Mental Health - CHIPTS - Center for HIV Identification, Prevention and Treatment Services

26Oct

Resiliency Education to Reduce Depression Disparities

Abstract: Depression is the leading cause of adult disability and common among lesbian, gay, bisexual (LGB) adults. Primary care depression quality improvement (QI) programs can improve outcomes for minorities more significantly than for nonminorities, but they are seldom available in safety-net systems. We build on findings from Community Partners in Care (CPIC) and Building Resiliency and Increasing Community Hope (B-RICH). CPIC compared depression QI approaches across healthcare and social /community services in communities of color. CPIC included healthcare and “community-trusted” programs (e.g., homeless, faithbased) to work as a network to address depression, compared to individual-program technical assistance. In CPIC, both conditions improved mental wellness, mental health quality of life, and depression over 12 months. B-RICH, a randomized study, evaluated lay delivery of a seven-session, CBTinformed resiliency education class versus case management on patients’ depressive symptoms over three months, in unpublished but completed analyses. The proposed demonstration supplements the resiliency class with a mobile/interactive voice response case management tool to reinforce class content and depression care reminders (BRICH+).

26Oct

Xiangya-UCLA HIV/AIDS Nursing Research Initiative

Abstract: The long-term objective of the Xiangya-UCLA HIV/AIDS Nursing Research Initiative is to enhance capacity at Xiangya School of Nursing (Central South University, Hunan, China) and affiliated institutions to conduct research addressing questions in HIV/AIDS nursing with a focus on mental health and management of cognitive/affective symptoms of HIV and concomitant conditions. Specific aims include 1) development of research expertise in a cadre of Chinese nurses and psychologists who will conduct collaborative HIV/AIDS behavioral research; and 2) enhancement of the institutional capacity for nursing, mental health and behavioral HIV/AIDS research, including rigorous measurement of biological outcomes. The research training plan comprises 1) long-term (9 month) post doctoral training in HIV behavioral studies for 8 Chinese investigators at UCLA; 2) medium term training (6 months) in measurement of biological outcomes for 1 Chinese laboratory fellow at Yale and UCLA; 3) part-time, long term, in-country training in behavioral research methods for a cohort of 20 Chinese nurses and psychologists; and 4) mentored research projects. The proposed program responds to and extends ongoing HIV/AIDS collaborations which have demonstrated the need for additional post doctoral training in order to conduct rigorous studies of emerging questions related to mental health and behavioral aspects of HIV/AIDS in China including measurement of biological outcomes. The rationale for the program is that while Xiangya has strengthened its doctoral studies program for nurses and psychologists, local expertise is limited regarding the behavioral research methods that are key to high quality investigations of psychosocial and self-management issues of interest to nurse-researchers and psychologists. The program links nursing and psychology in recognition of common academic interests and the existing relationship between these two disciplines among the partner institutions. The program design builds in collaboration, long term mentorship and ongoing support of trainees as they design, implement, and evaluate mentored research of immediate relevance to China and by extension to similar countries faced with maturing HIV epidemics. It is anticipated that this program will substantially increase the number of young and mid career nurse-scientists, psychologists, and others conducting research related to the mental health and behavioral aspects of HIV/AIDS. Increased capacity will be measured by the number of research projects conducted by trainees; peer reviewed publications and professional presentations; successful applications for external funding; and number of courses taught and individuals mentored by trainees.

Project Number: 5D43TW009579-05

https://reporter.nih.gov/search/mAvAx45hhkqjhRc3K-_7tQ/project-details/9246344

Contact PI/ Project Leader

LI, LI, (lililili@ucla.edu)

KONIAK-GRIFFIN, DEBORAH, PROFESSOR, (dkoniak@sonnet.ucla.edu)

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

PUBLIC HEALTH RELEVANCE: This project will provide advanced training in HIV/AIDS research with a focus on mental health and management of cognitive/affective symptoms of HIV and concomitant conditions for nurses and psychologists at Xiangya School of Nursing in Hunan, China. The training will improve the ability of researchers at Xiangya to conduct studies of behavioral interventions for HIV/AIDS with benefits for patients in both the developed and developing world.

FOA: PAR-12-068/ Study Section: Special Emphasis Panel[ZRG1-AARR-H(57)R]

Project Start Date: 25-July-2013

Project End Date: 31-January-2019

Budget Start Date: 01-February-2017

Budget End Date: 31-January-2019

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE + FOGARTY INTERNATIONAL CENTER/ FY Total Cost by IC: $271,595

26Oct

Siempre Seguire: A Pilot Intervention to Improve Coping With Discrimination and Adherence Among HIV-Positive Latino MSM

Abstract: HIV-related disparities in diagnosis and disease outcomes persist among Latinos, and Latinos living with HIV show a lower percentage of viral suppression compared to the general HIV-positive population. A growing body of work suggests that stigma and discrimination contribute to health disparities, especially among people living with HIV, who may experience discrimination due to multiple stigmatized identities related to HIV- serostatus, race/ethnicity, and sexual orientation. Internalized stigma and discrimination may lead to health- related disparities by increasing detrimental physiological stress responses, resulting in maladaptive coping and poor health behaviors, including non-adherence to treatment. Moreover, the chronic stress of discrimination may weaken immune function, leading to worse HIV outcomes, including increased HIV viral load. In the proposed research, we will integrate adherence skills-building strategies into a recently developed intervention, Siempre Seguiré, a 7-session group cognitive behavioral therapy (CBT) intervention for HIV- positive Latino men who have sex with men (LMSM) that aims to improve adaptive coping responses to discrimination. In a small pilot of 30 participants, the intervention was associated with improved coping at follow-up as compared to baseline. However, this pilot did not include a control group, did not address or examine HIV-related behaviors and outcomes such as adherence, retention in care, and viral load suppression, and had a very low sample size. Thus, in the proposed research, we will conduct a larger pilot study in which preliminary effects on HIV outcomes can be assessed. The specific aims are: (1) To modify and refine Siempre Seguiré, a newly developed culturally congruent CBT group intervention for HIV-positive LMSM, to include strategies for antiretroviral treatment adherence and retention in HIV care; and (2) To conduct a small randomized pilot of Siempre Seguiré to examine feasibility and acceptability, as well as to explore preliminary effects on: (a) coping responses to discrimination; and (b) antiretroviral treatment adherence, viral load suppression, and HIV care retention, among LMSM living with HIV. In Phase 1, we will work with HIV treatment adherence intervention experts and key stakeholders, including a community advisory board, to refine our pilot intervention as needed and update our manual to integrate information and skills building regarding HIV treatment adherence and retention in care. In Phase 2, we will conduct a small randomized controlled trial of 80 participants (40 intervention participants divided evenly over 4 intervention groups vs. 40 wait-list control participants). To our knowledge, our study will be the first to test an intervention that addresses coping with discrimination from multiple identities. Our proposed research is consistent with the Institute of Medicine report, The Health of Lesbian, Gay, Bisexual, and Transgender People, which recommends developing interventions to address racial disparities and mental health effects of discrimination among sexual minorities.

Project Number: 1R34MH113413-01A1

https://reporter.nih.gov/search/NfaaiDsLWUizEGUyXRmd4w/project-details/9407123

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 men who have sex with men, show HIV-related disparities, tending to be diagnosed at a later disease stage, leading to delays in care entry and antiretroviral treatment use, and lower rates of viral suppression. No culturally congruent interventions have been developed to address stress resulting from discrimination, a key contributor to disparities in HIV outcomes among Latino men who have sex with men. We propose to integrate adherence skills-building into a recently developed intervention that addresses coping with discrimination among Latino men who have sex with men.

FOA: PA-14-179/ Study Section:Behavioral and Social Consequences of HIV/AIDS Study Section[BSCH]

Project Start Date:01-August-2017

Project End Date: 31-May-2020

Budget Start Date: 01-August-2017

Budget End Date: 31-May-2018

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH/ FY Total Cost by IC: $194,834

15Feb

China TEA (Together for Empowerment Activities)- Intervention for HIV Affected Families

Abstract: This 5-year project is a randomized controlled trial of the TEA (Together for Empowerment Activities) intervention. TEA intervention is an innovative, theoretically-based, culturally sensitive family intervention for HIV-affected families in rural China. The intervention will have six sessions (plus a preparation session) delivered at three levels simultaneously: 1) TEA Gathering (small group for parents living with HIV (PLH) and their family members), 2) TEA Time (home-based family activities with children), and 3) TEA Garden (community events). Built on the extensive pilot work by the collaborative team in the past 5 years, we propose to conduct the randomized controlled trial of TEA intervention with 480 HIV-affected families in 24 villages in Anhui, China, including 480 PLH, 480 sero-negative family members, and 720 children aged 6-18. We will randomly assign villages to either: 1) TEA intervention group (with all three levels of activity), or 2) a control group (with limited activities). The efficacy the intervention will be determined over 24 months at five time points: baseline, 6, 12, 18, and 24 month follow-ups. The primary outcomes are children’s physical health, mental health and behavioral adjustment. Secondary outcomes will be the PLH’s and family members’ physical health, mental health, and quality of life, as well as family indicators such as consistent daily routines, positive family interactions, parenting, coping, and community integration.

HIV has impacted extended families by shifting the life patterns not only for the persons living with HIV/AIDS, but also for their children, partners, and other family members. Based on the previous pilot work we are currently conducting this 5-year randomized controlled trial of the TEA (Together for Empowerment Activities) intervention for HIV-affected families in rural areas of China.

A randomized controlled intervention trial in 480 HIV-affected families, including 480 PLH, 480 family members and about 720 children aged 6-18.
Intervention outcome will be assessed by making comparison between the intervention and control groups at baseline, 6, 12, 18, and 24 month follow-ups.

TEA intervention manual

Project Number: 5R01HD068165-05

https://reporter.nih.gov/search/4Ga-UvQgREuvFtXvdJhDyQ/project-details/8851998

Contact PI/ Project Leader

LI, LI (lililili@ucla.edu)

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

PUBLIC HEALTH RELEVANCE: The need to respond to the HIV epidemic is a global public health priority. The proposed study responds to the urgent need for interventions for PLH, family members, and children impacted by HIV/AIDS in China. Resulting data will provide an evidence-based intervention that can be delivered to HIV-affected families in China and other countries.

FOA: PA-10-067/ Study Section: Behavioral and Social Consequences of HIV/AIDS Study Section[BSCH]

Project Start Date: 01-May-2011

Project End Date: 31-October-2016

Budget Start Date:01-March-2015

Budget End Date: 31-October-2016

NIH Categorical Spending

Funding IC: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT/ FY Total Cost by IC: $511,460

24Jan

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.

23Jan

Teens and Adults Learning to Communicate (TALC: LA)

Project TALC was funded by the National Institute of Mental Health (NIMH) to evaluate the efficacy of a family-based intervention over time and to contrast the life adjustments of HIV-affected families and their non-HIV-affected neighbors in the current treatment era. Mothers living with HIV (MLH; n = 339) and their school-age children (n = 259) were randomly assigned to receive a behavioral intervention or standard care as the control condition. MLH and their children were compared to non-HIV-affected families recruited at neighborhood shopping markets.

Targeted Risk Group:

HIV-positive mothers and their adolescent children

Published Journal Articles:

[Download not found]
[Download not found]
[Download not found]
[Download not found]
[Download not found]
[Download not found]
[Download not found]
[Download not found]
[Download not found]
[Download not found]
[Download not found]
[Download not found]

Links to Interventions, Training Manuals, etc. :

Phase 1 – Taking Care Of Myself

Parents’ Curriculum

Phase 2 – Illness

Parents’ Curriculum

Adolescents’ Curriculum

Phase 3 – Adjustment

New Caregivers and Teens’ Curriculum

Young Adults’ Curriculum

Intervention Model:

Mothers and their adolescents attended a 16-session cognitive behavioral intervention over eight weeks. For MLH, intervention goals aimed to: 1) improve parenting while ill (i.e., reduce family conflict, improve communication, clarify family roles); 2) reduce mental health symptoms; 3) reduce sexual and drug transmission acts; and 4) increase medical adherence and assertiveness with medical providers. For adolescents, the intervention goals were to: 1) improve family relationships; 2) reduce mental health symptoms; 3) reduce multiple problem behaviors (e.g., drug use, criminal justice acts, school problems, teenage pregnancy); and 4) school retention.

Research Methods:

In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a control group on mental health and health behaviors, including sexual behavior and substance use. Both intervention and control families were compared to a neighborhood cohort, matched on sociodemographics. Because study participants were followed over two years, longitudinal random effect regression models were used to test the efficacy of the intervention.

Surveys and Scales Used:

Local Significance:

There was a lack of significant findings for an intervention effect on HIV-transmission behaviors and mental health. HIV-transmission behaviors were low to begin with and participants had little room for improvement. The populations affected by the HIV epidemic in the U.S. have shifted over the past number of years since a similarly mounted intervention in New York City led to improvements. HIV interventions in the U.S. need to shift their focus to persons living with HIV who are experiencing substantial problems.

International Significance:

While the focus of U.S.-based HIV interventions need to shift, interventions for the general HIV population may be effective outside the U.S.

23Jan

Los Angeles County Methamphetamine Prevention Initiative

There is a significant unmet need in Los Angeles County for methamphetamine-specific training, and community service agencies and outreach workers need education and training on effective approaches to engage and serve persons in the community at risk. Training and technical assistance is also needed for service providers on the latest evidence-based methamphetamine treatment approaches.

More specifically, trainings are needed that cover methamphetamine-specific issues crucial for the development of skills by medical providers, clinicians and outreach workers serving clients who use methamphetamine and address specific concerns around providing culturally appropriate care for specific populations. These trainings address issues such as: mental health considerations, psychological complications, sexual and cybersex addiction and current evidence based treatments.

This training project included the following activities:

Providing consultation and technical assistance to the Los Angeles County Alcohol and Drug Program Administration (ADPA) and the Office of AIDS Programs and Policy (OAPP)
Developing training curricula and module for ADPA or OAPP-funded substance abuse or HIV/AIDS treatment providers
Developing and disseminating web-based training module
Providing in-service trainings for Los Angeles County Methamphetamine Task Forces
Providing in-service trainings for ADPA and OAPP-funded Drug Abuse and HIV prevention agencies serving young women
Providing tailored technical assistance

23Jan

Mamekhaya

In South Africa, where a large portion of pregnant women are HIV positive, prevention of mother-to-child transmission of HIV (PMTCT) is an important endeavor. To improve the effectiveness of the standard PMTCT programs, the Mamekhaya program used peer mentoring and a culturally adapted cognitive behavioral intervention (CBI).

Research Methods:

HIV-positive pregnant women at the Gugulethu Midwife Obstetric Unit and at the Vanguard Community Health Center in Cape Town were invited to participate in the study. Participants at both sites received the standard PMTCT care; however, participants at the Gugulethu site received the Mamekhaya intervention.The first part of the intervention consisted of assigning a participant with a mentor mother through Mothers2mothers. The mentor mother was a woman who was HIV-positive, had recently had a child, and had received PMTCT and was doing well. Participants also attended group sessions of a cognitive-behavioral intervention. The sessions included information on living with HIV, preventing HIV transmission, parenting, social support, and mental health.

Local Significance:

Participants in the Mamekhaya intervention had increased HIV knowledge scores, significantly increased social support, and significantly decreased depression scores compared to women in the control group.

20Jan

Vietnam – Development of a Family Intervention to Address Drug Use and HIV in Vietnam

This two-year study will be conducted in Phu Tho Province, Vietnam in collaboration with the Vietnam National Institute of Hygiene & Epidemiology (NIHE). This study will develop and pilot an intervention aimed at increasing family support for IDU’s behavior change and family capacities to effectively cope with the impact of IDUs and HIV.

Targeted Risk Group:

IDUs, family members

Intervention model:

Planned behavior change, Stages of change, and Psych-education

Research Methods:

• Focus group to develop the content, format and delivery plan for the intervention
• Intervention will be delivered to 40 IDUs and 40 their family members
• Assessments will be conducted with 80 IDUs and 80 Family members at baseline, 3-month and 6-month follow-ups.

Local Significance:

The findings from the study will inform the design of the full-scale intervention trial for families coping with IDU and/or HIV in Vietnam. By addressing HIV and IDUs, this intervention could potentially reduce the psychological, physical and emotional demands of living with chronic HIV, coping with drug use, and improve the safety of society. A dissemination of the intervention design to district hospitals in Vietnam can improve the lives of families in dealing HIV and IDUs.

International Significance:

This study demonstrates a model to combine traditional drug use treatment with psychosocial and behavioral intervention. This can be applied to other countries with different cultures.

20Jan

Grief Interventions for PLAs, Adolescents and Guardians

By the year two thousand, 80,000 children will be orphaned by AIDS in the U.S. and this number will continue to rise. Parental death during one’s childhood has been consistently associated with negative outcomes for children, however, there have been no prospective studies of adolescent bereavement from any type of parental death, including death from AIDS. This continuation study is aimed at delivering and evaluating an intervention to alleviate grief associated with the death of a parent. These results are likely to have implications for millions of AIDS orphans internationally and for the 550,000 US adolescents bereaved annually by parental death.

Scope:

Over the last two and a half years, 310 parents living with AIDS (PLAs) and their 498 adolescent children, age 12-18 were recruited. They were randomly assigned to receive: (1) a standard care condition in which extensive social welfare services are provided; or (2) an enhanced care condition in which three modules of coping skills intervention (Project TALC: Teens and Adults Learning to Communicate) plus social services are provided. Linked to the phases of parental illness, PLAs, their adolescents, and new custodial guardians are schedule to meet individually and jointly in over 32 sessions. Because the life span of women with AIDS extended from 14.3 months to 27 months over the last two years, about two thirds of the sample of PLAs continue to live longer than anticipated, delaying the delivery of the final intervention module. Over the next 18 months, the investigator anticipates that the PLAs will die, and the final, post-death module of the intervention will be delivered. The present continuation study will allow the investigator to complete the delivery and the evaluation of the intervention, and in addition, pursue the following activities: (1) follow youths of PLAs prospectively and longitudinally for four additional years to evaluate their mental health, behavioral, and social outcomes; (2) complete the delivery and evaluation of the enhanced coping skills intervention, particularly of Module 3 to new custodial guardians and youths; and (3) develop new measures of grief to describe the bereavement process over time.

Parents living with AIDS reported a mean of 3.3 (SD=1.3) areas of conflict with their adolescents and 1.5 (SD=1.7) stressful parenting events over the previous three months. The parents were very ill, with many physical symptoms and diseases. Simultaneously, substance use was common (17% used daily), but not injection drug use (3.3%). Half had a sexual partner (63% protected partners by using condoms consistently). Regression analysis revealed that parent-adolescent conflict was significantly associated with high parental drug use: stressful parent events were significantly related to the lifestyle (high drug use and frequent sex acts) of Latino and African-American parents, but not white parents. In contrast to parents with other illnesses, parent-adolescent conflict and stressful parenting events were not influenced by parents’ health status, but were significantly influenced by substance use and sexual lifestyles. Both mothers (87%) and fathers were significantly more likely to disclose their serostatus to adolescents (73%), compared to younger children (23%). Only 44% disclosed to all their children; 11% disclosed to none. Most PLAs (80%) discussed custody plans; however, only 30% initiated legal plans, typically for younger children. Adolescents informed of their PLA’s serostatus engaged in more sexual risk acts, smoked more cigarettes, reported more severe substance use, and greater emotional distress than did uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or followup.

National Institute of Mental Health, grant 2R01MH49958-06