Research

The STAR Program’s research has primarily focused on HIV since its inception in 1990.  Past research includes pharmaceutical trials of antiretroviral medications and interventions to promote prevention with positives and retain patients in care.  The following are active research projects:

Multicenter AIDS Cohort Study (MACS)/Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS)

The Multicenter AIDS Cohort Study (MACS) / Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) is a collaborative research effort that aims to understand and reduce the impact of chronic health conditions—including heart, lung, blood, and sleep (HLBS) disorders—that affect people living with HIV. For decades, the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (NIH), has supported the separate MACS and WIHS cohort studies. MACS was a study of gay and bisexual men, while WIHS was a study of women who had other risk factors for HIV. In 2019, the NHLBI became the primary steward of the new MWCCS. For this effort, the NHLBI is working in close collaboration with the NIH Office of AIDS Research (OAR) as well as several co-funding institutes across the NIH.

The STAR Program’s Women’s Interagency Health Study (WIHS) had been following women living with HIV and a comparison group of at risk HIV negative women for 25 years. Data gathered here at Downstate have contributed to over 900 publications to date on a range of topics including the impact of HIV on women’s health, aging, cardiovascular health, genomics, hepatitis C, pulmonary conditions, renal issues and neurocognition.

The NIH refunded the Brooklyn study site as one of 14 centers to participate in the MACS/WIHS Combined Cohort Study (MWCCS).  All of the former WIHS sites as well as the former Multicenter AIDS Cohort Study (MACS) sites, which had been following men for over 35 years, will enroll participants into a common protocol.  Participants in the MACS and WIHS will be asked to participate in the MWCCS. Researchers will also recruit new participants with a special focus on hard-hit population groups, such as black and Hispanic men and women and residents of southern states.

The MWCCS is designed to investigate a spectrum of questions relating to the basic science, clinical science, and epidemiology of HIV infection in the US, with a focus on comorbidities among men and women living with HIV.  Major areas of investigation include: cardiovascular and pulmonary, neuropsychological, aging, cancer, psychosocial, and health disparities. Enrollment into MWCCS began in 2021.

eHealth HIV Prevention Studies

Sabina Hirshfield, PhD, Principal Research Scientist, Department of Medicine, and Visiting Associate Professor in Downstate’s STAR Program, is conducting the following eHealth HIV prevention studies.

The NYS Department of Health AIDS Institute funded study entitled “Maximizing HIV viral suppression via home collection of DBS for VL quantification” (Hirshfield, PI) will assess the feasibility of HemaSpot dried blood spot (DBS) home collection in outpatient clinical settings among people living with diagnosed HIV (PLWDH) who have been linked to care but do not necessarily follow US recommendations for HIV care retention or who are not durably suppressed.

In partnership with University at Albany’s School of Public Health and the NYS Department of Health, a seed grant from the Brooklyn Health Disparities Center to examine “Racial and ethnic disparities in HIV testing and PrEP uptake among Black and Latino men who have sex with men in New York State” (Hirshfield, PI), will address HIV testing and pre-exposure prophylaxis (PrEP) uptake disparities among Black and Latino men who have sex with men (BLMSM) in NYS. In this pilot study, approximately 30 Black and 30 Latino MSM (from sexual networking websites/apps) who reside in one of 5 NYS counties (Westchester, Erie, Albany, Monroe, and Rockland) will be recruited online. The specific aims are to: 1) develop culturally and linguistically (English/Spanish) appropriate materials (i.e., focus groups with BLMSM from across NYS to develop DBS and PrEP messaging by race and ethnicity) to understand barriers to PrEP uptake in order to successfully engage BLMSM in home DBS collection for acute HIV testing and subsequent linkage to (and monitoring of) PrEP or ART; 2) determine the efficacy of a stepped wedge online intervention to: increase HIV testing via home DBS collection; identify undiagnosed HIV infections; and increase linkage to PrEP services or ART care; 3) evaluate costs associated with this model of reaching, linking, and monitoring high-risk negative (or unknown status) BLMSM with prevention services, as well as engaging newly diagnosed men in care; and 4) measure linkage and uptake of PrEP and ART (via self-report and DBS PrEP and viral load lab tests).

The NIDA funded study entitled “Supporting Treatment Adherence for Resilience and Thriving (START): A mHealth intervention to improve ART adherence for HIV-positive stimulant-using men” (Hirshfield, Co-PI) will test the efficacy of Supporting Treatment Adherence for Resilience and Thriving (START). START is a national mHealth intervention that will integrate two theoretically grounded, evidence-based behavioral interventions. The goal of START is to reach stimulant-using MSM, both inside and outside of major urban centers, to develop a scalable, efficacious, mHealth approach to optimize adherence to antiretroviral medications, regardless of whether men are seeking formal substance use treatment. This two-arm randomized controlled trial of a 6-month mHealth intervention for 350 HIV+ substance using MSM (SUMSM) seeks to improve viral load suppression at 6 months and determine whether any gains are maintained at month 12. If effective, START is scalable to reach a broader population of HIV+ SUMSM and may be adapted to clinic- and community-based settings.

The NINR funded study entitled “A Tailored Approach to Promoting Engagement in Public Health” (Hirshfield, Co-PI) aims to use algorithms from business and science fields to develop Strata, a real-time, web-based platform that will tailor messages, based on psycho-demographic and other characteristics, to encourage participants to enroll in public health research studies. If successful, this technology will improve recruitment and enrollment of underrepresented minorities and help to achieve greater representativeness in research.

The NIMHD funded study entitled “Increasing Engagement and Improving HIV Care Outcomes via Stigma Reduction in an Online Social Networking Intervention among Racially Diverse Young MSM and Transgender Women” (Hirshfield, Co-I) will: 1) test whether an online intervention that promotes user-generated content and engagement to address intersectional stigma is associated with improvements in the HIV prevention and care continuum (HIV testing, antiretroviral adherence, viral suppression) as compared to an information-only control arm; 2) explore whether user engagement, as measured by quantitative and qualitative paradata, mediates the intervention’s stigma- and HIV care-related outcomes; and, 3) examine how changes in intersectional stigma and improvements across the HIV care continuum vary between the researcher-driven vs. peer-driven social network intervention conditions.

The NIMHD funded study entitled “A Pragmatic Clinical Trial of MyPEEPS Mobile to Improve HIV prevention Behaviors in Diverse Adolescent MSM” (Hirshfield, Site PI/Co-I) will be the first study to test the efficacy of a scaled-up, mobile version of an existing HIV prevention intervention originally developed for, designed by, and piloted for, a diverse group of young men who have sex with men (MSM).