June 16, 2021

On June 11, 2021, Alexis Roth, PhD, MPH, associate professor in the department of Community Health and Prevention at the Dornsife School of Public Health and inaugural lead of Health Equity Advancement Lab, was awarded a National Institutes of Health (NIH) R01 grant for 4.9 million to conduct a randomized control trial to test the “Efficacy of a Trauma Intervention for Affect Regulation, Adherence, and Substance Use to Optimize PrEP for Women Who Inject Drugs” over the next 5 years.

Recent reports of HIV outbreaks across the United States forewarn a possible resurgence of the virus, especially among women who inject drugs (WWID). This is particularly threatening to this population if access, uptake, and adherence to effective harm reduction tools remain sub-optimal.

An effective and safe way to stop the spread of HIV among at-risk populations is ensuring that they have access to pre-exposure prophylaxis (PrEP), a daily oral medication, taken to prevent HIV. Though PrEP is proven to be beneficial, Roth’s earlier research has shown that social stigma, economic insecurity, traumatic experiences (or the threat of violence), and drug use greatly undermined WWID’s agency to prioritize and adhere to a PrEP regimen. Her new intervention, known fondly as TIARAS (Trauma Intervention for Affect Regulation, AIDS, and Substances), aims to address the intersectional nature of WWID’s risk of HIV exposure.

With this new funding, Roth will lead an interdisciplinary team of researchers from Drexel, Prevention Point Philadelphia, the University of Miami, the University of Michigan, and Beth Israel Deaconess Medical Center in evaluating whether TIARAS can produce durable reductions in HIV risk among WWID. The TIARAS intervention will integrate contingency management (CM), a proven strategy to reduce drug use and HIV risk, and expressive writing (EW), a safe and effective approach for addressing trauma symptoms, to test whether EW delivered during CM produces greater reductions in HIV acquisition risk compared to an attention-control condition. The specific aims are to:

1. Determine the efficacy of EW+CM for improving the proportion of participants achieving reductions in HIV acquisition risk at 12 months.

2. Examine key secondary outcomes such as greater PrEP persistence, reductions in substance use, PTSD symptoms, and depression, as well as entry into drug treatment over 12 months.

3. Evaluate the pathways through which the intervention operates using qualitative interviews, mediation analysis and moderation analysis.

As this work progresses, updates can be found on the Health Equity Advancement Lab's website.

Throughout Roth’s public health career, her research focuses on understanding how individual, social, and environmental factors influence health disparities. In particular, she is interested in the intersection of gender and drug use on women’s health and the use of novel interventions to prevent opioid-related overdoses and increase access to health care among people who use drugs.