2021 C-PARC Projects
Title: Developing patient-centered perinatal mental health services in Kenya: formative research with a human-centered approach
Principal Investigator: Keshet Ronen
Abstract: Untreated perinatal mood and anxiety disorders(PMAD) result in negative health outcomes for mother-infant pairs, especially in contexts of HIV. In settings with limited resources for mental health (MH), 75% of those in need do not receive care. The World Health Organization recommends expanding access by integrating MH services into programs with high patient attendance such as maternal child health (MCH) and prevention of maternal-to-child transmission of HIV (PMTCT) programs. However, linkage to MH care from MCH/PMTCT is low (<50%)in two ongoing studies in Kenya. Factors driving MH care-seeking are not well understood among perinatal women in sub-Saharan Africa. Health services designed with input from patients elicit better outcomes and satisfaction, thus MH care co-designed with women with PMAD may improve MH linkage and outcomes. As MH integration efforts gain momentum globally, it is critical to design patient-centered PMAD services for women at risk for and living with HIV. Our team proposes leveraging two ongoing studies among pregnant and postpartum Kenyan women to:1.Evaluate the MH referral cascade (acceptance, linkage, and satisfaction) and factors associated with each step among women with likely PMAD attending MCH/PMTCT, 2. Use a human-centered design approach to evaluate acceptability of existing and preferences for future PMAD services mapped to evidence-based interventions. We bring expertise in MCH, implementation science, and mental health to this project. Data from this study will inform a future trial testing the effectiveness of a patient-centered MH intervention integrated into MCH/PMTCT in a context of high HIV burden.
2021 SPARC Projects
Title: Making HIV prevention more user centered: A formative evaluation for at-risk adolescent girls with sexual victimization histories
Principal Investigator: Jessica Blayney
Abstract: During adolescence, alcohol and sexual risk patterns begin to form. Alcohol increases HIV-related sexual risk behaviors(SRB; e.g., sex with multiple/casual partners, inconsistent condom use). The majority of HIV cases in girls and young women are acquired through sex with men and new diagnoses have remained stable since 2014. Thus, adolescence is a critical point for HIV prevention. Most HIV prevention programs focus on condom use, but with minimal alcohol content and insufficient tailoring to adolescent girls, especially those with sexual victimization histories (SVH). Sexual victimization in adolescence is alarmingly high and girls with SVH report more mental health symptoms, alcohol use, and HIV-related SRB. Existing HIV prevention programs increase condom use, with stronger effects observed when content is specialized to the target population. A subset of interventions exist for adolescent girls who have experienced gender-based violence, though these are in-person and focus on dating violence. Technology-based approaches are equally effective and have unique advantages. Currently, there are no technology-based HIV prevention programs for adolescent girls with SVH. The proposed study aims to: (1) understand the dating and sexual experiences of adolescent girls ages 15-18with SVH, (2)determine their wants and needs for HIV prevention, and (3) develop and pilot test a technology-based HIV prevention program to address the unique needs of this population. This application provides the PI training with at-risk adolescents, qualitative methods, intervention development, and pilot testing. Findings will be used to support an NIH grant application to test intervention efficacy in a randomized controlled trial.
2022 SPARC Projects
Title: Development of a social media-based hybrid HIV prevention and treatment intervention for transgender Latina women: A community-based approach for HIV status neutral care
Principal Investigator: Jane Lee
Abstract: Transgender Latina women are disproportionately affected by HIV and poor mental health in the United States. However, few evidence-based HIV interventions have been designed for this community that adequately address stigma and the multiple and unique challenges that transgender Latina women face in accessing HIV-related services. Our proposal seeks to address this gap by adapting an evidence-based intervention for transgender Latina women that engages a culturally sensitive and community-based approach to HIV status neutral care. A critical step to Ending the HIV Epidemic in the U.S. is to develop strategies to address HIV prevention and treatment efforts that are informed by the communities they serve. Our proposal builds upon a well-established partnership with Entre Hermanos—a community-based organization (CBO) in King County, WA that serves the LGBTQ+ Latinx community. We will utilize the ADAPT-ITT Model to guide the adaptation and develop an intervention protocol. Given the availability of internet-based social networking tools, which has expanded the formats in which individuals can identify and build community, our adapted intervention will integrate the potential resources offered by social media platforms. We will also identify barriers and facilitators to implementation of the adapted intervention to promote mental health, HIV prevention and treatment among transgender Latina women. The proposed research will position the study team to pilot the adapted intervention in a future study to evaluate its efficacy and implementation in community-based settings. Our proposal is an important step towards enhancing evidence-based and culturally sensitive strategies to address mental health and HIV disparities in transgender Latina women.