SATEI Projects
COMMUNITY-BASED INTERVENTIONS IN NORTH CAROLINA
Current Projects in North Carolina
Woman-Focused HIV Prevention of African-American Crack Users (PI: Wendee Wechsberg)
Women's CoOp I
Conducted from 1999 to 2002, this study compared a woman-focused HIV intervention for crack-abusing, African-American women in the Raleigh-Durham area with a revised NIDA (National Institute on Drug Abuse) standard intervention and a control group. All groups significantly reduced crack use and high-risk sex at each follow-up but only woman-focused intervention participants constantly improved housing and employment status (Wechsberg et al., 2004). Compared with control subjects at 6 months, woman-focused participants were the least likely to participate in unprotected sex; revised standard intervention women reported the greatest reduction in crack use. A woman-focused intervention can successfully reduce risk and facilitate employment and housing and may effectively reduce the frequency of unprotected sex in the longer term. This intervention was found to be a "best-evidence" HIV behavioral prevention intervention by the U.S. Centers for Disease Control and Prevention (CDC) (Lyles et al., 2007). Please see our "Best Evidence Woman-Focused HIV Prevention" brochure for more information about this study and its adaptations.
Women's CoOp II
Following the success of the first Women's CoOp study in Durham and Wake Counties, Dr. Wendee Wechsberg and the project staff began a follow-up study in March 2004. Sponsored by the original funder, NIDA, this study aims to determine the long-term effects of the original Women's CoOp and offer booster sessions for risk reduction. In this study, women were interviewed at intake and at 6-, 12-, and 18-month follow-ups. More than 460 women were re-recruited for this study. Currently, outcome and cost-effectiveness analyses are being conducted.
Collaborations
Dr. Kyla M. Kurian is currently working with Dr. Wechsberg to adapt the woman-focused intervention to African-American college women at a local historically black college and university (HBCU). Dr. Kurian can be reached at kkurian@nccu.edu.
Woman-Focused HIV Prevention with Pregnant African-Americans in Treatment (PI: Wendee Wechsberg)
This NIDA-funded study tested an adapted the Women's CoOp intervention with pregnant African-American women in substance abuse treatment in North Carolina. Data collection for the Pregnant Women's CoOp began in May 2007. This randomized controlled trial will allow us to determine whether our adapted intervention is effective in helping women to reduce their substance use and HIV risk behaviors to a greater extent than traditional substance abuse treatment options.
Young Women's CoOp: Adapting the Women's CoOp for At-Risk Teens (PI: Wendee Wechsberg)
Co-Op Study logo
Data from our Women's CoOp studies show that many African-American women in North Carolina are at risk for dropping out of school, using drugs, and becoming sexually active in their adolescence. For these reasons, the Young Women's CoOp study was proposed to target this population. The Young Women's CoOp is a 5-year study funded by the CDC that will adapt the Women's CoOp for at-risk African-American females between the ages of 16 and 18 in North Carolina. The adapted intervention will address knowledge of HIV and sexually transmitted infections (STIs), health consequences of substance use and abuse, building healthy relationships with male partners and females, condom negotiation and communication with partners, positive social supports, gang and violence prevention methods, and HIV, STI and pregnancy risk-reduction.
During the formative phase of the study, which is currently on-going, we are soliciting input from young women and other community stakeholders in Raleigh-Durham on how to adapt the woman-focused intervention to our target population. A Teen Advisory Board (TAB) has been convened to provide the study team with gender-, age- and cultural- specific information to adapt the intervention for African American teenage girls. In the RCT phase, which will begin in early 2009, we will conduct a randomized-controlled trial with 400 young women to test the effectiveness of the adapted intervention relative to an attention-control intervention.
Healthy "Little" Lives Project to Target Big/Little Sister Mentors (PI: Michelle Kaufman)
With funding from the UNC Center for AIDS Research (CFAR), Dr. Michelle Kaufman is collaborating with Big Brothers/Big Sisters of the Triangle to develop a training program for Big Sisters called the Healthy "Little" Lives Project. This program teaches Big Sisters how to communicate with their Little Sisters about sexual health issues such as delaying sexual debut, pregnancy, STIs and HIV. The Healthy "Little" Lives Project consist of 2 training sessions with small groups of Big Sisters (Bigs), as well as one session with their Little Sisters (Littles). The program will be pilot tested with 100 Big/Little Sister mentor matches.
Training program outcomes will be measured 3 months after the Bigs complete the training. Bigs will be evaluated on their self-efficacy and outcome expectancies for talking with their Littles about sexual issues and will report the number and quality of conversations. Littles will answer questions about how comfortable they feel talking to their Big about sexual health issues and questions about her own sexual behavior.
Adapting a “Best Evidence” HIV Prevention Intervention for Latinas (PI: Amy Hernandez)
To adapt the “best evidence” Women’s CoOp for Latinas, RTI will conduct three focus groups with staff from community-based organizations that work with Latinas in the Triangle (Raleigh, Durham and Carrboro). The objectives of the focus groups are: (1) to collect information on Latinas and the community-based organizations they frequent; and (2) to identify effective delivery mechanisms for an HIV prevention program for Latinas. Topics during the focus groups will include the specific STI/HIV risks and barriers to treatment Latinas face when attempting to access these services. Staff members from the organizations that serve Latinas will also be asked to discuss their insights into stigma, health and HIV related services and programs offered within their communities. Establishing new opportunities for collaboration with community-based organizations will aid in developing culturally-sensitive HIV prevention efforts for Latinas. This formative work will lay the groundwork for future prevention research with the Hispanic population in the Triangle.
Tailored Cue-Card-Driven HIV/STI Intervention for High-Risk Groups (PI: William Zule)
This 2-year pilot study is developing and testing a computer-assisted two-session intervention that will be tailored to the gender, race/ethnicity, drug use, and risk behaviors of each person that receives it. The intervention is designed for use in rural areas and resource-poor settings where it is not feasible to have specialized interventions for each risk group.
Completed Projects in North Carolina
The Initial Community-Based Study: NC CoOp (PI: Wendee Wechsberg)
The NC CoOp was one of 23 Cooperative Agreement (CA) sites funded by NIDA. The protocol for the CA required each site to develop a site-specific "enhanced" intervention and compare it with the NIDA standard intervention, which was similar across all 23 CA sites. The original protocol limited the percentage of non-injecting crack users in the sample at each site to 30%. Since the initial focus of the CA program was on injectors, the bulk of the NIDA standard intervention dealt with injection risk behaviors, and was not relevant to non-injecting crack users. As the CA program progressed, it became clear that crack users were also at risk for HIV and, in many sites, non-injectors far outnumbered injectors. Consequently, the protocol was modified to allow sites to enroll more non-injecting crack users, and the number of non-injecting crack users in the study eventually exceeded the number of injectors in many sites. The NIDA standard intervention was revised for the last six sites in the CA program to emphasize non-injecting drug use and sexual risk (Wechsberg et al., 1998).
Pretreatment of African-American Crack Abusers (PI: Wendee Wechsberg)
This study examined the effects of a pretreatment intervention designed to enhance treatment motivation, decrease crack use, and prepare crack abusers for treatment entry. Using street outreach, African-American crack users were recruited in North Carolina and randomly assigned to either the pretreatment intervention or the control group. At a 3-month follow-up, intervention group participants were more likely to have initiated treatment. No differences were found in treatment enrollment, however, suggesting that structural barriers remain a problem in accessing treatment.
Men's Attitudes on Sex and Health (MASH) Study (PI: William Zule)
MASH is part of a cooperative agreement funded by the CDC to pilot test interventions to reduce sexual risks for HIV transmission among gay and bisexual men who use methamphetamine. MASH is testing a single session intervention using motivational interviewing (MI), a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. MI has been used to treat a variety of substance use problems, including methamphetamine. More recently is has been used to reduce sexual risk behaviors.
Following a year of formative work with current and former methamphetamine users and service providers, the intervention was refined and pilot-tested with men in the Raleigh-Durham and Charlotte areas. Each participant was scheduled for a baseline visit (which included a computerized risk assessment and optional rapid HIV test), a separate MI session and a two-month follow-up visit. All field operations ended in August 2009 and funding ending September 30, 2009. A paper on the process used to develop the intervention is under review.
Rural Urban Health Study (PI: William Zule)
The Rural-Urban Health Study was one of four projects in the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATH-CAP), funded by the National Institute on Drug Abuse (NIDA). The primary objective of SATH-CAP was to examine the potential for the sexual transmission of HIV from traditional high-risk groups (e.g., drug users, men who have sex with men) to more general population groups. This study operated in two urban (Wake and Durham) and two rural (Chatham and Johnston) counties between 2005 and 2008. A total of 1985 participants were recruited using respondent driven sampling (RDS), interviewed about their risk behaviors and tested for HIV and other STIs. An additional 526 people participated in a site-specific social network study. Each SATH-CAP site also developed a mathematical model of HIV transmission within the geographical area. Results of SATH-CAP data will help elucidate how risk behaviors are shared within local networks, similarities and differences between rural and urban areas in North Carolina, the impact of different combinations of substances on risk-taking, and more. These findings will be used to develop effective behavioral HIV prevention interventions at the individual and network levels. Supplement 1 in the Journal of Urban Health published in July 2009 was entirely devoted to findings from SATH-CAP.
The Holloway Street CoOp (PI: William Zule)
The Holloway Street CoOp was a NIDA-funded intervention study that works with out-of-treatment injecting drug users in the Raleigh-Durham area. The primary objective of the study was to compare the effects of two different interventions -- a motivational intervention and an educational intervention -- to reduce behaviors that may lead to transmission or progression of HIV or the hepatitis C virus (HCV). The project ended in 2008, and has generated a number of findings, important to improving health within this group. Compared to the educational intervention, at 6-month follow-up, people who received the motivational intervention were significantly less likely to be drinking alcohol (Zule et al., 2009). This study also found that methamphetamine use by both sexual partners increased the likelihood of unprotected sex with a new partner, anal sex alone and vaginal and anal sex during the same encounter (Zule et al., 2007).
The NC Community Advisory Board
An important component of our projects in North Carolina is our NC Community Advisory Board (CAB), which has been in existence since 1995. The NC CAB comprises key service providers, academics, researchers and members of the target populations of our studies. The CAB also includes several members who do not work in HIV or substance abuse fields, ensuring a voice from the larger community. CAB members are involved throughout all stages of the research process and provide valuable perspective on community problems and concerns to ensure community support of our projects. Members also help identify vital community resources and services for participants in the community-based studies, and assist in the interpretation and dissemination of study findings. If you are interested in serving on our CAB, please contact Rachel Middlesteadt Ellerson at 919-541-7255 or rachelm@rti.org.
COMMUNITY-BASED INTERVENTIONS AROUND THE WORLD
Current Projects Around the World
Women's Health CoOp (WHC)-Pretoria (PI: Wendee Wechsberg)
This 5-year study funded by National Institute on Alcohol Abuse and Alcoholism (NIAAA) was conducted in collaboration with Sizanang Centre for Research and Development. The primary objective of this community-based study was to understand the relationship between alcohol and other drug use, violence against women, and HIV risk. WHC-Pretoria also examined whether a woman-focused intervention can help women not only reduce risks associated with HIV, but also address personal goals, such as homelessness and unemployment.
Study findings indicate significant reductions in substance use at 3- and 6-month follow-ups among study participants, including alcohol, dagga (marijuana) and crack cocaine. Participants who were taught condom negotiation and condom-use skills and showed a significant increase at the 6-month follow-up in the percentage who were using condoms with their main partner at last sex act, and in the past 90 days, even under the influence of drugs. Participants were also taught violence prevention strategies and showed a continued decrease at 3- and 6-month follow-ups in violence perpetrated by their main partners.
Western Cape Women's Health CoOp (PI: Wendee Wechsberg)
This community-based effectiveness study (2007-2012) builds on findings from our recently completed Cape Town Women's Health CoOp pilot study (2004-2006). The primary aim of the pilot study was to adapt a woman-focused HIV prevention intervention for substance-using Black and Coloured women. Findings from the pilot study indicated that study participants reported a reduction in their substance use, sexual risk behavior, and experiences with victimization at the 1-month follow-up assessment.
With funding from NICHD, the Western Cape Women's Health CoOp builds on findings from the Cape Town pilot study. In collaboration with the Medical Research Council (MRC) of South Africa, this study is designed to reach a larger sample of women via a full-scale study by adding a woman-focused intervention after voluntary counseling and testing (VCT).
The study is currently in the randomized controlled trial (RCT) phase. The primary aim of this study is to test the effectiveness, through a randomized controlled trial (RCT), of VCT plus a woman-focused intervention relative to VCT only to increase knowledge and skills to reduce substance abuse, sexual risk, and victimization, and to an equal-attention (nutrition) control group at 3-, 6-, 9-, and 12-month follow-ups.
Couples Health CoOp (PI: Wendee Wechsberg)
With funding from NIAAA, this five-year community randomized trial (2008-2013) will reach men and their female main partners in Cape Town communities to reduce sexual risk behaviors, substance use and violence. Men in this study will be recruited through drinking establishments located in randomly-selected neighborhood blocks identified through geographic information systems (GIS). Blocks will be randomized to one of three conditions to compare the relative efficacy of a comprehensive intervention to gender-focused interventions and HIV testing. In collaboration with the MRC of South Africa, this full study will incorporate individual assessments, HIV testing, and group interventions, all of which will be conducted in a mobile unit outside drinking venues.
Currently, this study is in its formative phase. The formative phase activities includes counting and classifying drinking venues and neighborhoods from our GIS mapping for the randomized group trial, and conducting focus group discussions and intervention pretests with men and women who have main partners. Based on the information collected during this phase, we will refine our interventions and study materials for the target populations.
The Role of Dead Space Syringes in HIV Transmission among Injection Drug Users (IDUs)
This is a 2-year project funded by the National Institute on Drug Abuse (NIDA) to collect ecological data on HIV prevalence among injecting drug users (IDUs) in cities in Europe and Asia. The project is also collecting data on the types of syringes (i.e. high dead-space or low dead-space) used by IDUs in each city to determine if there is a correlation between the HIV prevalence in a city and the type of syringes used by local IDUs.
The amount of blood retained in a syringe is of particular interest because of the potential probability of HIV transmission among IDUs who share syringes. Preliminary studies show that high dead-space syringes retain far more fluid than low dead-space syringes, potentially increasing the risk of HIV transmission between IDUs who share syringes. Infection modeling has been done to test the potential benefits of switching from high dead-space to low dead-space syringes (results published in the journal Drug and Alcohol Dependence, 2009). These models show that use and sharing of high dead-space syringes is positively associated with increased odds of HCV and HIV infection among IDUs who share syringes.
Completed Projects Around the World
Sunnyside/Pretoria Women's CoOp-Pretoria (PI: Wendee Wechsberg)
The purpose of this NIDA-funded study (2001-2003) was to determine whether an HIV prevention intervention designed for the United States could be adapted and translated for use with Black/African women sex workers in South Africa who abuse crack cocaine. Results showed that the woman-focused prevention program encouraged safer behaviors among the participants, including more frequent use of the female condom and a reduction in daily use of alcohol and crack cocaine. Furthermore, program participants reported being victimized less often, though violence continues to be a major problem in this area.
Cape Town Women's Health CoOp (Cape Town-WHC) (PI: Wendee Wechsberg)
With funding from NIDA and in collaboration with the MRC, RTI adapted the brief woman-focused HIV prevention intervention to Black/African and Coloured high-risk substance-using women in the Western Cape region of South Africa. This intervention was originally developed for crack-using women in the U.S., and later adapted for substance-using women in Pretoria, South Africa. Cape Town-WHC (2004-2006) evaluated the feasibility of abbreviating the original four-session intervention to a two-session individual intervention or a two-session group intervention. Preliminary study outcomes demonstrate a reduction in sexual risk behavior, substance use, and experiences with victimization. Findings also indicate commensurate levels of effectiveness in the group and individual formats.
Cape Town Youth Study/Cape Town Methamphetamine Supplement (PI: Wendee Wechsberg)
In collaboration with the Medical Research Council of South Africa and with sponsorship from NIDA, RTI conducted a survey among 13- to 20-year-old out-of-school females to examine the prevalence of methamphetamine use in poor Black townships and Coloured communities. The study (2005-2007) also assessed drug use and risk behaviors. This research is now being used to develop the Western Cape Women's Health CoOp.
Community Advisory Boards – Pretoria and Western Cape
In all regions of the world, we have Community Advisory Boards (CABs). Our active CAB is in the Western Cape and comprises representatives from the community, NGOs, government, and professionals. CAB members provide input and valuable support to help make our work more effective. CAB members also help to identify other resources and services for women who participate in our CoOp studies, identify gaps and/or difficulties in the project, and help with interpretation of findings. If you are interested in serving on our CAB, please contact Dr. Bronwyn Myers at Bronwyn.Myers@mrc.ac.za.
Women's CoOp - Russia: Adapting the Women's CoOp for Injecting Drug Using Women in Russia (PI: Wendee Wechsberg)
With our partners at the Leningrad Regional Center of Addictions, we pilot-tested an adaptation of the Women's CoOp HIV prevention intervention among female injecting drug users (IDUs) in St. Petersburg, Russia. To be eligible for the study, an individual had to: (a) be female, (b) have injected drugs in the past year, (c) currently be in substance abuse treatment, (d) be between the ages of 18 and 30 years old, (e) consent to participate in the study, and (f) provide locator information for follow-up assessment in the St. Petersburg area.
One hundred female IDUs were recruited for this study and randomized into one of two study groups, and received either the woman-focused intervention or a nutrition intervention (an attention-control). Ninety one percent of women completed the 3-month follow-up assessment.
The study data indicated a high level of HIV prevalence and use of dead-space syringes, with high frequency of injecting among participants. There was also evidence to support the Woman-Focused intervention with regard to reducing unprotected sex acts and always using clean injection equipment. In this pilot study harm reduction interventions were largely successful for the woman-focused group (e.g., clean injection practices and protected sex).
Assessment of HIV Risk Factors Among IDUs and MSM in the Republic of Georgia (PI: William Zule)
This study, funded by the Center for AIDS Research at UNC-Chapel Hill, examined drug use and HIV risks among injecting drug users (IDUs) and men who have sex with men (MSM) in Tbilisi, Georgia. Data were collected using focus groups, semi-structured qualitative interviews and quantitative social network interviews in 2006 and 2007.
Results of this study suggest that MSM in Tbilisi engage in high-risk sexual behaviors (including concurrent sexual partners, unprotected sex, and sex trading) that put them at risk of HIV and STIs. This is compounded by the environment of extreme intolerance, which often acts to promote risk behaviors and prevents monogamous, stable sexual relationships. The study also found there to be a population of bisexually active men, who have the potential to act as a bridge population and put far more people at risk for HIV infection. Based on these results, it is clear that HIV preventative interventions are necessary to encourage safe sexual practices in order to prevent an HIV epidemic seen in many other countries in the region.
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