Research
Past Research
2025-2026
“Haga Más, Siéntase Mejor”- Adaptation and pilot testing of a community health agent-delivered behavioral activation intervention for older adults with depression in Peru.
Funder: Partners In Health
Role: Principal Investigator
This project built off a currently funded NIH project [3R01MH124956-03S1 (PI: Gum,
A)] to adapt and pilot test a low-intensity, layperson-delivered psychological intervention
using behavioral activation for older adults with depression (called “Do More, Feel
Better”) in Lima, Peru. Activities include theater-testing of the U.S. Spanish-language
manual for adaptation to Peru; pilot testing the intervention among 5 Community Health
Agents and 10 older adults; and intervention scale-up with municipal health authorities.
2023-2025
Spanish-Language Lay-Delivered Behavioral Activation in Senior Centers.
Funder: NIH/NIMH - 3R01MH124956-03S1 (PI: Gum, A)
Role: Co-Investigator
In response to large numbers of senior center clients who suffer from 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 in reengaging with pleasant and rewarding
daily activities and reducing depressive symptoms. To show that the lay delivery model
has a positive impact in comparison to clinician-delivered Behavioral Activation,
we 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.
2022-2026
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.
Funder: The Collaborative Initiative for Paediatric HIV Education and Research (CIPHER),
International AIDS Society
Role: Principal Investigator
This proposal developed and tested the 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 accompanying ALWH struggling to maintain optimal antiretroviral adherence.
Borne out of our work with Peruvian ALWH, this project directly responded to their
request to increase access to depression care services.
2023
Collaborative Care for USF Pediatric Outpatient Care.
Funder: USF Department of Pediatrics
Role: Co-Principal Investigator (Co-PI: Emmanuel, P)
The goal of this project was for the School of Social Work and the Pediatric Department
to collaborate to create the infrastructure and processes that facilitate the integration
of social work into pediatric primary care clinics. This was a one-year pilot and
began at the USF 17 Davis clinic in Tampa, FL.
*Denotes grants relinquished upon assuming the role of Agency Mental Health Coordinator at the United States Agency for International Development (USAID) in February 2024. USAID was later closed in March 2025.
2022-2024
*Disease Intervention Specialist Training Academy (DISTA)
Funder: State of Florida
Role: Co-Investigator (PI: Somboonwit, C)
The overall objective of DISTA was to develop a sustainable public health workforce,
with a specific focus on Disease Intervention Specialists (DIS) and other public health
workers in communicable diseases and public health readiness. DISTA provided a multidisciplinary
training approach and offered career ladders for the public health and/or healthcare
workforce. The Training Academy aimed to reduce DIS attrition, offer a comprehensive,
interdisciplinary pathway to prepare new public health workers for their DIS roles,
and provide advanced, specialized training that supports current employees' growth
in their public health professional careers.
2023-2024
*Understanding and addressing geographic barriers to accessing TB services in a high-burden urban setting
Funder: NIH/NIAD: R01AI168424-01A1 (PI: Jenkins, H)
Role: Co-Investigator
Tuberculosis (TB) is curable but remains one of the top 10 causes of death globally.
Middle-income countries (MICs) account for 86% of the global TB burden, with a significant
portion 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 drives 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
affect 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 to improve TB diagnosis and treatment. In this project,
in Lima, Peru, we: 1. Developed a community-level risk score that predicted incomplete
TB treatment, 2. Understood how geographic accessibility contributed to diagnostic
delay at the individual level, and 3. Identified treatment support interventions for
addressing geographic and other access barriers that are optimal for different types
of patients.
2022-2024
*Efficacy of a differentiated care intervention for adolescents transitioning to adult HIV care in Peru
Funder: NIH/NIMH - 1R01MH131414-01 (PI: Franke, M)
Role: Co-Investigator
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 estimated the short- and long-term efficacy of a community-based
differentiated care intervention to support adolescents during their transition to
adult HIV care; estimated the cost and cost-effectiveness in terms of cost per additional
successful transition achieved; and provided data on implementation considerations
essential for uptake, sustainability, and successful adoption by the public sector.
2022-2024
*Feasibility of a Community-engaged Social Marketing Strategy to Reduce HIV-related Stigma and Improve Health among Young People.
Funder: NIH/FIC - 1R01TW012394-01 (PI: Franke, M)
Role: Co-Investigator
In this project, we evaluated 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 identified key anti-stigma
messages and change goals. Next, we developed and pilot-tested a suite of locally
tailored Spanish-language multimedia tools. Finally, we examined the feasibility of
collaborating with key societal influencers in Peru to disseminate health-related
messages via social media.
2022-2023
From ambivalence to action—using a conversational agent or “chatbot” to support smoking cessation: a proof-of-concept study
Funder: University of South Florida, New Investigator Research Grant
Role: Principal Investigator (Co-Investigator, Nair, U)
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. Lacking are low-cost, scalable interventions that support smokers unready
to quit (“ambivalent smokers”) to promote smoking behavior changes until motivation
to quit arises gradually. At this time, they can be navigated to evidence-based smoking
cessation interventions. This project developed and pilot-tested a smoking-cessation
support chatbot for preliminary feasibility and acceptability.
2022-2023
Disclosure Deliberation Using Chatbot Technology
Funder: University of South Florida College of Behavioral and Community Sciences Internal
Research Grant
Role: Co-Principal Investigator (Co-PI, Kosyluk, K)
This project employed human-centered design methods to develop a chatbot that aids
college students with mental illness in making disclosure decisions.
2021-2022
A Solution to Halt Further Isolation of People Aging with HIV During the COVID-19 Pandemic
Funder: Merck Pharmaceuticals (PI: Brown, B)
Role: Co-Investigator
The overall objective of this research was to develop a virtual village for use by
older people living with HIV (PLWH) so that they could remain socially connected during
the COVID-19 pandemic and beyond. This was an innovative solution to address isolation-related
issues among older PLWH, which have been exacerbatedduring the COVID-19 pandemic.
The tools and protocols developed through this research are applicable beyond the
HIV context and can be adapted for people who are isolated or living with other chronic
conditions.
2021-2022
Evaluating the impact of incentives on clinical trial participation
Funder: Merck Pharmaceuticals (PI: Brown, B)
Role: Co-Investigator This study aimed to investigate the impact of incentives on
participation in clinical trials. Little is known about the topic, and although some
ethical guidance exists on payment in research, there is limited understanding of
how key stakeholders—study participants, researchers, and IRB members—view and consider
incentives in research projects. Given its robust historical commitment to social
justice and our expertise in HIV research, the HIV community was the ideal group to
initiate this work. However, the tools developed and the lessons learned will be transferable
to other areas of research.
2020-2021
Bending the Mental Distress Curve Among COVID-19 Responders: A Pilot Feasibility Study
This project developed and tested for feasibility and acceptability a chatbot aimed at screening and referring first responders experiencing mental distress to care matching their intensity of need, readiness for change, care preferences, and level of stigma surrounding help seeking.
2020-2021
Developing a Business Model for the “TABATHA” (Tampa Bay Area Treatment
& Health Advisor) Chatbot
This funding supported the exploration of the potential business market for the TABATHA chatbot, which aims to address behavioral healthcare systems demands and also the mental health care gap through screening and referral to services matching the intensity of one’s needs.
2019-2021
Transitioning from the Pediatric to the Adult Care Setting – Project PASEO
By building on our well-established community-health platform and existing
intervention research with HIV-positive adolescents in urban Lima, Peru, we sought
to fill a key implementation gap by examining whether a community-based accompaniment
intervention delivered by community health workers is efficacious in bridging the
transition for adolescents from pediatric to adult HIV care. This study sought to
determine the feasibility of community-based accompaniment as an intervention for
bridging the transition to adult HIV care in two groups of adolescents in Peru (perinatally
infected adolescents and newly diagnosed young men who have sex with men and transgender
women) and collect information critical to informing a future
randomized, clinical trial.
2018-2020
Halting All Types of Tuberculosis (HALT-TB)
This project comprised implementation research and impact evaluation of interventions
for tuberculosis (TB) active case-finding and treatment of tuberculosis infection
in Peru, Kenya, and Pakistan. In each of these sites, mobile digital radiograph units
provided rapid screening of TB hotspots previously identified by epidemiological surveillance;
in Peru, we plan to screen 100,000 persons. A major component of this project involved
community engagement. Using a social justice/rights-based perspective and informed
by the theory of diffusion of innovations, we promoted TB screening by working with
community leaders and other stakeholders to disseminate messages encouraging uptake
of TB screening and linkage to care and provision of community-based mental health
services
2019-2020
WHO EQUIP: Ensuring Quality in Psychological Support. Funder: WHO (PI: Lecca, L - Peru Site)
The goal of this project was to test a platform for training and supervision of mental health and psychosocial support helpers (particularly non-specialist providers) by applying the platform to helpers who will deliver WHO low-intensity psychological interventions and related non-WHO psychological interventions. This platform, entitled Ensuring Quality in Psychological Support (EQUIP), is an online resource being developed to include materials for evaluating core and specific competencies, training and training remediation for learning and attaining core competencies, and implementation guidance on designing and conducting competency-based trainings and supervision. The research evaluated the feasibility, acceptability, perceived utility, reliability and validity of the EQUIP platform and its materials in seven (7) countries: Jordan, Kenya, Lebanon, Peru, Uganda, Zambia and Ethiopia.
Project SexFlow: Mapping HIV among Venezuelan migrants in Peru
This was a large epidemiological study of HIV, sexually transmitted infections and associated risk factors among recent Venezuelan migrants in Peru.
2015-2019
Investigating off-prescription use of pre-exposure prophylaxis for HIV prevention
This project investigated the use of antiretroviral medication (ARV) to prevent people from acquiring HIV in countries where these drugs were not formally approved for such use. The aim is to understand, at a global level, the current practices and experiences of the clinicians who prescribe ARV and the patients who take them.
2016-2018
Diagnostic and treatment delays in pediatric tuberculosis.
TB is difficult to diagnose in children. Treatment delays can lead to severe and fatal forms of TB which itself is often undetectable with usual tests in children. As a result, clinicians must diagnose TB based on signs and symptoms. This study examined two key knowledge gaps about TB treatment delays in children to: (1) Understand how recently revised consensus criteria for standardized clinical case definitions for pediatric TB intersect with clinical diagnoses; and, (2) identify the factors that impede or facilitate rapid TB treatment initiation following a TB diagnosis through qualitative interviews with parents, providers, and field workers.
2015-2018
Metabolic factors that control the spectrum of human tuberculosis
This project addressed the link between metabolic and immunological determinants of TB, the function of T cells in TB infection, the determinants of TB drug resistance and the potential for improved diagnostics that identify pathogen-shed molecules in human samples.
2014-2018
Integrated discovery and development of innovative TB Diagnostics
This study laid the foundation for the development of a rapid, inexpensive tool to address these challenges through biomarker discovery and analysis, optimization of sampling strategies for children and the development and optimization of a microarray based test for TB and drug resistance.