Blank, Michael B PhD*†; Metzger, David S PhD*†; Wingood, Gina M ScD, MPH‡§; DiClemente, Ralph J PhD‡§
From the *Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, PA; †Social and Behavioral Sciences Core, Center for AIDS Research, University of Pennsylvania, Philadelphia, PA; ‡Department of Behavioral Sciences and Health Education Rollins School of Public Health, Emory University, Atlanta, GA; and §Social and Behavioral Sciences Core, Center for AIDS Research, Emory University, Atlanta, GA.
Correspondence to: Michael B. Blank, PhD, Center for Mental Health Policy and Services Research, Department of Psychiatry, School of Medicine, University of Pennsylvania, 3535 Market St., Room 3020, Philadelphia, PA 19104 (e-mail: firstname.lastname@example.org).
In November 2005, a small group of behavioral and social sciences investigators from the University of Pennsylvania and Emory University began planning for the establishment of a network between scientists involved in HIV prevention and treatment research. The purpose of this network was 3-fold. First, it was intended to foster multisite collaborations between behavioral and social scientists. Second, it was intended to share strategies on how behavioral and social scientists could be better partners with more basic and clinical scientists and how the basic and clinical sciences could be better used to inform behavioral and social science research. Finally, the Social and Behavioral Science Research Network (SBSRN) was explicitly intended to provide a forum for the exchange of the most recent information in the behavioral sciences regarding HIV/AIDS and to mentor the next generation of scientists engaged in social and behavioral science surrounding HIV prevention and treatment. By combining the intellectual capital and synergies among the community of scientists engaged in this work, it is hoped to invigorate state-of-the-art science in this area. In the National Institutes of Health (NIH) roadmap, the “research teams of the future” are described as problem-oriented multidisciplinary and interdisciplinary teams. We believe the SBSRN provides the foundation on which these teams can be built and directed toward HIV research.
The SBSRN planning meeting was held in Atlanta, March 27-28, 2006. The meeting was hosted by the Emory University Center for AIDS Research (CFAR) and jointly supported by the University of Pennsylvania and Emory University CFARs. Representatives from 14 CFARs attended this 2-day meeting that focused on the development of consensus on the importance of the SBSRN and its mission. The following mission statement was adopted: “To articulate a national research agenda for the Social and Behavioral Science Research Network across CFARs and to stimulate cross-CFAR sharing of resources and future collaborative research.” This meeting also established the network's research priorities and the development of an outline of the structure of the first national scientific meeting of the SBSRN. An Executive Committee was elected (Dr. DiClemente and Dr. Wingood from the Emory University CFAR and Dr. Metzger and Dr. Blank from the University of Pennsylvania CFAR) and given the responsibility to begin planning for a larger national meeting of the SBSRN. It was agreed that this first national scientific meeting of the SBSRN would be held in Philadelphia in the fall of 2006. The group also identified a number of potential shared resources that could be developed to support the efforts of individual CFAR cores and investigators. These included Web-based tools useful in the preparation of interdisciplinary research applications, a common database for tracking service delivery in social and behavioral sciences, a national directory, and a cross-CFAR list-serve to speed communication and enhance collaborations. The group thought that the value added by the SBSRN to each CFAR had the potential to encourage all sites to include support for this effort in their respective competitive renewal applications and that the SBSRN serves as an exemplar for how cross-site collaborations can be intentionally engineered.
At the Atlanta meeting, it was agreed that the scientific portion of the national SBSRN meeting would be structured around the top 3 research priorities developed by the group: (1) effectiveness and cost-effectiveness of primary and secondary HIV prevention research, (2) mental health and substance abuse comorbidity-prevention and treatment, and (3) racial and ethnic disparities in HIV prevention and treatment. The conference eventually expanded to include in the top 6 priorities (4) global perspective of the HIV pandemic, (5) effectiveness/translational studies of prevention and treatment models, and (6) future directions of the science. It was further agreed that this meeting would be designed to facilitate innovative research applications and result in a series of policy papers. The audience for the national meeting was expanded from social and behavioral scientists within CFARs to include other social and behavioral scientists who have a focus on HIV/AIDS and NIH program staff, representatives from clinical and basic sciences, and community representatives.
A supplement from the National Institute of Allergy and Infectious Diseases (NIAID) to the University of Pennsylvania CFAR (Principal Investigator: James Hoxie) allowed the first national SBSRN conference to be held in Philadelphia, October 10-13, 2006. Before the meeting, the SBSRN solicited concept plans from identified speakers for research within specified priority areas that reflect its mission and maximize the resources of the CFAR program. Concept plans that involved multiple CFARs and other social and behavioral scientists who were unaffiliated with CFARs and used multiple core resources were selected for presentation and discussion with a focus on protocol development. Each research area session began with a nationally prominent invited speaker who provided an overview of the current state of science within that area. These overview talks were followed by breakout groups that focused on selected research concept plans that were submitted by participants before the meeting. Each concept was critiqued and fully discussed by the attendees. Our goal for these sessions was to provide the investigators with feedback on design, measurement, specific ideas for collaboration, and guidance on the most appropriate funding mechanism. The series of articles presented here are an outgrowth of these efforts.
The first day of the meeting was structured around mentoring and identified 4 main goals: (1) to provide a team mentoring, supportive, and collegial atmosphere, where early career and transitional social and behavioral science investigators can meet and discuss common challenges they confront in establishing interdisciplinary HIV research careers; (2) to assist in addressing this gap by identifying promising early career and transitional investigators around the country, providing a day-long orientation, and facilitating early career and transitional investigator linkages with senior scientists; (3) to expose early career and transitional investigators seminars specifically tailored to their needs, including crafting a successful NIH grant, mechanisms for support for early career and transitional investigators, HIV research priorities, and a brief review of HIV prevention research among (a) adolescents, (b) substance users, (c) mental health aspects of HIV, (d) women, and (e) international HIV prevention research; and (4) to provide the opportunity to meet with senior-level researchers and prosper from their experiences (successes and failures).
The second and third days of the meeting were structured around the 6 research priorities identified at the Atlanta organizing meeting: (1) cost-effectiveness studies of prevention and treatment models, (2) racial disparities in HIV prevalence and incidence, (3) the role of mental health and substance abuse in HIV prevention and treatment, (4) global perspective of the HIV pandemic, (5) effectiveness of translational studies of prevention and treatment models, and (6) future directions of the science. It is important to note that these research priorities overlap significantly with those of the Office of AIDS Research (OAR). Overall, the mentoring and scientific meeting days were well attended by a plethora of participants from various backgrounds (see Table 1).
The SBSRN Planning Committee convened on the fourth and final day of the conference to define organizational and operational issues for the SBSRN further and to plan for future activities. It was determined that an application would be submitted to the NIH to support a series of 3 additional meetings. The University of Alabama at Birmingham volunteered to host the next meeting in 2007, and the University of Washington volunteered to host the meeting in 2008, followed by a consortium between Harvard and Brown Universities in 2009. An important area of consensus emerging from the First National Scientific Conference was the need to continue to develop a strategy to mentor early career social and behavioral scientists interested in establishing research careers that merge AIDS-related social and behavioral science research with other scientific disciplines. The group also recognized the importance of efforts designed to engage social and behavioral scientists who have established programs of research that have not focused on AIDS-related research. These transitional investigators represent an important potential resource to the research agenda of the NIH, and to HIV research generally. The guiding theme is to facilitate integration of social, behavioral, and biomedical research on HIV. The SBSRN can contribute to the development of the “research teams of the future,” which should be problem focused and utilize science and methods from many diverse and complementary disciplines.
We are pleased to be able to present the proceedings of the First National SBSRN Scientific Conference in this supplement entitled “Research Lessons: Setting the Social and Behavioral Sciences Agenda for Future HIV/AIDS Research.”
In the first article, James Kahn, Christine D. Des Jarlais, Loren Dobkin, Sarah French Barrs, and Ruth M. Greenblatt present “Mentoring the Next Generation of HIV Prevention Researchers: A Model Mentoring Program at the University of California San Francisco and Gladstone Institute of Immunology and Virology Center for AIDS Research.” Here, they note that mentoring is absolutely critical to develop and nurture early-career investigators and is especially important for investigators focused on HIV research because of the demands of high-impact multidisciplinary collaboration. They describe the highly successful mentoring program they developed targeting postdoctoral scholars and early career faculty. To date, more than 50 mentors and mentees have participated, and the article presents the results of the evaluation of that innovation. Activities that were particularly well received included networking among mentees, in addition to the networking between mentors and mentees, and workshops that focused on grant applications and first academic appointments and promotions. They conclude that a multidisciplinary mentoring program for postdoctoral fellows and early career investigators is useful and that umbrella organizations like the SBSRN are particularly well situated to provide these types of mentoring experiences. The University of California San Francisco mentoring program provides a model that we would encourage others to adopt and tailor for use in their own settings and for the needs of their own faculties.
In the next article, Steven D. Pinkerton, Cynthia R. Pearson, Susan R. Eachus, Karina M. Berg, and Richard M. Grimes present a “Proposal for the Development of a Standardized Protocol for Assessing the Economic Costs of HIV Prevention Interventions.” Here, they discuss the basic elements of a standardized cost data collection and analysis and further propose a standardized computer-based approach that could be used across sites. They argue that the development of such a protocol would foster increased dialogue and collaboration among HIV behavioral and social science researchers, cost-effectiveness analysts, community collaborators, public health decision makers, and funding agencies. This contribution is in keeping with the spirit and intent of the SBSRN, because it provides a primer for multisite efforts that ultimately are likely to be useful to policy makers and health and mental health authorities in allocation of resources to mitigate the impact of the epidemic.
In the next article in this series, James Walkup, Michael B. Blank, Jeffrey S. Gonzalez, Steven Safren, Rebecca Schwartz, Larry Brown, Ira Wilson, Amy Knowlton, Frank Lombard, Cynthia Grossman, Karen Lyda, and Joseph E. Schumacher present their contribution on “The Impact of Mental Health and Substance Abuse Factors on HIV Prevention and Treatment.” It is becoming increasingly apparent that mental illness and substance abuse interact synergistically to affect HIV prevention and treatment; not only are persons with mental illnesses at increased risk for seroconversion, but HIV/AIDS has profound effects on subsequent mental health and substance use.
In “Examining Racial Disparities in HIV: Lessons From Sexually Transmitted Infections Research,” Julie Kraut-Becher, Marlene Eisenberg, Chelsea Voytek, Tiffany Brown, David S. Metzger, and Sevgi Aral examine 15 factors that have been shown to relate to racial and ethnic disparities in rates of sexually transmitted infections. This comprehensive and timely review concludes that observation of individual-level behaviors and individual factors to the exclusion of analyses of ecologic, contextual, and community-level factors is inadequate to explain these disparities and that interventions not addressing sexually transmitted infections at multiple levels are inadequate to address the problem.
In the next article, Jeffrey A. Kelly, Freya Spielberg, and Timothy L. McAuliffe present “Defining, Designing, Implementing, and Evaluating Phase 4 HIV Prevention Effectiveness Trials for Vulnerable Populations.” These authors argue that we have a number of behavioral HIV prevention interventions with proven effectiveness in clinical phase 3 randomized controlled trials but that little is known about the effectiveness of these same interventions when delivered by community-based providers to their own clients. These authors argue for phase 4 effectiveness trials that have been found efficacious in the research arena in the community and raise a number of design and methodologic issues associated with the conduct of such trials.
Susan Cassels, Samuel J. Clark, and Martina Morris next present an article entitled “Mathematic Models for HIV Transmission Dynamics: Tools for Social and Behavioral Science Research.” In this article, the authors note that HIV researchers need to understand the social and behavioral determinants of HIV-related risk behavior and that mathematic modeling can help us to understand how individual behaviors affect HIV on the population level. They argue that methods for studying this are rarely part of traditional social science or epidemiology training programs and that mathematic modeling provides an approach to examine biologic and behavioral determinants of HIV transmission dynamics.
In the next article, “The ADAPT-ITT Model: A Novel Method of Adapting Evidence-Based HIV Interventions,” Gina M. Wingood and Ralph J. DiClemente present their work on dissemination of evidence-based interventions (EBIs) in different settings. The ADAPT-ITT model consists of 8 sequential phases that inform HIV prevention providers and researchers of a prescriptive method for adapting EBIs. The ADAPT-ITT model has evolved over repeated applications from adaptations of several of the authors' Centers for Disease Control and Prevention (CDC)-defined EBIs. The article cautions against transferring public health strategies and interventions from one setting to another or with diverse target populations without attention to social, ecologic, and contextual factors. The authors emphasize the need to use methodologically appropriate tools that are empirically supported and, at the same time, culturally congruent and include input from the target population. The article offers an approach to adapting EBIs, and implementation of the ADAPT-ITT model provides an efficient mechanism of designing culturally competent and effective prevention programs.
Finally, in the conclusion “Future Directions for HIV Prevention Research: Charting a Prevention Science Research Agenda” Ralph J. DiClemente, Gina M. Wingood, Michael B. Blank, and David S. Metzger outline a vision for the continuation and expansion of the SBSRN. This includes an emphasis on integration of social and behavioral sciences with basic and clinical science to forward research and interventions for HIV prevention and treatment and a vision for how multisite and cross-disciplinary collaborations can help to forward our combined mission for the SBSRN.
It has been a distinct pleasure for us to interact with the esteemed scientists who have contributed to the success of the SBSRN. We believe that a scientific collaborative such as this, which provides a vehicle for scientists from multiple disciplines to interact and exchange findings, ideas, and methodology, indeed represents the scientific teams of the future, not only for HIV but for improving generally the public health of our communities, nations, and world.
© 2008 Lippincott Williams & Wilkins, Inc.