Elwin Wu - US grants

DESCRIPTION (provided by applicant): In response to NIDA PA-01-097, this application details an R03 project that focuses on the service utilization of formal healthcare, mental health, and social services for men on methadone who perpetrate intimate partner violence (IPV). The proposed study will examine barriers and enhancers of service utilization among male methadone maintenance treatment program (MMTP) clients who perpetrate IPV. Drug-involved men who perpetrate IPV lie at the heart of two critical public health issues, drug abuse and IPV, that exact enormous financial and societal costs. Perpetrators of IPV represent a significant proportion of drug-involved men that may have a greater number and/or unique spectrum of service needs that differ from non-violent, drug-involved men and that remain unmet due to lack of service utilization. These needs extend beyond drug abuse and IPV to include mental and physical health and other social service needs. Most of the prior studies with perpetrators of IPV have been carried out with samples obtained from batterers intervention programs. Thus, service utilization among a more general population of men who perpetrate IPV remains unexplored. The proposed research will build upon findings from the Men's Health Project (MHP), an ongoing NIDA-funded study (PI: El-Bassel) to examine over time the relationships among drug abuse, IPV, and HIV-related risks among a random sample of 355 men attending MMTPs in New York City (NYC). We propose to extend the MHP by reinterviewing MHP participants who perpetrated IPV to study factors that impact their service utilization, an area not addressed in the parent study. The proposed study also includes a qualitative inquiry with MMTP service providers to understand MMTP service providers' perspectives on factors that impede or promote service utilization among their male clients who perpetrate IPV, as well as identify potential targets of change in the MMTP service delivery system. Aims, hypotheses, and measurements in the proposed study are guided by the Network Episode Model, which conceptualizes utilization of formal services as a series of behaviors influenced by individual/social context, social network, and service system factors. This study will provide pilot findings for the development of an R01 study testing the efficacy of an intervention designed to increase service utilization among men attending MMTPs who perpetrate IPV.

DESCRIPTION (provided by applicant): The Center for Intervention and Prevention Research on HIV and Drug Abuse (CIPRHDA), a NIDA Social Work Research Development (SWRD) program at the Columbia University School of Social Work (CUSSW), is seeking funding to host a scientific conference entitled NIDA SWRD Programs' Promising New Investigators Conference. Consistent with NIDA's recognition of the valuable role that social workers play in the field of drug abuse intervention as well as NIDA's efforts to enhance the research infrastructure in schools of social work, the goals of the proposed conference are to bring together drug abuse researchers from NIDA-funded social work research training centers in order to (1) enhance the capabilities and speed the development of promising new social work researchers in conducting drug abuse research; (2) identify key activities, infrastructure, and support mechanisms crucial to implementing a university-housed/supported drug abuse research training program for social workers building a new drug abuse research program; and (3) promote collaboration across SWRD programs and drug abuse researchers located in different schools of social work, departments/ disciplines, and universities across the country. The proposed conference, tentatively planned for Fall 2004, will gather a cadre of promising new investigators from each SWRD program, Directors from each of the SWRD programs who are all experienced drug abuse researchers charged with building and implementing a training and mentorship program for new social work drug abuse researchers, Deans from each school of social work that has a NIDA-funded SWRD program, and Program Officials from each division of NIDA.

This application details a proposal for a prospective longitudinal panel study with a random sample of 360 individuals attending alternative to incarceration (ATI) programs in New York City (NYC) that serve drug- involved offenders. The proposed study focuses on (1) the impact of utilization of formal healthcare and psychosocial services on outcomes of ATI program completion, recidivism, technical violations (i.e., law- breaking behaviors not resulting in re-incarceration), and pro-social change (e.g., fulfilling child- and elder- caretaking roles);and (2) factors affecting service utilization among ATI program participants. The study fulfills several recommendations from the Blue Ribbon Task Force on Health Service Research at NIDA, including broadening both (a) the venues of drug abuse services researchto include programs in "nontraditional" settings, especially the criminal justice system, and (b) the range of needs and characteristics of subgroups that are studied in order to address a fuller "continuum of care and patient groups." The Task Force's recommendations echoed other calls regarding the need to elucidate mediators of success of treatment, especially those in nontraditional settings such as criminal justice programs for drug-involved offenders.Also consistent with the Task Force report, the proposed research will employ new data analysis methods for causal inference using observational data. The significance and feasibility of the proposed study are substantiated by findings from a pilot study successfully completed by the investigators. For the proposed study, we will recruit individuals at the start of their participation in ATI programs designed for adult, drug-involved offenders in NYC, conducting structured interviews every 3 months over the course of 18 months for each participant. Aims, hypotheses, and measurements are guided by the Network Episode Model, an innovative model that conceptualizes access and attendance of formal services as a time-varying behavior driven by level of need and shaped by dynamic processes involving individual/social context factors and service system experiences. The proposed study is designed to achieve the following primary aims: (1) To examine the causal relationship between service utilization and (a) ATI program completion, (b) recidivism, (c) technical violations, and (d) pro-social change;and (2) To identify and estimate the causal impact of factors that influence access and utilization of formal services among ATI participants. Findings will generate substantive and practical implications for researchers and professionals in the areas of drug abuse, services research, criminal justice, and public health in developing and testing future interventions and programs for drug-involved offenders. The proposed study will be conducted by Dr. Elwin Wu and Dr. Nabila EI-Bassel of the Social Intervention Group at the Columbia University School of Social Work.

DESCRIPTION (provided by applicant): The purpose of this study is to rigorously test the efficacy of a couples-based HIV and sexually transmitted infection (HIV/STI) preventive intervention for African American/Black men who have sex with men (MSM) in same sex intimate relationships in which at least one partner is using stimulants (herein referred to as stimulant-using, African American MSM couples). The proposed study is a logical progression from the investigative team's prior formative research to take an existing couples based intervention originally for heterosexual couples (Connect) and revise/tailor it for methamphetamine-using, African American MSM couples. The adapted intervention was pilot tested using a pre-/post-test design. Findings revealed statistically and clinically significant reductions in sexual and drug risk behaviors. In addition, this formative research informs the proposed study in several additional ways: (1) the importance of addressing stimulants beyond methamphetamine with African American MSM; (2) qualitative data on how a couples-based intervention can interrupt relationship dynamics more unique to drug-involved, African American MSM couples that lead to risk behavior; and (3) couples-based HIV prevention research is feasible, promising, and safe for stimulant using, African American MSM. This earlier research has culminated with a 7-session, manualized intervention entitled Connect 'n Unite (or CNU-pronounced seein' you-for short) as a candidate couples-based HIV preventive intervention for stimulant-using, African American MSM couples. The proposed study is a randomized clinical trial with 270 stimulant-using, African American MSM couples to test the impact of CNU versus a wellness promotion (WP) attention control condition on behavioral and biologically assayed outcomes over a 12-month follow-up period. The study has the following primary aims: (1) to test whether participants assigned to CNU engage in lower HIV/STI behavioral risk-fewer number of unprotected acts of anal intercourse, greater proportion of protected acts of anal intercourse, and fewer number of sexual partners-compared to participants assigned to WP; (2) to test whether participants assigned to CNU have lower cumulative incidence of STIs-chlamydia and gonorrhea-confirmed via biological assay compared to participants assigned to WP; and (3) to test whether participants assigned to CNU engage in less drug use and drug-related HIV risk (i.e., sex under the influence of drugs/alcohol) compared to participants assigned to WP. If successful, this study will advance the field by providing an evidence-based, innovative intervention that can be delivered in drug treatment and other service settings to reduce the spread of HIV among stimulant-using, African American MSM.

DESCRIPTION (provided by applicant): This R25 proposal responds to PAR-11-002, which aims to increase the number of highly-trained multidisciplinary HIV scientists from groups underrepresented among NIH Principal Investigators (PIs). It focuses on increasing the number of NIH funded new HIV investigators from underrepresented groups and train them to conduct dissemination and implementation (D&I) research that addresses HIV and co- morbid mental health disorders. This grant proposes to renew support for the PIs' successful NIMH R25 training program: the HIV Intervention Science Training Program for Underrepresented New Investigators (HISTP). The training program employs a multidisciplinary set of training activities and a number of dedicated, interdisciplinary mentors who will work with junior investigators from underrepresented groups recruited from Columbia University (CU) and other universities around the U.S. The proposed renewal continues and extends past innovations as well as shifts the focus to an important research area that has been neglected in the HIV field and that has been highlighted as a top priority by NIH. There is an urgent need to increase D&I research to ensure that effective HIV prevention interventions are delivered to the communities that need them; a new generation of HIV researchers needs to be trained to conduct such research to make a major impact in reducing new HIV infections, particularly among communities of color. This application is also responsive to the President's National HIV/AIDS Strategy for the U.S., which states the need for the intensification of HIV prevention efforts in areas marked by high HIV prevalence, utilization of a combination of effective, science-based approaches, and implementation of community- level interventions that target HIV prevention and other social service needs. These strategies are suggested to meet the goals of reducing new HIV infections and HIV-related health disparities and co- morbidities and ensure the training of research scientists to deliver evidenced-based HIV prevention interventions to communities in an expeditious manner. The HISTP will enroll 16 promising new investigators from underrepresented groups, 2 mentors for each new investigator, and includes a multidisciplinary Scientific Advisory Board. The program will be led by Drs. Nabila El-Bassel and Elwin Wu (as Multiple PIs) from Columbia University School of Social Work. They have synergistic expertise from working closely together on the implementation of the recently completed NIMH R25 as well as several NIH-funded research studies. The grant will include a number of senior HIV and mental health researchers from CU and across the county who will serve as mentors as well as on the Scientific Advisory Board.

? DESCRIPTION (provided by applicant): This study will test the efficacy of a social network-based HIV intervention designed to increase the number of men who have sex with men (MSM) who use drugs across Kazakhstan into the continuum of care. From the start of the HIV/AIDS pandemic, MSM have been disproportionately affected-both in terms of morbidity and mortality-by HIV/AIDS. Success against HIV in general has progressed to the point where getting to zero new HIV infections entered the public discourse. Whereas HIV infection rates have been decreasing over the last decade for key affected populations globally, we have witnessed increasing infection among MSM, a so-called re-emergent epidemic for MSM. Kazakhstan is one of the few countries that saw a >25% HIV incidence increase in the 2000s and had the largest increase in rate of new infections among countries in the region. A recent study estimated HIV prevalence among MSM in Almaty to be 20.2%, a rate which exceeds HIV prevalence among adults in Sub-Saharan Africa and the most vulnerable populations in the U.S. HIV transmission in the region is driven largely by illicit drug use, and for MSM, this includes both injecting and non-injecting drug use. Kazakhstan has also been noted as lagging in ART coverage as well as adherence, especially for key populations that are vulnerable and marginalized such as MSM. Building upon the resourcefulness and strengths of MSM community members operating in a sociopolitical repressive environment, combined with the investigative team's success in adapting and pilot testing the evidence-based SHIELD social network intervention for outreach and recruitment with MSM in HIV research in the U.S. and Kazakhstan-a social network-based HIV intervention has promise to increase seek, test, treat, and retain-related behaviors. The proposed study involves a stepped wedge clinical trial across 4 cities in Kazakhstan with 1,000-1,400 drug-involved MSM to test the efficacy of the social network-based intervention for increasing the following outcomes among drug-involved MSM in Kazakhstan: (1) proportion of participants visiting a service provider to get tested for HIV; (2) proportion of HIV-infected participants initiating HIV-related care; (3) proportion of HIV-infected participants receiving ART; and (4) proportion of HIV-infected participants achieving 90% adherence to ART. In addition, the study will examine the intervention's effect on increasing use of services that address issues that co-occur with HIV, including drug abuse, HCV infection, and other sexually transmitted infections (STIs). The study has a secondary, exploratory aim designed to facilitate insight into social context (e.g., experienced stigma, social network attributes) and structural factors (e.g., number and density of services) that may moderate the impact of the intervention.

PROJECT SUMMARY This R25 proposal aims to increase the number of highly-trained multidisciplinary HIV scientists from groups underrepresented among NIH Principal Investigators (PIs). It focuses on increasing the number of NIH funded new HIV investigators from underrepresented groups by providing training, mentorship, and other research and professional development activities that will enable them to conduct implementation research focused on criminal justice populations and outcomes regarding the HIV continuum of care, with a special emphasis on solutions that rely or take advantage of health technology (e.g., mHealth, social media interventions, gamification, wearable technology). This grant proposes to renew support for the PIs? successful NIMH R25 training program: the HIV Intervention Science Training Program for Underrepresented New Investigators (HISTP). The HISTP employs a multidisciplinary set of training activities and a number of dedicated, interdisciplinary mentors. The proposed renewal targets promising new investigators from underrepresented groups who are in their first two years of a tenure track faculty position at universities around the U.S.; it extends past innovations as well as shifts the focus to the following key research areas: implementation science, criminal justice, and health technology. A new generation of HIV researchers needs to be trained to conduct such research and better fulfill the promise of technology to make a major impact in reducing new HIV infections, particularly among communities of color. This renewal builds upon the success of the prior cycles of funding, prompting the creation and use of an Alumni Advisory Board consisting of past HISTP trainees who have achieved research and career success. In addition, the HISTP design and methodology have been strategically refined based on lessons learned about mentees? research and career trajectories, mentee and mentor engagement with the program and each other, and feedback from mentees and mentors. The HISTP will enroll 12 promising new investigators from underrepresented groups, 2 mentors for each new investigator, and includes a multidisciplinary Scientific Advisory Board in addition to the Alumni Advisory Board. The program will continue to be led by Drs. Nabila El-Bassel and Elwin Wu (as Multiple PIs) from Columbia University School of Social Work. They have synergistic expertise from working closely together for 10 years on the HISTP as well as more than 20 years of highly productive research collaboration. Targeting the significance of implementation research and criminal justice and combining with the innovation of health technology will truly strengthen the nation?s diverse biobehavioral and biomedical research workforce in delivering evidenced-based, technology-driven and/or supported HIV prevention interventions to communities in an expeditious manner, ultimately reducing new HIV infections and HIV-related health disparities and co-morbidities.