Mopati: A Pilot HIV Treatment Partner Intervention in Botswana

Abstract:Botswana has the second-highest HIV prevalence in the world. Low-cost, scalable interventions are essential to support people living with HIV to adhere to antiretroviral treatment (ART) and remain in care. One such intervention is the use of treatment partners, which are recommended by HIV treatment guidelines in at least 20 countries worldwide. Specifically, national HIV policies of several countries, including Botswana, recommend that healthcare providers encourage patients initiating ART to identify an individual who can provide support, accompany patients to appointments, and provide medication reminders. Although a large body of work indicates the key role of social support in promoting adherence, research on treatment partners’ effectiveness has shown mixed results. Thus, research is needed to determine how support from treatment partners can be better harnessed. Our R21 study examined optimal characteristics of treatment partners. Results indicated that effective treatment partners not only help with adherence, but also provide essential non-medical support (e.g., transport, food preparation), and that effective treatment partners are more likely to be spouses or other intimate partners than other types of network members. Treatment partners, especially of unsuppressed patients, requested counseling skills training. Using our R21 as a basis, we propose to pilot test the effects of the Mopati program (“partner” in Setswana, the official language of Botswana), a multi-level intervention that guides healthcare providers and patients about treatment partner selection, and trains treatment partners on provision of effective support. The Specific Aims are: (1) To develop a multi-level treatment partner intervention with input from community and healthcare provider stakeholders in Botswana; and (2) To conduct a pilot test of the feasibility, acceptability, and preliminary effects on viral suppression of a multi-level treatment partner intervention. We will recruit 80 people living with HIV who are not virally suppressed and their 80 treatment partners in 2 matched clinic pairs (4 clinics total; 20 dyads/clinic) in Gaborone, Botswana. Clinics will be randomly assigned to standard of care or a healthcare provider guidance and treatment partner training intervention (i.e., all clinic providers receive training on advising patients about treatment partner selection, and all treatment partners receive HIV treatment education and training on counseling patients using a non-confrontational, non-judgmental style). We will survey patients and treatment partners at baseline and 6-months post-baseline and collect viral load from clinic records. Intervention feasibility and acceptability will be assessed via mixed methods (e.g., semi-structured interviews with patients, treatment partners, and clinic staff; refusal rates). We will present results to the committee that develops the Botswana National HIV and AIDS Treatment Guidelines. This research presents a unique opportunity to examine ways to improve ART use in practice across countries and has relevance for both HIV- care as well as healthcare for other conditions (e.g., diabetes, tuberculosis) that require strict adherence.

 

Project Number:5R34MH121229-03

https://reporter.nih.gov/search/_VOqXMKqJUm7lziiCBdL8A/project-details/10175050

 

Contact PI/ Project Leader

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

MOSEPELE, MOSEPELE

 

Organization

RAND CORPORATION

 

PUBLIC HEALTH RELEVANCE: Treatment adherence partners are recommended by HIV treatment guidelines in at least 20 countries worldwide to reduce treatment nonadherence and discontinuation by accompanying patients to appointments and providing medication reminders. The proposed research will develop and pilot test a multi-level clinic- based intervention to guide people living with HIV on treatment partner selection, educate treatment partners about HIV treatment, and train treatment partners on counseling skills, in order to increase the number of patients who are virally suppressed. This research has public health relevance not only for the treatment of HIV globally, but for the treatment of other health conditions that require strict adherence (e.g., diabetes, tuberculosis).

 

 

Project Start Date: 16-July-2019

Project End Date:31-May-2023

Budget Start Date: 01-June-2021

Budget End Date: 31-May-2023

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES / FY Total Cost by IC:$241,074

Promoting Reductions in Intersectional Stigma to Improve HIV Testing and PrEP Use Among Latino Sexual Minority Men

Abstract: HIV prevention continuum disparities persist among Latinos in the U.S., especially those who are immigrants and sexual minority men (SMM). Latinos tend to be diagnosed with HIV (i.e., tested) at a later disease stage and use pre-exposure prophylaxis (PrEP) at much lower rates than do Whites. However, of the existing evidence-based HIV prevention interventions, only one was developed for Latino SMM, and none have yet been developed or assessed for PrEP uptake. Based on the scientific premise and empirical evidence that stigma contributes meaningfully to HIV disparities, we propose to conduct a randomized controlled trial (RCT) of an 8-session cognitive behavior therapy group intervention, Siempre Seguiré (“I will continue being”; named by community stakeholders after a popular song conveying gay empowerment), which aims to increase effective coping responses to stigma from intersectional identities (related to ethnicity, immigration status, and sexual minority identity) among Latino SMM, with the goal of improving HIV prevention continuum outcomes. Siempre Seguiré 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 and increased trust in providers and healthcare. The specific aims are: (1) To conduct a randomized controlled trial of Siempre Seguiré, a culturally congruent cognitive behavior therapy group intervention for immigrant Latino sexual minority men, to test intervention effects on regular HIV testing and PrEP uptake; (2) To examine mechanisms of intervention effects on regular HIV testing and PrEP uptake, including more effective coping (e.g., reduced internalized stigma, anticipated stigma, and medical mistrust); and (3) To conduct a cost- effectiveness analysis of the intervention. In the context of an established community-academic partnership, we will conduct the RCT with 300 immigrant Latino SMM, randomizing 150 to the intervention and 150 to an attention control group (a community-based wellness-oriented support group, with sessions matched to the intervention condition in number, timing, and length). Participants will complete surveys at baseline and 3, 6, and 12 months post-baseline to assess the primary outcomes, potential mediators, covariates, and moderators. Regular HIV testing will be confirmed with official copies of HIV testing results, and PrEP uptake will be confirmed through copies of prescriptions, medical records, and urine testing. With the exception of our own work, we are not aware of any interventions that address coping with stigma from intersecting identities in order to improve health outcomes. Our research is consistent with Healthy People 2020, which recommends developing interventions to address effects of stigma among sexual minority individuals. Although structural- level interventions are critical for reducing societal stigma as a long-term strategy, individual-level interventions—such as Siempre Seguiré—are needed in tandem to reduce stigma’s immediate health effects.

 

Project Number:5R01MH121256-03

https://reporter.nih.gov/search/IFI0_tkBV0WwBnvpf1ingA/project-details/10163917

 

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

 

PUBLIC HEALTH RELEVANCE: Latinos in the U.S., especially those who are immigrants and sexual minority men (SMM), are highly affected by HIV-related disparities, tending to be diagnosed at a later disease stage, leading to delays in antiretroviral treatment use and lower rates of viral suppression. No culturally congruent interventions have been developed to address intersectional HIV-related stigmas, a key contributor to disparities in the HIV prevention continuum among Latino SMM. We propose a randomized controlled trial of an 8-session cognitive behavior therapy group intervention that aims to increase regular HIV testing and PrEP uptake by increasing effective coping responses to intersectional stigmas from ethnicity, immigration status, sexual minority identity, HIV, and PrEP among Latino SMM.

 

 

Project Start Date: 01-August-2019

Project End Date: 31-May-2024

Budget Start Date: 01-June-2021

Budget End Date: 31-May-2022

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH + NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES / FY Total Cost by IC: $715,688

Evaluating the Feasibility and Acceptability of a Latino MSM Focused PrEP Uptake Intervention

Abstract: HIV disparity persist among Latino men who have sex with men (MSM), especially those who are immigrants. The CDC estimates the lifetime HIV risk is 1 in 5 for Latino MSM compared to 1 in 11 for white MSM. Pre-Exposure Prophylaxis (PrEP) is a biomedical strategy highly effective in preventing HIV acquisition, with the potential to reduce the number of new HIV infections among Latino MSM in the U.S. PrEP involves once daily dosing of medications. The FDA has approved two medications, sold under the brand names Truvada® and Descovy® for daily use as PrEP. The Centers for Disease Control and Prevention (CDC) has established clinical guidelines for administering PrEP to high-risk candidates. While evidence indicates that PrEP use is rising in the U.S., disparities persist in uptake among Latino MSM, despite their reported high levels of interest in using PrEP. To address this disparity, we propose a 2-phase project to develop a pilot PrEP intervention called Estoy PrEParado (I’m PrEPared) to facilitate initiation and adherence to PrEP among immigrant Latino MSM. The project will develop an engaging, culturally tailored intervention using the Information-Motivation-Behavioral Skills (IMB) model. The specific aims of the project are: Aim 1: based on data from a prior study, the project will elicit feedback, validation and modification to the initial content areas of the Estoy PrEParado intervention to facilitate PrEP adoption and adherence among immigrant Latino MSM; and Aim 2: the project will conduct a small randomized pilot of Estoy PrEParado to assess the feasibility, acceptability and preliminary impact of the intervention in moving immigrant Latino MSM along the PrEP cascade to initiation. In formative phase 1, the project will use the innovative and novel World Café approach to facilitate a community conversation with immigrant LMSM (n≈40) to validate, modify and refine the initial intervention content areas of the Estoy PrEParado pilot intervention. The World Café is a powerful conversational process for facilitating constructive group dialogue that produces ideas and knowledge that can be put into practice. The project will also elicit feedback and input on the contents of the intervention from a project-specific Intervention Advisory Committee (IAC) comprised of academic and community experts. In phase 2, the project will conduct a small randomized pilot of 80 participants (40 participants receiving the PrEP intervention and 40 participants receiving standard care, i.e., PrEP referrals) to establish feasibility, acceptability and preliminary impact. If the intervention shows promise, the findings will support the preparation of a larger scale R01 efficacy trial.

 

Project Number: 5R34MH121228-02

https://reporter.nih.gov/search/JhB7cXNmT0WkoNOjh9xCBQ/project-details/10239232

 

 

Contact PI/ Project Leader

BROOKS, RONALD ANDREW, ASSISTANT PROFESSOR (rabrooks@mednet.ucla.edu)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: For Public Health, it is important to facilitate adoption of PrEP, a highly effective biomedical HIV prevention strategy that can help reduce new HIV infections among immigrant Latino MSM in the U.S. Our study will make use of HIV testing sites as an entry point to enroll participants into our pilot PrEP intervention with information tailored to address the specific needs of immigrant Latino MSM who are considering PrEP for HIV prevention. The insights from this R34 grant will serve as the basis for a subsequent R01 grant application to assess efficacy of the intervention.

 

 

Project Start Date: 15-August-2020

Project End Date: 31-July-2023

Budget Start Date: 01-August-2021

Budget End Date: 31-July-2022

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH/ FY Total Cost by IC: $214,211

A.S.K.-PrEP Program (Assistance Services Knowledge-PrEP)

Abstract: The A.S.K.-PrEP (Assistance Services Knowledge-PrEP) program works with extremely high-risk HIV-negative trans women and men who have sex with men to link participants into PrEP medical services. A.S.K.-PrEP consists of individualized, client-centered PrEP navigation sessions to assess PrEP readiness, assess barriers to PrEP initiation and/or adherence, assess readiness for adherence, and to plan for PrEP persistence. Additionally, through the five-session A.S.K.-PrEP intervention, the PrEP navigator works with each participant to remove structural barriers to PrEP initiation/adherence (mental health, substance use [including injection drug use], intimate partner violence, STDs, housing, hormones, sex work), insurance enrollment/patient assistance), link participants into needed ancillary services, all with the ultimate goal of linkage to PrEP and persistent daily PrEP adherence. Discussions of PrEP readiness and individual and structural barriers to PrEP linkage and adherence occur throughout the five sessions. Throughout the duration of the project, participants can opt-in/opt-out of receiving culturally competent, theory-based PrEP adherence support text messages. Each text message has a theoretical conceptual foundation based on Social Support Theory (to provide informational, emotional or instrumental PrEP support), Health Belief Model (to identify or reduce HIV risks) or Social Cognitive Theory (to increase self-regulation skills and self-efficacy for PrEP persistence). A.S.K.-PrEP partners with three local clinics to provide culturally appropriate PrEP medical services.

Healthy Divas: Improving engagement in HIV care for high-risk women

Abstract: Trans women are disproportionately impacted by HIV and have culturally unique barriers and facilitators to engagement in HIV care. Trans women living with HIV (hereafter:  TWH) are less likely than other populations to take antiretroviral therapy (ART), and those who initiate ART have lower rates of ART adherence, lower self-efficacy for integrating ART into daily routines, and report fewer positive interactions with health care providers than non-transgender adults. As a result, TWH have an almost three-fold higher viral load than non-transgender adults; TWH are less likely to be virally suppressed than any other behavioral risk group. There are both individual and public health consequences to poor engagement in care among TWH stemming from high transmission risk factors, including substance abuse, high numbers of sex partners, engagement in sex work, and high rates of mental illness. Healthy Divas is a randomized controlled trial, grounded in Models of Gender Affirmation and Health Care Empowerment, that compares the Healthy Divas intervention to a treatment as usual (TAU) control condition. The Healthy Divas intervention is a combination of 6 individual sessions, completed within 3 months, with a peer counselor and a peer-led group workshop with other TWH, a HIV primary care provider, and a transgender health care provider. TWH (N=286) who are confirmed HIV-positive and show evidence of suboptimal engagement in care, defined as meeting one or more of the following three indicators: a) not on ART, b) on ART but reporting non-adherence, c) reporting no HIV care appointments in the prior 6 months, are enrolled at either the San Francisco site or the Los Angeles site (n=143/site). The primary outcome is virologic control. The specific aims are: 1) To evaluate rates of virologic control for TWH in response to the Healthy Divas intervention; 2) To evaluate the efficacy of the intervention on HIV treatment engagement among TWH; and, 3) To explore the effect of the intervention on hypothesized mechanisms of action. The randomized two-group design uses repeated assessments at baseline and at 3-, 6-, 9-, and 12-month post-randomization follow-up.

Project Number: 5R01MH106373-03

https://reporter.nih.gov/search/0yGsD9H-3UaHRoJMIRctgg/project-details/9312318

 

Contact PI/ Project Leader

SEVELIUS, JEANNE M. (jae.sevelius@ucsf.edu)

 

Organization

UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

 

PUBLIC HEALTH RELEVANCE: The proposed trial is grounded in a novel transgender-specific framework and is the culmination of years of work in a community at heightened risk for HIV treatment failure and transmission of HIV to others. If effective, the proposed intervention approach has the potential to optimize health outcomes in a population highly burdened by HIV while preventing further transmission.

 

 

Project Start Date: 08-September-2015

Project End Date:30-June-2020

Budget Start Date: 01-July-2017

Budget End Date: 30-June-2018

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $788,397

Text Me, Girl! – Text Messaging to Improve Linkage, Retention and Health Outcomes among HIV-positive Young Transgender Women

Abstract: Young trans women experience a number of psychosocial challenges including discrimination, prejudice, stigmatization, and social/economic marginalization, which stand as obstacles to linkage and retention in HIV care and ART medication adherence. Due to these challenges, and their often transient nature, a text-messaging HIV intervention that is easily accessible, culturally competent, private and portable is a particularly salient method for engaging and retaining young trans women in HIV care. This project utilizes a text-messaging intervention to improve engagement, retention, and health outcomes along the HIV Care Continuum, with the desired outcome of viroligical suppression, among HIV-positive young trans women, aged 18-34, who are not linked to care, or not retained in care, or not prescribed ART, or nonadherent to ART, or not virologically suppressed. Over the course of the 90-day intervention, participants receive 270 theory-based text messages that are targeted, tailored, and personalized specifically for HIV-positive young trans women; participants receive three messages per day in real-time within a 10-hour graduated and automated delivery system. The text-message content is pre-written along the HIV Care Continuum (i.e., HIV positivity/physical and emotional health, linkage/retention in care, ART adherence/viral load suppression) and is based on three proven theories of behavior change (i.e., Social Support Theory, Social Cognitive Theory, and Health Belief Model). Following screening for eligibility, informed consent, and baseline assessment, participants are randomized into one of two conditions: Group A: Immediate Text Message Intervention Delivery (ID, n=60); or, Group B: Delayed Text Message Intervention (DD, n=60) whereby participants are delivered the text-messaging intervention after a delayed 90-day period. Participants in both groups receive the exact same 90-day text-messaging intervention. Following the 90-day theory-based, trans-specific text-messaging intervention, participants may opt in/opt out of continued weekly post-intervention messages for ongoing retention and engagement support derived from the HRSA-funded UCARE4LIFE library. The randomized two-group repeated measures design assesses participants at 3-, 6-, 12-, and 18-months post-randomization to determine observed intervention effects and longitudinal intervention effects.

The Alexis Project

Abstract: Trans women of color experience a number of psychosocial challenges including discrimination, prejudice, stigmatization, and social/economic marginalization, which stand as obstacles to HIV care and other needed services. The Alexis Project* employs a multi-tiered, comprehensive approach, which includes network, individual and structural components to identify, recruit, test, link, treat and retain trans women of color into quality HIV care. The Alexis Project incorporates three proven models, Social Network Recruitment (network), Peer Health Navigation (individual) and Contingency Management (structural), into one multi-leveled project to optimize HIV health outcomes for trans women of color. Through Social Network Recruitment, local trans women recruit trans women of color from their social, sexual and drug-using networks into the project for either testing (HIV unknown status) or (for those who are aware of their HIV infection but not in care) to the combined Peer Health Navigation and Contingency Management intervention. Over the five-year study, 139 trans women of color will enroll in the combined Peer Health Navigation and Contingency Management intervention.  The project goals are: 1) to identify trans women of color who are unaware of their HIV-positive status and identify trans women of color who are already aware of their HIV infection but have never been engaged in care or have refused a referral to care or have dropped out of care; 2) to directly link HIV-infected trans women of color to a Peer Health Navigator; 3) to link HIV-infected trans women of color to quality HIV care; 4) to work with HIV-infected trans women of color to address the barriers in their life that limits or impedes their access to HIV care; and, 5) to retain HIV-infected trans gender women of color in HIV care to reach and sustain HIV milestones. Peer Health Navigators work with participants to identify HIV care services and other needed services, develop a specific client-centered treatment plans, remove barriers to those services and access those services. Contingency Management provides increasing valuable incentives for attending HIV medical visits and reaching and sustaining HIV milestones.

Hours: Weekdays, 10:30 a.m. to 7:00 p.m.

Contact: 323-793-4645 or 323-512-7014

Funding Source: This project is funded by the Health Resources and Services Administration (HRSA) and sponsored by Friends Research Institute, Inc.

https://www.friendscommunitycenter.org/alexis-project

*The Alexis Project is named after Alexis Rivera who died on March 28, 2012, at the age of 34, from complications related to HIV. Alexis was a proud Latina trans woman; a community activist, a peer advocate and a gatekeeper.

Adapting the Hope Social Media Intervention to Reduce Prescription Drug Abuse

Abstract:  This proposal seeks to determine the feasibility, acceptability, and preliminary effectiveness of applying the Harnessing Online Peer Education (HOPE) intervention, or peer support social media community model, to reduce prescription drug abuse among chronic opioid non-cancer pain patients. Prescription drug abuse has reached epidemic proportions in recent years. Chronic opioid therapy, prescribed to treat patients experiencing chronic pain, is the most frequently abused of all prescription medications. Complications from chronic opioid misuse/abuse include respiratory suppression, infectious disease transmission, drug dependence/addiction, and fatal overdose. Chronic non-cancer pain patients with the following risk factors are at the highest risk for complications: 1) High dosage of opiods, 2) opioid use with concomitant use of sedatives (polysubstance use), and 3) aberrant medication-related behaviors (e.g. early refills requests). Although low cost, novel interventions are needed to reduce these risk behaviors before they lead to addiction and overdose, few studies have focused on this area. Community-based approaches, such as peer leader and peer support interventions, have been successful in creating health behavior change and could be applied to reduce opioid abuse. However, because peer support groups often require in-person visits and a great deal of time and financial resources, these groups have high drop-out rates. With the recent increase in social media/online communities, these technologies could be used as cost-effective platforms to deliver peer support interventions for opioid abuse and overdose. The HOPE intervention is an evidenced-based peer-led social media intervention provided over Facebook that has been successfully used to change health behaviors. However, no published research has studied whether the HOPE approach, or other social media-based peer social support interventions can be adapted to reduce prescription drug abuse, making this an important feasibility study. We propose the following specific aims to address this research: Specific Aim 1: Explore (qualitatively) how the HOPE social media-based intervention can be adapted for opioid abuse/overdose prevention among patients on chronic opioid therapy. Specific Aim 2: Assess the feasibility, acceptability, and preliminary effectiveness of applying th HOPE model to reduce opioid abuse/overdose risk among high-risk chronic non- cancer pain patients. Secondary aim: Explore the feasibility of using participants’ publicly-viewable social media conversations to better understand prescription opioid abuse and to improve intervention implementation. The pilot data collected from this study will be used to develop an R01 proposal for a larger randomized trial designed to assess the effectiveness of using social media to scale peer-led prescription drug abuse interventions to reduce prescription opioid abuse and polysubstance use among chronic opioid users.

 

Project Number: 5R21DA039458-02

https://reporter.nih.gov/search/8qC8nINxEEyRsUXqvC-aLw/project-details/8919331

 

Contact PI/ Project Leader

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

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: The ability to use low cost, novel technologies, such as social media, to deliver social support, community- based drug abuse interventions is critical to controlling drug addiction and the increasing number of overdoses. This project is particularly significant because it 1) attempts to address prescription drug abuse, the top cause of injury-related death in the United States, 2) seeks to adapt an evidenced-based, social media-delivered, peer support intervention to reduce risk factors for prescription opioid and polysubstance-related addiction and overdose, allowing the potential for these methods to be rapidly and cost-effectively scaled using social media, and 3) seeks to explore the use of new methods of using social media free-text group conversations to understand participant perspectives to provide additional observational data and improve future intervention delivery.

 

FOA: RFA-CA-14-009 / Study Section:ZCA1-TCRB-B(O2)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

Project Start Date: 01-September-2014

Project End Date: 31-August-2018

Budget Start Date: 01-September-2015

Budget End Date: 31-August-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $169,527

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