Site Principal Investigator: April D. Kimmel, Ph.D.

Funding Source: National Institutes of Health (NIH), National Cancer Institute (NCI), National Institute of Allergy and Infectious Diseases (NIAID), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and National Institute on Drug Abuse (NIDA)

Project Summary: 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 are 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 Sub-Saharan 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:

• 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
• Been highly productive scientifically with >20 publications even while data collection was in development
• 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: Anika Hines, Ph.D.

Funding Source: Johns Hopkins University

Project Summary: The goal of this study is to explore and examine the associations between the food environment — an upstream social determinant — with psychosocial stressors and downstream chronic disease outcomes within the context of a dietary provision and nutritional advisement intervention. This study provides a critical psychosocial component to a randomized control trial of a dietary intervention for African Americans with hypertension and kidney disease, which may further explain variation in outcomes of the intervention. Using qualitative and quantitative approaches, it: 1) characterizes food insecurity among study participants; 2) examines the associations between perceptions of food insecurity and measures of stress and whether these associations change from baseline to 4-month follow-up; 3) determines if these changes are associated with kidney damage or blood pressure reduction among study participants.

Principal Investigator: Anika Hines, Ph.D.

Funding Source: National Heart, Lung, and Blood Institute (NHLBI)

Project Summary: Hypertension contributes to high rates of morbidity and mortality of other chronic conditions, including cardiovascular disease, obesity, diabetes, and end stage renal disease. African Americans (AAs) are more likely to develop high blood pressure and at a younger age compared to other racial/ethnic groups, and despite higher treatment rates, are less likely to have blood pressure under control. Racial disparities persist by sex—AA women have higher incidence of hypertension and earlier onset compared to their white counterparts. Experiences of stress, including race- and gender-related stress, and stress-related coping are thought to be at the root of these disparities. African American women demonstrate greater stress as evidenced by higher allostatic load over the life course relative to male and white counterparts. Higher incidence and earlier onset of hypertension make younger AA women a prime target for prevention; however, the development of effective prevention-focused interventions is inhibited by limited understanding of underlying mechanisms in this subgroup. To fill these critical gaps, this proposal will use a sequential mixed methods approach, including the following: 1) quantifying stress responses in vivo using a 14-day ecological momentary assessment (EMA) protocol with 24-hour physiological monitoring; and 2) developing and testing the feasibility, acceptability and preliminary efficacy of a stress management intervention that may mitigate the effects of the chronic stress on blood pressure levels in young AA women. The candidate for this mentored Career Development Award, Dr. Anika L. Hines, is an Assistant Professor in Health Policy at the Virginia Commonwealth University School of Public Health. Her long term career goal is to: 1) become an independent investigator who explicates the complex and cumulative effects of stress in the lived experiences of racial/ethnic minorities within the context of health disparities; and 2) design and implement innovative, evidence-based interventions and policies to address these stressors using an interdisciplinary, socioecological approach. During this award, Dr. Hines will undergo rigorous didactic and research training, including an didactic courses, experiential lab training, and practical research experience, that will substantially build her skills in intervention development and the conduct of randomized controlled trials for behavioral interventions. These career development activities will be conducted within the rich training environment of Virginia's largest academic medical center with direct guidance from mentors, advisors, and collaborators with expertise in multi-level and behavioral interventions, evidence-based behavioral medicine approaches, race-related stress, qualitative methods, physiological pathways linking stress and cardiovascular risks, advanced statistical analyses, health equity, and grant development. These activities will provide Dr. Hines with a solid foundation to ensure her successful transition to an independent, interdisciplinary investigator who is well equipped to conduct behavioral intervention trials in service of health equity.

Co-Investigator: April D. Kimmel, Ph.D.

Funding Source: National Heart, Lung, and Blood Institute (NHLBI)

Project Summary: 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.

Principal Investigator: Anika Hines, Ph.D.

Funding Source: Johns Hopkins University

Project Summary: The primary objective of this research project is to explore the stress experiences of young African American women aged 18-40 years old. The proposed one-year study is a collaboration between The Virginia Commonwealth School of Medicine, the Johns Hopkins Bloomberg School of Public Health and the Young Adult Missionary Society (YAMS) of the Mid-Atlantic Episcopal District of the African Methodist Episcopal (AME) Zion Church. We administered an electronic survey to respondents regarding their health concerns, psychological stressors, psychological distress, stress coping mechanisms, health status, health behaviors, healthcare access, and utilization to individuals aged 18 to 40 years who self-identified as African American or Black women. The study aimed to: 1) identify modifiable social and individual stressors and targetable health concerns among young African American women; and 2) explore associations among reported stressors, health conditions and health concerns, and stress-reduction strategies.