Learn more about our current global research projects.

Khanya R01

Stepped Care, Peer-Delivered Intervention to Improve ART Adherence and SUD in Primary Care

Project Start together

Supporting Treatment for Anti-Retroviral Therapy Together

 

SUBSTANCE USE STIGMA R36

Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South Africa

Siyakhana-CHW R34

Training CHWs to Support Re-Engagement in TB/HIV Care in the Context of Depression and Substance Use

Siyakhana-Peer R21

Evaluating the Role of Peers to Reduce Substance Use Stigma and Improve HIV Care Outcomes in South Africa

 
 

Masculinity R21

A Longitudinal Mixed-Methods Investigation of Masculinity, Stigma, and Disclosure on Men's ART Initiation in South Africa

CHW Interpersonal Skills NRSA

Effectiveness and implementation of pre-training interpersonal skills assessment of community health workers in South Africa to predict post-training competence in mental health care

 

Learn more about our current local research projects.

PRISM

Peer Recovery to Improve Polysubstance Use and Mobile Telemedicine Retention

FOREward Together

Training Peer Recovery Coaches to Promote Retention and Adherence to Medications for Opioid Use Disorder among Low-Income Adults

Stigma & Racial Discrimination R36

The Intersecting Effect of Substance Use Stigma, Methadone Treatment Stigma, and Racial Discrimination on Methadone Treatment Outcomes

HEAL Together

Peer-Delivered Behavioral Intervention to Improve Adherence to MAT Among Low-Income, Minority Individuals with Opioid Use Disorder

HEAL Covid-19 Supplement

Understanding the Impact of COVID-19 on Methadone Retention and Adherence in an Underserved, Minority Population with OUD

syndemics oud project

Syndemic Factors Influencing Retention in MAT for Opioid Use Disorder in Baltimore, MD

HEAL Stigma Supplement

How Peers Can Shift Stigma to Retain Low-Income, Minority Individuals in Opioid Treatment

 

Learn more about our past global and local research projects.

Boston

Evaluating Peer Recovery Coaches to Improve Treatment Outcomes and Reduce Health Care Costs among Patients with Substance Use Disorders

peer recovery global review

Systematic Review on Peer-Delivered Recovery Support Services for Substance Use in Low- and Middle-Income Countries

WASHINGTON DC

Research Projects at Salvation Army Harbor Light Residential Substance Use Treatment Center in Northeast Washington DC

Project Khanya

Hybrid Effectiveness-Implementation Trial for ART Adherence and Substance Use in HIV Care in South Africa

peer act!vate

Utilizing Peer Recovery Advocates to Implement an Evidence-based Intervention to Decrease Substance use among Low-income Minority Adults

 

Khanya: Stepped Care, Peer-Delivered Intervention to Improve ART Adherence and SUD in Primary Care

Globally, a substance use treatment gap exists, with only 1-4% of individuals who need treatment in the most resource-limited contexts receiving minimally adequate treatment. Given the impact of untreated substance use on poor HIV outcomes along the care continuum, efforts are needed to sustainably integrate behavioral interventions into primary care settings to reach individuals at highest risk for poor antiretroviral therapy (ART; i.e., HIV medication) and substance use outcomes. This project attempts to help fill this gap in care by implementing a peer-delivered, stepped care intervention ("Khanya"), which was previously successfully piloted in Khayelitsha, Western Cape, South Africa. Khanya integrates Life-Steps, a single-session problem solving and motivational intervention for ART adherence, with brief behavioral skills to reduce substance use (i.e., behavioral activation, mindfulness, relapse prevention).

In this study, a Type 2 hybrid effectiveness-implementation trial will be used to evaluate the effectiveness and implementation of a stepped-care Khanya. 150 people living with HIV (PLWH) with substance use will be recruited from an integrated primary care site and randomized to enhanced standard of care (i.e., facilitated referral to a public substance use treatment program) or Khanya. In the first step of Khanya, all participants will receive one session of Life-Steps + enhanced standard of care. Only participants who continue to demonstrate poor ART adherence after step 1 will be "stepped-up" to Khanya Step 2, which consists of six Khanya sessions.

The overall aims of this study are (1) to evaluate the effectiveness of Khanya over 12 months on (a) ART adherence, (b) substance use, and (c) HIV clinical outcomes; (2) to evaluate the implementation of Khanya on (a) reach and uptake, (b) adoption, and (c) peer fidelity to the intervention; and (3) to estimate the cost of implementing and sustaining Khanya compared to enhanced standard of care.

Location: Cape Town, South Africa; Funding: NIDA R01DA056102; 2022 - 2027; PI: Magidson. Partnering with University of Cape Town (UCT). Opportunities for staff and graduate students to be involved in study coordination.

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Project Khanya: Hybrid Effectiveness-Implementation Trial for ART Adherence and Substance Use in HIV Care in South Africa

South Africa is home to the largest number of HIV-infected individuals in the world. Although SA has one of the largest global antiretroviral therapy (ART) programs, a barrier to achieving successful HIV treatment and prevention outcomes is untreated substance use disorder (SUD). Integrating evidence-based interventions to address both HIV treatment adherence and SUDs in HIV care has potential to improve HIV treatment and prevention in SA. This study is a five-year implementation science trial funded by the National Institute of Drug Abuse to adapt and implement a brief, paraprofessional-delivered integrated intervention for SUD and HIV treatment adherence in Cape Town, South Africa. We are evaluating whether an adapted intervention, delivered by paraprofessionals in this setting, is feasible and acceptable and can reduce SUD symptoms, improve HIV treatment adherence, and reduce HIV viral load.

Location: Cape Town, South Africa; Funding: NIDA (K23DA041901; 2016-2021; PI: Magidson). Partnering with University of Cape Town (UCT). Opportunities for staff and graduate students to be involved in study coordination, secondary data analysis, and future grant submissions.

Publication of results:

“Someone who is in this thing that I am suffering from”: The role of peers and other facilitators for task sharing substance use treatment in South African HIV care

“Too much boredom isn’t a good thing”: Adapting behavioral activation for substance use in a resource-limited South African HIV care setting.

Adapting a behavioral intervention for alcohol use and HIV medication adherence for lay counselor delivery in Cape Town, South Africa: A case series.

Project Khanya: A randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa.

Project Khanya: Results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa.

 

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Training CHWs to Support Re-Engagement in TB/HIV Care in the Context of Depression and Substance Use

South Africa is home to the largest number of people living HIV/AIDS (7.7 million) and one of the highest incidence rates of tuberculosis (TB) globally. Community Health Worker (CHW) programs have been rolled out to improve TB/HIV care outcomes in South Africa, yet depression, substance use, and CHW stigma towards patients remain significant barriers to care engagement. This study is a 3-year implementation science trial funded by the National Institute of Mental Health focused on training community health workers (CHWs) in South Africa to reduce stigma around substance use and mental health as a means to improve engagement in TB/HIV care

Location: Cape Town, South Africa; Funding: NIMH (R34MH122268;2020-2023; PIs: Magidson, Myers). Partnering with South African Medical Research Council (SAMRC). Opportunities for staff and graduate students to be involved in study coordination, secondary data analysis, and future grant submissions.

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Project START Together: Supporting Treatment for Anti-Retroviral Therapy Together

The START Together project is a Canadian Institutes of Health Research (CIHR) funded study that aims to develop and evaluate a couple-based intervention targeting antiretroviral therapy (ART) medication adherence for HIV-infected women and their male partners living in KwaZulu-Natal, South Africa. This intervention has the potential to simultaneously improve HIV-infected women’s adherence to life-saving ART as well as engage men into HIV-related care, both of which are major barriers to meeting global goals of eradicating new HIV infections. This study uses a mixed methods research design to develop and test the START Together Program. Qualitative interviews will first be conducted with women and men from the target population to develop and refine the intervention (ensuring it is culturally appropriate) before pilot-testing it with a small number of South African couples to evaluate its efficacy. We have completed the study formative work and are preparing for the pilot study to test the intervention.

Location: KwaZulu-Natal, South Africa; Funding: CIHR Postdoctoral Fellowship (Dates: 2018- 2020; PI: Belus; Mentors: Drs. Ruanne Barnabas (UW), Heidi van Rooyen (HSRC) and Jessica Magidson (UMD)); UMD Dean’s Research Initiative. Partnering institutions and colleagues at the Human Sciences Research Council (HSRC) in South Africa and the University of Washington in the US. Opportunities for involvement in study coordination, data management and analysis (qualitative and quantitative), and future grant submissions.

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Masculinity R21: A Longitudinal Mixed-Methods Investigation of Masculinity, Stigma, and Disclosure on Men's ART Initiation in South Africa

Over 7.9 million people in South Africa (SA) are living with HIV. Among men living with HIV (MLWH) in SA, only 56% who know their status have initiated antiretroviral therapy (ART). This mixed-methods study focuses on hegemonic masculinity beliefs (HMBs), or the idealized forms of what it means to ‘be a man’, which has been identified as a major reason why men do not seek and stay engaged in HIV care. This project aims to examine whether disclosing HIV status mediates the association between HMBs and ART initiation and whether internalized stigma moderates the association between HMBs and disclosure among men newly diagnosed with HIV. This is a 2-year study funded by NIMH to improve knowledge on interpersonal factors related to optimal HIV care and support UNAIDS’ priority to engage and retain MLWH in care.

Location: Cape Town, South Africa; Funding: NIMH (1R21MH123280 - 01A1; PIs: Belus, Marais, Magidson). Partnering with the University of Cape Town (UCT). Opportunities for staff and graduate students to be involved in data management, qualitative coding and analysis, and future grant submissions.

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Evaluating the Role of Peers to Reduce Substance Use Stigma and Improve HIV Care Outcomes in South Africa

South Africa (SA) is home to the largest number of people living HIV/AIDS (7.8 million). While SA has one of the largest global antiretroviral therapy (ART) programs, a barrier to achieving successful HIV treatment and prevention outcomes is untreated substance use disorder (SUD) and SUD-related stigma among healthcare workers. Peer recovery coaches (PRCs) have been scaling in the US to decrease barriers to successful treatment outcomes for substance use, including stigma. This study, jointly funded by the National Institute on Drug Abuse & Fogarty International Center (FIC), aims to develop and evaluate a peer recovery coach model in community-based HIV care teams in South Africa to reduce substance use stigma among health care workers and improve HIV care engagement. This project includes a specific capacity building component to train students and health workers in both sub-Saharan Africa and at UMD in how to conduct mental health and substance use stigma research in low-resource settings. The ultimate aim is to build a network of researchers focused on mental health, substance use, and HIV stigma research in sub-Saharan Africa. 

Location: Cape Town, South Africa; Funding: NIDA/Fogarty (R21DA053212; 2020-2022; PIs: Magidson, Myers). Partnering with South African Medical Research Council (SAMRC). Opportunities for staff and graduate students to be involved in study coordination, qualitative coding and analysis, secondary data analysis, and future grant submissions.

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Peer-Delivered Recovery Support Services in LMICs

This systematic review aims to examine the evidence on characteristics, feasibility, acceptability, and effectiveness of peer-delivered recovery support services for individuals living with problematic substance use in low- and middle- income countries (LMICs). This review will be conducted and reported according to PRISMA guidelines and will include a search of the published literature across PubMed, PsycINFO, Embase, Global Health, and Global Index Medicus. Studies will be double-screened for eligibility criteria; key data will be extracted from included studies and quality assessment measures will be used to describe methodological limitations. Data will be analyzed and reported using narrative synthesis.

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Effectiveness and implementation of pre-training interpersonal skills assessment of community health workers in South Africa to predict post-training competence in mental health care

Health workers with little formal healthcare training, known as lay health workers, can effectively provide mental health care to expand access to services in low resource settings, but not all lay health workers achieve adequate skill in mental health care delivery. Existing evidence suggests lay health workers’ skill in mental health care may be predicted by their interpersonal skills before training. Developing and testing a pre-training assessment of lay health worker interpersonal skills could help predict lay health worker skill in mental health care and, in the longer term, help align lay health workers with appropriate resources for training in order to maximize their effectiveness in mental health care delivery.

Location: Cape Town, South Africa; Funding: NIMH (1F31MH123020-01A1; PI: Rose)

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Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South Africa

Internalized substance use stigma has been identified as a barrier to engagement in HIV care and substance use treatment, including in South Africa, the country with the highest number of people living with HIV globally and a high burden of untreated and under treated substance use disorder. While HIV can be a manageable chronic disease for people adherent to antiretroviral therapy (ARTs), substance use is associated with poorer ART adherence and poorer engagement in care for people living with HIV.

Integrating peer recovery coaches (PRCs)—or persons with lived substance use disorder experience—into larger healthcare teams may be a promising way to reduce internalized substance use stigma among people living with HIV who are disengaged from care, and consequently, increase retention in HIV care and substance use treatment. Yet, despite the prevalent assumption that PRCs reduce internalized substance use stigma, no studies have examined this quantitatively, and none have examined this in the context of HIV care. Further, although PRC models have been rapidly scaled in the US, little research has examined PRC models in low- and middle-income countries.

Therefore, this study aims to examine if integrating a PRC into existing healthcare worker teams tasked with re-engaging HIV patients in care reduces substance use stigma among these patients who also use substances. Using quantitative and qualitative methods, the study will also evaluate if changes in stigma are related to re-engagement in HIV care and substance use treatment. To increase the feasibility of this dissertation study, it is integrated into the Siyakhana – Peer R21 study (R21DA053212).

Location: Cape Town, South Africa; Funding: NIDA (R36DA057167; 2022-2024; PI: Regenauer). Additional funding: Dr. Dennis F. Marion Research Endowed Scholarship (Awardee: Regenauer); UMD College of Behavioral and Social Sciences’ Dean’s Research Initiative (DRI) 2022-2023 (PI: Regenauer); and DRI 2023-2024 (PI: Regenauer). Partnering with the South African Medical Research Council (SAMRC). Potential opportunities for undergraduate and graduate students to be involved in transcription, coding, and data management.

Peer Recovery to Improve Polysubstance Use and Mobile Telemedicine Retention

This randomized Type 1 hybrid effectiveness-implementation trial (n=180) aims to evaluate a peer-delivered behavioral activation intervention delivered on a mobile treatment unit (Peer Activate-MTU) in rural Maryland compared to enhanced treatment as usual over 12 months. Primary outcomes are OUD treatment retention and poly substance use (effectiveness), implementation outcomes (guided by RE-AIM), and cost-effectiveness. This project is designed to lead to a potentially scalable model for improving OUD treatment retention and polysubstance use in underserved, rural areas.

Location: Eastern Shore of MD; Funding: NIDA (R01DA057443; 2022-2027). Partnering with University of Maryland, Baltimore (PIs: Kattakuzhy, Magidson). Opportunities for staff and graduate students to be involved in study coordination, primary data collection, secondary data analysis, and future grant submissions

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Peer-Delivered Behavioral Intervention to Improve Adherence to MAT Among Low-Income Individuals with Opioid Use Disorder

The opioid use disorder (OUD) crisis is an epidemic of poor access to care, including lack of access to evidence-based behavioral interventions alongside medication for OUD. This project aims to evaluate how peer recovery coaches, trained individuals with their own lived experience with OUD, can improve retention in care for underserved, minority individuals with OUD. In this two-phase, five-year project as part of the NIH HEAL Initiative, we will evaluate the effectiveness and implementation of a peer-delivered behavioral activation intervention delivered at the University of Maryland Drug Treatment Center, in close collaboration with UMB Psychiatry.

Location: Baltimore, MD; Funding: NIH HEAL Initiative (R61AT010799, R33DA057747B; PI: Magidson). Opportunities for staff and students to be involved in study coordination, data collection, qualitative analyses, and secondary data analysis.

Publication of results:

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Syndemic Factors Influencing Retention in MAT for Opioid Use Disorder in Baltimore, MD

This is a mixed methods study partnering with the University of Maryland Drug Treatment Center (UMDTC), a community-based, outpatient substance use treatment center in West Baltimore. This project aims to determine the prevalence and types of psychosocial and structural syndemic factors among individuals initiating Methadone Maintenance Therapy (MMT) for OUD and the relation between syndemic factors and subsequent 6-month retention in an MMT program. 

Location: Baltimore, MD; Funding: Dean’s Research Initiative; PIs: Kleinman, Magidson, Greenblatt; Opportunities for students to be involved in study coordination, qualitative analyses, and secondary data analysis. 

Publication of results:

Syndemic barriers to successful treatment outcomes for individuals receiving medication for opioid use disorder

Psychosocial challenges affecting patient-defined medication for opioid use disorder treatment outcomes in a low-income, underserved population: Application of the social-ecological framework

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Training Peer Recovery Coaches to Promote Retention and Adherence to Medications for Opioid Use Disorder among Low-Income Adults

The Foundation for Opioid Response Efforts has awarded over $555,000 to Michigan State University in a partnership with GMAP at UMD to develop a training manual for peer recovery coaches serving low-income, minority communities in Detroit as well as Baltimore. FORE supports partners in advancing patient-centered, innovative, evidenced-based solutions to the opioid crisis. The approach will serve as a guide to coaches in providing positive reinforcement and helping those in treatment to schedule and engage in valued activities. Researchers will examine the effectiveness of the intervention, supervision and training models, and share results with policymakers and treatment programs.

Location: Detroit, MI and Baltimore, MD; Funding: Foundation for Opioid Use Recovery Efforts (FORE) grant (2020-2022). Partnership with Michigan State University (PIs: Felton, Magidson). Opportunities for staff and students to be involved in study coordination, data collection, qualitative analyses, and secondary data analysis.

Publication of results:

“How can I hug someone now [over the phone]?”: Impacts of COVID-19 on peer recovery specialists and clients in substance use treatment

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Understanding the Impact of COVID-19 on Methadone Retention and Adherence in an Underserved, Minority Population with OUD

With the emergence of COVID-19, regulations and policies surrounding methadone maintenance therapy (MMT) have been relaxed in order to increase flexibility and prioritize pandemic-related safety regulations. Given these unprecedented changes affecting methadone dispensation, it is a critical time to evaluate how these relaxed restrictions are affecting client and staff treatment experiences to inform sustained policies. This supplement aims to evaluate changes in methadone treatment retention and adherence following COVID-19 dictated relaxed opioid treatment program regulations and patient and staff experiences of COVID-19 changes, including increased take home doses and tele-health services.

Location: Baltimore, MD; Funding: NIDA (R61AT010799-01S1; 2020-2021; PIs: Magidson, Belcher). Opportunities for staff and graduate students to be involved in study coordination, qualitative interviewing, coding, transcription, and analysis, secondary data analysis, and future grant submissions. 

 

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How Peers Can Shift Stigma to Retain Low-Income, Minority Individuals in Opioid Treatment

Preliminary qualitative work for HEAL Together has indicated that stigma, at multiple levels (substance use, racial, socio-economic, etc.), act as barriers to successful treatment outcomes for individuals with opioid use disorder (OUD). Peers may be uniquely positioned to help clients overcome stigma-related barriers in treatment for OUD, due to their shared lived experience with substance use that they can incorporate into interventions. The aim of this supplement is to test whether and how a peer recovery coach model can reduce multiple intersecting stigmas, including internalized and anticipated substance use stigma, and whether changes in stigma translate into improvements in methadone treatment retention.

Location: Baltimore, MD; Funding: NCCIH (R61AT010799-01S2; 2020-2021; PI: Magidson). Opportunities for staff and graduate students to be involved in study coordination, qualitative interviewing, coding, transcription, and analysis, secondary data analysis, and future grant submissions. 

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The Intersecting Effect of Substance Use Stigma, Methadone Treatment Stigma, and Racial Discrimination on Methadone Treatment Outcomes in Baltimore, MD

Opioid overdose deaths continue to rise precipitously, and Black/African American communities are experiencing drastic increases in opioid-related fatalities. Methadone treatment has a long history of efficacy for treating OUD, but adequate engagement in treatment is a persistent challenge. Racially minoritized individuals with OUD disproportionately evidence poor treatment outcomes. There is an urgent need to better understand barriers to treatment engagement in order to inform targeted and efficient interventions, especially among Black/African American individuals with OUD. Stigma surrounding both substance use disorder and methadone treatment, is a key driver of poor treatment outcomes and inequality. Further, racially minoritized individuals with OUD also routinely experience race-related stigma and discrimination in everyday social situations, which has been found to be broadly associated with poor mental and physical health outcomes, and may further worsen OUD outcomes. Research evaluating the intersection of racial discrimination, substance use and methadone treatment stigma is sparse, and rarely tested in relation to methadone treatment outcomes.

In this study, we evaluate the experience of racial stigma as well as substance use and methadone treatment stigma in a population of patients receiving methadone treatment who identify as Black/African American. We prospectively examine the effects of substance use, methadone treatment, and racial stigmas on subsequent methadone treatment engagement. Finally, we will utilize exploratory moderation models to evaluate interactive effects of racial stigma on substance use and methadone treatment stigma predicting methadone treatment outcomes. Results of this study have the potential to inform theory and data driven interventions to improve methadone treatment outcomes.

Location: Baltimore, MD; Funding: NIDA (R36DA056761; 2022-2024; PI: Kleinman)

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Evaluating Peer Recovery Coaches to Improve Treatment Outcomes and Reduce Health Care Costs among Patients with Substance Use Disorders

This project aims to evaluate the clinical and cost effectiveness of integrating recovery coaches into primary care for outpatient management of substance use disorders.

Location: Boston, MA; Funding: Partners Healthcare Population Health Management Delivery System Innovation Pilot Grant; 2016-2017. Partnering with the Massachusetts General Hospital (MGH) Substance Use Disorder Initiative (PIs: Wakeman, Magidson). Opportunities for staff and graduate students to be involved in secondary data analysis, and future grant submissions.

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Research Projects at Salvation Army Harbor Light Residential Substance Use Treatment Center in Northeast Washington, DC

UMD Psychology has a longstanding clinical and research partnership with Salvation Army Harbor Light Residential Substance Use Treatment Center in Northeast Washington, DC. Prior NIH-funded trials at this site include:

Effectiveness trial evaluating a group-based behavioral activation intervention to reduce substance use treatment dropout and depressive symptoms (NIDA; 2010-2012; PI: Magidson)

Project evaluating factors explaining the relationship between depression and HIV medication adherence among individuals living with HIV/AIDS (NIDA: 2012-2013; PI: Magidson)

Collaborations at Salvation Army Harbor Light could allow for opportunities for staff and graduate students to be involved in clinical interviewing, primary data collection, secondary data analysis, and future pilot projects and grant submissions.

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Peer Act!vate: Utilizing Peer Recovery Advocates to Implement an Evidence-Based Intervention to Decrease Substance use among Low-income Minority Adults

This is an implementation science study in collaboration with UMB Nursing and Michigan State University to evaluate the use of peer recovery coaches to address substance use in a community health center in Baltimore.  This project aims to adapt behavioral activation for use by peer recovery coach advocates and to pilot the modified approach and training procedures at Paul’s Place, a community health center in Baltimore, MD.

Location: Baltimore, MD; Funding: UMB-UMCP Research Innovation Seed Grant; 2018-2020. Partnering with Michigan State University and UMB Nursing (PIs: Felton, Doran, Magidson). Opportunities for staff and graduate students to be involved in study coordination, primary data collection, secondary data analysis, and future grant submissions

 Publication of results:

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City.

Implementing a peer recovery coach model to reach underserved, minority individuals not engaged in substance use treatment.