Welcome to the Simoni Lab!
Research Projects in the Simoni Lab

Antiretroviral Adherence and Depression on the U.S.-Mexico Border

This project has just received NIH funding and is in the start-up phase. More information about this project is centralized on the study website.

Principal Investigator: Jane Simoni

Developing an Antiretroviral Adherence Program in China

Project Summary: China is facing an HIV/AIDS crisis. Although treatment, including free medication, is increasingly available, reports of nonadherence are already surfacing. Within the current window of opportunity, there is an urgent need for research for the development of adherence enhancement programs, which will bolster the efficacy of the medication regimens and thwart the development and transmission of drug resistant virus. This study is a 3-year developmental project to design and pilot a culturally appropriate, clinical feasible, and generalizable program. This project is a multidisciplinary collaboration among experienced investigators at the University of Washington, expert consultants across the U.S., physicians from China's CDC, and care providers at Ditan Hospital in Beijing – the proposed study site. The primary aims of the project are to (1) Collect qualitative data regarding barriers and facilitators to antiretroviral adherence enhancement in China; (2) Design a culturally sensitive and theoretically grounded adherence program; (3) Pilot test the program on 10 patients; (4) Implement a feasibility RCT of 60 participants in a 2-arm study (minimal vs. enhanced intervention conditions); 5) Write an R01 application for a larger project. Although the exact nature of the intervention will depend upon findings from the qualitative phase of the project, research from studies based in the West as well as preliminary work in China suggest the potential acceptability and usefulness of a comprehensive program involving such components as informational group meetings, one-on-one psycho-educational counseling with nurses, DOT provided by family members, alarm reminders, and peer support.

This project is currently in the data analysis and dissemination phase.

Principal Investigator: Jane Simoni

PAL: Peer and Pager Support to Improve Antiretroviral Medication Adherence

Project Summary: New combination antiretroviral therapies have demonstrated unprecedented efficacy yet require strict adherence to complex dosing regimens to inhibit rapid virus replication and the generation of multi-drug resistant strains. This study is a randomized, controlled intervention to enhance antiretroviral adherence among inner city outpatients at a public hospital clinic in Seattle, WA. The intervention tests the relative efficacy of a "buddy" system and a pager intervention against standard of care in a 2 X 2 factorial design. Both interventions are practical, relatively inexpensive, do not require extensive training or additional staff, and have the potential for easy and widespread dissemination. Conceptually based in the social support literature and social learning theory and supported by findings from the original buddy project and preliminary studies of the pager intervention, the current project is designed to test the effects of providing affirmational, emotional, spiritual, and informational support to target key groups of mediators known to affect adherence: self-efficacy, negative affective states, substance abuse, knowledge of the medication regimen, and remembering doses. The buddy intervention involves clinic staff nominating adherent patients as "buddies" who undergo a brief training and receive regular supervision thereafter. The buddies provide social support to fellow patients in accordance with a protocol explained and rehearsed in their training. The pager intervention employs two-way pagers that prompt participants with descriptions of doses and special instructions and provide information about the medications. Adherence of 240 patients will be assessed with self-reports, pharmacy refills, 3-day recall telephone interviews at months 2 and 4, and the Medication Event Monitoring System (MEMS). All participants will be administered face-to-face interviews (assessing demographics and other potential moderators, social support, adherence, and the proposed mediators) at baseline, at the end of the 3-month intervention, and at a 3-month follow-up. This study will provide useful data on rates and correlates of adherence in this at-risk population, on various adherence assessment methodologies, and on the efficacy of two interventions with high exportability.

This project is currently in the data analysis and writing phase.

Principal Investigator: Jane Simoni

Health of Two-Spirit Native Americans

This project is currently in the data analysis and writing phase. More information can be found at this website.

Principal Investigator: Karina Walters

Improving Depression Treatment for Latinas

Project Summary: Latinos comprise one of the fastest growing racial/ethnic populations in the United States, currently constituting 14% of the total U.S. population. The increasing rate of Latinos will undoubtedly increase the number of people at risk for mental health disorders. Latina women will be at heightened risk since previous studies have found greater lifetime prevalence of mental health disorders, especially depression, in comparison to men. Social capital is a promising construct with which investigators may examine a community's capacity to respond to challenges and promote individual-level health. However, the relation between social capital and mental health in ethnic minority populations remains unclear. Obtaining or expanding social capital, especially for marginalized communities, may therefore improve mental health outcomes. The proposed study will investigate the construct of social capital among Latina women of Mexican descent. Specifically, the qualitative phase will provide a description of the construct of social capital and how it operates among this population, while the quantitative phase will investigate the mental health and access to care outcomes of social capital and test a hypothesized model.

This project is currently in the data collection phase.

Principal Investigator: Dellanira Valencia-Garcia, dvgarcia@u.washington.edu

Lesbian and Bisexual Women's Health

Project Summary: The most prevalent mental disorders afflicting women are anxiety and affective disorders, while common health risk behaviors include alcohol and drug use as well as smoking. Lesbian and bisexual women, who constitute an estimated 3.6% -20% of the female population, are at particular risk for these adverse outcomes. For example, sexual minority women are up to three times more likely to experience depression compared to their heterosexual counterparts. Indeed, this population has been acknowledged as at risk for health disparities in Healthy People 2010. Researchers have hypothesized that the elevated rates of mental disorders and health risk behaviors among sexual minority women are linked to the individual and cultural oppressions experienced by this population. However, this "minority stress" hypothesis has not been adequately examined in empirical studies of women, in part due to the lack of a gender-sensitive model and instrument to assess sexual minority women's specific concerns. Research on the impact and nature of minority stressors in this population is desperately needed in order to design interventions. The proposed mixed-methods study will examine associations among minority stress and health and mental health outcomes of sexual minority women. Specifically, the qualitative phase will use focus groups and individual in-depth interviews of 24 sexual minority women to provide a description of the novel category "gender expression" and explore its relation to health outcomes. The quantitative phase will investigate a theoretical model of the effects of gender expression and minority stressors on the outcomes of mental health (i.e., depression, anxiety) and health risk behaviors (i.e., alcohol and drug use, smoking). Minority stressors we will study include bias-related victimization, stigma consciousness, concealment, internalized homophobia, and internalized sexism. Quantitative data will be collected in a national web-based survey of 200 diverse sexual minority women. The applicant, who is a top student at a highly ranked clinical psychology program, has outlined an extensive and detailed training plan for the fellowship. Moreover, she has assembled a team of experts in this area who are well situated to mentor her and assist in achieving the fellowship goals. This project has direct relevance for public health because it examines serious mental health problems and related health risk behaviors among a vulnerable and understudied population. Understanding which factors contribute to these adverse outcomes and how to target those most at risk will help inform public health interventions targeting these individuals and, ultimately, improve their well-being.

This project is currently in the data collection phase.

Principal Investigator: Keren Lehavot, klehavot@u.washington.edu