Category: Funding News

Funding has been awarded to principal investigator and Global Health doctoral student Chris Kemp by the NIH National Institute of Mental Health for "Strengthening the Integration of Mental Health and HIV Services in South Africa: Implementation Science In Support Of Scale-Up, Adaptation, and Dissemination".

Abstract:

The burden of co-morbid HIV and mental illness in South Africa is staggering: 19% percent of South Africans live with HIV, and 14-30% of people living with HIV suffer from common mental disorders. Only 25% receive mental health treatment of any kind. Common mental disorders co-morbid with HIV threaten the effectiveness of HIV treatment and carry damaging stigmas. Integrating care for mental illness into HIV-related services has the potential to address these stigmas, reduce treatment gaps, and improve treatment outcomes. Integrated services are demonstrating effectiveness in South Africa, yet the barriers to and facilitators of successful implementation remain undefined.

This multi-disciplinary project benefits from a timely collaboration, rich with many combined years of experience at the intersection of mental health and HIV/AIDS, and applies the methods of implementation science to strengthen the implementation of integrated mental health and HIV- related services in South Africa. This study applies the Consolidated Framework for Implementation Research to identify and explain the intervention- and provider-level barriers and facilitators that are associated with the successful screening and referral of patients by nurses as part of integrated HIV and mental health services in South Africa. It will gain a holistic understanding of the challenges of integration by combining questionnaire and interview data collected from nurses with available secondary data from routine program monitoring.

This study builds on the results and resources of three ongoing projects. The DFID-funded Programme for Improving Mental Health Care (PRIME) project and NIH-funded pragmatic cluster randomized controlled Comorbid Affective Disorders, AIDS/HIV, and Long Term Health (COBALT) trial are examining the methods for and impact of integrated mental health and HIV services in a subset of health facilities in two districts in North West Province, South Africa. Simultaneously, a CDC-funded collaboration of the University of Washington, I- TECH South Africa, and the University of KwaZulu-Natal is strengthening these efforts and scaling to two new districts.

By leveraging these projects, and triangulating robust quantitative and qualitative data, this study will address key gaps in knowledge about the factors associated with the successful integration of mental health and HIV services. This will be the first study to apply a rigorous framework for implementation science research, including validated measures of predictors of successful implementation, to the investigation of the process of integrating mental health and HIV services in a low-resource setting. Moreover, assessment of these barriers and facilitators will lead directly to refinement of approaches to scale-up in South Africa, improving scale-up and subsequent patient outcomes.

Sponsor Award Number: 5F31MH112397-02

Funding has been awarded to principal investigator Dr. Carey Farquhar by the NIH National Institute of Allergy and Infectious Diseases for "Implementing Assisted Partner Services to HIV Test and Treat Men in Western Kenya".

Abstract:

It is estimated that >50% of HIV-infected Kenyans are unaware of their status and men are significantly less likely to test and link to care than women. Unless more attention is focused on men, Kenya and other sub- Saharan African countries with high HIV prevalence will not achieve UNAIDS 90-90-90 goals by 2020. This proposal addresses low uptake of HIV testing and poor linkage to care and treatment services among men in sub-Saharan Africa. The overarching goal is to demonstrate using implementation science methods that assisted partner services (aPS) is a safe and effective strategy to increase the proportion of men living with HIV who know their serostatus and that aPS will improve male engagement in HIV treatment programs.

The study will be based in two counties in Kenya with the highest HIV prevalence in the nation: Homa Bay (27% prevalence) and Kisumu (18.7% prevalence) and be conducted by an experienced and collaborative team with an exceptionally strong track record in HIV partner testing research and implementation science in Kenya. Principal Investigator Carey Farquhar (University of Washington [UW]) will work closely with a multidisciplinary group of investigators and consultants from UW, PATH, Kenya's Ministry of Health, and the National AIDS and STI Control Program (NASCOP), and build on a successful randomized clinical trial of assisted partner services (aPS) conducted by UW and NASCOP from 2012-2015. The proposed research also leverages PATH's vast experience providing HIV testing and treatment in government facilities through the APHIAplus program, as well as PATH's recent mapping of >21,000 adolescent girls and young women for services as part of the DREAMS initiative in western Kenya.

The specific aims are as follows: AIM 1: Determine aPS effectiveness by demonstrating that aPS improves HIV testing, identifies new HIV infections, and promotes linkage, treatment and viral suppression among male partners when implemented among women and adolescent girls in government facilities in Kenya. AIM 2: Evaluate fidelity, feasibility, and cost/cost-effectiveness when implementing aPS at 38 APHIAplus facilities and 9 “safe spaces” established by the DREAMS initiative in western Kenya. Using a mixed methods approach in this real-world setting, we will obtain data critical to national and regional scale-up. For Aim 1, we will offer aPS to more than 8,000 HIV-infected adolescent girls and women and all of their male partners; if a male partner is HIV-infected aPS will also be offered to his female partners. For Aim 2, we will use quantitative and qualitative methods to collect and evaluate data from a subset of facilities that are high and low performers, determine “necessary” elements of aPS at the level of implementation, and conduct a feasibility study, including analyses of acceptability, integration, demand, technical efficiency and cost data. In this way, the UW/PATH/MOH team will work towards building capacity in Kenya to effectively implement and sustain a model aPS program that could be replicated across sub-Saharan Africa.

Sponsor Award Number: 5R01AI134130-02

Funding has been awarded to principal investigator Dr. Mary L. (Nora) Disis by the NIH National Center for Advancing Translational Sciences to "Transform Dissemination and Implementation Science in CTSA Programs".

Abstract:

The Institute of Translational Health Sciences (ITHS) is dedicated to speeding science to the clinic for the benefit of patients and communities throughout Washington, Wyoming, Alaska, Montana, and Idaho. Since 2007, we have worked with our partners—the University of Washington (UW), Seattle Children's, and the Fred Hutchinson Cancer Research Center (Fred Hutch)—to develop our hub as a catalyst for high-quality clinical and translational research in our five-state region and across the nation. Our past progress has focused on developing and providing resources, education, and expertise for investigators in our region, thereby creating critical community collaborations to establish a research-ready community, develop partnerships with our regional universities, and build the infrastructure for a learning healthcare system. As a result, we are well positioned to create a seamless interface between the clinical and research arms of our institutions, and also to increase the pipeline of underrepresented minority students and faculty in translational science.

In the next five years, we will transform our education programs into a virtual clinical and translational science college that will provide directed education to improve the quality of research in our region. Our work will include systematic review of existing programs to ensure all elements of successful approaches to adult education are represented, guarantee accessibility across our region, and ensure development of new areas of scholarship. We will also further develop lasting local, regional, and national collaborations that are project- based and instill a culture of collaboration that results in measurable health impacts for our communities.

This impact will be achieved by accelerating the development of new collaborations, providing a focus on dissemination of health innovation, and a more complete integration of our longstanding community partners into the governance of the ITHS. In addition, we will work to ensure, through newly developed collaborations, that every patient has access to participate in research, whether urban or rural, at the extreme of the lifespan, or a member of one of the rapidly growing minority populations in the Pacific Northwest. We are leaders in the Toyota Production System Lean Continuous Process Improvement, and we will work to continue to transform the institutions in the region to conduct research more efficiently and with higher quality. We will expand on these efforts to develop training for our partners in the region, and nationally so that the Pacific Northwest will be the leader in conducting research better, faster, and cheaper. Finally, we will create common and communicating informatics platforms across our partner institutions and regional partners that will be the basis of a “learning healthcare system” in our region.

Our work will include implementation of a cross-institutional clinical trials management system, development of a federated central portal and cohort discovery engine, deployment of an integrated self-service research data access tool, and enhanced regional access to electronic data capture tools via the Northwest Regional Medical Library.

Sponsor Award Number: 3UL1TR002319-02S1

Funding has been awarded to principal investigator Aaron Lyon by the NIH National Institute of Mental Health for "The Impact of Inter-Organizational Alignment (IOA) on Implementation Outcomes".

Abstract:

Integrated care is increasingly common, yet contemporary implementation frameworks typically assume a single organization within which system-level processes influence service quality and implementation success. This perspective does not represent the emerging realities of modern mental health care and inhibits what can be learned about organizational processes in implementation. Recent frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP).

The proposed study will be the first to empirically examine this prediction. By expanding the focus of implementation science beyond single organizations, this project aims to improve implementation of mental health services in integrated care settings. School-based mental health (SBMH) services provide an important example of an integrated care setting, where two organizations with distinct, but related, objectives overlap. SBMH services are most frequently delivered by clinicians embedded in schools but employed by external community-based organizations (CBOs). Thus, the typical SBMH clinician is someone who functions within – and whose practices are impacted by – multiple organizational contexts. In integrated care settings, the unique and combined impact of the two overlapping organizations on any individual provider are likely to vary as a function of how embedded the provider is within each setting.

SBMH provides a unique opportunity to examine organizational alignment as well as the impact of embeddedness. This study is the first to examine the specific impact of overlapping organizational contexts in which EBP implementation increasingly occurs. We will conduct exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and CBOs as they relate to mental health EBP implementation. We will estimate the effects of different aspects of the school and CBO organizational influences on the implementation outcomes identified as most critical to SBMH (fidelity, acceptability, appropriateness). We also will explore the mechanisms through which inter-organizational alignment influences implementation outcomes.

Using a sample that represents the vast majority (>90%) of CBOs in two geographically distinct and diverse regions, we will address the following aims: Aim 1: Using quantitative methods, estimate the effects of (a) each intra-organizational implementation context (school and CBO) and (b) inter-organizational alignment (IOA) on implementation outcomes. Aim 1a: Estimate the moderating effect of clinicians' degree of school embeddedness on Aim 1 effects. Aim 2: Using a sequential mixed methods approach, examine the underlying mechanisms through which IOA facilitates or hinders EBP implementation.

Sponsor Award Number: 5R21MH110691-02

Funding has been awarded to principal investigator Scott McClelland by the NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development for an "RCT of an Implementation Science Tool to Integrate HIV Testing Into Family Planning Services".

Abstract:

Dr. McClelland has been a highly productive researcher in human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention and treatment since 1998. He has published 120 peer-reviewed manuscripts of original research and been Principal Investigator on 13 research grants including 8 major NIH- funded studies. Dr. McClelland leads the University of Washington (UW) Mombasa HIV/STD Research Field Site in Kenya, where he has developed an outstanding research and training infrastructure. His past and present trainees include 18 masters (15 as chair), 10 PhD (5 as chair), and 26 post-doctoral researchers (21 as primary mentor). These trainees have been exceptionally successful in career advancement, publishing, and securing additional funding to support their training and research. More than 75% of Dr. McClelland's mentees have remained in academics or other settings where they focus on patient-oriented research. Dr. McClelland has received two prestigious mentoring awards; the UW School of Public Health Outstanding Mentor Award (2012), and the Department of Medicine Mentor of the Year Award (2015). Career Plan, Institutional Environment, and Institutional Commitment.

The research and mentoring proposed in this application focus on multidisciplinary implementation science. During the past several years, Dr. McClelland has been expanding his research program in this emerging and important field. As a young HIV researcher in the late 1990s, Dr. McClelland began his career by conducting clinical and epidemiological studies of HIV and STD prevention and treatment in Africa. At that time, the key research questions related primarily to `what' works. Today, with a range of proven prevention and treatment tools available, it is a natural extension to include research that focuses on `how' to implement these interventions to maximize population impact. Dr. McClelland is at an ideal point in his career to expand his leadership of multidisciplinary mentoring teams while gaining new skills and refining his approach through structured courses, independent study, and exploration of new mentoring strategies.

The overarching objective of Dr. McClelland's mentorship is to support trainees' progress on the path to full research independence. The UW is an ideal environment for this research and mentoring program, with more than 1 billion dollars in annual research funding, numerous grants to support young investigators in patient-oriented research, and top-ranked programs in Infectious Diseases, Epidemiology, Global Health, and Implementation Science attracting a large number of superb trainees each year. The UW has a strong commitment to Dr. McClelland and his research and mentoring plan. Research Plan Integration of HIV and family planning (FP) services is an approach that holds considerable promise for improving delivery of HIV treatment and prevention services to women.

The United States Government Global Health Initiative Strategy of 2010 emphasized linkage of these services to increase efficiency, lower costs, and improve the health of women in low-resource settings. Testing for HIV is the gateway to care and prevention. Integrating HIV testing into FP clinics could open this essential gateway to far more women. Reviews of the literature support the feasibility of integrating these services, but highlight the need for additional research.

In this K24 application, we propose a trial of a systems analysis and improvement approach (SAIA) to optimize rates of HIV testing in women presenting to FP clinics in Mombasa County, Kenya. This work will be conducted in collaboration with the Mombasa County Department of Health (DOH) and Kenya's National AIDS and STI Control Programme (NASCOP), ensuring rapid dissemination of results and facilitating scale up of successful strategies. Our proposal includes three specific aims. We will first conduct a cluster-randomized trial comparing the effect of the SAIA approach versus usual procedures on rates of HIV testing in first-time attendees at 12 intervention versus 12 control FP clinics. Second, to determine whether the SAIA training results in a lasting effect, we will compare HIV testing rates for first-time FP clinic attendees in SAIA intervention versus control facilities after an additional year, during which FP clinics in the intervention arm will be encouraged to continue to use the SAIA tools without further support or training from the study team. Third, we will estimate the incremental cost of applying the SAIA intervention versus standard procedures. Budget impact will be estimated from the payer (DOH) perspective.

We envision that each aim will be led by one of Dr. McClelland's mentees. Collaboration and team mentoring with Drs. Sherr (Implementation Science) and Barnabas (Costing/Budget Impact Analysis) will provide the multidisciplinary expertise that is key to the success of this research and mentoring proposal. Integrating HIV and FP services in Mombasa County will result in improved rates of HIV testing, opening the gateway for linkage of women to other HIV prevention and treatment services. Rigorous testing of the SAIA intervention will provide a framework for scale-up in a wide range of settings with a high burden of HIV.

Sponsor Award Number: 5K24HD088229-03