Kristyn Zajac, Ph.D. - US grants

DESCRIPTION (provided by applicant): The goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to develop the applicant into an independent investigator prepared to lead large-scale rigorously designed treatment outcome research focused on high-risk youth. Specifically, the applicant will focus on integrated treatments for substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) targeting high-risk transition age youth. The proposed career development and research plan builds on the applicant's prior training in clinical psychology, trauma populations, and PTSD treatments. The research aims are consistent with Goal 2 of the NIDA Strategic Plan, to develop successful treatments for drug abuse and addiction and improve treatment accessibility and implementation and specifically, Objective 2.2, to develop treatments for drug abuse and addiction in association with comorbid conditions. Through the proposed training plan, the applicant will: (1) develop expertise in evidence-based SUD treatments; (2) develop the skill set to conduct clinical trials; (3) become proficient in approaches for integrating interventions for SUDs and PTSD; and (4) gain expertise in the study and treatment of transition age youth. Training activities will include mentorship from a team of experts in the fields of SUDs treatments, clinical trials, and transition age youth; intensive training in SUDs treatment; [expert consultation and training on longitudinal statistical methods;] coursework and lectures on conducting clinical trials and protection of human subjects; and participation in scientific workshops and conferences. The applicant will apply these skills to pilot research aimed at developing and evaluating an integrated SUD/PTSD treatment for high-risk transition age youth through the integration and adaptation of existing empirically supported interventions for SUDs (Contingency Management) and PTSD (Prolonged Exposure). The project will be conducted in [three phases]: 1) integration and adaptation of the treatment protocol using an iterative approach; [2) initial piloting and revision of the protocol b the applicant;] and 3) a pilot feasibility study of the integrated treatment with a sample of [30] justice-involved transition age youth to examine acceptability, safety, and symptom reduction in both primary (self-report and biological measures of substance use, self-report and interview measures of PTSD) and secondary outcomes (self-report and archival records of criminal justice involvement, self-report of adaptive functioning). The proposed research plan will adhere to the treatment development recommendations of the Stage Model of Behavioral Therapies (Carroll & Nuro, 2002), with a focus on Stage 1a and 1b research. Given the high rates and particularly detrimental effects of comorbid SUD/PTSD among transition age youth, the goals of this application have the potential to address an important and costly public health problem. As the presence of comorbid PTSD greatly interferes with effective SUDs treatment, development of an integrated evidence-based treatment for this population is critical.

Abstract African American and Latina women, as well as women living in poverty, are at disproportionate risk for contracting HIV (CDC, 2018). Prevalence is increased further in these women if they have other risk factors for HIV, including substance use, history of intimate partner violence, and homelessness. Despite the relatively high prevalence rates in these populations, many women with these characteristics have never been tested for HIV (CDC, 2016a). Knowledge of one?s HIV status is crucial for rapid access to treatment and reducing the spread of HIV. Thus, effective interventions for enhancing testing in these women are an imminent need. Reinforcement interventions can be efficacious in enhancing testing, and our NIH-funded study in Canada (Hull et al., 2013) found that rates of successful testing in high risk adults increased from 11% to 83% when reinforcers were provided. In the proposed project, we will evaluate a systems approach applying a similar intervention for enhancing HIV testing in high risk women. We will train ~50 staff from multiple community agencies that provide services to high risk women to encourage HIV testing and deliver reinforcement for testing. After staff training, 334 women recruited at these community agencies will be randomized to standard care referral procedures plus HIV risk reduction education or the same plus reinforcement, in which they can receive up to $40 for completing HIV testing at study initiation and for repeat testing 6 and 12 months later. Primary systems outcomes will include staff knowledge and attitudes about HIV testing and reinforcement interventions. The primary client outcome will be proportions who undergo testing. Exploratory analyses will evaluate moderators of testing, including clinic, clinician, and client characteristics, as well as indices of change in sexual risk and other behaviors over time and by condition over time. We will also estimate costs of the intervention and its cost effectiveness in promoting HIV testing. This project evaluates new models to promote HIV testing. It institutes trainings and provides direct resources for integrating reinforcement-based HIV testing referral procedures to women accessing services at substance abuse treatment clinics, Federally Qualified Heath Centers, domestic violence agencies, and homeless shelters. Trainings address systemic and structural issues and provide concrete methods and resources to enhance testing (i.e., reinforcers). Our experiences integrating reinforcement for substance use treatment through the Veterans Administration (VA) speak directly to this project?s potential success, with over 90% of VA clinics implementing reinforcers after training (DePhillipis et al., in press; Petry et al., 2014a). Due to this success, the VA has committed to supporting this intervention indefinitely. This project likewise proposes to initially provide reinforcers with the presumption that, if effective, costs will be justified by HIV testing outcomes. Thus, results from this project hold the potential to establish a highly effective method to increase HIV testing in vulnerable women, which could be readily applied more globally to slow the spread of HIV.