The annual ARI Strategic Support Awards are given to UCSF researchers conducting innovative work in HIV/AIDS. Winners are selected through a competitive review process led by the ARI Director and ARI Leadership Committee, and all submissions are sponsored by an ARI Executive Board member. The next opportunity to apply for this funding mechanism will be in January 2018, with funding to begin in April 2018.
Funded in 2017
In 2017, the ARI supported Strategic Awards for a second year. With the 2017 awards, detailed below, we targeted awards for postdocs who had lost a key federal funding source:
- A new policy at the National Institute of Allergy and Infectious Disease (NIAID) discontinued funding for essential pilot awards for postdocs. Postdocs rely on pilot funding like this to establish their research portfolios and advance in their careers.
- ARI quickly created a stopgap grant mechanism to provide pilot research support for the postdocs impacted by the NIAID policy.
- These funds enabled 6 postdocs to proceed with their pilot research projects - filling a potentially career-threatening gap in research support.
- ARI joined calls from across the country for NIAID to continue funding essential pilot awards. The NIAID policy has since been reversed and the pilot grants—now more in demand than ever—are expected to continue.
Evaluating the inflammation and microbial translocation on the development of insulin resistance in HIV-infected adults in the UGANDAAC cohort
In order to better understand both the biological determinants of insulin resistance and diabetes mellitus in HIV-infected individuals, as well as the clinical and programmatic challenges of delivering care for patients living with HIV and diabetes in sub Saharan Africa, Dr. Reid is conducting a pilot study exploring insulin resistance and diabetes risk in individuals enrolled in the Ugandan Non-Communicable Diseases and Aging Cohort (UGANDAC). This is a longitudinal cohort of older-aged people living with HIV infection in southwestern Uganda and age/gender-matched HIV uninfected controls. The study will evaluate the impact of HIV comorbidity on the pathogenesis of insulin resistance and diabetes mellitus, as well as the impact of these comorbidities on ART adherence and HIV treatment outcomes.
Patient and provider knowledge and attitudes about infant feeding among HIV-infected women
Dr. Tuthill’s pilot project uses qualitative and quantitative research methods to explore the current culture around infant feeding among women living with HIV in the United States. The first component of the pilot project is to conduct a national survey of providers caring for perinatal women living with HIV, and followed by an in-depth interview with these providers. The second component is to conduct interviews with pregnant women living with HIV. The goal is to understand attitudes and knowledge of infant feeding among patients and providers so that we can better support and inform guidelines on infant feeding in the context of HIV in the U.S.
Bio-Behavioral surveillance study of transgender women in Jamaica
Dr. Harris is conducting a pilot study to understand the risk environment of transgender women in Jamaica, and to determine the acceptability and feasibility of a home-based HIV testing intervention for this population. While Jamaica has established a comprehensive response to the HIV epidemic, the criminalization of homosexual behavior has limited the impact of the national response among sexual and gender minorities. There is currently limited research that has examined HIV prevalence among trans women in Jamaica. Dr. Harris’ mixed methods study aims to fill this gap.
Patient-provider communication on adherence among HIV-positive patients in Zambia
Dr. Mody, an infectious disease fellow based in Zambia, is conducting a pilot project to systematically evaluate the clinic experience of HIV-infected patients. The research will particularly focus on patient and provider communication, and its subsequent effects on patient retention and virologic suppression. This research is key because despite rapid scale-up of antiretroviral therapy (ART) in sub-Saharan Africa, significant gaps remain in the HIV treatment cascade - such as retention in care - that prevent realization of the optimal effects of ART. Preliminary findings highlight the importance of interpersonal interactions in clinical settings, and underscore the need to better understand these clinic-based drivers of patient engagement.
Unstable housing and outcomes in HIV: Evaluating the impact of unstable housing on early clinical outcomes in HIV
As antiretroviral therapy has become more robust and less toxic, a greater number of people living with HIV have suppressed the virus. However, these gains have not been equally enjoyed by all populations, including the homeless population. Dr. Clemenzi-Allen’s research focuses on characterizing the impact of housing instability on HIV treatment outcomes, and to deepen our understanding of the barriers to care for these patients. He is assessing the various kinds of housing status in patients at Zuckerberg San Francisco General Hospital’s HIV clinic, and investigating the associations between housing instability and viral suppression, adherence to ART, CD4 cell count, and sexually transmitted infections.
Antiretrovial treatment in pregnancy and the risk of preterm birth
Dr. Murnane is conducting a pilot project that aims to improve our understanding of the effect of antiretroviral therapy (ART) during pregnancy on preterm delivery. Preterm birth is a leading cause of infant and childhood morbidity and mortality. While HIV infection during pregnancy in the absence of ART is associated with an increased risk of preterm birth, the impact of ART on this association remains unclear. A critical knowledge gap remains regarding the potential effects of ART regimens on prematurity and other adverse birth outcomes. Dr. Murnane is conducting a retrospective cohort study using medical records to compare the frequency of preterm birth in HIV-infected women on ART to the frequency in HIV-uninfected women, and to test whether timing of ART initiation (pre-conception or during pregnancy) is associated with an increased risk of preterm birth.
Funded in 2016
PrEP Uptake Among At-Risk HIV-Uninfected Women
Recent studies from San Francisco suggest rapidly increasing levels of interest and uptake of PrEP among men who have sex with men, but data are limited on knowledge of PrEP and attitudes about PrEP use among cisgender women. In order to reach at-risk women who may benefit from PrEP, foundational research is needed to identify levels of knowledge and interest in PrEP and factors that may impede PrEP uptake among women who are interested in using it. The study aims to assess knowledge of and interest in PrEP, motivations for and barriers to PrEP uptake among at-risk HIV-uninfected women, and to identify women-centered PrEP delivery strategies that may facilitate adherence.
Develop Tat/rev Inducible Limiting Dilution Assay (TILDA)
The funding will supplement the validation and implementation of a novel diagnostic laboratory test in the Virology and Immunology Core laboratories that support HIV cure research initiatives. TILDA is designed to provide a biologically relevant assessment of HIV-1 latent reservoir recrudescence in vivo—a key measurement in evaluating the efficacy of ongoing innovative experimental therapeutic strategies designed to ablate or reduce the size of the HIV-1 reservoir. The ultimate goal of this research is to achieve virologic remission in the absence of antiretroviral therapy (ART), or a functional cure. The Virology and Immunology Core labs plan to leverage their shared technology, expertise and established infrastructure to offer this assay to UCSF researchers.
Filling Funding Shortfall of I-Care Study
The I-Care study is a cluster randomized trial to improve linkage to and retention in HIV care at primary and community health care clinics in a high prevalence district in rural South Africa. The trial compares three conditions: use of text messaging or short message service for medication and appointment reminders and to encourage healthy living, peer navigation services for medication and personal support, and standard of care. Preliminary analyses have been very encouraging, and indicate that both intervention approaches significantly shortened the time needed to link to care as compared to standard of care. However, the I-Care study faced an unexpected funding close-out by the extramural funding agency, leaving the study team unable to collect final participant data, analyze the data, and disseminate the intervention data. The ARI Strategic Support funding will allow the I-Care team to extract final clinical data, needed to establish behavioral and clinical program impacts.