Principal Investigator: April D. Kimmel, Ph.D.
Funding Source: National Institute on Minority Health and Health Disparities
While clinical care for HIV has made tremendous advances, the majority of persons living with HIV in the US do not receive the evidence-based care that will allow them to fully extend life and improve health. Lack of effective HIV care is particularly problematic in the Southern region, the epicenter of the US HIV epidemic and where poverty, uninsurance, rurality, and a constrained health workforce further threaten effective care. Research suggests that system-level factors, or the structural and policy-related aspects of health care delivery, have the potential to improve quality of care and health outcomes. But little is known about their role in the context of HIV care delivery, quality of care, and health outcomes. The proposed research will study how two modifiable system-level factors—geographic accessibility to care and physician payment policies—affect quality of HIV care and population outcomes, including new HIV infections, along the HIV care continuum in the US South. Because racial and ethnic minorities face increased barriers to HIV care, we pay special attention to how these system-level factors may contribute to disparities in quality of HIV care and population outcomes along the HIV care continuum. The research involves developing a novel database that combines multiple data sources, including Medicaid administrative claims files, HIV surveillance data, and county and state characteristics from national datasets. Our approach will rely on state-of-the-art spatial network analysis and data visualization (mapping), statistical tests using econometric methods, and systems science forecasting techniques that have been used to study quality of care and population health outcomes. The work moves beyond examination of core quality of HIV care measures to include HIV-related preventive care measures that collectively are critical to reducing HIV morbidity and mortality. In investigating these factors, the study will answer a number of important questions. How do geographic accessibility, measured in travel time to receive care, and physician payment for services affect quality of HIV care in the South? Are these effects different among racial and ethnic minorities? Do improvements in geographic accessibility or increased physician payments reduce new HIV infections and racial and ethnic disparities along the HIV care continuum? The proposed study will address these questions and others. By quantifying the role of system-level factors in quality of HIV care and population health along the HIV care continuum, as well as understanding disparities in these effects, the research will provide valuable information to state and federal policy makers who seek to address systemic challenges to effective HIV care, efficiently allocate scarce resources, and improve public health.
Site Principal Investigator: April D. Kimmel, Ph.D.
Funding Source: National Institutes of Health: National Cancer Institute, National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Institute on Drug Abuse.
Elimination of HIV infection as a cause of human illness and death, and achieving "zero HIV transmission" have been embraced by the AIDS research and treatment communities as achievable. As HIV care and treatment programs are implemented throughout Africa, critical advances in research and policy are needed, so that care and treatment resources can be deployed to optimal benefit: decreasing both new HIV transmissions and HIV-related morbidity and mortality. Among the most important challenges to maximizing the public health benefits of HIV care and treatment programs are late diagnosis of HIV-infection, low rates of linkage to care, and high rates of late ART initiation which in turn ar associated with high rates of mortality, more costly clinical management and continued HIV transmission. In addition there remain unanswered clinical questions for persons living with HIV (PLWH) even with optimal ART. For PLWH in SubSaharan Africa (SSA), ART has been highly effective in decreasing HIV-related morbidity (and mortality), but the association of HIV with metabolic diseases and other conditions of aging (e.g. cancers), and the impact of under- or over-nutrition are not well defined. Newly funded as CA-IeDEA four years ago, we have built a new Central Africa IeDEA (CA- IeDEA), and have 1.) Compiled and managed secondary source patient-level data on ~52,000 patients through both extraction from existing electronic data and new on-the-ground systems for efficient capture of clinical data in low-resource clinical settings; 2.) Been highly productive scientifically with >20 publications even while data collection was in development, and 3.) have continued to foster African leadership and build local research capacity. We propose now to increase the database modestly (to ~80,000 patients) to increase the representativeness of HIV in the region geographically and in service delivery strategies and success and to expand our implementation science approaches to optimize short- and long-term HIV care outcomes both in Central Africa and globally, continue to investigate epidemiologic questions with clinical impact, with a focus on the comorbidities of aging and women's reproductive health.
Principal Investigator: Richard Brown, Ph.D.
Funding Source: American Cancer Society Research Scholar Grant
The purpose of this study is to demonstrate the efficacy of an established method, tailored health messaging, to aid African American (AA) cancer patients’ decision-making about joining a therapeutic clinical trial. This study moves the field forward as it is the first to utilize tailored heath messages to directly intervene in the physician – AA patient clinical trial consultation communication process to increase patient activation in the consultation and thus, potentially improve a range of relevant patient outcomes associated with AA barriers to accrual. We propose to conduct a randomized controlled trial to assess the differential impact on consultation communication of two different levels of tailored messages, (deep vs shallow tailoring) and the additional impact of either providing or not providing the patient’s oncologist with a summary of the tailored messages prior to the trial consultation.
Principal Investigator: Andrew J. Barnes, Ph.D.
Funding Source: National Cancer Institute Grant No. 1UG1CA189869-01
Massey Cancer Center (MCC) will serve as the primary component site for an NCORP Minority/Underserved Community Site award in partnership with nine collaborating community component sites. The overall objectives of this partnership are to extend novel, innovative, and effective minority recruitment approaches to an expanded base of community component sites, increase opportunities for minority and medically underserved individuals to participate in Cancer Clinical Trial Research (CCTR), and to integrate Cancer Care Delivery Research (CCDR) into the overall MB-NCORP. Accordingly, the specific aims of this proposal are to (1) establish a research infrastructure that will further enable community component sites to conduct CCTR with an emphasis on trials relevant to minority and medically underserved populations, (2) conduct NCI-approved CCTR at the MCC primary component site and throughout the community component sites, and (3) integrate Cancer Care Delivery Research (CCDR) into the overall MB-NCORP.
The research design of the MB-NCORP offers a full menu of cancer studies including those in cancer prevention and control, screening, treatment, imaging, and CCDR. The proposed research is relevant to the mission of the NCI as MCC and the community component sites will bring cancer clinical trials and research to low-income, minority, and medically underserved individuals who otherwise would not have access to such studies. These studies will address many diverse factors from patient, provider, organizational, and policy perspectives that contribute to known disparities in cancer detection, treatment, and outcomes. Targeting the minority/underserved populations in their communities is a critical step toward alleviating the cancer care disparities prevalent in these populations.
Co-Investigator: Jessica LaRose, Ph.D.
Funding Source: National Institutes of Health
There is an urgent need for innovative approaches to obesity prevention and treatment, particularly among African Americans (AA), a population at increased risk of obesity and its associated morbidity and mortality. Research and clinical practice guidelines consistently recommend that parents should be included in their children’s obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment is unclear. The adolescent period presents substantial challenges to family-based care, as youth experience increased desire for independence and autonomy, contributing to resistance to authority figures; yet they still rely on parents for many needs. Given these challenges, it is not surprising that research investigating specific clinical paradigms for involving parents in adolescent obesity treatments is inconsistent. To that end, the current application pilots two distinct approaches for involving parents in their adolescents’ obesity treatment. TEENS (Teaching, Encouragement, Exercise, Nutrition, Support) is a family-based, multidisciplinary behavioral treatment program targeting primarily AA, obese adolescents. This investigative team previously demonstrated that participation in the TEENS intervention is associated with significant reductions in body mass index (BMI) at 6 months. In TEENS, parents were included in monthly groups to support their adolescent’s weight management. Although parent weight was not targeted, a significant correlation between parent and adolescent BMI change was found. These findings highlight the importance of parental involvement and suggest that parent weight management might be an important intervention target. Indeed, directly targeting parent weight loss within adolescent treatment might be associated with even greater adolescent BMI reductions, as parents engaged in concurrent weight management might make greater changes to the shared environment and serve as powerful role models, given their common goals. Towards that end and building on our previous work, we developed TEENS+, a family-based adolescent obesity intervention. This application proposes a randomized controlled pilot to determine the feasibility and preliminary efficacy of two parent treatments within TEENS+ among 96 overweight or obese adolescents (BMI>85th percentile) and parent(s) (BMI>25 kg/m2). Families will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child’s weight management, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments will be completed at 0, 4, and 7 months. Results of this investigation will inform a subsequent larger trial investigating the role of parents in adolescent obesity treatment, targeting predominately African American families.
Principal Investigator: Maria Thomson, Ph.D.
Funding Source: National Institutes of Health/National Cancer Institute
This study will examine whether families and patients with blood cancers communicate well with each other about treatment and care decisions. These cancers can disrupt patient and caregivers’ lives and can cause patients and caregivers stress and make it difficult from them to continue to work or meet their family obligations. This study will examine whether and how their communication is associated with these outcomes and how we can intervene in the future to improve their quality of life and is important because a growing number of people are affected by these diseases, many of whom are working age adults.
Co-Director of Research and Evaluation: Kellie E. Carlyle, Ph.D., M.P.H.
Funding Source: Community-Engagement Grant and Avon Foundation
Principal Investigator: Maghboeba Mosavel, Ph.D.
Funding Source: DentaQuest Foundation/Fiscal Agent Pathways
The DentaQuest Foundation funded the Petersburg Wellness Consortium (Team Lead: Dr. Mosavel) to explore the oral health landscape in Petersburg using various community engaged research strategies. The Foundation’s current campaign – Oral Health 2020 – is mobilizing a national network across the grassroots, grassmiddles and grasstops to increase awareness of health equity and racial justice in the understanding of oral health disparities. The PWC and VCU will conduct community engaged research to assess how 1) oral health can be integrated into education and other services, 2) to optimize oral health literacy, 3) to build a strong community prevention and care infrastructure. Laypersons will be engaged in all aspects of the research.
Principal Investigator: Vanessa B. Sheppard, Ph.D.
Funding source: NIH / Georgetown University
Grant No. R21NR016905
Abstract BRCA1/2 mutation carriers are at higher risk of developing breast and ovarian cancer (HBOC). Breast cancer survivors with a BRCA1/2 mutation are at higher risk of developing contralateral breast cancer. Genetic cancer risk assessments (GCRA) for HBOC can inform prevention and treatment decisions. Despite guidelines to refer women at risk of carrying a mutation to GCRA, Latina and Black women underuse these services. Reasons for low GCRA use include access and psychosocial factors (e.g. low knowledge). Our preliminary data with at-risk Black and Latina women suggests that improving access does not necessarily translate into higher GCRA uptake. Theoretically guided interventions that support GCRA uptake in underserved populations are needed. Fuzzy Trace Theory posits that people tend to construct gist representations that capture the essential bottom-line meaning of the risk information, including the emotional experience. However, most interventions tend to prioritize quantitative risk communication and do not often consider emotional aspects, despite evidence that emotions influence risk perceptions. BRCA-gist is an Intelligent Tutoring System intervention informed by Fuzzy Trace Theory that uses avatars to emulate tailored one-to-one human tutoring and includes the HBOC risk messages’ bottom-line meaning. The preliminary efficacy of BRCA-gist has been established in a non-clinical sample of mostly White college students but has not been tested in at-risk women. This study aims to adapt BRCA-gist and test its feasibility, acceptability, and efficacy in a sample of at-risk Black and Latina women. In Aim 1 we will gather input from providers (n=10) about adaptations for implementation in clinical settings and from at-risk Latina and Black women (n=20) about cultural adaptations. In Aim 2 we will randomize at-risk Black and Latina women to BRCA-gist (n=50) or NCI Web arms (n=50). Participants will complete a baseline and a post- intervention assessment. A research assistant will refer them to local free genetic counseling services. Our primary outcome is GCRA uptake at 3 months. Aim 1: Adapt BRCA-gist. Providers and at-risk Black and Latina women will do the BRCA-gist intervention and provide suggestions to make cultural adaptations to implement BRCA-gist in community/clinic settings. Aim 2: Test the feasibility, acceptability, and efficacy of BRCA-gist intervention in a two-arm RCT. We expect high overall retention (≥75%) and high satisfaction among women in the BRCA-gist arm (≥75%) (H.2.1., H.2.2). H.2.3. Participants in the BRCA-gist arm (vs. NCI Web) will have a higher uptake of GCRA services 3 months post intervention. H.2.4. Participants in the BRCA-gist arm (vs. NCI Web) will have a greater increase in knowledge, gist comprehension, and GCRA intentions. We will explore differences by ethnicity and health literacy and assess emotional reactions to risk information to inform future affective-tailored interventions. If successful, BRCA-gist can be tested in larger samples and could constitute a scalable inexpensive intervention with promising translational applications and potential to reduce disparities.
Principal Investigator: Kim, Sun Jung "Sunny"
Funding Source: NCI/Dartmouth
Grant No. :P30CA23108
Investigator Sun Jung Kim, PhD (“Sunny”) at Virginia Commonwealth University will undertake online recruitment, online surveys, data analysis, and reporting. She will be involved in all aspects of the project as currently approved by CPHS. The Dartmouth team will be submitting a modification to add in-person focus groups in NH and VT; Dr. Kim will not be involved with recruitment or the moderation for those focus groups. Her involvement with those focus groups will be limited to data analysis and reporting.
Principal Investigator: Bernard Fuemmeler, Ph.D.
Funding Source: NCI
Grant No.: 2T32CA093423-11
This application seeks continued support for the Training Program in Behavioral and Health Services Cancer Control Research (application # R25 CA093423-06A1) from the National Cancer Institute T32 mechanism. This Training Program is located within the Massey Cancer Center (MCC) of Virginia Commonwealth University (VCU) and provides transdisciplinary training for predoctoral and postdoctoral candidates in cancer prevention and control research. The overall goal of this training program is to provide an environment that encourages the development of cancer prevention and control research at the highest levels. Training is targeted to individuals in the social sciences (psychology, sociology, economics, anthropology), public health, biostatistics, and those who have completed their clinical requirements for specialty training in medicine and nursing. To accomplish this goal, a training program has been structured to foster transdisciplinary research - a precondition to conducting research in this field. The predoctoral training component aims to recruit one potential future investigators to this research area at the earliest time in their careers. This is important if we are to speed up the development of focused cancer prevention and control research by creating a cadre of students who are focused on this research area at the outset of their research training. The flexible 2 year postdoctoral training component helps guide young investigators to this field of study and provides them with integrated but focused training to conduct fundamental and interventional studies in cancer prevention and control. This program will specifically and especially foster research that contributes to the understanding of the production of health disparities in cancer outcomes. VCU is uniquely positioned to provide this training because of its role as a safety net hospital, the population it serves, and its standing as an NCI- designated cancer center. The goal of this program is to train the next generation of cancer prevention and control researchers. To accomplish this goal we will do the following: 1) Offer a multidisciplinary integrated research training program with a broad range of research opportunities; 2) Meet the needs for training in emerging research areas in cancer prevention and control; 3) Provide training to researchers from diverse academic and ethnic backgrounds and intensive mentoring; 4) Provide a specialized curriculum that coalesces cancer control strengths at our institution.