Nabila El-Bassel - US grants

This study will explore and assess specific knowledge of female reproductive anatomy and sexually transmitted diseases (STDs), and attitudes towards female condom use among low-income African-American and Latina women attending a primary care clinic in Harlem. Few HIV/AIDS studies have included specific knowledge on female reproductive anatomy. Studies indicate that knowledge of female reproductive anatomy is low among poor minority women, limiting their understanding of STD transmission. Acceptance of the female condom, among low-income African- American and Latina women, will depend on their level of knowledge of female reproductive anatomy and on their level of comfort in using barrier devices. The proposed study will consist of two phases. Phase I: a total of 100 women will be randomly selected to participate in ten focus groups. Phase II: an additional 150 women will be randomly selected to participate in a 25 minute face-to-face interview. Qualitative and quantitative data will be produced through the combination of focus groups and a cross-sectional survey, yielding an understanding of the relevance of knowledge of female reproductive anatomy to female condom use and sexual risk reduction among minority women. In addition, this pilot study will inform the development of a NIMH R01 application on HIV/AIDS intervention strategies combining reproductive anatomy and STD education and female condom use skills. This study will be conducted by an investigator from Columbia University School of Social Work.

DESCRIPTION: (Applicant's Abstract) Estimated lifetime rates of partner violence among women in methadone maintenance treatment programs (MMTPs) range between 60% and 75% and rates of current crack/cocaine use among this population vary between 50% and 66%. Despite the high prevalence of both crack/cocaine and partner abuse among women in MMTP's and mounting evidence suggesting that they are interrelated phenomena, studies have yet to disentangle the temporal and multidimensional relationships between partner abuse and crack/cocaine dependence. A few studies have implicated partner abuse as a factor for sexual risk behaviors, further research is needed to explore the bidirectional relationships between partner abuse and sexual risk behaviors among women in MMTPs. Social support factors have been found to moderate drug use and HIV risk behaviors, and a few studies have suggested the importance of social support in helping women to avoid abusive situations and to mitigate the more deleterious effects of abuse such as post-traumatic stress disorder (PTSD). However, the influence of social support factors in mitigating the effects of partner abuse among women drug users remains unclear. Addressing these critical knowledge gaps, the proposed study will: 1) use in-depth qualitative methods to explore the relationship dynamics, drug and alcohol use situations and event sequences that culminate in actual episodes of partner violence among women in MMTP's; and 2) determine the prevalence and incidence of partner abuse and longitudinally examine the interrelationships among partner abuse, crack/cocaine use, sexual risk behavior, PTSD and social networks and support over time. The qualitative study, conducted early in the first year, will include 150 women on methadone who have recently experienced partner abuse, and who will participate in focus groups. An additional 50 abused women will participate in gender script interviews. For the longitudinal study beginning late in the first year, 750 women will be recruited and then pretested with a six and twelve month follow-up. All study participants will be recruited from Beth Israel Medical Center MMTP's in Harlem. Data from the proposed study may inform the assessment, treatment and referral protocols used by MMTP's staff to meet the diverse needs of their patients. The research will be led by investigators from the Social Intervention Group at Columbia University School of Social Work and conducted collaboratively with Beth Israel Medical Center and the HIV Center for Clinical and Behavioral Studies of the New York State Psychiatric Institute at Columbia University.

DESCRIPTION (adapted from the Abstract): The AIDS epidemic among women in the United States continues disproportionately to affect racial and ethnic minorities: three quarters of women with AIDS are African-Americans and Latinas, and the infection rates among African-American and Latin women are 16 and 7 times greater, respectively, than that of white women. The majority of these HIV-infected heterosexual women have been exposed to HIV through a steady sex partner with a history of drug use. Many studies have shown that although women have reduced their sexual risk behavior with casual or commercial partners, they continue to practice unsafe sex with their regular partners. In this study the researchers will evaluate the effectiveness of a social-cognitive preventive intervention tailored to low-income African American and Latina women and their main sexual partners. A total of 450 women (and their male partners) will be recruited from a primary health care clinic in the South Bronx, a community with a high HIV prevalence. Following a baseline interview, couples will be randomly assigned to one of three study arms: (1) Six conjoint sessions of social-cognitive HIV/AIDS prevention, in which a woman and her main regular partner will participate together in the intervention (a facilitator and the couple). (2) Six individual sessions of social-cognitive HIV/AIDS prevention, in which a woman alone participates in the intervention (a facilitator and the woman). (3) One individual session of HIV/AIDS information, in which a woman alone participates in the intervention (a facilitator and the woman). The researchers will conduct follow-up interviews with women and their main regular partners 3-, 6-, and 12 months after the completion of the intervention. Protocols and outcomes from the proposed study will be of immediate relevance in primary health care settings. In contrast to the STD clinic setting, the primary care setting is non-stigmatized and touches a vulnerable population that may be unaware of HIV infection. Moreover, in such settings, interventions with individuals and couples may be delivered and replicated more feasibly than those with groups. The research will be conducted by members of the Social Intervention Group at Columbia University and conducted collaboratively with St. Barnabas Hospital.

Accumulating evidence links partner violence and HIV infection. Among the groups disproportionately affected by these trends are methadone patients. Estimated lifetime rates of partner violence reported by women in drug treatment programs range from 60% to 75%. Seroprevalance rates of HIV among methadone patients in East Coast urban areas range from 28% to 43%. Despite the high prevalence of partner violence and HIV among methadone patients and mounting evidence suggesting that partner violence and HIV-risk behaviors may be interrelated phenomena in this population, studies have yet to untangle the multi-dimensional relationship between these two critical public health problems. Moreover, as of yet, no empirical research has examined these relationships from the male perpetrator's perspective. Longitudinal data on the bi-directional relationships between the perpetration of partner violence and HIV-risk behaviors among men on methadone may address some of the major gaps in research. The proposed study will: 1) explore the relationship dynamics and sequences of events that culminate in the co- occurrence of inflicting partner violence and engaging in HIV-risk behaviors among men who are enrolled in methadone maintenance treatment programs (MMTPs) using in-depth qualitative methods; and 2) examine longitudinally the relationships between the perpetration of partner violence and HIV-risk behaviors among men in MMTPs, controlling for background variables and risk factors (e.g., drug use, communications, prevalence of violence in perpetrator's social network). In the beginning of the first year, men attending MMTPs who report perpetrating partner violence in the past year will participate in focus groups (n=64) and in-depth interviews (n=50) for the longitudinal study that will begin in the second year, 600 men will be interviewed at baseline and at six and twelve month follow-ups. At the completion of the longitudinal study, two focus groups will be conducted with 16 men who report perpetrating partner violence in the part year, to elicit their interpretation of the quantitative research findings. Subjects will be recruited from Beth Israel Medical Center methadone clinics in Harlem. This study will be led by investigators from the Social Intervention Group (SIG) at Columbia University School of Social Work and Beth Israel Medical Center. Data from the proposed study will help inform assessment, treatment and referral protocols to reduce partner violence and HIV-risk behaviors among men and women in MMTPs.

DESCRIPTION (adapted from the Abstract): The AIDS epidemic among women in the United States continues disproportionately to affect racial and ethnic minorities: three quarters of women with AIDS are African-Americans and Latinas, and the infection rates among African-American and Latin women are 16 and 7 times greater, respectively, than that of white women. The majority of these HIV-infected heterosexual women have been exposed to HIV through a steady sex partner with a history of drug use. Many studies have shown that although women have reduced their sexual risk behavior with casual or commercial partners, they continue to practice unsafe sex with their regular partners. In this study the researchers will evaluate the effectiveness of a social-cognitive preventive intervention tailored to low-income African American and Latina women and their main sexual partners. A total of 450 women (and their male partners) will be recruited from a primary health care clinic in the South Bronx, a community with a high HIV prevalence. Following a baseline interview, couples will be randomly assigned to one of three study arms: (1) Six conjoint sessions of social-cognitive HIV/AIDS prevention, in which a woman and her main regular partner will participate together in the intervention (a facilitator and the couple). (2) Six individual sessions of social-cognitive HIV/AIDS prevention, in which a woman alone participates in the intervention (a facilitator and the woman). (3) One individual session of HIV/AIDS information, in which a woman alone participates in the intervention (a facilitator and the woman). The researchers will conduct follow-up interviews with women and their main regular partners 3-, 6-, and 12 months after the completion of the intervention. Protocols and outcomes from the proposed study will be of immediate relevance in primary health care settings. In contrast to the STD clinic setting, the primary care setting is non-stigmatized and touches a vulnerable population that may be unaware of HIV infection. Moreover, in such settings, interventions with individuals and couples may be delivered and replicated more feasibly than those with groups. The research will be conducted by members of the Social Intervention Group at Columbia University and conducted collaboratively with St. Barnabas Hospital.

DESCRIPTION: (adapted from the abstract) Intimate partner abuse and HIV risk are emerging as intersecting problems that threaten the welfare of inner-city African American and Latino communities. Emergency departments (EDs) provide medical care to a disproportionate number of abused women and women infected with HIV and other STDs. Partner abuse has been implicated as a risk factor for having unprotected sex and contracting STDs. Some evidence, however, suggests that disclosure of STD or HIV status by either partner may precipitate partner violence. Similarly, other studies have found significant associations between having sex with a risky partner (e.g. HIV-infected or injecting drug user) and partner violence. To date, research on the bi-directional relationships between partner violence and HIV-risk behaviors remains limited because of small sample sizes, cross-sectional designs, and failure to control for confounding variables. The proposed study will explore the relationship dynamics and sequences of events that culminate in the co-occurrence of partner violence and sexual and drug-related HIV risk behaviors among women visiting an ED. Qualitative methods will be used. Secondly, it will examine longitudinally the prevalence and incidence of partner violence. Thirdly, it will elucidate the temporal relationships between intimate partner violence and HIV risk among women in the ED. In the first year, 48 women attending an ED who have recently experienced partner abuse will participate in focus groups. An additional 35 abused women will participate in in-depth narrative interviews. For the longitudinal study, 450 women will be assessed at baseline and at six and twelve months. Participants will be recruited from St. Barnabas Hospital Emergency Department. In the final year the research team will conduct two focus groups with 16 participants to elicit their interpretation of study findings. This study will be organized by investigators from the Social Intervention Group (SIG) at the Columbia University School of Social Work and St. Barnabas Hospital. Findings from the proposed study will increase understanding of the relationship between partner violence and HIV risk behavior and may inform assessment, referral, and treatment protocols used by ED staff to meet the diverse needs of women who are at risk of partner abuse and HIV.

DESCRIPTION: (Applicant's Abstract) Urban minority women are currently among the fastest growing populations with HIV/AIDS in the nation. The vast majority of cumulative female AIDS cases are African-American (56 percent) or Latina (20 percent), living in inner city communities with high rates of substance abuse. This application seeks funding to establish a Social Work Research Development (SWRD) Program at the Columbia University School of Social Work (CUSSW) to develop the social work profession's capacity to conduct intervention research on HIV and other STDs among drug-involved women, their sex partners, and their children. The Social Intervention Group (SIG) at CUSSW in collaboration with the HIV Center for Clinical and Behavioral Studies, and several other Columbia University research centers, National Development and Research Institutes, Inc., state authorities and community-based service agencies, proposes to establish a SWRD Program in order to train junior social work faculty in research on the overlapping issues of HIV and substance abuse among women, their main partners, and their children. Our strategic plan to enhance faculty research includes: 1) developing structured mentorship relationships for junior faculty; 2) facilitating pilot studies and grant proposals; 3) providing access to expert scientific consultations; 4) establishing ongoing seminars and scientific work-groups; 5) providing administrative, technical, and clerical support; 6) promoting meaningful, multidisciplinary collaborations with other research centers and 7) facilitating dissemination and diffusion of findings to providers, policy makers, students, and consumers. To establish an enduring infrastructure for faculty substance abuse research, the SWRD program will create: a) an Executive Board to direct the proposed SWRD program, b) a scientific advisory board, c) a panel of mentors, d) a research resources unit, e) a panel of scientific consultants, and f) a community collaborators board. In addition to increasing the number of social work faculty and graduate students, who are trained in substance abuse research, the SWRD program aims to promote high quality, interdisciplinary research, which will advance the design of theoretically sound, contextually specific HIV interventions for different populations of drug-involved women and enhance knowledge and strategies for maintaining behavioral change as well as for diffusing HIV and relapse prevention interventions into communities. The SWRD Program will be directed by Dr. Nabila El-Bassel and co-directed by Drs. Steven Schinke and Mary McKay, all CUSSW faculty with strong programs of federally funded research related to substance abuse and HIV.

DESCRIPTION (provided by applicant): The broad objective of this proposal is to test the efficacy of a contextually appropriate intervention to reduce the risk of sexually transmitted diseases among African American HIV serodiscordant heterosexual couples. This is a collaborative effort by four PIs (El-Bassel in New York, Jemmott in Philadelphia, Wingood in Atlanta, and Wyatt in Los Angeles) to use a common protocol to implement a randomized controlled trial. While most HIV/STI risk-reduction interventions are conducted at the individual level, a couple-based approach may be more efficacious and consistent with cultural values. The participants will be 800 African American HIV serodiscordant couples (200 per site) recruited from community-based organizations (CBOs), health departments, and HIV clinics. The couples will be randomized to one of two interventions: an 8-session HIV/STI sexual risk-reduction intervention (the Eban Program) or an 8-session general health promotion intervention concerning health issues unrelated to sexual behavior, which will serve as the control group. Both interventions will involve couple and group sessions led by specially trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, and the applicants? previous HIV/STI risk-reduction research with inner-city African American populations. The primary biological outcome is sexually transmitted infections (Chlamydia, gonorrhea, and trichomoniasis) based on DNA amplification tests on urine and vaginal specimens. The primary behavioral outcome is the self-reported rate of condom-protected sexual intercourse. Secondary outcome measures include theoretically relevant variables hypothesized to mediate intervention effects. Audio Computer-Assisted Self-Interviewing (ACASI) will be used to collect data at baseline, immediately post-intervention, and at 6- and 12-month follow-up. To address the Specific Aims, we will analyze the data with generalized estimating equations (GEE). For instance, analyses will test (a) the effects of the intervention on STI incidence, sexual behavior, and mediators of sexual behavior; and (b) whether the intervention?s effects are different depending on key moderator variables, including gender of seropositive partner, length of relationship, psychological distress, sexual abuse history, and substance abuse history, ethnic identity and relationship satisfaction. The findings will contribute significantly to the field of HIV/STI risk reduction by developing and testing an intervention with African American couples that can be offered to HIV clinics and CBOs.

[unreadable] DESCRIPTION (provided by applicant): Heterosexual transmission accounts for the fastest growing risk group of people with HIV/AIDS and is the chief mode of affection among women in the United States. Research has shown that there is a continued low rate of condom use among heterosexuals in established relationships. Young adult crack/cocaine and heroin abusing patients and their primary sexual partners rank among those at highest risk for heterosexual HIV/STI transmission. A growing body of research, including recent randomized clinical trials, has found that couple-based approaches to HIV risk reduction are efficacious in increasing condom use. The proposed study will rigorously test the efficacy of a couple-based HIV/STI prevention intervention to increase condom use and reduce sexually transmitted infections (STIs) among heroin or crack/cocaine abusing, outpatient drug treatment or methadone maintenance patients, aged 18-35, and their main heterosexual partners, who are both HIV negative and report risk of sexually-acquired HIV. This study will enroll 450 index participants, aged 18 to 35, who will be recruited from an MMTP or outpatient drug treatment program for crack/cocaine and/or heroin abuse, and their main heterosexual partners and who will report having had unprotected sex and at least one risk factor for HIV in the past 90 days. The index participants and their main heterosexual partners will be randomized to one of three conditions: a 7-session couple-based HIV/STI risk reduction intervention (CSTI) provided to the index participant and her/his main partner; a 7-session couple-based stress reduction intervention (CSR) provided to the index participant and her/his main partner, which will serve as a attention control condition; and a 7-session individual HIV/STI risk reduction intervention (ISTI) provided to the index participant alone, which will serve as a comparison condition. Dr. E1-Bassel, the Social Intervention Group (SIG) investigative team and Dr. Remien, from the HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute, will lead the study. In addition, several consultants will be involved in the study: Dr. Steinglass from the Ackerman Institute for the Family, Dr. Long shore from the University of California at Los Angeles, Dr. Sharp from St. Luke's Hospital in New York City, and Dr. Fals-Stewart from the Research Institute on Addictions at the University of Buffalo. [unreadable] [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): The HIV/AIDS epidemic continues to be a major public health concern that has hit African Americans particularly hard. Individual-level prevention approaches, although effective, are too narrowly focused and ignore the role relationships play in HIV/STD transmission. Couple-level interventions, especially with serodiscordant couples, redirect the focus to changing the relationship factors that influence sexual decision-making and increase the likelihood that sexual risk reduction will be stable over time. This U10 competing continuation application seeks four additional years of support to meet the original plan to enroll 800 African American HIV serodiscordant couples into Project Eban, the NIMH Multisite HIV/STD Prevention Trial for African American Couples, that is being conducted in four clinical sites-Atlanta, Los Angeles, New York, and Philadelphia-in collaboration with the NIMH and a Data Coordinating Center. Although attendance rates at intervention sessions and retention rates at follow-up assessments have been excellent, recruitment challenges have caused slower couple enrollment than was originally planned. Additional time is needed to implement new recruitment activities that are anticipated to recruit these hard-to-reach couples. As in the original trial, we will randomize couples to (1) an 8-session couples-focused HIV/STD Risk Reduction Intervention or (2) an 8-session individual-focused Health Promotion Intervention (the comparison condition) that addresses health issues unrelated to sexual behavior. Both interventions involve couple and group sessions led by trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, an Afro centric paradigm and the applicant teams' previous work with African American populations. The primary behavioral outcome is self-reported proportion of condom- protected sexual intercourse; the primary biological outcome is the incidence of STDs (i.e., chlamydia, gonorrhea, and trichomonas) assessed by DNA amplification tests on urine and vaginal specimens. Secondary outcomes include theoretically relevant variables hypothesized to mediate and moderate intervention effects. Audio computer-assisted self-interviewing (ACASI) will be used to collect data at baseline, immediately post-intervention, and at 6- and 12-month follow-up. Generalized estimating equations (GEE) and mixed-effects modeling (MEM) will be used to test (1) the effects of the intervention on STD incidence and condom use as well as on mediator variables of these outcomes and (2) whether the effects of the intervention differ depending on key moderator variables (e.g., gender of the seropositive partner, length of relationship, psychological distress, sexual abuse history, and substance abuse history. The findings will contribute significantly to an understanding of HIV/STD risk reduction among African American serodiscordant couples, a population at high risk of transmission. [unreadable] [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): This proposal responds to PAS-06-447 entitled Mentoring Programs to Diversify Mental Health HIV/AIDS Research Workforce through Innovative Educational Initiatives that highlights a need to "develop new and improved research mentorship for racial/ethnic minority (REM) individuals focused on HIV/AIDS disparities issues and/or to establish a network of senior mentors for REM mentees." This application proposes to develop and facilitate the growth of a new cadre-4 per year for a total of 12-of REM scientists capable of serving as PIs on extramurally funded studies in the areas of HIV prevention research on the co-occurring problems of posttraumatic stress disorder (PTSD), trauma and related mental health issues among REM groups and on the design of HIV culturally-congruent prevention interventions to address these co-occurring problems that reflect and drive health disparities. The proposed program will have a strong set of research training activities and a network of committed and active mentors for promising REM trainees. It will be led by Drs. Nabila El-Bassel and Elwin Wu from the Columbia University School of Social Work (CUSSW), and Dr. Alex Carballo-Dieguez from the HIV Center for Clinical and Behavioral Studies at Columbia University. An existing network of 22 senior HIV and mental health researchers-the majority of whom are people of color-have been recruited and committed to (1) serve as mentors, (2) recruit promising REM trainees for the program, and (3) recruit additional mentors. The proposed training program will utilize the research resources and infrastructure at the CUSSW Social Intervention Group (SIG). Directed by Dr. El-Bassel, SIG's goal is to develop innovative, culturally-congruent, integrated interventions to address the co-occurring issues of HIV, substance abuse, violence/trauma, and PTSD in low income, REM communities. The training program will also be conducted in collaboration with the HIV Center for Clinical and Behavioral Studies at Columbia University, Directed by Dr. Anke Ehrhardt. The HIV Center serves as a national and international hub for a network of more than 100 researchers, clinicians. This training program will also be conducted in collaboration with the Columbia Center for Homelessness Prevention Studies (CCHPS), Directed by Dr. Carol Carton. CCHPS is a multidisciplinary effort to develop ways to prevent chronic homelessness among people with severe mental illness and on Health disparities such HIV. Finally, it will be conducted in collaboration with the Columbia Center for the Health of Urban Minorities (CHUM), Directed by Dr. Olveen Carrasquillo. CHUM's mission is to promote minority health. All these Centers have been collaborating on HIV, trauma/PTSD, and/or health disparities research and have designed mechanisms of collaborations that would serve vehicles of training of the REM new investigators. [unreadable] [unreadable] [unreadable]

PROJECT SUMMARY The proposed study responds to RFA-DA-08-007, which calls for research to develop and test integrated drug use and HIV risk behavior prevention interventions in criminal justice settings. Despite the large and growing number of drug-involved female offenders under community supervision and accumulating evidence of their elevated risk for HIV/STIs, there remains a critical gap in evidence-based HIV prevention interventions for this population. The proposed study is designed to address this critical gap by conducting a randomized controlled trial (RCT) that will rigorously test the efficacy of a multimedia version of 4-session, gender-specific, integrated drug use and HIV/STI prevention intervention (Multimedia WORTH) in increasing condom use and decreasing the incidence of sexually transmitted infections (STIs) among 420 drug-involved female offenders in a large Alternative-to-Incarceration(ATI) Probation Program in New York City, compared to a non-media version of the same intervention (Traditional WORTH) and to a 4-session NIDA standard HIV prevention control condition, which is not gender-specific (NIDA Control). Participants will be assessed with repeated measures at baseline, immediate post test (IPT), 6-month, and at 12-month post-intervention follow-ups. Multimedia interventions have been found to be efficacious in promoting HIV risk reduction and reducing substance use compared to non-multimedia interventions. Furthermore, multimedia interventions hold promise for increasing the fidelity of implementation and the speed, scale and quality of dissemination. The Traditional WORTH intervention was developed by this study's investigative team as a group-based, integrated drug use and HIV prevention intervention for low income, urban female offenders which addresses intimate partner violence (IPV) and other gender specific risk factors for HIV. WORTH has been tested in two different RCTs and found to be efficacious in increasing condom use among drug-involved female inmates and among women in drug treatment. Multimedia WORTH contains the same content as Traditional WORTH, but employs multimedia interactive tools and culturally tailored animation and video enhancements that are designed to enhance the delivery of the intervention by maximizing individual learning opportunities and feedback, while at the same time optimizing the group format to build positive peer norms and social support for HIV risk reduction. This rigorous RCT will advance the science and extend the boundaries of multimedia HIV prevention research while aiming to close a critical gap in HIV prevention efforts in the criminal justice system.

DESCRIPTION (provided by applicant): The proposed study will rigorously test the efficacy of an innovative, couples-based HIV/STI risk reduction intervention (CHSR) to decrease new cases of HIV and Hepatitis C (HCV) and incidence of sexually transmitted infections (STIs), as well as to reduce unsafe injection practices and increase condom use among injecting drug users (IDUs) and their heterosexual, intimate partners in Shu, Kazakhstan. Central Asia has experienced one of the fastest growing HIV/AIDS epidemics due to a sharp increase in injection drug use. This investigative team from the Social Intervention Group at Columbia University and the Shu Policlinic Needle Exchange Program in Kazakhstan completed a pilot randomized controlled trial of the proposed CHSR among 40 IDUs and their primary, heterosexual partners (N=80) in Shu, Kazakhstan. Compared to participants assigned to the wellness promotion comparison condition (WP) (n=40), CHSR participants (n=40) reported significantly fewer unsafe injection behaviors and greater condom use from baseline to the 3-month follow-up. For the proposed study, the participants will be 400 IDUs and their heterosexual, intimate partners, who meet eligibility criteria (e.g., at least one partner reports unsafe injection and unprotected sexual intercourse in the past 30 days). Participants will be recruited from the Shu Policlinic needle exchange program and through street outreach in Shu. Shu is located along a major drug trafficking route and has an estimated 4,500 IDUs out of a population of 35,000. In the proposed study, 400 couples will be randomized to one of two interventions: a 5-session couples-based HIV/STI risk reduction intervention or a 5- session couples-based wellness promotion intervention, which will serve as a comparison condition. Participants will be assessed with repeated measures at baseline, 3-, 6- and 12-months post-intervention. The primary behavioral outcomes are self- reported proportion of injection acts in which needles or syringes are shared in the past 30 days and proportion of condom-protected acts of sexual intercourse in the past 30 days. The primary biological outcomes are the rate of new HIV cases and new HCV cases, as well as the incidence of Chlamydia, gonorrhea, and syphilis over the 12-month post-intervention period. The proposed study will advance the understanding of HIV/HCV/STI risk reduction among a population of IDUs and their heterosexual partners, and thereby help to stem the rising epidemic of HIV, HCV, and STIs in Kazakhstan and Central Asia. PUBLIC HEALTH RELEVANCE The proposed study addresses a significant public health threat of HIV, HCV and other STIs among a very high risk population of active IDUs and their sexual partners in Kazakhstan - a region that is experiencing one of the fastest rising HIV epidemics in the world. There is a race to develop and implement effective HIV preventive interventions for IDUs and their sexual partners to stem the spread of HIV, HCV and other STIs in Shu and other Central Asian towns along drug trafficking routes.

DESCRIPTION (provided by applicant): This proposal responds to PAS-06-447 entitled Mentoring Programs to Diversify Mental Health HIV/AIDS Research Workforce through Innovative Educational Initiatives that highlights a need to "develop new and improved research mentorship for racial/ethnic minority (REM) individuals focused on HIV/AIDS disparities issues and/or to establish a network of senior mentors for REM mentees." This application proposes to develop and facilitate the growth of a new cadre-4 per year for a total of 12-of REM scientists capable of serving as PIs on extramurally funded studies in the areas of HIV prevention research on the co-occurring problems of posttraumatic stress disorder (PTSD), trauma and related mental health issues among REM groups and on the design of HIV culturally-congruent prevention interventions to address these co-occurring problems that reflect and drive health disparities. The proposed program will have a strong set of research training activities and a network of committed and active mentors for promising REM trainees. It will be led by Drs. Nabila El-Bassel and Elwin Wu from the Columbia University School of Social Work (CUSSW), and Dr. Alex Carballo-Dieguez from the HIV Center for Clinical and Behavioral Studies at Columbia University. An existing network of 22 senior HIV and mental health researchers-the majority of whom are people of color-have been recruited and committed to (1) serve as mentors, (2) recruit promising REM trainees for the program, and (3) recruit additional mentors. The proposed training program will utilize the research resources and infrastructure at the CUSSW Social Intervention Group (SIG). Directed by Dr. El-Bassel, SIG's goal is to develop innovative, culturally-congruent, integrated interventions to address the co-occurring issues of HIV, substance abuse, violence/trauma, and PTSD in low income, REM communities. The training program will also be conducted in collaboration with the HIV Center for Clinical and Behavioral Studies at Columbia University, Directed by Dr. Anke Ehrhardt. The HIV Center serves as a national and international hub for a network of more than 100 researchers, clinicians. This training program will also be conducted in collaboration with the Columbia Center for Homelessness Prevention Studies (CCHPS), Directed by Dr. Carol Carton. CCHPS is a multidisciplinary effort to develop ways to prevent chronic homelessness among people with severe mental illness and on Health disparities such HIV. Finally, it will be conducted in collaboration with the Columbia Center for the Health of Urban Minorities (CHUM), Directed by Dr. Olveen Carrasquillo. CHUM's mission is to promote minority health. All these Centers have been collaborating on HIV, trauma/PTSD, and/or health disparities research and have designed mechanisms of collaborations that would serve vehicles of training of the REM new investigators.

DESCRIPTION (provided by applicant): Central Asia (CA) is experiencing one of the fastest growing HIV epidemics in the world with an annual doubling of infection rates in some areas since 2000. The mass migration in CA following the collapse of the Soviet Union has been identified as a key factor in fueling the heterosexual spread of HIV and other STIs in the region. The proposed study responds to PA-07-147 which strongly encourages international research on cross-cultural determinants of sexual risk behaviors and incidence of HIV and other sexually transmitted infections (STIS) among underresearched populations of heterosexual men. The proposed four-year study will rigorously examine the influence of theory-driven, multi-level determinants on sexual HIV risk behaviors and incidence of HIV/STIs among male migrant market workers from Barakholka Market in Almaty, Kazakhstan from four dominant countries in Central Asia (CA), including Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan and a comparison group of non-migrant, market workers who are permanent Almaty residents and citizens of Kazakhstan. The proposed study will use mixed methods of a qualitative study of 60 market workers followed by a longitudinal study with a random sample of 2,000 market workers from the Barakholka market in Almaty, Kazakhstan (400 migrant workers from each of the four CA countries and a comparison group of 400 non-migrant market workers). The Barakholka market has approximately 30,000 stalls and is one of the biggest trading centers in CA. The proposed grant application has been informed by two feasibility pilot studies that were conducted with migrant market workers at the Barakholka Market. The proposed study findings will have HIV prevention, intervention and policy implications. Furthermore, the proposed study may serve as a prototype for conducting longitudinal HIV/STI research with migrant workers, which has been identified as a priority area of needed research by WHO, World Bank, UNAIDS and international HIV experts. The study will be led by Dr. Nabila El-Bassel, Louisa Gilbert, Dr. Elwin Wu and Dr. Peter Bearman from Columbia University (CU) and the investigative team from Almaty including Dr. Assel Terlikbayeva, (site Principal Investigator);Dr. Baurzhan Zhusupov (Co-Investigator) from the Centers for Disease Control (CDC) in Almaty and Dr. Gulsum Askarova (Co-Investigator) from the Republican Skin and Veneral Disease Institute. This multidisciplinary collaboration will be strengthened with the expertise of Dr. Christopher Beyrer (Co-Investigator), Director of the John Hopkins Fogarty AIDS International Training and Research Program, Dr. Mary Jane Rotheram-Borus (Consultant) from University of California at Los Angeles and Dr. Naihua Duan, Director, Division of Biostatistics at CU College of Physicians and Surgeons. PUBLIC HEALTH RELEVANCE: Migrant men in Central Asia have been identified as a key bridge population in facilitating the heterosexual spread of HIV/STIs. This grant application examines different social and cultural contexts and determinants that influence sexual risk behaviors that spread HIV and other sexually transmitted infections (STIs) among young migrant market workers in Central Asia. The findings from this study will inform future prevention efforts to stem heterosexual transmission of HIV and STIs in Central Asia among male migrant workers.

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. PUBLIC HEALTH RELEVANCE: The proposed training program seeks to expand the pool of highly-trained, multidisciplinary HIV scientists from groups that are underrepresented among NIH Principal Investigators (PIs). Via an innovative gamut of multidisciplinary training activities and a number of dedicated, interdisciplinary mentors, the training program will facilitate the growth and development of a new cadre of researchers from underrepresented groups who will conduct dissemination and implementation research on interventions targeting HIV and co-morbid mental health issues to ensure that effective prevention and treatment programs reach underserved HIV vulnerable populations.

DESCRIPTION (provided by applicant): The proposed study responds to PA-09-236 entitled HIV/AIDS, Drug Use, and Vulnerable Populations. This study is a randomized controlled trial (RCT) that will rigorously evaluate the implementation, effectiveness and cost-effectiveness of a couple-based integrated HIV/STI and drug abuse prevention intervention (Connect II) with drug-involved male offenders charged with misdemeanors and their primary female sexual partners, implemented by frontline providers in Criminal Court, Community Court or Probation (CCP) sites in the Bronx, NY, compared to CCP standard treatment of care services (TAU). The primary outcomes are biologically confirmed sexually transmitted infections (STIs) and self-reported condom use. This study will yield important data on implementation factors associated with effectiveness of the proposed intervention in real world resource-constrained criminal justice settings. The proposed CCP study sites are located in the South Bronx, the poorest Congressional District in the U.S. with 96% of residents identifying as Black or Latino. The South Bronx has an HIV prevalence rate of 2.6%. Research has found that 12% of men on probation in New York City are HIV positive. Though the criminal justice system is recognized as the epicenter of the epidemic in the U.S., few, if any, HIV prevention interventions have been developed for the huge number of male offenders under community supervision who represent 90% of the corrections population. No HIV/STI prevention services are currently provided at the proposed CCP sites. The proposed intervention is designed to address this critical gap in services. Connect II was found to be efficacious among drug-involved couples in reducing risky drug and sexual behaviors and drug use. In the proposed study we aim to advance the knowledge of implementation science by testing the effectiveness and cost-effectiveness of Connect II delivered by frontline providers in the real world settings of CCP sites with 240 drug-involved male offenders and their female partners (N=480 participants). Eligible couples will be randomly assigned to either (1) a 4-session Connect II delivered to both partners together + TAU delivered to male participant alone, or (2) a TAU control condition delivered to the male participant. Repeated assessments will occur at baseline and 3, 6, and 12-months post intervention. The study will be conducted by Dr. Nabila El-Bassel, Dr. Louisa Gilbert, and an investigative team from Columbia University in collaboration with Michael Rempel from the Center for Court Innovation and the New York City Department of Probation. If found to be effective, Connect II may be scaled up in community criminal justice settings nationwide to curb the spread of HIV/STIs and to reduce HIV disparities in heavily impacted communities like the South Bronx. PUBLIC HEALTH RELEVANCE: This study addresses the significant public health threat of HIV and other STIs among drug- involved male offenders under community supervision and their female partners. This study will evaluate the implementation, effectiveness and cost-effectiveness of a brief couple-based HIV and drug abuse prevention intervention for drug-involved male offenders and their female partners delivered by frontline providers in Criminal/Community Court and Probation sites in the South Bronx, the poorest congressional district in the U.S. If found to be effective, the proposed brief intervention may be scaled up to community criminal justice sites nationwide to curb the spread of HIV/STIs and reduce HIV disparities.

DESCRIPTION (provided by applicant): The proposed study is a randomized controlled trial (RCT) that will rigorously evaluate the effectiveness and cost-effectiveness of delivering a multimedia evidence-based intervention (WORTH) and streamlined HIV testing to prevent HIV and other sexually transmitted infections (STIs) with Black/African-American (hereafter referred to as Black) women drug users in probation sites in New York City (NYC), compared to streamlined HIV testing alone. The primary outcome will be to reduce cumulative incidence of biologically confirmed STIs (i.e., Chlamydia, gonorrhea and trichomonas). Advancing a continuum of HIV interventions in probation settings nationwide has tremendous potential for reaching a large number of drug-involved Black women who remain at very high risk for HIV/STIs and helping to reverse highly concentrated HIV/STI epidemics in their networks and communities. The proposed RCT will be conducted with 420 drug-involved Black women at 5 probation sites located in communities in NYC heavily affected by HIV and STIs. Eligible women will be randomly assigned to: (1) WORTH consisting of an individual Streamlined HIV Testing session followed by a 4-session group-based multimedia HIV/STI prevention intervention or (2) an individual Streamlined HIV Testing session alone, which will serve as the comparison condition. Both conditions will be delivered by probation providers at the 5 probation sites. Repeated assessments will occur at baseline and 3, 6, and 12- months post intervention. This study will also employ mixed methods to identify multi-level theory-driven factors that may influence the effectiveness of delivering WORTH and Streamlined HIV testing interventions in the real world setting of probation to inform future dissemination strategies for these interventions. We will conduct repeated assessments and qualitative interviews on multi-level factors that may influence the effectiveness of WORTH on study outcomes with probation providers delivering the interventions, frontline probation staff, and probation administrators. If the multimedia WORTH intervention is found to be effective, it may be scaled up in probation settings nationwide to curb the spread of HIV/STIs among Black women and to reduce HIV disparities in heavily impacted communities. If no difference is found between study arms, the Streamlined HIV Testing intervention offers a highly cost-efficient model of HIV testing that may also be scaled up in probation settings.

DESCRIPTION (provided by applicant): This T32 is submitted by the Columbia University (CU) School of Social Work (SSW) and the Department of Sociomedical Sciences at the Mailman School of Public Health (SMS/MSPH). It proposes to train the next generation of pre- and post-doctoral scholars in the prevention, treatment, and care of HIV and drug abuse among individuals in the criminal justice system. This training application places a strong emphasis on individuals involved in alternatives to incarceration and community supervision (e.g., diversion programs, probation, and community and drug courts) who are affected by health disparities. This training program will provide: (1) interdisciplinary research instruction and training for pre doctoral students and post-doctoral fellows on the intersecting issues of drug abuse, HIV and the criminal justice system; and (2) hands-on, mentored experience conducting independent research in the study of HIV and drug abuse prevention, treatment, and care for criminal justice-involved populations. This program is designed to strengthen the pool of researchers by increasing the diversity of academic backgrounds-e.g., social work, public health, medicine, sociology, political science, anthropology-and those from underrepresented populations-e.g., underrepresented minorities (URM), people with disabilities and individuals from disadvantaged backgrounds. The faculty who will participate in this proposed training program are drawn from a number of CU departments and schools as well as other universities and research centers. Participating faculty are leaders in HIV, drug abuse, and criminal justice fields, with strong trac records of support from NIDA and NIMH and other institutes. They are also well-qualified to provide training, as evidenced by their strong records of mentorship of pre-doctoral students and postdoctoral fellows. Each year, the training program will select and appoint pre-doctoral trainees who will be supported for up to 5 years, and 2 postdoctoral fellows, who will be supported for up to 3 years. At full capacity, the program will support 4 pre-doctoral students and 4 post-doctoral fellows per year. Altogether, the program is anticipated to support a total of 6-8 pre-doctoral trainees and 8-10 post-doctoral trainees over the 5-year funding period. Thus, the program will add a substantial number of highly qualified new scholars to the field focusing on HIV and drug abuse among criminal justice-involved populations. Dr. Nabila El-Bassel (SSW) and Dr. Lisa Metsch (SMS/MSPH) will serve as PIs/Co-Directors for the proposed training program, which provides an opportunity for two noted and distinguished scientists to collaborate and lead this initiative. They each contribute over 20 years of experience in the HIV, drug abuse, and criminal justice fields.

DESCRIPTION (provided by applicant): The proposed study will examine the efficacy of a combined HIV and microfinance intervention to reduce biologically confirmed sexually transmitted infections (STIs), and new incidence of HIV and HCV, as well as reported sexual and drug risk behaviors among 520 women who have injected drugs in the past year and who engage in sex trading in Temirtau and Pavlodar, Kazakhstan. Kazakhstan is one of nine countries worldwide that has experienced a continuing rise in HIV infections (>25%) over the past decade. The epidemic is exacerbated by structural forces such as poverty and a lack of employment options for people who use drugs, especially women, which makes transactional sex a survival strategy. Recent calls for action by HIV prevention scientists have emphasized the need for innovative structural interventions for women engaged in sex work who are also drug-involved. The proposed study builds on findings from an R34 by the investigative team testing a combination HIV prevention and microfinance intervention. Building on successful protocols and significant results, we will randomly assign 520 women who inject drugs and engage in sex trading from Temirtau and Pavlodar, Kazakhstan to either (1) a 4 session HIV prevention intervention combined with a 6 session financial literacy intervention, enrollment in an existing vocational training program and receipt of matched savings (HIVRR+MF); or to the 4 session HIV prevention intervention alone. The HIVRR intervention is guided by social cognitive theory. The HIVRR+MF intervention integrates asset theory with social cognitive theory. The MF includes: 1) financial literacy; 2) vocational training; and 3) micro-savings to support transitionto a more permanent employment status. We hypothesize that increasing financial literacy, enhancing vocational skills required to fill marketable positions in the local economy, and beginning a personal savings program, combined with HIV risk reduction, will lead to significant reductions in study outcomes compared to an HIVRR intervention without a microfinance intervention. A qualitative component to examine factors that facilitate or impede women's ability to participate in and benefit from a microfinance intervention, and a cost and cost effectiveness analysis will provide additional data to inform a disseminable program if findings are significant. The findings from this study will be important not only for Central Asia, but may also have vital public health implications in the U.S. and other countries where HIV/STIs and HCV remain high and employment rates remain low among drug- involved women engaged in sex trading.

? DESCRIPTION (provided by applicant): Driven by injection drug use, Kazakhstan and other Central Asian nations are currently experiencing the fastest growing HIV incidence in the world and continue to report huge gaps in the continuum of HIV care for PWID. According to 2014 national data, only one-third of the estimated 19,000 HIV-positive PWID in Kazakhstan are ever linked to HIV care and only 10% initiate ART with 4% achieving viral suppression. As Kazakhstan is expanding eligibility for ART from <350 CD4 to <500 CD4 in 2015, there is an urgency to enroll previously ineligible HIV-positive PWID in ART. Large gaps in Kazakhstan's continuum of care for PWID mirror gaps found in other countries in which only a small proportion of PWID initiate ART. Mounting research demonstrates that improving rates of ART among PWID may be an effective strategy to prevent HIV transmission, lower mortality, improve quality of life, and reduce drug and sexual risk behaviors. There is a critical need for effectiveness and implementation research to identify how best to improve HIV service delivery to close the critical Treat gap in the continuum of care. This will occur by identifying and linkng HIV-positive PWID to HIV care, and reaching out to those who have never been in HIV care, are intermittent users of care, or have dropped out of treatment. The proposed study is designed to evaluate the implementation and effectiveness of an enhanced HIV service integration package (BRIDGE) that may be scaled up in Kazakhstan's vast network of needle-syringe programs (NSPs) for PWID. This package includes low threshold strategies of peer-driven recruitment, HIV counseling and rapid testing (HCT) in NSPs conducted by HIV care clinic nurses, and ARTAS, CDC's highly effective case management strategies for linking PWID to HIV care. BRIDGE is systematically designed to address specific service barriers to testing PWID for HIV, linking them to HIV care, and promoting ART initiation. This study will employ an innovative stepped wedge design to evaluate implementation and effectiveness of BRIDGE on improving linkage to HIV care and initiation of ART in 24 NSPs located in 4 geographically disparate Kazakhstani cities using site-level data collected from NSPs and HIV clinics. We will also conduct a longitudinal panel study with a random sample of HIV-positive PWID (N=600) from four cities in Kazakhstan using repeated assessments at baseline, 6-, and 12-months follow-up. This study will employ mixed methods to identify multi-level structural, community, and organizational factors that influence the implementation and effectiveness of BRIDGE and the cost of BRIDGE, examining implications for cost-effectiveness, feasibility of expansion, and sustainability. The study builds on the investigative team's extensive HIV intervention research among PWID in Kazakhstan in collaboration with the Republican AIDS Center over the past decade. It addresses implementation research questions to improve and integrate HIV service delivery systems for PWID that are not only important to the region, but have relevance to other countries that have concurrent injection drug use and HIV epidemics.

DESCRIPTION (provided by applicant): The proposed study will examine the efficacy of a combined HIV and microfinance intervention to reduce biologically confirmed sexually transmitted infections (STIs), and new incidence of HIV and HCV, as well as reported sexual and drug risk behaviors among 520 women who have injected drugs in the past year and who engage in sex trading in Temirtau and Pavlodar, Kazakhstan. Kazakhstan is one of nine countries worldwide that has experienced a continuing rise in HIV infections (>25%) over the past decade. The epidemic is exacerbated by structural forces such as poverty and a lack of employment options for people who use drugs, especially women, which makes transactional sex a survival strategy. Recent calls for action by HIV prevention scientists have emphasized the need for innovative structural interventions for women engaged in sex work who are also drug-involved. The proposed study builds on findings from an R34 by the investigative team testing a combination HIV prevention and microfinance intervention. Building on successful protocols and significant results, we will randomly assign 520 women who inject drugs and engage in sex trading from Temirtau and Pavlodar, Kazakhstan to either (1) a 4 session HIV prevention intervention combined with a 6 session financial literacy intervention, enrollment in an existing vocational training program and receipt of matched savings (HIVRR+MF); or to the 4 session HIV prevention intervention alone. The HIVRR intervention is guided by social cognitive theory. The HIVRR+MF intervention integrates asset theory with social cognitive theory. The MF includes: 1) financial literacy; 2) vocational training; and 3) micro-savings to support transitionto a more permanent employment status. We hypothesize that increasing financial literacy, enhancing vocational skills required to fill marketable positions in the local economy, and beginning a personal savings program, combined with HIV risk reduction, will lead to significant reductions in study outcomes compared to an HIVRR intervention without a microfinance intervention. A qualitative component to examine factors that facilitate or impede women's ability to participate in and benefit from a microfinance intervention, and a cost and cost effectiveness analysis will provide additional data to inform a disseminable program if findings are significant. The findings from this study will be important not only for Central Asia, but may also have vital public health implications in the U.S. and other countries where HIV/STIs and HCV remain high and employment rates remain low among drug- involved women engaged in sex trading.

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.

PROJECT SUMMARY New York State (NYS) ranks second in the nation in absolute numbers of opioid overdose deaths. From 2015- 2016, opioid overdose deaths in NYS increased by 32%, including an 88% increase in synthetic opioid-related deaths. The proposed research will develop and test a County-system Hub and Spoke Empowerment model (?CHASE?) to reduce incidence of fatal overdoses in 15 geographically and racially diverse counties in NYS that averaged 28.2 deaths per 100,000 in 2017 and meet all the UM1 RFA-DA-19-016 criteria. CHASE is a modified Hub and Spoke model that is adaptable to the unique needs of any particular county with the aim of developing a blueprint that could be applied to counties across the U.S. CHASE is a coordinated multi-system, multi-sector public health response to the opioid epidemic, directed by County Health Commissioners, and driven by robust community engagement and real-time learning based on data science and systems science. CHASE addresses structural barriers to decreasing opioid deaths by engaging underutilized county systems ?Spokes? (e.g., jails, other justice settings, emergency departments (EDs), and other health and social service settings ) will be linked to ?hubs? which will include federally qualified health care clinics, primary care settings and addiction programs. CHASE will target gaps in the opioid prevention and treatment cascade by (1) expanding number of medications for opioid use disorder (MOUD) providers and addiction expertise; (2) identifying people at risk of opioid use disorder (OUD) using evidence-based screening, brief intervention and referral tools and linking and retaining them in MOUD using peer navigation; (3) scaling up overdose education and naloxone distribution (OEND) in community settings; (4) improving access to MOUD in jails and EDs, (5) deploying evidence-based prevention programs in schools, social media and other venues; and (6) scaling up prescription monitoring and prescription take-back programs. The county leadership will work with a county community advisory board of key stakeholders to customize and calibrate the intervention components of CHASE. This calibration process will be guided by an interactive dashboard that facilitates data-driven system modelling to identify the combination of evidence-based strategies to best address specific gaps and opioid overdose trends in their county. This dashboard will also provide real-time feedback on how to improve and optimize implementation efforts. The study will employ mixed methods to rigorously identify multi-level theory- driven factors that impede or facilitate the implementation and sustainability of CHASE in each county. If effective, CHASE can be scaled up as comprehensive public health response to the opioid epidemic in counties across the U.S. This study will build on the extensive research of the multidisciplinary team on OUD and other substance use disorders, HIV, HCV and other comorbid conditions, opioid overdose prevention, pharmacology, data and system science, implementation science, and community-based participatory research and will include government investigators from NYS Department of Health.