Moving Forward Together: Advancing Health Care for Those Left Behind

Maryann Zacharias Uncategorized

Robert Cook, MD, MPH

Robert Cook, MD, MPH

On September 27, 2016, Florida Community Health Action Information Network (CHAIN) will host its second annual conference, Moving Forward Together: Advancing Health Care for Those Left Behind. The conference will join national experts, advocates, consumers, health care providers, and other stakeholder together in an effort to spread information about current health care topics and ways to improve the health of all Floridians.

The conference schedule includes discussions on children’s and seniors’ health, mental health, and infectious diseases, among others.

This year, among the plenary speakers is our very own director, Dr. Robert Cook. As an expert on infectious diseases, Dr. Cook will cover various aspects of diseases in Florida, and along with the other speakers will discuss topics such as innovative delivery systems, preventive services, and health literacy.

We look forward to seeing you there!

Marijuana and HIV Viral Load Suppression

Maryann Zacharias Uncategorized

A recent study from SHARC headed by Dr. Chukwuemeka Okafor indicates that marijuana use may not have an adverse effect on viral load suppression in persons living with HIV (PLWH). The article was titled Marijuana use and viral suppression in persons receiving medical care for HIV-infectionand was published in the American Journal of Drug and Alcohol Abuse.

Dr. Okafor stated, “Marijuana use is common among people with HIV as some individuals report that marijuana relieves a wide range of symptoms, including chronic pain, nausea and loss of appetite.” However, studies on the effects of marijuana on HIV clinical outcomes are limited. This study aimed to fill that gap as it reports the effects of marijuana use on viral suppression.

The study used data from SHARC’s Medical Monitoring Project (MMP) and analyzed data collected from five annual cross-sections from 2009 to 2013. The results showed no statistically significant association between marijuana use and viral suppression.

This study is especially relevant in Florida because Florida has the third highest number of PLWH as well as the highest number of newly diagnosed HIV infections in the United States. In addition, Florida voters will consider, in November, a constitutional amendment to legalize medical marijuana. Dr. Okafor stated, “If passed, it is possible that Florida residents with HIV may have increased access to marijuana, yet any association between marijuana use and viral suppression among those receiving medical care has not been thoroughly described.”

Dr. Okafor suggests, “Future research should include larger studies using longitudinal designs and more precise measures of the marijuana used by participants, including the cannabidiol and tetrahydrocannabinol content.”

Effects of Heavy Alcohol Use on Clinical Outcomes of HIV Patients on ART

Maryann Zacharias Uncategorized


Dr. Christopher W. Kahler

Two longitudinal studies from Brown University have found that persons living with HIV (PLWH) who have alcohol use disorder or engage in high levels of alcohol consumption may be at increased risk of all-cause mortality. This is increasingly significant in terms of clinical research as resent estimates indicate that approximately 61% of PLWH have consumed alcohol in the past year with nearly 15% reporting to be heavy drinkers.

Dr. Christopher W. Kahler, professor and chair in the department of behavioral and social sciences in the Brown University School of Public Health and SHARC executive committee member, and his colleagues looked at the impact of past 30-day frequency drinking on both HIV- and non-HIV-related clinical outcomes. They also examined the extent to which the reduction of adherence to antiretroviral therapy (ART) could be seen as the cause for these outcomes. The team used data from the Study to Understand the Natural Hisotry of HIV/AIDS in the Era of Effective Therapy. They used longitudinal mediation analysis, which allowed them to estimate natural direct effects of heavy drinking frequency on clinical outcomes and natural indirect effects mediated through ART adherence.

Essentially, Dr. Kahler and his colleagues found that PLWH who also engaged in heavy drinking experienced deleterious effects on multiple clinical biomarkers, including HIV VL, CG4+ T-cell counts, and estimated liver fibrosis, while reducing such engagement exhibited benefits, such as increasing ART adherence and reduction of the negative effects of heavy drinking on the body.

Click here to read the full study.


Spotlight: Chukwuemeka Okafor, Ph.D.

Maryann Zacharias Uncategorized

Chukwuemeka Okafor, PHD

Chukwuemeka Okafor, PHD

Dr. Okafor Giving his presentation

Dr. Okafor Giving his presentation

On Thursday, June 30th, 2016 Chukwuemeka Okafor, MPH, Ph.D, defended his dissertation titled, “Marijuana Use Among HIV-Seropositive and HIV-Seronegative Men: Long Term Trends, Predictors of Use, and Impact on Cognitive Function.”

Dr. Okafor earned his Bachelors in Biochemistry from the University of Lagos in Nigeria and his Masters in Health Behavior from the University of North Florida in 2012. He then came to the University of Florida to pursue his Ph.D in Epidemiology as a graduate fellow through the College of Public Health and Health Professions. Dr. Okafor has since focused on the cognitive and inflammatory impacts of substance use, including cannabis use, in individuals living with HIV.

Dr. Okafor has been a major contributor to SHARC since he joined in 2012. He has helped recruit participants in the Florida Cohort Study, presented several posters using SHARC data, and has been actively involved with the WHAT-IF? project.

During his time with SHARC, Dr. Okafor finds that his most significant accomplishments must be the collaborations he was able to do with faculty and students. “It was truly and amazing learning experience that was productive in the end,” he said. These collaborations culminated in the publication of two primary-authored papers. In addition to this, another important accomplishment for Dr. Okafor was obtaining an F31 research training grand from NIDA, and he acknowledged, “The many interactions with the faculty in SHARC proved very helpful in fine-tuning my research protocol/study design for the training grant.”

Currently, Dr. Okafor is working on publishing two of the papers from his dissertations. The first looks at long-term trends in the prevalence of marijuana use and the second looks at the effects of cumulative exposure to marijuana cognitive function among HIV-positive and HIV-negative men.

Regarding his future goals, Dr. Okafor plans to pursue an academic research career that will focus on biomedical HIV prevention approaches, particularly among high-risk groups that include young minority men who have sex with men, as well as among drug users. Dr. Okafor has accepted a post-doctoral position at the University of California, Los Angeles, and plans to continue research there.

Spotlight: Jon Mills, M.B.A, Ph.D.

Maryann Zacharias Uncategorized

Jon Mills

Jon Mills, MBA, PHD

On June 2, 2016, Jon Mills, MBA, PhD, defended his dissertation titled, “Comparative Effectiveness of Dual-Action versus Single-Action Antidepressants for Treatment of People Diagnosed with Co-Occurring HIV/AIDS and a Major Depression: A Growing Syndemic,” a study that involved a collaboration with the CFAR Network of Integration Clinical Systems (CNICS) cohort study.

Dr. Mills was a doctoral student at SHARC. He completed his Masters in Business Administration at the University of Colorado and went on to pursue a PhD in Health Services Research as a student at the University of Florida.

Dr. Mills was an active student member of SHARC. He has attended all SHARC conferences and presented posters using SHARC data. He was the leader of the Medical Monitoring Project (MMP) working group and is the primary author on three abstracts and one manuscript using this data.

His most recent paper as a primary author is titled, “The comparative impact of different patient-centered medical home domains on satisfaction among individuals living with type II diabetes.” The study focused on diabetes, however, patient-centered medical homes (PCMHs) are a model of providing care that is quite applicable to people living with HIV/AIDS. Dr. Mills hopes to complete a study at some point in the future analyzing collaborative care models like PCMHs in a population with HIV/AIDS and depression.

When asked about his most significant accomplishments at SHARC, Dr. Mills stated,“The main accomplishment was taking advantage of an incredible opportunity to collaborate with an exceptional group of faculty, students and staff. I experienced first hand the importance of collaboration especially when addressing a health issue as complex as HIV/AIDS and the co-morbidities common among this population.  Our task is not a one person job.”

Regarding his future goals, Dr. Mills has expressed interest in pursuing a career in academia. He intends to continue his research studying the impact of interventions, policies, and treatment for people suffering from co-occurring psychiatric/substance use disorder and HIV/AIDS. He would also like to continue developing expertise in comparative effectiveness research (CER), stating, “I learned from my dissertation that CER is much more complex than meets the eye. I find CER to be an essential type of research in translational science especially in the absence of a paradigm shift in treatment (e.g. discovery of a cure of HIV/AIDS).

Vanessa Ayala Wins Best Poster Presentation Award

Maryann Zacharias Uncategorized

MPH student Vanessa Ayala

From FIU’s Stemple News:

Most people don’t expect to catch Shark Week on TV until late June. But at FIU, we celebrated our own SHARC week a little earlier…

This year’s SHARC Conference took place on FIU’s Modesto A. Maidique Campus on May 18 and included workgroups, speakers and a poster session where students and investigators presented some of their work. However, this conference didn’t address the dangers of sharks in our waters and instead dealt with the twin dangers of alcohol and HIV.

“SHARC” stands for Southern HIV Alcohol Research Consortium and it’s a collaboration between researchers at FIU and the University of Florida who are on a mission to improve health outcomes and reduce HIV transmission among the diverse range of populations affected by alcohol and HIV infection in the Southeastern United States. Within this mission, the SHARC team is focusing on persons living in Florida, a state with high HIV incidence, substantial population diversity, and a high number of older persons living with HIV.

Although these are preliminary findings,  it suggests that there is more to learn about the process of testing, getting diagnosed and getting linked to the appropriate care resource for those who are incarcerated.

During the conference, Vanessa Ayala, who is pursuing a Masters in Public Health with a specialization in Epidemiologypresented a poster on linkage to care for those who were diagnosed with HIV in correctional facilities versus those who were diagnosed elsewhere. She found that those who were diagnosed in correctional facilities took longer to get linked to care, which has policy implications.

SHARC is funded by the National Institute on Alcohol Abuse and Alcoholism. Its principal investigators are Bob Cook, M.D., Ph.D. of UF and Maria Jose Miguez, M.D., Ph.D. of FIU. Other FIU investigators include FIU Stempel College faculty Jessy Devieu, M.P.H., Ph.D. andGladys Ibañez, Ph.D.For her work, Vanessa received the award for Best Poster Presentation.

Read the original article here.
Ms. Ayala was also featured in the ASPPH Friday newsletter!

Alcohol Use and Treatment in Women Living with HIV

Maryann Zacharias Uncategorized

From The Association of Schools and Programs of Public Health, written by Jill Pease:

A pair of recent University of Florida studies examines reasons for alcohol consumption and use of alcohol treatment among women living with HIV.

About half of women who are HIV positive report consuming alcohol and 14 to 24 percent drink at hazardous levels. Hazardous drinking can lead to adverse health effects, such as lower medication adherence and increased risky sexual behavior, and, as a result, higher levels of HIV virus in the body and more rapid disease progression. To better understand the unique reasons that women with HIV drink alcohol, a UF team conducted four focus groups in Jacksonville, FL, Washington, DC, and Chicago, IL.

Robert Cook, MD, MPH

Dr.Robert Cook

“Most all of the existing data on alcohol and HIV is from studies that mostly included men,” said lead author Dr. Robert Cook, a professor of epidemiology and medicine at the UF College of Public Health and Health Professions and the College of Medicine, and director of the Southern HIV Alcohol Research Consortium. “Women often drink alcohol for different reasons than men do. For example they are more likely to drink in response to depression. Therefore, we were interested in learning the consequences of drinking in women, as well as the potential benefits women get from drinking.”

The team found that women’s reasons for drinking included managing pain, coping with emotions or social engagement. Participants reported several consequences to their drinking, such as negative effects to their health, including poor medication adherence, risky or regrettable behavior and adverse effects on relationships. The findings appear in the journal BMC Public Health.

In the second study, published in the Journal of Substance Abuse Treatment, a team led by Dr. Xingdi Hu, a recent graduate of the UF doctoral program in epidemiology, studied use of alcohol treatment programs in nearly 500 women with HIV who were participants in the Women’s Interagency HIV Study cohort. About one in five said they had recently used some kind of alcohol treatment, with Alcoholics Anonymous being the most commonly reported program.

“We were surprised to learn that women with fewer economic resources were more likely to obtain treatment,” said Dr. Cook, the study’s senior author. “Usually, it’s the other way around — people with more resources get more health services. But in this case, perhaps if participants were unemployed they had more time available to engage in treatment, or they could take advantage of a treatment program that has little to no costs, such as Alcoholics Anonymous.”

Taken together, the two studies provide researchers with important information for developing alcohol interventions and implementing them in public health settings.

“Our research suggests that women may be more receptive to treatment if we can ensure that we can manage any symptoms that they were treating with alcohol, such as pain or depression,” Dr. Cook said. “We also need to think of ways to provide substance abuse interventions that involve little or no cost, for example, cell phone apps.”

Researchers Explore Key Lessons from HIV Programs to Redesign Refugee Health Services

Maryann Zacharias Uncategorized

Dr. Miriam Rabkin (photo credit: ASPPH)


Dr. Wafaa El-Sadr (photo credit: ASPPH)

The worldwide response to the HIV epidemic provides a standard which researchers, policymakers, and providers can use to better service those with non-communicable, chronic diseases, particularly in emergencies. In a recent study, Dr. Wafaa El-Sadr, professor of epidemiology at Columbia University and ICAP global director, and Dr. Miriam Rabkin, professor of epidemiology at Columbia and director of Health Systems Strategy at ICAP, and Fouad M. Fouad, assistant research professor of epidemiology and population health at the American University of Beirut, explored evidence-based approaches, intensive patient education, and the use of outreach workers and peer educators as potential lessons from HIV programs in order to reevaluate and redesign refugee health services.

The refugee crisis is a contemporary problem, highlighting the significance of this research. While the health needs of displaced groups have expanded in recent years, health and relief organizations have traditionally concentrated on infectious diseases, acute illness, and reproductive health. Chronic, non-communicable diseases (NCDs) such as cardiovascular disease, cancer, and diabetes, are gaining attention as a serious burden for refugees, and especially for refugees from middle-income countries, such as Syria, Iraq, and Ukraine.

According to Dr. El-Sadr, “The challenge of providing services for chronic illness in the context of displacement is a daunting one, given that a key element of effective care for NCDs is continuity – the need to deliver coordinated services over time, but evidence from HIV programs shows that continuity care can be delivered in challenging settings – including in complex humanitarian emergencies – and suggests key priorities for NCD services for forcibly displaced people.”


Brown Unviersity Develops Coding System to Characterize Topics of Patient Speech in a Motivational Intervention for Alcohol and HIV/Sexual risk in Emergency Department Patients

Maryann Zacharias Uncategorized


Dr. Christopher W. Kahler (photo credit: ASPPH)

Brown University’s Dr. Christopher W. Kahler, professor and department chair of behavioral and social sciences, and colleagues developed a topic coding system and found that topic coding may be a valuable resource for counselors.

Coding patient language allows for healthcare professionals to gain insight into patient behavior. It is a way to understand the causes behind behavior change and could thus lead to more efficient and effective methods in health behavior counseling. According to the paper, behavior change counseling covers topics such as the patient’s behavior pattern, barrier and facilitators of change, and change plans. Dr. Kahler and his colleagues explore how the topics discussed in a health behavior intervention correlate to patient change language across two target behaviors: alcohol use and sex risk.

In the study, researchers used the new Generalized Behavior Intervention Analysis System (GBIAS) in coding sessions of an effective intervention that reduced both alcohol use and sexual risk behaviors. The demonstration resulted in insight that could be valuable to counselors when dealing with alcohol and sex with patients.

The study was published in Patient Education and Counseling. To read the complete paper, click here.

2016 CHAART Scientific Meeting

Maryann Zacharias Uncategorized


CHAART Consortia from the 2016 Scientific Meeting in Washington, D.C.

The CHAART Scientific Meeting took place February 8-9, 2016 in Washington, D.C. The meeting was organized by the consortium to improve outcomes in HIV/AIDS, alcohol, aging, and multi-substance use  and included active participation by the NIAAA scientific staff and other CHAART members, including SHARC’s very own Robert Cook, MD, MPH, Natalie Kelso, MSW, and Eric Porges, Ph.D.