A doctoral student in social psychology who is an affiliate of the Center for Health Intervention and Prevention recently won a prestigious National Research Service Pre-Doctoral Fellowship Award (NRSA) from the National Institute of Mental Health.
Laramie Smith is the 10th psychology graduate student in the College of Liberal Arts and Sciences working with a CHIP mentor to receive such an award in as many years. She credits CHIP’s supportive atmosphere and researcher services, including the annual internal research grant competitions, with helping her to win her NRSA.
“My CHIP seed grants showed the NRSA reviewers that I already have an established track record, and allowed me to be seen as someone capable of securing her own funding and building a program of research and research collaborations independently,” she says.
Smith will use the award, which is a training grant, to develop and test a theory-based intervention to support retention in HIV medical care for people living with HIV who are tenuously engaged in care.
Retention in HIV care is a critical issue around the world.
Currently in the U.S., people living with HIV are recommended to come in for regular HIV-related care at three to six-month intervals, depending on how well their HIV is controlled. These care visits largely involve the monitoring of HIV for potential progression, checking for potential ill effects of antiretroviral therapy, and evaluation of the current treatment plan. It is estimated that one-third of people living with HIV who initiate care do not use HIV-care services at these recommended intervals, Smith says.
“Inconsistent use of HIV medical care has been associated with potentially dire outcomes, such as poorer prognosis, higher viral loads, and the development of drug-resistant strains of the disease due to intermittent antiretroviral medication adherence,” she says. “Regular clinic visits also provide an ideal window of opportunity for delivering behavioral health interventions to people living with HIV, to promote engagement in self-care and use of HIV-care services.
“While there have been recent intense efforts to enroll people living with HIV into care and to re-engage people living with HIV lost to care, less is known about factors influencing sustained maintenance in HIV care once initiated or re-initiated,” she adds.
A continuation of work begun as part of her master’s thesis, Smith’s NRSA involves two studies to address this gap in the existing literature on engagement in HIV care and unmet service-related needs.
For the first study, Smith will test an Information, Motivation, and Behavioral Skills (IMB) model of retention in HIV medical care with 150 people living with HIV at an HIV care clinic in Bronx, N.Y.
For the second study, Smith will design, implement, and evaluate a proof-of-concept intervention to address core IMB model determinants of retention in care and to promote retention in care in a tenuously engaged inner-city population.
The intervention will be an intensive IMB model-based interview to identify individual barriers to retention in care. The findings will be used to tailor a patient-centered discussion targeting adherence to the next clinic visit. Smith will deliver the intervention at the same Bronx clinic with patients who have had gaps in care over the last 18 months.
As part of her master’s thesis work, she previously conducted qualitative interviews with the same population to learn some of the common facilitators of, and barriers to, retention in HIV care.
Some of the most commonly cited facilitators included the patients’ perceived vulnerability regarding the health consequences of living with HIV and health benefits of maintaining care, as well as their perceived ability and confidence in being able to obtain support from important others (e.g., family, friends, doctors, and clinic staff) for remaining engaged in HIV care.
Some of the most commonly cited barriers included patients’ attitudes and low perceived ability or confidence in being able to negotiate HIV medical care in the face of everyday competing priorities (i.e., managing family stressors or multiple appointments) or more challenging life demands (such as living with comorbid depression or substance use disorder). Smith says that adjustment to living with HIV was an important factor in people’s discussions of coming in or staying out of HIV care.
She says very few researchers are currently working in the field of engagement in HIV medical care, CHIP Principal Investigator Rivet Amico being one of a handful of experts in the field nationally.
Amico and CHIP director Jeffrey Fisher are Smith’s co-sponsors for the NRSA.
Smith hopes to use the training she receives and the pilot data she collects through her NRSA to secure a post-doctoral or young investigator award.
