Goals for Adherence with Low-cost Incentives (GOALS)

Abstract: Treatment outcomes of HIV-positive youth in Uganda and elsewhere are threatened by low medication adherence. Despite the clear need for adherence support among youth, few interventions target this particularly vulnerable group during a time of heightened risk-taking behavior and unfinished development of cognitive control processes such as planning and goal-directed behavior. Incentives informed by behavioral economics (BE) have successfully changed a range of health behaviors by countering present bias (the tendency of overly discounting the future benefits of preventive health behaviors) including our own study that improved ART adherence. However, they have rarely been tested among youth living with HIV (YLWH) who are likely to particularly benefit from such extrinsic rewards given their observed problems with self-control. Traditional incentives that require individuals to reach a uniform, high eligible threshold by design leave out those unable to meet it, often most in need of support. In a pilot study, we tested a novel incentive design that allowed even those with low initial adherence to qualify for incentives, resulting in their improved adherence. BE theory suggests that the effort exerted to reach a goal depends on how far away it is from the participant; if the goal is within close reach, the participant shows great willingness to achieve it, but if the goal is set too high, s/he becomes demotivated and may give up. Based on this insight, we restructured our incentive design to allow participants to set their own eligibility threshold. We propose to build on our pilot results using a randomized controlled trial (RCT) to establish effectiveness. Our intervention, GOALS, proposes testing externally assigned sub-goals gradually increasing towards 90% (T1, n=140) and self-chosen, participatory interim goals (T2, n=140), against a traditional, fixed goal of 90% (T3, n=140). The control group (n=140) will receive the usual standard of care. The primary outcome is electronically measured ART adherence collected throughout the study and for 12 months after incentives are withdrawn to measure the persistence of behavior change; suppressed viral load will be the secondary outcome. The Specific Aims in year 1 (Improvement Phase) is to evaluate the relative effectiveness of the three incentivization approaches for improving adherence among YLWH. In year 2 (Maintenance Phase), we test the relative effectiveness of the three ways of incentivization for maintaining adherence. In year 3 (Persistence Phase) the goal is to investigate for 12 months the relative effectiveness of the three GOALS intervention arms at creating behavioral persistence once incentives are removed. Specific Aim 4 is to perform a cost-effectiveness analysis including a comparative analysis of those GOALS intervention arms that show a positive intervention impact for improving and/or maintaining adherence.

Project Number: 1R01HD104555-01

https://reporter.nih.gov/search/4vgAl9SY20-gSBejiQexgQ/project-details/10161248

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

PUBLIC HEALTH RELEVANCE: There is a paucity of support for young people living with HIV (YLWH) who often fail to achieve viral suppression, with catastrophic consequences in particular in resource-constrained countries in which treatment options are limited. This study aims to improve ART adherence among YLWH by providing small incentives based on insights from behavioral economics, combined with text messages sent by mobile phone. The approach is particularly targeted at those with low adherence as it allows to adjust eligibility thresholds for incentives to participants’ initial adherence, thereby reducing health inequality and facilitating high, long-term ART adherence for a particularly vulnerable group of HIV clients.

 

 

Project Start Date: 17-May-2021

Project End Date:31-January-2026

Budget Start Date: 17-May-2021

Budget End Date:31-January-2022

 

NIH Categorical Spending

Funding IC:  EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT / FY Total Cost by IC:$724,445

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

Youth Services Navigation Intervention for HIV+ adolescents and young adults being released from incarceration: A randomized control trial

Abstract: The continuum of HIV care has forced new focus on the urgency to identify and effectively serve high-need, under-resourced, and often transient populations to facilitate their receiving the necessary ongoing care and antiretroviral therapy (ART) to suppress HIV RNA viral load (VL). Crucial target groups for improving care along the continuum are young (aged 16-25), sexual and gender minority (SGM) populations being released from jail settings. HIV prevalence among incarcerated youth living with HIV (YLWH) is three times that of the general population and one in seven of all HIV+ persons experience incarceration each year. HIV incidence, prevalence, and incarceration rates are higher for blacks and Latinos than for any other group – these disparities are especially prominent among youth. Furthermore, only an estimated 6% of HIV+ youth are virally suppressed, due to poor retention and adherence to ART. Existing linkage and retention services are insufficient to meet the acute needs of criminal justice-involved (CJI) HIV+ youth, particularly in the high-need period following release from incarceration. Moreover, because of their lack of experience, many youths may struggle to obtain needed services and stabilize their living conditions. Disparities in HIV continuum outcomes are inextricably linked to incarceration, substance use disorders (SUDs), homelessness, and mental health (MH) problems among YLWH. If HIV is to be controlled and the benefits of ART experienced broadly, the problems of CJI YLWH must be addressed with innovative, youth-, and sexual and gender minority (SGM)- sensitive approaches. We propose to enroll 240 CJI YLWH, aged 16-25, incarcerated in Los Angeles and Chicago jails and juvenile detention facilities. We will randomize participants to the YSN intervention (n=120) vs. a usual-care control group (n=120). The youth services navigators (YSNs) will assist with addressing immediate unmet needs such as housing, transportation, and food prior to clinical care and ongoing; will guide intervention participants to a range of community services to support progress along the continuum of HIV care; and will provide direct ART adherence support. The proposed study has two Primary Specific Aims: 1. Adapt an existing peer navigation intervention for adults to create a Youth Service Navigation (YSN) intervention sensitive to SGM culture that guides youth to needed services along the continuum of HIV care. This intervention combines medical, substance use and mental health care with comprehensive reentry support for CJI YLWH, aged 16-25 upon release from large county jails and juvenile detention systems; 2. Using a two-group RCT design, we will test the effectiveness of the new YSN, youth SGM-sensitive intervention among CJI YLWH aged 16-25, compared to controls offered standard referrals to services. We will evaluate the YSN Intervention’s effect on post-incarceration linkage, retention, adherence, and viral suppression, as well as on SUDs, mental health, services utilization, and met needs. Secondary Aims: We will assess YSN’s effects on recidivism, costs and potential cost-offset/effectiveness.

 

Project Number:1R01MD011773-01

https://reporter.nih.gov/search/WBAx0xWJNESVugqyMSVW8A/project-details/9395728

 

 

Contact PI/ Project Leader

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

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Crucial target groups for improving care along the Continuum of Care are young (aged 16-25) HIV+ sexual and gender minority youths with criminal-justice involvement (CJI) – a population that is poorly retained in HIV care. If HIV is to be controlled and the benefits of ART advances experienced broadly, the problems of CJI young people living with HIV must be addressed with innovative, youth-, and sexual and gender minority-sensitive approaches. The proposed Youth Services Navigation intervention will address this gap, testing a youth- focused approach that is adapted from our successful intervention with HIV+ CJI adults.

 

 

Project Start Date: 08-August-2017

Project End Date: 31-March-2022

Budget Start Date: 08-August-2017

Budget End Date: 31-March-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES / FY Total Cost by IC: $708,966

Investigating the Impact of Substance Use, Intimate Partner Violence, and COVID-19 on HIV Care Engagement among Young Black Sexual Minority Men with HIV in the US South

Abstract: Among sexual minority men, young Black sexual minority men are the most disproportionately impacted by HIV, with the majority of new infections among sexual minority men occurring among this group. Intimate partner violence (IPV) is one of the most understudied factors that may exacerbate these disparities. Little is known about the impact of substance use and IPV on HIV care continuum (CC) outcomes and HIV transmission risk behaviors among young Black sexual minority men with HIV (YBSMM+). Both IPV and substance use leading to IPV may help explain poorer CC engagement among YBSMM+ and are likely to be exacerbated by the COVID-19 pandemic, which is having devastating health and economic impacts. The COVID-19 pandemic is also likely to interfere with CC engagement and viral suppression. The research that we propose is designed to overcome these gaps and limitations, and to identify modifiable intervention targets for strengthening the CC during times of acute psychosocial and economic stress. We propose to use existing data and to collect new data from the United Black Element+ project (UBE+; R01 MH102171). We will use structural equation modeling to explore the associations between substance use and IPV and their impact on HIV care engagement, viral suppression, condomless anal sex, and to determine if distinct forms of resilience (global resiliency, coping skills, and social support) buffer associations between these relationships among YBSMM+ in the U.S. South. This study can shed new light on the associations between substance use, IPV and CC outcomes and risk and will support the submission of an intervention development grant (R34) to develop a resiliency and advocacy-based intervention that reduces the impact of substance use and IPV on CC engagement and retention among YBSMM+. The project’s focus on the role that resiliency factors may play in moderating harmful effects of substance abuse and IPV among YBSMM+ is innovative. This research can inform the development and adaptation of substance use, IPV, and CC interventions for YBSMM+.

 

Project Number: 1R21DA053164-01

https://reporter.nih.gov/search/OJfd0e_VikGzwfdQswpoGw/project-details/10161009

 

 

Contact PI/ Project Leader

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

 

Organization

SAN DIEGO STATE UNIVERSITY

 

 

PUBLIC HEALTH RELEVANCE: Young Black sexual minority men (YBSMM) in the US South are disproportionately burdened by HIV. Intimate partner violence (IPV) is one of the most understudied factors that may exacerbate these disparities, yet little is known about the relationship between substance use and IPV, and the combined impact these factors have on the HIV care continuum and HIV transmission risk behaviors among YBSMM living with HIV. The proposed research is designed to overcome these gaps and limitations, and to identify modifiable intervention targets for reducing substance use and IPV risk and strengthening the HIV care continuum by using existing and new data collected from an ongoing cohort study of YBSMM living with HIV in the US South.

 

 

Project Start Date: 01-July-2021

Project End Date:30-June-2023

Budget Start Date: 01-July-2021

Budget End Date: 30-June-2022

 

 

NIH Categorical Spending

Funding IC: OFFICE OF THE DIRECTOR, NATIONAL INSTITUTES OF HEALTH / FY Total Cost by IC:$231,383

A Comprehensive Community-based Strategy to Optimize the HIV Prevention and Treatment Continuum for Youth At HIV Risk, Acutely Infected and with Established HIV Infection

Abstract: America’s increasing HIV epidemic among youth aged 12-24 and our concurrent failure to identify, link to care, and achieve viral suppression among youth living with HIV (YLH) suggests the need to identify novel community-based strategies to leverage gateways and settings where high risk and infected youth can be engaged in HIV prevention and treatment. Scientific successes reducing HIV viral reservoirs among acutely infected infants, stopping HIV transmission from HIV-infected adults with undetectable viral loads, and documenting the efficacy of Treatment as Prevention (TASP) suggest strategies to reduce the trend of increasing adolescent HIV infections. This U19 will evaluate the usefulness of these advances for youth aged 12-24 at the highest risk of acquiring HIV- gay, bisexual, transgender youth (GBTY) and homeless youth (HY) – as well as youth living with HIV (YLH) in two HIV epicenters (Los Angeles and New Orleans). All GBTY and HY at five gay-identified community-based organizations (CBO) and homeless shelters will be screened over 18 months. From these screenings, a cohort of 220 YLH and 1,500 highest risk seronegative GBTY and HY will be formed. Over 24 months, this cohort will be repeatedly tested at four month intervals for sexually transmitted infections (STI) and serious drug use, and with 4th Gen HIV tests if seronegative, in order to identify acutely infected youth, engage youth in medical care, and monitor outcomes. Youth are triaged to: Study 1: Acute infection. Using 60 ARV-naive YLH with established infection as controls, we expect to identify 36 YLH with acute infection. All youth with acute infections will be aggressively treated with at least four highly potent antiretroviral therapies (ARV) and repeatedly assessed to examine if prolonged viral suppression is achieved, with reduced viral reservoirs to potentially allow ARV- free HIV remission. Study 2: Stepped care for YLH. Adapting strategies to manage chronic illnesses, we will conduct a RCT comparing a Standard Care Arm (repeated assessments every four month and an Automated Messaging and Monitoring Intervention [AMMI]) to Stepped Care. In the Stepped Care Arm, increasingly more intense interventions are delivered if viral load is detectable: a) the Standard Care Arm; b) an AMMI that is tailored to comorbidities of the specific YLH; or c) a Coach to support during crises, make treatment referrals, and brief interventions. Dried blood spots will monitor viral load and, on a small sample, ARV adherence over time. Study 3: Engaging seronegative youth in the HIV Prevention Continuum. Youth will be randomized to either: a) an AMMI Arm; b) Peer-Support plus AMMI Arm; c) eNavigator and an AMMI arm; or d) Peer-Support plus eNavigator plus AMMI Arm. Each condition aims to optimize the HIV Prevention Continuum. An interdisciplinary team of basic, clinical, and applied researchers with expertise in HIV, STI, behavioral interventions, biomedical interventions, CURE research, perinatal HIV, and a history of participating and coordinating multi-site RCT is participating on this U19 from six universities.

 

Project Number: 3U19HD089886-05S1

https://reporter.nih.gov/search/SBBoz9XDVUyX_k7No8tfLg/project-details/10397368

 

 

Contact PI/ Project Leader

SWENDEMAN, DALLAS TRAVIS , ASSOCIATE PROFESSOR, CENTER CO-DIRECTOR (dswendeman@mednet.ucla.edu)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: HIV among youth has doubled in the last 15 years, with incidence expected to increase 39% by 2020. If acutely infected youth can be identified and treated during the period when their infectivity to others is 5-to 10-fold, we can reduce this expected rise as well as improve youth’s long-term health, reflected in smaller viral reservoirs. The set of studies in this U19 tests a comprehensive set of strategies for acutely infected youth, youth with established infection, and seronegative youth at highest risk of acquiring and transmitting HIV –with policy implications for communities and the Centers for Disease Control and Prevention.

 

FOA: PA-20-272Study Section: Unavailable

 

Project Start Date: 01-June-2021

Project End Date: 31-May-2022

Budget Start Date: 01-June-2021

Budget End Date: 31-May-2022

 

 

NIH Categorical Spending

Funding IC: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT/ FY Total Cost by IC: $2,429,844

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

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

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

SMS as an Incentive to Adhere (SITA)

Abstract: HIV care requires high medication adherence to achieve optimal clinical outcomes such as slowing the progression to AIDS. Youths face special and unique challenges to adherence. Despite a wealth of interventions designed to increase adherence outcomes, few have focused on interventions that are sustainable in resource-limited settings, or for the period of adolescence. Developing ways to increase adherence rates among adolescents is particularly important as this groups experiences the fastest growth in new HIV/AIDS cases. Existing interventions often require scarce human resources, limiting their practical use. Novel ways of adapting traditional interventions in a sustainable manner are important in resource-limited settings, where second-line therapy is often too expensive or altogether unavailable. The recent rapid rise in mobile phone coverage and ownership among developing country populations has spawned the advent of mobile-phone based interventions to improve health service delivery; short message service (SMS)-based interventions have been found to increase adherence rates to ART among adult patients. However, more knowledge about this promising technology is needed as currently no clear-cut evidence exists about the pathways through which they work. The proposed study ‘SMS as an Incentive To Adhere’ (SITA) proposes novel ways of using SMS messages that are explicitly grounded in the theoretical framework of Social Cognitive Theory (SCT). The first intervention is that of self-monitoring, i.e. providing participants with feedback about their adherence performance. Traditionally this involves clinic visits that take up provider and patient time and resources; SIT instead suggests providing objective, real-time information measured by electronic monitoring (Wisepill) devices sent to patients by weekly SMS. Such feedback builds self-efficacy, a key SCT concept and so may contribute to improved adherence. The second intervention is based on the SCT concept of social learning. Perceived group norms, and interventions that affect those perceptions, are a key influence on health behavior among youths, providing a substitute for direct learning. This approach is adapted to a mHealth environment by providing patients not only with their own adherence information but also that of a reference (peer) group. The first aim of the study is to hold focus groups with key stakeholders to tailor the SMS-intervention to the local needs of youths. The second aim planned is a small, six-month randomized controlled trial testing the two SITA intervention groups against a control condition of usual care to determine which method of informing and motivating drug adherence can best achieve its goals. The third aim is to synthesize lessons learned and discuss them with the clinics and other key stakeholders. The purpose of such capacity building and knowledge transfer activities part of this study is to build up mHealth knowledge at Mildmay and Uganda more generally to a point where ideas can be generated and implemented locally.

Project Number: 5RMH107218-02

Improving Drug Adherence Among Adolescents in Uganda Using SMS Reminders

Abstract: To realize the benefits of HIV care requires high medication adherence that has been found lower than previously assumed and declining over time in sub-Saharan Africa (SSA). Youths with still developing emotional and cognitive capacities face special and unique challenges to adherence. Despite a wealth of interventions designed to increase adherence outcomes, few have focused on the period of adolescence. Developing ways to increase adherence rates among adolescents is particularly important as this group experiences the fastest growth in new HIV/AIDS cases. Such interventions are important in resource-limited settings important where second-line therapy is often too expensive or altogether unavailable. Similarly, youths are often on pre-ART co-trimoxazole prophylaxis to defer the need to take costly ART, yet most interventions do not take this reality into account. The recent rapid rise in mobile phone coverage and ownership among developing country populations has spawned the advent of mobile-phone based interventions to improve health service delivery; short message service (SMS)-based interventions have been found to increase adherence rates to ART among adult patients, yet their effectiveness among an adolescent population remains unknown. Such interventions are likely particularly effective for adolescents who have been central to the rapid growth in mobile phone ownership in developing countries. This proposal suggests to develop and test potentially cost-effective and scalable short message service (SMS)-based interventions to improve adherence to ART and pre-ART prophylaxis, as well as retention in care among HIV positive young patients aged 15-24 at two clinics in Uganda. The first aim is to hold focus groups with key stakeholders to tailor the SMS-intervention to the local needs of youths. The second aim proposed is a two-year randomized controlled trial testing one- way and two-way SMS messages (the latter offer the possibility for clients to signal health problems for follow-up by clinic staff) against a control condition of usual care to determine which method of reminding and motivating drug adherence can best achieve its goals, and whether the potentially higher adherence achieved in the two-way messages justify their increased cost. The third aim is to synthesize lessons learned and discuss them with the clinics and other key stakeholders. A cost-effectiveness analysis of one- versus two-way messages will also be performed as part of this aim.

 

 

Project Number: 5R01HD074925-05

https://reporter.nih.gov/search/T1Or88nrek2qodWnmLC_Hg/project-details/9211357

 

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

PUBLIC HEALTH RELEVANCE: A key public health question is how to sustain drug adherence over a lifetime for individuals in HIV care, and particularly for adolescents who are in the midst of intense emotional and psychological changes. Messages delivered by mobile phones may offer a low-cost method to improve adherence in resource-limited settings and may be particularly appropriate for adolescents who have been central to the recent dramatic rise in mobile phone ownership throughout the developing world. We propose to implement a randomized controlled trial that tests one-way versus two-way text messages (where the latter allow for recipients to respond to the message to receive further support) to increase medication adherence and retention in care among young HIV-patients at two urban clinics in Kampala, Uganda.

 

 

FOA:  RFA-HD-12-206Study Section: ZHD1-DSR-W(55)R

 

 

Project Start Date:01-February-2013

Project End Date: 31-January-2019

Budget Start Date: 01-February-2017

Budget End Date: 31-January-2019

 

 

NIH Categorical Spending

Funding IC: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT/ FY Total Cost by IC: $405,374