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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.

Specific Aims

  1. 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.
  2. 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. 
  3. 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.
  4. 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. 
Enhancing the quality and quantity of social and behavioral HIV/AIDS research.

Services Offered

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.

Peer Review
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).

Scientific Consultations

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. 

Training

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.

Research Highlights

Title: Research Training Program for Low-and Middle-Income Country Institutions
Principal Investigators: John Bartlett, MD
Funding: Fogarty International Center (
D43 TW009595)
The proposed training program will create a Sociobehavioral Sciences Research Core Team at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania through a carefully selected portfolio of training opportunities. This Team will study HIV voluntary counseling and testing, linkage and retention in care, adherence to medications, and co- morbidities of mental illness and substance abuse. The knowledge gained from this research will improve public health by informing health care providers and policymakers about best practices in the management of persons living with HIV infection.

Title: Interdisciplinary Research Training Program in AIDS (IRTPA)
Principal Investigators: Nathan Thielman, MD, MPH and Georgia Tomaras, Ph.D.
Funding: National Institute of Allergy and Infectious Diseases (
T32 AI007392)
In response to the magnitude and course of the AIDS epidemic, the Duke Division of Infectious Diseases successfully competed for an interdisciplinary research-training program to recruit and train promising young investigators in the field of AIDS research. The training program is coordinated by Dr. Nathan Thielman and Dr. Georgia Tomaras, and draws on resources at both Duke and the Durham VA Medical Center. A principal resource is the Center for AIDS Research (CFAR). It assembles the talents of over 60 independent investigators within 13 academic departments and includes research programs in HIV Immunology, HIV/Viral Pathogenesis, Adult Clinical HIV/Infectious Diseases, Maternal/Child HIV Infection, Global HIV/AIDS, and Social and Behavioral Sciences.

Title: A Systems Biology Approach to HIV-Associated Neurocognitive Impairment: Role of Drug Abuse and Neuroinflammation
Principal Investigators: David Murdoch, MD and Christina Meade, Ph.D.
Funding: National Institute on Drug Abuse (
R01 DA043241)
Over half of HIV-infected Americans experience neurocognitive impairments that impact daily functioning. Marijuana and cocaine, two of the mostly commonly abused drugs among HIV-infected persons, may accelerate the development and progression of neurocognitive impairments. Using a systems biology approach, this study will combine neuroimaging, neurocognitive testing, advanced immune profiling, and computational modeling to quantify the neurological impact of marijuana and cocaine use in HIV-infected patients. Results will inform new lines of investigation into the complex biological intersection of HIV and drug abuse, with strong clinical implications for the development innovative therapeutics.

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 AA021133)
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 hepatologists 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 MH106388)
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 MH096633)
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 HD090984)
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: 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 MH102001)
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 developed and piloted 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: Developing a Measure of Caregiver Readiness to Disclose HIV Serostatus
Principal Investigator: Eric Green, Ph.D.
Funding: Eunice Kennedy Shriver National Institute of Child Health & Human Development (
R21 HD076695)
This study aims to develop the first reliable and valid measure of a caregiver's readiness and self-efficacy to disclose to the child his/her own serostatus or his/her child's serostatus. The instrument, the Readiness to Disclose to Children (R2D2-C), is intended to be suitable for administration by lay counselors or trained personnel in a community or clinic setting. The project anticipates that this tool will be useful to researchers and practitioners alike, and envisions that it will inform how existing and future disclosure interventions can be tailored based on an assessment of caregiver readiness and self-efficacy to disclose.

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 AI124344)
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: A Stigma Reduction Intervention at time of Entry into Antenatal Care to Improve PMTCT Services in Tanzania
Principal Investigator: Melissa Watt, Ph.D.
Funding: Fogarty International Center (
R21 TW011053)
HIV-related stigma has been identified as a significant reason for loss to follow up in prevention of mother to child transmission of HIV (PMTCT) programs. By addressing HIV stigma during the first antenatal care (ANC) visit, we can impact HIV care engagement among HIV-infected women at a key, early juncture of care. In addition, among those are who HIV-uninfected, we can promote acceptance and empathy towards PLWH during the heightened emotional period of HIV testing. This application proposes to develop and pilot test a brief, scalable intervention called Maisha (Swahili for life), to address HIV stigma for women presenting to ANC in Tanzania.

Title: Integrating Mental Health into an HIV Clinic to Improve Outcomes in Tanzanian Youth
Principal Investigator: Dorothy Dow, Ph.D.
Funding: Fogarty International Center (
K01 TW009985)
This project aims to address the mental health treatment gap that exists in the HIV youth clinic in Moshi, Tanzania with the goal of improving adherence to antiretroviral therapy (ART) and HIV outcomes. Addressing this treatment gap is highly relevant in two important ways. First, improved ART adherence is important not only for one's own health, but as these youth become sexually active, it also decreases the risk of sexual transmission of HIV to their partners. Second, as perinatally HIV-infected children age into adolescence, their mental health difficulties and traumatic experiences must be addressed to facilitate a healthy and productive adulthood.

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 DA040226)
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: Increasing HIV Testing & Counseling (HTC) via Adolescent Wellness Visits in Tanzania
Principal Investigator: Joy Noel Baumgartner, Ph.D.
Funding: Core B

Adolescents ages 15-19 are less likely to access HIV testing and counseling (HTC) than adults, yet young women in particular are driving the HIV epidemic in sub-Saharan Africa. Implementation of Adolescent Wellness Visits (AWVs) is an innovative strategy for increasing adolescent uptake of HTC and other preventative health services. This pilot study will assess the feasibility and acceptability of implementing AWVs within two government primary schools matched to nearby public health facilities at one urban site and one rural site in Tanzania.

Title: A Model of Family Therapy for HIV Prevention and Adolescent Emotional Support in Rural Kenya: A Developmental and Pilot Study
Principal Investigator: Eve Puffer, Ph.D.
Funding: Core B

This multi-informant qualitative study was conducted in Eldoret, Kenya to examine associations of family relationship factors with negative or positive adolescent outcomes to identify interaction patterns that should be the focus of family-level treatment. These data provide the foundation for the content and strategies of a family-based treatment intervention utilizing lay counselors from church congregations to target family functioning, mental health, and sexual risk behavior.

Title: PrEP for PWID: Gathering Evidence for Integrating PrEP into Syringe Services Programs
Principal Investigator: Mehri McKellar, MD
Funding: CFAR Administrative Supplement

Daily oral pre-exposure prophylaxis (PrEP) has been proven effective for reducing HIV acquisition among people who inject drugs (PWID). However, the public health benefits, logistics and feasibility of a PrEP program for PWID in the U.S. have not been well-studied. This study partners with syringe services programs (SSPs) in Wilmington, North Carolina to examine the feasibility of PrEP delivery to PWID.

Title: Customizing a Tool to Collect Complex Network Data among HIV-positive Youth in South Africa
Team Leader: Marta Mulawa, Ph.D.
Funding:
Bass Connections
The goal of this Bass Connections project is to customize a novel network data capture tool and to understand the types and structures of social networks among individuals living with HIV. Data collection regarding the social networks of HIV Positive women occurred with participants enrolled in an NIH-funded study titled, “Improving the Health of South African Women with Traumatic Stress in South Africa” (NIH Grant R34 MH102001; PI: Dr. Kathleen Sikkema).

Core Staff Contact

Leadership:

Kathleen Sikkema, Core Director
kathleen.sikkema@duke.edu

Dr. Kathleen Sikkema is the Gosnell Family Professor of Global Health and Professor of Psychology and Neuroscience, 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 over 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.

 

Melissa Watt, Associate Core Director
melissa.watt@duke.edu

Dr. Melissa Watt is an Associate Professor of the Practice 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 two NIH-funded studies on the implementation of Option B+ in Tanzania and developing a stigma-based intervention to support long-term care engagement for pregnant women with HIV. She conducted 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

 

Brandon Knettel, Core Coordinator
brandon.knettel@duke.edu

Dr. Brandon Knettel is a postdoctoral fellow at DGHI and earned his doctorate in counseling psychology from Lehigh University. He is a licensed psychologist with experience in both clinical and research settings and brings expertise related to mental health and substance use assessments, behavioral interventions, community based research, program evaluation, and qualitative analysis. Dr. Knettel 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, he coordinates and provides scientific consultations and peer reviews, and helps facilitate connections across the Duke CFAR and beyond to build the network of HIV researchers.

 

Beth Stringfield, Community Liaison
beth.stringfield@duke.edu

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.

 

Amy Corneli, Investigator and SWG Director
amy.corneli@duke.edu

Dr. Amy Corneli is an Associate Professor in Population Health Sciences. 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 CFAR scientific working group.

 

Elizabeth Knippler, Research Assistant
elizabeth.knippler@duke.edu

Lizzy Knippler is a research assistant at the Duke Global Health Institute. She supports the ongoing research of Dr. Sikkema and Dr. Watt, and is primarily involved with Dr. Watt’s projects promoting HIV care engagement among pregnant and postpartum women in Tanzania. She previously served as the Coordinator for the SBS Core.