Month: August 2012

CHIP Research Presented at International AIDS Conference

Options for HealthWith presentations by six principal investigators (PIs) and more than 15 affiliates, UConn’s Center for Health, Intervention, and Prevention (CHIP) had a strong presence at the 19th biannual International AIDS Conference held in Washington, D.C. in late July.

Five of the presentations made there highlighted results from CHIP Director Jeffrey Fisher’s five-year, $6.4 million National Institute of Mental Health (NIMH) grant to translate his evidence-based Options intervention for HIV-positive individuals for use in South Africa and to test the effectiveness of the adapted version, Options for Health/ Izindlela Zokuphila, at reducing HIV risk behavior among people living with HIV/AIDS (PLWH) at 16 clinics in KwaZulu-Natal province.

Based on the Information-Motivation-Behavioral Skills (IMB) model for health behavior change that Dr. Jeff Fisher and his brother, William A. Fisher, developed two decades ago, Options enlists trusted healthcare providers to have theory-based conversations with HIV-positive patients during routine medical appointments about reducing their risky sexual and drug use behaviors. Clinicians work collaboratively with patients in assessing their risky behaviors and willingness to change. Together, clinicians and patients then develop strategies and set future goals that are written out in a “behavioral prescription” for safer sex or drug use behaviors.

Options is one of relatively few HIV risk reduction interventions for use with HIV-positive patients. It has been lauded by the Centers for Disease Control and Prevention (CDC) as a promising intervention and has been included in its Compendium of Evidence-Based HIV Prevention Interventions.

At the International AIDS Conference, Fisher’s research team reported results from the randomized, controlled trial of Options for Health/ Izindlela Zokuphila, which involved 1,891 people living with HIV (PLWH) on antiretroviral therapy (ART) who received either the intervention or a standard of care control and who were followed for 18 months.

Fisher said his team’s findings support the efficacy of the Options for Health/ Izindlela Zokuphila intervention for reducing HIV transmission risk behavior among PLWH on ART in South Africa. Intervention participants, compared to standard of care control group participants, experienced consistent, statistically significant, and meaningful reductions in unprotected sex on each of eight HIV transmission risk behavior endpoints. These included reductions in unprotected sex with partners perceived to be HIV-negative and status unknown, across intervals varying from four weeks to six months. The intervention was delivered during routine care by trained lay counselors, nearly all of whom were already employed at the clinical care sites.

“This approach provides efficient and continuing intervention exposure that links clinical care with prevention,” Fisher said. “The South African HIV epidemic has caused catastrophic human suffering. Fortunately, in recent years, a record number of South Africans are being tested for HIV, learning their antibody status, entering care, and receiving lifesaving antiretrovirals.

“For the first time, it has been possible to develop potentially widely disseminable, South African, prevention-with-positives interventions that can be implemented in tandem with routine HIV care to protect the health of people living with HIV and, importantly, to prevent HIV transmission to others.”

At present, high level discussions are occurring between Fisher’s team and South African government officials to disseminate Options for Health/ Izindlela Zokuphila widely throughout KwaZulu-Natal, and to make it the standard of care for PLWH in that province, he said.

Other Options-related results reported at the International AIDS Conference included the following:

  • CHIP Associate Director Deborah Cornman reported that 48 lay counselors from the trial’s eight active intervention sites (vs. the eight standard of care  sites) had been trained to deliver the intervention within the context of routine clinic care; the intervention was implemented in 75 percent of more than 6,100 lay counselor visits; Options was delivered with fidelity (mean = 7 out of 8 protocol steps), and did not reduce the frequency with which lay counselors provided ART adherence counseling; and exit interviews and focus groups confirmed Options was feasible to implement in busy South African public clinics and the intervention was acceptable to patients and counselors.
  • CHIP Affiliate William Fisher reported results from an analysis of data collected prior to trial participants’ exposure to the adapted Options intervention, which applied the IMB model to identify factors associated with HIV transmission risk behavior in the trial population. His results from the first test of the IMB model in HIV-infected South Africans on ART demonstrated the roles, differing by gender, of HIV prevention information, HIV prevention motivation, and HIV prevention behavioral skills as correlates of HIV transmission risk behavior in this population. Gender differences in the findings suggest that motivated men may act to practice safer sex more or less unilaterally, with minimal involvement of their partners, and without reliance on complex behavioral skill performance. Women, in contrast, may require complex and sophisticated behavioral skills to negotiate safer sex with their partners and effectively ensure that safer sexual practices are initiated and maintained. Implications of these findings are that gender-targeted interventions for HIV-infected men on ART may emphasize strengthening their HIV prevention motivation and gender-targeted interventions for HIV-infected women on ART may emphasize strengthening HIV prevention behavioral skills.
  • CHIP Affiliate Paul Shuper reported gender-specific risk factors associated with HIV transmission behavior, based on audio computer-assisted self-interviews (ACASI) in isiZulu or English that trial participants completed upon enrollment in the trial. He found HIV transmission risk behavior among female PLWH was indicative of challenging partnerships, in which the prospect of physical abuse, low perceived power, and a lack of disclosure may have hindered safer sex efforts. For male PLWH, three unique, modifiable risk factors were identified: depression, negative condom attitudes, and seeking help from Traditional Healers. Additionally, male PLWH who were relatively younger tended to be riskier. These findings have implications for “positive prevention” in South Africa. Efforts targeting female PLWH could focus on empowerment, skills training, and the provision of referrals for abuse. For male PLWH, prevention efforts could focus on identifying and treating depression, altering HIV risk perceptions associated with traditional medicine, and improving attitudes toward condoms.
  • Laramie Smith, a CHIP affiliate and UConn doctoral student in Social Psychology, used an IMB-based measure as a rapid needs assessment to identify the most prevalent retention in pre-ART care barriers among four primary healthcare clinics in KwaZulu-Natal. Smith found that barriers to pre-ART care identified across two or more clinics included: misinformation about ART eligibility, HIV transmission, and health screening; motivational barriers such as low perceived social support for attending care, and confidentiality and anticipated stigma concerns; and lower perceived skills to manage clinic wait times and transportation costs. Smith also found that each clinic had unique barriers to retention in pre-ART care and that the IMB-based measure can serve an important role in identifying clinic-specific barriers to retention in care among ART-ineligible patients and informing intervention approaches to address these specific barriers.

CHIP PI Rivet Amico also was a part of Fisher’s Options research team and CHIP PIs Seth Kalichman, Leslie Snyder, and Lisa Eaton presented research results from separate projects at the International AIDS Conference.

Dr. Kelly D. Brownell To Speak at CHIP Thursday, August 30th, 2012

Kelly BrownellOn Thursday, August 30, 2012, from 12:30 – 1:30 pm, the lecture series welcomes Kelly D. Brownell, PhD, Professor of Psychology and Director of the Rudd Center for Food Policy & Obesity at Yale University to give a lunch-time lecture about “Is there the Courage to Change the American Diet?”

The lecture will be in Video Conference Room 204 on the second floor of Ryan at 2006 Hillside Road at the University of Connecticut in Storrs.  For a map of the area, look at http://www.chip.uconn.edu/about/directions-to-chip/.

You can also view this talk streamed live during or after the lecture at the following link: https://mediasite.dl.uconn.edu/Mediasite/Play/f0afe35bfb0f48f39201d788cfab1edf1d

This lecture is co-sponsored by the CHIP Obesity Interest Group and the Children’s Center for Community Research at Connecticut Children Medical Center.

Dr. Kelly Brownell is Professor in the Department of Psychology at Yale University, where he also serves as Professor of Epidemiology and Public Health and as Director of the Rudd Center for Food Policy & Obesity. In 2006 Time magazine listed Kelly Brownell among “The World’s 100 Most Influential People” in its special Time 100 issue featuring those “… whose power, talent or moral example is transforming the world.”

Dr. Brownell was elected to membership in the Institute of Medicine in 2006 and served as President of several national organizations, including the Society of Behavioral Medicine, Association for the Advancement of Behavior Therapy, and the Division of Health Psychology of the American Psychological Association. He has received numerous awards and honors for his work, including the James McKeen Cattell Award from the New York Academy of Sciences, the award for Outstanding Contribution to Health Psychology from the American Psychological Association, the Distinguished Alumni Award from Purdue University, and the Lifetime Achievement Award from Rutgers University. He has served in a number of leadership roles at Yale including Master of Silliman College and Chair of the Department of Psychology from 2003 to 2006.

He has published 14 books and more than 300 scientific articles and chapters. One book received the Choice Award for Outstanding Academic Book from the American Library Association, and his paper on “Understanding and Preventing Relapse” published in the American Psychologist was listed as one of the most frequently cited papers in psychology.

Dr. Brownell has advised members of congress, governors, world health and nutrition organizations, and media leaders on issues of nutrition, obesity, and public policy. He was cited as a “moral entrepreneur” with special influence on public discourse in a history of the obesity field and was cited by Time magazine as a leading “warrior” in the area of nutrition and public policy.

Newly Hired Faculty to Join CHIP this Fall

Newly hired faculty members, from prestigious research institutions, will join CHIP this fall.

Elizabeth Schifano, PhDCHIP and the Statistics Department jointly hired a biostatistician from Harvard University’s School of Public Health – Elizabeth Schifano, who received her PhD in Statistics from Cornell University in 2010. Dr. Schifano’s primary research interests lie in the development of statistical methods for high-dimensional and correlated data.  Motivated by high-dimensional genomic data, her research to date has focused on methods for variable selection via penalized regression models and powerful model-based inference.  Her most recent collaborative projects include a longitudinal investigation of lung disease in textile workers and a multivariate investigation of genetic markers related to smoking behavior. Beginning this fall, Dr. Schifano and an advanced Statistics graduate student will be on site at CHIP 20 hours a week performing statistical consultations on CHIP grants. Please visit them at your earliest convenience, and let them help you with statistics and methodology sections of new grants you are submitting, or with analysis of your current Chip research.

Frederick Gibbons, PhDCHIP and the Psychology Department jointly hired two renowned health psychologists from Dartmouth College who focus on cancer-risk behavior – Frederick Gibbons, PhD, and Meg Gerrard, PhD. The Gibbons–Gerrard Health-Psychology Lab at Dartmouth applies social psychological theory to health-risk behavior. Much of their work is based on a social-reaction model of adolescent health-risk behavior, the Prototype/ Willingness (PW) model, which they developed. The model contends that adolescents’ health decision-making strategies are often reactions to risk-conducive situations rather than planned activities. Examples of some of Dr. Gibbons and Dr. Gerrard’s collaborative research in the area of cancer prevention include: predicting and preventing youth alcohol and substance use, assessing smoking risk behavior and the effectiveness of smoking cessation interventions, applying social psychological theory to interventions for UV protection, and determining psychological and behavioral predictors of HPV vaccination in African American women. Dr. Gibbons will be a CHIP principal investigator (PI) and a Professor of Social Psychology at UConn.

Meg Gerrard, PhDDr. Gerrard, Co-Director of the Cancer Control Research Program at the Norris Cotton Comprehensive Cancer Center at Dartmouth Medical School, is a health psychologist with more than 38 years of experience studying adolescent and young adult health behavior. For the past 15 years, her primary research area has been health risk and health promoting factors of African American adolescents and emerging adults. Dr. Gerrard has examined cancer susceptibility profiles in young African American adults and created a theoretical model of the integration of psychological and physiological stress response pathways to markers of cancer vulnerability, i.e., smoking, risky sex, elevated BMI, increased inflammation, and reduced telomere maintenance. Dr. Gerrard will be a CHIP PI and a Research Professor through CHIP and the Psychology Department. In addition to performing her own externally-funded research, Dr.  Gerrard will spend 25 percent of her time coordinating and building CHIP’s cancer prevention efforts.

Two other new UConn faculty members, who were hired by the Communication Sciences Department and who are both assistant professors in that department, already have become CHIP Affiliates.

John Christensen, PhD
John Christensen has a PhD from the University of Southern California (2011). He is currently a Post-Doc at Penn’s Annenberg School for Communication. His research focuses on using social media, virtual reality, and video games for health intervention – making him a great fit with the digital media initiative and CHIP. He is currently working on a virtual grocery store that communicates the risks of an unhealthy diet as well as a virtual nightclub designed to prevent risky alcohol, drug, and sexual decisions. This summer, prior to his arrival at CHIP, John has already submitted two grants through the Center.

Saras Bellur, PhD
Saras Bellur will receive her PhD from Penn State University in June of 2012. Her work in human computer interaction and interactivity will make her a good fit with the digital initiative at UConn. Situated in the broad area of media effects paradigm her research interests include understanding the psychological and physiological effects of interactive media on key user experience and user engagement outcomes. Her studies adopt an interdisciplinary approach by combining theories from various disciplines such as media effects, human-computer interaction, social cognition and health communication. She will teach computer mediated communication and mass media systems as well as other courses related to technology and media effects.

Researchers Mentored at CHIP Have Earned UConn Tenure Track Positions

Two CHIP researchers, who were mentored by CHIP PIs as doctoral and post-doctoral students, will be starting in new tenure track positions at UConn this fall.

Tania Huedo-Medina, PhDTania Huedo-Medina, PhD, came to CHIP as a post-doctoral Associate Research Scientist and as part of CHIP PI Blair T. Johnson’s Synthesis of HIV/AIDS Research Project (SHARP) in 2006 and, in 2011, Dr. Huedo-Medina became an assistant research professor through the Psychology Department. She will be an Assistant Professor of Biostatistics in the Department of Allied Health Sciences. Dr. Huedo-Medina’s research interests involve developing and applying multilevel analysis methodology to health promotion and related prevention research at both the individual and community level. She is an expert on analytic statistics using Monte Carlo techniques to obtain more precise estimations of the biological-behavioral-contextual relationships to understand and predict health outcomes. Dr. Huedo-Medina has conducted methodological work to improve the statistical techniques applied in meta-analysis and has applied them on meta-analytic projects in multiple health domains (e.g., HIV/AIDS and sexual health, cancer, mental health, blood pressure).

Lisa Eaton, PhDLisa Eaton received her PhD in Social Psychology from UConn in 2009 and has worked as part of CHIP PI Seth Kalichman’s Southeastern HIV/AIDS Research Evaluation (SHARE) project for the past nine years. Most recently, Dr. Eaton has been an assistant research professor in the Psychology Department. She will be an Assistant Professor of Human Development and Family Studies. During FY12, Dr. Eaton won a five-year National Institute of Mental Health (NIMH) grant to conduct a large-scale, randomized clinical trial of an HIV prevention intervention she successfully piloted in Atlanta. The trial of Dr. Eaton’s Think Twice intervention involves 670 HIV-negative, young, black men who have sex with men (MSM). The intervention is designed to teach MSM the risks associated with an HIV prevention strategy known as “serosorting” (limiting sexual partners to those who are of the same HIV status), which has emerged as an alternative to condom use, but actually has been shown to increase, rather than decrease, HIV risk for a variety of reasons.