Friends Community Center

Research Projects

Ecological Momentary Assessments with/without a Counselor to Optimize Methamphetamine Treatment Outcomes among Gay and Bisexual Men

Principal Investigator: Mary Jane Rotheram-Borus, Ph.D.
(UCLA Department of Psychiatry and Biobehavioral Sciences)
Co-Investigator: Cathy J. Reback, Ph.D.
Co-Investigator: Dallas Swendeman, Ph.D.
(UCLA Semel Institute for Neurosciences and Human Behavior)
Funded by: National Institute on Mental Health
Grant Number: P 30 MH 58107
Total Project Period: 7/13 – 6/14

This study will evaluate pilot data on the use of Ecological Momentary Assessment (EMA) for optimizing treatment outcomes among gay and bisexual men enrolled in the Friends Getting Off (FGO) outpatient methamphetamine abuse treatment service program at Friends Community Center, a division of Friends Research Institute. The EMA surveys consists of five (5) surveys per day covering the following domains: 1) external triggers, 2) internal triggers/affect, 3) substance use cravings and substance use, 4) sexual behaviors; and, if appropriate, 5) medication adherence. EMA surveys will assess external triggers, internal triggers/affect, and substance use cravings and substance use in the past 3 hours; whereas, sexual behaviors and, if appropriate, medication adherence will be assessed in the past 24 hours. This study will examine the feasibility, acceptability, and potential utility of EMA using cell phones and an open-source mobile health application platform, along with an EMA visualization dashboard on a secure website, and comparing self-utilization of the dashboard to brief weekly discussions of the dashboard with a counselor. The specific aims of this study are: 1) To assess the feasibility, acceptability and utility of EMA self-monitoring surveys using a cell phone application along with a web-based EMA visualization dashboard among FGO participants; 2) Compare the effects of “EMA + Dashboard” versus “EMA + Dashboard + Counselor” for optimizing methamphetamine abuse treatment outcomes among FGO participants; and, 3) Compare the effects of an EMA intervention (both “EMA + Dashboard” and “EMA + Dashboard + Counselor”) versus Treatment As Usual (TAS) for reducing methamphetamine use and HIV sexual risk behaviors, using historical records from 60 matched FGO participants. Assessments are conducted at baseline, 8-week (treatment completion), and 3-month post-enrollment.

Enhancing Linkages to and Retention in HIV Primary Care for Transgender Women of Color (lay title: The Alexis Project)

Principal Investigator: Cathy J. Reback, Ph.D.
Project Director: Kimberly Kisler, Ph.D.
Funded by: Health Resources and Service Administration
Grant Number: H97HA24968
Total Project Period: 9/12 – 8/17

Transgender women (“transwomen”) of color experience a number of psychosocial challenges including discrimination, prejudice, stigmatization, and social/economic marginalization, which stand as obstacle to HIV care and other needed services. The Alexis Project will incorporate three proven models, Social Network Recruitment (network), Peer Health Navigation (individual) and Contingency Management (structural), into one multi-leveled project to identify, recruit, test, link, treat and retain transwomen of color into quality HIV care (N=140). Through Social Network Recruitment, local transwomen will recruit transwomen of color from their social, sexual and drug-using networks into the project for either testing (HIV unknown status) or (for those who are aware of their HIV infection but not in care) to the combined Peer Health Navigation and Contingency Management intervention. Peer Health Navigators will work with participants to identify HIV care services and other needed services, develop a specific client-centered treatment plans, remove barriers to those services and access those services. Contingency Management will provide increasing valuable incentives for attending HIV medical visits and reaching and sustaining HIV milestones. This multi-tiered, comprehensive approach will serve to optimize HIV health outcomes for transwomen of color. The Alexis Project is named after Alexis Rivera who died on March 28, 2012, – while the grant application was in development – at the age of 34, from complications related to HIV. Alexis was a proud Latina transwoman; a community activist, a peer advocate and a gatekeeper. When she was just 20 years old, Alexis worked with Dr. Reback as a community outreach worker targeting and reaching high-risk transwomen. Assessments are conducted at baseline, 6-, 12-month, and 18-month post-enrollment.

HBV Prevention for Homeless At Risk for HBV/HCV/HIV (Hep-Safe Hollywood)

Principal Investigator: Adeline Nyamathi, Ph.D., ANP (UCLA School of Nursing)
Co-Investigator: Cathy J. Reback, Ph.D.
Program Coordinator: Katie Branson, M.P.H.
Funded by: National Institute on Drug Abuse
Grant Number: 2R01 DA016147
Total Project Period: 4/09-3/14

Homeless, stimulant-using gay/bisexual men and transgender women are at high risk for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection due to high rates of injection drug use and high-risk sexual behaviors. Thus, use of stimulants threatens to intensify homeless persons’ risk of exposure to hepatitis B, C viruses and HIV; therefore, research focused on this group is critical. A contingency management (CM) intervention may be particularly well suited for this high-risk population. CM is an intervention that attempts to modify a targeted behavior by providing incentives for changing that behavior (in simple terms, positive reinforcement). The Hep-Safe Hollywood study implements a CM intervention to increase successful HAV/HBV vaccination completion program among homeless, stimulant-using gay/bisexual men and transgender in Hollywood. This randomized, control trial will assign 500 homeless, stimulant-using gay and bisexual men to either an enhanced nurse case managed program, which includes specialized education and CM, or a standard program, which includes brief education and CM. The study will evaluate the effectiveness of homeless, stimulant-using gay/bisexual men and transgender women on completion of the HAV/HBV vaccine and, secondarily, on reduction of risk for hepatitis and HIV. Additionally, the study will assess the relative cost of these programs in terms of completion of the vaccine series. The study combines best strategies to approach, engage and intervene with this hidden and high-risk population and to assess the feasibility and efficacy of interventions that may prove beneficial in preventing hepatitis A, B, C and HIV infections.

Mobile App Targeting Meth Use, HIV Sex Risks & ART Adherence for Gay/Bisexual Men

Principal Investigator: Cathy J. Reback, Ph.D.
Project Director: Jesse Fletcher, Ph.D.
Funded by: National Institute on Drug Abuse
Grant Number: 1R41DA036438
Total Project Period: 9/13 – 8/14

HIV prevalence is significantly higher among men who have sex with men (MSM) who report frequent use of methamphetamine and highest among those meeting diagnostic criteria for methamphetamine dependence. Methamphetamine use among MSM is deeply integrated into socio-sexual networks including digital spaces such as cell phone applications, websites, and digital chat rooms used to “hook up” for sex. Given the available technology and advances in mobile health innovation, it is no longer necessary or reasonable to limit treatment options to physical brick-and-mortar sites. Building upon the efficacy of the manualized, theory-driven methamphetamine-abuse treatment intervention, “Getting Off: A Behavioral Treatment Intervention for Gay and Bisexual Male Methamphetamine Users,” this project will evaluate the feasibility of translating this intervention into a computerized treatment intervention application (“app”). This project will conduct Phase 1 formative research, design and develop a cross-platform treatment app, and conduct a feasibility pilot test of the app. A methamphetamine abuse treatment app will capitalize on the ease in which MSM integrate technology into their daily lives and provide members of this extremely high-risk population with a treatment opportunity that is easily accessible, culturally-competent, and private. The app will then undergo user feasibility pilot testing with a small number of participants (N=15). Both focus group and pilot participants will be representative of a typical consumer of the app. The specific aims of the research project are: 1) To conduct formative work to assist in the development of a culturally competent and consumer responsive computerized app based on the Getting Off methamphetamine-abuse treatment intervention for GBM; 2) To design and develop eight sessions of the Getting Off methamphetamine-abuse treatment intervention into a cross-platform computerized mobile app targeted to reduce methamphetamine use and HIV sexual risk behaviors and increases in ART medication adherence; and, 3) To conduct feasibility pilot testing and refinement of the eight session app.

Theory-based Text Messaging to Reduce Methamphetamine Use and HIV Risks among MSM (lay title: Project Tech Support)

Principal Investigator: Cathy J. Reback, Ph.D.
Co-Investigator: Dallas Swendeman, Ph.D.
(UCLA Semel Institute for Neurosciences and Human Behavior)
Project Director: Mitch Metzner, Ph.D.
Funded by: National Institute on Drug Abuse
Grant Number: 1R01DA035092
Total Project Period: 2/13 – 1/17

Methamphetamine use is highly associated with HIV infection due specifically to concomitant high-risk sexual behaviors that occur while using the drug. Text-messaging is a novel, feasible, and sustainable approach for targeting high-risk, out-of-treatment MSM; particularly, MSM who fail to attend face-to-face or site-based interventions. Project Tech Support will assess the impact of an 8-week, gay-specific, theory-based text-messaging intervention designed to decrease methamphetamine use and HIV sexual risk behavior and, for the HIV-infected participants, simultaneously increase HIV antiretroviral treatment/adherence in out-of-treatment, methamphetamine-using MSM (N = 285). Participants will receive text messages that are personally tailored to fit their risk profile; the theory-based text messages serve as the mechanisms of behavior change. Participants will be randomized into one of three conditions: Group 1: culturally relevant theory-based text messages interactively transmitted by peer health educators (TXT-PHE); or, Group 2: the same culturally relevant theory-based text messages transmitted by automation (TXT-Auto); or, Group 3: assessment-only (AO) control with no theoretically based text messages. Participants will receive brief weekly text-message assessments on their methamphetamine use and HIV sexual behaviors in the previous seven days. The specific aims of this research are: 1) To determine differential immediate and sustained effects of transmitting theory-based text messages by PHE (TXT-PHE) versus by automation (TXT-Auto), compared to an assessment-only (AO) control condition among out-of-treatment, methamphetamine-using MSM for reductions of methamphetamine use and HIV sexual risk behaviors; and, 2) To determine the cost-effectiveness of TXT-PHE vs. TXT-Auto compared to AO for reducing methamphetamine use and HIV sexual risk behaviors. The randomized three-group design uses repeated assessments at baseline, at the end of the intervention, and at 3-, 6-, and 9-month post-randomization follow-up


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