A Randomized Controlled Trial of an Antiretroviral Treatment Adherence Intervention for HIV+ African Americans

Abstract: Compared to Whites, Black people living with HIV are less likely to adhere to antiretroviral treatment (ART) and be virally suppressed. Our research has identified culturally relevant factors contributing to disparities among HIV-positive Black Americans, including stigma and medical mistrust (e.g., “conspiracy beliefs,” that ART is poison), in addition to structural and psychosocial factors related to poverty, healthcare access, and mental health. However, ART adherence interventions have rarely been culturally congruent, which may explain why relatively few interventions have shown robust effects on adherence or viral suppression. We propose to conduct a randomized controlled trial (RCT) of Rise, a culturally congruent adherence counseling intervention for HIV-positive Black men and women. Rise counselors possess specialized HIV treatment knowledge and are trained in motivational interviewing (MI) skills to overcome culturally relevant barriers to adherence and retention in care; they also assist with linkage to social services. Rise is ideally implemented in community organizations, enabling clients to seek services in non-medical settings, which helps to overcome mistrust of healthcare, and increase readiness for adherence. In a pilot RCT, Rise led to increased adherence (measured by electronic monitoring) relative to a wait-list control group over time, showing a large effect size (Cohen’s d=.87). However, the pilot did not evaluate effects on viral suppression or include long-term follow-up. Thus, we propose to conduct an RCT of Rise that follows best practices for evidence-based HIV treatment adherence intervention design and testing. The Specific Aims are: (1) To conduct a randomized controlled trial to examine the effects of a culturally congruent adherence intervention on antiretroviral treatment adherence, retention in care, and viral suppression among Black men and women living with HIV; (2) To examine culturally relevant mediators (e.g., medical mistrust, stigma) that may help to explain the effects of the intervention on antiretroviral treatment adherence, retention in care, and viral suppression among Black men and women living with HIV; and (3) To conduct a cost effectiveness analysis of the intervention. A total of 350 Black men and women will be randomly assigned to the intervention or usual care control group (175 per group). Adherence will be electronically monitored daily (and downloaded bi-monthly) from baseline to 12- months post-baseline. Viral load will be assessed through venipuncture at baseline and 6- and 12-months post-baseline. If Rise is found to be effective, the next step would be to conduct research to determine effective and feasible methods for intervention implementation and dissemination to community settings.

 

Project Number:5R01NR017334-05

https://reporter.nih.gov/search/fBC_i3mW8Um9oV5TwXdA_A/project-details/10111573

 

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

 

PUBLIC HEALTH RELEVANCE: Black people living with HIV show lower levels of antiretroviral treatment adherence than do Whites. However, few culturally congruent interventions have been developed and tested. We propose to conduct a randomized controlled trial (RCT) of Rise, an innovative, culturally congruent adherence intervention for HIV-positive Black men and women that targets cultural and structural issues contributing to health disparities. Rise facilitates improved adherence and retention in care through client-centered counseling and assistance with linkage to social services.

 

 

Project Start Date: 01-May-2017

Project End Date:28-February-2023

Budget Start Date: 01-March-2021

Budget End Date: 28-February-2023

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF NURSING RESEARCH/ FY Total Cost by IC:$678,640

Still Climbin’: A Randomized Controlled Trial of an Intervention to Improve Coping with Discrimination, Address Medical Mistrust, and Reduce Health Disparities among Black Sexual Minority Men

Abstract: Black men, especially Black sexual minority men (SMM), are negatively affected by health and healthcare disparities: They show worse outcomes for preventable conditions and preventable complications from chronic conditions, and are less likely to engage with healthcare than are White men and women. Moreover, Black SMM display strikingly high rates of HIV and other sexually transmitted infections. Based on evidence-based theory that discrimination contributes meaningfully to disparities, we propose to conduct a randomized controlled trial (RCT) of an 8-session culturally congruent cognitive behavior therapy group intervention, Still Climbin’, which aims to increase effective coping responses to discrimination (from intersectional race and sexual minority identities) and reduce medical mistrust among Black SMM, with the goal of improving healthcare engagement and receipt of evidence-based preventive care. Still Climbin’ has a strong scientific basis in our prior pilot work, which found that the proposed intervention is acceptable to key stakeholders, feasible to conduct, and associated with improved effective coping. The specific aims are: (1) To conduct a randomized controlled trial to test the effects of Still Climbin’, a culturally congruent cognitive behavior therapy group intervention, on healthcare engagement (e.g., at least one ambulatory visit in the past 6 months) and receipt of evidence-based preventive care (e.g., chronic disease screenings) among Black sexually minority men; (2) To examine mechanisms of the intervention’s effects on improved healthcare engagement and receipt of evidence-based preventive care, including more effective coping skills and reduced medical mistrust; and (3) To examine potential moderators of the intervention’s effects (e.g., age, HIV-serostatus and other health conditions). In the context of established community-academic partnerships, we will conduct the RCT with 300 Black SMM, randomizing 150 to the intervention group and 150 to a wait-list control group. Participants will complete surveys at baseline and 3-, 6-, and 12-months post-baseline to assess the primary outcomes, and potential mediators, covariates, and moderators. Healthcare engagement, receipt of evidence-based care, and health conditions will be verified with medical records. With the exception of our own work, we are not aware of any interventions that address coping with discrimination from intersectional identities in order to improve health outcomes among Black SMM. Our research is consistent with Healthy People 2020, which recommends developing interventions to address effects of discrimination among sexual minority individuals. Although structural-level interventions are critical for reducing societal discrimination as a long-term strategy, individual- level interventions—such as Still Climbin’—are needed in tandem to reduce discrimination’s immediate health effects.

 

Project Number:5R01MD014722-03

https://reporter.nih.gov/search/o5468n5DokOS3FYxFf7EXw/project-details/10307134

 

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

 

PUBLIC HEALTH RELEVANCE: Large racial/ethnic and sexual minority health and healthcare disparities exist for preventable conditions in the U.S., and discrimination is thought to be a major contributor. We propose a randomized controlled trial of an 8- session culturally congruent cognitive behavior therapy group intervention that aims to increase healthcare engagement and receipt of evidence-based preventive care by increasing effective coping responses to discrimination (from race and sexual minority identity) and reducing medical mistrust among Black sexual minority men.

 

 

Project Start Date: 10-February-2020

Project End Date: 30-November-2024

Budget Start Date: 01-December-2021

Budget End Date: 30-November-2022

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES/ FY Total Cost by IC: $566,690

The BARS Study: Building Agent Based Models of Racialized Justice System Study in Black MSM

Abstract:  Large disparities in HIV rates in black men who have sex with men (BMSM) are not explained by higher engagement in risky behaviors and are particularly high among younger MSM. Despite the efficacy of several prevention interventions, reducing these disparities requires approaches that maximally engage these men’s social and sexual networks. Because of frequently transient life circumstances, disruption of social and sexual networks and HIV transmission overlap with other groups, criminal justice involved (CJI) BMSM who use substances represent an important target for intervention. Although effective behavioral and structural interventions exist that target CJI populations, their successful implementation for CJI BMSM networks and communities has not been demonstrated. Furthermore, research to determine intervention impact at these larger social units is costly and does not readily lend itself to the randomized control trial approach. This proposal aims to utilize a systems dynamic approach using an agent-based model (ABM) to estimate the effectiveness of HIV prevention and substance-abuse interventions for CJI substance-using BMSM. Our project brings together investigators with a proven track record in the study of BMSM, criminal justice settings, substance-abuse intervention, social network analysis, ABMs and HIV clinical care provision. We will adapt a previously developed core open access ABM platform (using Repast Simphony) that includes baseline national data on people and households by geography, as well as the dynamic features of the target population such as incarceration, health center, and activity (time-use) data. We will scale the ABM to three counties: Harris TX, Los Angeles CA, and Cook IL where our team has collected data for model parameterization. Our approach will assess the interplay between social and behavioral variables and viral and host factors in a matter that will be adaptive to temporal, network and setting-specific changes. Our aims are to: 1) Build upon our flexible ABM by incorporating HIV transmission and suppression probabilities at the individual level, including host/viral factors and biologic/behavioral data from HIV prevention and substance-abuse intervention studies; 2) Parameterize this ABM with multiple network data sources available to investigators in each city on specific transition periods of BMSM from the community, to jail, and back to the community/ supervision; such “shocks” lead to social and sexual network formation and disruption. We will supplement these data with newly collected data (n=50/city) specifically on network shocks and HIV prevention and treatment utilization during these critical transition periods; 3) Simulate HIV prevention interventions within criminal justice contexts using the model parameterized in Aim 2. Because our open access Repast Simphony ABM platform is widely used, we will make model parameters, specifications and variables publicly available. This will allow for external validation of our findings and for additional use of the core model by others for context and community-specific integrated HIV prevention and treatment planning in at risk populations.

 

Project Number: 3R01DA039934-03S1 

https://reporter.nih.gov/search/t_ZFuN8IDEyXUzgwJWV1mg/project-details/9480136 

 

Contact PI/ Project Leader

NINA, HARAWA, CORE DIRECTOR, POLICY IMPACT CORE (nharawa@mednet.ucla.edu)

SCHNEIDER, JOHN,  ASSOCIATE PROFESSOR OF MEDICINE (jschnei1@medicine.bsd.uchicago.edu)

 

Organization

UNIVERSITY OF CHICAGO

 

PUBLIC HEALTH RELEVANCE: Large disparities in HIV rates in black men who have sex with men (BMSM) are not explained by higher engagement in risky behaviors and are particularly high among younger MSM. Because of frequent transient life circumstances, disruption of social and sexual networks and HIV transmission overlap with other groups, criminal justice (i.e., jail and community supervision) involved (CJI) BMSM who use substances represent an important target for intervention. This proposal aims to estimate the effectiveness of HIV prevention interventions and substance-abuse interventions for criminal justice (i.e., jail and community supervision) involved substance-using BMSM.

 

FOA: PA-12-281  / Study Section: Special Emphasis Panel[ZRG1-AARR-K(05)S]

 

Project Start Date: 01-July-2015

Project End Date: 30-April-2020

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: $38,102

Hope Social Media Intervention for HIV Testing and Studying Social Networks

Abstract: In a randomized controlled trial, with 6-month and 1-year follow-up, this application aims to evaluate whether the Harnessing Online Peer Education (HOPE) social media intervention can be used to increase HIV self- testing among African American and Latino men who have sex with men (MSM), and to analyze the changing social network characteristics of participants in this intervention. Innovative approaches to HIV prevention and treatment are critical in the attempt to control the spread of HIV, especially among African American and Latino men who have sex with men (MSM), who are at the highest risk for HIV. Community-based HIV prevention strategies, such as peer leader diffusion models, have been successful in spreading HIV-risk behavior reductions, but require time and economic resources. With the recent increase in social media usage among African American and Latino MSM, social media and online social networks such as Facebook might be used to efficiently and cost-effectively deliver evidenced-based, peer-led HIV prevention interventions. Advances in testing technology, such as home-based HIV testing, can be integrated into an online HIV prevention intervention to allow participants to anonymously test for HIV without risking the stigmatization associated with in-person testing. Because social networking interventions provide rich data on social network characteristics (e.g., the number of friends participants make over time, content of health communication within online networks), this information can be recorded and used to improve intervention delivery. Results from our Los Angeles HOPE pilot study have already demonstrated a) the feasibility and acceptability of using social networking technologies to deliver peer-led HIV prevention among African American and Latino MSM, b) interest in home-based HIV testing among these populations, and c) the relationship between social network dynamics and HIV prevention behavior change. However, additional research is needed with a larger sample to determine the large-scale effectiveness of using social media to increase HIV testing and linkage to care among African American and Latino MSM. In this study, HIV negative African-American and Latino MSM will be invited to join an online (private) Facebook group related to HIV prevention and interact with peer leaders trained in HIV prevention over 12 weeks, with 6-month and 1-year follow-up. Compared to control group participants receiving 12 weeks of peer- delivered general health information over Facebook groups, we predict that participants receiving 12 weeks of peer-delivered HIV prevention information will be more likely to take a home-based HIV test. We will also measure participants’ social network data to assess the relationship between changing social network dynamics (e.g., density, network size) and intervention effects.

 

Project Number: 5R01MH106415-03

https://reporter.nih.gov/search/PAZ4BFXiRUWUpX1Uq9YqZA/project-details/9211389 

 

Contact PI/ Project Leader

YOUNG, SEAN, ASSOCIATE PROFESSOR (syoung5@hs.uci.edu)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

PUBLIC HEALTH RELEVANCE: The ability to rapidly deliver community-based HIV interventions is critical to controlling the spread of HIV in high-risk populations in Los Angeles and the rest of the world. This project is particularly significant because it 1) deals with groups who are the most impacted by HIV, African American and Latino men who have sex with men (MSM), 2) deals with MSM who are particularly important to reach due to the fact that many use the Internet to find sex partners, and 3) seeks to use social network analysis as an additional innovative tool for enhancing the effectiveness of social media-based HIV prevention intervention among high-risk population.

 

FOA: PA-14-132 / Study Section: Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section[BSPH]

 

Project Start Date: 08-April-2015

Project End Date: 31-January-2020

Budget Start Date: 01-February-2017

Budget End Date: 31-January-2018

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $556,208

Mining Real-Time Social Media Big Data to Monitor HIV: Development and Ethical Issues

Abstract:  Social “big data” holds information with wide-ranging implications for addressing issues along the HIV care continuum. Social big data refers to information from social media and online platforms on which individuals and communities create, share, and discuss content. One in four people worldwide, or over a billion people, are publically documenting their activities, intentions, moods, opinions, and social interactions on these sites. They are doing so with increasing volume and velocity, including 400 million “tweets” per day on Twitter and 4.75 billion content items shared per day on Facebook. With an increasing number of these platforms supporting access to publicly-available user data, social big data analysis is a promising new approach for attaining organic observations of behavior that can be used to monitor and predict real-world public health problems, such as HIV incidence. New tools such as social data are therefore needed to supplement existing HIV data collection methods. In preliminary research, our team developed the first approach that identifies psychological and behavioral characteristics from social big data (>550 million tweets) found to be associated with HIV diagnoses. Since groups at the highest risk for HIV (e.g., minority populations) are the fastest growing Twitter users, and because social media users have been found to publicly share personal information, we identified and collected tweets suggesting HIV risk behaviors (e.g., drug use, high-risk sexual behaviors, etc.) and modeled them alongside CDC statistics on HIV diagnoses. We found a significant positive relationship between HIV- related tweets and county-level HIV cases, controlling for socioeconomic status measures and other variables. The problem is that this approach is not currently scalable for use by HIV researchers and public health organizations. Although public health agencies are interested in mining social data to address HIV, current tools are not accessible to most health scientists, as the tools require advanced computer science expertise. For example, analyzing 500 million tweets a day requires expertise in big data engineering, advanced machine learning, natural language processing, and artificial intelligence. Developing a single platform for mining social data that has been designed and tested by and for HIV researchers could provide a significant impact on HIV prevention, testing, and treatment. We seek to create a single automated platform that collects social media data; identifies, codes, and labels tweets that suggest HIV-related behaviors; and ultimately predicts regional HIV incidence. Because of the potential ethical issues associated with mining people’s data, we also seek to interview staff at local and regional HIV organization and participants affected by HIV to gain their perspectives on the ethical issues associated with this approach. The software developed from this application will be shared with HIV researchers and health care workers to provide additional tools that can be used to combat the spread of HIV.

Project Number: 1R56AI125105-01A1

https://reporter.nih.gov/search/jRCGXVrkakWONMVPH59sPA/project-details/9317061

 

 

Contact PI/ Project Leader

YOUNG, SEAN, ASSOCIATE PROFESSOR (syoung5@hs.uci.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Project Narrative Surveillance and monitoring of HIV and related risk behaviors is a top priority. This project is of particularly high impact because it seeks to develop software to allow researchers to analyze real-time conversations from social media big data to monitor HIV diagnoses. It also will provide data on the ethical issues associated with the increasing number of these “social data mining” approaches. The software developed from this application will be shared with HIV researchers and health care workers to provide additional tools that can be used to combat the spread of HIV.

 

 

 

 

Project Start Date: 01-September-2016

Project End Date: 31-August-2019

Budget Start Date: 01-September-2016

Budget End Date: 31-August-2019

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES / FY Total Cost by IC: $671,438

Racial/Ethnic Disparities in Health Insurance Coverage Stability: Implications for Chronic Disease Management and Use of Preventative Services

Abstract:  Unstable health insurance coverage (i.e., gaining and/or losing coverage over time) affects millions of individuals in the US. The Affordable Care Act (ACA) has helped 16.4 million of the uninsured gain coverage through the expansion of Medicaid in 31 states (including the District of Columbia as of September 1, 2015) and subsidies through the Health Insurance Exchanges (HIE) and is projected to reduce racial/ethnic disparities in coverage. However, disruptions in coverage may continue to be an important post-ACA issue, as changes in eligibility are expected to continue resulting in churning (i.e., losing and/or gaining coverage over time) between coverage through Medicaid, the HIE and employer-provided health insurance. Despite the abundance of research on the uninsured, little is known about how coverage stability affects access to care, especially in terms of disease management and use of preventive services, and whether important differences exist between racial and ethnic groups. The limited amount of research that does exist on coverage stability have largely been descriptive and have relied on measures that only capture one aspect of coverage stability at a time (e.g., ever lost coverage in the past year). Additionally, few studies have made use of methods that address the influence of unobservable characteristics that may be associated with both coverage stability and access to care (i.e., endogeneity of health insurance coverage). Thus, to address these gaps in the literature, the proposed dissertation will use data on a nationally representative sample of non-elderly adults (ages 18-64) from the Medical Expenditure Panel Survey (MEPS) to: (1) Construct a coverage stability index measure that encompasses multiple aspects of coverage stability using month-to-month coverage status and principal component analysis; (2) Evaluate the effect of coverage stability on disease management among those living with a chronic condition (i.e., diabetes, hypertension, and high cholesterol) by race/ethnicity; and (3) Examine the effect of coverage stability on the use of preventive services among the near-elderly (ages 50-64) by race/ethnicity. The proposed project will contribute and improve upon the existing body of research by developing and testing a coverage stability measure that accounts for multiple aspects of the phenomenon, demonstrating the effect of coverage stability on access to care among vulnerable populations and disparities by race/ethnicity, and making use of methods that address the endogeneity of coverage to produce less biased estimates. Such a contribution would bring to light the magnitude of the issue and provoke urgency among policymakers and other stakeholders to engage in discussions and efforts geared towards identifying those at highest risk for unstable coverage and developing strategies that will make coverage transitions less burdensome on access to care, thus alleviating the perpetuation of racial/ethnic disparities in health.

 

Project Number: 1R36HS024862-01A1

https://reporter.nih.gov/search/tRh4M7PY80G_22Aco4BUqA/project-details/9379776

 

Contact PI/ Project Leader

TAN, DIANE, (diane.tan@ucla.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE:Project Narrative Unstable health insurance coverage (i.e., gaining and/or losing coverage over time) affects millions in the US. Although the Affordable Care Act (ACA) has greatly improved access and is projected to reduce racial/ethnic disparities in coverage, disruptions in coverage may continue to be an important post-ACA issue, as changes in eligibility are expected to continue resulting in churning between the different sources of coverage (i.e., Medicaid, the health insurance exchanges, and employer-provided health insurance). The proposed project will contribute to the small albeit growing body of research by developing and testing a multi-dimensional coverage stability measure, demonstrating the effect of coverage stability on access to care among vulnerable populations, determining disparities by race/ethnicity, and using methods that address the endogenity of coverage to produce less biased estimates.

 

 

 

 

Project Start Date: 01-July-2017

Project End Date: 30-June-2018

Budget Start Date: 01-July-2017

Budget End Date: 30-June-2018

 

 

NIH Categorical Spending

Funding IC: AGENCY FOR HEALTHCARE RESEARCH AND QUALITY / FY Total Cost by IC:$41,931

Engaging Seronegative Youth to Optimize HIV Prevention Continuum

Abstract: Young people at highest risk for HIV in the U.S. will be gay, bisexual transgender youth (GBTY) and homeless youth (HY) in communities with high HIV incidence and overwhelmingly Black and Latino. Focusing on Los Angeles and New Orleans, seronegative youth at highest risk for HIV will be screened in homeless shelters and gay-identified community-based organizations (CBO). A cohort of 1500 seronegative youth will be recruited that is 82% male (79% GBTY), 66% Black, 16% Latino, and 18% white, non-Hispanic. About 27% will be 12-17 and 73% between 18-24 years old. All youth will be followed longitudinally over 24 months at four month intervals and tested for HIV, STI, serious substance abuse, health care utilization, and comorbid conditions – a Prototypical Retention/Prevention (R/P) Strategy. Over 24 months, acutely HIV infected youth will be triaged to Study 1. This Prototypical R/P Strategy operationalizes the CDC’s recommendations for the engagement of GBTY in repeat HIV testing, linkage to care, and options for combination prevention (PrEP, PEP – with behavioral interventions). Building on this team’s extensive experience with behavioral and mobile/social media interventions, a randomized controlled trial (RCT) will be conducted with four intervention conditions: 1) an Automated Messaging and Monitoring Intervention (AMMI), which will use texts to diffuse prevention messages daily and to monitor risk behaviors weekly (n=900); 2) a Peer Support intervention on a social media platform (i.e., Facebook) in which young people will post messages and stories about their experiences preventing HIV, plus the AMMI (n=200); 3) an eNavigator intervention in which a B.A.-level staff supports youth, primarily through texting and social media, but also in-person meetings, to provide support in crisis situations, refer to treatment, and assist in gaining access to health care and other services, plus Peer Support and AMMI (n=200); and, 4) a combined intervention of eNavigator, Peer Support, and AMMI (n=200). A single outcome will be composed of six key behaviors (access to medical care, accessing and adherence to PrEP or PEP, treatment of all STI, and 100% condom use). In addition to evaluating the added benefit of increasing levels of intervention, the brief 7- item weekly text-messaging monitoring surveys will provide approximately 100,000 weekly reports of indicators of primary and secondary outcomes that can inform our understandings about the relationships between risk and comorbid states. This study will have policy implications for the allocation of resources to HIV testing resources in local communities, the uptake and scalability of text and social media interventions, and the models for diffusing evidence-based interventions (EBI) globally (without requiring replication with fidelity to a manual).

Project Number: 5U19HD089886-02

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

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

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-12-222Study 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