Jannette Berkley-Patton - US grants

[unreadable] DESCRIPTION (provided by applicant): This K01 Mentored Research Scientist Development Award will provide advanced training for the candidate to establish an independent research program focused on HIV prevention and screening in underserved communities. The qualitative and quantitative studies proposed here focus on HIV testing, as 50% of newly diagnosed HIV cases are estimated to be caused by individuals who are unaware of their HIV+ serostatus. African Americans who are unaware of their HIV+ status likely contribute to the disproportionately high observed rates of HIV in this population. Given their reach and capacity, African American churches are ideal settings to recruit and retain research participants as well as impact community norms related to HIV testing. The primary aim of the proposed study is to develop and pilot test the feasibility of a church-based intervention to promote HIV testing among African American church members and community members receiving church outreach services between the ages of 18 to 64. We will use a 2-arm design with four churches (N = 400) to test a culturally and religiously tailored intervention against a standard non-tailored information intervention on HIV testing rates at 6 and 12 months. Intervention components are based on the Theory of Planned Behavior (TPB), an empirically-validated behavioral change strategy commonly used in health screening research. Delivery of intervention components will be conducted using an Ecological Model widely utilized in African American church-based research studies. This model combined with the TBP model, provides an ecologically-expanded TBP (eTPB) framework for developing and delivering the intervention's components through the multiple levels (e.g., church-wide, ministry groups, individual) of the church setting. Prior to the pilot study, we will conduct focus groups with African American church and church-affiliated community members to elicit information on facilitators and barriers and eTBP factors (attitudes/beliefs, subjective norms, and perceived behavioral control) related to receipt of church-based HIV testing in order to guide the development of the pilot study intervention. Feasibility of the intervention will be assessed using post-study interviews with participating church leaders, documentation of intervention components implemented by churches, and study completion rates. A Community Advisory Board will assist in providing guidance in all phases of development and implementation of the focus group and pilot studies. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The proposed study focuses on African Americans (AAs) - a population experiencing multiple health disparities. Promotion of healthy behaviors among AAs across the continuum of care from prevention to diagnosis and treatment services is critical to addressing AA health disparities. Black churches may be an ideal setting for health promotion interventions as they have extensive influence and reach in AA communities, high AA attendance rates, and a strong emphasis on health. Yet, limited studies exist on AA church-based health interventions that support a continuum of health services from prevention to linkage to care with church members and community members using church outreach services. This study focuses on planning, developing, and pilot testing an AA church-based multilevel health promotion intervention to address an AA health disparity. Using community-based participatory (CBPR) principles, our faith-health- community-academic partnership's (Heartland Health Network) CAB will assist in engaging faith and other community partners in all aspects of this study from setting the research agenda to pilot intervention development, implementation, evaluation, and dissemination of findings. In Year 1, the planning phase will consist of: a) conducting a needs assessment survey with 10 churches (n=450 adult church members total) and 10 health and community-based organizations (n=50 key stakeholders) to identify a health condition that disproportionately impacts AAs and feasible multilevel intervention strategies; b) holding a church/community forum to review needs assessment survey findings and explore facilitators/barriers and a plausible multilevel intervention strategies; and c) guided by the CAB and needs assessment findings, developing a culturally/religiously tailored, multilevel health promotion intervention that engages church health liaisons and health providers in promoting prevention, health screening, and linkage to care. In Years 2 and 3, a 2- or 3- arm pilot intervention will be tested with 6 AA churches (N=400 church and community members) assessed at baseline and 12-months. Post study focus groups will be conducted with church leaders and CAB members (n=40 total) to assess the CBPR process used in the study. RELEVANCE: This study is the first to test a multilevel health promotion intervention in African American (AA) churches through delivery of prevention, health screening, and linkage to care services to AA church and community members. This model could have a significant public health impact by providing a faith community engagement model for implementing scalable, wide-reaching socio-ecological interventions and supporting AA faith leaders with a religiously and culturally-appropriate church-based intervention strategies and tools.

DESCRIPTION (provided by applicant): CDC's HIV screening guidelines encourage routine screening of all individuals aged 13 to 64 in medical settings. However, many African Americans (AAs) have limited access to health care and barriers to HIV services may prohibit some from seeking HIV screening. The African American church is an institution with extensive influence in Black communities and may be an ideal setting for increasing reach of HIV screening beyond traditional medical settings; yet, no controlled studies exist on HIV interventions in AA churches. The primary aim of this study is to fully test a culturally/religiously-tailored, church-based HIV screening intervention against a standard HIV information intervention on HIV screening rates at 6 and 12 months with adult AA church members and community members who use church outreach services. In this two-arm clustered, randomized community trial, churches will be matched on SES, membership size, and denomination, then randomized to treatment condition. It is projected that 14 churches (7 churches per arm; 110 church and community members per church; 1,540 participants total) will be required to detect significant increases in HIV screening in the intervention arm. Intervention content is guided by the Theory of Planned Behavior (TPB). Intervention delivery will be guided by a Community Engagement and Social-Ecological approach. This approach includes church leaders delivering culturally/religiously-appropriate HIV education and screening materials (e.g., sermon guides, HIV screening testimonials, church bulletins) and activities (e.g., pastors modeling receipt of HIV screening, HIV screening events) from a church-based HIV Tool Kit through multilevel church outlets (community-wide, church-wide services, ministry and outreach groups, individual) to increase intervention reach and dosage. It was hypothesized that this church-based HIV screening intervention will significantly increase HIV screening rates vs a standard HIV information intervention in AA church-populations at 6 and 12 months. The role of potential mediators and moderators related to receipt of HIV screening will be evaluated and a process evaluation to determine modifiable implementation fidelity, facilitators, barriers, and costs related to increasing church-based HIV testing rates will be conducted. This intervention study could provide an effective, scalable model for HIV screening interventions in AA churches.

PROJECT SUMMARY African Americans (AAs) are disproportionately burdened by diabetes mellitus (DM) with rates twice as high as Whites (13% vs 7.5%), and increased rates of DM-related complications and comorbidities (e.g. amputations, cardiovascular disease). A key pre-DM risk factor is overweight/obesity. Nearly 70% of AAs are overweight or obese, with higher rates among AAs with low-income. A critical component of national efforts to reduce growing obesity rates and prevent DM is the Diabetes Prevention Program (DPP), a lifestyle intervention proven to reduce or delay DM onset with diet change, exercise, and modest weight loss (5-7%) in a rigorously evaluated national trial. A group-based version of the DPP has been widely disseminated and numerous community-based trials support its efficacy. In spite of these successes, there are significant health disparities in DPP attendance and outcomes and considerable room exists for improving success rates among AAs, a population that tends to experience half the amount of DPP weight loss compared to Whites. We aim to build on our promising pilot studies by tailoring the DPP via a social determinants (SD) of health lens to achieve optimal DPP attendance and clinically meaningful weight loss with pre-DM AAs. This includes tailoring on cultural and socioeconomic SD mechanisms that are associated with improving health outcomes and align with predisposing needs among AAs who are primarily of low-income and live in low-resource AA communities. We propose a randomized controlled trial of 360 pre-DM AA patients from a safety net hospital (SNH) to test a standard DPP (S-DPP) against a culturally tailored DPP (TC-DPP; e.g., tailoring of language, foods, values, religiosity, norms, values) alone and a culturally tailored DPP enhanced to address access and support related economic barriers (TCE-DPP; hybrid group/online/text DPP; community health worker support to improve access to DPP classes, healthy food, exercise, and other community and health resources; and financial incentives) over 12 months. We will: 1) examine effects of TC-DPP and TCE-DDP on percent weight loss and attendance (primary outcomes) and on secondary outcomes (physical activity, completion of physician follow- up visit, hbA1c, and blood pressure) at 6 and 12 months with SNH AAs, 2) evaluate potential mediators/ moderators related to weight loss and attendance among AA SNH patients at 6 and 12 months to determine modifiable facilitators and barriers, and 3) conduct a process evaluation to examine TCE-DPP acceptability, feasibility, and fidelity, and relationships between delivery dose, exposure, costs, and outcomes to identify and improve essential intervention components. Our multidimensional DPP interventions are guided by our past pilots, and based on components that, all together, were used to help drive clinically important outcomes in the original DPP trial ? and are certainly needed to achieve similar outcomes with AA primarily of low-income. To our knowledge this is the first study to test multidimensional tailoring via an SD lens to truly impact DPP attendance and outcomes, and has potential to be a feasible, scalable model to reduce DM disparities among at-risk AA.

PROJECT SUMMARY African Americans (AA) are disproportionately burdened by COVID19 across the spectrum of related cases, hospitalizations, and deaths compared to Whites. Many multilayered barriers increase risk for COVID19 among AA including poverty, essential jobs with increased virus exposure, cultural norms (eg, risk denial, medical/contact tracing mistrust), and limited access to healthcare and other services/resources. These barriers highlight the need for accessible, trusted COVID19 testing and linkage to care (LTC) services (eg, health, prevention programs, community resources, contact tracing) to help slow COVID19 spread in AA communities. The AA church is an institution with extensive influence in AA communities and may be an ideal setting for increasing reach of COVID19 testing and LTC in hard hit AA communities. Yet, no controlled AA church-based studies exist on COVID19 testing interventions. The primary aim of this study is to fully test a culturally/religiously-tailored, church-based COVID19 testing and LTC intervention condition against a non- tailored intervention condition on COVID19 testing rates at 6 months with adult AA church members and the community members they serve. Churches will be matched on membership size, denomination and past participation in church health intervention studies, then randomized to treatment condition. Sixteen churches (8 churches/arm; 45 church and 15 community members/church; N=960 total) will participate in the study. LTC use, contact tracing approval, and COVID19 prevention behaviors will also be examined at 6 months as secondary outcomes. Guided by the Theory of Planned Behavior and Socioecological Model, our community- engaged approach includes trained church leaders delivering a culturally, church-appropriate COVID19 Toolkit inclusive of digital tools: a) individual self-help materials and tailored text messages; b) in-person/virtual group seminars for caregivers of persons with COVID19; c) in-person/virtual church services with COVID19 related materials/activities (e.g., sermons, testimonials, responsive readings); and d) church-community level LTC services (eg, insurance, healthcare, prevention programs, community resources, contact tracing) provided virtually by community health workers, church-community-based re-opening guidelines, and church-based COVID19 testing events with health agencies. Examination of LTC use and contact tracing approval will aid in understanding intervention impact on COVID19 testing by addressing participant essential needs. Potential mediators/moderators related to receipt of COVID-19 testing will be evaluated, and a process evaluation to determine implementation facilitators, barriers, and fidelity related to increasing COVID19 testing rates. Our ongoing meetings with our long-term faith and health partners is enabling us to quickly adapt our AA church- based HIV testing and diabetes prevention interventions for the proposed study. This multilevel study could provide an effective, scalable model for increasing COVID19 testing, prevention, and LTC/contact tracing approval with AA churches in partnership with health agencies, and provide strategies to streamline delivery/uptake of future COVID-19 vaccination.