The objective of this Mentored Research Scientist Development Award (K01) is to provide Dr. Angela Robertson Bazzi with the training, mentoring, research experience, and protected time needed to support her transition to research independence in the development of prevention interventions for marginalized populations affected by substance use. Training goals (TGs) include developing skills and expertise in intervention development (TG1), implementation science (TG2), research ethics (TG3), and professional development for a successful academic research career (TG4). Training will be accomplished through an intensive combination of formal structured courses, training workshops and institutes, directed readings, applied research experience, and interactions with experienced mentors who are renowned experts in intervention development, implementation science, substance use, and antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention. The overarching objective of the candidate?s research is to develop a community- based PrEP intervention for people who inject drugs (PWID). Although PrEP is recommended for HIV prevention among PWID, uptake in this high risk and socially marginalized population has been low, and acceptability and adherence challenges remain poorly understood. This revised proposal, which is guided by a model of healthcare utilization for vulnerable populations, a systematic approach to intervention development, and implementation science frameworks, will meet the following specific aims:
Aim 1 : identify the modifiable determinants of PrEP access and utilization among HIV-uninfected PWID (n=30) and key informants (n=15);
Aim 2 : develop a manualized intervention (TG1) to improve PrEP uptake and adherence among PWID attending a community-based syringe exchange program (SEP);
and Aim 3 : conduct a pilot randomized controlled trial (RCT) of the resulting SEP-based PrEP uptake and adherence intervention for PWID (n=50) with a mixed methods process evaluation focused on implementation outcomes (TG2). Despite the existence of effective HIV prevention strategies for PWID (e.g., access to sterile syringes through SEPs), the increasing prevalence of opioid misuse over the past decade is threatening past achievements in HIV prevention. The high proportion of U.S. PWID who report past-year receptive syringe sharing and/or condomless intercourse (77%) highlights a need for expanded delivery of PrEP, which is efficacious and recommended for HIV prevention among PWID. By situating this K01 on the Boston University Medical Campus, which is co-located with community-based health and social service organizations, the candidate will be able to access a large population of PWID and leading experts in intervention development and implementation science. While the proposed pilot trial may not be powered to detect changes in PrEP uptake or adherence outcomes, it will provide the necessary skills and preliminary data to determine intervention feasibility, maximize stakeholder acceptability, and infer effect size estimates and implementation aspects for a future full-scale R01 study.

Public Health Relevance

/ Public Health Relevance: Antiretroviral pre-exposure prophylaxis (PrEP) is efficacious and recommended for HIV prevention among people who inject drugs (PWID), yet uptake in this population has been low and acceptability and adherence challenges remain poorly understood. The proposed research will enable the candidate to identify and address barriers to PrEP uptake and adherence among PWID in the U.S. Northeast, where injection of opioids and related health harms are increasingly prevalent. Training in intervention development and implementation science will uniquely position the candidate to become an independent prevention scientist working to prevent HIV transmission in the context of substance use.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01DA043412-03
Application #
9665710
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Jenkins, Richard A
Project Start
2017-04-01
Project End
2022-03-31
Budget Start
2019-04-01
Budget End
2020-03-31
Support Year
3
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Boston University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Biello, K B; Bazzi, A R; Mimiaga, M J et al. (2018) Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs. Harm Reduct J 15:55
Drainoni, Mari-Lynn; Biancarelli, Dea L; Leech, Ashley A et al. (2018) Implementing a Pre-Exposure Prophylaxis Intervention for Safer Conception among HIV Serodiscordant Couples: Recommendations for Health Care Providers. J Health Dispar Res Pract 11:19-33
Gnatienko, Natalia; Wagman, Jennifer A; Cheng, Debbie M et al. (2018) Serodiscordant partnerships and opportunities for pre-exposure prophylaxis among partners of women and men living with HIV in St. Petersburg, Russia. PLoS One 13:e0207402
Bazzi, Angela; Saitz, Richard (2018) Screening for Unhealthy Alcohol Use. JAMA 320:1869-1871
Boehmer, Ulrike; Stokes, Jeffrey E; Bazzi, Angela R et al. (2018) Dyadic stress of breast cancer survivors and their caregivers: Are there differences by sexual orientation? Psychooncology 27:2389-2397
Bazzi, Angela R; Biancarelli, Dea L; Childs, Ellen et al. (2018) Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs. AIDS Patient Care STDS 32:529-537
Malone, Jowanna; Syvertsen, Jennifer L; Johnson, Blake E et al. (2018) Negotiating sexual safety in the era of biomedical HIV prevention: relationship dynamics among male couples using pre-exposure prophylaxis. Cult Health Sex 20:658-672
Bazzi, Angela Robertson; Yotebieng, Kelly A; Agot, Kawango et al. (2018) Perspectives on biomedical HIV prevention options among women who inject drugs in Kenya. AIDS Care 30:343-346
Bazzi, Angela R; Mogro-Wilson, Cristina; Negi, Nalini Junko et al. (2017) Developing scientists in Hispanic substance use and health disparities research through the creation of a national mentoring network. Mentor Tutoring 25:151-165
Bazzi, Angela R; Leech, Ashley A; Biancarelli, Dea L et al. (2017) Experiences Using Pre-Exposure Prophylaxis for Safer Conception Among HIV Serodiscordant Heterosexual Couples in the United States. AIDS Patient Care STDS 31:348-355