Posts classified under: Policy Impact

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

Behavioral Economics Incentives to Support HIV Treatment Adherence in Sub-Saharan Africa

Abstract: It is imperative to find ways to improve retention boost ART adherence in sub-Saharan Africa where adherence rates have been found to decline over time, and where treatment options such as second-line regimens are very limited. A promising tool is the Lottery Incentives to Facility Treatment Adherence (LIFT) program suggested in this proposal, i.e. the use of small prizes for healthy HIV-related behavior allocated by a drawing. LIFT is based on the results of the applicant’s R34 `Rewarding Adherence Program (RAP)’ [R34 MH096609] that demonstrated feasibility and acceptability of lottery incentives for HIV-related behaviors, and established preliminary efficacy. The current R01 application will build on these promising results with the aim to a) use viral loads as biological endpoints that were not included in the R34 for cost reasons; b) establish efficacy in a fully powered intervention including comparative efficacy of two different ways of implementing the lottery incentives (incentivization of adherence; incentivization of timely clinic visits and viral suppression) and; c) establish the cost effectiveness of these two implementation modes as a further input for policy-makers. The intervention is targeted at increasing the motivation of treatment-mature clients who have been on ART for several years through the added benefit and joy of potentially winning a prize, thereby attempting to overcome the treatment `fatigue’ that can develop in the context of mundane, daily pill taking over the course of life-long treatment. Insights from behavioral economics suggest that such an intervention may be particularly effective for people with present bias (i.e. those who have a tendency to give in to short-term temptation at the cost of more long-term benefits) that was found to be prevalent among HIV clients in the R34 study. LIFT will be implemented among 330 adult clients who have been on ART for at least two years in three groups: for the first intervention group, timely clinic attendance will determine the number of entries they receive for winning a monthly prize, and participants are eligible for an annual lottery based on viral suppression. The second treatment group will be incentivized on high demonstrated ART adherence, including at an additional annual lottery. The control group will receive the usual standard of care. All participants will receive MEMS caps to record adherence and five study assessments over 24 months (at baseline and every 6 months thereafter). The first Specific Aim will be to evaluate the effectiveness of LIFT; the second aim is to compare the effectiveness of the adherence-based arm and the revised arm directly incentivizing viral suppression that subsequently could be incorporated into clinical care as it does not require costly devices and instead relies only on information available in the clinic. The third Specific Aims is to perform a comparative cost- effectiveness analysis of the two LIFT intervention arms as a further policy input.

Project Number: 5R01MH110350-05

https://reporter.nih.gov/search/3MnscHY5qkaP-H3GhQ-H-A/project-details/10205950

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

PUBLIC HEALTH RELEVANCE: For public health it is important to improve adherence to antiretroviral drugs and support viral suppression, especially in resource-constrained countries in which treatment options are limited, and for an increasing number of treatment-mature clients who have been on ART for several years. Our study will investigate the role of small lottery incentives in improving these HIV-related behaviors and health outcomes that can be used in combination with other strategies. The current R01 application builds on the promising results of an earlier R34 study that demonstrated acceptability, feasibility, and preliminary efficacy of such incentives.

 

 

Project Start Date: 13-September-2017

Project End Date: 30-June-2022

Budget Start Date: 01-July-2021

Budget End Date: 30-June-2022

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $290,065

Innovative HIV Testing Strategy for Middle-to-Upper Income Men in a Resource Limited Setting

Abstract:In Botswana, the setting of the proposed study, nearly one in five adults are living with HIV. Men in Botswana over age 40, the focus on the present research, show relatively high levels of HIV prevalence and risk behavior, and low levels of HIV testing. Moreover, higher income is associated with increased risk of being HIV-positive in sub-Saharan Africa (SSA). The proposed research will use mixed methods to develop an intervention that de- stigmatizes and encourages HIV testing among men of middle-to-higher socio- economic status (SES) in Gaborone, Botswana. We will focus on increasing HIV testing among men of higher SES. Fear of being stigmatized among financially secure men in employment in Botswana may contribute to low HIV testing uptake. The Specific Aims are: Aim 1: To initially conduct formative qualitative work to explore the role of stigma on low HIV testing uptake among 20 men via face to face interviews, and then to obtain feedback about potential interventions using asynchronous online focus group discussion among 40 men all with relatively high socio-economic status (SES) in Botswana. Aim 2: To develop and conduct a small pilot test of a local, culturally appropriate HIV testing strategy targeting 100 men in the higher-SES in Botswana. Hypothesis: At least 60% of men will access the new HIV testing strategy, equivalent to a ~20% point increase above testing strategies not tailored to men. Aim 3: To build capacity for HIV stigma and related behavioral research by conducting focused workshops in Botswana. To reach the remaining 10-10-10, it is essential to develop differentiated, tailored approaches for risk groups, such as men of relatively higher SES, that are untouched by existing prevention and testing frameworks in countries of high HIV prevalence.!

 

Project Number:5R21TW011069-02

https://reporter.nih.gov/search/ukRDruCWsESODyaoaOckJg/project-details/9730678

 

 

Contact PI/ Project Leader

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

MOSEPELE, MOSEPELE, SENIOR LECTURER (mosepelemosepele@gmail.com)

 

 

Organization

UNIVERSITY OF BOTSWANA

 

 

PUBLIC HEALTH RELEVANCE: In Botswana, the setting of the proposed study, nearly one in five adults are living with HIV, and men over age 40, especially those of higher income, are at particularly high HIV risk due to concurrent multiple partnerships and low rates of HIV testing. We propose to explore qualitatively how stigma in the context of masculine gender role norms may be a barrier to HIV testing among men over age 40 years of higher socioeconomic status in Botswana, and use these results to develop and pilot an innovative HIV testing strategy through major employers that is tailored to men.

 

 

Project Start Date: 01-July-2018

Project End Date:30-April-2022

Budget Start Date: 01-May-2019

Budget End Date: 30-April-2022

 

 

NIH Categorical Spending

Funding IC: FOGARTY INTERNATIONAL CENTER / FY Total Cost by IC:$106,708

Mopati: A Pilot HIV Treatment Partner Intervention in Botswana

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

 

Project Number:5R34MH121229-03

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

 

Contact PI/ Project Leader

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

MOSEPELE, MOSEPELE

 

Organization

RAND CORPORATION

 

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

 

 

Project Start Date: 16-July-2019

Project End Date:31-May-2023

Budget Start Date: 01-June-2021

Budget End Date: 31-May-2023

 

NIH Categorical Spending

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

Evaluation of the Implementation of PrEP Provision for Ugandan Fisherfolk

Abstract: In Ugandan fisherfolk communities, HIV prevalence is an order of magnitude higher than in the Ugandan general population, and high HIV prevalence among fisherfolk helps to drive the general epidemic. In a prior R21 study, we demonstrated that bringing HIV testing to fisherfolk communities, where healthcare facilities are scarce, can identify a large number of high-risk HIV-negative fisherfolk. To have a significant impact on the HIV epidemic among fisherfolk, a key next step in this research program would be to offer pre-exposure prophylaxis (PrEP; a highly effective and safe daily pill containing tenofovir and emtricitabine to prevent HIV) to high-risk HIV-negative fisherfolk following HIV testing. Although the 2016 Ugandan HIV prevention and treatment guidelines recommend PrEP for HIV prevention in fisherfolk, there is currently no governmental support for PrEP implementation in fisherfolk communities. Pilot data are urgently needed to demonstrate to the Ugandan Ministry of Health that PrEP can be feasibly delivered to fisherfolk, in order to secure government support for PrEP for fisherfolk. The Specific Aims are: (1) To conduct formative qualitative research to examine barriers to and facilitators of PrEP uptake, and to obtain input on acceptable PrEP messaging and provision, for fisherfolk communities on Lake Victoria, Uganda; and (2) To conduct a mixed-methods analysis comparing the implementation of community-based vs. healthcare facility-based PrEP provision for fisherfolk communities on Lake Victoria, Uganda. For both PrEP interventions, we will conduct monthly HIV testing and PrEP and antiretroviral treatment provision events, using messages developed from the formative work to raise awareness about PrEP. PrEP will be offered to 100 fisherfolk in two Lake Victoria landing sites during testing events on specified days of the month: In one site, PrEP will be distributed in a nearby healthcare facility during monthly events, and in the other site, PrEP will be distributed in a temporary community space. Among those who are non-adherent (based on refill data), PrEP provision will be supplemented via PrEP delivery by community health workers or at community PrEP pick-up points, based on strategies elicited in the formative work. To evaluate implementation, we will conduct semi-structured interviews with healthcare providers and fisherfolk who do and do not decide to initiate PrEP, and obtain medical records data to compare the proportion of fisherfolk: identified as PrEP-eligible, who initiate PrEP, who adhere to PrEP (i.e., refills over 6 mos.), who seroconvert, and who discontinue PrEP, overall and by socio-demographic characteristics (e.g., gender). We will engage with Ugandan Ministry of Health policymakers throughout the research, to keep them apprised of results and to determine directions for future policy around PrEP for fisherfolk. To realize the 90- 90-90 goals, it is critical to seek out the hardest to reach, most at-risk populations such as fisherfolk, who reside and work in areas without easy access to healthcare.

 

Project Number: 5R34MH119924-02

https://reporter.nih.gov/search/ZZ4mAxmcFEuQAaU8pv87Bw/project-details/10136099

 

 

Contact PI/ Project Leader

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

 

Organization

RAND CORPORATION

 

 

PUBLIC HEALTH RELEVANCE: Among Ugandan fisherfolk, HIV prevalence is very high and is likely a driver of the general epidemic in the country. To have a significant impact on HIV among fisherfolk, it is essential to offer pre-exposure prophylaxis (PrEP) to high-risk HIV-negative fisherfolk in tandem with treating HIV-positive fisherfolk with antiretroviral therapy. We will evaluate the feasibility, acceptability, and preliminary effects of PrEP delivery interventions in two separate fisherfolk communities.

 

 

Project Start Date: 01-April-2020

Project End Date: 31-March-2023

Budget Start Date:01-April-2021

Budget End Date:31-March-2022

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH/ FY Total Cost by IC:$298,735

Racial/Ethnic Disparities in Health Insurance Coverage Stability: Implications for Chronic Disease Management and Use of Preventative Services

Abstract:  Unstable health insurance coverage (i.e., gaining and/or losing coverage over time) affects millions of individuals in the US. The Affordable Care Act (ACA) has helped 16.4 million of the uninsured gain coverage through the expansion of Medicaid in 31 states (including the District of Columbia as of September 1, 2015) and subsidies through the Health Insurance Exchanges (HIE) and is projected to reduce racial/ethnic disparities in coverage. However, disruptions in coverage may continue to be an important post-ACA issue, as changes in eligibility are expected to continue resulting in churning (i.e., losing and/or gaining coverage over time) between coverage through Medicaid, the HIE and employer-provided health insurance. Despite the abundance of research on the uninsured, little is known about how coverage stability affects access to care, especially in terms of disease management and use of preventive services, and whether important differences exist between racial and ethnic groups. The limited amount of research that does exist on coverage stability have largely been descriptive and have relied on measures that only capture one aspect of coverage stability at a time (e.g., ever lost coverage in the past year). Additionally, few studies have made use of methods that address the influence of unobservable characteristics that may be associated with both coverage stability and access to care (i.e., endogeneity of health insurance coverage). Thus, to address these gaps in the literature, the proposed dissertation will use data on a nationally representative sample of non-elderly adults (ages 18-64) from the Medical Expenditure Panel Survey (MEPS) to: (1) Construct a coverage stability index measure that encompasses multiple aspects of coverage stability using month-to-month coverage status and principal component analysis; (2) Evaluate the effect of coverage stability on disease management among those living with a chronic condition (i.e., diabetes, hypertension, and high cholesterol) by race/ethnicity; and (3) Examine the effect of coverage stability on the use of preventive services among the near-elderly (ages 50-64) by race/ethnicity. The proposed project will contribute and improve upon the existing body of research by developing and testing a coverage stability measure that accounts for multiple aspects of the phenomenon, demonstrating the effect of coverage stability on access to care among vulnerable populations and disparities by race/ethnicity, and making use of methods that address the endogeneity of coverage to produce less biased estimates. Such a contribution would bring to light the magnitude of the issue and provoke urgency among policymakers and other stakeholders to engage in discussions and efforts geared towards identifying those at highest risk for unstable coverage and developing strategies that will make coverage transitions less burdensome on access to care, thus alleviating the perpetuation of racial/ethnic disparities in health.

 

Project Number: 1R36HS024862-01A1

https://reporter.nih.gov/search/tRh4M7PY80G_22Aco4BUqA/project-details/9379776

 

Contact PI/ Project Leader

TAN, DIANE, (diane.tan@ucla.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE:Project Narrative Unstable health insurance coverage (i.e., gaining and/or losing coverage over time) affects millions in the US. Although the Affordable Care Act (ACA) has greatly improved access and is projected to reduce racial/ethnic disparities in coverage, disruptions in coverage may continue to be an important post-ACA issue, as changes in eligibility are expected to continue resulting in churning between the different sources of coverage (i.e., Medicaid, the health insurance exchanges, and employer-provided health insurance). The proposed project will contribute to the small albeit growing body of research by developing and testing a multi-dimensional coverage stability measure, demonstrating the effect of coverage stability on access to care among vulnerable populations, determining disparities by race/ethnicity, and using methods that address the endogenity of coverage to produce less biased estimates.

 

 

 

 

Project Start Date: 01-July-2017

Project End Date: 30-June-2018

Budget Start Date: 01-July-2017

Budget End Date: 30-June-2018

 

 

NIH Categorical Spending

Funding IC: AGENCY FOR HEALTHCARE RESEARCH AND QUALITY / FY Total Cost by IC:$41,931

Combating Craving with Contingency Management: Neuroplasticity and Methamphetamine Abuse in South Africa

Abstract: Methamphetamine (MA) dependence is a significant health problem in South Africa and the U.S. In South Africa, a shift in policy focus is required away from allocating health resources primarily to HIV/AIDS and TB and toward the financial, social and personal consequences of untreated stimulant addiction. In response to PAR 14-331, this application proposes to build capacity for a new linkage of productive teams of clinical researchers at UCLA and the University of Cape Town to conduct studies on the neurobiological foundation of treatment for stimulant dependence. The research direction is innovative in linking findings from neuroscience with clinical outcomes using contingency management (CM) to identify changes in brain structure and function that emerge during purely behavioral therapy. The knowledge gained may guide development of optimally effective behavioral and/or medication therapies. The application design will correlate MA-abstinence outcomes from an 8-week program of voucher-based incentives using an escalating schedule for 30 treatment-seeking, MA-dependent individuals with scores on tasks of working memory and assessments of neuropsychological and demographic status. At the beginning and end of the CM program, participants will participate in MRI scans while performing a working memory task, and will complete a battery of select neurocognitive and psychological assays to address two specific aims: (1) to determine whether changes in neural function within front striatal circuitry from baseline to end of the 8- week CM program are associated with parallel changes in measures of cognitive control and impulsivity and with MA abstinence outcomes; (2) to determine whether structural changes in front striatal circuitry over the 8-week CM intervention correspond with neurocognitive, psychological and MA abstinence measures. Findings from this study will describe associations between: (1) functional and structural indices of brain areas that support working memory, cognitive control/inhibition; (2) performance on select neurocognitive and psychological assessments; and (3) associations between these with MA abstinence outcomes. Study activities and the neuroscience data generated will provide preliminary data for a larger, adequately powered study that will test ways to optimize behavioral therapies for treating stimulant use disorder.

 

Project Number: 3R21DA040492-02S1 (2017); 5R21DA040492-02 (2016)

https://reporter.nih.gov/search/WrJtBSqGgUKo9EPZYXxZsA/project-details/9480137

 

 

Contact PI/ Project Leader

SHOPTAW, STEVEN J, PROFESSOR (SSHOPTAW@MEDNET.UCLA.EDU)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: Statement Methamphetamine addiction (MA) is a global health problem with high prevalence and great social and health costs in the United States and in the Republic of South Africa and there is a strong need for development and implementation of effective MA treatment approaches. This project will correlate outcomes from an 8-week program of contingency management with findings from pre- and post- treatment neuroimaging and neurocognitive assessments to identify structures and/or processes that may represent targets for development of novel behavioral and/or medication therapies. The public health relevance of this application is enhanced by its effort to develop capacity for a productive and impactful neuroscience research agenda between groups of strong clinical scientists in the U.S. and in the Republic of South Africa.

 

 

 

 

Project Start Date: 01-September-2015

Project End Date: 31-August-2018

Budget Start Date: 01-September-2016

Budget End Date: 31-August-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $9,353

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

UCLA/Cambodia HIV/AIDS Training Program in Data Management and Analysis

Abstract: The prevalence of HIV/AIDS in Cambodia increased sharply in the 1990s, reaching upwards of 40% among high-risk populations.2 While the prevalence rate declined to approximately 0.9% by 2006, it remains inflated among high-risk groups.3 In the wake of the epidemic, the Cambodian government initiated national data collection and disease monitoring efforts that have produced rich, longitudinal data from HIV/AIDS treatment and surveillance programs. However, a shortage of professionals trained to manage and interpret these types of data, persists. The UCLA Department of Epidemiology and the Cambodian University of Health Sciences (UHS) propose a program to train a cohort of Cambodian public health professionals in the management, analysis and evaluation of secondary data. Trainees will have two tracks from which to choose. The UCLA MS/MPH track requires coursework in epidemiologic methods and principles, biostatistics, data management, behavioral sciences and HIV/AIDS epidemiology. This track also requires completion of a master’s project that must be relevant for HIV/AIDS policy development in Cambodia. The UCLA PhD track requires trainees complete core courses in epidemiology as well as courses in logic, causation and probability, the biology of HIV/AIDS, graduate statistics and pass a qualifying exam. Trainees then carry out a dissertation in Cambodia that is relevant to HIV/AIDS policy. The overall program will be assessed based on trainee progress and matriculation rates; thesis/dissertation quality, policy relevance and the proportion published; the program’s impact on UHS recruitment rates and trainee placement in national HIV/AIDS monitoring and data analysis roles.

 

Project Number: 5D43TW009590-04

https://reporter.nih.gov/search/2I1xWUcvb0-Q8T6WUaR75A/project-details/9267555

 

 

Contact PI/ Project Leader

GORBACH, PAMINA MAE , PROFESSOR (PGORBACH@UCLA.EDU)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: The National Center for HIV/AIDS, Dermatology and STDs (NCHADS) in Cambodia has created databases of longitudinal HIV/AIDS, STI and behavioral data, opportunistic infections data, antiretroviral therapy and voluntary HIV counseling and testing behaviors. Cambodia seeks to integrate these databases to better facilitate longitudinal tracking and aggregate reporting, however a dearth of professionals skilled in data management, analysis and interpretation challenges this progress. The UCLA Department of Epidemiology and the Cambodian University of Health Sciences (UHS) propose to train a cohort of health professionals in the management and use of large, repeated-measures datasets to prepare and enable these professionals to better identify critical health trends, epidemiologic shifts and use their knowledge to inform HIV/AIDS policies and program improvements.

 

 

 

Project Start Date: 25-May-2014

Project End Date: 31-March-2019

Budget Start Date: 01-April-2017

Budget End Date: 31-March-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE + FOGARTY INTERNATIONAL CENTER / FY Total Cost by IC: $289,346

HIV Technology Transfer in Los Angeles

The aims of the HIV Technology Transfer in Los Angeles project are to document and develop resources for technology transfer among HIV/AIDS community-based organizations (CBOs) serving Los Angeles communities. Several CBOs have publicly commented on the gap between current mandates to implement and evaluate evidence-based HIV interventions and the resources that are available to meet these requirements. A long-term objective is to share CBOs insights into using science-based interventions and to increase the training, materials and other resources they need to carry out HIV prevention. CHIPTS and the City of Los Angeles AIDS Coordinator (ACO) seek to assist CBOs in meeting these objectives. The potential impact of the study is enhanced implementation of evidence-based interventions in Los Angeles and throughout California.

The process of adapting evidence-based interventions into CBO settings is known as technology transfer. The Technology Transfer Model (TTM) outlines three primary phases of this process: pre-implementation, implementation, maintenance and evolution. The pre-implementation phase consists of identifying the need for an intervention, acquiring information, assessing the fit between an intervention and the goals and activities of the organization, and preparing the organizational staff. Implementation includes obtaining technical assistance and conducting process evaluation of the interventions. Finally, maintenance and evolution includes ensuring the presence of staff that can continue to implement the intervention, organizational change, and program evolution.

CBO staff who have been involved in the three phases of technology transfer can offer rich insights on best practices and lessons learned in their communities. Up to 18 science-based programs have been or are being implemented in Los Angeles. Up to two staff from each of these programs are eligible to participate (N = 36). Eligible participants for this study completed close-ended background surveys regarding their organization’s characteristics and were interviewed for up to 90 minutes. Participants were paid $30 for each interview completed. Interviews were conducted twice with staff from these programs. The first wave of interviews asked about pre-implementation and implementation phases of technology transfer. The second wave of interviews, scheduled when many of the programs finished at least one cycle of implementation, asked about maintenance and evolution. Surveys were summarized and used to describe the general organizational characteristics of CBOs using evidence-based programs. Interviews were transcribed, coded and analyzed for techniques, challenges, strategies, and resources used or needed by the CBOs.

Interventions, Training Manuals, etc. :

  1. HIV Technology Transfer in LA (developing resources for technology transfer among HIV/AIDS community-based organizations)- Interview Questions
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