A spotlight on our international projects
In this e-newsletter we spotlight a sample of global research conducted by the Division of Prevention Science.
In this issue
  1. Director's message
  2. Projects in Africa
  3. Project in the Middle East
  4. Projects in Asia
  5. Projects in South America
  6. Announcements
  7. How can we assist your organization?
Marguerita Lightfoot, PhD - Director's Message
The latest statistics from the World Health Organization indicate that since the beginning of the epidemic, 75 million people have acquired HIV. In 2018, an estimated 37.9 people were living with HIV, 1.7 million were newly infected, and there were 770,000 HIV-related deaths.¹ While countries in Africa are hardest hit, practically no continent has been spared from HIV. I am proud to announce CAPS and the PRC spring 2020 newsletter, dedicated to international research projects. Our cadre of acclaimed faculty are conducting innovative, high-impact projects that span multiple continents and reach diverse populations: men who have sex with men, transgender individuals, couples, families, and youth. Our inquiries into HIV throughout the world for the past 3 decades have helped, in no small way, to reduce HIV incidence among these populations and within their communities. I invite you to enjoy this newsletter and click on available links to learn more about the researchers and their projects.

Projects in Africa

Social Media Messaging for HIV Testing in Zimbabwe
In Zimbabwe, more than 1.18 million people are living with HIV and AIDS. However, just 45% of young women and 24% of young men who had sexual intercourse in the preceding 12 months report having been tested for HIV and receiving their result, suggesting the need for sustainable strategies for HIV testing for youth. Marguerita Lightfoot and colleagues are investigating the efficacy of a peer-driven, social media HIV-testing campaign through the use of social networks. They aim to determine if youth (aged 16-24) who participate in the intervention are more likely to test for HIV than those who are offered standard voluntary counseling and testing for HIV. Additionally, they will examine the feasibility and acceptability of the peer-driven linkage-to-care and retention support strategy.

Disclosure Intervention for Zimbabwean Parents
In Zimbabwe, large numbers of families are affected by HIV/AIDS. Many children (more than 900,000) have lost one or both of their parents to AIDS. Parents are faced with the challenge of whether, how, and when to disclose their HIV status to their children. Dr. Lightfoot and colleagues’ randomized controlled trial examines the impact of a culturally competent intervention to facilitate parental HIV disclosure and the subsequent impact of the disclosure on the parent, child and family. When available, study findings could have the potential to inform current knowledge about the impacts of disclosure on vulnerable families in developing countries.
Self-Test Strategies and Linkage Incentives to Improve ART and PrEP Uptake in Men or the Owete Study (meaning “ brothers ” in Dholuo ), tests combination behavioral and biomedical interventions to improve HIV prevention and care outcomes among highly socially-connected and mobile fishermen in the Nyanza region of western Kenya. Fishermen will be recruited, trained to distribute HIV self-tests, and supported to provide HIV-care and prevention support to men in their close social networks. Carol Camlin and colleagues will determine whether this social network-based approach along with transport vouchers can improve rates of self-testing, linkage to and subsequent progression along the care and prevention cascades (ART and PrEP). A longitudinal qualitative and mixed-methods assessment will help identify the intervention pathways and explore how the social network-based approach can facilitate positive health outcomes.
Projects in the Middle East
Pilot of Culturally Tailored Mpowerment Project for HIV Prevention Among YMSM in Beirut
Susan Kegeles and Scott Tebbetts have been collaborating with Glenn Wagner of the Rand Corporation who was awarded an NIMH RO1 to adapt and pilot the Mpowerment Project (MP) in Beirut, Lebanon. MP is an evidence-based community-level HIV prevention intervention developed for YMSM by Susan Kegeles and Robert Hayes. This is the first implementation and evaluation of any psychosocial sexual health intervention for MSM in the Middle East and North Africa (MENA). It is also the first study of the social network-driven MP project that will use social network (SN) methodology for evaluating and adapting the intervention. Read more here . 
Projects in Asia

Addressing the continuum of care among high-risk Thai men
Young Thai men who have sex with men (YMSM) are at extraordinarily high risk for HIV. HIV prevalence among YMSM is estimated to be 10-15% in Northeastern Thailand. Partnering with the Thailand Ministry of Public Health (MOPH), Thomas Guadamuz of Mahidol University was awarded an RO1 from NIMH and will collaborate with Susan Kegeles and Scott Tebbetts to implement and evaluate a multicomponent, multi-level, community mobilization, combination intervention (HUG-M+) to address the entire Continuum of Prevention and Care. HUG-M+ is based on the Mpowerment Project , an evidence-based community-level HIV prevention intervention developed for YMSM by Susan Kegeles and Bob Hays. Read more here.

Reducing HIV Stigma among Healthcare Providers in India
Health professionals can serve as a crucial source of HIV stigma and could benefit from scalable, sustainable stigma reduction interventions that are adaptable to different cultural contexts. DriSti, conducted by Maria Ekstrand and colleagues, evaluated the efficacy of a promising, pilot-tested stigma reduction intervention in a cluster randomized controlled trial. Significant reductions in misconceptions and worry about acquiring HIV at work were reported. Intervention participants also reported significantly greater reductions in endorsement of coercive policies and in the number of situations in which they intended to discriminate against PLWH than control participants. This brief, scaleable and adaptable intervention has important implications for current global stigma reduction initiatives and training curricula.

Rates of Viral Suppression Improve among Adherence-Challenged People Living with HIV in South India
The success of antiretroviral therapy (ART) has led to both extended life expectancy and improved quality of life among people living with HIV (PLWH). In India, Maria Ekstrand and colleagues conducted the Chetana Study, an adherence intervention trial designed in collaboration with local community groups, to engage adherence-challenged PLWH in a comprehensive wellness program that used a peer-led adherence support approach. At the 12-month follow up visit, intervention participants were more likely to be virally suppressed than control participants. They were also more likely than control participants to self-report adherence and to have eliminated individual adherence barriers and clinic attendance barriers. These low-cost strategies can be implemented by local NGOs, making it both scalable and sustainable in this and similar settings.

Tel-me-Box: Validating and testing a novel, low-cost, real-time monitoring device with hair level analysis among adherence-challenge patients
Maria Ekstrand and her team at St. John’s Research Institute in Bangalore, India have developed a wireless real-time adherence monitoring device called Tel-Me-Box (TMB), that sends wireless signals to a server whenever opened. It is small, low-cost, and rechargeable with a micro-USB cord, and can be programmed to deliver tailored reminders via sound or light. Since it cannot assess actual drug ingestion, this study will validate the TMB data against hair ARV concentrations as a biological measure of adherence in collaboration with Monica Gandhi’s HAL lab at UCSF.   This study will also assess if tailored real-time reminders improve ART adherence in a pilot RCT. The results could have utility for adherence interventions, both in India and globally.
Stigma as a barrier to cancer palliative care outcomes among people with HIV in India
Maria Ekstrand is collaborating with Manipal Academy of Higher Education and King’s College, London on a study to understand the role of HIV and cancer stigma in care-seeking and palliative care in South India. Findings from their prior research demonstrate that HIV stigma is a barrier to engagement and retention in HIV care. However, little is known about the experiences of PLWH who are dually diagnosed with cancer. This study will adapt and test the team’s measures of HIV stigma and palliative care outcomes for use among PLWH seeking cancer treatment in India. The results will inform the adaption of an effective intervention for use with patients and family members in India to improve cancer and palliative care outcomes. Read more here .
Projects in South America

Trans Amigas and Guerrieras: Research with transgender women in Brazil. Globally, transgender (‘trans’) women have 49 times higher odds of HIV infection compared to other groups. In countries with concentrated HIV epidemics, like Brazil, HIV prevalence among trans women is estimated between 25%-33%. Trans women may also experience family and social isolation as well as education and employment barriers.
In May 2018, Drs. Sheri Lippman , Jae Sevelius , and Maria Amelia Veras launched Trans Amigas. The study has trained 9 transgender women living with HIV in Brazil to provide support and guidance for up to 150 participants either just starting care or re-starting HIV treatment after leaving treatment for a time. Peer navigators accompany clients to medical appointments to ensure that care is respectfully and client questions are answered. Navigators also assist clients with disclosure conversations to loved ones. Trans Amigas crowdfunding page
Guerreiras’ (‘warrior women’, as named by trans women participants in Brazil), funded in 2019, is informed by a trans-specific conceptual model, the Model of Gender Affirmation. The model describes intersectional stigma faced by trans women, informs investigations of how intersectional stigma results in health disparities, and provides a framework for intervention development and testing. Implementation of a randomized wait-list controlled, multi-level intervention compares HIV testing uptake (self-testing and clinic-based) and assesses PrEP initiation and persistence as well as reductions in internalized stigma and increased resilience to anticipated and enacted stigma. The intervention can potentially optimize health outcomes in a population where intersectional stigma results in extreme health disparities. The project team includes Drs. Sheri Lippman and Jae Sevelius . Read more here .
Proyecto Orgullo+ (Project Pride +): Promoting prevention and care among MSM and transgender women (TW) in Lima, Peru
Based on formative research and the acceptability of a previous pilot project, Susan Kegeles and colleagues are implementing a multi-level intervention to improve the Continuum of Prevention and Care (CPC) among MSM and transgender women (TW) in San Juan de Miraflores in Lima South. The project aims to facilitate community and individual empowerment around the CPC by building a stronger and healthier community in which MSM and TW support each other, regardless of HIV status. The goals of this community level intervention, which adapts the Mpowerment Project (a USA-based intervention), and the accompanying health system intervention are to: 1) reduce HIV sexual risk, 2) increase HIV testing to every 6 months, and 3) increase engagement in HIV care. Project findings could potentially provide evidence of international relevance, particularly for other Latin American countries with concentrated HIV epidemics among MSM and TW.
ANNOUNCEMENTS
The 23rd International AIDS Conference (AIDS 2020) will take virtually July 6-10, 2020. AIDS 2020 is the world’s largest gathering on HIV and AIDS and serves as a forum at the intersection of science, advocacy, and human rights. Find the calendar for local planning meetings here.
Congratulations to Jae Sevelius , who received the'Bolstering the Pipeline to Achieve Health Equity' award. This 2-year award recognizes faculty members with a strong research track record, commitment to diversity in health sciences, and service to underserved and vulnerable populations.  Dr. Sevelius is one of three faculty members from the Department of Medicine selected for this well-deserved award.
UCSF is responding to the outbreak of the respiratory illness COVID-19. This website provides regularly updated information for the UCSF community. https://coronavirus.ucsf.edu/
HIV and COVID-19. Here you will find guidance and resources prepared by leading HIV organizations: https://prevention.ucsf.edu/COVID19 
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We are home to 101 prevention scientists, researchers and staff who conduct high impact HIV prevention science. We also provide Technical Assistance in the use of HIV science.
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The mission of Center for AIDS Prevention Studies is to end the HIV epidemic and associated health and social disparities by conducting high impact HIV prevention science and building capacity among researchers and communities to effectively address HIV.  Project #: 2P30MH062246
The mission of the UCSF Prevention Research Center is to maintain an interdependent network of community, academic, and public health partners to design and implement prevention research aimed at answering significant and innovative HIV research questions and promoting the wide use of practices proven to promote health for those infected and affected by HIV.  Project #: 5U48DP004998