At a recent Journal of Social Work Practice in the Addictions panel addressing COVID-19’s impact on teaching, faculty productivity, and research, Professor and Associate Dean for Research Marya Gwadz discussed her Intervention Innovations Team Lab’s (IIT-Lab) new mixed methods study examining perspectives on and effects of COVID on Black and Latino long-term survivors of HIV who have not been well-engaged in care and who have not been taking HIV medications.
The broad focus of Dr. Gwadz's research is the development and optimization of potent, innovative, and culturally salient social/behavioral interventions to address racial/ethnic, socioeconomic, and gender inequity in health, using the multiphase optimization strategy framework (MOST), and with a specific focus on HIV and substance use. The IIT-Lab is engaged in a number of research projects that include populations of color, who have been most affected by the COVID-pandemic. As she explained at the panel, after the reality of COVID began to emerge in March 2020 and New York State was put “on PAUSE,” her IIT-Lab not only suspended some studies and shifted to a virtual format for others, but they also built on their existing Heart to Heart 2 (HTH2) project to examine the effects of COVID-19 on that study’s population.
HTH2 is an NIH-funded study using MOST to optimize a behavioral intervention for populations living with HIV with serious barriers to engagement along the HIV care continuum. The study aims to develop a highly efficacious, efficient, scalable, and cost-effective intervention to foster engagement along the HIV care continuum for people living with HIV from African American/Black and Latino and low socioeconomic status backgrounds who are not taking HIV medication at levels sufficient to achieve undetectable viral load. Moreover, HIV and substance use are considered twin epidemics, and Dr. Gwadz noted that most participants have had substance use problems in the past and some also have them currently, which complicates engagement in HIV care. The HTH2 study is testing five intervention components with the primary outcome of improvements in HIV medication use to the point where participants achieve HIV viral suppression.
As COVID-19 cases, hospitalizations, and deaths rose, and disproportionately affected people of color, the IIT-Lab initiated a mixed methods sub-study to explore a range of potential effects of the coronavirus on the lives of HTH2 participants. About 100 participants were engaged in a structured assessment and 26 of them also participated in in-depth qualitative interviews. Explained Dr. Gwadz, “We were interested in risks but also identifying ‘indigenous coping strategies’ and gaps that could be addressed for better future preparedness in times of crisis. We define these as effective ways of managing health and wellbeing in the time of COVID-19 that emerge from the community, but are not necessarily strategies that researchers or experts would have come up with.”
“Also, from a research perspective,” Dr. Gwadz continued, “we need to understand the effects of COVID-19 on our studies as well as we can in order to interpret our results. An event like COVID-19 can be classified as a threat to internal validity of a study. For example, in the case of our HTH2 study, COVID might make some participants more likely to take HIV medication, because they hope being in the best possible health will protect them from COVID-19. Others will have difficulty getting health care and prescriptions filled. Still others may find that the lack of support, structure, and services makes it challenging to use substances at a non-hazardous level, and may experience substance use problems.” Dr. Gwadz expects findings of the COVID sub-study to be published in early 2021.
HTH2 and the COVID sub-study are just two of the IIT-Lab’s active research projects. Others include a project grounded in behavioral economics called, “Addressing serious barriers to HIV viral suppression in populations at-risk: New methods, new directions,” funded by the NYU University Research Challenge Fund, and another project grounded in behavioral economics and MOST entitled, “Supporting Health Behavior Among Persons Living With HIV Using Tech, MOST, and Behavioral Economics”, funded by NYU Silver’s Constance and Martin Silver Artificial Intelligence and Social Impact Fund. The team’s most recent publication, Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: a qualitative exploration through the lens of symbolic violence in the International Journal for Equity in Health, is available with open access. Follow @IITLabNYU on Twitter to keep up on the team’s activities and publications.
Update: Findings of this study were published online first in the journal AIDS and Behavior.
Gwadz, M., Campos, S., Freeman, R. et al. Black and Latino Persons Living with HIV Evidence Risk and Resilience in the Context of COVID-19: A Mixed-Methods Study of the Early Phase of the Pandemic. AIDS Behav (2021). https://doi.org/10.1007/s10461-021-03177-0