Florida Cohort

The Florida Cohort (Phase 1) will enroll up to 1,500 participants with HIV infection and an additional 200 without HIV across the state of Florida. The project’s goal is to assess how individual, clinic, and community level factors influence accessibility and use of healthcare as well as HIV clinical outcomes, such as CD4 count and viral load. Also explore substance use, such as drugs and alcohol and mental health conditions influence HIV clinical outcomes and linkage to care. Addresses a variety of questions such as the types of healthcare services that participants use or treatment they receive, how they feel in general, their daily health behaviors, including alcohol, drug use, and sexual activity. Additionally, for each participant in the Florida Cohort, we will work with the Florida Department of Health to link the responses to the eHARS database, which will allow us to continuously follow HIV viral load and CD4 counts from all persons in the cohort.

Approved Concepts

Title: Assessing the Impact of Depression of the Intention to Use mHEALTH Interventions Among People Living with HIV and Participating in the Florida Health Cohort
Concept Investigator: Cesar Escobar-Viera, Ph.D., M.P.H.
Faculty Mentor: Jeffrey S Harman, Ph.D.
Other Researchers: Robert L. Cook, M.D., M.P.H.
Project Description: Examining the association between socio-demographic characteristics of PLWH and the use of cell phones, the use of phone features and intention to use mHealth application to manage HIV-related conditions. Determining the relationship between screening positive for depression and the intention to use mHealth applications to manage HIV-related conditions among PLWH.

Title: Impact of Indicators of Life Stress on Clinical and Behavioral Outcomes Among Persons Living with HIV
Concept Investigator: Natalie Kelso, MSW, Ph.D. Candidate
Faculty Mentor: Robert L. Cook, M.D., M.P.H.
Other Researchers: Chuwuemeka Okafor, M.P.H.
Project Description: To assess the baseline distribution of and interaction between reported life stressors among persons living with HIV; association of stressor type (predictor on HIV progression and ART adherence and to assess the baseline association of stressor type on alcohol consumption and marijuana use (outcomes) among persons living with HIV.

Title: HIV-Related Stigma and HIV Disease Progression Among People Living With HIV in Florida
Concept Investigator: Tenesha Avent, M.P.H., Ph.D. Student
Faculty Mentor: Gladys Ibañez, Ph.D.
Other Researchers: Robert Cook, M.D., M.P.H.
Project Description:  To examine the association between HIV-related stigma and HIV progression; and the moderating role of HIV treatment among HIV-1infected individuals residing in Florida; and to examine the relationship of socio-demographic characteristics, such as age, gender, race and socioeconomic status (SES) on the association between HIV-related stigma and HIV progression.

Title: The Relationship Between Memory Complaints, HIV, and Current Hazardous Alcohol Use
Concept Investigator: Vaughn Bryant, ScM, Ph.D. Student
Faculty Mentor: Ronald Cohen, Ph.D.
Other Researchers: Eric Porges, Ph.D.
Project Description:  Assessing whether current hazardous alcohol use, aging or their interactions predict total memory score, and individual time memory complaints, and whether individual memory complaints predict SF-36 health outcomes measures.

Title: Self-Reported Marijuana Use for Therapeutic  Reasons for Persons Living with HIV in Florida: Characteristics, Patterns of Use and Association with Self-reported Adherence, and Quality of Life.
Concept Investigator: Chuwuemeka Okafor, M.P.H., Ph.D. Candidate
Faculty Mentor: Robert L. Cook, M.D., M.P.H.
Project Description:  Determining the baseline sociodemographic, psychosocial and marijuana use parameters in terms of frequency, quantity, duration and age of onset of use of PLWHA who self-report exclusively using marijuana for a therapeutic reason as compared non-exclusive therapeutic use and whether PLWHA who exclusively self-report using marijuana for a therapeutic reason have optimal ART adherence, undetectable HIV viral RNA value and better quality of life.

Title:  Loneliness and Substance Use: The Influence of Gender Among HIV+ Individuals
Concept Investigator:  Zachary Mannes, BSMS Student
Faculty Mentor:  Nicole Whitehead, Ph.D.
Other Researchers: Larry Burrell, MS, Eugene Dunne, MA, Vaughn Bryant, ScM
Project Description: Identify the most commonly used substances associated with loneliness and examining if gender moderates the relationship between loneliness and substance use.

Title:  Information and Communication Technology Among People Living with HIV Who Consume Alcohol: A Cross-Sectional Study
Concept Investigator:  Danielle Sharpe, BS, MS Student
Faculty Mentor: Robert L. Cook, M.D., M.P.H.
Other Researchers: Cesar Escobar-Viera, Ph.D., M.P.H., M.D.
Project Description: Identifying how PLWH who consume alcohol have accessed the Internet; the cell phone situation of PLWH who consume alcohol and how alcohol is consumed by PLWH who use cell phones and the volume of cell phone apps that PLWH who consume alcohol have.

Title:  A Mixed-Method Assessment of the Influence of Impulsiveness on Medication Adherence
Concept Investigator: Eugene Dunne, MA, Ph.D. Student
Faculty Mentor: Nicole Whitehead, Ph.D.
Other Researchers: Robert L. Cook, M.D., M.P.H.
Project Description: Exploring the influence of impulsivity on medication adherence and as a risk factor for prescription opioid misuse among those living with HIV who report experiencing pain

Title: Demographic differences in interest and use of technology among HIV-positive individuals in Florida
Concept Investigator: Robert Lucero, Ph.D., M.P.H., RN
Faculty Mentor: Robert L. Cook, M.D., M.P.H.
Other Researchers: Jemima Frimpong, Ph.D., Danielle Sharpe, M.P.H.
Project Description: Differences in demographic characteristics in technology use among a cohort of PLWH in Florida and do the demographic differences predict technology use among the Cohort; What are the patterns of HIV care and treatment; engagement in HIV care, substance use, sexual behaviors and health among a Florida cohort of PLWH who are interested and not interested in technology use.

Title: Identifying the psychosocial and structural healthcare antecedent of antiretroviral therapy non-adherence and their relationship to perceptions of pre-exposure prophylaxis among HIV-positive patients.
Concept Investigator: Jordan Neil, Ph.D. Student
Other Researchers: Robert L. Cook, M.D., M.P.H., Janice Krieger, Ph.D.
Project Description: To identify whether there is a relationship between the key antecedent of ART non-adherence in HIV Positive patients and whether they impact perceived safety, self-efficacy, response efficacy and behavior intention towards PrEP

Title: Treatment engagement and disease control among HIV-positive individuals with an incarceration history
Concept Investigator: Gladys Ibanez, Ph.D.
Other Researchers:  Vanessa Ayala, Robert L. Cook, M.D., Jordan See, Danielle Sharpe, M.P.H., Zhi Zhou
Project Description: To examine sociodemographic characteristics of HIV-positive individuals with a history of incarceration versus those who have not been incarcerated

Title:  Housing status, alcohol consumption and adherence to antiretroviral therapy among people living with HIV
Concept Investigator: Jordan See, MS1
Other Researchers:  Robert L. Cook, M.D., M.P.H., Gladys Ibanez, Ph.D., Christa Cook, Ph.D., Lisa Agate, Zhi Zhou, Joseph Sacht, B.S.
Project description: To summarily determine the association between housing status, alcohol consumption and adherence to medication therapy; to determine if a change in housing status is associated with changes in associated variables.


  • Survey (HIV+) Baseline and Follow-up
    • Demographics
    • General health
    • Social support
    • HIV care and treatment
    • Healthcare services
    • Mental health
    • Cognition function
    • Pain
    • HIV stigma
    • Substance use
    • Sexual behavior
    • Use of digital technology
  • Survey (HIV-) Baseline and Follow-up
    • Demographics
    • General health
    • Social support
    • Perceptions of HIV/AIDS
    • Healthcare services
    • Mental health
    • Cognition function
    • Pain
    • HIV stigma
    • Substance use
    • Sexual behavior
    • Use of digital technology
  • Electronic Medical Record Abstraction
  • eHARS

For access to surveys and related documents, contact Zhi Zhou (zzhou0412@ufl.edu)

30 – 90 Day Challenge

There is new study titled, “Effects of experimentally-induced reductions in alcohol consumption on brain cognitive, and clinical outcomes and motivation for changing drinking in older persons with HIV infection.”

SHARC researchers, Robert Cook, M.D., M.P.H. and Ronald Cohen, Ph.D., in partnership with faculty at the Florida International University and the University of Miami have been awarded a U01 5-year renewal grant. The $4 million grant will be used to conduct research on the effects of alcohol reduction on the brain and on the liver. The study will build on past findings to determine the extent to which marked reductions in alcohol consumption over 12 weeks via contingency management (CM) improves cognitive performance, brain functions and pathophysiology, and HIV-associated health outcomes.

Alcohol consumption may affect the brain directly or indirectly via liver toxicity and systemic inflammation. Past findings indicate that current heavy alcohol use is more strongly associated with cognitive/brain dysfunction among HIV+ adults than lifetime consumption, suggesting that these effects may be reversible with reduction in drinking. HIV-associated neurocognitive dysfunction continues even with antiretroviral treatment, and even mild cognitive impairment is associated with detrimental health outcomes in older HIV+ adults. Ongoing heavy alcohol use on the brain and cognition may be reversible, providing a strong impetus for the study. The research will be conducted in Florida, which has the highest number of new HIV infections in the U.S., as well as an increasingly diverse population with HIV, 50% of whom are now aged 50 years or over.

The grant, funded by the National Institute of Alcohol Abuse and Alcoholism (NIAAA), will enroll 20 HIV+ heavy drinking participants in the first year and expand each year with a target total of 180.


Approved Concepts

Concept Investigator:
Other Researchers:
Project Description:




The title of this new study is MAPLE, an acronym for ,”Marijuana and Potential Long-term Effects.” This is a R01 research study funded by NIH under the project title, “Health Outcomes and Cognitive Effects of Marijuana Use Among Persons Living with HIV/AIDS.”

The overarching goals of this study are to obtain evidence regarding the influence of marijuana on major health outcomes and behavior in persons living with HIV (PLWH) in order to help guide clinical recommendations and identify risk factors for consequences. We are especially interested in the relationship of marijuana to novel aspects of cognitive function (e.g. motivation, intention, planning) and to systemic inflammation.

Specific Aims
1) To prospectively determine the association of daily and occasional marijuana use with HIV care engagement, viral suppression, and HIV disease progression
2) To prospectively determine the association of past and current marijuana use with cognitive function, motivation, and planning; and 3) to prospectively determine the association of chronic marijuana use with cytokine markers of chronic inflammation.

This will be the largest prospective cohort study focused on the health effects of marijuana in PLWH. The findings will inform HIV treatment providers and patients who are considering marijuana to manage HIV-related symptoms or HIV disease itself, and will identify patterns of marijuana use that are most strongly associated with the incidence of substance use disorders.

We aim to screen up to 980 PLWH in Alachua, Hillsborough, and Miami-Dade counties. We will enroll 480 total participants, including 360 marijuana users and 120 non-users. Participants will be asked to complete a baseline visit, with yearly follow-up visits for up to five years.


Approved Concepts

Concept Investigator:
Other Researchers:
Project Description:



MMP (Medical Monitoring Project)

Through a partnership with the Florida Department of Health, the Southern HIV & Alcohol Research Consortium (SHARC) has developed a protocol that allows investigators to work with the Medical Monitoring Project (MMP) data. This project is led by Christa Cook, PhD, MSN. The purpose of this research is to complete a secondary analysis of existing surveillance data collected through the Centers for Disease Control and the Florida Department of Health (FLDOH).

Investigators at the University of Florida aim to use MMP data to understand health care utilization and determinants of health in a randomly sampled population of HIV patients in Florida. From analysis of the data, we will: 1) provide information to the FLDOH that may help to inform policy and 2) assist in the development and implementation of research relevant to Florida residents with HIV.

Those interested in working on MMP data should contact our office and we can help facilitate access to the data through the FLDOH.
Access the Fact Sheet on HIV-Positive Adults in Care in Florida from 2009-2014

Approved Concepts

Title: An Examination of Unmet Needs Among Older HIV+ Adults
Concept Investigator: Nicole E. Whitehead, Ph.D.
Other Researchers: Larry Burrell, MS, Lauren Hearn, MS
Project Description: To examine the relationship between substance misuse, depression, and unmet needs in HIV+ adults 50 and older in the MMP dataset. We hypothesize that substance misuse and greater depressive symptoms will be associated with a greater level of unmet needs for this population.Secondarily, to examine health care utilization among older HIV+ adults who misuse substances.  We hypothesize that greater substance use will be associated with greater health care utilization, specifically emergency department visits.

Title: Substance Abuse Patterns and their Prevalence within Different Groups of Persons with HIV, and the Associations with Engagement in HIV Care
Concept Investigator: Robert L. Cook, M.D., M.P.H.
Other Researchers: Christa Cook, Ph.D., MSN, BSN, Allison Trainor, M.P.H., CPH
Project Description:  To describe the prevalence of various substance abuse patterns within different groups of the population in order to prioritize those who may most benefit from more aggressive interventions at the population (versus individual) level, and to identify a common definition that can be used to describe different variables that serve as factors in HIV-related health outcomes.

Title: Depression, Alcoholism, and HIV: Prevalence and Impact on HIV-Related Hospitalizations
Concept Investigator: Jon Mills, Ph.D. Student
Faculty Mentor: Jeffery S. Harman, PhD
Other Researchers: Robert Cook, M.D., M.P.H., Allyson Hall, Ph.D., Chris Harle, Ph.D., Christa Cook, Ph.D., MSN, BSN
Project Description: Prevalence of depression and alcoholism are high among PLWHA. Both conditions are associated with poor health outcomes and higher use of acute care. The prevalence of concurrent diagnosis and the impact of these conditions on HIV-related hospitalizations have yet to be established. Understanding these relationships will highlight the importance of early diagnosis and treatment in order to improve the quality of care. We examine the prevalence of depression and alcoholism among people living with HIV/AIDS (PLWHA) and assess the impact of these conditions independently as well interactively on HIV-related hospitalizations.

Title:  Comparative Effectiveness of Single-Action verses Multi-Action Antidepressants on Depression, Antiretroviral Adherence, HIV Clinical Outcomes and Acute Care Utilization among People Living with HIV/AIDS and Depression
Concept Investigator: Jon Mills, Ph.D. Candidate
Faculty Mentor: Robert L. Cook, M.D., M.P.H.
Other Researchers: Allyson Hall, Ph.D., Chris Harle, Ph.D., Christa Cook, Ph.D., MSN, BSN
Project Description: Using three comparison groups: 1) SSRIs reference 2) SNRIs 3) NDRIs this study seeks to assess whether compared to SSRIs, SNRIs and NDRIs will be associated with lower levels depression, better ARV adherence and HIV clinical outcomes (viral load and CD4 T-Cell count) and lower acute care utilization.

Title: Social Support as a Function of Sexual Identity in MSMs
Concept Investigator: Larry E. Burrell II, MS, Ph.D. Student
Faculty Mentor: Nicole E. Whitehead, Ph.D.
Other Researchers: Vaughn E. Bryant, ScM, Natalie Kelso, MSW, Chukwuemeka Okafor, M.P.H.
Project Description: Using MMP data to determine the demographic characteristics unique to various types of MSMs. Also examining perceived social support.

Title: Factors Associated with Prescription Opioid Abuse Among Persons Living with HIV/AIDS in Florida
Concept Investigator: Eugene Dunne, MA, Ph.D. Student
Faculty Mentor: Nicole E. Whitehead, Ph.D.
Other Researchers: Robert L. Cook, M.D., M.P.H.
Project Description: Evaluating several demographic and behavioral factors that may be associated with prescription opioid misuse among persons living with HIV/AIDS in the Medical Monitoring Project. Specifically, it is hypothesized participants who report prescription painkiller misuse will be more likely to report heavy alcohol consumption, risky sexual behavior, and difficulties with HIV medication adherence.

Title: The Relationship Between Complementary and Alternative Medicine Use and Substance Use and Depressive Outcomes Among Persons Living With HIV/AIDS in Florida
Concept Investigator: Chukwuemeka N. Okafor, M.P.H., Ph.D. Student
Faculty Mentor: Robert L. Cook, M.D., M.P.H.
Other Researchers: Christa Cook, Ph.D., MSN, BSN, Natalie Kelso, MSW
Project Description: To determine the prevalence and determinants of various types of CAM use in PLWHA in Florida and whether the use of specific CAM types is associated with reducing levels of substance use and depressive symptoms in PLWHA in Florida.

Title: Healthcare Utilization among HIV-Positive Black Men who have Sex with Men (MSM) in the Medical Monitoring Project (MMP)
Concept Investigator: Leandra Stubbs, MS, BS
Other Researchers: Mildred Maldonado-Molina, Ph.D., Robert L. Cook, M.D., M.P.H., Nicole E. Whitehead, Ph.D.
Project Description: Comparing unmet healthcare service needs, undetectable viral loads and the incidence of a detectable viral load due to higher incidences of disabling characteristics of Black MSM and non-Black MSM.



  • Standard (2009-2013)
    • Demographics
    • Access to care
    • Stigma and Discrimination
    • HIV treatment and adherence
    • Sexual behavior
    • Drug and alcohol use
    • Transmission risk behaviors
    • Prevention activities
    • Anxiety and depression
    • Health conditions and preventive therapy
    • Gynecological and reproductive history
  • Medical Record Abstraction
  • Facility Attributes

For access to surveys and related documents, contact Zhi Zhou (zzhou0412@ufl.edu)

***All interview instruments can be downloaded from the CDC website: http://www.cdc.gov/hiv/statistics/systems/mmp/resources.html


The Pharmacotherapy for hazardous drinking in HIV-infected women: a randomized trial, aims to enroll 240 women with HIV infection who exceed recommended drinking levels (>7 drinks per week). Nicknamed WHAT-IF? for the question, Will having alcohol treatment improve functioning?, the study will determine whether a specific drug, naltrexone, will help reduce drinking levels in HIV-infected women, thus improving their HIV-related outcomes such as adherence to medication, CD4 count and viral load. Women are randomized to take naltrexone (50mg) or placebo every day for 4 months. Outcomes, assessed at 2-months, 4-months, and 7-months, include alcohol consumption, HIV medication adherence, HIV disease control and progression, and risky sexual behavior. Enrollment began in December of 2012, and has now concluded. The data is still available for anyone interested in submitting a concept.

Approved Concepts

Title: Regulation of Cannabinoid Receptors and Endocannabinoid Levels in Peripheral Blood Mono-Nuclear Cells (PBMC): A Longitudinal Study in Women with HIV and History of Heavy Alcohol Consumption
Concept Investigator: Marisela Agudelo, Ph.D.
Other Researchers: Gloria Figuero, BS
Project Description: Assessing the levels of CB1, CB2, GPR55 receptor expression and to assess the production of endocannabinoids and the endocannabinoid-degrading enzyme fatty acid amide hyrdolase (FAAH) in peripheral blood mononuclear cells (PBMC) isolated before and after naltrexone therapy. To measure inflammatory cytokine profiles in PBMC isolated before and after naltrexone therapy.

Title: FGF-23 Stability Study
Concept Investigator: Purnima Madhivanan, MBBS, M.P.H., Ph.D.
Other Researchers: Robert L. Cook, M.D., M.P.H., Karl Krupp, MSc, Samikkanu Thangavel, Ph.D.
Project Description: Examining the relationship of FGF-23 and CVD mortality.

Title: The Impact of pain on alcohol reduction treatment among women living with HIV
Concept Investigator: Natalie Kelso, MSW, Ph.D. Candidate
Faculty Mentor: Bridgett Rahim-Williams, Ph.D., M.P.H., MA
Other Researchers: Robert L. Cook, M.D., M.P.H.
Project Description: Understanding the impact of pain on baseline alcohol use and changes in alcohol use at 4-month follow-up, and determining if alcohol use to reduce pain is associated with lower odds to reduce alcohol use at the 4-month follow-up.

Title: Assessment of Errors in Alcohol Use Measurement in Latent Variable Approach
Concept Investigator: Xinguang Chen, M.D., Ph.D.
Other Researchers: Robert L. Cook, M.D., M.P.H., Yan Wang, Ph.D., Zhi Zhou, DDS, M.P.H.
Project Description: To determine if self-reported alcohol use measures and biomarkers of alcohol exposure are determined by the same latent construct; to establish the latent variable model and use it to determine errors of individual alcohol use measures, including self-reported data and biomarkers.

Title: The Preliminary Study of the Effect of Naltrexone on Reducing Hazardous Drinking on HIV-Infected Women
Concept Investigator: Dan Chen
Faculty Mentor: Babette Brumback, Ph.D.
Project Description: To determine whether an alcohol treatment intervention involving naltrexone can reduce hazardous drinking in HIV-infected women.


  • Baseline/Follow-up Questionnaires
    • Demographics
    • Brief Pain Inventory
    • Medication Adherence
    • SF-12 for Health Condition
    • Short Inventory of Problem (SIP)
    • Domestic Violence
    • Belief/Attitude about treatment of hazardous drinking
    • Addiction Severity
    • Sexual Risk Measures
    • HIV Women Health Services Utilization
  • MINI Partial Interview: alcohol dependence/abuse
  • Timeline Follow Back Interview: self-reported drinking patterns
  • Concomitant Medications
  • Visit Forms:
    • Laboratory tests
    • Pre-existing conditions
    • CRC assessment
    • BSI and physical activity
    • AUDIT 10
    • Side effects and other adverse events
    • Pill count
    • Brief import persons

For access to surveys and related documents, contact Zhi Zhou (zzhou0412@ufl.edu)