mHealth to Enhance & Sustain Drug Use Reduction of the QUIT BI in Primary Care

Abstract:The QUIT-Mobile study proposes to use mobile phone self-monitoring and feedback to enhance and sustain over 12-months the impacts of the Quit Using Drugs Intervention Trial (QUIT), an ef- fective screening and brief intervention (SBI) previously successful in reducing risky drug use (i.e., moderate use) in low-income, diverse patients over a 3-month follow up. We propose to conduct the QUIT-Mobile study for primary care patients who receive care in 8 clinics of federally qualified health centers (FQHC) in Southern California over 12-months follow up, comparing to QUIT and Usual Care (UC). The proposed study is an Effec- tiveness-Implementation Hybrid Type 1 design consisting of a single-blind, 3-arm, RCT with adult, mostly La- tino FQHC primary care patients with risky drug use (ASSIST score 4-26), randomized to 3 conditions (n=320/arm, n=960 total): 1) QUIT-Mobile; 2) standard QUIT; 3) Usual Care. Qualitative data on implementa- tion facilitators and barriers will inform future scale-up and sustainability, in addition to cost data and cost-effec- tiveness analysis. The aims are to examine effectiveness in reducing risky drug use and cost-effectiveness comparing the three arms over 3-, 6- and 12-months. Drug use measures include urine drug tests, and timeline follow-back self-reports for past 7-days and past 30-days (risky drug users have sporadic drug use patterns requiring longer self-report recalls for drug use that urine screens may not detect). The 3-arm study enables testing of the independent and synergistic effects of QUIT-Mobile compared to QUIT and both to Usual Care, acknowledging that mHealth components alone may not be effective outside of a clinical/coaching relationship. The 12-month timeline reflects anticipated scale-up scenarios of annual primary care visits when screening and brief intervention would be repeated routinely. QUIT contains 3 components: 1) patient screening with the WHO ASSIST, 2) brief clinician advice (<4 minutes) including opioid overdose prevention education, and 3) 2- and 6-week telephone drug-use health coaching sessions utilizing motivational interviewing and cognitive be- havioral techniques, delivered by paraprofessional health coaches. QUIT-Mobile proposes to test the addition of mobile phone self-monitoring, feedback, and coach monitoring dashboard to enhance and sustain QUIT’s drug use reductions using mobile app, text-messaging (SMS), or interactive voice response (IVR) to allow par- ticipation by with varying technological preferences. This study does not test which technology platform is more effective, but rather, the effectiveness of the intervention functions (i.e., self-monitoring, automated feedback, coach monitoring) that are delivered via patients’ preferred technologies. This study is novel and timely in inte- grating massively scalable mobile phone tools into an effective primary care BI to prevent substance use disor- der (SUD) in FQHC patients delivered by paraprofessionals. QUIT-Mobile is responsive to the National Opioid Crisis, and the US Mental Health Parity Act and National Academy of Medicine recommendations to integrate behavioral health SBIs into primary care settings to prevent higher level SUD requiring specialty treatment.

Project Number: 5R01DA047386-03

https://reporter.nih.gov/search/XqGvUHDw-U2JrS-UaBk2iQ/project-details/10381700

 

Contact PI/ Project Leader

GELBERG, LILLIAN GELBERG, GEORGE F. KNELLER PROFESSOR (lgelberg@mednet.ucla.edu)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: Only recently has a screening and brief intervention in low-income primary care settings been shown to reduce patients’ illicit drug use over 3-months. Good as this finding is, the next challenge is to sustain patients’ drug use reductions over 12-months to coincide with routine annual primary care visits for rescreening. We propose adding mHealth tools to enhance and sustain drug use reductions in an effective SBI to reduce drug use and prevent addiction.

 

 

Project Start Date: 01-June-2020

Project End Date:31-March-2025

Budget Start Date: 01-April-2022

Budget End Date: 31-March-2023

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE OF DRUG ABUSE / FY Total Cost by IC: $746,806

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: 5U19HD089886-05

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

 

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:  Unavailable

 

FOA: RFA-HD-16-035Study Section: ZHD1-DSR-N

 

Project Start Date: Unavailable

Project End Date: 31-May-2022

Budget Start Date: 01-June-2020

Budget End Date: 31-May-2021

 

NIH Categorical Spending

Funding IC:  EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT / FY Total Cost by IC: $200,503

Biobehavioral Research Approaches to reduce Effects of Trauma on Mental and Physical Health and Cognitive Outcomes in South Africa

Abstract: The UCLA/South African Trauma Training Research (Phodiso) Program seeks five additional years of funding to prepare future investigators to conduct research on trauma exposure and injury prevention in the context of South Africa’s high levels of interpersonal and community violence and intentional injuries. The Phodiso Program is an international collaboration between UCLA and the South African Research Consortium (SARC), which includes the Human Sciences Research Council (HSRC), North-West University (NWU), and University of Cape Town (UCT) and is based on a number of NIH-funded projects: 1) The Eban Project, a randomized clinical trial testing a culturally congruent intervention for HIV serodiscordant African American couples (R01; 2001-2009; El Bassel, et al., 2010); 2) The Implementation of the Eban Project, (NIH RO1; 2012-2017) 3) The Aftermath of Rape among South African Women (The Fulufhelo Project), a study examining the short- and long-term psychosocial sequelae of rape among South African women (R03; 2009-2013); and 4) The HIV/AIDS Substance use and Trauma Training Program for racial and ethnic minority postdoctoral scholars and early career investigators (R25; 2013-2018) (Wyatt and Milburn, co-PIs). Guided by ecological theory, social learning theory, and the Sexual Health Model, the focus of the Phodiso Scholar’s research will be to minimize the negative health and mental health effects of trauma exposure, specifically depression and post-traumatic stress disorder (PTSD), in South Africa. An additional emphasis of the training will focus on the neurobiological and neurobehavioral manifestations of trauma, disease, substance use and intentional injury. In the past 10 years of funding, a total of eleven scholars have graduated from the Phodiso program and will join the core SARC and the TAMT, to assist with mentoring new Scholars. For this renewal, the UCLA and SARC core faculty and TAMT will conduct a countrywide application process to select one early career research candidate per year for a two-year postdoctoral fellowship. Scholars will receive research mentorship including a quarter of study (i.e., a 3-month period) at UCLA, one selection and planning meeting and one short-term trauma workshop each year in South Africa. Scholars will conduct their own research projects in South Africa as a basis for future studies in this field, and work closely with their SARC host university and TAMT mentors. The Phodiso Trauma Training program and the research careers of the scholars will be tracked over time. Specifically, the sustainability of the training program and integration into academic, private, and government-supported agencies and the Scholar’s ability to establish and sustain independent research careers will be evaluated and documented. Future goals will include encouraging the South African government to adopt the Phodiso program as a successful and replicable model of cross-cultural trauma research training.

Project Number: 2D43TW007278-11

https://reporter.nih.gov/search/3mBMfcaKOkGk9o8D_fB3Zw/project-details/9232020

 

Contact PI/ Project Leader

WYATT, GAIL E, PROFESSOR (GWYATT@MEDNET.UCLA.EDU)

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: Myanmar has experienced one of the most serious HIV/AIDS epidemics in Southeast Asia. Because the country has been isolated from the rest of the world for 50+ years, there are very few researchers and public health specialists trained in advanced research methodologies who can do research to guide HIV/AIDS policy and staff the Myanmar University of Public Health. This program will address that need by providing degree and postdoctoral training in advanced research methodology.

 

 

Project Start Date: 25-May-2005

Project End Date: 31-August-2021

Budget Start Date: 15-September-2016

Budget End Date: 31-August-2017

 

NIH Categorical Spending

Funding IC:  FOGARTY INTERNATIONAL CENTER + OFFICE OF THE DIRECTOR, NATIONAL INSTITUTES OF HEALTH/ FY Total Cost by IC: $269,997

The impact of cannabinoids on inflammation, HIV viral load and symptoms of distress among persons living with HIV

Abstract: This Mentored Research Scientist Development Award (K01) will provide Dr. Chukwuemeka N. Okafor with training and expertise needed to facilitate his transition toward research independence in HIV and drug use prevention research. Dr. Okafor’s proposed training plan is designed to build upon his previous work in HIV and drug use epidemiology to increase his knowledge and expertise in: (1) the design, implementation and analysis of clinical trials and behavioral interventions for drug use prevention in the context of HIV (2) addiction research and research that integrates behavioral science and biological markers in the context of drug use and HIV (3) training in the ethical conduct of research and (4) career skills necessary for academic research. Dr. Okafor will achieve these training goals via didactic coursework, directed readings, workshops, scientific conferences, fieldwork and mentoring from an expert multidisciplinary panel of mentors led by Dr. Steve Shoptaw (primary mentor). The proposed research activities addresses an important public health issue regarding the impact of cannabis on health outcomes among persons living with HIV (PLWH). Majority of the few studies of the consequences of cannabis use in PLWH have produced mixed findings. Potential explanations for lack of clear evidence of the health consequences of cannabis might be due to the different active constituents (cannabinoids) in the cannabis products used. Tetrahydrocannabidiol (THC) and cannabidiol (CBD) are the most frequently studied cannabinoids and growing evidence suggest that they have opposing effects on symptoms of distress (e.g. depression and anxiety) and HIV relevant health outcomes (inflammation and HIV viral load). Specifically, THC is associated with mood altering and negative health effects, while CBD does not alter mood and may have therapeutic properties. Therefore, whether quantifiable biomarkers of THC and CBD in PLWH who use cannabis can provide clarification on the consequences of cannabinoids in PLWH has not being determined. The proposed project will employ two approaches to address this question including a secondary analysis of existing data from a cohort study and a pilot feasibility study involving PLWH who use cannabis. Specifically, the proposed project aims to: 1) determine relationships between measured concentrations of THC and CBD in urine with biomarkers of inflammation and HIV viral load in PLWH, (2) investigate associations between measured concentrations of THC and CBD in urine with symptoms of distress among PLWH and 3) To determine feasibility of and impact of a 28-day cannabis abstinence based contingency management (CM) program on changes in symptoms of distress, inflammation and HIV viral load. Completing the proposed project will provide an excellent pedestal for Dr. Okafor to transition into an independent research career.

Project Number: 1K01DA047912-01A1

https://reporter.nih.gov/search/DNeos6ubMUitt9tNVrm4Lg/project-details/9779460

 

Contact PI/ Project Leader

SHOPTAW, STEVEN J, PROFESSOR (sshoptaw@mednet.ucla.edu)

 

Organization

BAYLOR UNIVERSITY

 

PUBLIC HEALTH RELEVANCE: With the evolving state laws governing cannabis use in the United States, there is a need for sound scientific evidence on the impact of the different active constituents in cannabis on the health outcomes of vulnerable populations particularly persons living with HIV (PLWH). Through this K01 award, I will develop skills and knowledge in clinical trials, behavioral interventions for drug use, addiction research and research integrating biological markers in HIV and drug use research. Findings from this study will provide timely data on the impact of THC and CBD on symptoms of distress, inflammation and HIV viral load in PLWH.

 

 

Project Start Date: 01-August-2019

Project End Date: 31-July-2024

Budget Start Date: 01-August-2019

Budget End Date:31-July-2020

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE ON DRUG ABUSE/ FY Total Cost by IC:  $156,368

Linking Refugees to HIV Clinical Care in Uganda

Abstract: There are an estimated 3.4 million refugees living in sub-Saharan Africa, a region of the world which hosts 71% of the global population living with HIV. Displaced for an average of 17 years, refugees are a vulnerable population at risk of exposure to HIV due to violence and persecution. With competing survival needs, language and cultural barriers, and disrupted social networks, refugees face unique challenges accessing HIV care. HIV prevalence in refugee settlements in sub-Saharan Africa is often unknown and HIV research in this population is limited. Candidate: During my research fellowship, I conducted a clinic-based routine HIV testing study in Nakivale Refugee Settlement in Uganda demonstrating that only 54% of newly diagnosed HIV-infected clients linked to care. I am applying for a K23 Career Development Award to acquire the skills to become an independent investigator focused on understanding linkage to HIV care for refugees and developing interventions to improve engagement in care for this unique population. Mentoring: Dr. Ingrid Bassett (Mentor) is an expert on linkage to HIV care in resource-limited settings and winner of the Harvard Medical School Young Mentor Award. I will also be guided by Co-Mentors, Dr. Paul Spiegel (the Deputy Director of the Division of Programme Support and Management at the United Nations High Commissioner for Refugees [UNCHR], expert in the structural dimensions of refugee health), Dr. Edgar Mulogo (HIV researcher, faculty in Uganda), and Dr. Laura Bogart (expert in behavioral science, HIV intervention research, and qualitative methods). Committed advisors include Dr. Richard Mollica (Director of the Harvard Program in Refugee Trauma), Dr. Alexander Tsai (psychiatrist, expert on psychosocial intervention research for HIV- infected people in Uganda), Dr. Julius Kasozi (UNHCR in Uganda, expert in refugee health and Uganda health policy), Dr. Michael VanRooyen (Director of the Harvard Humanitarian Initiative), Dr. Norma Ware (qualitative methods), and Dr. Robert Parker (biostatistics, HIV trial design). Research: Within the social-ecological framework, I will 1) use qualitative methods to understand barriers to HIV care and means to overcome barriers for refugees in Nakivale; 2) prospectively enroll a cohort of HIV-infected refugees to assess which social-ecological factors correlate with failure to link to HIV care in Nakivale; and 3) use intervention mapping methodology to develop, implement, and evaluate a pilot intervention to improve linkage to HIV care in Nakivale. Training: The research is supported by training in health behavior theory and ecologic context of HIV care in resource-limited settings with an in-depth focus on mental health, analytic techniques including survey and geographic information system methods, and intervention development. The project will provide training and pilot data needed to develop an R01 application for a randomized HIV linkage intervention trial in three refugee settlements in Uganda. With my dedication to evaluating interventions to improve care for refugees, support from an exceptional mentoring team, strong institutional commitment, and an innovative research plan, I am well-positioned to become an independent clinical investigator focused on refugee health.

Project Number: 5K23MH108440-06

https://reporter.nih.gov/search/qs4MWlGAxUeMKzbgrNfMIA/project-details/9935159

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

PUBLIC HEALTH RELEVANCE: Refugees in sub-Saharan Africa face considerable hardships accessing HIV clinical care. I propose to evaluate barriers to linkage to HIV care and potential means to overcome those barriers in Nakivale Refugee Settlement in Uganda. I will develop and pilot a refugee-specific linkage intervention to assess whether this strategy improves engagement in care for newly diagnosed HIV-infected clients in the settlement.

 

 

Project Start Date: 01-August-2019

Project End Date: 31-May-2022

Budget Start Date: 01-June-2020

Budget End Date: 31-May-2022

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $186,192

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

Developing Capacity for Opioid Use Disorder Treatment in Mental Health

Abstract: Untreated opioid use disorders (OUDs) can have devastating consequences for people with serious mental illness (SMI). While the size of the population with unmet need is unknown, studies indicate that 87% of US adults with co-occurring disorders do not receive SUD treatment, and large numbers of individuals with mental illness are on chronic prescription opioids, a risk factor for heroin use and the development of an OUD. Untreated OUDs in the SMI are important because OUDs increase morbidity and mortality and are associated with higher healthcare and social costs, homelessness, and incarceration. Increasing access to OUD treatment and improving patient outcomes in the SMI will require addressing both the supply of and the demand for treatment. At the system and provider level, the availability of treatment needs to be increased. At the patient level, patient demand for treatment needs to increase, by identifying and addressing patient perceptions of need, desire and preferences for treatment. In this developmental R34, we propose to evaluate system, provider and patient-level facilitators and barriers, and then to use this information to develop an implementation strategy and toolkit to promote the use of medication assisted treatment (MAT)–the use of FDA-approved medications for OUDs in combination with behavioral therapies–for people with COD receiving public mental health treatment. The results of the R34 will prepare us for a future R01 study of the effectiveness of the implementation strategy and toolkit on MAT adoption, implementation and sustainability. We focus on MAT because of its demonstrated effectiveness and cost-savings, and specialty mental health because of the large role the mental health system plays in treating individuals with COD. Aims 1-3 seek to assess organizational capacity (at the system and provider level); organizational readiness (at the provider level); and perceived needs, attitudes and preferences (at the patient level). In Aim 4, we will use findings from Aims 1-3 to guide development of the implementation strategy and toolkit, using stakeholder input and a systematic process for strategy development. By implementation strategy we mean a group of implementation interventions that will address barriers at multiple levels. By toolkit, we mean the resources providers and clinics will need to execute implementation. To conduct the research, we will collaborate with the Los Angeles County Department of Mental Health, the largest mental health department in the United States. Despite serving nearly 20,000 individuals with COD, in 2016 only 37 prescriptions for MAT were written. Using a mixed methods approach, we will conduct interviews, focus groups, and surveys with patients and providers from 8 clinics serving an ethnically and geographically diverse population. Our study is a first step towards increasing access to OUD treatment for a vulnerable, costly and underserved population. Our approach is innovative because we consider barriers from the system, provider, and patient perspectives, and address both organizational supply and patient demand.

 

Project Number:5R34DA046950-03

https://reporter.nih.gov/search/lgY4Yg_KkkiENbzm6wpebg/project-details/9989081

 

 

Contact PI/ Project Leader

OBER, ALLISON, ASSOCIATE BEHAVIORAL SCIENTIST (ober@rand.org)

 

 

Organization

RAND CORPORATION

 

 

PUBLIC HEALTH RELEVANCE: Opioid use disorders (OUDs) can have devastating consequences for people with serious mental illness. We propose to evaluate system, provider and patient-level facilitators and barriers, and then to use this information to select and tailor an implementation strategy to promote the use of medication assisted treatment (MAT)–the use of FDA-approved medications for OUDs in combination with behavioral therapies–for people with co- occurring disorders receiving public mental health treatment. Our study is a first step towards increasing access to OUD treatment for a vulnerable, costly and underserved population.

 

 

Project Start Date: 15-September-2018

Project End Date:28-February-2023

Budget Start Date: 01-September-2020

Budget End Date: 28-February-2023

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $133,361

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

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

 

Project Number:5R01NR017334-05

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

 

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

 

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

 

 

Project Start Date: 01-May-2017

Project End Date:28-February-2023

Budget Start Date: 01-March-2021

Budget End Date: 28-February-2023

 

 

NIH Categorical Spending

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

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.