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Browsing by Author "Gilbert, Louisa"

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    Effectiveness of a Culturally Tailored HIV and Sexually Transmitted Infection Prevention Intervention for Black Women in Community Supervision Programs A Randomized Clinical Trial
    (American Medical Association, 2021) Gilbert, Louisa; Goddard-Eckrich, Dawn; Chang, Mingway; Hunt, Timothy; Wu, Elwin; Johnson, Karen; Richards, Stanley; Goodwin, Sharun; Tibbetts, Richard; Metsch, Lisa R.; El-Bassel, Nabila; Columbia University; University of Alabama Tuscaloosa
    IMPORTANCE Concentrated epidemics of HIV and sexually transmitted infections (STIs) have persisted among Black women in community supervision programs (CSPs) in the United States. Accumulating research has highlighted the effectiveness of culturally tailored HIV/STI interventions for Black women; however, there is a dearth of such interventions for the large number of Black women in CSPs. OBJECTIVE To determine the effectiveness of a 5-session culturally tailored group-based intervention (Empowering African-AmericanWomen on the Road to Health [E-WORTH]) with individualized computerized modules and streamlined HIV testing in reducing STIs and condomless sex vs a 1-session streamlined HIV testing control condition. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from November 18, 2015, (first recruitment) to August 20, 2019 (last 12-month follow-up). Black women mandated to probation, parole, or alternative-to-incarceration programs in New York City who had a history of drug use were recruited and randomized to receive either E-WORTH or a streamlined HIV testing control condition. Both conditions were delivered by Black female staff at a large CSP. The analysis took an intention-to-treat approach. INTERVENTION E-WORTH included a 1-hour individual HIV testing and orientation session and 4 weekly 90-minute group sessions. The control condition included one 30-minute session of HIV testing and information. MAIN OUTCOMES AND MEASURES Primary outcomes were incidence of any STI (biologically assayed chlamydia, gonorrhea, and Trichomonas vaginalis) at the 12-month assessment and the number of condomless acts of vaginal or anal intercourse in the past 90 days during the 12month period. RESULTS A total of 352 participants who identified as Black or African American were enrolled, including 79 (22.5%) who also identified as Latinx. The mean (SD) age was 32.4 (11.0) years. A total of 172 participants (48.9%) were assigned to the E-WORTH condition, and 180 (51.1%) were assigned to the control condition. Compared with control participants, participants assigned to the E-WORTH condition had 54% lower odds of testing positive for any STI at the 12-month follow-up (odds ratio, 0.46; 95% CI, 0.25-0.88; P =.01) and reported 38% fewer acts of condomless vaginal or anal intercourse during the 12-month period (incidence rate ratio, 0.62; 95% CI, 0.39-0.97; P =.04). CONCLUSIONS AND RELEVANCE The magnitudes of effects found across biological and behavioral outcomes in this randomized clinical trial indicate the feasibility and effectiveness of implementing E-WORTH in real-world CSPs. The findings lend further evidence to the promise of culturally tailored HIV/STI interventions for Black women.
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    The effectiveness of a group-based computerized HIV/STI prevention intervention for black women who use drugs in the criminal justice system: study protocol for E-WORTH (Empowering African-American Women on the Road to Health), a Hybrid Type 1 randomized controlled trial
    (BMC, 2018) Johnson, Karen; Gilbert, Louisa; Hunt, Timothy; Wu, Elwin; Metsch, Lisa; Goddard-Eckrich, Dawn; Richards, Stanley; Tibbetts, Rick; Rowe, Jessica C.; Wainberg, Milton L.; El-Bassel, Nabila; University of Alabama Tuscaloosa; Columbia University
    Background: This paper describes the study protocol of a hybrid type I randomized controlled trial that evaluates the effectiveness and cost-effectiveness of implementing Empowering African-American Women on the Road to Health (E-WORTH), an Afrocentric, group-based, computerized human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention intervention for controlled substance-using black women in community corrections settings in New York City. Methods/design: We provide an overview of E-WORTH's hybrid type I design, which is guided by the Consolidated Framework for Implementation Research (CFIR). E-WORTH combines HIV/STI and intimate partner violence (IPV) prevention components and tests the comparative effectiveness of E-WORTH and streamlined HIV testing versus streamlined HIV testing alone in decreasing biologically confirmed HIV and STI incidence, sexual risk, and IPV, as well as in improving access to HIV and STI prevention services and care. Discussion: This paper provides an overview of E-WORTH's intervention protocol and serves as a framework for using hybrid type I designs, guided by the CFIR conceptual framework, to evaluate HIV/STI and IPV prevention interventions in community corrections settings. We discuss how E-WORTH's hybrid type I design advances implementation science through its effectiveness and cost-effectiveness aims as well as through a mixed-methods study that evaluates multilevel theory-driven factors (structural, organizational, staffing, and client) guided by the CFIR that influences the implementation of E-WORTH in a criminal justice setting. This study also addresses the novel challenges and opportunities of implementing an intervention that targets specific racial subgroup(s) in a community corrections setting that services all populations, implementing a group-based intervention with technological components in such settings, and employing community-based participatory research strategies to guide recruitment and retention efforts.
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    Evidence of Help-Seeking Behaviors Among Black Women Under Community Supervision in New York City: A Plea for Culturally Tailored Intimate Partner Violence Interventions
    (Mary Ann Liebert, 2022) Goddard-Eckrich, Dawn; Henry, Brandy F.; Sardana, Srishti; Thomas, Brittany, V; Richer, Ariel; Hunt, Timothy; Chang, Mingway; Johnson, Karen; Gilbert, Louisa; Columbia University; Pennsylvania State University; Pennsylvania State University - University Park; University of Alabama Tuscaloosa; Johns Hopkins University; Johns Hopkins Bloomberg School of Public Health
    Background: Black women involved in the legal system disproportionately experience intimate partner violence (IPV); however, current research does not satisfactorily describe the risk and protective factors associated with IPV among Black women under community supervision.Methods: We conducted a subgroup analysis of Black women (N = 128) using data from a randomized controlled trial that evaluated the feasibility and efficacy of two IPV screening and prevention programs for women under community supervision. Participants in the original study were randomized into two IPV prevention conditions-computerized or case manager Women Initiating New Goals of Safety (WINGS). In this study, we examine the effects of that study's two conditions on linkage to IPV services and secondary outcomes, specifically among Black participants who experienced physical, sexual, and psychological IPV.Results: Both conditions showed significant reductions in days of substance use abstinence over the 3-month period among Black women who experienced sexual or verbal IPV. Participants in the case manager arm were 14 times more likely to receive IPV services in the past 90 days-from baseline to the 3-month follow-up (adjusted odds ratio = 14.45, 95% confidence interval [CI] = 1.25 to 166.51, p = 0.032). Participants in the computerized arm were significantly more likely to report receiving social support from baseline to the 3-month follow-up assessment (regression coefficient [b] = 2.27, 95% CI = 0.43 to 4.11, p = 0.015).Conclusions: Although both conditions showed significant reductions in the number of days of abstinence from substance use among this subgroup of Black women, the findings showed differential effectiveness between the computerized WINGS arm and the case manager WINGS arm in improving social support and linkage to services. These findings may indicate that different modalities of WINGS may work better for specific activities and point to the need for a hybrid format that optimizes the use of distinct modalities for delivering activities.
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    HIV/STI/HCV Risk Clusters and Hierarchies Experienced by Women Recently Released from Incarceration
    (MDPI, 2023) Johnson, Karen A.; Hunt, Timothy; Puglisi, Lisa; Chapman, Ben; Epa-Llop, Amali; Elumn, Johanna; Braick, Peter; Bhagat, Navya; Ko, Elizabeth; Nguyen, Antoinette; Johnson, Rachel; Graham, Heather K.; Gilbert, Louisa; El-Bassel, Nabila; Morse, Diane S.; University of Alabama Tuscaloosa; Columbia University; Yale University; University of Rochester
    This study examines cross-sectional clusters and longitudinal predictions using an expanded SAVA syndemic conceptual framework-SAVA MH + H (substance use, intimate partner violence, mental health, and homelessness leading to HIV/STI/HCV risks)-among women recently released from incarceration (WRRI) (n = 206) participating in the WORTH Transitions (WT) intervention. WT combines two evidence-based interventions: the Women on the Road to Health HIV intervention, and Transitions Clinic. Cluster analytic and logistic regression methods were utilized. For the cluster analyses, baseline SAVA MH + H variables were categorized into presence/absence. For logistic regression, baseline SAVA MH + H variables were examined on a composite HIV/STI/HCV outcome collected at 6-month follow-up, controlling for lifetime trauma and sociodemographic characteristics. Three SAVA MH + H clusters were identified, the first of which had women with the highest overall levels of SAVA MH + H variables, 47% of whom were unhoused. Hard drug use (HDU) was the only significant predictor of HIV/STI/HCV risks in the regression analyses. HDUs had 4.32-fold higher odds of HIV/STI/HCV outcomes than non-HDUs (p = 0.002). Interventions such as WORTH Transitions must differently target identified SAVA MH + H syndemic risk clusters and HDU to prevent HIV/HCV/STI outcomes among WRRI.
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    Moderation Analysis of a couple-based HIV/STI Intervention Among Heterosexual Couples in the Criminal Legal System Experiencing Intimate Partner Violence: Results from a Randomized Controlled Trial
    (Springer, 2023) Goddard-Eckrich, Dawn; Gilbert, Louisa; Richer, Ariel; Chang, Mingway; Hunt, Timothy; Henderson, Ambuir; Marotta, Phillip; Wu, Elwin; Johnson, Karen; Moses, Hermione; Liu, Yifan; El-Bassel, Nabila; Columbia University; Washington University (WUSTL); University of Alabama Tuscaloosa
    Since the COVID-19 pandemic, intimate partner violence (IPV) rates have increased in the United States. Although accumulating research has documented the effectiveness of couple-based interventions in reducing HIV/STIs, it remains unclear whether they are effective and safe for couples experiencing IPV. We used moderation analysis from a randomized clinical trial to evaluate whether a couples-based HIV/STI intervention may have differential effectiveness in reducing HIV/STI risks among couples where one or both partners reported experiencing IPV compared to couples without such IPV among a sample of 230 men at risk for HIV/STIs who reported using drugs and were mandated to community supervision settings in New York City and their main female sexual partners. The findings of this study suggest that the effectiveness of this evidence-based couple HIV intervention in reducing condomless sex and other HIV/STI risks did not differ between couples with IPV compared to couples without IPV. Intimate partners who use drugs and are involved in the criminal legal system are disproportionately impacted by both HIV/STIs and IPV, underscoring the importance of couple-level interventions that may be scaled up to address the dyadic HIV risks and IPV together in community supervision settings.
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    Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration
    (Frontiers, 2022) Johnson, Karen A.; Hunt, Timothy; Puglisi, Lisa B.; Maeng, Daniel; Epa-Llop, Amali; Elumn, Johanna E.; Nguyen, Antoinette; Leung, Ashley; Chen, Rachel; Shah, Zainab; Wang, Jiayi; Johnson, Rachel; Chapman, Benjamin P.; Gilbert, Louisa; El-Bassel, Nabila; Morse, Diane S.; University of Alabama Tuscaloosa; Columbia University; Yale University; University of Rochester
    BackgroundU.S. women recently released from incarceration experience significantly higher rates of trauma and exacerbation of mental health conditions, and the period following release has been identified as a window of heightened risk for mental health distress and human immunodeficiency virus (HIV), sexually transmitted infections (STI) and hepatitis C (HCV) transmissions. Despite these vulnerabilities, and an urgent need for supports, optimal engagement strategies remain unclear. WORTH Transitions is a program made up of two evidence-based interventions focused on improving the health of women returning to the community from incarceration with substance use disorders. Combining the two was designed to reduce HIV/STIs/HCV risks and increase overall health treatment engagement using a community health worker led intervention. MethodsWe examined associations between trauma, mental health symptomology, and HIV/STI/HCV outcomes among women who engaged in the WORTH Transitions intervention (N = 206) Specifically, bivariate and longitudinal multivariate models were created to examine associations between trauma and mental health distress (defined as depressive and PTSD symptoms), on (1) types of engagement in HIV/STIs/HCV prevention and behavioral health services; and (2) HIV/STIs/HCV risk outcomes. The women who engaged in the intervention were 18 years and older and some were White, Black and other racial or ethnic minority. ResultsPTSD symptomology and being a Black or indigenous woman of color was significantly (p = 0.014) associated with individual or group session engagement. Neither trauma nor PTSD symptoms were associated with higher HIV/STIs/HCV risks. Instead, relative to those who did not engage in HIV/STI/HCV risky behaviors, PTSD symptomology (p = 0.040) was associated with more than 3-fold increase in the probability of being lost to follow up (relative risk ratio = 3.722). ConclusionGiven the impact of PTSD-related symptoms on driving both engagement in HIV/STIs/HCV prevention services and intervention attrition among women leaving incarceration, physical and behavioral health interventions must be both overtly trauma- and mental health-informed. As was the case with WORTH Transitions, physical and behavioral health services for this population must include intentional and active support of the forms of treatment participants endorse to ensure maximal engagement.