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Social and Behavioral Sciences Core
The mission of the Social and Behavioral Sciences (SBS) core is to support interdisciplinary research on the social and behavioral determinants of HIV-related outcomes, in order to prevent new infections, develop innovative interventions and support the application of treatments, and improve the quality of life of people living with HIV.
- Use our expertise in mental health and substance use, in collaboration with the Clinical Core, to build a strong base of innovative research that advances HIV treatment and prevention both domestically and internationally.
- Enhance the quality and quantity of social and behavioral HIV/AIDS research at Duke, by providing scientific consultations throughout the grant development and research process.
- Build the individual and collective capacity of SBS investigators at Duke University and its international partners, by attracting and supporting new investigators, providing mentorship and training, and facilitating networking both within Duke and between Duke and other CFARs.
- Enhance the reach and impact of Duke SBS studies by supporting collaborative community research and assisting investigators in the dissemination of findings to the community and larger scientific arena.
The Roles of Behavioral and Social Science Research in the Fight Against HIV/AIDS: A Functional Framework.
Landmark advances have been made in HIV/AIDS prevention and treatment. These include proof-of-concept and public health implementation of preexposure prophylaxis and "treatment as prevention" to reduce HIV transmission as well as definitive evidence of the clinical gain from early antiretroviral treatment initiation. Significant progress has been made in understanding and addressing the socialcontexts and behavioral factors that impact HIV prevention, care, and treatment interventions. These include facilitating uptake of testing and counseling, developing technology-based interventions that increase viral suppression, reducing HIV/AIDS-related stigma, and addressing other sociobehavioral and structural barriers to care and treatment. This evolving landscape provides an important juncture to assess current and future directions for HIV/AIDS behavioral and social science research (BSSR). We propose a functional framework for HIV/AIDS-related BSSR, highlighting 4 primary BSSR domains: (1) understanding vulnerable populations and contexts of risk ("Basic BSSR"); (2) improving behavioral and social factor approaches to risk reduction, prevention, and care ("Elemental BSSR"); (3) strengthening the design and outcomes of biomedically focused research in HIV/AIDS treatment and prevention ("Supportive BSSR"); and (4) contributing building blocks to integrated HIV/AIDS prevention and treatment approaches ("Integrative BSSR"). These domains and their resulting confluence at the highest level underscore how fundamental and essential BSSR is to current and future efforts to prevent, treat, and cure HIV/AIDS.
Early Planning and Grant Preparation
The SBS Core supports investigators with early conceptualization of their research, including advice on research ideas, funding opportunities, and framing to fit NIH AIDS priorities. As investigators move forward with grant preparation, we provide additional input and administrative support, including proofreading, compiling supplemental materials, and providing letters of support from the SBS Core.
The SBS Core offers a peer review – including early informal discussions of study ideas and specific aims, and formal discussions of study design, scientific contribution, and responses to critiques for resubmission – to improve the quality of HIV-related grant submissions. We prioritize these services for faculty by convening a panel of 2-3 Duke investigators and may also be available to conduct more informal reviews for others (e.g., students, postdoctoral scholars).
The SBS Core provides advice on post-award consultation for efficient study start-up and continuous support during study implementation, including selection of appropriate SBS measures, and consultations on study methods, intervention designs, data analysis techniques, and project management strategies.
The SBS Core offers scientific guidance in qualitative and quantitative methods, including survey administration, semi-structured interviews, and focus group moderation. We can provide assistance with refining in-depth interview guides, survey development and formatting, REDCap programming, training qualitative data collectors, and developing procedures for interview transcription and approaches to qualitative data analysis.
Networking and Mentoring
The SBS Core brings together researchers across Duke who understand and address the HIV epidemic through holding interactive seminars, using the Core’s listserv for communication, liaising with investigators across disciplines, building ties with community partners and study communities, and offering science sharing opportunities to grow and boost the research of the Core. We provide mentorship to new CFAR members and connect junior and minority investigators with senior faculty.
Dissemination of Findings, Manuscript Preparation, and Community Engagement
The SBS Core produces dissemination materials, offers advice on community feedback sessions, and provides consultations on scientific journals for submission. We offer assistance with manuscript formatting as well as reviews and edits on manuscript drafts. The SBS Core also provides opportunities to discuss implications of study findings that will lead to new grant applications. We support community outreach in Durham and other research sites, including in global settings, and assist researchers in the community engagement process.
Facilitation of Collaboration with the Duke CFAR Clinical Core
The SBS Core enhances the conduct of SBS research in the Duke Infectious Disease Clinic and other clinical settings by linking SBS investigators who are interested in conducting collaborative SBS research related to treatment, bio-behavioral factors, or prevention to Duke CFAR Clinical Core members. The SBS Core also provides resources and facilitates opportunities for those new to conducting SBS research in HIV clinics to learn from others who have experience working in clinical settings as well as HIV-positive or HIV-affected individuals.
In addition to the services listed above, the Duke SBS Core possesses particular expertise in the areas of global mental health and substance use, and integrates this expertise into all areas of service provided.
Title: Improving the Health of South African Women with Traumatic Stress in HIV Care
Principal Investigator: Kathleen Sikkema, Ph.D.
Funding: National Institute of Mental Health (R34)
Women in South Africa face dual epidemics of HIV and sexual violence. The resulting traumatic stress may compromise retention in HIV care and adherence to antiretroviral therapy, and increase sexual risk behavior and substance use. This study will develop and pilot Improving AIDS Care after Trauma (ImpACT), an intervention based on theories of stress and coping, for women with histories of sexual trauma initiating ART in South Africa. This intervention has the potential to improve care engagement and retention, improve ART adherence, reduce risk behaviors, and therefore prevent HIV transmission within the target population
Title: Postpartum HIV Care Engagement in the Context of Option B+ in Tanzania
Principal Investigator: Melissa Watt, Ph.D.
Funding: National Institute of Allergy and Infectious Disease (R21)
Under the Option B+ protocol for prevention of mother to child transmission (PMTCT), all HIV-infected pregnant women initiate antiretroviral therapy (ART) for lifetime use, regardless of clinical staging. Retention in care and sustained adherence to ART following childbirth are vital to the success of the Option B+ protocol. This study will produce implementation science data to examine the facility- and patient-level factors that impact postpartum engagement in care, and to identify innovative implementation solutions to support the scale-up of Option B+ in Tanzania and other high-infection, low-resource settings.
Title: Decision Making and HIV Risk: New Approaches to NeuroAIDS Research in Drug Users
Principal Investigator: Christina Meade, Ph.D.
Funding: National Institute on Drug Abuse (DP2)
Individuals who abuse stimulant drugs like cocaine and methamphetamine contribute disproportionately to new HIV infections, sub-optimal HIV clinical outcomes, and growing HIV-related health disparities in our society, largely due to engagement in risky behaviors and poor utilization of healthcare services. This study is implementing novel approaches in the field of neuroAIDS to advance our understanding of how HIV infection and drug addiction impact decision-making processes relevant to real-world HIV risk behaviors. The goal of this research is to develop mobile health interventions that improve decision making in high-risk situations.
Title: RCT of an integrated treatment of persons with co-occurring HCV and alcohol abuse
Duke Principal Investigator: Rae Jean Proeschold-Bell, Ph.D.
Funding: National Institutes of Alcohol Abuse and Alcoholism (R01)
This randomized control trial is being conducted in three liver clinics in North Carolina with hepatitis C patients who use alcohol. A six-month integrated model of alcohol treatment has been developed and piloted to include brief alcohol counseling, co-locating addictions therapists in the liver clinic, therapy that emphasizes the interplay between alcohol and liver health, and case conferencing between the hepatolgists and addictions therapists. The integrated treatment is now being compared to brief counseling only to assess its impact on alcohol abstinence, as well as other alcohol and drug use outcomes, and to calculate its cost effectiveness.
Title: Does Preference-Based HIV Testing Increase Uptake in High Risk Populations?
Duke Principal Investigator: Nathan Thielman, M.D.
Funding: National Institutes of Mental Health (R01)
Despite worldwide efforts to promote HIV Counseling and Testing (HCT), rates of testing remain low. Understanding how high risk groups decide to test and adapting available testing options to their preferences has the potential to broadly improve HCT uptake and cost-effectiveness. This study uses a Discrete Choice Experiment, a survey method increasingly used by health economists for the design of patient-centered health care options, to rigorously quantify HIV testing preferences among two high-risk populations, identify their preferred testing options, and evaluate, in a pragmatic randomized controlled trial (RCT), the effect of a preference-based HIV counseling and testing (PB-HCT) intervention on testing uptake.
Title: Improving Health Outcomes for Orphans by Preventing HIV/STD Risk
Duke Principal Investigator: Kathryn Whetten, Ph.D.
Funding: National Institute of Mental Health (R01)
The primary goal of this R01is to study the effectiveness of Trauma-focused Cognitive Behavioral Therapy (TF-CBT) for treating unresolved grief and traumatic stress for orphaned children and adolescents in two East African countries, Tanzania and Kenya. The mental health gap is substantial, with few individuals in need of treatment receiving even minimal supports. Among those in need, orphaned children and adolescents, who currently number 143 million worldwide, with nearly 50 million in Sub-Saharan Africa alone, often have mental health problems subsequent to parental loss.
Title: Positive outcomes for children orphaned by AIDS (POFO)
Duke Principal Investigator: Kathryn Whetten, Ph.D.
Funding: National Institute of Child Health and Development (R01)
POFO is a 10-year observational study of orphaned and abandoned children (OAC) and a small cohort of non-OAC in five low and middle-income countries (Cambodia, Ethiopia, India, Kenya, and Tanzania). The objective is to follow children (starting from ages 6 to 12) and their caregivers to examine the influence of orphan placement characteristics, caregiver characteristics, and culture, on: 1) behavioral and emotional adjustment; 2) educational achievement, labor for participation, and civic engagement; 3) relationship outcomes, including HIV risk behaviors and family formation; and 4) health outcomes.
Title: Alcohol-Related HIV Risks among South African Women
Duke Principal Investigator: Kathleen Sikkema, Ph.D.
Funding: National Institutes of Alcohol Abuse and Alcoholism (R01)
This project was a multi-level prospective analysis of alcohol-related HIV risks among women who drink in alcohol serving establishments in Cape Town, South Africa. The analysis was grounded in Social Action Theory and incorporated factors derived from three levels of analysis: structural/environmental, social/interpersonal, and individual. The study centered around 12 drinking establishments (shebeens) in a township community consisting of Black Africans of Xhosa heritage and Coloureds (mixed race). Data were collected from key informants, alcohol serving business owners, managers and servers, qualitative interviews and cross-sectional surveys of men and women drinkers, and a prospective cohort of 540 women. Assessments were conducted at 4 time points: baseline, 4-, 8-, and 12-months. Data analysis examined the factors that influenced women’s alcohol-related HIV risks, including a focus on mental health issues.
Core Staff Contact
Dr. Kathleen Sikkema is a Professor of Psychology and Neuroscience, Global Health, and Psychiatry and Behavioral Sciences at Duke University. She is an internationally recognized expert on community intervention trials for HIV prevention and mental health. Dr. Sikkema’s interdisciplinary HIV research and capacity building projects have been supported by the NIH for 25 years. Her current research includes a grant from NIMH to develop and pilot test an intervention to reduce traumatic stress and improve care engagement among HIV-positive women initiating ART in South Africa. Her team’s LIFT (Living in the Face of Trauma) intervention for HIV-infected adults with histories of childhood sexual abuse was named a CDC Best Evidence intervention in 2008 and a SAMHSA NREPP (National Registry of Evidence-Based Programs and Practices) intervention in 2011. Dr. Sikkema has led the SBS Core since its inception in 2007.
Dr. Melissa Watt is an Assistant Professor in Global Health at Duke University. She brings experience to the Core in qualitative and quantitative methods and the conduct of international research. She is currently serving as the PI on an NIH-funded study on the implementation of Option B+ in Tanzania, and conducts similar research on postpartum HIV care engagement in South Africa, funded by a CFAR Small Grant. Her expertise spans other areas of global women’s health, including obstetric fistula and the prevention of fetal alcohol syndrome disorder. Dr. Watt has had a leadership role in the Duke CFAR since 2008. She is responsible for promoting the activities of the Core, providing scientific consultations, and facilitating networking among investigators
Lizzy Knippler serves as the SBS Core Coordinator, overseeing the day-to-day functioning of the Core and supporting investigators on a variety of projects. In this role, she coordinates consultations and peer reviews, helps prepare study documents and materials for grant submissions, and provides administrative support. Lizzy also helps organize SBS events and facilitates connections across the Duke CFAR and beyond to build the network of HIV researchers. In addition to her role in the SBS Core, she also supports the on-going research of Dr. Sikkema and Dr. Watt.
Beth Stringfield works in the Center for Health Policy and Inequalities Research(CHPIR), where she serves as a Project Coordinator on multiple projects focused on access to medical care and substance abuse treatment for people living with HIV. Ms. Stringfield brings to the CFAR over 15 years of experience working in the field of HIV in North Carolina. In the effort that Ms. Stringfield gives to the Core, she promotes and enhances community-based research, specifically study development and the dissemination of findings to nonscientific communities, and consults with investigators to develop interventions based in communities.
Dr. Amy Corneli is an Associate Professor in the Division of General Internal Medicine. She has conducted mixed-method, social science research in multiple countries in sub-Saharan Africa, the Middle East, and South and Southeast Asia, primarily focusing on HIV prevention. She served as the behavioral PI of FEM-PrEP, a multi-site, phase III, placebo-controlled trial of emtricitabine/tenofovir disoproxil fumarate as pre-exposure prophylaxis (PrEP) for HIV prevention among women in sub-Saharan Africa. She has also served as the PI of NIH-funded research on PrEP and risk compensation among women in South Africa and Kenya and as a multiple-PI on NIH-funded research on informed consent in HIV-related clinical research. Dr. Corneli joined the SBS core in 2017 and is the director of the Biomedical Prevention scientific working group.
Dr. Brandon Knettel is a postdoctoral fellow at DGHI and earned his doctorate in counseling psychology from Lehigh University, where he led research projects in Tanzania, Haiti, and refugee communities in the U.S. Currently, Dr. Knettel is involved with Dr. Watt’s projects aimed at understanding HIV care engagement among pregnant women in Tanzania and reducing FASD in South Africa, as well as Dr. Sikkema’s interventions for sexual violence and HIV adherence in South Africa. Dr. Knettel completed his clinical training at Duke Integrative Medicine and is a licensed psychologist in North Carolina. As part of the SBS Core, he is available for consultation on community-based behavioral interventions and research design.