the intervention will be determined over 24 months at five time points: baseline, 6, 12, 18, and 24 month follow-ups. The primary outcomes are children’s physical health, mental health and behavioral adjustment. Secondary outcomes will be the PLH’s and family members’ physical health, mental health, and quality of life, as well as family indicators such as consistent daily routines, positive family interactions, parenting, coping, and community integration.

HIV has impacted extended families by shifting the life patterns not only for the persons living with HIV/AIDS, but also for their children, partners, and other family members. Based on the previous pilot work we are currently conducting this 5-year randomized controlled trial of the TEA (Together for Empowerment Activities) intervention for HIV-affected families in rural areas of China.

  • A randomized controlled intervention trial in 480 HIV-affected families, including 480 PLH, 480 family members and about 720 children aged 6-18.
  • Intervention outcome will be assessed by making comparison between the intervention and control groups at baseline, 6, 12, 18, and 24 month follow-ups.
TEA intervention manual

 

Project Number: 5R01HD068165-05

https://reporter.nih.gov/search/4Ga-UvQgREuvFtXvdJhDyQ/project-details/8851998

 

 

Contact PI/ Project Leader

LI, LI  (lililili@ucla.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: The need to respond to the HIV epidemic is a global public health priority. The proposed study responds to the urgent need for interventions for PLH, family members, and children impacted by HIV/AIDS in China. Resulting data will provide an evidence-based intervention that can be delivered to HIV-affected families in China and other countries.

 

 

Project Start Date: 01-May-2011

Project End Date: 31-October-2016

Budget Start Date:01-March-2015

Budget End Date: 31-October-2016

 

 

NIH Categorical Spending

Funding IC: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT/ FY Total Cost by IC: $511,460

Teens and Adults Learning to Communicate (TALC: LA)

Project TALC was funded by the National Institute of Mental Health (NIMH) to evaluate the efficacy of a family-based intervention over time and to contrast the life adjustments of HIV-affected families and their non-HIV-affected neighbors in the current treatment era. Mothers living with HIV (MLH; n = 339) and their school-age children (n = 259) were randomly assigned to receive a behavioral intervention or standard care as the control condition. MLH and their children were compared to non-HIV-affected families recruited at neighborhood shopping markets.

Targeted Risk Group: 

HIV-positive mothers and their adolescent children

Published Journal Articles:

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Links to Interventions, Training Manuals, etc. : 

 Phase 1 – Taking Care Of Myself

Parents’ Curriculum

Phase 2 – Illness

Parents’ Curriculum

  1. TALC LA- Parents Phase 2, Sess 1: What Are My Children's Needs?
  2. TALC LA- Parents Phase 2, Sess 2: Who Will Take Care of My Children?
  3. TALC LA- Parents Phase 2, Sess 3: What Kind of Arrangements Can I Make?
  4. TALC LA- Parents Phase 2, Sess 4: How Do I Start My Plan?
  5. TALC LA- Parents Phase 2, Sess 5: How Can I Really Listen To My Children?
  6. TALC LA- Parents Phase 2, Sess 6: How Can I Tell My Children What I Feel?
  7. TALC LA- Parents Phase 2, Sess 7: How Should I Deal with Problem Behavior?
  8. TALC LA- Parents Phase 2, Sess 8: How Can We Create a Positive Atmosphere at Home?
  9. TALC LA- Parents Phase 2, Sess 9: How Can We Resolve Conflicts at Home? (Part 1)
  10. TALC LA- Parents Phase 2, Sess 10: How Can We Resolve Conflicts at Home? (Part 2)
  11. TALC LA- Parents Phase 2, Sess 11: How Can We Work Together on Selecting a Custodian?
  12. TALC LA- Parents Phase 2, Sess 12: How Can We Deal with Drugs and Alcohol?
  13. TALC LA- Parents Phase 2, Sess 13: How Do I Prevent Pregnancy and Fatherhood?
  14. TALC LA- Parents Phase 2, Sess 14: Where Am I in Making a Custody Plan?
  15. TALC LA- Parents Phase 2, Sess 15: How Can Mothers Encourage Safer Sex?
  16. TALC LA- Parents Phase 2, Sess 16: What is the Mother's Legacy and the Youth's Goals?

 Adolescents’ Curriculum

Phase 3 – Adjustment

New Caregivers and Teens’ Curriculum

  1. TALC LA- New Caregivers and Teens Phase 3, Sess 1: What Do Adolescents and Caregivers/Parents Need from Each Other?
  2. TALC LA- New Caregivers and Teens Phase 3, Sess 3: Dealing with Loss and Grief - Part I
  3. TALC LA- New Caregivers and Teens Phase 3, Sess 4 (Caregivers): Raising an Adolescent
  4. TALC LA- New Caregivers and Teens Phase 3, Sess 4 (Youths): Planning for My Future - Part I
  5. TALC LA- New Caregivers and Teens Phase 3, Sess 5: Dealing with Loss and Grief - Part II
  6. TALC LA- New Caregivers and Teens Phase 3, Sess 6: How Can We Improve Communication - Part I (Effective Expressing)
  7. TALC LA- New Caregivers and Teens Phase 3, Sess 7: Ways of Helping Someone Cope with Loss and Grief
  8. TALC LA- New Caregivers and Teens Phase 3, Sess 8: How Can We Improve Communication - Part II (Active Listening and Responding)
  9. TALC LA- New Caregivers and Teens Phase 3, Sess 9 (Caregivers): Caregiver Support
  10. TALC LA- New Caregivers and Teens Phase 3, Sess 9 (Youths): How Do I Achieve My Goals?
  11. TALC LA- New Caregivers and Teens Phase 3, Sess 10: (Joint) How Can We Deal With Anger in the Relationship?
  12. TALC LA- New Caregivers and Teens Phase 3, Sess 11: How Can I Cope with Sadness?
  13. TALC LA- New Caregivers and Teens Phase 3, Sess 12 (Caregivers): How Should I Deal with Problem Behavior?
  14. TALC LA- New Caregivers and Teens Phase 3, Sess 12 (Youths): How Do I Deal with Fear?
  15. TALC LA- New Caregivers and Teens Phase 3, Sess 13: How Do We Practice Safer Sex, Prevent Pregnancy, and Reduce Alcohol and Drug Use?
  16. TALC LA- New Caregivers and Teens Phase 3, Sess 14: How Can We Resolve Conflicts at Home?
  17. TALC LA- New Caregivers and Teens Phase 3, Sess 15: How Can We Create a Positive Atmosphere at Home?
  18. TALC LA- New Caregivers and Teens Phase 3, Sess 16: Looking to the Future Together, What Can We Do?

Young Adults’ Curriculum

  1. TALC LA- Young Adults Phase 3, Sess 1: How Are Things Going?
  2. TALC LA- Young Adults Phase 3, Sess 2: Planning for My Future - Part I
  3. TALC LA- Young Adults Phase 3, Sess 3: Dealing with Loss and Grief - Part I
  4. TALC- Young Adults Phase 3, Sess 4: Where and How Can Young People Get Support?
  5. TALC LA- Young Adults Phase 3, Sess 5: Dealing with Loss and Grief - Part II
  6. TALC LA- Young Adults Phase 3, Sess 6: Ways of Coping with Loss and Grief
  7. TALC LA- Young Adults Phase 3, Sess 7: Planning for My Future (Part II) - How Do I Achieve My Goals?
  8. TALC LA- Young Adults Phase 3, Sess 8: Hearing and Getting Heard
  9. TALC LA- Young Adults Phase 3, Sess 9: How Can We Deal with Anger?
  10. TALC LA- Young Adults Phase 3, Sess 10: Relationships and Sex (Part 1)
  11. TALC LA- Young Adults Phase 3, Sess 11: Relationships and Sex (Part 2)
  12. TALC LA- Young Adults Phase 3, Sess 12: How Can I Cope with Sadness?
  13. TALC LA- Young Adults Phase 3, Sess 13: Pregnancy and Parenthood
  14. TALC LA- Young Adults Phase 3, Sess 14: How Do I Deal with Fear?
  15. TALC LA- Young Adults Phase 3, Sess 15: How Can I Reduce Substance Use?
  16. TALC LA- Young Adults Phase 3, Sess 16: Looking to the Future

Intervention Model: 

Mothers and their adolescents attended a 16-session cognitive behavioral intervention over eight weeks. For MLH, intervention goals aimed to: 1) improve parenting while ill (i.e., reduce family conflict, improve communication, clarify family roles); 2) reduce mental health symptoms; 3) reduce sexual and drug transmission acts; and 4) increase medical adherence and assertiveness with medical providers. For adolescents, the intervention goals were to: 1) improve family relationships; 2) reduce mental health symptoms; 3) reduce multiple problem behaviors (e.g., drug use, criminal justice acts, school problems, teenage pregnancy); and 4) school retention.

Research Methods:

In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a control group on mental health and health behaviors, including sexual behavior and substance use. Both intervention and control families were compared to a neighborhood cohort, matched on sociodemographics. Because study participants were followed over two years, longitudinal random effect regression models were used to test the efficacy of the intervention.

Surveys and Scales Used:

  1. Living Situation, Including Neighborhood Problems - Scale
  2. Religion: Attendance and Experience
  3. Financial, Labor, and Educational Experience - Scale
  4. Loss and Grief - Scale
  5. Treatment History - Survey
  6. Social Support - Survey
  7. Romantic Relationships - Survey
  8. Needle Use and Sharing - Survey
  9. Reproductive Health - Survey
  10. Parentification - Survey
  11. Goals Scale
  12. Natural Mentors
  13. Dealing with Mother's Illness - Survey
  14. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
  15. Sexually Transmitted Disease - Survey
  16. Medication Adherence - Survey
  17. Educational (Academic) Experience Assessment
  18. Family Functioning - Scale
  19. Family Composition - Scale
  20. Employment and Labor Experience Assessment - Survey
  21. World Health Organization Quality of Life (WHOQOL) - Survey
  22. Self Harm: Suicide History - Survey
  23. CDC Sexual Behavior Questions (CSBQ)
  24. [Download not found]
  25. Detention and Jail History Assessment - Survey
  26. [Download not found]
  27. Alcohol and Other Drug Abuse (AOD) - Scale
  28. Adolescent Substance Use - Survey
  29. PTSD Index for DSM IV (Adolescent version) - UCLA
  30. Parker Parental Bonding Instrument
  31. Positive and Negative Affect Scale (PANAS)
  32. Network Assessment
  33. Janis Self-Esteem - Scale
  34. Medical Outcomes Study (MOS) Social Support - Survey
  35. Living Situation for Adolescents - Survey
  36. Life Outcome Expectancies Assessment - Survey
  37. Life Goals Assessment - Survey
  38. Life Events Assessment - Survey
  39. House Rules - Scale
  40. HIV Related Incidents - Survey
  41. Healthcare Utilization, Providers, and General Health Assessment: Including STD and Pregnancy - Survey
  42. HIV Testing Assessment - Survey
  43. General Medical History Assessment
  44. Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder
  45. Conflict Resolution - Conflict Tactics Scale (CTS)
  46. Adult Adolescent Parenting Inventory (AAPI) - Survey
  47. Nutrition and Exercise - Survey
  48. Rosenberg Self-Esteem (RSE) - Scale
  49. Dealing with Illness - Scale

Local Significance: 

There was a lack of significant findings for an intervention effect on HIV-transmission behaviors and mental health. HIV-transmission behaviors were low to begin with and participants had little room for improvement. The populations affected by the HIV epidemic in the U.S. have shifted over the past number of years since a similarly mounted intervention in New York City led to improvements. HIV interventions in the U.S. need to shift their focus to persons living with HIV who are experiencing substantial problems.

International Significance:

While the focus of U.S.-based HIV interventions need to shift, interventions for the general HIV population may be effective outside the U.S.

Family-Focused HIV Disclosure Intervention in Thailand

This is a Mentored Research Scientist Development Award (K01). HIV disclosure is a key stressor among HIV-affected families in Thailand, and the impact radiates throughout the family. By addressing HIV disclosure as a family matter, the proposed study aims to develop and pilot a culturally tailored intervention in Northeastern Thailand in Nakhon Ratchasima Province.

In Phase 1, formative research will be conducted using in-depth interviews with 20 People Living with HIV (PLH), 20 family members, and 10 healthcare providers to explore the concerns, barriers and motivators around HIV disclosure.  In Phase 2, we will develop a culturally tailored HIV disclosure intervention by engaging 20 PLH through a series of focus groups.  In Phase 3, we will pilot test the intervention with 40 PLH and compare their physical, psychological and social outcomes with the outcomes of 40 PLH in the standard care group. Follow-up assessments with PLH will be conducted at 6 months.