Jeanne M. Sevelius, Ph.D. - US grants

DESCRIPTION (provided by applicant): Transgender women (assigned 'male'at birth with a female identity) are an understudied group with HIV prevalence rates in the range of 22 - 66%. Public health intervention research has produced no theory-driven, evidence-based interventions for transgender women. The unique cultural context of transgender women creates distinct risk factors that require systematic investigation and then integration into culturally relevant, community-based approaches to intervention. This K08 application describes a comprehensive, integrated training and research plan designed to serve as a pathway to scientific independence and the expertise to develop and test an innovative and urgently needed intervention to improve health outcomes among a highly marginalized population disproportionately affected by the HIV epidemic. The following training objectives are proposed: (1) to acquire expertise in the evaluation and application of theories of behavior change to marginalized populations;(2) to enhance skills in the use of mixed methods data collection and analysis, with an emphasis on techniques relevant to measurement development and theory testing;(3) to gain knowledge and experience with clinical trails methodology, including issues of sampling, randomization, design, protocol development, and ethics;and (4) to obtain training and experience in methods for developing, implementing, and evaluating culturally grounded, theory-driven HIV prevention interventions for transgender women. The specific research aims of the mentored original research are: (1) to describe the role of transgender women's unique cultural context on their HIV-related risk and protective factors;(2) to create new and to adapt existing quantitative measures to more accurately assess psychological dimension sand behavior relevant to transgender women's HIV risk and protective factors;(3) to identify psychosocial factors associated with HIV-related sexual and injection risk behaviors and protective factors among transgender women;and (4) to develop and test the feasibility and acceptability of a theory-driven, culturally grounded HIV prevention intervention for transgender women.

DESCRIPTION (provided by applicant): The purpose of this study is to assess the feasibility and acceptability of Sheroes, a theory-driven, culturally grounded intervention to reduce sexual risk behavior among male-to-female transgender women (transwomen) at risk for HIV acquisition or transmission. HIV prevalence estimates among this population are markedly higher than estimates for other at-risk groups, and transwomen also experience severe stigma, discrimination, alienation, poverty, and victimization. Despite elevated risk for HIV, the rates of HIV testing among transwomen are much lower than other at-risk groups, and our team's research with transwomen living with HIV indicates unique barriers to treatment uptake and antiretroviral medication adherence, which puts them at elevated risk of poor HIV-related clinical outcomes, including morbidity, mortality, and transmission of HIV to uninfected partners. There is a dire need for rigorously-evaluated interventions designed specifically to meet the unique needs of transwomen. To address this need, we developed 'Sheroes,' a group-based intervention that addresses the unifying lived experiences of HIV-positive, HIV-negative, and unknown status high-risk transwomen. Sheroes was designed in close collaboration with the transgender community and is grounded in our team's innovative Model of Gender Affirmation. While a number of investigators have observed an intense need for (and often lack of access to) gender affirmation among transgender individuals, its relationship to high-risk behavior has rarely been directly investigated. This study is a pilot randomized controlled trial (RCT) comparing the Sheroes intervention to a time- and attention-matched film-based control condition. From a projected 223 to be screened, 60 self-identified transwomen who are at least 18 years of age, of any HIV status, and reporting unprotected receptive and/or insertive anal intercourse (UAI) in the past 3 months will be stratified by HIV status and randomized to receive the 5-session Sheroes intervention or a time- and attention- matched control group. Follow-up assessments will be conducted at 3 and 6 months post-randomization. While this pilot study is not powered for a formal test of outcomes or effect size estimation, we will collect data on our primary and secondary outcomes of interest to determine feasibility and acceptability of data collection and to explore our hypotheses via preliminary analyses. We hypothesize that following intervention exposure relative to control group, Sheroes participants will report a lower mean number of unprotected sexual partners. Moreover, we will test the secondary/exploratory hypotheses that Sheroes participants will report a) higher HIV testing rates (for HIV-negative transwomen at baseline); b) higher STI testing rates (for all serostatus transwomen), and c) higher HIV medical appointment attendance and ART readiness or ART use and adherence (for HIV-positive transwomen). An additional secondary/exploratory aim is to examine mediators/mechanisms of change based on the Model of Gender Affirmation (e.g., need for gender affirmation, self-objectification) and moderators of the intervention (e.g., HIV status, dru use).

DESCRIPTION (provided by applicant): The purpose of this study is to develop and pilot test a culturally relevant, theory-driven adaptation of the evidence-based intervention Project START to improve post-incarceration health care engagement among transgender ('trans') women. The adapted intervention (Trans START) will focus on improving linkage to and engagement in four health care domains (HIV, substance use, mental health, and transgender-related medical care), responsive to each participant's self-identified needs. Incarceration is a significant publi health issue that disproportionately impacts trans women, and the cycle of incarceration interacts with high levels of substance use, mental illness, and HIV to produce an elevated burden of disease among trans women. Trans women who have been arrested are more likely to report mental illness, using substances, engaging in risky sex, and needing trans-sensitive services upon release. Gender differences in health, post-release service needs, and predictors of engagement in healthcare call for gender-specific strategies. This adaptation of Project START will incorporate an innovative, transgender-specific theoretical model, the Model of Gender Affirmation. Unmet need for gender affirmation predicts HIV risk among HIV- trans women and treatment failure among those who are living with HIV, and access to gender affirmation is related to better mental health. Furthermore, access to gender affirmation supports linkage, engagement, and retention in care among trans women who are living with HIV. Using the ADAPT-ITT strategy to guide the adaptation process, we will conduct qualitative interviews with 15-20 trans women who are incarcerated in the San Francisco County Jail (SFCJ), prior to and after release. We will also conduct qualitative interviews with 5-10 key stakeholders who work with this population in SFCJ and in the community. Once the adapted materials are finalized, we will conduct a pilot randomized controlled trial to test the feasibility and acceptability of the adapted intervention, as well as the protocols and procedures, to inform a future full-scale randomized controlled trial for efficacy of the adapted intervention. To accomplish this aim, we will randomize 50 trans women who have been incarcerated for a minimum of one week to either Trans START (adapted Project START curriculum plus treatment as usual) or treatment as usual alone (TAU). We expect that following intervention exposure, relative to control group, Trans START participants will report higher rates of HIV testing (among HIV- women at baseline) and higher HIV medical appointment attendance (for HIV-positive trans women). Moreover, intervention participants will report: a) higher levels of linkage to and engagement in substance abuse treatment, mental health care, and transgender-related medical care (among participants who identify these as needs). With the data from the feasibility and acceptability pilot, we will leverage funding to conduct a larger efficacy study of the adapted curriculum with the goal of producing a replicable, culturally relevant, evidence-based health promotion intervention for incarcerated trans women who are preparing for release into the community.

? DESCRIPTION (provided by applicant): Transgender women (assigned `male' at birth but who do not identify as male) are disproportionately impacted by HIV and have culturally unique barriers and facilitators to engagement in HIV care. Transgender women living with HIV (TWH) are less likely than others to take antiretroviral therapy (ART), and those who initiate ART have lower rates of ART adherence, lower self-efficacy for integrating ART into daily routines, and report fewer positive interactions with health care providers than non-transgender adults. As a result, TWH have an almost three-fold higher viral load than non-transgender adults in San Francisco; in Los Angeles, TWH are less likely to be virally suppressed than any other behavioral risk group. In our formative work, we have identified culturally-specific and modifiable barriers to HIV treatment engagement among TWH, including prioritization of transition-related health care (i.e. hormone therapy) at the expense of HIV treatment, avoidance of HIV care settings due to past negative health care experiences, misinformation about ART including potential drug interactions with hormones, intensified HIV stigma, low levels of social support, and poor coping skills. There are both individual and public health consequences to poor engagement in care among TWH stemming from high transmission risk factors, including substance abuse, high numbers of sex partners, engagement in sex work, and high rates of mental illness. These findings strongly suggest that TWH face unique challenges to engaging in and adhering to HIV treatment, and that the public health consequences for poor engagement in this population are of grave concern. Interventions to mitigate these barriers to engagement in care are critical in efforts to alter the pattern of HIV-related disparities that lead to disproportionately poor health outcomes for this highly vulnerable and marginalized population. We propose a randomized controlled trial of a theory- driven, population-specific, piloted intervention to improve engagement in care for TWH. Grounded in the investigators' Models of Gender Affirmation and Health Care Empowerment, the proposed research is the first to systematically intervene on complex barriers to optimal engagement in HIV care for TWH. We have developed and piloted the Healthy Divas intervention to optimize engagement in HIV care for TWH at elevated risk for treatment failure and consequential morbidity, mortality, and transmission of HIV.

Project Summary Transgender women are at significantly higher risk of contracting HIV, yet analysis of the iPrEx study indicates use of pre-exposure prophylaxis (PrEP) had no effectiveness in preventing HIV in this group on an intention-to- treat basis. While significantly understudied, qualitative work suggests that trans women experience unique, trans-specific issues, including prioritization of hormone therapy and transition-related medical care over HIV prevention, and real and perceived trans-related stigma and discrimination in healthcare settings. The result is a significant group who is highly vulnerable to HIV infection and its negative health consequences, yet is less likely to benefit from PrEP. Research is urgently needed to understand how trans women perceive their HIV risk and make decisions about PrEP, as well as how healthcare providers address stigma and structural barriers to treatment, so that appropriate interventions can be developed. Utilizing perceptual mapping and vector modeling techniques, we will conduct a mixed methods study in San Francisco and Philadelphia combining in-depth qualitative methods with quantitative surveys to assess trans women's perceptions of PrEP, and get feedback on stigma and structural barriers to accessing healthcare from providers. Using vector message modeling, these maps will be used to identify specific message strategies to be embedded into larger interventions to address trans women's PrEP barriers and providers' barriers to treating trans women. Specific aims of the research are: 1: To create perceptual mapping survey instruments for trans women and healthcare providers to assess perceptions of PrEP, trans-related stigma, and barriers to healthcare. To accomplish this we will conduct focus groups (n=60) and interviews with healthcare providers (n=10) serving trans women and then develop perceptual mapping surveys based on findings; 2. To develop highly targeted messages to enhance PrEP decision-making in trans women and address structural barriers and beliefs in providers using perceptual mapping and vector modeling. To accomplish this aim we will conduct perceptual mapping surveys with trans women (n=100) and healthcare providers (n=50) and perform perceptual mapping and vector message modeling analysis to develop messages; 3. To assess the messages for cultural salience and get insight into acceptable communication channels and intervention activities to enhance decision making around PrEP use in HIV-negative trans women and address stigmatizing beliefs and structural barriers in providers. We will accomplish this by conducting focus groups with trans women (n=40) and interviews with providers (n=10) to get feedback on how messages would be best delivered in an intervention and analyze data to identify the most effective messages and delivery strategies. We expect our innovative methods will have wide application for designing effective, tailored messages to address barriers to PrEP and concerns about structural barriers to receiving healthcare, an important strategy for eliminating health disparities among an at- risk trans women.

Transgender (`trans') women (i.e., individuals with a feminine and/or female gender identity who were assigned male at birth) are among the populations at highest risk for HIV in the United States and worldwide. One of the most consistently reported contexts for HIV transmission among trans women is within a primary partnership with a non-transgender male. Despite the critical importance of primary partnerships for HIV prevention, the vast majority of HIV prevention studies and interventions for trans women have been individually-focused. For the past 10 years we have conducted research to identify intervention targets for reducing HIV transmission among trans women and their male partners using qualitative, survey, and intervention adaptation methodologies (R01DA018621; R34MH093232). Based on our conceptual and empirical understandings of HIV transmission risks among these couples, we recently developed and pilot tested the first known couples- based HIV prevention intervention for trans women and their male primary partner dyads (called ?Couples HIV Intervention Program?; CHIP), which was feasible, acceptable, and produced significant reductions in sexual risk behavior compared to the control group. Based on our highly successful R34 findings, we propose to test the efficacy of the CHIP program in large-scale randomized controlled trial (RCT) to reduce HIV risk among seroconcordant negative and serodiscordant couples. We will enroll racially diverse trans women and their male partners and randomize couples to either the CHIP intervention or an enhanced standard of care (SOC) control condition. Couples will be followed quarterly over 12-months. Analysis of study outcomes will utilize both individual- and dyadic-level data. Our primary outcome is a composite measure of risk for HIV transmission which encompasses validated behavioral indicators of HIV risk as well as biomedical confirmation of viral suppression and PrEP adherence. The CHIP intervention builds on years of formative work that targets interpersonal and social factors as mechanisms of HIV risk behavior among trans women and their male partners. If the CHIP intervention demonstrates efficacy in comparison to an enhanced SOC control condition, there will be support for implementing this approach within HIV prevention and care settings in order to reduce disparities in HIV transmission and acquisition among some of the highest priority HIV prevention populations.

PROJECT SUMMARY Globally, transgender (`trans') women experience extreme social and economic marginalization due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are multiply oppressed. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the `most-at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups, despite availability in the public sector and documented interest in the community. Through extensive formative work, we have developed a multi-level intervention utilizing HIV prevention strategies which have demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement of trans women in the HIV prevention continuum. We propose to test `Guerreiras' (`warrior women', as named by trans women participants in Brazil), comprised of two intervention components designed to address intersectional stigma: 1) a group-level, peer-led intervention and 2) an individual-level peer navigation program to increase uptake of HIV testing and PrEP. Guerreiras is informed by a trans-specific conceptual model, gender affirmation theory, that describes intersectional stigma faced by trans women, informs investigations of how intersectional stigma results in health disparities, and provides a framework for intervention development and testing. We will recruit trans women (N=400) from clinical sites, outreach events, and an observational cohort in São Paulo, Brazil. Guerreiras will be evaluated using a randomized wait-list controlled trial to compare HIV testing uptake (self-testing and clinic-based) (Aim 1), PrEP initiation and persistence (Aim 2), and other prevention services (e.g. harm reduction) among trans women in the intervention arm compared to those in the control arm with data collection scheduled every three months. We will assess changes in intersectional stigma (Aim 3), including reductions in internalized stigma and increased resilience to anticipated and enacted stigma, among those assigned to intervention compared to those assigned to control, and assess how changes in stigma domains result in prevention uptake. Outcomes will be monitored through the national medications dispensing system (PrEP initiation and persistence), clinical records and self-report (HIV testing), and through comprehensive surveys (intersectional stigma). The proposed research leverages a productive multi-disciplinary HIV research partnership with extensive experience working with trans women in Brazil, multi-level intervention components, and a context where PrEP and HIVST are available publicly, providing an opportunity to evaluate and scale-up an HIV prevention initiative in a key health disparity population, while contributing to nascent research in intersectional stigma.

PROJECT SUMMARY/ABSTRACT Transgender women have some of the highest rates of HIV in the world and are the highest HIV risk group in the United States and Brazil. Transgender women experience multiple stigmas that complicate their access to and adherence to healthcare, resulting in intersectional stigma and negative health outcomes. Intersectionality is a critical theory which posits that power relations construct our perspectives and experiences and has the potential to meaningfully inform research with transgender communities as well as an approach to mentorship across differences. Using novel applications of the framework of intersectionality, Dr. Jae Sevelius, Associate Professor in Residence, University of California, San Francisco, proposes (1) a plan for their own career development that will expand their research to include substance use and implementation science, (2) a plan to expand their program of research to provide ample training opportunities for mentees, and (3) a plan to provide mentoring focused on supporting mentees who are underrepresented in medicine (URM) and/or are launching a program of research focused on addressing health disparities among sexual and gender minorities (SGM). Their community-based, patient-oriented research is focused on the investigation of risk and protective factors in transgender communities and the relationship between stigma, discrimination, and health-related behaviors and outcomes. Dr. Sevelius' efforts have been dedicated to developing, implementing, and evaluating health promotion interventions that decrease health risks, including HIV transmission and acquisition, and improve treatment through behavioral changes, community programming, and increased access to culturally appropriate health care. Their research and scientific contribution of the trans-specific Model of Gender Affirmation is recognized nationally and internationally in the field of transgender health and HIV prevention and treatment. Mentee training will leverage the infrastructure and resources of Dr. Sevelius' ongoing intervention research and their collaborations with multidisciplinary and international researchers in the areas of HIV, substance use, and transgender health domestically and in Brazil. In order to expand the scope of their mentoring program, they propose to launch a group-based distance mentoring program, conduct facilitated writing intensives with their mentees, and produce scholarship and training in the area of intersectional mentoring. Lastly, Dr. Sevelius proposes to conduct K24 supported research studies that will serve as training vehicles for mentees and develop their research by (1) expanding their research experience and scholarship to include the characterization of substance use among transgender women within the context of HIV treatment, (2) cultivating expertise in implementation science to identify best practices for implementation of efficacious HIV prevention interventions among transgender populations who use substances, and (3) gaining experience assessing and contextualizing intersectional stigma among transgender populations in Brazil.

PROJECT SUMMARY The Center for AIDS Prevention Studies (CAPS) is a highly productive, vibrant, integrated, multidisciplinary center that conducts cutting-edge, high-impact HIV prevention research with robust institutional support from one of the highest ranked medical schools in the country. CAPS has a multidisciplinary faculty who conduct research driven by the center's mission. CAPS's significant contributions to HIV science are evident in the over 553 manuscripts published during the current award period (9/01/2016-6/30/2020). CAPS has continued to catalyze HIV science by obtaining NIH research grants at an almost 60% success rate and has grown a diverse portfolio that addresses the continuum of HIV prevention and treatment. This portfolio spans basic social and behavioral science to intervention development, implementation and policy research. The significant and ongoing scientific contributions of CAPS necessitate the center continue its leadership in advancing the next generation of research required to end the HIV epidemic. We will continue to provide critical support to a cadre of world-class scientists who push disciplinary boundaries. This will be accomplished via an agile infrastructure of research cores designed to ignite scientific innovation and high-impact research with the depth and breadth necessary to reach global indicators for ending the epidemic. Overall, CAPS aims to: 1. Catalyze a strong scientific environment: Ignite timely, innovative, high-impact, multidisciplinary research to nimbly address current and emerging issues critical for ending the HIV epidemic, particularly those related to the center themes; 2. Strengthen the scientific workforce: Build the number, competence, capacity, effectiveness, and diversity of investigators, as well as community and public health partners to conduct high-priority, high- impact HIV research that is responsive to addressing co-occurring and multiplicative factors driving HIV and HIV-related health systems; 3. Advance innovative methods: Promote the use of novel research designs, integrative methods, and cutting-edge technologies that are necessary for addressing the complex, multilayered, co-occurring, multiplicative factors and strategies that facilitate rather than hinder access to HIV prevention and treatment within HIV-related health systems; 4. Maximize public health impact: Bridge the gap between research and practice by supporting research that ensures that efficacious interventions and practices translate optimally and equitably into effective implementation within and across diverse community and health systems. In summary, consistent with NIMH Division of AIDS Research's areas of high priority,3 CAPS will drive progress towards an end to the HIV epidemic by catalyzing and supporting innovative, multidisciplinary HIV research that integrates and sustains HIV prevention and treatment delivery across diverse health systems to address the co-occurring and multiplicative factors that drive the epidemic.

PROJECT SUMMARY The Center for AIDS Prevention Studies (CAPS) is a highly productive, vibrant, integrated, multidisciplinary center that conducts cutting-edge, high-impact HIV prevention research with robust institutional support from one of the highest ranked medical schools in the country. CAPS has a multidisciplinary faculty who conduct research driven by the center's mission. CAPS's significant contributions to HIV science are evident in the over 553 manuscripts published during the current award period (9/01/2016-6/30/2020). CAPS has continued to catalyze HIV science by obtaining NIH research grants at an almost 60% success rate and has grown a diverse portfolio that addresses the continuum of HIV prevention and treatment. This portfolio spans basic social and behavioral science to intervention development, implementation and policy research. The significant and ongoing scientific contributions of CAPS necessitate the center continue its leadership in advancing the next generation of research required to end the HIV epidemic. We will continue to provide critical support to a cadre of world-class scientists who push disciplinary boundaries. This will be accomplished via an agile infrastructure of research cores designed to ignite scientific innovation and high-impact research with the depth and breadth necessary to reach global indicators for ending the epidemic. Overall, CAPS aims to: 1. Catalyze a strong scientific environment: Ignite timely, innovative, high-impact, multidisciplinary research to nimbly address current and emerging issues critical for ending the HIV epidemic, particularly those related to the center themes; 2. Strengthen the scientific workforce: Build the number, competence, capacity, effectiveness, and diversity of investigators, as well as community and public health partners to conduct high-priority, high- impact HIV research that is responsive to addressing co-occurring and multiplicative factors driving HIV and HIV-related health systems; 3. Advance innovative methods: Promote the use of novel research designs, integrative methods, and cutting-edge technologies that are necessary for addressing the complex, multilayered, co-occurring, multiplicative factors and strategies that facilitate rather than hinder access to HIV prevention and treatment within HIV-related health systems; 4. Maximize public health impact: Bridge the gap between research and practice by supporting research that ensures that efficacious interventions and practices translate optimally and equitably into effective implementation within and across diverse community and health systems. In summary, consistent with NIMH Division of AIDS Research's areas of high priority,3 CAPS will drive progress towards an end to the HIV epidemic by catalyzing and supporting innovative, multidisciplinary HIV research that integrates and sustains HIV prevention and treatment delivery across diverse health systems to address the co-occurring and multiplicative factors that drive the epidemic.

PROJECT SUMMARY The Center for AIDS Prevention Studies (CAPS) is a highly productive, vibrant, integrated, multidisciplinary center that conducts cutting-edge, high-impact HIV prevention research with robust institutional support from one of the highest ranked medical schools in the country. CAPS has a multidisciplinary faculty who conduct research driven by the center's mission. CAPS's significant contributions to HIV science are evident in the over 553 manuscripts published during the current award period (9/01/2016-6/30/2020). CAPS has continued to catalyze HIV science by obtaining NIH research grants at an almost 60% success rate and has grown a diverse portfolio that addresses the continuum of HIV prevention and treatment. This portfolio spans basic social and behavioral science to intervention development, implementation and policy research. The significant and ongoing scientific contributions of CAPS necessitate the center continue its leadership in advancing the next generation of research required to end the HIV epidemic. We will continue to provide critical support to a cadre of world-class scientists who push disciplinary boundaries. This will be accomplished via an agile infrastructure of research cores designed to ignite scientific innovation and high-impact research with the depth and breadth necessary to reach global indicators for ending the epidemic. Overall, CAPS aims to: 1. Catalyze a strong scientific environment: Ignite timely, innovative, high-impact, multidisciplinary research to nimbly address current and emerging issues critical for ending the HIV epidemic, particularly those related to the center themes; 2. Strengthen the scientific workforce: Build the number, competence, capacity, effectiveness, and diversity of investigators, as well as community and public health partners to conduct high-priority, high- impact HIV research that is responsive to addressing co-occurring and multiplicative factors driving HIV and HIV-related health systems; 3. Advance innovative methods: Promote the use of novel research designs, integrative methods, and cutting-edge technologies that are necessary for addressing the complex, multilayered, co-occurring, multiplicative factors and strategies that facilitate rather than hinder access to HIV prevention and treatment within HIV-related health systems; 4. Maximize public health impact: Bridge the gap between research and practice by supporting research that ensures that efficacious interventions and practices translate optimally and equitably into effective implementation within and across diverse community and health systems. In summary, consistent with NIMH Division of AIDS Research's areas of high priority,3 CAPS will drive progress towards an end to the HIV epidemic by catalyzing and supporting innovative, multidisciplinary HIV research that integrates and sustains HIV prevention and treatment delivery across diverse health systems to address the co-occurring and multiplicative factors that drive the epidemic.

PROJECT SUMMARY The Center for AIDS Prevention Studies (CAPS) is a highly productive, vibrant, integrated, multidisciplinary center that conducts cutting-edge, high-impact HIV prevention research with robust institutional support from one of the highest ranked medical schools in the country. CAPS has a multidisciplinary faculty who conduct research driven by the center's mission. CAPS's significant contributions to HIV science are evident in the over 553 manuscripts published during the current award period (9/01/2016-6/30/2020). CAPS has continued to catalyze HIV science by obtaining NIH research grants at an almost 60% success rate and has grown a diverse portfolio that addresses the continuum of HIV prevention and treatment. This portfolio spans basic social and behavioral science to intervention development, implementation and policy research. The significant and ongoing scientific contributions of CAPS necessitate the center continue its leadership in advancing the next generation of research required to end the HIV epidemic. We will continue to provide critical support to a cadre of world-class scientists who push disciplinary boundaries. This will be accomplished via an agile infrastructure of research cores designed to ignite scientific innovation and high-impact research with the depth and breadth necessary to reach global indicators for ending the epidemic. Overall, CAPS aims to: 1. Catalyze a strong scientific environment: Ignite timely, innovative, high-impact, multidisciplinary research to nimbly address current and emerging issues critical for ending the HIV epidemic, particularly those related to the center themes; 2. Strengthen the scientific workforce: Build the number, competence, capacity, effectiveness, and diversity of investigators, as well as community and public health partners to conduct high-priority, high- impact HIV research that is responsive to addressing co-occurring and multiplicative factors driving HIV and HIV-related health systems; 3. Advance innovative methods: Promote the use of novel research designs, integrative methods, and cutting-edge technologies that are necessary for addressing the complex, multilayered, co-occurring, multiplicative factors and strategies that facilitate rather than hinder access to HIV prevention and treatment within HIV-related health systems; 4. Maximize public health impact: Bridge the gap between research and practice by supporting research that ensures that efficacious interventions and practices translate optimally and equitably into effective implementation within and across diverse community and health systems. In summary, consistent with NIMH Division of AIDS Research's areas of high priority,3 CAPS will drive progress towards an end to the HIV epidemic by catalyzing and supporting innovative, multidisciplinary HIV research that integrates and sustains HIV prevention and treatment delivery across diverse health systems to address the co-occurring and multiplicative factors that drive the epidemic.

ABSTRACT Ujima ? a Swahili word meaning ?collective work and responsibility? to build and maintain community, solving problems together ? exemplifies the primary mission of the proposed research training program. The proposed NIMH AIDS Research Centers (ARC) Ujima Mentoring Program (Ujima Program) will develop and support early career investigators who focus their programs of research on high priority areas that address HIV/AIDS treatment, prevention, and care in Black/African American (hereafter Black) communities. While accounting for 13% of the US population in 2018, Black people represented 42% of the new HIV diagnoses among adolescent and adults in the US and territories. Furthermore, Black scientists face specific challenges in obtaining research funding, securing appropriate mentoring, sustaining their programs of research, and continuing in the research pipeline. Thus, the Ujima Program has a primary focus on reducing HIV-related health disparities in Black communities and the development of early career investigators, particularly those at Historically Black Colleges and Universities (HBCUs), who can competently establish mutually beneficial partnerships with Black communities to conduct high-impact HIV/AIDS research. To accomplish this goal, Ujima Program leadership will conduct outreach to faculty and administrators of HBCUs and other NIMH- funded ARCs to promote the program, recruit HBCU and ARC scientists to serve on the steering committee and will identify and link program participants to potential ARC mentors. Program participants will form a Ujima research team to support their research to address HIV/AIDS in Black communities. The teams will consist of the program participant (scholar), a senior faculty mentor affiliated with a NIMH-funded ARCs (ARC mentor), and a mentor from the scholar?s home or similar institution (local mentor). The program will provide ongoing support to Ujima research teams through quarterly webinars, monthly check-in calls, annual workshops, and research funding. Through these activities, the Ujima Program will provide critical multidisciplinary mentoring and research training for early-stage scientists, particularly those at HBCUs, who are best equipped to undertake high-impact research to address HIV-related health inequities in Black communities.