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: 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.
Co-Investigator: April D. Kimmel, Ph.D.
Funding Source: NHLBI
Grant No. U01HL138682
The grant funds a community-based clinical trial designed to coordinate asthma care for elementary school aged children, factoring in their family, home, community and medical services. The study employs interventions that have been proven effective in other cities, but were customized to address the barriers and challenges faced by urban Richmond families of children with asthma. Children will participate for one year and outcomes will be assessed to determine the program’s impact. Partnerships with Richmond area organizations will help ensure the long-term sustainability of the program and its findings.
Co-Investigator: April D. Kimmel, Ph.D.
Funding Source: CDC
Grant No. U01CE002766
Youth violence is a major threat to the health and wellbeing of youths in the U.S. Our project focuses on Richmond, Virginia, a medium-sized city that is ravaged by violence and poverty. In 2014, the rate of homicide among youths was nearly four times the national average. Although prevention science has shown progress in identifying promising youth violence prevention programs that focus on the individual-, family-, or school-levels, progress on community-level interventions has been scarce. Our project involves the implementation of a community level approach employing the Communities That Care prevention system (CTC), enhanced with the Walker-Talker (WT) community outreach program (CTC PLUS). While the CTC builds and cultivates social capital through coalition building and identification and implementation of evidence-based youth violence programs, the WT model will increase community capacity and awareness to make full use of these resources. The overall goal of this project is to implement and evaluate the community-level impact of the CTC PLUS strategy within the context of a multiple-baseline design. Our specific objectives include: a) determine the effectiveness of CTC PLUS on primary youth violence outcomes (e.g., youth homicides and intentional injury rates), b) determine the extent to which CTC PLUS leads to proximal outcomes including decreased neighborhood disorganization, increased numbers of youth served by high quality, evidence-based violence prevention programs, and decreased risk and increased protective/promotive factors associated with youth violence, and c) understand the impact of CTC PLUS on aspects of neighborhood and community capacity associated with youth violence prevention. Three comparable communities will be randomly assigned to receive the intervention at different implementation starting dates. The intervention will begin in the first randomly selected community (Community A), while the other two communities (Communities B and C) serve as controls. The following year, the second randomly selected community (Community B) will begin the intervention (along with the first intervention community), while the third community serves as a control. In years 4 and 5, communities A and B will continue implementing the intervention. This design will provide adequate time (i.e., 3-4 years) for the intervention effect to emerge in Communities A and B. The third community (Community C) will receive training and technical support for implementing the intervention following the last wave of data collection in Year 5 (i.e., representing a no-intervention control community during this funding period). This randomization of multiple elements of the design (i.e., both the order in which the communities receive the intervention and the timing) strengthens this design considerably because it increases the number of possible assignments while maintaining the systematic staggering of the intervention introduction. This provides a basis for conducting parametric analyses and alternative analytic strategies that make fewer assumptions about the data. If proven effective, this innovative intervention will advance the science and practice of youth violence prevention and have significant public health implication.