Posts classified under: Education

The UCLA HIV/AIDS Substance Abuse, and Trauma Training Program

Abstract: The NIH Working Group on Diversity in the Biomedical Research Workforce recently released a set of recommendations to improve the diversity of the research workforce, including establishing a “system of mentorship “networks” for underrepresented minority students that will provide career guidance throughout their career development.” To that end, this R25 application responds to PAR-10-173 (NIDA Research Education Program for Clinical Researchers and Clinicians) and seeks five years of funding for the UCLA HIV/AIDS, Substance Abuse, and Trauma Training Program (hereafter, “Program”). The Program mission is to provide training and mentorship to early career clinician researchers or post-doctoral scholars who are ethnically and culturally diverse and whose focus is reducing substance abuse and HIV transmission in underserved populations at high risk for traumatic stress and health disparities. The goal is for Scholars to establish career independence, including NIH funding for their research. This program represents an evolution of our multidisciplinary, multiethnic team’s NIMH ARRA-funded HIV/AIDS Translational Training Program, which successfully provided two years of training and mentorship to five postdoctoral scholars, several of whom have received or are seeking NIDA funding. Our pilot program highlighted the need to make substance abuse and traumatic stress more central to the Program’s conceptual orientation because this link has not been the focus of training grants that target underserved populations at risk for HIV and health disparities. Our Program will provide a two-year course of training and mentorship to a total of 20 (five per year for 4 years) early career clinical researchers and post-doctoral scholars who hold funded fellowships or other academic positions but need specific training in HIV/AIDS, substance abuse, traumatic stress and health disparities. Underserved populations, particularly those racial/ethnic minority populations, are disproportionately affected by substance abuse and HIV/AIDS and typically experience a high degree of traumatic stress. To learn about the confluence of these phenomena, Scholars will attend two week-long Institutes per year for two years and will receive continual, personalized career mentoring, training, and research supervision. Each cohort of Scholars will be followed for the duration of the training grant and each cohort will present their research in Year 2, form a network of collaborative mentoring, and come together in Year 5 to share their experiences and progress in achieving Program goals. Scholars will be mentored by a core faculty mentor as well as a “home” mentor, i.e., someone regularly accessible to the Scholar who has the relevant expertise and commitment to mentoring the Scholar for the duration of the Program. Each Scholar will be expected to use pilot funding from the Program to conduct research (e.g., qualitative study, secondary analyses, etc.) that will serve as preliminary studies in their NIDA application during their two year tenure.

Project Number: 5R25DA035692-025

Implementation Science for Intervention Delivery in Healthcare Settings

Abstract:  Implementation science examines the efficiency of intervention implementation and to translate the existing efficacious intervention models to real world services. It could potentially enhance the effectiveness and sustainability of the behavioral intervention projects. I received my PhD in epidemiology from the University of California, Los Angeles (UCLA) in 2009. Through my involvement in several large-scale HIV behavioral intervention projects and my doctoral dissertation study, I realized the importance of implementation science in intervention delivery and determined long-term career goal to become an implementation science researcher to bridge the gap between existing knowledge and service delivery. To fill in the gap between my current skill set and the career goal, I will receive training in areas related to implementation science, including health policy, intervention adaptation, and healthcare management. The health policy training will familiarize me with the process of policy development and its influence on the intervention adaptation and implementation; the intervention adaptation courses will inform me with the general concept and framework to design the study ensuring all aspects of intervention implementation are addressed; and the health management training will provide me with analytical tools to model leadership decision making and to evaluate the implementation flow in healthcare settings. The mentor team members, Drs. Li Li, Mary-Jane Rotheram-Borus, Thomas J. Coates and Zunyou Wu, are all internationally reorganized experts in behavioral intervention implementation and adaptation. My institute, the UCLA Semel Center for Community Health (CCH) and the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), UCLA, provide me with support from a multidisciplinary team of top researchers. Collaborating with the National Center for AIDS/STD Control and Prevention (NCAIDS), China CDC, I will conduct a mentored research using an intervention trial with significant yet heterogeneous outcome to investigate multilevel factors influencing the intervention implementation and outcome, and to find the optimal approach to incorporate the intervention model into the current healthcare settings. The study will be conducted in three phases. Phase 1 will be review of related policies and in-depth interviews with healthcare administrators and hospital directors, with the aim to explore the policy barriers and facilitators in adaptation of the intervention model. Phase 2 will be conjoint analysis with hospital directors to model the decision-making in intervention adaptation and routinization in the healthcare facilities. Phase 3 will be bottleneck analysis to locate structure bottlenecks in compliance with the intervention component. The finding will provide implications for future intervention delivery in healthcare settings. Application of some analytical tools in other fields, including conjoint analysis and bottleneck analysis, will potentially contribute to the development of implementation science methodology. Based on the data achieved from the study, I will prepare for a R01 application in implementation science in Year 4 of the K award period.

Project Number: 5K01MH1021447-05

MMT CARE for HIV Prevention: A Randomized Controlled Trial

Abstract: This project uses a combination prevention approach to respond to the urgent need for improved quality of services at methadone maintenance therapy clinics, provider-client interactions, and client outcomes.

We conduct the 5-year randomized controlled trial that targets methadone maintenance treatment (MMT) programs in China. Applying the principles of combination prevention, the intervention (MMT CARE) integrates psychosocial and behavioral components into a pharmacological framework for methadone maintenance. A total of 68 MMT clinics are randomly selected from five provinces. From each clinic, 6 service providers and 36 clients are recruited, totaling 408 providers and 2,448 clients in the study. The 68 clinics are randomized to 1) an MMT CARE intervention group or 2) a control group (34 clinics each). Service providers who complete the training conduct three individual motivational enhancement sessions with clients. Efficacy of the intervention is evaluated at baseline and at 6, 12, 18, and 24-month follow-ups.

Project Number: 4r01da033160-05

Natural History of AIDS in Homosexual Men

Abstract: The UCLA Center of the Multicenter AIDS Cohort Study proposes to continue to document clinical, immunologic, physiologic, behavioral, virologic, genetic and psychosocial changes in HIV-infected and -uninfected men-who-have-sex-with-men (MSM). This includes proposed studies to document these changes in MSM recruited 1983-4 and 2001-2, as well as plans to recruit new untreated and recently treated HIV-infected MSM (primarily African- and Hispanic- Americans), to maintain the cohort. The UCLA MACS will provide leadership and participation in the working groups, MACS-wide and local studies and research publications, and collaborative multi-cohort studies, as it has since the inception of the MACS 30 years ago. The UCLA MACS has recruited a large team of young and established co-investigators from a wide range of disciplines. These investigators have developed, and are continuing to develop, innovative proposals to advance our understanding of the pathophysiology, immunology, genetics and biobehavioral characteristics of treated and untreated HIV infection. The breadth, youth, experience and innovation of the UCLA MACS investigators, combined with the experience and commitment of the long-term staff, and our leadership of quality control procedures for immunologic and virologic measures and specimen processing, will continue to play an invaluable role in the success of the MACS over the next five years.

Project Number: 5U01SI035040-25

An mHealth Platform for Health Care Workers to Link South Africans to HIV Care

Abstract:  The South African National Development Plan recognizes the value of health care delivery models such as home based counselling and testing (HBCT) by aiming to train between 700,000 and 1.3 million community health workers (CHW) to implement community-based health care by 2030. The CHW role include working with households to facilitate access and linkage to primary health care facilities, provide outreach and community organization support, health education and coaching on health system navigation. Key barriers to sustainability and scale-up of community health worker programs include: i) a lack of integration between CHW and the health system; ii) poor tracking of how many people receive health services in their home; and iii) once referrals are successful, inadequate communication about the referral to and from the referral site. The South African health information system is currently ill equipped to handle these challenges and needs to be strengthened. We propose a 2-year study to develop and test a mHealth platform aimed at addressing these challenges for persons living with HIV (PLH). We focus on HIV due to the high prevalence rates in South Africa and impact that mobile technologies can make on HIV care. A mHealth platform will be developed that can be used by CHW to enroll household members and track their movement into and between health facilities. It will provide a standard interface by which current and future systems can query the stored data, thereby increasing interoperability and long term sustainability. The platform will unobtrusively support communication between clinic-based health providers and CHW supervisors. In summary, we aim to:1) Assess the perceived barriers and benefits to implementing an mHealth platform to link PLH to care through key informant interviews and foucs groups with health officials, clinic staff, CHW, and PLH; 2) Develop an mHealth platform that is inexpensive, scalable, open to integration, and can monitor patients from HBCT into facility based health care; and 3) Pilot test the mHealth platform and compare linkage to care between PLH from two communities that deploy our mHealth platform (mHealth communities) and PLH from two control communities where HBCT is currently being conducted without our mHealth platform. In the mHealth communities, we will also evaluate process measures to identify bottle necks between HBCT and visitation to an mHealth clinic.

Project Number: 5R21MH16351-02

Ai Shi Zi

Ai Shi Zi is a five-year NIMH-funded prevention and treatment study, the goal of which is to teach physicians how to enhance prevention and care for HIV and STIs. Because HIV and STIs are closely linked, prevention requires both state-of-the-art treatment and changes in sexual behavior. This study aims to teach physicians how to focus on both of these elements.

A total of 60 counties in China’s Anhui Province will be randomly assigned to one of two conditions: 1) primary and secondary training, in which county-level physicians are trained and, in turn, train township-level physicians; and 2) delayed-intervention control, in which physicians receive training only at the end of the 12-month assessment. Our primary endpoint is a hypothesized reduction in the one-year incidence of Chlamydia and gonorrhea among patients of trained county- and township-level physicians relative to delayed-intervention controls. Physicians and patients at the county- and township-levels will also be assessed using questionnaires at baseline and at 6 and 12 months following baseline.

Local significance (How has this project impacted the immediate population?):

This project provides training to county- and township-level physicians in Anhui Province, China and, hopefully, improved  care and treatment to their patients at risk for STIs, including HIV.

International significance (How has this project impacted the global community?):

This study may provide a useful model for training of physicians in a variety of developing country settings who care for patients at risk for STIs, including HIV.

NIMH Project Accept

Project Accept is a Phase III randomized controlled trial of community mobilization, mobile testing, same-day results, and post-test support for HIV in in sub-Saharan Africa and Thailand. Thirty-four communities in Africa (South Africa, Tanzania, and Zimbabwe) and 14 communities in Thailand are randomized to receive either a community-based HIV voluntary counseling and testing (CBVCT) intervention plus standard clinic-based VCT (SVCT), or SVCT alone. The CBVCT intervention has three major strategies: (1) to make VCT more available in community settings; (2) to engage the community through outreach; and (3) to provide post-test support. These strategies are designed to change community norms and reduce risk for HIV infection among all community members, irrespective of whether they participated directly in the intervention.

Research Methods:  

  • Community Engagement
  • Baseline Behavioral Assessment
  • Community Matching
  • Qualitative Assessment
    • Community Mapping and Ethnography
    • In-Depth Interviews
  • CBVCT Communities
    • Community Mobilization
    • Easy Access to VCT
    • Post-Test Support Services
    • Quality Assurance
  • Control Communities
    • Clinic-Based VCT
    • Quality Assurance
  • Post-Intervention Assessment
    • Post-Intervention Biological Assessment
    • Post-Intervention Behavioral Assessment
  • Cost-Effectiveness Analysis

From the perspective of national AIDS control planners in hard-hit countries, evidence-based strategies that have maximum epidemic impact are critically needed. These planners need interventions that are sustainable and can be adapted to the context of their local cultures. This is the first randomized controlled Phase III trial to determine the efficacy of a behavioral/social science intervention with an HIV incidence endpoint in the developing world. Provided that we can document efficacy with regard to HIV incidence and incremental cost-effectiveness, we expect that resources for widespread implementation of community-based VCT will become available from USAID or the Global Fund. We have worked closely with representatives of national AIDS programs in the host countries to ensure that the intervention is sustainable even in countries with limited resources.

 

Promoting Migrant Health Through HIV Awareness

For some Mexican migrants, the opportunities for receiving HIV-related interventions may be quite limited, especially for migrants who are in transition from one locale to another and who may not have the residential stability oftentimes required by HIV prevention programs.  Such transient populations may benefit from HIV prevention programs provided by individuals with similar backgrounds as theirs who are able to provide HIV-related information in informal one-on-one settings in the migrants’ own environments.  This project seeks to determine whether a peer education intervention with Mexican migrants is just as effective as a provider-based small group HIV prevention lecture as measured by the recipients’ HIV knowledge, HIV-related risk reduction skills, self-efficacy with respect to such skills, and intentions to engage in low-risk practices.

A total of 612 Mexican migrants will be recruited.  Mexican migrants from three migrant shelters in Mexicali will be trained as peer educators of a theory-driven HIV prevention intervention.  Each peer educator will conduct individual educational interventions with other Mexican migrants.  An outcome evaluation will be conducted to determine the extent to which those who received the peer education intervention differed from the recipients of the small group HIV prevention lecture with regards to the areas mentioned above and how both interventions differed from a no-treatment control group.

 

Testing of an HIV Prevention Card Game for the Angolan Armed Forces

Brief overview: The goals of this pilot study are to evaluate the effectiveness and cultural applicability of a game that promotes greater awareness of HIV/AIDS prevention messages.  By using a consumer driven approach and adapting innovations from computer and video gaming, a low-cost prevention tool can be produced and utilized throughout a resource-poor country that is threatened by rising HIV infections. Specifically, this proposal aims 1) To assess the added benefit of learning a novel, entertaining and culturally appropriate HIV prevention card game on HIV-related knowledge, attitudes and behaviors among Angolan soldiers receiving a standard HIV prevention intervention, and 2) To assess the diffusion of the game to others residing on the same base where the game is being taught and determine its impact on their HIV related knowledge, attitudes and behaviors.

Creating a culturally appropriate and enjoyable card game that promotes HIV/AIDS prevention has the potential to substantially increase awareness of risk behaviors and prevention methods in a high risk group. In the long-term, prevention materials that engage and entertain may have greater and longer lasting impact than other types of prevention strategies particularly in low resource settings where there are fewer opportunities for novel entertainment.

Geographical Location: Angola

Targeted risk group: Soldiers

Intervention Model: Randomized Control Trial

Research methods: Community-based randomize control trial with participants randomized to either an HIV prevention lecture or an HIV prevention lecture in which they are also taught to play the card game.  Knowledge of HIV assessed at pre- and post-intervention

Local and International significance: In very low resource settings with low literate populations, low cost, low tech prevention solutions that are culturally congruent may work best.  Among soldiers a card game that also teaches an HIV prevention message may be an effective strategy to increase knowledge of HIV and help reduce risk.

Community Health Study

There have been few attempts to monitor the risk behaviors and HIV seroprevalence among the general population.

Understanding the HIV epidemic in Los Angeles requires establishing an integrated, multilevel surveillance system for HIV, sexually transmitted diseases (STDs), and the Hepatitis C virus (HCV). Information about sexual and substance use risk behaviors, HIV seroprevalence, and public knowledge, attitudes, and norms regarding HIV are needed for public health planning. A surveillance system will be required in order for Los Angeles to maintain funding for Ryan White and other federal and state funding sources. To begin to develop a method for mounting a comprehensive surveillance system, the City of Los Angeles is planning a study examining the acceptability of anonymous HIV testing and volunteering information about one’s risk behaviors in order to allow planning for HIV-related services.

Most studies of HIV seroprevalence and risk behaviors have been conducted with subgroups identified at high risk for HIV: young gay men, injecting drug users, homeless adolescents, or seriously mentally ill adults. There have been few attempts to monitor the risk behaviors and HIV seroprevalence among the general population (not necessarily from identified high-risk groups). Before any comprehensive surveillance system can be established, the ability to monitor HIV in community settings and among households in neighborhoods with high rates of AIDS cases must be established. To fill this gap, a two-phase project is being initiated by the city in order to assess the acceptability of HIV testing and reporting one’s risk behaviors when approached: 1) in a household survey; or 2) in a neighborhood setting such as a shopping mall, grocery center, theater, or church.

First, the acceptability of gathering HIV-related information from a household will be examined by conducting a supplement to the Los Angeles Health Survey that will be mounted this summer. An anonymous telephone interview will be conducted with random digit dialing of households within the City of Los Angeles. Randomly selected telephone numbers (n=100) will be surveyed on knowledge of transmission of HIV, attitudes and norms towards members of high-risk groups (e.g., gay men) and infected persons, and willingness to anonymously be tested for HIV. All responses will be recorded unlinked from telephone numbers selected by random digit dialing; therefore the identify of all respondents will be unknown and can never be traced. From gathering this information, the acceptability of a household approach as a method of gathering information about HIV-related information will be assessed.

Second, a community with a high rate of AIDS cases will be selected. In this neighborhood, local leaders will be consulted to identify a strategy for sampling community members anonymously and in settings accessible to all community members. In shopping malls in both communities, adults will be asked to anonymously volunteer to participate in a survey of attitudes and norms regarding HIV prevention activities, recent sexual and substance use risks acts, and consent to a saliva-based HIV test. The results of any individual test results will not be available; unmarked samples will be collected in order to indicate a community seroprevalence rate. Interested individuals will be offered an incentive for participating in the survey and test. The willingness of adult members of the community to participate in a study anonymously will be evaluated. Similar to the telephone household survey, no identity of any participant will be obtained. Overall, community rates will be obtained, but no individual information regarding risk or infection status.

The results of these two activities will be used to inform the Los Angeles County Board of Supervisor’s decisions regarding the best method for establishing surveillance methods for HIV infection and predictions regarding the future routes and subgroups for HIV infection. Currently, the County is considering adopting a method of practitioners informing public health officials of all persons testing seropositive for HIV or for a system of unique identifiers for persons who test seropositive for HIV. Both of these systems rely on the identification of seropositive persons, an event that typically occurs about 10 years after a person has become infected. Alternative strategies for monitoring the epidemic, especially among communities with an emerging epidemic must be identified. These studies will inform the strategy selected by the County and may become a national model.

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