Active Projects
Improving Assessment for Neurocognitive Impairment among Perinatally HIV Infected Youth
NIH R01: 1R01HD095256-01
Neurocognitive impairment (NCI) has significant medical and behavioral consequences and is common among perinatally HIV-infected youth. In South Africa, where there are hundreds of thousands of perinatally HIV- infected youth, there are few neurocognitive tests available to detect neurocognitive impairment that are brief, computerized, available in isiXhosa (the predominant language of perinatally infected youth in the Western Cape region of South Africa, where the proposed study will take place), designed to be used by lay health workers, and use the interactivity of touchscreens available on tablet devices. The proposed study will validate NeuroScreen, a brief, easy-to- use app for Android devices to assess and screen for NCI that is designed to be administered by a wide range of non-expert healthcare personnel in clinical settings, for use with PHIV+ adolescents in SA
Developing an mHealth Intervention that Leverages Social Networks to Improve ART Adherence among HIV-infected Adolescents in South Africa
1K01MH118072-01A1
With access to mobile phone technology increasing among youth in settings like South Africa mHealth interventions hold promise as an effective way to reach young people in HIV prevention and care interventions. The rationale for the proposed research is that its completion will provide new insights into how social networks can be effectively engaged in an mHealth ART adherence intervention targeting adolescents
Extension of a longitudinal cognitive and brain imaging study of early-treated perinatally HIV infected children through adolescence
1R01HD099846-01
Extension of a longitudinal cognitive and brain imaging study of early-treated perinatally HIV infected children through adolescence In this study, we will extend our longitudinal follow-up of two extremely well-characterized PHIV+ cohorts, adding neuroimaging and cognitive assessments at 14 and 16 years, and continuing 6-monthly clinical visits. The study will include PHIV+ children from the “Children with HIV early antiretroviral therapy” (CHER) trial, originally supported by the Comprehensive International Program for Research on AIDS in South Africa (CIPRA-SA). The cohort incorporates children who commenced ART before 12 weeks, and children whose treatment was delayed until immunological criteria were met. We will also include 30 PHIV+ children from the IMPAACT (International Maternal Pediatric Adolescent AIDS Clinical Trials Network) P1060 and P1104S studies who started ART at 2 to 36 months after exhibiting relatively advanced disease, and uninfected controls from the same cohort.
Health Needs of First Generation HIV-Infected Adolescents
R21HD089825-02
This R21 explores the sexual and reproductive needs of HIV infected adolescents in Cape Town, South Africa and refines direction for future intervention design to promote sexual and reproductive health as well as prevention of further HIV transmission to future partners and children.
Nurse-Delivered CBT for Depression-Adherence in HIV Primary Care South Africa.
5R01MH103770
This study is an RCT aimed at establishing whether cognitive-behavioural therapy for adherence and depression is effectively administered by nurse-therapists. The participant population include majorly-depressed PLWH with evidence of recent virological failure.
Project Someleze: A randomized trial of ImpACT+, a coping intervention to improve clinical and mental health outcomes among HIV-infected women with sexual trauma in South Africa
1R01MH118004
This study builds on one of our pilot studies by consolidating the IMPACT intervention for coping, in women with sexual trauma, using registered nurses and social workers in primary health care.
Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa
K23DA041901
This NIH K award comprised 3 components, culminating in a hybrid effectiveness pilot trial to integrate an alcohol reduction intervention into HIV care, using peers.
Neuropsychiatric problems related to HIV infection and antiretroviral therapy in Cape Town
MRC Newton Fund
In this study we aimed to take advantage of the switch from EFV to DTG based regimens in order to investigate cognitive and CSF effects.
Completed Projects
Improving the health of South African women with traumatic stress in HIV care (ImpACT).
NIMH R34 MH102001
The aim of this study is to develop and pilot-test a theory- and evidence-based intervention for traumatic stress for women who are newly initiating antiretroviral therapy to maximize their engagement in HIV Care.
Cape Town Adolescent Antiretroviral Cohort (CTAAC).
NICHD R01 HD074051
This cohort study capitalizes on an existing infrastructure to recruit HIV-infected adolescents over a 3-year period to conduct multi-system assessments. The impact of neurologic disease on adolescent brain development and psychosocial outcomes is the focus of the sub-aim.
Masivukeni: A Multimedia ART Adherence Intervention for Resource-Limited Settings.
NIMH R01 MH095576
The aim of this study is to refine a multi-media intervention designed to deliver information regarding HIV treatment readiness to patients initiating anti-retroviral treatment; and to compare its effectiveness against standard of care in a randomised controlled trial.
A Mobile App for LMIC Lay Health Workers to Screen for Neurocognitive Impairment.
R21HD084197
The aim of this pilot study is to test the validity of a tablet-based neuropsychology application against a paper-and pencil battery in ART-experienced individuals in Cape Town, South Africa, in order to establish whether the application allows for enhanced task-sharing of neuropsychological testing.
Neuropathogenesis of Clade C HIV in South Africa.
NIMH R01 MH083578
The aim of this study is to investigate HIV subtype and its impact on neuropsychological performance and imaging measures of white matter integrity in the brain, in a sample of participants about to commence treatment with anti-retroviral therapy.
A randomized controlled trial of lithium carbonate in individuals with HIV clade C-associated neurocognitive impairment: a phase IIb proof of principle study.
EDCTP
Acceptability of PrEP for HIV Prevention among HIV-positive and HIV-negative Adolescents
NIH R21:1R21AI116309-01
One of the most important and novel biomedical strategies in our toolkit for combination HIV prevention is oral antiretroviral pre-exposure prophylaxis (PrEP). PrEP has enormous potential to avert new infections among adolescents. The overall objective of this exploratory R21 study is to develop knowledge on acceptability of PrEP; to explore willingness to use PrEP, to support partners’ use of PrEP, or to prescribe PrEP; and to understand how messaging about PrEP efficacy based on adult trials may influence adolescents’ expectations and predicted user behaviors. Our immediate goals are to understand adolescent-specific factors that affect the design of safety, feasibility, and efficacy PrEP trials for adolescents under 18 years of age and to develop an initial empirical conceptual model to guide adolescent-tailored PrEP messaging to address uptake, adherence, and risk compensation.
Conditional Economic Incentives for Improving Adolescent Adherence to HIV Treatment
NIH R21: 1R21AI118393 - 01A1
Few behavioral interventions are specifically tailored by and for adolescents on ART. Adolescent-patient-centered conditional economic incentives (CEIs) have not yet been explored as an approach towards improving adherence behaviors among adolescents. The theoretical premise of this patient-centered and behavioral economic approach is that individual decision making often favors self-actualization but needs to contend with immediate gratification and discounted future outcomes. Patient-centered CEIs contingent on a behavior or outcome can alter this calculus by allowing recipients to experience immediate benefits of a positive health behavior rather than the weaker reward of improved health in the distant future. Adolescence is an ideal developmental timepoint to utilize CEIs since behavioral patterns are being developed. As such, short-term delivery of CEIs during a critical phase might be enough to start habituation of behaviors over the long term. Adherence is an ideal behavior for habituation.
Epigenetic and Psychosocial Drivers of NeuroHIV in HIV+ South African Adolescents
R21 MH107327-01A1
DNA methylation (DNAm), an epigenetic process, is critical for neurodevelopment and for neurologic functioning throughout the lifespan. Aberrations in DNAm result in developmental, neurodegenerative, and psychiatric disorders. HIV+ adults have altered DNAm in both brain and peripheral blood mononuclear cells (PBMC). Perinatally HIV-infected (PHIV+) children are at increased risk of neurodevelopmental delay and lasting neurocognitive dysfunction. One possible mechanism driving this, as well as a potential biomarker of aberrant functioning, is DNA methylation. In this proposed study, we will characterize with high accuracy the genome-wide DNAm in South African PHIV+ adolescents and matched HIV-uninfected controls. The immediate goal of this study is to delineate the complex relationship between epigenetics, HIV infection, neurophysiological and neurocognitive functioning, and environmental factors in PHIV+ adolescents.