Reaching the poorest children with nutrition and WASH in Urban settings: Implementation science priorities in East Africa
Dr. Sembajwe is the CUNY contact on urbanization and development, on the USAID supported project to improve the health of poor children in urban areas. Working closely with its implementing partners, University Research Company (URC) and East, Central and South Africa Health Community (ECSA), the project aims to develop an evidence informed implementation science agenda for improving the health of poor children through nutrition and WASH interventions and attaining Sustainable Development Goals (SDG). Thereby, the project has committed to using a multi-sectoral platform to facilitate and integrate a comprehensive urban health policy and community response that ensures engagement of all stakeholders in urban WASH and nutrition challenges.
Frequent Utilizers of Hot Spotters in U.S. Jails
A multi-jurisdictional project to characterize frequent utilizers or hot spotters in US jails, identify local policy responses, and lay foundation for developing new tools and responses. The research team is conducting a descriptive inventory and conducting exploratory analyses of frequent utilizers or hot spotters across ten sites (city/county jails) to identify similarities and differences, investigate different prevention strategies, and assess the feasibility of adapting effective strategies to other jurisdictions. Project of CUNY Institute for State and Local Governance.
Determining Barriers to PrEP Uptake Among Black Women
CUNY Office of Research, Evaluation, and Program Support
This study examines awareness of and experiences with pre-exposure prophylaxis (PrEP) among Black women in New York City. Black women are disproportionately impacted by HIV. In 2015, nearly two-thirds (61%) of women diagnosed with HIV were Black, despite comprising just 12% of women in the US. Biomedical HIV prevention strategies, such as PrEP represent new opportunities to reduce HIV rates among Black women, yet PrEP uptake has been low. In an effort to close this gap, this study aims to understand Black women’s awareness of PrEP, attitudes about administration and uptake, barriers to and facilitators of use, and perceived effective dissemination strategies. Such data will serve as the foundation for future research that will develop and test an intervention to increase PrEP uptake among Black women, with an emphasis toward Black women in urban environments.
Einstein-Rockefeller-CUNY Center for AIDS Research (ERC-CFAR)
The Einstein-Rockefeller-CUNY Center for AIDS Research is driving a clinical implementation and community-based research agenda, with resources devoted to behavioral science, clinical translation of research findings into novel treatments, the discovery of biomarkers, applying advanced technologies for improving clinical outcomes and developing an HIV vaccine. Experts in implementation science determine and apply the most effective ways to provide patient care, therapies, testing, and pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medications to prevent HIV acquisition.
The new center is one of 19 CFARs nationwide that are funded as part of an NIH-coordinated initiative to support multidisciplinary research aimed at reducing the burden of HIV in the United States and abroad. A major focus of the ERC-CFAR's mission is to translate research into sustainable implementation of population level interventions and strategies that have the potential to improve HIV-related outcomes and reduce health disparities on a large scale.
Program Refinements to Optimize Model Impact and Scalability based on Evidence (PROMISE)
The PROMISE study aims to prospectively and rigorously evaluate the implementation and impact of modifications to a multi-component NYC Ryan White care coordination model that has already shown evidence of effectiveness. The revised-Care Coordination Program (rCCP) will be rolled out in June 2018 and compared to a) the original CCP model and to b) usual care outside of the CCP. The proposed study, to be conducted on a large scale within real-world HIV service settings, will identify attributes and drivers of provider and client engagement in the intervention and provider and client preferences for future revised-CCP delivery and receipt. In this way, the work will advance a second generation of interventions capable of strengthening the care continuum among PLWH who have been unable to achieve desired ART outcomes in existing interventions, due to major structural or psychosocial barriers. This project is a collaboration between CUNY ISPH and the NYC Department of Health and Mental Hygiene.
Collaboration on HIV and Aging Research – Hudson Valley
Dr. Baim-Lance leads the research component for the Collaboration on HIV and Aging Research-Hudson Valley (CAHAR-HV). CAHAR-HV is made up of a diverse group of stakeholders of patients, providers, government agencies and researchers, working together to develop projects that improve the care for older individuals with HIV. CAHAR-HV is in the process of developing feasible, scaled-up implementation science studies on issues pertinent to HIV and aging using community-based, participatory research methods. CAHAR-HV is supported with a Pipeline to Proposal Award from the Patient Center Outcomes Research Institute (PCORI).
SMAART Well Being Dashboard
This project is a supplement with the DOHMH to design, develop, implement and conduct a usability evaluation of an interactive, internet enabled human centered SMAART dashboard. The dashboard will facilitate data collection, data processing and tracking of the well-being and mental health of first aid workers across the New York City.
The Healthcare Stories Project
New York State Department of Health
The Healthcare Stories Project (HCSP) is an initiative of the New York State Department of Health AIDS Institute. HCSP was developed in consultation with Dr. Baim-Lance based on findings from her Consumer Lens Study (Baim-Lance et al., 2015). The HCSP consists of three interactive activities designed to learn from patients about their healthcare experiences, and engage them more fully in quality improvement taking place at their healthcare facilities. The HCSP is designed to move from patient engagement, through analyses of service delivery and making meaningful, long-lasting patient-provider partnerships. HCSP is funded by the Ryan White Program.
Prenatal Stress and Risk of Offspring Asthma/Allergy
University of Western Australia
The goal of this study is to examine the potential role of prenatal stress exposure to the development of allergy and asthma among offspring in the RAINE birth cohort study.
Together 5,000 (T5k): Following a U.S. National Cohort of Vulnerable Men to Improve HIV Prevention and Care
This project addresses critical needs in HIV prevention research by using innovative technology to enroll a sample of 5,000 high-risk HIV-negative gay, bisexual, and other men who have sex with men ages 16 to 49—the population representing the highest percentage of new infections annually—and follow them prospectively for four years. The study design is specific to identifying individual-, network-, and contextual-level predictors and correlates of HIV seroconversion, identifying missed HIV prevention opportunities among those seroconverting during the course of the study, and using our findings to inform interventions to further reduce acquisition and transmission.
WHO/ILO joint methodology for estimating work-related burden of disease and injury
Dr. Sembajwe is a lead reviewer of a systematic review on the psychosocial exposures in relation to stroke, one of ten systematic reviews being conducted as part of the WHO/ILO joint methodology for estimating work related burden of disease and injury. As lead reviewer, she is responsible for driving the systematic review, participating in coordination activities across working groups and area experts, and is the focal point between WHO, ILO and INAIL secretariats. In addition to this lead role, Dr. Sembajwe is also an active member of the review team on silica dust exposure in relation to tuberculosis for the WHO/ILO join project. Overall, the project involves nine working groups spread across 21 countries. Additional reviews are being conducted on identified pairs of prioritized occupational risk factors and health outcomes including occupational noise, violence and exposure to dusts and fibers.
The New York City Department of Health and Mental Hygiene (DOHMH) has started an exciting new project that integrates PrEP navigation services into the standard of care at eight sexually transmitted disease (STD) clinics throughout the city. The new navigation program has tremendous potential to improve access to PrEP services for individuals who need it most. Many cities across the U.S. are interested in adopting this type of STD clinic-based PrEP program, and NYC can serve as a model to help inform and develop those efforts.
At the same time, it is a significant challenge to implement an innovative, large-scale program at eight STD clinics that are already extremely busy and juggling multiple competing demands. Traditional "evaluation" efforts track program activities, but often don't dig deeper to understand how a program really works in practice. Because it is so innovative, it is critical to understand how and why this program is helping patients, and identify any "gaps" or challenges in the model that could be changed to better meet the needs of specific patient populations.
Project IMPrOVE is a collaboration between NYC DOHMH and the Hunter HIV/AIDS Research Team (HART) of City University of New York. The goal of Project IMPrOVE is to learn from the implementation process of this new PrEP navigation program and better understand what works and what doesn't. But the real focus of Project IMPrOVE is to understand why. Project IMPrOVE is designed to ask three types of questions:
- Are there aspects of the PrEP navigation program that need to be changed to better serve patients or better integrate the program into the existing workload of the clinic?
- Are there specific types of clients who are more or less likely to be helped by the PrEP navigation program? What program modifications or alternative strategies would help better reach them?
- What happens to clients once they are connected to clinical referral sites? What makes certain sites successful in engaging and retaining clients that are referred? What additional support, training, or resources are needed to improve the referral process?
Over the next two years, the research team at Project IMPrOVE will be working with STD clinics to answer these questions and provide concrete suggestions for improving the program. In collaboration with our STD clinic partners, we will collect data from clients, staff, and referral sites. The objective of Project IMPrOVE is not only to improve NYC's PrEP navigation program, but also to provide a template for dissemination of a successful model that could be adopted by STD clinics across the country.
The LSTART Study examines the multi-level factors associated with late antiretroviral therapy (ART) initiation in Kenya, Mozambique, Rwanda, Ethiopia and Tanzania. The study covers multiple areas including, 1) multi-level factors (contextual, clinic, and individual) associated with late ART initiation; 2) clinic-level barriers and enablers to timely enrollment, identified through observation of provider-patient interactions and provider in-depth interviews at four clinics in Ethiopia and 3) identification of individual risk factors for late ART initiation through quantitative surveys from 6 clinics in Ethiopia that combine cross-sectional survey data with longitudinal service delivery/clinic data and include information on HIV testing and care history, HIV beliefs, stigma, disclosure, quality of life and sexual behavior. The study is a collaboration between the CUNY ISPH, Columbia University-ICAP, the HIV Center for Clinical and Behavioral Studies at Columbia University, and the Oromia Regional Bureau of Health.
This study aims to assess the effectiveness of the NYC Ryan White comprehensive HIV Care Coordination Program (CCP) relative to that of usual care outside the CCP for persons living with HIV and residing in NYC, to determine what individual and program-level factors are associated with optimal care outcomes for CCP participants and to determine the cost-effectiveness of the CCP relative to usual care outside the CCP. Through this work, CHORDS is generating much-needed evidence related to the effectiveness, outcome determinants and cost-effectiveness of a promising, scalable service delivery strategy, ultimately increasing the capacity of HIV care programs to achieve the greatest possible uptake and impact. The project is a collaboration between the CUNY ISPH, the New York City Department of Health and Mental Hygiene, and New York University Section on Value and Effectiveness (SOLVE).
The Central Africa IeDEA (CA-IeDEA) project is part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA)- an international research consortium established in 2005 by the U.S. National Institute of Allergy and Infectious Disease (NIAID) to address high priority HIV/AIDS research questions.
The CA-IeDEA network includes 15 partners in Burundi, Cameroon, the Democratic Republic of Congo (DRC), and Rwanda, who are utilizing implementation science to identify effective strategies for optimizing HIV care outcomes, including timely diagnosis and care enrollment, care retention, ART initiation and viral suppression. CA-IeDEA partners are also conducting clinical epidemiologic investigations of co-morbidities among people living with HIV , including non-communicable chronic diseases, and mental health and substance use disorders. Members of the CA-IeDEA team also lead and contribute to multi-regional IeDEA projects, and maintain updated population-based data from various sources for use in examining contextual determinants of HIV outcomes.
CA-IeDEA research is jointly led by Dr. Denis Nash (CUNY ISPH) and Dr. Kathryn Anastos (Albert Einstein College of Medicine), in partnership with investigators from the Centre National de Reference en Matière de VIH/SIDA (Burundi); the Centres de Traitement Ambulatoire de Pointe Noire and Brazzaville (Republic of Congo); Douala General Hospital/Clinical Research Education, Networking and Consultancy (CRENC) (Cameroon); the Kinshasa School of Public Health and Kalembelembe Pediatric Hospital (DRC); Rwanda Military Hospital, Data Solutions LLC, Vanderbilt University, Columbia University, Ohio State University, and Virginia Commonwealth University.
The purpose of the End of the Epidemic (ETE) Dashboard System is to measure, track and disseminate actionable information on progress towards achieving New York State’s Ending the Epidemic Initiative’s goals to all interested stakeholders. The Dashboard provides dynamic and interactive content on key indicators of the HIV epidemic including prevention, new infections, testing, new diagnoses and linkage. By integrating these various data realms into one platform, the ETE Dashboard provides users the opportunity to monitor and report progress on HIV-related outcomes and initiatives throughout New York State. Incorporated within the ETE Dashboard is the ETE Data Portal, a web-based data import platform designed for HIV/AIDS organizations and programs to submit and view outcome and performance data on key indicators such as timely linkage to care, retention in care and viral load suppression. The ETE Data Portal has the ability to generate in real-time, facility-, region-, and program-level reports via interactive data displays to both enhance quality improvement activities at the local level and to disseminate outcomes to a wider audience via the ETE Dashboard. The ETE Dashboard was designed and developed by the ISPH, in collaboration with the New York State AIDS Institute, the New York City Department of Health and Mental Hygiene, and the Data Subcommittee of the New York State End of the Epidemic Task Force.
Pre-ART Retention in Care (PARC)
The PARC study, conducted in Tanzania, was set up to better understand barriers and enablers to retention and engagement in HIV care among adult patients who are enrolled in HIV care and are not yet eligible for ART. The study seeks to describe barriers and enablers to retention and engagement in HIV care and to estimate the incidence of short-term outcomes, including the rate and proportion of disengagement from HIV care, death, and transfer out. In addition, the PARC study also conducted qualitative interviews and focus groups on perceived barriers to engagement as well as exhaustive patient interviews to obtain baseline information on potential determinants of disengagement from care among ART-ineligible patients. The findings of the study will help design interventions to maximize retention and engagement in HIV care. Partners in this study include Columbia University-ICAP and the National Institute for Medical Research of Tanzania.
Focused Action towards Suppression and Stopping Transmission (FASST)
HIV Center for Clinical and Behavioral Studies
Focused Action towards Suppression and Stopping Transmission (FASST) is centered on the study of persons living with HIV (PLWH) who attend New York City’s (NYC) public STD clinics. Specifically, FASST aims to quantify and describe gaps in HIV care among patients newly diagnosed with HIV at STD clinics, as well as clinic attendees with previously diagnosed HIV who are in need of linkage or re-linkage to HIV primary care. In addition, the study is focused on assessing patient and provider perspectives about the challenges associated with current procedures for referring HIV-diagnosed patients to HIV primary care, and gauging the feasibility of providing STD clinic medical providers with access to data from the NYC Department of Health and Mental Hygiene (DOHMH) HIV Surveillance Registry to identify STD clinic attendees previously diagnosed with HIV who may need assistance accessing or re-accessing HIV primary care. The Bureaus of HIV and STD Control and Prevention at the New York City Department of Health and Mental Hygiene are partners in this study.
Haiti Demographic and Health Project
The Haiti Demographic and Health Project aims to describe the population structure, mortality and morbidity patterns, including prevalence of select communicable and non-communicable disease (NCDs) symptoms and their risk factors, in urban slum populations in Port-au-Prince, Haiti. To this end, exhaustive surveys are being conducted with 550 randomly selected households and 1,100 adults. The study is unique due to its combination of population-representative design, emphasis on NCDs, and systematic measurement of blood pressure in an understudied, largely healthcare-naïve, urban slum population in Haiti. Study results will help identify health needs and promising interventions for rapidly evolving slums settings, as well as serve as the foundation of extramural interdisciplinary research proposals on NCD determinants and interventions. The study is led by investigators from Weill Cornell Medical College Center for Global Health, CUNY ISPH, the University of Minnesota, and the GHESKIO clinic in Port-au-Prince, the largest HIV and TB care center in the Caribbean.
HIV and AIDS Repository Project (HARP)
The HIV and AIDS Repository Project (HARP) is a global database that includes information from 5 global databases; The Global Burden of Disease, Demographic Health Surveys, UNAIDS, GHO and UNDP, and covers all countries and dependencies across the six regions of the world as defined by The World Health Organization. The repository provides easy, electronic access to HIV/AIDS related outcomes and predictors and is designed to be updated as additional information becomes available. As one of the few aggregate data repositories of this nature, HARP promotes a cohesive assessment of disease burden epidemic characteristics and achievements, whether just at a snapshot in time, or analyzing trends over time.
The Vital Strategies Data Impact Program
The CUNY ISPH has partnered with Vital Strategies to provide technical assistance to the Ministry of Health in Morocco in the establishment of Regional Public Health Observatories (RPHO) throughout the country through the Bloomberg-funded Data for Health Initiative. As part of this work, the CUNY ISPH providing guidance and recommendations to improve data flow and decision support systems, and creating templates for both data reports and dashboard/website design. Partners include Vital Strategies and the Ministry of Health in Morocco.
Positive Pathways is an innovative public health demonstration initiative funded by the Centers for Disease Control and Prevention. This initiative has the potential to identify new and existing cases of HIV in the correctional setting, link these individuals to medical care for HIV during incarceration and ensure continued linkage to medical care for HIV upon and 6 months after release to the community. Project activities are currently underway in 17 NYS DOCCS correctional facilities across NYS.
Y Get it? Project
The Y Get it? Project was created by the NYS Department of Health-AIDS Institute as part of New York State’s (NYS) Ending the Epidemic 2020 and HRSA’s Special Projects of National Significance (SPNS) initiative. The project is designed to facilitate the timely entry of young HIV+ individuals age 18-34 into HIV care, encourage vulnerable young persons to remain in care, and sustain viral load suppression among those in care. Y Get It? is comprised of a mobile application (named “get”) and Peer Engagement Educator Professionals (PEEPs) who serve as mentors at two engagement hubs. The CUNY ISPH serves as the Local Evaluator for this project.
DOHMH DSRIP Data sources
Public Health Solutions / NYC DOHMH
The New York Delivery System Reform Incentive Payment Program (DSRIP) provides a unique opportunity for collaboration to address HIV at the population level in New York City. To best address the drivers of the HIV epidemic in New York City, Performing Provider Systems (PPS) who have chosen Domain 4cii HIV projects have joined together to establish the DSRIP HIV Coalition. These PPSs have committed to building on their individual resources and expertise and coordinate their DSRIP responses to maximize all PPSs’ ability to successfully address barriers to increased access to and retention in HIV care. In support of the work of the DSRIP HIV Coalition, The CUNY Institute for Implementation Science in Population Health provides evaluation and technical assistance for data use for programs implementing DSRIP HIV population‐level interventions who are participating in the DSRIP HIV Coalition.
For more information visit http://hivdatacompendium.org/
Created by the NYS Department of Health AIDS Institute (NYSDOH AI), New York Links (NYLinks) supports the delivery of routine, timely, and effective care for Persons living with HIV/AIDS (PLWHA) in New York State. Specifically, the project is focused on bridging systemic gaps between HIV related services in order to achieve better outcomes for People Living With HIV (PLWH) by improving systems for monitoring, recording, and accessing information about HIV care in NYS and improving outcomes for PLWA through more effective system monitoring, recording and accessing information about HIV care in NYS. NYLinks was created in 2011 through a HRSA HIV/AIDS Bureau (HAB)-sponsored Special Projects of National Significance (SPNS) and has been under the Governor’s Ending the Epidemic Initiative through the NYSDOH AI since September 2015. The ISPH serves as the Evaluator of this initiative and provides regional data support for the project. The NYS Department of Health AIDS Institute is a partner in this project.