Mallory O. Johnson - US grants

PROJECT SUMMARY/ABSTRACT ? Developmental Core The Developmental Core advances the scientific mission of CAPS by fostering the growth of trainees and scientists and by cultivating excellence in influential, groundbreaking, and timely HIV science. The landscape of the HIV epidemic is changing rapidly, and there is a critical need for multidisciplinary research to optimize recent and forthcoming advances and to address new challenges in HIV prevention. Social and behavioral research is paramount to the development, evaluation, and implementation of cutting-edge approaches to preventing HIV and its consequences. In this innovative iteration of CAPS, the Developmental Core will coordinate a wide range of resources and services that will (1) Stimulate creative, timely, and rigorous multidisciplinary research; (2) Cultivate the capacity and diversity of investigators; and (3) Nurture a high-impact scientific environment. Key activities proposed in this application include the coordination of our existing successful programs, including the Innovative Grants Program, our internal peer review system, and our rigorous training programs. We also introduce a new grant writing incubator program, propose a deepening our mentor training program, and have centered many of our core activities on our new cross- cutting themes of multiplicative and co-occurring factors and HIV-related health systems. We will continue to work closely with all other cores to ensure that the Developmental Core's resources are easily accessible and optimally utilized by a spectrum of stakeholders? academic and community institutions, individual investigators, and policymakers?within and outside of UCSF. We will prioritize core activities focused on the two identified priority themes, while continuing to cultivate the wide range of pioneering, investigator-driven, entrepreneurial HIV research that is a hallmark of CAPS's successful history.

Abstract Among men who have sex with men (MSM), there is an urgent need to optimize the unprecedented clinical and public health benefits of pre-exposure prophylaxis (PrEP) to prevent HIV with those who use stimulants (i.e., methamphetamine, cocaine, and crack-cocaine). Stimulant-using MSM display 3-6 fold faster rates of HIV seroconversion, and one-in-ten MSM with newly diagnosed HIV infection report recent stimulant use. Findings from our team and others also demonstrate that stimulant use is a key obstacle to PrEP adherence and persistence. Stimulant-using MSM have a 3-fold greater rate of disengagement from PrEP care and 5-fold greater odds of sub-optimal PrEP adherence. The proposed multi-site randomized controlled trial (RCT) will leverage a promising intervention model of delivering a positive affect intervention during contingency management (CM), which we have recently demonstrated achieves durable and clinically meaningful reductions in viral load among HIV+, methamphetamine-using MSM. In the proposed multi-site RCT, we plan to test whether delivering an Affect Regulation Treatment to Enhance Medication Intervention Success (ARTEMIS) positive affect intervention during smartphone-based CM for directly observed PrEP doses achieves more durable reductions in HIV acquisition risk over 12 months. HIV acquisition risk (the primary outcome) will be operationalized as tenofovir diphosphate (TFV-DP) levels <700 fmol per punchand self- reported recent condomless anal sex (CAS). Up to 300 MSM on PrEP who report stimulant use and CAS in the past 3 months as well as any PrEP non-adherence in the past month will be recruited from social networking applications as well as PrEP clinical services in South Florida and San Francisco. Participants who meet the inclusion and exclusion criteria at an in-person baseline assessment will provide a dried blood spot (DBS) specimen that will be stored to measure TFV-DP levels and begin 3-months of smartphone-based CM that includes financial incentives for completing up to four directly observed PrEP doses per week (48 doses total over the 3 months). Participants will complete a run-in period (waiting period) where they will complete 4 directly observed smartphone-based CM PrEP doses prior to randomization. At a separate randomization visit, 240 participants (120 South Florida and 120 San Francisco) will be randomized to receive their first individually delivered ARTEMIS positive affect intervention or attention-control session. All 5 individually delivered intervention sessions will be delivered during the 3-month CM intervention period. Follow-up assessments will be conducted at 3, 6, and 12 months after beginning CM, with DBS collected to measure TFV-DP at 6 and 12 months. Consistent with the NIH OAR high priority area of ?reducing the incidence of HIV/AIDS,? this clinical research will meaningfully inform the targeted deployment of limited public health resources to optimize the unprecedented clinical and public health benefits of PrEP in stimulant-using MSM, one of highest priority populations for decreasing HIV incidence.

PROJECT SUMMARY This application supports the launch of the innovative HIV Nexus Scholars Program at the University of California, San Francisco (UCSF) under NIAID PAR-20-289. This program will leverage a rich infrastructure of training, research, and expertise to address cross-cutting, high-priority areas in the 2019/2020 Office of AIDS Research (OAR) Strategic Plan and NIAID mission, including the integration of state-of-the-art biomedical, social/behavioral, and clinical science; health inequities research; and training and diversifying the research workforce to conduct high-priority HIV research. Our program will provide three years of education, research experiences, and mentoring to early-stage investigators (ESIs) from outside institutions who have not yet attained R01-level funding, but who demonstrate a commitment to improving the health of U.S. marginalized communities (e.g., racial, ethnic, sexual, and gender minorities) disproportionately affected by HIV, and are initiating innovative research at the intersection of biomedical, social/behavioral, and clinical science. Scientists from or closely connected to the most impacted communities are often best positioned to lead research that addresses the specific needs of the affected populations, consistent with the objectives of the 2019/2020 Office of AIDS Research Strategic Plan and the critical need to foster diverse scholars in the HIV research pipeline. The centerpiece of the Nexus Scholars Program is an intensive six-week annual training institute in which Scholars are in residence at UCSF for three consecutive summers, where they meet frequently with mentors, connect with other researchers, participate in skills-development short courses/seminars, develop and implement applied research experience plans, and conceptualize and write NIH funding applications. Such training will provide a foundation for the next generation of HIV researchers who are prepared to continue and outpace the recent momentum to end the HIV epidemic, particularly in communities disproportionately affected.

ABSTRACT The goal of this diversity supplement is to leverage global positioning systems (GPS) spatial mobility data to guide in-depth qualitative interviews examining the antecedents and consequences of intersectional minority stress in HIV-negative Black and Latinx sexual minority men (SMM) who use stimulants. Black and Latinx SMM experience profound HIV-related health disparities that are amplified by co-occurring use of stimulants. In 2018, 47% of all new US HIV infections were among Black and Latinx SMM. Overlapping structural factors such as racism, heterosexism, incarceration, and urban migration patterns within the built environment are important drivers of these racial disparities. Use of GPS tracking to analyze spatial mobility will allow us to use objective location data paired with narratives from participants explaining how interactions within certain spaces lead to stigmatizing experiences, and how those impact substance use behaviors. We can use this paired, mixed method approaches to place to the exposure before the outcomes, i.e., the environmental movements before the intersectional stigma and consequential substance use. This is a novel application of GPS methods to advance our understanding of intersectional stigma. To our knowledge, no previous studies have used GPS data to understand the impact of spatial mobility on the relationships among intersectional stigma, stimulant use, and HIV risk. We will Enroll 30 HIV-negative Black and Latinx sexual minority men living in South Florida who use stimulants as part of parent R01. Implement a mixed-methods design, first collecting GPS data from participants to plot their geographic mobility within the different areas of interests, including work, home, social and sexual activity spaces over a two-week span. A following qualitative component would leverage the mobility maps to guide an in-depth qualitative interview to understand how their dynamic movements related to experiences of intersectional stigma vary across settings, and what (if any) implications this has for their substance use. Mentoring and Training: The proposed diversity supplement training plan is sponsored by Dr. Adam Carrico and co-sponsored by Drs. Dustin Duncan and Audrey Harkness. Training includes advanced methods in GPS spatial mobility data collection and analysis, geographic information systems (GIS) computation methodology, design and implementation of intersectional stigma qualitative research, psychopathology, social psychology, and cognitive neuroscience relevant to addiction, and HIV prevention, care and treatment science. This diversity supplement will provide an ideal foundation for a planned F32 application where I will build upon this work to integrate ecological momentary assessment (EMA) methods with GPS data collection to understand how the experiences of intersectional stigma that fuel stimulant use and HIV risk vary across environmental contexts.