Local, National, and Global HIV/AIDS Research & Resources | Spring 2018
Computers, Texting, & Mobile Applications: The Role of Technology in HIV
Technology today plays a significant role in innovation of methods for preventing and treating HIV. This e-newsletter features CAPS/PRC research that discusses the application of technology in various formats, including computers, short-message service (SMS) texting, mobile health (mHealth) tools and applications (apps), and new hardware devices.

Shout out to our Visiting Professors for summer 2018 ! We are welcoming five (5) first-year professors and welcoming back four (4) returning professors who all improved their programs of HIV-related health disparities research.
In This Issue

  1. Local projects
  2. National projects
  3. International projects
  4. Fact sheets: Black men and heterosexual men
  5. National HIV/AIDS Awareness Days: Research and Resources Booklets and Faculty Videos
  6. Announcements
Local research projects
Judy Tan is working with Black gay couples to develop a couples-based mobile health tool for enhancing relationship factors that support HIV care engagement. Interviews and focus groups will generate iterative feedback on prototypes of the app. Findings show that couples engage in dyadic coordination of care engagement, including scheduling appointments together, co-attending appointments, managing ART together. Dyadic coordination appears to involve joint problem solving, and couples who are resilient (e.g., have been through thick and thin together) may be engaging in dyadic coordination of care and treatment. The N’Gage Study is now designing an app, LetSync, to target dyadic coordination in order to improve care engagement and relationship dynamics among these couples. 
Emily Arnold and her collaborators at UCSF and CAL-PEP continue to work with the Bay Area House Ball and Gay Family Communities in the “We Are Family” Study. Focus groups were done to “co-create” and design a mobile health app to promote HIV-related health. Participants said that the app should do four things: provide accurate information, connect users to local resources with maps and reviews, share stories and challenge HIV stigma, and create an online community to promote health and well-being. Community members supported the creation of online channels to promote culturally appropriate sexual health services and accurate HIV prevention and care information.
Parya Saberi’s newest project, PrEP-OI, aims to support and educate healthcare providers on HIV pre-exposure prophylaxis (PrEP). The intervention includes a web-based tool (called PrEP-Rx) and PrEP coordination (by a PrEP Coordinator). The intervention aims to helps healthcare providers improve their knowledge around PrEP, assess risk behaviors that increase the risk of HIV acquisition, prescribe PrEP, and effectively monitor patients on PrEP. The PrEP-OI study will randomize eight primary care clinics across the San Francisco Department of Public Health to sequentially start this intervention.
Parya Saberi and Carol Dawson-Rose are working with youth living with HIV (YLHW) ages 18-29 in the San Francisco Bay Area and their providers to assess the feasibility and acceptability of delivering weekly sessions with a social worker to improve HIV care engagement, improving mental health, and decreasing substance use through text messaging and teleconferencing (telehealth). Existing interventions for YLWH will be adapted and developed to create the “Youth To Text or Telehealth for Engagement in HIV Care” (Y2TEC) intervention. 

Youth most in need of HIV services do not access common, resource intensive approaches frequently implemented in schools or community programs. Marguerita Lightfoot and colleagues’ tested the acceptability and feasibility of youth sending youth generated text messages to their sexually active friends, encouraging them to visit the clinic and test for HIV/STIs. Their innovative strategy, implemented in an urban clinic in the US, diffused text messaging to adolescent’s social networks. The approach was found to be feasible and acceptable, having the potential to impact HIV testing. Given the low number of youth accessing health care services and STI/HIV screening, strategies like this are needed to address barriers that exist and encourage connection with the healthcare system and STI screening. Similar research is currently being implemented in Zimbabwe.
National research projects
Parya Saberi is leading the RxPix study, a nationwide study that compares novel ways of measuring medication adherence remotely for people living with HIV. The study is comparing four different ways of measuring adherence: self-report, text-messaged photos of pharmacy refill dates, text-messaged photos of pill counts, and testing drug levels in hair samples mailed by study participants. Data are now being cleaned, analyzed, and prepared for manuscripts and presentations. The UCSF Hair Analysis Laboratory has also developed a method for measuring drug levels for dolutegravir in hair samples collected in the RxPix study and is in the validation process.
Parya Saberi is leading the development of WYZ (pronounced wise), a mobile health app that addresses the unique needs of youth living with HIV (YLWH). The goal of WYZ is to establish a balance between anonymity and community. WYZ does three things for YLWH: helps with self-care by tracking HIV lab results and reminding to take medications; making communication between providers and patients easier; and building community to reduce social isolation and stigma associated with HIV. WYZ will be field-tested in 2018 and its feasibility, acceptability, and preliminary clinical benefits will be examined in a pilot randomized trial of YLWH.
International research projects
Maria Ekstrand and her Indo-US collaborative team have developed “Tel-Me-Box,” a small, low-cost, wireless pillbox that uses a SIM card to monitor adherence in real time. For the pilot, they printed tel-me-boxes on a 3D printer with respect to size, shape, color and function. During the past year, they made final modifications to the device, adding SD cards to store pillbox information when offline, an antenna to improve network strength in rural areas, and an improved battery. The final version of tel-me-box has now been distributed to almost 100 participants, who will be followed quarterly for 18 months.

William Brown, III and colleagues  implemented a text message-based SMS-CASI system  “FrontlineSMS v1”  in the U.S. and three other countries to aid adherence and monitor behavior in MTN-017, comparing acceptability of rectally-applied reduced-glycerin 1% tenofovir gel to oral emtricitabine/tenofovir disoproxil fumarate tablets. Implementation challenges and solutions in six areas (privacy and security, speed and functionality, standardization across sites, cost, malfunctions, and data management) are discussed. After challenges were addressed, the system was found to be successful in monitoring behavior and biomedical treatment adherence. Results support the use of multilingual SMS-based adherence reminder and CASI system in international settings.
What are Black men's HIV prevention needs?
HIV is a health emergency among Black men of every age and sexual orientation. In 2015, 33% of HIV infections diagnosed in the U.S. were among Black men. They were diagnosed eight times more than white men and two times more than Hispanic men.

What do heterosexual men want and need around HIV?
HIV is a concern for heterosexual men , as almost 14% of new male HIV cases in 2016 occurred among heterosexuals,
through sex with a woman and injecting drug use. Most of those cases were among Black and Latino men, and men living in the Southeast and Northeast of the US.

National HIV/AIDS Awareness Days - 
Research and Resources

These brochures list CAPS/PRC research and helpful resources for the past awareness days this year:

Questions? Contact Daryl Mangosing at Daryl.Mangosing@ucsf.edu
  • National Transgender HIV Testing Day on Wednesday, April 18, 2018 - Check out #NTHTD on Twitter
  • DPS Faculty and Affiliate presentations at CROI 2018 (Conference on Retroviruses and Opportunistic Infections)
  • Congrats to the Saberi Team for launching a new community research group: CAPS Youth Advisory Panel or YAP!
  • New staff: Arianna Salinas (Peer Health Navigator for TRIUMPH Project), Aaron Hostetler (Recruiter/Interviewer for DuoPACT Project), and Hadley Burroughs (Assistant Project Coordinator for Dr. Maria Ekstrand)
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