Understanding and addressing geographic barriers to accessing TB services in a high burden urban setting.
Tuberculosis (TB) is curable but remains one of the top 10 causes of death globally. Middle-income countries (MIC) have 86% of the global TB burden, with much of this burden concentrated in urban settings. Around 30% of people with TB are not diagnosed, and among those who start treatment, around 15% do not achieve a successful outcome. Undiagnosed and untreated TB drive continued transmission, morbidity, and mortality. TB elimination requires an improved understanding of how to reduce barriers to diagnosis and treatment. Geographic barriers to accessing TB services – e.g. long travel times, lack of public transit, and difficult terrain – can contribute to both undiagnosed and untreated TB. There is limited knowledge about how geographic access barriers impact TB outcomes in MIC urban settings, how best to measure geographic accessibility in these settings, and, most critically, how to design interventions that address intersecting access barriers, thus improving TB diagnosis and treatment. In this project, in Lima, Peru, we will: 1. Develop a community-level risk score that predicts incomplete TB treatment, 2. Understand how geographic accessibility contributes to diagnostic delay at the individual level, and 3. Identify treatment support interventions for addressing geographic and other access barriers that are optimal for different types of patients.
Spanish-language Lay-delivered Behavioral Activation in Senior Centers
In response to large numbers of senior center clients who suffer untreated depression and the dearth of geriatric mental health providers, we have simplified Behavioral Activation to be delivered by lay volunteers (“Do More, Feel Better”; DMFB). The focus of Behavioral Activation is to guide clients to reengage in daily pleasant and rewarding activities and reduce depressive symptoms. If we can show that the lay delivery model has positive impact in comparison to clinician-delivered Behavioral Activation, we will have identified an effective intervention that can be used by a large untapped workforce of older adult volunteers across the nation; this Spanish language initiative has the potential to reach the large and growing numbers of Spanish-speaking older Americans, many of whom experience depression and barriers to accessing mental health services.
Collaborative Care for USF Pediatric Outpatient Care
The goal of this project is for the School of Social Work and the Pediatric Department to work together to create the infrastructure and processes that will foster the integration of social work in the pediatric primary care clinics. This will be a one year one-year pilot and begin at the USF 17 Davis clinic in Tampa, Florida.
Efficacy of a differentiated care intervention for adolescents transitioning to adult HIV care in Peru
The transition to adult HIV care is often accompanied by reduced medication adherence, retention in treatment, and HIV viral load suppression; however, little is known about which interventions might be most effective in supporting adolescents undergoing this care transition. We will estimate the short- and long-term efficacy of a community-based differentiated care intervention to support adolescents during their transition to adult HIV care; estimate the cost and cost-effectiveness in terms of cost per additional successful transition achieved; and provide data on implementation considerations essential for uptake, sustainability, and successful adoption by the public sector.
Feasibility of a Community-engaged Social Marketing Strategy to Reduce HIV-related Stigma and Improve Health among Young People
In this project, we will evaluate the feasibility of a social marketing public health strategy for reducing HIV-related stigma, and associated intersectional stigma, among young people in an urban Latin American setting. First, we will identify key anti-stigma messages and change goals. Next, we will develop and pilot-test a suite of locally tailored Spanish-language multimedia tools. Finally, we will examine the feasibility of collaborating with key societal influencers in Peru to disseminate health-related messages via social media.
Development and pilot testing of an optimized conversational agent or "chatbot" for Peruvian adolescents living with HIV to facilitate mental health screening, education, self-help, and linkage to care
This proposal develops and tests for feasibility and acceptability of a “chatbot” to deliver depression education, self-help skills, and care linkage for adolescents living with HIV (ALWH) in Lima, Peru and builds on several years’ experience by our team in providing accompaniment to ALWH struggling to maintain optimal antiretroviral adherence. Borne out of our work with Peruvian ALWH, this project is in direct response to their request to increase access to depression care services.
Disease Investigator Specialist Academy (DISTA)
The overall objective of DISTA is to develop a sustainable public health workforce more specific to Disease Intervention Specialists (DIS) and other public health workforce in communicable diseases and public health readiness. DISTA provides a multi-disciplinary approach to train and provide career ladders to the public health and/or health care workforce. The Training Academy will seek to reduce DIS attrition, provide a comprehensive and cross-disciplinary pathway to prepare new public health workers for their DIS role, and provide advanced and specific training that supports current employee growth in their public health professional career.
From ambivalence to action -- using a conversational agent or “chatbot” to support smoking cessation: a proof-of-concept study
Smoking is the leading preventable cause of disease and death in the US, and while about 68% of adult smokers want to quit, less than a third actively seek cessation services. We propose to develop and pilot test preliminary feasibility and acceptability of a smoking cessation support chatbot.
Disclosure Deliberation Using Chatbot Technology
This project aims to use human centered design methods to develop a chatbot to aid college students with mental illness to tackle disclosure decisions.
A Solution to Halt Further Isolation of People Aging with HIV During the COVID-19 pandemic
The overall objective of this research is to develop a “virtual village” for use by older people living with HIV (PLWH) so that they can remain socially connected during the COVID-19 pandemic and beyond. This is an innovative solution to address issues related to isolation for older PLWH which have been exacerbated during the COVID-19 pandemic. The tools and protocols developed through this research will be applicable beyond the HIV context and can be adapted for people who are isolated or living with other chronic conditions.
Evaluating the impact of incentives on clinical trial participation
The objective of this research is to investigate the impact of incentives on clinical trial participation. Little is known about the topic, and while some ethics guidance exists on payment in research, there is no understanding of how key stakeholders (study participants, researchers, and IRB members) view and consider incentives in research projects. Considering its robust, historical commitment to social justice, and our own expertise in HIV research, the HIV community is the ideal group in which to initiate this work; however, the tools we develop, and lessons learned will be transferable to other areas of research.