The U.S. Agency for International Development (USAID) has published a case study on a CHIP evidence-based intervention to reduce alcohol-related HIV risk behaviors in sub-Saharan South Africa and is encouraging healthcare providers in developing countries to use it.

A randomized controlled trial showed that the Phaphama (Zulu for “Wise Up”) intervention, developed and tested by CHIP Principal Investigators (PIs) Seth Kalichman, a UConn psychology professor, and Leickness Simbayi of the South Africa Human Sciences Research Council, reduced unprotected sexual acts by 65 percent.

The trial showed the behavior change was sustained over a six-month period.

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A new $1.3 million National Institute of Mental Health (NIMH) research education grant brings together researchers from CHIP, Yale University’s Center for Interdisciplinary Research on AIDS (CIRA) and the Institute for Community Research (ICR) in Hartford to mentor diverse scholars in community-based HIV/ AIDS research. The title of the grant is “Research Education Institute for Diverse Scholars (REIDS). 

CHIP Principal Investigators (PIs) Merrill Singer, a professor of anthropology, and Jean Schensul, ICR founding director, are serving as the UConn and ICR PIs respectively for the five-year grant that will address the documented challenges and barriers to the advancement of underrepresented, disadvantaged, ethnic minority and disabled scholars in the field of community-based HIV/AIDS research. 

Yale Associate Professor of Nursing Barbara Guthrie is the Yale PI for the grant. 

Recognizing the importance of quality mentoring and access to practical experience in setting new investigators’ trajectory for productivity and success, Singer, Schensul, and Guthrie will recruit a total of 20 underrepresented scholars at the advanced post-doctoral and junior faculty level to participate in an intensive six-week Summer Institute, which the grant PIs will organize, conduct and evaluate. 

The Summer Institute will deliver a research education curriculum, training, and professional development opportunities to enrolled scholars; develop and roll out a mentoring typology that addresses structural and individual barriers to advancement of program participants in community-based HIV research; and evaluate the effect and efficacy of the overall education program on scholars, mentors, and their respective organizations. 

Four scholars will participate in the Summer Institute each summer, taking classes and special group instructional offerings at UConn, Yale and ICR and working one-on-one with the mentors with whom the grant PIs paired them based on their research interests. Although they will only be at CHIP, CIRA and ICR during the summer, participants will be considered scholars and communicate with their mentors for the entire year. 

In addition to recruiting a new cohort of scholars for the next Summer Institute, the grant PIs will invite half of the previous year’s scholars back to CHIP, CIRA or ICR for the following summer to focus on writing grant applications with the assistance of their mentors. 

“As we know, in this country the HIV/AIDS epidemic is disproportionately centered in the African American community, and also the Latino and Native American communities. Those communities are getting infected, not getting tested and not getting into treatment at higher rates. They have worse outcomes, including higher fatality rates,” Singer said. “Yet people of similar backgrounds are not populating the HIV/ AIDS research arena for a whole host of reasons that begin long before they get their PhDs.” 

Singer suggested some of the scholars he and his colleagues will recruit may be working at institutions with a teaching, rather than research, focus. Some may never have had training in grant writing. Most of them likely lack a collaborative, multidisciplinary network of researchers like the one behind this grant. 

“It’s a relatively small number of scholars we’ll mentor through this grant, but it would be enough to have an impact if all of them develop expertise in HIV/AIDS community-based research,” Singer said. 

“We’re 30 years into this epidemic and 25 percent of the people with HIV in this country don’t even know they’re infected. We need a varied group of researchers to address an epidemic as complex as this epidemic,” Singer said. 

Singer said this grant focuses on mentoring scholars in community-based or participatory research, where members of the target communities have input into the study’s design, because of the strong applied focus of much HIV/AIDS research. 

In addition to helping organize the Summer Institute and recruit participants, Singer will match participants to mentors at CHIP and supervise the mentors who select UConn as their primary summer site. 

He said three CHIP PIs have agreed to serve as mentors for the scholars so far. He also said CHIP will provide funding for fellows to conduct pilot studies. The funds will be awarded through a competitive process similar to the one in place for other CHIP seed grants. 

“It is good for CHIP to be a partner in this post-doctoral training grant,” Singer said. “It enhances CHIP’s national reputation to be seen taking the lead in the training of underrepresented scholars in this field.”

Click here to listen to CHIP PI Merrill Singer discuss the REIDS project in more detail.

Click here to visit the REIDS project web site.

Laramie Smith, a CHIP-affiliated doctoral student in social psychology, recently won a prestigious National Research Service Pre-Doctoral Fellowship Award (NRSA) from the National Institute of Mental Health (NIMH).

Smith is the tenth psychology graduate student working with a CHIP mentor to receive an NRSA in as many years. She credits CHIP’s supportive atmosphere and researcher services, including the annual internal research grant competitions, with helping her to win her NRSA.

She will use the award to develop and test a theory-based intervention to support retention in HIV medical care for people living with HIV (PLWH) who are tenuously engaged in care.

Presently, in the US, PLWH are recommended to come in for regular HIV-related care in 3 to 6 month intervals, depending on how well their HIV is controlled. These care visits largely involve the monitoring of HIV for potential progression, checking for potential ill effects of antiretroviral therapy, and evaluation of current treatment plan. It is estimated that one third of PLWH who initiate care do not use HIV-care services in these recommended intervals, Smith explained.

“Inconsistent use of HIV medical care has been associated with potentially dire outcomes, such as poorer prognosis, higher viral loads, and the development of drug-resistant strains of the disease due to intermittent antiretroviral (ARV) medication adherence,” Smith said. “Regular clinic visits also provide an ideal window of opportunity for delivering behavioral health interventions to PLWH to promote engagement in self-care and use of HIV-care services.”

“While there have been recent intense efforts to enroll PLWH into care and to re-engage PLWH lost to care, less is known about factors influencing sustained maintenance in HIV care once initiated or re-initiated,” Smith explained.

A continuation of work begun as part of her Master’s Thesis, Smith’s NRSA involves two studies to address this gap in the existing engagement in HIV care literature and unmet service-related needs.

For the first study, Smith will test an Information, Motivation and Behavioral Skills (IMB) model of retention in HIV medical care with 150 PLWH at an HIV care clinic in Bronx, NY.

For the second study, Smith will design, implement and evaluate a proof-of-concept intervention to address core IMB model determinants of retention in care and to promote retention in care in a tenuously engaged inner-city population.

The intervention will be an intensive single-session, motivational-interviewing-based intervention using an IMB-model-based screener to identify individual barriers to retention in care. Findings from the interview will then be used to tailor a patient-centered discussion targeting adherence to the next clinic visit.  Smith will deliver the intervention at the same Bronx clinic with patients who have gapped in care over the last 18 months.

As part of her Master’s Thesis work, she previously conducted qualitative interviews with the same population to learn some of the common facilitators and barriers to retention in HIV care. Some of the most commonly cited facilitators included patient’s perceived vulnerability regarding the health consequences of living with HIV and health benefits of maintaining care, as well as their perceived ability and confidence in being able to obtain support from important others (e.g., family, friends, doctors and clinic staff) for remaining engaged in their HIV care. Some of the most commonly cited barriers included patient’s attitudes and low perceived ability or confidence in being able to negotiate HIV medical care in the face of everyday competing priorities (i.e., managing family stressors or multiple appointments) or more challenging life demands (i.e., while living with comorbid depression or substance use disorder). Smith said that adjustment to living with HIV was an important factor in people’s discussions of coming in or staying out of HIV care.

Very few researchers currently are working in the field of engagement in HIV medical care, Smith said. In fact, CHIP Principal Investigator Rivet Amico is one of a few experts in the field nationally, she said.

Amico and CHIP Director Jeffrey Fisher are Smith’s co-sponsors for the NRSA, which is a training grant.

Smith said winning two internal CHIP seed grants previously, as well as participating on a third CHIP seed grant that Amico and CHIP Affiliate Kevin Dieckhaus had in this field, strengthened her NRSA application.

“First and foremost, the experience applying for grants and getting feedback on my proposals was extremely helpful. I applied what I learned from my CHIP seed grant reviews to my NRSA application,” Smith said.

“My CHIP seed grants showed the NRSA reviewers that I already have an established track record and allowed me to be seen as someone capable of securing her own funding and building a program of research and research collaborations independently,” Smith said.

NRSA reviewers also viewed CHIP, with its focus on multidisciplinary collaborations and portfolio of researcher services, as a very positive atmosphere for her to receive her training, she said.

Smith hopes to use the training she receives and the pilot data she collects through her NRSA to secure a post-doctoral or young investigator award.

This recent New York Times article shows that retention in HIV care is a critical issue around the world.

To learn more about CHIP’s annual internal research funding competitions, click here

For a complete listing of CHIP services, and who is eligible for each service, click here.