Institute Fellows

Cohort 1 RETI Fellows (2011 - 2013)

Michelle Broaddus, PhD

RETI Fellow

Assistant Professor
Center for AIDS Intervention Research
Medical College of Wisconsin
Milwaukee, Wisconsin

Background
Michelle Broaddus's research has been guided by the study of gender roles, how individuals negotiate condom use within relationships, and contexts of sexual risk among high-risk young adults and adolescents. She obtained her PhD in social psychology at the University of Colorado at Boulder in Social Psychology in 2008, focusing on condom attitudes and gender and power in heterosexual relationships. She has published articles examining associations with consistent condom use and the effects of a HIV risk reduction randomized controlled trial among adolescents in detention, detailing gender specific models of condom use intentions and use among adolescents on probation, and perceptions of condom proposers among college students. She completed a NRSA postdoctoral fellowship at CAIR in 2010, and conducted a developmental project on the uses of social media technology, including Short Messaging Service (SMS, also known as “texting”) in sexual relationships among HIV and STD at-risk young adults. After being hired as an assistant professor at CAIR in 2010, Dr. Broaddus’s interests remain focused on the potential for mobile phone technologies in innovative HIV prevention interventions, both as a medium for intervention delivery, and as a tool for at-risk populations to increase safer sex communication.

Mentored Research Project (MRP) Title
Participant perspectives of risks and benefits of participating in a text message-delivered intervention for safer sex communication

Abstract
Text-messaging may offer a new effective medium of HIV prevention intervention delivery. The lack of established precedents to these innovative modalities means new ethical concerns should be considered. Privacy of participants and security of data may be of most importance to IRBs. However, denying access to these interventions may undermine principles of beneficence, and respect for persons, and may not reflect participants’ views of the potential interventions’ benefits versus risks. Aim: To survey potential participants’ perceptions of risks and benefits of participating in a sexual communication intervention delivered via text messaging compared to face-to-face. Participants: Young African American women recruited from an STI clinic. Method: Three focus groups, 100 surveys (to be collected). Results/Conclusion: Focus groups results indicate high levels comfort with a text message-based intervention, identified barriers and benefits to both modalities, and suggested ways to increase benefit of text message based intervention.

MRP Publications
Broaddus, M. R. & Marsch, L. (2015). "Comparing risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American young women in the Midwestern U.S." Ethics & Behavior, 25(2): 146-168. Ethics Behav.

Peter Davidson, PhD

Peter Davidson

Assistant Adjunct Professor
Division of Global Public Health
University of California, San Diego

Background
Peter Davidson received his PhD in medical sociology from the University of California, San Francisco in 2009. Dr. Davidson has been conducting research and harm-reduction based intervention development around heroin-related overdose and the transmission of HIV, hepatitis C, and sexually transmitted infections among drug users in Australia and the United States since 1997. Dr. Davidson's dissertation project explored the influence of policing practices on the movements and economic activities of a highly mobile group of homeless young injecting drug uses in San Francisco, and how these in turn affect the willingness and ability of young injectors to utilize needle exchange services. His work also involves explorations of how injecting drug users and other economically marginalized populations ‘make sense’ of research participation, and the ethical implications of these understandings.

Mentored Research Project (MRP Title)
Disjuncts in understanding: An exploration of differences in the ways drug users, researchers, and federal code understand research participation

Abstract
The research will utilize a grounded theory / situational analysis approach to explore how a specific population of young people who inject drugs understand and experience participation in epidemiologic research, and will compare these understandings with those embedded in US Federal Code regulating research with human subjects, as well as with perspectives provided by researchers and IRB members. The research is expected to offer insight into disjuncts in understanding which have the potential to inadvertently leave research participants feeling mistreated.

Jennifer Hettema, PhD

RETI, fellow

Assistant Professor
Department of Family and Community Medicine
University of New Mexico
Albuquerque, New Mexico

Background
Jennifer Hettema is an Associate Research Professor in the Department of Family and Community Medicine at UNM. She is a clinical psychologist and conducts behavioral health research. Her research focuses on the development and evaluation of behavioral health interventions in primary care, meta-analysis, medical education, and implementation of effective interventions. She is particularly interested in interventions focused on risky alcohol use, prevention of alcohol exposed pregnancy, and HIV medication adherence. Dr. Hettema is a member of the Motivational Interviewing Network of Trainers and incorporates this treatment modality into much of her research.

Mentored Research Project (MRP) Title
Physician attitudes and behavior towards HIV+ IDUs

Abstract
While adherence to HAART may be affected among IDUs, due to the instable lifestyle associated with drug seeking and use (Wood et al., 2008), the risk of development of antiretroviral resistance among IDUs has not been found to be higher than their non-IDU counterparts (Werb et al., 2010). Despite this, IDU status has been found effect access to care for HIV (WHO, 2006; Wood et al., 2008), with evidence that physician reluctance to prescribe HIV may play contribute to this disparity (Bassetti, 1999; Ding et al., 2005). To determine the impact of IDU status on physician prescribing behavior, a national sample of community-based HIV prescribing providers completed an online survey in which they were presented with two case vignettes describing a patient with previous adherence issues presenting for treatment and requesting reinstatement on antiretroviral medications. The vignettes were identical with the exception of the IDU status of the patient. Participants were randomly assigned to see either the IDU or non-IDU (NIDU) vignette first. To date 156 participants have consented to participate in the study and 112 of these submitted complete responses. Participants were predominately female (55.8%), White (77.9%), and practicing in Urban settings (80.5%). Participants were well distributed by state. Most participants were physicians (47.8%) or nurse practitioners (45.1%), with a smaller samples of physician assistants (7.1%). Independent samples t-tests revealed that neither IDU prescribing behavior (t(118)=-.258, p=.797) nor NIDU prescribing behavior (t(117)=-.693) differed significantly by condition (order of presentation). Consequently, conditions were collapsed for future analyses. A paired samples t-test was conducted to evaluate the impact of patient IDU status on prescribing behavior. There was a statistically significant difference between reported likelihood of prescribing for NIDU (M=3.51, SD=1.37) versus IDU patients (M=3.03, SD=1.37), t(115) = -5.03, p < .001. Attitudes towards shared decision making and concerns about adherence are both predictive of less willingness to prescribe to IDUs.

Kristin Kostick, PhD

Kristin Kostick

Research Associate
Baylor College of Medicine
Houston, Texas

Background
Kristin Kostick is a medical anthropologist with expertise in applied prevention/ intervention research, with specific experience in HIV/AIDS prevention and interdisciplinary research methods. She specializes in the design and implementation of culturally-specific and community-based health interventions, including those aimed at reducing sexual risk and promoting psychosocial health and gender equity. She has engaged in training and capacity-building among local non-governmental and community-based organizations in developing countries, particularly among impoverished urban slum communities in India and Mauritius. She has also conducted evaluation research on evidence-based research programs, including Supported Employment rehabilitation services for individuals with severe mental illness in the US, and malaria control interventions in West Africa.

Dr. Kostick has experience collaborating with both local and national entities, and coordinating research activities across academic and clinical settings. Her current research focuses on the role of MDMA (ecstasy) –use on sexual risk behaviors among urban young adults, as well as the use of ecstasy to improve intimacy, communication and sexual satisfaction in relationships characterized by significant intimate partner conflicts. In conjunction with her previous work in India, she continues to focus on culturally-based symptom markers that can help to identify women who are in relationships whose dynamics put them at greater risk for HIV and other sexually transmitted infections. Dr. Kostick has conducted research in India, Africa, Mauritius and the US.

Mentored Research Project (MRP) Title
Exploring participant experiences in a peer-delivered HIV intervention with IV drug users

Abstract
The goal of this project is to use qualitative methodologies to explore the role of communication between research staff and patients involved in a peer-delivered HIV risk and harm reduction program for intravenous (IV) drug users in Hartford, CT. Peer-delivered interventions among drug users have come under close scrutiny by ethics researchers because of their potential to inadvertently and negatively impact patient rehabilitation efforts due to continued exposure to and engagement with drug-using social networks in conjunction with peer-delivered intervention strategies. This study aims to explore whether enhanced communication of patient concerns and experiences with research staff may help to reduce the potential for inadvertent maleficence in peer-delivered drug treatment interventions.

MRP Publications
Kostick, K., Weeks, M., & Mosher, H. (2014). "Participant and Staff Experiences in a Peer-Delivered HIV Intervention with Injection Drug Users". Journal of Empirical Research on Human Research Ethics. 9(1), 6-18.

Purnima Madhivanan, MBBS, MPH, PhD

Associate Professor
Robert Stempel College of Public Health & Social Work
Florida International University
Miami, Florida

Background
Purnima Madhivanan received her medical degree from Mysore Medical College in India. She served as an HIV physician at the Y.R. Gaitonde Centre for AIDS Research and Education in Chennai, India, before going on to earn an MPH and PhD in Epidemiology at the University of California, Berkeley. Dr. Madhivanan is founder and Executive Director of Public Health Research Institute of India that is recognized by Government of India as a research organization carrying out basic and translational research on women’s health issues in India. She is also the guiding force behind Prerana Women’s Health Initiative which provides voluntary, comprehensive, and culturally sensitive services including HIV/STI management, family planning and cancer screening.

Prerana operates a free reproductive health clinic in an urban Mysore slum and mobile antenatal clinics serving 144 rural villages in Mysore Taluk, an area with a large concentration of low-income and farming communities. Dr. Madhivanan has an active research program on prevention of HIV/STIs, primary and secondary prevention of cervical cancer, and domestic violence. She has more than 30 peer-review manuscripts in journals including AIDS, BMJ, Sexually Transmitted Diseases, AIDS & Behavior, Global Public Health, Vaccine, BMC Public Health, and Human Resources for Health. She was the 2007 recipient of the prestigious Elizabeth Glaser Pediatric AIDS Foundation’s International Leadership Award for her work on prevention of pediatric AIDS in India. Currently, Dr. Madhivanan Associate Professor of Epidemiology at the Robert Stempel College of Public Health & Social Work at FIU. She continues her research and advocacy for HIV infected women in India.

Mentored Research Project (MRP) Title
Ethical issues in the deliver of prevention of mother-to-child transmission of HIV interventions in South India

Abstract
GOI recently changed guidelines for HIV testing from “opt-out” testing to routine HIV testing of all pregnant women receiving antenatal care. This qualitative study examined the experiences and perceptions of recently delivered women undergoing HIV testing during ANC and healthcare workers who conduct HIV testing and counseling in government and private hospitals in Mysore, Karnataka, India. Only six of the 15 women recalled being informed about the purpose of routine HIV testing. A large majority of the women (11) said that only their doctor informed them that they had to get an HIV test if they wished to deliver at the hospital. Only 3of the 15 women said they recalled signing a consent form for testing but a majority (8) said they had been given forms that they were told to sign. The seven HCW attending the FGD had sufficient knowledge about HIV testing and PMTCT. While they said that they kept confidentiality about women’s HIV test results, many admitted that other hospital employees might occasionally find out about a women’s HIV status. In addition, several expressed derogatory and stigmatizing remarks about “uneducated rural women” who did not comprehend HIV counseling or understand the reasons for giving consent. Women are poorly informed about the risks and reasons for routine antenatal HIV testing. Healthcare workers should be further trained on confidentiality and informed consent in addition to sensitizing them about the need for non-stigmatizing HIV care and testing.

MRP Publication
Madhivanan, P., Krupp, K., Kulkarni, V., Kulkarni, S., Vaidya, N., Shaheen, R., Philpott, S. & Fisher, C. B. (2014). "HIV testing among Pregnant Women Living with HIV in India: Are Private Providers Routinely Violating Women’s Human Rights?" BMC International Health and Human Rights. 14:7.

Cynthia Pearson, PhD

RETI, fellow

Research Assistant Professor
Indigenous Wellness Research Institute
University of Washington
Seattle, Washington

Background
Cynthia Pearson directs the Research Methods and Policy Core at the Interdisciplinary Indigenous Wellness Research Institute where she collaborates with indigenous scholars in the development of research policies and directs iterative data analysis on historical and cultural determinants of physical and mental health among American Indians and Alaska Natives. Dr. Pearson expertise is in designing community-based health studies from an ecological perspective that emphasize social, economic, political, environmental, and historical determinants of health. Specifically, Dr. Pearson’s research focuses on the intersecting risk of substance use, historical and lifetime trauma, and HIV risk and how culture, place, and community serve as protective factors.

Dr. Pearson meets community members where they are and identifies community ways of knowing and resources to create innovative sustainable interventions. She is involved in several CBPR health and wellness projects across Pacific Northwest tribal communities identifying strengths and protective factors that support young women’s wellness, maternal health, cardiovascular disease, youth academic achievement, and suicide prevention.

Mentored Research Project (MRP) Title
Human subject research training for community researchers: A Pacific Northwest Native American cultural prospective

Abstract
This RETI mentored research project will develop a model to adapt and augment the Collaborative Institutional Training Initiative (CITI) human subject certification training curriculum. The model will describe the steps taken to adapt a CITI module to be culturally-responsive and user friendly for rural American Indian (AI) community researchers from Pacific Northwest tribal communities. An expert panel of AI academic and community researchers will prioritize focus areas; adapt and augment components from 1 to 2 CITI Social and Behavioral Sciences modules, highlighting cultural relevance (i.e. sovereignty), priorities and values. The Aims are: 1) in collaboration with Pacific Northwest tribal partners, define the process to produce a culturally relevant CITI human subject certification curriculum module; and 2) produce and evaluate the validity of the culturally-adapted module among 40 tribal members who: a) are 18 years or older; 2) have never taken the CITI training; 3) currently collaborate with an academic research partner or are interested in research; and, 4) reside on a reservation. Improving human subject training usability and cultural relevance for community partners will enhance HIV prevention research ethics practices.

MRP Publications
Pearson, C. R., Parker, M., Fisher, C. B., & Moreno, C. (2014). "Capacity Building from the Inside Out: A Randomized Control Trial on Adapting the CITI Ethics Certification Training Course for American Indian Community Researchers". Journal of Empirical Research on Human Research Ethics, 9(1), 46.

Elizabeth Reed, MPH, ScD

Assistant Professor
Division of Global Public Health
University of California San Diego

Background
Elizabeth Reed is an Assistant Professor at the University of California San Diego's Division of Global Public Health. Her research has focused on gender-based violence (GBV) and HIV prevention in multiple global settings, with particular attention to the influence of social, environmental, and structural factors on risk (e.g. economic position, gender inequities and norms, other challenges across individuals’ ‘life contexts’). Given the increasing recognition that such contextual-level factors are contributing significantly to these health burdens and thereby, the need for interventions that aim to alter such structures within communities, Dr. Reed’s research agenda focuses on the development, implementation, and evaluation of structural-level interventions to address GBV and HIV –particularly those that consider both social and economic aspects of women’s lives. Given the contribution of GBV to HIV risk across populations and contexts, her work related to GBV prevention is also central to HIV prevention.

Dr. Reed’s recent work in the US has involved investigation of social and environmental contexts in relation to GBV perpetration, as well as the mechanisms explaining the link between such perpetration and STI/HIV risk. Her most recent work abroad has involved the investigation of social and environmental factors (e.g. residential instability, economics, migration/mobility, forced migration) and relation to vulnerability for GBV and HIV risk among women working as sex workers in South India.

Mentored Research Project (MRP) Title
Perceptions of HIV prevention research participation among women working as sex workers in Andhra Pradesh, India

Abstract
The proposed project aims to explore qualitatively the perspectives of female sex workers (FSW) in Rajahmundry, Andhra Pradesh (India) regarding their participation in HIV research studies, with primary focus on ethical issues in research. FSW face multiple burdens due to various contextual challenges in their lives, as well as high levels of stigma and related discrimination. Thus, efforts are needed to ensure that research is being conducted in a way that is most ethical, and specifically considers the multitude of unique factors relevant to women working as sex workers in this high HIV prevalence region of India. Findings will inform the implementation of future HIV prevention research efforts in this context, determine whether revisions to research ethics protocols are needed as well as to guide such changes, and have implications for work conducted in similar settings.

MRP Publications
Reed, E., Khoshnood, K., Blankenship, K. & Fisher, C.B. (2014). "Confidentiality, Privacy, & Respect: Perspectives of Female Sex Workers Participating in HIV Prevention Research in Andhra Pradesh, India". Journal of Empirical Research on Human Research Ethics, 9(1), 19-28.

Reed, E., Fisher, C. B. Blankenship, K. & Brook, S. W. Khoshnood, K. (2016 online). Why Female Sex Workers Participate in HIV Research: The Illusion of Voluntariness. AIDS Care.

Lianne Urada, PhD, MSW, LCSW

RETI, fellow

Postdoctoral Fellow
Division of Global Public Health
University of California, San Diego

Background
Lianne Urada is a postdoctoral scholar in the Division of Global Public Health, UCSD Department of Medicine, with a PhD in Social Welfare from UCLA (March, 2011), and a former doctoral training fellow in the Social and Behavioral Determinants of HIV/AIDS Prevention in the Department of Community Health Sciences, UCLA School of Public Health. She also worked with persons living with HIV/AIDS for eight years in Los Angeles, California. She served as a Field Education faculty member in Social Welfare at UCLA and holds a California license in clinical social work. For her dissertation, she conducted surveys of 498 female entertainment workers and 48 managers from 54 establishment venues (night clubs/bars, spa/saunas, karaoke bars) in the Philippines. She received grants to assess the socio-structural influences of risk behavior among the entertainers and to develop and evaluate a new intervention.

Specifically, she examined factors in the risk environment (at physical, social, economic, and policy levels) and their effects on behavioral outcomes. She used a mixed method, collaborative community-based research approach. She also interviewed 48 key informants (health officials, managers, NGOs) and held focus groups of entertainers prior to administering questionnaires. Dr. Urada wishes to examine the ethics surrounding research with sex workers in the Philippines who are concerned about their legal risks and human rights. The criminal contexts of substance use, sex work, and trafficking often pose perceived risks to participants. Interviews with policymakers, law enforcement, and establishment managers regarding police practices in relation to sex workers and substance users are necessary.

Mentored Research Project (MRP) Title
Social and structural constraints on disclosure and informed consent with female sex workers and their managers in the Philippines

Abstract
This project explored the experiences of female sex workers (FSWs) working in night clubs, karaoke bars, and spa/saunas in the Philippines in participating in behavioral HIV prevention research, including their process of consent to research, their knowledge of research ethics, barriers to disclosure of sensitive topics, and the necessary conditions for their involvement in HIV research prevention interventions.

Participants: 7 former interviewers participated in a focus group, and 20 FSWs and 10 establishment managers were interviewed individually as key informants about the research process. Method: This qualitative research used semi-structured interview guides for the individual interviews, focus group, and community advisory board meetings, and ethnographic approaches.

Emergent themes include FSW issues with trust of the research and interviewer, intrusiveness of survey questions, problems seeing any changes made as a result of the research, and feeling forced by government to do surveys. FSWs expressed desire to actively participate in intervention design and implementation and to learn new skills and obtain job training to learn other ways to earn money. Both FSW and managers expressed dissatisfaction with government support: having to pay for clinic health exams, and managers expressed problems with the government’s ability to intervene around police raids and bribes.

This project has the potential to improve HIV prevention research practices with FSWs by 1) foregrounding ethical issues by addressing barriers to respect, trust, and/or disclosure stemming from risks in the structural environment or micro-level social aspects of the research process and 2) developing a more transparent and participatory approach to HIV prevention research that engages participants/ FSWs in the research process in order to reduce perceived and actual risks to participants.

MRP Publications
Urada, L. A., & Simmons, J. (2014). "Social and Structural Constraints on Disclosure and Informed Consent for HIV Survey Research Involving Female Sex Workers and Their Bar Managers in the Philippines". Journal of Empirical Research on Human Research Ethics, 9(1), 29-40.

Urada, L. A., & Simmons, J. (2014). "A Collaborative Methodology for Investigating the Ethical Conduct of Research on Female Sex Workers in the Philippines". Journal of Empirical Research on Human Research Ethics, 9(1), 41-45.

Cohort 2 RETI Fellows (2012 - 2014)

Tania Basta, PhD, MPH

RETI, fellow

Associate Professor
Department of Social and Public Health
Ohio University
Athens, Ohio

Background
Dr. Tania Basta received a BS in Kinesiology and a Master of Public Health (MPH) in Community Health Education from Indiana University and a PhD in Health Promotion and Behavior from the University of Georgia. Currently, she is an Associate Professor in the Department of Social and Public Health in the College of Health Sciences and Professions at Ohio University and is also affiliated faculty in the Center for International Studies and the College of Communications. She is also the Associate Director of the Appalachian Rural Health Institute, an interdisciplinary health services and research institute, collaboratively run by the Colleges of Osteopathic Medicine and Health Sciences and Professions at Ohio University. Dr. Basta has over 13 years of combined public health research and professional experience. She started her public health career as a worksite health practitioner, but in the past 10 year has worked extensively with domestic community-based organizations focused on HIV/AIDS.

She is currently the Chair of the HIV/AIDS Section of the American Public Health Association. Dr. Basta’s research interests focus on increasing the quality of life among individuals living with HIV/AIDS. The majority of her publications are focused on the mental health status of low-income individuals living with HIV/AIDS in the United States. Now that she lives rural Appalachian Ohio, she has become interested in HIV prevention and treatment among individuals living in Appalachia. Recently, she was funded by the NIH Loan Repayment Plan to conduct rural Appalachian HIV research (2010-2012). Dr. Basta also has considerable experience with community-based participatory research (CBPR) and is a Co-Investigator on a Department of Energy Public Outreach Project that was funded to use CBPR methods to develop alternative uses for the Portsmouth Gaseous Diffusion Plant in Appalachian, Ohio.

Mentored Research Project (MRP) Title
Consent Preparedness for Home-Based HIV Testing Research in Rural Appalachia

Abstract
HIV rates are low in Appalachia, however individuals are engaging in high risk behaviors. Very few individuals get tested for HIV due to low HIV-related knowledge, high HIV-related stigma, and lack of access to testing sites. Home HIV testing kits will be available in October 2012 at Walmart, which will increase access for many rural individuals. The participants in this study will be residents of rural Appalachian counties in Ohio, West Virginia and Kentucky. Participants must be 18 years of age or older, live in a rural Appalachian county, do not have an HIV diagnosis, and speak fluent English. This study will be a mixed-methods study (focus groups, survey, and intervention) and will occur three phases.

MRP Publications
Basta, T. B., Stambaugh, T., & Fisher, C. B. (2015). "Efficacy of an Educational Intervention to Increase Consent for HIV Testing in Rural Appalachia". Ethics & Behavior, 25(2): 129-145.

Brandon Brown, PhD, MPH

RETI, fellows

Lecturer
Department of Population Health and Disease Prevention
University of California, Irvine

Background
Dr. Brandon Brown is a lecturer in the UC Irvine Program in Public Health, where his efforts are spent in both education and research. He teaches several courses, including ethics and responsible conduct of research in public health, international epidemiology, and advances in global health. He also serves as the director of undergraduate education, chair of the curriculum committee, director of the global health infrastructure development program, and is a clinical research ethicist. Brandon received his MPH from UCLA and his PhD in International Health from Johns Hopkins Bloomberg School of Public Health in the Global Disease Epidemiology and Control program. His dissertation titled ‘HPV prevalence and risk factors among female sex workers (FSWs) in Peru’ has yielded four peer review publications, with another five articles in preparation. Dr. Brown completed Postdoctoral studies at UCLA in the Global HIV/AIDS Prevention Research program, and in the UCSD Global Public Health program.

Brandon has worked on projects in Peru for over 7 years, and is currently Principal or Co-Investigator on 6 HIV focused or related studies in Peru and Mexico. These projects include vaccine acceptability, building clinic infrastructure, studies of comorbidity of HIV with HPV, examining behaviors related to HPV infection, estimating HPV prevalence in developing countries, conducting interventions for cervical cancer prevention, recruitment and retention of high risk groups in clinical trials, and studies of STIs affecting FSWs and MSM. Dr. Brown is very interested is the topic of international research ethics, and works closely with the University of Cayetano Heredia in Peru. He hopes to begin a program training international scholars in research ethics at UC Irvine. A topic of particular interest is undue inducement in clinical studies of HIV in developing countries with vulnerable populations.

Mentored Research Project (MRP) Title
Voluntary study participation in a clinical trial of HPV vaccine with Peruvian FSWs

Abstract
People should have voluntary choice to participate in a study. Informed consent may allow free choice, but measures to help ensure this during and after consent to gauge continued voluntariness and understanding of study participation are lacking. Understanding of acceptable/excessive incentive types and amounts is lacking, and study integrity may be brought into play if subjects falsify eligibility

MRP Publications
Brown, B., Blas, M. M., Heidari, O., Carcamo, C., & Halsey, N. A. (2013). Reported changes in sexual behavior and human papillomavirus knowledge in Peruvian female sex workers following participation in a human papillomavirus vaccine trial. International Journal of STD & AIDS, 24(7), 531-535.

Brown, B., Davtyan, M., & Fisher, C.B. (2015). "Peruvian female sex workers’ ethical perspectives on their participation in an HPV vaccine clinical trial". Ethics & Behavior, 25(2): 115-128.

Brown B, Galea JT, Davidson P, Khoshnood K. Transparency of participant incentives in HIV research. Lancet HIV 2016; 3(10): e456-7.

Brenda Curtis, PhD

RETI, fellow

Research Associate
University of Pennsylvania's Perelman School of Medicine
Philadelphia, Pennsylvania

Background
Dr. Brenda Curtis is currently a Research Associate at the University of Pennsylvania's Perelman School of Medicine. She received her Masters of Science in Public Health from the University of Illinois and her Doctoral degree from the Annenberg School for Communication at the University of Pennsylvania. Her principal research interests have been in the fields of Health Communication and Public Health. She is very interested in providing scientifically tailored health information that is evidence based. She attempts to translate research into programs that allow for the building of individual and community capacity. In her recent research, she developed a web-based smoking cessation intervention program and conducted a randomized controlled trial to assess the relative effectiveness of tailoring the intervention content to particular demographic (age, gender, ethnicity), and also functional behavioral attributes of the individuals in the target population. That is, the computer used particular presentations of the same message that were individually designed to attributes known to be important in gaining attention and shaping behavior. She found that this relatively simple and inexpensive procedure was able to improve intention to quit by over 19%.

Dr. Curtis is continuing to explore this line of research and recently deployed a substance use screening and brief intervention web-based interactive program she developed into a New York school district. Dr. Curtis is also working on innovative ways to increase enrollment and retention of hard to reach populations into HIV clinical trials. Her research has led her to examine the ethical implications raised by the use of the Internet and social media to recruit and retain subjects into HIV related studies. She is particularly interested in assessing how Institutional Review Boards are implementing new policies and procedures to deal with online recruitment.

Mentored Research Project Title (MRP)
Online Recruiting for HIV Research: Ethical Issues and Concerns for Investigators and IRBs

Abstract
Institutional Review Boards (IRBs) are facing major challenges in the research environment due to changes in how investigators recruit human subjects. Specific Aims: To examine the ethical challenges investigators and IRBs have encountered in developing adequate human subjects protections for recruitment procedures for HIV prevention. To provide examples of how these dilemmas were resolved by investigators and IRBs. Study Population: PHS Funded Principal Investigators and IRB chairs at academic institutions. Research Design: Semi-structured phone interviews will be conducted with 15 IRB Chairs/Directors and 15 HIV prevention principal investigators.

MRP Publications
Curtis, B. (2014). "Social networking and online recruiting for HIV research: ethical challenges”. Journal of Empirical Research on Human Research Ethics. 9(1), 58-70.

Shira Goldenberg, PhD

shira goldenberg

Postdoctoral Fellow
Gender and Sexual Health Initiative
British Columbia Centre for Excellence in HIV/AIDS
Department of Medicine
University of British Columbia
Vancouver, British Columbia

Background
Dr. Shira Goldenberg is a Spanish speaking global health investigator with seven years of experience conducting research on social and structural factors shaping HIV and sexually transmitted infection (STI) risk among vulnerable populations. After completing her MSc in Epidemiology at the University of British Columbia, she received a Canada-U.S. Fulbright award to pursue her PhD through the University of California San Diego (UCSD) and San Diego State University Joint Doctoral Program in Public Health (2008-2011). Dr. Goldenberg is currently a post-doctoral fellow in the UCSD Division of Global Public Health, where her work focuses on structural factors shaping HIV/STI risk, gender-based violence and sex trafficking among female sex workers along the Mexico-U.S. and Mexico-Guatemala borders. She has also worked with the Pan American Health Organization on issues related to mobility and HIV in Central America and Mexico. As data on social and structural factors, such as gender inequities, poverty, and laws/policies are necessary to better understand and prevent HIV/STI infection, Dr. Goldenberg’s short-term goal is to develop the methodological and ethical skills to investigate social and structural influences shaping HIV/STI infection among formerly trafficked women. Her long-term research plans are to develop and evaluate structural interventions to reduce the impacts of sex work among women at high risk of HIV infection in border settings, which is a pressing public health concern in the U.S., Latin America, and globally.

Mentored Research Project (MRP) Title
Barriers and Facilitators to Participation in HIV Research: Female Sex Workers’ Perspectives

Abstract
Research with female sex workers (FSWs) is critical to inform prevention; few data on barriers and facilitators to participation. This study aims to investigate perceived barriers and facilitators to participation, and develop recommendations to enhance FSWs’ participation. Study Population: FSWs ≥18 years old in Tecun Uman/Xela. Research Design: 3-5 focus groups + follow-up interviews (min. n=5). IMPACT: Development of interventions to address barriers and facilitators and enhanced ethical practices in sex work research.

MRP Publications
Collins, S. P., Goldenberg, S. M., Burke, N. J., Bojorquez-Chapela, I., Silverman, J. G., & Strathdee, S. A. (2013). Situating HIV risk in the lives of formerly trafficked female sex workers on the Mexico–US border. AIDS care, 25(4), 459-465.

Goldenberg SM, Brouwer KC, Rocha Jimenez T, Morales Miranda S, Rivera Mindt M. Enhancing the Ethical Conduct of HIV Research with Migrant Sex Workers: Human Rights, Policy, and Social Contextual Influences.’ PLOS One. PLoS One. 2016; 11(5): e0155048.Published online 2016 May 9.

Goldenberg, S., Rivera Mindt, M., Jimenez, T.R., Brouwer, K.C., Miranda, S.M., & Fisher, C.B. (2014). "Structural and interpersonal benefits and risks of participation in HIV research: perspectives of female sex workers in Guatemala”. Ethics & Behavior, 25(2): 97-114.

Thomas Guadamuz, PhD, MHS

RETI, fellow

Assistant Professor
Medical Social Sciences and Public Health
Deputy Head, Center for Health Policy Studies
Mahidol University, Thailand

Background
Dr. Thomas Guadamuz completed graduate training in infectious disease epidemiology at Johns Hopkins Bloomberg School of Public Health and later completed postdoctoral training in behavioral and social sciences and health at the University of Pittsburgh and Mahidol University in Thailand. He is currently a recipient of a Mentored Research Scientist Development Award from NIMH to develop a community-level behavioral change intervention for high-risk young men who have sex with men in Thailand. He is also working with transgender populations in Thailand and the Philippines to understand HIV risk contexts that will inform intervention development.

Dr. Guadamuz has worked in partnership with numerous community-based organizations in the US and Asia and has collaborated with the U.S. CDC, the Thailand Ministry of Public Health, World Health Organization, International Labor Organization, and Family Health International. Dr. Guadamuz currently holds a joint appointment at the Center for Health Policy Studies in the Faculty of Social Sciences and Humanities at Mahidol University where he has close research collaborations and teaches on gender, sexuality and health. His current research interests are the social determinants of health among marginalized populations, recruitment of hard-to-reach populations and HIV risk contexts in online and offline spaces, including gender- and sexuality-based violence and cyber bullying.

Mentored Research Project (MRP) Title

Barriers and facilitators to YMSM participating in HIV-related research studies in Thailand: Perspectives of parents and teens

Abstract
Young men who have sex with men (YMSM) continue to bear the burden of new HIV infections in Southeast Asia. Currently, there are very few studies that include YMSM under 18 years. Reasons for not including YMSM in research studies include the requirements of parental consent from IRBs. This resents a problem because many YMSM have not disclosed their sexual activities or sexual orientation identities to their parents. This study aims to examine the barriers and facilitators related to the participation of YMSM in HIV-related research studies from the perspectives of parents and teens. Using purposive sampling, 6 groups of parents and YMSM will be recruited: (1) Parents of sons, (2) parents of gender non-conforming YMSM, (3) parents of “out”/disclosed YMSM, (4) “out” /disclosed YMSM (15-17 years), (5) “not out” YMSM (18-20 years), (6) street-based YMSM. Research Design: Qualitative research methods: Focus group discussions and semi-structured in-depth interviews (5-8 persons per group above and 1-2 persons per FGD will be asked to participate in in-depth interviews). A total sample size of 50 is expected. Social and cultural values and related issues specific to the Thai context will be explored in detail. IMPACT: To reduce the barriers of adolescent participation in sexuality-related research in Thailand.

MRP Publications
Guadamuz, T., Goldsamt, L.A., & Boonmongkon, P. (2014). "Consent challenges for participation of young men who have sex with men (YMSM) in HIV prevention research in Thailand". Ethics & Behavior, 25(2), 180-195

Charmaine Thokoane

RETI, fellow

Project Coordinator
Centre for the Study of AIDS
University of Pretoria, South Africa

Background
Charmaine Thokoane is a project coordinator at the Centre for the Study of AIDS (CSA), University of Pretoria. Her current position entails coordinating the HIV/AIDS and Human Rights project of the AIDS and Human Rights Research Unit (AHRRU). This unit is a joint initiative between the Centre for the Study of AIDS and the Centre for Human Rights. Her duties include training, research, material development, fundraising, organizing seminars and events. She has been involved in several research projects at the CSA in collaboration with national and international institutions and organizations, both on the University of Pretoria campus as well as in various communities within South Africa. In addition to this, she has worked with governmental and non-governmental institutions in South Africa, as well as, non-governmental organizations and academic institutions in the Eastern and Southern African region on Human Rights and, Sexual and Reproductive Health. She has represented the CSA in various forums in South African and other African countries.

Her areas of interest in Public Health and Human Rights developed after joining the CSA as a volunteer in 2005, while studying towards a degree in natural and agricultural sciences. In 2010, she was selected by the US Embassy, to be part of the US State Departments’ International Visitor Leadership Programme on Skills and Youth Development (February 2011). The knowledge and skills she gained through this experience, has helped shape the community work she does in her current project with the AHRRU.

Mentored Research Project (MRP) Title
Knowledge of rights to sexual reproductive health services among 12-18 year olds in Hammanskraal

Abstract
An HIV prevention program involving 40 male and female participants ages 12–18 in Hammanskraal, South Africa, aimed at increasing awareness and knowledge of laws protecting children’s sexual health rights and access to services through a culturally based “study circle” format. Challenges highlighted by the project included Institutional Review Board approval of youth consent procedures, cooperation and coordination with local policymakers, the need to modify presentation materials to youths’ comprehension levels, availability of youth-based sexual health service providers, and cultural ambiguity over parental involvement in youth health care decisions and laws pertaining to sexual relationships among minors.

MRP Publications
Thokoane, C. (2014). "Ethical challenges for piloting sexual health programs for youth in Hammanskraal, South Africa: bridging the gap between rights and services". Ethics & Behavior, 25(2): 185.

Kristen Underhill, JD, PhD

RETI, fellow

Associate Professor of Law
Columbia Law School
New York, NY

Background
Dr. Kristen Underhill holds a DPhil in Evidence-Based Social Intervention from Oxford University, where she focused on behavioral HIV prevention, systematic reviewing, and research with vulnerable populations. She completed her postdoctoral training under an NIH T32 grant in the Department of Community Health at Brown University, where she focused on the behavioral implications of biomedical HIV prevention strategies. Dr. Underhill's published articles have included studies of abstinence-based HIV prevention approaches, HIV risk among transgender women and their male partners, and the implementation of pre-exposure prophylaxis (PrEP). She also holds a JD from Yale Law School, and her legal research focuses on law and public health, the use of behavioral science concepts in the law, and healthcare financing.

She is jointly affiliated with the Yale Center for Interdisciplinary Research on AIDS and Yale Law School. Dr. Underhill is currently PI of a K01 Mentored Research Scientist Development grant focusing on behavioral issues involved in the use of oral anti-retroviral PrEP by men who have sex with men (MSM). This research grant uses mixed methods to investigate willingness to use PrEP, attitudes towards risk compensation behavior, and perceptions of drug efficacy. Dr. Underhill's legal research aligns with her public health research interests; one of her recent legal projects examined legal doctrines and regulations applying to health insurance coverage of biomedical HIV prevention technologies.

Mentored Research Project (MRP) Title
Exploring IRB Responses to Participant Complaints: Processes, Values, and Resources

Abstract
Under U.S. federal regulations, participants providing informed consent must receive information regarding whom to contact in case of a research-related injury or complaint. Although informed consent processes routinely direct participants to contact institutional review boards (IRBs) with questions or concerns, there has been little empirical study of the ways in which IRBs act to resolve participants' research-related complaints. This article explores available literature on participant complaints, considers the responsibilities of IRBs in dispute resolution, and outlines a research agenda. As a case study, this review considers disputes arising from HIV/AIDS research, focusing on novel issues arising from biomedical HIV prevention trials.

MRP Publications
Underhill, K. (2014). "Legal and Ethical Values in the Resolution of Research-Related Disputes: How Can IRBs Respond to Participant Complaints?". Journal of Empirical Research on Human Research Ethics. 9(1), 71-82

Cohort 3 RETI Fellows (2013 - 2015)

Stella Njuguna, BPharm, MPH

Stella Njuguna, HIV Fellow

Research Officer
Kenya Medical Research Institute

Background
Dr. Stella Njuguna is a Research Officer at Kenya Medical Research Institute (KEMRI). She earned her pharmacy degree from the University of Nairobi, Kenya and a MPH in Epidemiology from the University of California, Berkeley. Her main research interests include: HIV prevention care and treatment as well as socio-behavioral research especially within HIV discordant couples.

Stella has participated in several studies in various capacities. Currently, she is a Co-Investigator for the HIV- Neurology in Kenya Study 2 (THINK-2) and a pharmacist and epidemiologist for Sustainable East Africa in Community Health (SEARCH) study. THINK-2 is a longitudinal study that aims to assess the impact of cognitive impairment on adherence to anti-retroviral therapy (ART). SEARCH project is a cluster-randomized multi-site clinical trial which aims to quantify the health, economic and education impact of early diagnosis and immediate ART treatment using a streamlined care delivery system in rural communities in East Africa. Furthermore, she has keen interest in research ethics and currently provides technical support to KEMRI’s Ethics Review Committee. Dr. Njuguna is also a member of the ADILI Taskforce Secretariat which has been mandated by the Director of KEMRI to restructure the Institute’s research and regulatory review system. She is also a production editor for the quarterly bioethics newsletter in KEMRI.

Mentored Research Project (MRP) Title
Post-trial access of Truvada® amongst HIV-1 discordant couples enrolled in the PrEP study in Kisumu, Kenya

Abstract
In Kenya, 44% of married/cohabiting HIV infected persons have an HIV uninfected partner and this population contributes significantly to the incidence HIV infections in the country. Given the high risk of transmission in this population, novel HIV prevention strategies are critical in decreasing the incidence of HIV infection. Recent studies have shown that TRUVADA is efficient in preventing HIV infections in most at risk populations. However, TRUVADA has not been availed to the HIV discordant couples who were enrolled in the Pre-Exposure Prophylaxis (PrEP) study in Kisumu, Kenya. This is a critical ethical issue embodied in the principle of distributive justice that needs to be addressed. The study's objective is to describe the attitudes regarding post-trial benefits amongst a random sample of serodiscordant couples enrolled in the PrEP study in Kisumu, Kenya. This is a mixed method cross sectional study where qualitative and quantitative data will be collected. Focus group discussions (FGD) conducted by an experienced moderator will explore views and probe for information regarding post-trial access to Truvada from former PrEP study participants. We will conduct four FGDs of a random sample of HIV-1 discordant couples. Each FGD will be gender and age specific and be composed of eight to ten HIV-negative women and men. In-depth interviews will also be conducted for the principal investigators of the study to explore the attitudes, opinions and feelings about PTA. FGD guides and interview scripts will be piloted tested prior use. Each FGD and interview will be audio recorded and later transcribed and translated for analysis. Field notes will also be taken during the FGDs and interview sessions. Finally, a brief questionnaire will be administered to participants to capture their socio-economic demographics and trial experience. Informed consent will be sought from study participants’ prior data collection. FGDs and interviews will be recorded and the audio files will be transcribed and translated into English. The transcripts from the in-depth interviews and FGDs will be coded by two analysts. This will be done by identifying themes and organizing them into the categories based on the tenets of grounded theory. Quantitative data will be analyzed using descriptive statistics. Limited data exists on individual views regarding PTA therefore the findings from this study will provide guidance in the implementation of PrEP services.

Nicole Overstreet, PhD

RETI, fellow

Assistant Professor
Clark University
Department of Psychology
Worcester, Massachusetts

Background
Dr. Nicole Overstreet received her PhD in social psychology from the University of Connecticut, where she was a NIMH-funded T32 pre-doctoral fellow in the Social Processes of HIV/AIDS Training Program. Currently, she is an Assistant Professor in the Department of Psychology at Clark University. Previously, she was a NIMH-funded T32 post-doctoral fellow at the Center for Interdisciplinary Research on AIDS, Yale University. Her program of research examines the intersection of intimate partner violence (IPV) and HIV risk in marginalized groups, with a particular focus on social factors that influence risk (e.g., stigma, prejudice, discrimination).

Dr. Overstreet’s recent work considers how stigmatizing experiences with IPV victimization influence HIV risk factors, negative self-appraisals, and negative affect. Her work also examines mechanisms linking IPV and HIV risk, including substance use and psychological distress (e.g., PTSD, depression). Dr. Overstreet’s short-term goal is to establish a strong methodological and ethical foundation to investigate the effect of IPV and stigma on HIV risk behavior, mental health, and utilization of support networks. Her long-term research plans include developing interventions to address IPV, stigma, and HIV risk among groups disproportionately affected by HIV and other STIs.

Mentored Research Project (MRP) Title
Assessing the role of stigma on women’s participation in and perceptions of intimate partner violence research

Abstract

African American women living with HIV who have experienced intimate partner violence (IPV) may experience multiple forms of stigma and discrimination related to their HIV status, experiences of IPV, race, and gender. Despite these experiences of intersectional stigma, few studies have explored whether living with multiple marginalized social identities elicits ethical concerns when participating in HIV research.

Alexis Roth, PhD, MPH

RETI, fellow

Assistant Professor

Drexel University
Dornsife School of Public Health
Philadelphia, Pennsylvania

Background
Dr. Alexis Roth pursued a PhD to address how individual and neighborhood-level factors contributing to disproportional rates of STI/HIV in urban settings. Over time, she became increasing interested in “mHealth research” as a mechanism for measuring event-level behavioral phenomenon and capturing information about high- and low-risk activity spaces. She completed a Predoctoral Research Fellowship sponsored by the Indiana University Purdue University Center for Urban Health to use smartphone-delivered digital diaries to measure how situational factors (e.g. drug craving; mood; relationship to sexual partner; day, time or location of sex) impact HIV risk among female sex workers.

In 2012, Dr. Roth began a NIDA-funded postdoctoral fellowship (T32 DA 023356) in the Division of Global Public Health (GPH) at the University of California San Diego (UCSD). At UCSD, her interest in mHealth research intensified as she began to consider how polydrug use impacts adherence to antiretroviral treatment (ART) among persons who inject drugs (PWID). In September 2014, she joined the Department of Community Health and Prevention at Drexel University as an Associate Professor. There her research will use daily diaries to unpack how drug use impacts HIV risk behaviors and anti-retroviral medication adherence over time. Findings will contribute to subsequent text messaging interventions that respond in real-time to identified antecedents of risk and non-adherence that may be amenable to intervention.

Mentored Research Project (MRP) Title

Ethical considerations for mHealth research with persons who inject drugs

Abstract
"mHealth” research refers to an emerging discipline that leverages the increasingly sophisticated capabilities of mobile communications technology for both measurement and intervention in health behavior research. mHealth is a new but growing field, it’s been approximately 5 years since the first mHealth randomized controlled trial, thus, a set of commonly agreed upon ethical standards for the use of these tools has yet to be established. Improving our understanding of the benefits and harms associated with involvement in mHealth studies, as well as concerns participants might have about privacy and data security, will be critical if mHealth research is to move forward. This project aims to draw upon participant perspectives to investigate ethical considerations for conducting one type of mHealth research, event-level monitoring of drug use via digital diaries entered on smartphones, to establish best-practice guidelines for researchers interested in using mHealth tools with drug using populations.

MRP Publications

AM Roth, J Rossi, JL Goldshear, Q Truong, RF Armenta, SE Lankenau, RS Garfein, & Janie Simmons. Potential Risks of mHealth Research: An exploration of perceptions among persons who inject drugs. Substance Use and Misuse. In Press.

Darpun Sachdev, MD

HIV Vaccine Fellow
San Francisco Department of Public Health

Background
Darpun Sachdev, MD is the HIV Vaccine Fellow at Bridge HIV and a post-doctoral research fellow at the Center for AIDS Prevention Studies at the University of California, San Francisco (UCSF). After receiving her MD at Brown University, she was a resident and Chief Resident in Internal Medicine at Mount Sinai Hospital in New York and completed her Infectious Disease Fellowship at Columbia University. She is a board certified internist and completed her specialty training in Infectious Disease. She sees patients at Ward 86 at San Francisco General Hospital.

Darpun’s research focuses on the epidemiologic and biologic risk factors for acquisition of HIV, and clinical trials of biomedical interventions to prevent HIV transmission. She is currently leading a quantitative study to evaluate preferences toward antiretroviral-based prevention strategies in Bronx, NY and a qualitative study to evaluate community and stakeholder perspectives toward standards of prevention care in HIV prevention trials. She recently completed a national survey to evaluate physicians’ willingness to prescribe oral and topical pre-exposure prophylaxis. At Bridge HIV, she provides scientific expertise and leadership to conduct Phase 1-3 HIV vaccine trials in San Francisco.

She plans to continue to focus on improving the design and delivery of HIV prevention modalities. Ultimately, she hopes to design combination HIV prevention trials that evaluate community-level impact and effectively utilize surrogate endpoints. Darpun will pursue a certificate in Advanced Training in Clinical Research at UCSF in her first year of training.

Mentored Research Project (MRP) Title
Fair Access to effective Interventions in Research trials (FAIR study): A qualitative study

Abstract
Determining the standard prevention in HIV‐related clinical trials has been a controversial and enduring ethical dilemma, as increasing levels of care for trial participants also increases the time and cost necessary to carry out a trial. HIV prevention trials must weigh the need for rigorously‐designed trials that enable sound scientific results with the obligation to provide appropriate benefits to trial participants. The FAIR study (Fair Access to effective Interventions in Research trials) is a qualitative three part study to understand the biostatistical, ethical and scientific considerations in determining if, when and how to incorporate a new prevention modality as part of the standard of prevention in biomedical prevention trials. To address this complex issue we will conduct semi‐structured interviews with biostatisticians to understand current and innovative clinical trial design approaches to address changing standards of care in HIV prevention. Next, we will interview bioethicists to understand how the ethical “threshold” to include a new standard of prevention is reached and what the ethical considerations are when implementing a new modality into an existing trial. Finally, we will interview principal investigators from vaccine, PrEP and microbicide trials to understand the scientific and practical implications of including new prevention modalities as part of the standard of care in clinical trials. Aim 1: Understand the biostatistical implications of incorporating new prevention modalities as part of the standard of prevention in biomedical HIV prevention trials. Aim 2: Understand the bioethical perspectives that guide the decision that an ethical “threshold” is reached and a moral obligation has been triggered to include a new prevention modality in a biomedical prevention trial. Aim 3: Understand how principal investigators approach the ethical and practical challenges of conducting biomedical prevention trials in a constantly evolving landscape of prevention modalities. To our knowledge, this would be the first study to systematically and critically analyze biostatistical, ethical and clinical perspectives on the tension of providing the best possible standard of care versus a ‘good enough’ package. These data will provide crucial information on how to address standard of care dilemmas and ethically design future multinational combination prevention trials.

Sean Young, PhD

Sean Young, HIV Fellow

Executive Director
University of California Institute for Prediction Technology
Los Angeles, California

Background
Dr. Sean D. Young is an Assistant Professor in the Department of Family Medicine and Center for Behavior and Addiction Medicine at UCLA. Dr. Young studies HIV prevention decision-making and testing behavior in the U.S., Peru, and South Africa. He also has conducted extensive user experience research and development, designing and evaluating social media and health behavior change methods and social media “apps” for HIV prevention, addiction medicine, and general health. He has spent the past 7 years studying the relationship between social media and HIV prevention/sexual risk behaviors among Los Angeles homeless youth, African American and Latino MSM, Peruvian MSM, and American and Iranian college undergraduates. He is the Primary Investigator of the HOPE UCLA study, the first intervention trial to assess whether social networking technologies can be used to deliver peer-led HIV prevention information to increase HIV testing among African American and Latino MSM. He is currently replicating this study among Peruvian MSM, in Lima, Peru. Dr. Young’s clinical work is focused on designing and evaluating engaging electronic platforms and medical decision-making tools.

Mentored Research Project (MRP) Title
Ethics and Social Networking for HIV Research

Abstract
In a number of studies, we have discovered ways that social networking technologies can be used for HIV prevention research. However, little work has been done to identify and to address potential ethical issues pertaining to participants’ experiences in these studies. It is important that we re-contact past participants to find out about their experiences in order to understand the ethical issues associated with social networking for HIV prevention research and how to design future studies that take into account these ethical challenges. Therefore, we propose a study to survey men who have sex with men (MSM) in Peru (greater Lima area) and Los Angeles (LA) who were participants in our prior studies on ethical-related issues based on their experiences in the HOPE studies, a social networking-based HIV prevention intervention in Los Angeles and Peru. The specific aims are to: Identify ethical-related concerns related to the recruitment process Hypothesis: We are able to contact participants to identify ethical-related concerns related to the recruitment process. Identify positive and negative deviations from expectations related to the consent process Hypothesis: Education level might impact the understanding of the consent material and the expectations of the intervention. Assess intervention and follow-up-related benefits and harms Information on benefits and harms during recruitment, intervention, and post-intervention will be collected.

MRP Publications
Chiu, C. J., Menacho, L., Fisher, C., & Young, S. D. (2015). Ethics Issues in Social Media–Based HIV Prevention in Low-and Middle-Income Countries. Cambridge Quarterly Health Care Ethics, 24(3) 303-310

Young, S., Chiu, C.J. & Menacho, L. (2015). "The Association Between Age and Ethics-Related Issues in Using Social Media for HIV Prevention in Peru". Ethics & Behavior.

Cohort 4 RETI Fellows (2014 - 2016)

Erin Bonar

RETI, fellow

Assistant Professor of Psychology
Addiction Research Center
University of Michigan
Ann Arbor, Michigan

Background
Dr. Erin E. Bonar received her PhD in Clinical Psychology at Bowling Green State University and completed an NIAAA T32 research fellowship at the University of Michigan Addiction Research Center. She is currently an Assistant Professor in the Department of Psychiatry at the University of Michigan. As a licensed clinical psychologist, she provides clinical care in the University of Michigan Addiction Treatment Service and teaches Motivational Interviewing to fellows in Addiction Psychiatry. Her research focuses on understanding and reducing substance use and concomitant risk behaviors (e.g., HIV risk behaviors) and related negative consequences for both individuals and communities. She received a NIDA K23 Career Development Award in 2013. Using mobile technologies, Dr. Bonar is studying the daily relationships between substance use and HIV-related sexual risk behaviors among at-risk emerging adults in a low resource community. The findings from this study will inform the development of an intervention for substance use and HIV risk behaviors in this population. Dr. Bonar also collaborates on a number of studies of adolescents and adults focused on improving care in substance abuse treatment centers as well as on identifying and screening for substance use among patients in a variety of healthcare settings.

Mentored Research Project (MRP) Title
The goal of this study is to understand perceptions of risks and benefits experienced by emerging adults who complete text message assessments of alcohol use, drug use, and sexual behavior in order to inform ethical procedures for future research using mHealth with this population. The population consists of 18-25 year-olds from an urban, low resource community who report using drugs and engaging in sexual risk behavior. At follow-up assessments, participants will complete tablet based surveys assessing domains of risks and benefits experienced during participation in a daily text message survey study. Relevance to HIV Prevention Research: mHealth is increasingly used in HIV prevention and substance use research, particularly with young people who are at high risk. The data can inform the appropriate delivery of informed consent and confidentiality protections in this type of research and will also be informative to IRBs that must make decisions about the risk level and perceived benefits of this type of research.

MRP Publications
Erin E. Bonar, Gerald P. Koocher, Matthew F. Benoit, R. Lorraine Collins, James A. Cranford & Maureen A. Walton (2017): Perceived Risks and Benefits in a Text Message Study of Substance Abuse and Sexual Behavior, Ethics & Behavior

Faith Fletcher

Faith Fletcher

Assistant Professor
Division of Community and Health Services
University of Illinois at Chicago

Background
Dr. Faith Fletcher is Assistant Professor in the Division of Community Health Sciences at the University of Illinois at Chicago School of Public Health and an Affiliate Member of the Chicago Developmental Center for AIDS Research (D-CFAR). Dr. Fletcher’s research program broadly addresses reproductive and cancer-related disparities among disadvantaged women living with HIV/AIDS. Her undergraduate exposure to health inequities through Tuskegee University’s National Center for Bioethics in Research and Health Care influenced her decision to pursue a career in health disparities research and promote social justice among underserved populations. She obtained a MA through Michigan State University’s interdisciplinary program in Bioethics, Humanities, and Society (2006) and PhD in Health Promotion, Education, and Behavior from the University of South Carolina’s Arnold School of Public Health (2011).

Dr. Fletcher completed a Postdoctoral Fellowship in the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center. Her National Cancer Institute R25T-funded study used combined qualitative and quantitative methods to explore barriers associated with cervical cancer screening utilization among HIV-positive women at an urban, comprehensive HIV clinic in Houston, Texas. Dr. Fletcher is a recent recipient of the Kaiser Permanent BURCH Minority Leadership Award Program which aims to enhance the voices and leadership development of minority researchers committed to improving service to the underserved and reducing health and healthcare inequalities. She is also a Building Interdisciplinary Careers in Women’s Health (BIRCWH) Associate and an Institute for Research on Race and Public Policy (IRRPP) Faculty Fellow at the University of Illinois at Chicago. Relevant training opportunities further position her to address health inequities among HIV-positive women through an enhanced interdisciplinary, translational research framework. Dr. Fletcher ultimately seeks to build a programmatic line of research that would engage innovative approaches to expand the provision of cancer preventive services in HIV clinic-based settings.

Mentored Research Project (MRP) Title
Perceptions of Facilitators and Barriers to Consenting Daughters Participation in HIV Prevention Research among African American Women Living with HIV/AIDS

Abstract
African American female youth are disproportionately impacted by STIs and HIV. Factors that may increase young women’s vulnerability to STIs and HIV acquisition include a lack of awareness regarding safe sexual practices, cultural and gender incapacity to insist on male partner condom use, biological development, psychosexual maturation, and socio-cultural factors. Thus, innovative methods are needed to thwart the negative effects of STIs, including HIV. One potential biomedical method to reduce HIV acquisition among uninfected populations is Pre-Exposure Prophylaxis (PrEP). PrEP is indicated in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 in adults at high risk. Despite studies demonstrating PrEP effectiveness with high risk populations, none of these studies have included adequate representation of youth, particularly African American female youth. General Objective: Given the disproportionate rates of STIs and HIV among African American female youth in general and their under-representation in PrEP clinical trials, the overall goal of this study is to assess perceptions of barriers and benefits to adolescent participation in PrEP clinical trials among African American women and their adolescent daughters. Methods: To understand perceptions of adolescent participation in PrEP clinical trials, For Our Daughters research study will be conducted. For Our Daughters presents a hypothetical PrEP clinical trial to African American women and their adolescent daughters followed by a series of focus group questions in Phase I and a cross-sectional survey administered in Phase II. Utilizing a convenience sample, women and daughters will be recruited from a two-armed randomized controlled trial (IMARA). Scientific Translation: Limited data exists on perceptions related to adolescent PrEP research study participation among African American women and their adolescent daughters. Therefore, study findings will inform future study design and participant protection procedures specific to African American female youth for PrEP clinical trials.

Julia Lechuga

RETI, fellow

Assistant Professor of Psychology
University of Texas at El Paso

Background
Dr. Julia Lechuga received her PhD from the University of Texas at El Paso in Health Psychology in 2008. In 2010, Dr. Lechuga was a finalist for the Harry and Pola Triandis Outstanding Dissertation Award from the International Association of Cross-Cultural Psychology (IACCP) and received an Honorable Mention. Dr. Lechuga completed a National Institutes of Health NRSA Ruth L. Kirschstein postdoctoral fellowship at the Medical College of Wisconsin in 2010. In 2010 she started a faculty position at MCW and in 2013 moved to The University of Texas at El Paso, where she currently is assistant professor. Dr. Lechuga's research focuses on the development, cultural adaptation, and dissemination and implementation of behavioral interventions to reduce the risk of infectious disease in ethnic minorities and vulnerable populations such as injection and non-injection drug users. In 2012, Dr. Lechuga received an NIH R21 to design a sexual and reproductive health behavioral intervention for mother-daughter dyads.

Mentored Research Project (MRP) Title

Benefits and barriers to continued HIV treatment for drug using individuals (largely crack cocaine) who have participated in an HIV intervention study in El Salvador

Abstract
There is limited research on the effectiveness of social network-based community-level HIV risk reduction behavioral interventions in non-injection drug users and the risks and benefits encountered. In addition, there is a dearth of research on participants’ expectations and motivations to participate. The purpose of the study will be to retrospectively assess the research experiences of crack users who took part in such an intervention. The goal will be to shed light on the motivations to participate, perceived drawbacks of participation, and behavior change intentions and perceived sustainability of behavior change. Participants will be recruited from a study currently evaluating the effectiveness of such intervention with crack users in San Salvador. We will conduct 80 quantitative surveys immediately post intervention and 20 in-depth interviews at one month post intervention. Findings will inform the development of guidelines to inform IRB decision-making regarding the risk/benefit ratio of participation in such interventions.

Abby Rudolph

RETI, fellow

Assistant Professor
Boston University School of Public Health
Department of Epidemiology
Boston, Massachusetts

Background
Dr. Abby E. Rudolph is an infectious disease epidemiologist at the Pacific Institute for Research and Evaluation (PIRE). She received her PhD from Johns Hopkins University Bloomberg School of Public Health and her MPH from Columbia University Mailman School of Public Health. Her research focuses on understanding how individual, environmental, and network factors act together to shape disease transmission dynamics, risk behaviors, and health service utilization among populations disproportionately burdened with HIV. Dr. Rudolph's publications cover a variety of topics including HIV and drug use-related stigmas, recruitment strategies for hidden populations, network, neighborhood, and spatial correlates of HIV and risk behaviors, pharmacy syringe access for people who inject drugs (PWID), and community-based participatory interventions to connect marginalized populations with health services.

She is currently the recipient of a Mentored Research Scientist Development Award from the National Institute on Drug Abuse (K01 DA033879A) that aims to better understand the independent and combined influence of sociometric network, spatial, and neighborhood factors on health-seeking and risk behaviors among PWID in Baltimore, MD. She is also Co-investigator on 1) R01HD077891 (PI: Stockman, J), which aims to evaluate the impact of the built and social environment on forced sex and, in turn, elucidate how forced sex and physiological factors influence behavioral mechanisms that increase risk for HIV acquisition among at-risk, HIV-negative African American women in Baltimore, MD and 2) R01DA035098 (PI: Pollini, RA), which aims to assess the implementation of Senate Bill 41 (passed on January 1, 2012 and designed to expand sterile syringe access by allowing California pharmacies to sell up to 30 syringes without a prescription) in two inland counties of California’s Central Valley.

Mentored Research Project (MRP) Title
Ethical Considerations for the Collection of Spatial Data for HIV Prevention Research among Illicit Drug Users

Abstract
GIS methods are used to identify health service deserts, evaluate associations between proximity to health services and their use, and link contextual factors with individual-level data. Current methods for collecting geographic information range from interviewer-administered surveys to geographical momentary assessments, which combine ecological momentary assessments with time-stamped GPS data. However, technological advancements for data collection have outpaced the development of ethical standards and guidance, particularly for research involving populations engaged in illicit and/or stigmatizing behaviors. The major goals of this project are to 1) describe the privacy and confidentiality concerns associated with different approaches used to collect geographic information from drug using populations in HIV-prevention and substance-use research and 2) assess how these concerns may influence the validity of participant responses.

MRP Publications
Rudolph AE, Bazzi AR, Fish S. (2016) Ethical considerations and potential threats to validity for three methods commonly used to collect geographic information in studies among people who use drugs. Addictive Behaviors. 61: 84-90.

Arunansu Talukdar

RETI, fellow

Associate Professor of Medicine
Medical College Kolkata, India

Background
Arunansu Talukdar started his professional career as physician and got involved in caring AIDS patients. Later he obtained his PhD in Epidemiology from School of Public Health at University of California Los Angeles in 2007, focusing on sexual risk behavior and STD/HIV scenario among homeless people in Kolkata, India. He has published several articles on association of circumcision and reduced HIV acquisition, inconsistent condom use and high prevalence of STDs among homeless people. He completed WHO Fellowship in 2011 and later published articles on coping strategy, quality of life among HIV infected people. After joining Medical College Kolkata, India, he conducted a course on research methodology in STD/HIV in collaboration with Washington University. He is now guiding five MD students who are conducting research on HIV prevention and care. He hopes to develop a training centre for health research for all categories of staff.

Mentored Research Project (MRP) Title
Study of voluntariness of consent to research for female participants in Clinic-Based Intervention Research in Kolkata, India

Abstract
A core ethical principal in research is voluntary participation. Voluntariness is ensured through the informed consent process, in which research participants receive detailed information about study procedures, risks, and benefits; are informed of their rights as research participants; and are given the opportunity to decide – without penalty or coercion – whether or not to participate in a research study. Unfortunately, there are at least two potentially significant barriers to this process, many of which are apparent in the developing world. First, literacy levels (both reading levels and levels of scientific literacy required to understand the research process) are often low among resource-limited groups, thus raising questions regarding the capacity of potential research participants to understand the informed consent process. Second, cultural barriers might impact the ability of an individual to provide informed consent. For example, the informed consent process assumes that an individual makes the decision of whether or not to participate in a research project. However, in many cultures important decisions are made by other family or community members, or are made collectively. While these decision-making processes reflect community norms, they are in direct conflict with the autonomy of potential research participants that is embedded in the informed consent process. These potential barriers to informed consent can be seen in the patient population at Medical College & Hospital, Kolkata, which is located in Kolkata, India. This hospital operates a large clinic for HIV+ patients, where clinical care (including antiretroviral medication, ART) is provided free of charge. Within the hospital, medical and social science research is regularly conducted, overseen by local and state internal review boards. A research project will be conducted soon on trial of cognitive behavior therapy (CBT) for non-ART adherent patients at ART centre in collaboration with Psychiatry department. Patients who enroll in this research project will first complete an informed consent process. This proposed study will assess the degree of voluntariness of this informed consent process prior to the initiation of CBT. A community advisory board will provide input on measures and research design. Semi-structured interviews will be conducted with 60 Bengali-speaking women who have provided informed consent but not yet begun therapy. Findings will be reviewed by focus groups of women, men and link workers to help contextualize results and make recommendations to improve the informed consent process for future research studies.

Thespina Yamanis

RETI, fellow

Assistant Professor
School of International Service
American University
Washington, D.C.

Background
Thespina "Nina" Yamanis' research interests lie in two primary areas: 1) understanding social and structural determinants of HIV risk for most at-risk populations; and 2) reaching these populations through place-based and social network approaches to sampling and intervention. She received her PhD in Health Behavior in 2009 from the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health. For her dissertation she lead qualitative and quantitative formative research studies on the social and sexual networks of high risk young men who socialize in "camps" in Dar es Salaam, Tanzania. Her published articles from this work demonstrate how characteristics of the social spaces and networks both protected and promoted HIV risk among the young men in Dar es Salaam, including engagement in concurrent sexual partnerships. This research was the basis for a current R01 trial in Tanzania on which she is a Co-Investigator.

The NIMH-funded trial is a multi-level intervention combining microfinance and health leadership with young men in camps to reduce their sexual risk behavior and perpetration of intimate partner violence. Dr. Yamanis' RETI project will add a study on the ethical dimensions of participation in this trial. Dr. Yamanis was a post-doctoral fellow at Duke University's Global Health Institute from 2009-2011 and published research empirically examining the recruitment bias in Respondent-Driven Sampling using data from female sex workers in China. She is currently an Assistant Professor in the School of International Service at American University (AU). Her new research work at AU involves exploring the dimensions of HIV risk for two highly vulnerable groups in Washington, DC: young Latino and adolescent Black men who have sex with men (MSM). She is broadly interested in how public health interventions for vulnerable populations can better address and harness social and structural factors to reduce risk.

Mentored Research Project (MRP) Title
Young men’s perspectives on the ethical issues of participating in a randomized controlled trial (RCT) to prevent HIV in Tanzania

Abstract
This study examines the ethics of involving social networks in HIV prevention interventions. Network interventions often train leaders to model health behaviors to members of their networks. Limited attention has been paid to ethical concerns associated with this approach, including: voluntariness (leaders may influence members’ decisions to participate); beneficence at the network level (network characteristics may change in harmful ways); and beneficence at the individual level (members may experience stigma and mistrust). We will explore these concerns during an ongoing HIV prevention trial (R01MH098690) with young men in Tanzania who socialize in networks known as “camps”. 60 camps with 1278 individuals are enrolled. Health leaders at 30 intervention camps deliver HIV prevention messages to members. I will quantitatively describe network changes from baseline to midpoint and use mixed methods to describe members’ perceptions of the intervention’s benefits and harms. The results will guide those interested in network-related HIV prevention research.

Cohort 5 RETI Fellows (2016 - 2018)

Roberto Abadie, PhD

Roberto Abadie

Postdoctoral Research Associate
University of Nebraska-Lincoln

Background
Dr. Roberto Abadie received his PhD from the Graduate Center (CUNY) in Anthropology in 2006. Dr Abadie has conducted research on a variety of topics related to health inequalities and risk, from the experiences of research subjects enrolled in Phase I and HIV clinical trials in Philadelphia, to the study of how breast cancer patients undergoing a non-diagnostic research biopsy understood the risks involved in the procedure. Currently, he is the senior ethnographer and fieldwork director of a multi-year NIH/HIDA R01 project “Injection Risk Networks in Rural Puerto Rico”. Before joining the University of Nebraska-Lincoln, he was a Postdoctoral Fellow at the Biomedical Ethics Program at the Mayo Clinic and a Research Associate at the Biomedical Ethics Unit at McGill University. He enjoyed his fifteen minutes of media attention from venues such as Times Magazine, BBC and The Guardian when his book “The Professional Guinea Pig: Big Pharma and the Risky World of Human Subjects” was published with Duke University Press.

Mentored Research Project (MRP) Title
Establishing Trust Among People Who Inject Drugs (PWID) Enrolled in a Community Health Study of Social Networks and Risk in Rural Puerto Rico

Current Project Description
Trust in Research is critical to advance HIV prevention particularly among People Who Inject Drugs (PWID) and other vulnerable populations, yet, empirical research on how to establish and maintain trust in the course of community health research is lacking. This project will (1) document how PWID perceive and understand research trust within the context of HIV epidemiological studies, and (2) develop recommendations to inform best research ethics practices that enhance research trust. This study will draw on perspectives of active PWIDs in rural Puerto Rico to document barriers and facilitators to research trust. Instead of assuming a shared definition of trust, this study investigates how participants themselves understand trust in research, as well as the factors that support or undermine it in the course of research. The study will be conducted among active PWID > 18 years of age, living in towns within rural Puerto Rico. Research Design: I will conduct up to 40 in depth semi structured interviews in order to document barriers and facilitators to establishing trust in research.

Suzanne Carlberg-Racich, MSPH, PhD

Suzanne Carlberg-Racich

Assistant Professor

Master of Public Health Program at DePaul University in Chicago

Background
The primary aim of Dr. Suzanne Carlberg-Racich's scholarly work is to investigate access to quality services to improve the health of disenfranchised populations, from a social justice framework. Within this aim, populations of particular focus include persons who inject drugs, persons living with HIV and Hepatitis C, and pregnant women who use substances. More specifically, her work examines the lived experiences of individuals who are systematically isolated by the intersection of stigma and policy that permeates health systems, social services, and broader society. She is motivated by community-based participatory research practices that maximize participant voice, agency, and partnership in the research process, and the use of research findings to advocate for community-defined change. Dr. Carlberg-Racich teaches courses across the MPH curriculum, including: Public Health Concepts and Practice, Health Behavior Theory, Maternal & Child Health, Public Health Program Evaluation, Public Health & High Risk Behavior, Substance Use & Abuse, and the MPH Capstone Seminar. In addition to her University work, she has been volunteering for the Chicago Recovery Alliance, a comprehensive harm reduction program in Chicago, for the past fifteen years. Prior to her work at DePaul, Dr. Carlberg-Racich spent twenty years as a public health practitioner focused on improving health outcomes at the community level, engaging in community outreach, creating and implementing targeted interventions, training clinical providers and social service practitioners, and evaluating public health programs.

Mentored Research Project (MRP) Title
Agency in Photovoice Research: Exploring the lived experience of persons who inject drugs

Current Project Description
Photovoice (Wang & Burris, 1997) is a method used to prompt critical consciousness about community issues through photography. Participants become partners in the process, making the method particularly empowering for disenfranchised communities. Persons who inject drugs (PWIDs) are systematically silenced from community advocacy processes due to stigma or fear of legal repercussions, and Photovoice may provide a vehicle for safe participation, particularly with IRB protections that may prompt the use of anonymous photography. However, little is known about the lived experience of PWIDs who participate in Photovoice. This study will explore the ethical implications of using Photovoice with PWIDs, through a Self-Determination Theory lens, examining the potential to increase perceptions of autonomy, competence, and relatedness. Findings from this study may inform future efforts to engage PWIDs in research that informs local policy, while also illuminating how IRB protections of safety may affect participant experience in partnership-based research efforts.

Alana Janell Gunn, PhD

gun

Assistant Professor
Department of Social Work in the College of Community and Public Affairs
Binghamton University
Binghamton, New York

Background
Before joining faculty in the fall of 2015, Dr. Alana Janell Gunn completed a NIDA funded T32 Postdoctoral Fellowship at the National Development and Research Institutes in New York City. Dr. Gunn has worked extensively with populations in jails and under correctional community-based supervision as well as with service agencies that support their community reintegration. Her program of research focuses on the ways in which multiple levels of stigmatization shape the health and well-being of women of color with intersecting experiences of incarceration and substance use disorders. She is currently a National Research Mentoring Network, Steps Towards Academic Research (STAR) Fellow, a grantsmanship and mentoring program administered through NIH’s National Institute on Minority Health and Health Disparities and a Faculty Affiliate at the NIAAA funded Developmental Alcohol Research Center. Dr. Gunn received a MPP from the Irving B. Harris School of Public Policy Studies, as well as an AM and PhD in Social Work from the School of Social Service Administration all from the University of Chicago. Dr. Gunn ultimately wants to develop a programmatic line of research that promotes culturally-responsive and trauma-sensitive interventions for marginalized women to reduce experiences of stigmatization and improve their sexual health.

Mentored Research Project (MRP) Title
Stigma and Ethical Concerns Related to Interviewing Women with Incarceration and Drug Use Experiences

Current Project Description
This proposed mentored research project will examine the multi-level stigma experiences and ethics-related perceptions of 25-30 women who identify as Black who have experiences of drug use and incarceration. This qualitative study will employ semi-structured interviews with a sample of women who have been recently released from criminal justice systems who are engaged in re-entry program in the city of Binghamton, New York. This research project aims to: 1) identify Black women’s concerns of the risks of to participating in research that examined their potentially stigmatizing experiences with drug use and incarceration 2) investigate their perceptions of the benefits of engaging in research related to their intersecting experiences and 3) explore the extent to which Black women’s sense of stigmatization may shape their emotional reaction to answering sensitive questions. With these aims, this study seeks to enhance interviewing processes with stigmatized population in efforts to increase trust, minimize harm in participation and inform IRB decision-making around issues of discomfort and distress.

Kimberly M. Nelson, MPH, PhD

Nelson

Assistant Professor of Psychiatry and Human Behavior
The Warren Alpert Medical School of Brown University,
Research Scientist in the Centers for Behavioral and Preventive Medicine at The Miriam Hospital
Providence, Rhode Island

Background
Dr. Nelson earned her MPH in epidemiology from the University of Washington (UW) and a PhD in clinical psychology also from UW. Following receipt of her doctoral degree in August 2014, she was awarded a NIMH-funded postdoctoral fellowship in child/adolescent bio-behavioral HIV research (PI: Brown, T32MH078788) at Rhode Island Hospital as a part of the Clinical Psychology Consortium Postdoctoral Training Program at Brown University. Having both a public health and psychology background, Dr. Nelson focuses on community- and population-level health implications while conducting individual-level behavioral research. Her research to date has primarily concentrated on psychological and structural factors associated with the transmission or acquisition of HIV among sexual and racial/ethnic minority populations, particularly among men who have sex with men (MSM). During her employment and graduate education she coordinated multiple NIH-funded HIV and substance use prevention trials targeting adult MSM (PI: Dilley, R01MH065138; PI: Dilley, R01MH073425; PI: Humfleet, P50DA009253) and conducted a two-phase, mixed-methods, NIMH-funded (F31MH088851) study on sexually explicit online media use and sexual risk-taking among adult MSM. Dr. Nelson’s current work focuses on media influences on risk behaviors among sexual minority adolescents. She is funded by a career development award from NIMH (K23MH109346) during which she will develop an online sexual health media literacy intervention to promote adolescent sexual minority males’ critical examination of online media and decrease their sexual risk-taking. Ultimately she hopes to develop HIV prevention interventions – using new and increasingly accessible and influential online media – to address disparities among sexual minority populations across key developmental periods.

Mentored Research Project (MRP) Title
Developing methods to promote the sexual health and protect the welfare of adolescent males who are interested in sex with males in the United States

Current Project Description
Young males who are interested in sex with males (YMSM) are in need of sexual health education programs that address male-male sexual behaviors and sexual health-related online media. Institutional review boards (IRBs) create barriers to YMSM-specific sexual health research when they overestimate the risks of participation and refuse to adequately consider the YMSM-unique risks surrounding guardian permission requirements. Two hundred 14-17 year old, cisgender YMSM from across the United States will be recruited for a cross-sectional online survey designed to inform a sexual health education intervention. Ethics questions will be imbedded in the survey to assess: (1) the extent to which questions related to sexual health education and online media meet IRB minimal risk criteria and (2) the degree to which guardian permission is a barrier to YMSM-specific sexual education research. Data will help investigators and IRBs develop methods that promote the sexual health and protect the welfare of YMSM.

H. Jonathon Rendina, MPH, PhD

Jonathon Rendina

Assistant Professor
Department of Psychology and Faculty Investigator,
Director of Quantitative Methods at The Center for HIV Educational Studies and Training (CHEST), CUNY
New York, NY

Background
Dr. H. Jonathon Rendina received his MPH in Biostatistics in 2013 from Hunter College, CUNY, and his PhD in Social Psychology in 2014 from The Graduate Center, CUNY. He completed his NIMH-funded NRSA pre-doctoral research training (F31-MH0958622) at Hunter College’s Center for HIV Educational Studies & Training (CHEST;www.chestnyc.org) and currently serves as a Research Scientist at CHEST. Dr. Rendina received a NIDA career development award (K01-DA039030) in 2015 to gain advanced training in neuroscience and behavioral intervention development. He is broadly interested in the role of social stress on health, and is currently pursuing research looking at how HIV-related stigma influences the mental, behavioral, and physical health of HIV-positive gay and bisexual men. Much of his research uses online-based methods, particularly intensive longitudinal designs such as ecological momentary assessment (EMA), and his ultimate goal is to develop and test a stress management/emotion regulation mobile health (i.e., mHealth) intervention. Through his role at CHEST, Dr. Rendina also collaborates on a wide variety of formative and intervention studies on primary and secondary HIV prevention (e.g., pre-exposure prophylaxis, HIV medication adherence) as well as substance use and treatment.

For Dr. Rendina's current research interests, please visit his CUNY faculty page.

Mentored Research Project (MRP) Title 
Examining Privacy Concerns and Trust in the Context of Online and Mobile Research with Men who have Sex with Men

Current Project Description
Despite increasing popularity of using online and mobile technologies to conduct research, little research has examined the ethical implications of integrating these technologies into research protocols. This study aims to: (1) test newly developed measures of privacy/confidentiality concerns and trust and to examine the overall patterns in levels of concern and trust; (2) explore sociodemographic and behavioral factors associated with privacy/confidentiality concerns and trust; and (3) test the hypothesis that providing the purpose for data collection/storage, anonymous sharing, and anonymous selling will decrease levels of privacy/confidentiality concerns. I will enroll a large national sample GBMSM across the U.S. through three online and mobile sources and ask them to complete a brief-one time survey on these topics. It is expected that these findings will be used to develop strategies to better guard participant privacy and confidentiality and improve research trust as well as to inform the development of collaborations between HIV researchers and owners of online and mobile technologies. Moreover, by providing participant perspectives on risk, this study is a critical step towards informing ethical decision making about mobile health research in which HIV prevention techniques are becoming more embedded within mobile app environments, blurring the lines between app use and research participation.

Cohort 6 RETI Fellows (2017 - 2019)

Stephanie Cook, DrPH

Cook

Assistant Professor
New York University

Background
Dr. Stephanie H. Cook is currently an Assistant Professor in the Departments of Biostatistics and Social and Behavioral Health at New York University's College of Global Public Health. She is also a Faculty Affiliate at the Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS).

Dr. Cook aims to understand the pathways and mechanisms linking attachment, minority stress, and health among disadvantaged individuals. In addition, she examines how the inter- and intra- personal features of close relationships influence the health of racial/ethnic and sexual minorities.Through her development of an integrated theory of adult attachment (i.e., the development, or lack, of strong socio-emotional bonds) and minority stress (i.e., social stress experienced by individuals in minority social groups), she seeks to better understand the poor health and HIV prevention needs of disadvantaged youth transitioning into adulthood. She then utilize this theoretical framework of attachment and minority stress to inform effective prevention programs for vulnerable racial/ethnic and sexual minority youth transitioning to adulthood.

As the Principal Investigator and Director of the Attachment and Health Disparities Research Lab, her team assesses the association of attachment-related functioning on health disparities among racial/ethnic and sexual minority youth. Dr. Cook is first exploring how adult attachment orientation is associated with HIV risk in a community sample of Black gay and bisexual men transitioning into adulthood. Second, she illustrates how transitions in attachment during adolescence are associated with trajectories of depression among a community based cohort sample of African-American youth. Third, she seeks to understand how adult attachment, in the context of minority stress, is associated with biomarkers of physical health.

Working Mentored Research Project (MRP) Title
Ethical Considerations in the Collection of Blood among Young Sexual Minority Men (YSMM)

Anthony Estreet, PhD

Estreet reti 1

Assistant Professor
Morgan State University

Background
Dr. Anthony Estreet is currently an Assistant Professor in the School of Social Work at Morgan State University. He received his Bachelor of Science Degree from Bowie State University in 2005, his Master of Social Work Degree from Virginia Commonwealth University in 2007, and his Doctor of Philosophy in Social Work from Morgan State University in 2012.

As a clinical social worker, Dr. Estreet works with urban communities through program evaluation, training, and capacity-building at the local and state level.
He is currently a national trainer for the Substance Abuse and Mental Health Services Administration’s (SAMHSA), Addiction Technology Transfer Center (ATTC) region 3 and provides ongoing training around evidence based interventions (motivation interviewing, clinical supervision, and screening, brief intervention, and referral to treatment (SBIRT)), addressing the opioid overdose epidemic, medication assisted treatment, cultural competence, and peer workforce development. Additionally, Dr. Estreet was responsible for development and implementation of the addictions training curriculum within the MSW program which serves to increase the knowledge and skills of emerging social work students. Dr. Estreet is the Co-PI of a HRSA Behavioral Health Workforce Enhancement and Training Grant and an ASCEND research grant that focuses on alcohol use and trauma among black youth.

As a social work researcher, he has primarily focused on applied/prevention research that addresses HIV/AIDS, substance use, and mental health issues among African Americans. He specializes in the design and evaluation of culturally sensitive and community based behavioral health interventions, including those focused on addressing treatment related outcomes. Dr. Estreet’s research focuses on understanding and reducing substance use and related negative consequences (e.g., HIV risk behaviors) among urban African American individuals and communities. His current research project focuses on improving medication adherence and retention among African American HIV positive substance users using a culturally adapted mHealth approach.

Working Mentored Research Project (MRP) Title
Examining barriers and facilitators to research participation among black HIV positive substance users

Rebecca Fielding-Miller, PhD

Fielding-Miller

Postdoctoral Fellow
University of California, San Diego

Background
Dr. Rebecca Fielding-Miller, MSPH is a Postdoctoral Fellow at UC San Diego in the Division of Global Public Health and the Center on Gender Equity and Health. Her research agenda addresses structural drivers of HIV and gender-based violence in the US and sub-Saharan Africa, particularly the intersection of race, gender, and economics. She holds a Master’s of Science in Public Health from the Johns Hopkins Bloomberg School of Public Health, and a PhD in Behavioral Sciences and Health Education from Emory University. She served as a Peace Corps Volunteer in South Africa from 2006-2008, and as a Fulbright Scholar in Swaziland in 2013.

Working Mentored Research Project (MRP) Title
Experiences of secondary trauma among study staff for HIV and GBV related research in low and middle-income countries

Adrian Guta, PhD

Guta

Assistant Professor
University of Windsor

Background
Dr. Adrian Guta received an MSW specializing in Diversity and Social Justice in 2007 from the Factor-Inwentash Faculty of Social Work, University of Toronto. He then received a PhD in Social and Behavioural Health Sciences in 2013 from the Dalla Lana School of Public Health, with a collaborative program in Bioethics from the Joint Centre for Bioethics, University of Toronto. Dr. Guta was awarded Canadian Institutes of Health Research (CIHR) postdoctoral fellowships at Carleton University (2013-2015) and then at the University of Ottawa (2015-2016) before taking an Associate Professor position at the School of Social Work, University of Windsor in 2016.

Dr. Guta’s research interests are in the areas of health equity, the social determinants of health, HIV prevention, treatment and care, substance use and harm reduction, bioethics, research ethics and public health ethics, discourse analysis, qualitative and mixed-methods, and community-based and participatory research approaches. Past work includes a national study of ethical issues in HIV community-based research in Canada. Currently, Dr. Guta is involved in a multi-study, federally funded program of community-based research which seeks to understand the health care needs of people living with HIV who are actively substance using (e.g., using illicit drugs or drinking hazardously) during hospital admissions. The goal of this research is to develop protocols to support patients to remain engaged in care (e.g., prescribing high-dose opiates to prevent withdrawal symptoms), reduce stigma towards people living with HIV who use substances, and better integrate harm reduction in hospitals.

Dr. Guta is also working on a project exploring clinical care providers understanding of what leads to disengagement from care for people living with HIV and a study on gay and bisexual men’s experience of accessing and using HIV oral pre-exposure prophylaxis (PrEP) in Toronto Canada. Finally, Dr. Guta serves as an Associate Editor for the Journal of Empirical Research on Human Research Ethics.

Working Mentored Research Project (MRP) Title
Community preferences for ethical conduct in research conducted in the context of harm reduction programs and services

Jesica Pagano-Therrien, PhD

Pagano-Therrien

Assistant Professor
University of Massachusetts

Background
Dr. Jesica Pagano-Therrien received her PhD in Nursing from the University of Massachusetts, Worcester, where she is now an Assistant Professor in the Graduate School of Nursing. Her doctoral dissertation, a qualitative study exploring research fatigue among youth and parents of youth with chronic health conditions, was inspired by her work as a pediatric nurse practitioner and research nurse. For over a decade, she has worked in the clinical setting with HIV-infected and HIV-at-risk children and adolescents. Her research identified factors that protect against research fatigue, including patient-provider trust. She is interested in the ethical challenges of the dual clinician-researcher role. Dr. Pagano-Therrien’s clinical practice in HIV prevention guides her research which will utilize simulation exercises for training clinician-researchers to conduct culturally appropriate discussions and informed consent procedures without bias among high risk adolescents and young adults.

Working Mentored Research Project (MRP) Title
Simulation-based, community-engaged research intervention for informed consent protocol testing and training: Part 2 (SCRIIPTT-2)

Elizabeth Pasipanodya, PhD

Elizabeth P.

Postdoctoral Scholar
University of California, San Diego 

Background
Dr. Elizabeth Pasipanodya received her Ph.D. in Clinical Psychology from the University of Delaware in 2016 and is currently a postdoctoral scholar in the HIV NeurobehavioralResearch Program (HNRP) at the University of California, San Diego (UCSD).Her research interests lie broadly in the promotion and maintenance of well-being in the midst of chronic illness.Much of her work at the HNRP is oriented towards studying factors related to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP)adherence among individuals at risk for nonadherence,with the goal of designing and implementing interventions to better support adherence. Motivated also by an interest in multilevel modeling and investigating within-person associations, Dr. Pasipanodya attempts to understand the intra-individual and temporal relationships that exist between substance use and ART adherence. She believes that focusing on such within-person processes may have greater clinical implications, as within-person linkages are more amenable to translation to strong clinical interventions.

Consequently, Dr. Pasipanodya is interested in the use of Just-In-Time interventions for medication adherence and relapse prevention. As a step in this direction, she was recently awarded a UCSD Frontiers of Innovation Scholar's Program (FISP) grant to engage in collaborative and interdisciplinary research to assess dynamic individual and contextual risk factors that may predict states of vulnerability during which a person is more likely to use methamphetamine and be ART nonadherent. Dr. Pasipanodya sees such work in identifying dynamic indicators of risk, so as to define windows of opportunity to intervene, as foundational to later work in developing adaptive interventions to support adherence.

Working Mentored Research Project (MRP) Title
Exploring the concerns of HIV-infected African-American and Hispanic adults with concomitant methamphetamine use (HIV+/METH+) on research using adaptive mobile interventions to support relapse prevention and ART adherence

Morgan Philbin, PhD

Philbin

Assistant Professor
Columbia University

Background
Dr. Morgan Philbin is a social and behavioral scientist whose work explores how social-structural factors impact health outcomes for vulnerable populations. She received her Masters of Health Sciences in International Health: Social and Behavioral Interventions (2007) and PhD in Health, Behavioral and Society (2013) from the Johns Hopkins Bloomberg School of Public Health. Dr. Philbin completed her postdoctoral fellow in the Division of Gender, Sexuality and Health (HIV Center for Clinical and Behavioral Studies) at Columbia University. She is currently an Assistant Professor in the Department of Sociomedical Sciences at the Columbia University Mailman School of Public Health. Her primary project is a NIDA-funded K01 that explores how state-level policies impact sexual health and substance use risk for sexual minority youth, and the factors that influence of the uptake of these policies; she is also leading an HIV Center funded pilot study that explores how state-level immigration policies influence health outcomes for Latinos. Dr. Philbin is currently a Co-Investigator on an NICHD-funded project through the Adolescent Trials Network that examines how HIV-infected youth transition to adult care; her previous work has explored factors that influence linkage to care and engagement in care for newly diagnosed HIV-positive adolescents.

Working Mentored Research Project (MRP) Title
HIV Prevention Intervention Involvement among young men who have sex with men (YMSM) of color: A qualitative exploration of how YMSM decide to participate and the benefits they expect to gain

John Sauceda, PhD

John S.

Assistant Professor
University of California, San Francisco

Background
Dr. John Sauceda received his MA in Clinical Psychology and PhD in Health Psychology from the University of Texas at El Paso (2013). After completing his doctoral training on the U.S.-Mexico Border, he completed both a postdoctoral fellowship (2016) at the Center for AIDS Prevention Studies (CAPS) and a MSc program in Global Health Sciences (2014) at the University of California, San Francisco (UCSF). He is currently an Assistant Professor at CAPS in the Department of Medicine at UCSF. Dr. Sauceda’s research is aimed at reducing health disparities and improving the mental health of Latino/a communities impacted by HIV. He has been supported by a NIMH predoctoral diversity supplement (R34MH084674-S1) and a T32 training grant (5-T32MH1910527). He has received a NIMHD LRP Award, a UCSF CFAR Pilot Grant, and a NIMH supplement for investigators developing independent research careers (3R01MH102198-03S2). He has also worked on a HRSA-funded multi-site initiative to develop and evaluate culturally-specific service delivery models focused on improving health outcomes among Latinos/as living with HIV.

Dr. Sauceda is currently conducting two qualitative studies to test the concept and dimensions of engagement in HIV care among Spanish and English-speaking Latinos in San Francisco, as well as the role that internalized study has on engagement in HIV care. He is also conducting a secondary retrospective analysis to model the trajectories of HIV treatment outcomes as a function of depression and substance use in a national cohort of Latinos in HIV care settings. His research aims to identify how culture and language affect one's ability to be fully engaged in HIV care and utilize mental health care; which can ultimately inform the development of adaptive treatment strategies to treat mental health problems and promote sustained engagement in HIV care.

Working Mentored Research Project (MRP) Title
The role of language and culture on concerns of confidentiality and appraisal of research risks and benefits among Latino/a and immigrant populations