2023 Scholars
Ayesha Appa, MD, School of Medicine, DOM, Division of HIV, Infectious Diseases and Global Medicine at ZSFG
Proposal Title: IMPACT (Infection Management Plus Addiction Care Together): combined contingency management for substance use disorders & antibiotic adherence in the acute care setting
Abstract: Amidst interrelated problems of increasing infections related to drug use and overdose deaths, contingency management (CM) is an underutilized substance use disorder treatment that leverages incentives for objective behavior change. CM implementation outside of drug treatment settings is limited, despite its regard as gold-standard treatment for stimulant use disorder. Our objective is to describe feasibility and preliminary effectiveness of a novel CM program called IMPACT (Infection Management Plus Addiction Care Together), incentivizing both drug use reduction and antibiotic adherence in the acute care setting. Results from this study will inform expanded implementation of CM, particularly to support multiple health behaviors (e.g., infection treatment and substance use disorders) in a patient-centered manner.
About Dr. Appa: Dr. Appa is a physician dually board-certified in Infectious Diseases & Addiction Medicine, interested in developing effective, patient-centered models of care for HIV, other serious infections, and substance use disorders. She received an MD with distinction from UCSF, completed residency and chief residency in Internal Medicine at the University of Washington, and returned to UCSF for fellowship, where she completed training in both HIV/ID and Addiction Medicine. She is an Assistant Professor in the Division of HIV, ID, and Global Medicine at SFGH whose focus is on integrating treatment for stimulant use disorder and HIV medication adherence support.
Maria Castellanos, MD, School of Medicine, Division of Pediatric Oncology
Proposal Title: Evaluating geospatial and racial/ethnic disparities in children with acute leukemia living in California
Abstract: Survival disparities are persistently observed among Hispanic children with leukemia. The etiology of these disparities remains poorly understood but hypothesized to be multifactorial. Non-biological factors, including geographical residence, are associated with survival disparities for adult with different types of cancers. The Central Coast and Central Valley regions of California have medically underserved communities, with a significant portion of the population lacking health insurance, living in high rates of poverty, and experiencing barriers to health care. Little is known regarding survival outcomes for children with leukemia living along this unique geographic region of the state. Our study aims to evaluate the impact of geographical residence on survival in children with leukemia living along the Central Coast and Central Valley regions of California. Results from this study will begin to unravel the sociodemographic factors that contribute to the poorer outcomes observed among Hispanic children with leukemia living in medically underserved regions.
About Dr. Castellanos: Dr. Castellanos is Clinical Assistant Professor in the Division of Pediatric Hematology Oncology at University of California, San Francisco. She earned her Bachelor of Sciences degree from the University of Nevada, Las Vegas and her MD degree from Howard University College of Medicine. She completed her Pediatrics Residency at Stanford University and her Pediatric Hematology Oncology Fellowship at Texas Children’s Hospital at Baylor College of Medicine. Her research interests are in evaluating geospatial disparities in pediatric cancers, with a specific focus in pediatric leukemias, with her current work involves conducting research in the LatinX population who reside in medically underserved areas including the Central Coast and Central Valley regions of California as well as the US-Mexico border region.
Alison Comfort, PhD, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences
Proposal Title: How social networks may differentially affect contraceptive decision-making depending on sero-status: evidence from women in rural Uganda
Abstract: Social networks represent the social relationships individuals have within their communities. Social networks can affect contraceptive decision-making by providing social support, and they can impact these behaviors through social influence including making salient social norms. However, there is very little knowledge about how the role of social networks and contraception differs for women living with HIV compared to those who are HIV-negative. I will conduct a cross-sectional, quantitative social network study among reproductive-aged women in rural Uganda to understand the relationship between social network structure and composition and contraceptive decision-making, including variation by sero-status. I will also explore whether social support versus social influence affects contraceptive decision-making and if this varies by sero-status. This study will provide the foundations for developing, pilot-testing and evaluating a social network-based intervention focused specifically on ensuring access to contraceptive care, including adaptations based on different needs and roles of social networks by individuals’ sero-status.
About Dr. Comfort: Dr. Comfort is an Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences and an affiliate of the Bixby Center for Global Reproductive Health. Trained as a health economist, she focuses on understanding how individual- and social network factors affect care-seeking with the goal of developing interventions that harness the role of social networks. Her research is focusing on antenatal care use, infant HIV testing, COVID-19 vaccine uptake, and contraceptive decision-making. She leads studies in the Uganda, Madagascar, and the US.
Emilia De Marchis, MD, School of Medicine, Department of Family and Community Medicine
Proposal Title: Learning how to screen for digital health access
Abstract: Digital health access, including internet/device connectivity and digital literacy, has important implications for both health care access and health equity. Yet little research has explored how to identify barriers to digital health access at the point of care. The proposed work will strengthen a line of psychometric validity testing for digital health access screening questions that launched in 2021-2022 in collaboration with Kaiser Permanente. Population Health & Health Equity (PPHE) funding will expand the work to conduct cognitive interviews and surveys exploring the comparative content validity of digital health screening questions specifically for patients with limited English proficiency. This research is immediately policy relevant, since national groups like the Centers for Medicare and Medicaid Services and electronic health records vendors are making decisions about screening measure requirements in the absence of foundational evidence on specific instruments. Preliminary work will support future research on digital health access screening and related interventions.
About Dr. De Marchis: Dr. De Marchis is a family physician, health services researcher, and implementation scientist at the University of California, San Francisco. She is an affiliate faculty at the UCSF Social Intervention Research & Evaluation Network (SIREN), where she works to assess and improve how we screen for and address social risk factors within health care settings. Through her research and clinical practice, she hopes to advance the health care system’s integration of patient social risk data to provide high quality, patient-centered preventative health care, to reduce health disparities. Dr. De Marchis received her MD from Stanford University, and her MAS in Clinical Research and Certificate in Implementation Science from UCSF.
Kristin S. Hoeft, PhD MPH, School of Dentistry, Department of Preventive and Restorative Dental Sciences
Proposal Title: Pilot evaluation of California’s oral health literacy toolkit
Abstract: Tooth decay is the most prevalent chronic health problem of children, affecting 54% of kindergartners and 70% of 3rd graders in California. Personal and organizational oral health literacy (OHL) are important contributors to oral health inequities. Improving oral health literacy through patient-provider communication can influence the quality of children’s dental care experience and continuity of care. California Office of Oral Health has supported the development of an Oral Health Literacy Toolkit to improve patient-provider communication, but data is lacking on its implementation and efficacy from dental providers and patients. The objective of this proposal is to collect pilot data to inform a larger grant application to formally evaluate the Toolkit.
About Dr. Hoeft: Dr. Hoeft’s research interests include oral health disparities, oral health literacy, patient-provider communication, tobacco use in adolescents, and community-engaged research. Her research focuses on implementation and evaluation of best oral health practices in real-world, community settings. She specializes in qualitative research methods. Dr. Hoeft serves as Principal Investigator of the California Oral Health Technical Assistance Center and is affiliated with the UCSF Center to Address Disparities in Children’s Oral Health, Healthforce Center, and UCSF’s Dental Public Health Residency Program.
Elaine Khoong, MD MS, School of Medicine, DOM, Division of General Internal Medicine ZSFG
Proposal Title: Identifying brief digital exclusion screening questions for diverse patient populations
Abstract: This study identifies brief screening questions for digital exclusion and validates them in diverse populations. We will conduct brief cognitive interviews of pre-existing digital exclusion screening questions and modify questions as necessary for diverse populations. Then, we will validate the performance of these screening questions by observing individuals conducting digital tasks. Our goal is to identify short set of questions that healthcare systems can use to accurately identify patients at greatest risk of digital exclusion.
About Dr. Khoong: Dr. Khoong is a general internist and clinical informatician at San Francisco General Hospital. She is interested in leveraging technology and implementation science to improve equity in delivery of primary care. Her research aims to reduce chronic disease disparities in historically excluded populations. Dr. Khoong's research interests are driven by her experiences as a primary care clinician caring for diverse patients within a safety-net setting.
Emily Mrig, PhD MA, School of Pharmacy, Department of Clinical Pharmacy
Proposal Title: Augmenting electronic health records data with geospatial data to address disparities across the continuum of precision oncology care
Abstract: ‘Precision oncology’ offers individualized cancer treatment by using sequencing to select targeted therapies matched to the unique genetic fingerprint of each person’s cancer. However, not all patients are equally able to take advantage of these novel treatments, especially patients from underserved and vulnerable populations. Disparities may be related to insurance coverage and cost issues that create multiple delays in managing a person’s cancer care, which can have a cumulative impact on therapy and outcomes. The proposed study integrates electronic health records (EHR) and geospatial data to examine insurance and cost barriers throughout a patient’s cancer care. Using a case study of patients with lung cancer at UCSF, we will analyze differences in access to precision oncology care across patient population subgroups (e.g., race/ethnicity, neighborhood SES, etc.). Results will generate a more nuanced understanding of the underlying mechanisms of health disparities and provide the foundation for future interventions that strategically address inequities in timely access to precision oncology care for NSCLC patients at UCSF and the Bay Area community.
About Dr. Mrig: Dr. Mrig is an interdisciplinary scholar dedicated to investigating and alleviating inequities in access to precision medicine and oncology care. Her diverse experience and training in public health, health policy, and social science provide a unique perspective and a deeper and more nuanced understanding of the complex and multifaceted factors contributing to healthcare disparities. For the last several years, her research has focused on insurance coverage and reimbursement-related barriers to precision oncology care, including a study examining access to genetic testing and related genomic services among individuals and families at-risk for hereditary cancer.
Pamela Murnane, PhD, School of Medicine, Department of Epidemiology and Biostatistics
Proposal Title: Closing the gaps in perinatal HIV transmission
Abstract: For pregnant and postpartum women living with HIV, antiretroviral treatment (ART) optimizes health and prevents perinatal transmission. Despite near universal access to ART globally, critical gaps in prevention of perinatal transmission remain. Person centered care is increasingly recognized as an essential strategy to closing the gaps in HIV service delivery and ongoing perinatal HIV transmission. Leveraging programmatic data from an HIV treatment program in Kisumu County, Kenya, which implemented novel person-centered interventions for pregnant and breastfeeding women living with HIV, we will quantify maternal and infant HIV outcomes before and after implementation. In this observational pre-post analysis, we will assess potential biases via external data sources within Kenya across the same time period. We anticipate that this work will provide important information regarding the potential impact of person-centered interventions on maternal care engagement and HIV transmission in resource limited settings.
About Dr. Murnane: Dr. Murnane completed her doctoral training in epidemiology at the University of Washington, followed by 2 years in South Africa engaged in a novel study examining implementation and clinical impacts of infant HIV diagnosis at birth and early treatment initiation. She joined the faculty at UCSF in 2019, and her research focusses on biological, behavioral, and structural factors that influence maternal and child health outcomes in the context of HIV in resource limited settings. She has expertise in medication adherence measurement, risk prediction, and epidemiologic methods, and is currently the PI of a K01 Award aiming to identify implementation strategies to deliver targeted adherence support for pregnant and postpartum women living with HIV in western Kenya.
Shreya Patel, MD MPH, School of Medicine, DOM, Division of Gastroenterology ZSFG
Proposal Title: Implementation of a comprehensive colorectal screening program for an urban safety-net system
Abstract: Disparities in colorectal cancer (CRC) screening disproportionately affect patients in a safety-net system, where there are lower overall screening rates and delayed diagnoses. While CRC screening is highly effective, safety-net systems have struggled with achieving high rates within their population due to a variety of barriers including competing health priorities, socioeconomic factors, cultural and language issues, and the fundamental invasive nature of CRC screening methods. Many integrated health systems have invested in population health infrastructure to overcome these barriers using centralized tracking and patient navigation with improvements in screening rates and concurrent decreases in CRC mortality. This proposal aims to build upon an implementation project to transition the current opportunistic model of CRC screening at Zuckerberg San Francisco General Hospital (ZSFG) to a centralized, population health-based approach leveraging the electronic health record (EHR) registries and care pathways to provide cohesive, low-cost patient navigation to reduce disparities and increase overall screening of this vulnerable population.
About Dr. Patel: Dr. Patel graduated from Dartmouth College and then went on to complete her MD at University of Arizona and her MPH at Johns Hopkins. She completed a residency in internal medicine with a focus on global health at Massachusetts General Hospital before her gastroenterology fellowship at University of California San Francisco. She is currently an Assistant Professor at UCSF based at Zuckerberg San Francisco General Hospital where she serves as Director of Quality Improvement and Innovation, as well as an Assistant Program Director for the gastroenterology fellowship program. Her focus is on colon cancer screening efforts in underserved populations utilizing EMR-based registries, automation, and low-cost technology outreach.
Elena Tsoy, PhD, School of Medicine, Department of Neurology
Proposal Title: Psychometric and ecological validity of neuropsychological assessment in diverse older adults
Abstract: Neuropsychological assessment plays a critical role in detecting and monitoring cognitive health along the Alzheimer’s disease and related dementias spectrum, and neuropsychologists primarily rely on test scores to characterize the pattern of performance to determine the presence of an underlying disease. Minimizing cultural bias in measurement of cognitive abilities is thus essential for making accurate inferences about individual differences in neuropsychological performance and informing accurate diagnoses. This is particularly important as past research found that cognitive performance is significantly influenced by an individual’s race, ethnicity, and culture. This proposal aims to examine psychometric (measurement invariance) and ecological (cognitive-functional associations) validity of a widely used battery of cognitive measures thereby furthering our knowledge of cross-cultural differences in cognitive performance and informing selection of optimal neuropsychological tests for use in diverse populations through minimizing bias. The findings of this work will contribute to initiatives underway by faculty and Atlantic Fellows for Equity in Brain Health on the development and validation of cognitive assessment tools that are critically needed across cultures and geographies.
About Dr. Tsoy: Dr. Tsoy is a bilingual neuropsychologist with primary interests in early detection and diagnosis of neurodegenerative disease, multicultural neuropsychology, and social determinants of health and healthcare disparities in Alzheimer's disease and related dementias (ADRD). She works on elucidating social and structural factors underlying disparities in dementia diagnosis and care nationally and internationally and on the development and validation of novel cognitive assessment tools for the detection and diagnosis of cognitive disorders in underserved populations. An overarching goal of Dr. Tsoy’s research is to advance dementia prevention and care in diverse populations and lay the foundation for equity-based therapeutic and diagnostic practices which would improve the lives of all older adults.
Jack Turban, MD MHS, School of Medicine, Division of Child and Adolescent Psychiatry
Proposal Title: Systematic content analysis of federal appellate court rulings regarding the constitutionality of bans on gender identity and sexual orientation conversion effort bans
Abstract: Sexual and gender minority (SGM) people in the US face substantial mental health disparities. Past research has implicated conversion efforts (attempts to force SGM people to be cisgender and heterosexual) as potential drivers of these disparities. Subsequently, twenty states have introduced legislation restricting conversion efforts. However, these laws have been challenged in US federal courts on constitutional grounds. To date, there have been four federal circuit court rulings on this topic – three of which ruled that conversion effort bans are constitutional and one that ruled that they are not. This study will apply systematic content analysis to these decisions to identify what unanswered questions must be addressed by the medical and scientific communities for US federal courts to determine if conversion effort bans are constitutional. Given the strong links between exposure to conversion efforts and adverse mental health outcomes, these questions have important relevance for SGM mental health at the population level.
About Dr. Turban: Dr. Turban is the director of the UCSF gender psychiatry program in the division of child and adolescent psychiatry, and his research examines the determinants of mental health among transgender and gender diverse youth, with a focus on questions relevant to public policy. His research has been cited in state legislative debates around the country, major court cases regarding the civil rights of transgender people in the US, and in the United Nations Independent Expert Report on Conversion Therapy. He is co-editor of the textbook Pediatric Gender Identity: Gender-affirming Care for Transgender & Gender Diverse Youth.
2022 Scholars
Patience Afulani, PhD, MD, MPH, School of Medicine, Department of Epidemiology and Biostatistics
Proposal title: Adaptation and validation of a person-centered prenatal care scale for low- and middle-income countries
Abstract: Person-centered care, which refers to care that is respectful and responsive to people's preferences, needs, and values, is a key component of quality of care. In the last five years, my work has focused on research to advance measurement, identify barriers and facilitators, and develop interventions to improve the quality of care during pregnancy and childbirth, focusing on person-centered care. As part of this work, I led the development and validation of a scale to measure person-centered maternity care in Kenya, Ghana, and India. This scale has had widescale uptake and is being validated in several other settings. There are, however, still no validated scales for measuring person-centered prenatal care in low- and middle-income countries (LMICs). The Population Health and Health Equity Scholars award will help to bridge this gap by enabling me to adapt and validate a person-centered prenatal care scale for LMICs.
About Dr. Afulani: Dr. Afulani’s research focuses on the social and health system factors underlying disparities in reproductive, maternal, neonatal, and child health (RMNCH). She is particularly interested in how RMNCH outcomes are shaped by quality of care in health facilities as well as by social determinants. Dr. Afulani also seeks to contribute to improved measurement of quality of care, particularly person-centered care, and to the development of evidence-based interventions to improve RMNCH outcomes and reduce disparities.
Riham Alwan, MD, MPH, School of Medicine, Department of Emergency Medicine
Proposal title: Understanding and improving care delivery for patients with limited English proficiency in emergency department settings through a social needs screening tool
Abstract: Without the restrictions of insurance, documentation status, or clinic hours, emergency departments (EDs) cater to the acute and chronic needs of immigrants. Social determinants of health (SDH) affect health outcomes and utilization. Unstable housing and food insecurity have been linked to increased ED visits and hospitalizations. Social needs screenings (SNS), aimed at identifying and addressing social needs in the clinical setting, have been shown to be effective in ED settings. There is limited data to guide the adequacy of existing screening tools among immigrant families. Limited English Proficiency (LEP) designation has been used as a surrogate for immigrants. This mixed methods study seeks to understand and improve the care delivery for LEP patients in the ED setting by partnering with LEP adults to: 1) qualitatively develop an equitable and acceptable social needs screening tool and 2) implement the screening tool and quantitatively measure linkages to health care and community resources. This proposal seeks to fund the initial qualitative inquiry into the development of a culturally humble SNS.
About Dr. Alwan: As an emergency medicine physician researcher specializing in pediatrics, Dr. Alwan focus on the interplay of violence, health behaviors, and health outcomes. She strives to create systems that identify and empower victims of violence to achieve quality healthcare. Dr. Alwan’s robust clinical experiences, extensive research activity, skills in community engagement, and passion for continued education facilitate her success as a clinician-researcher. Dr. Alwan’s vision for the future is to excel as a clinician specialist, action researcher, and lead advocate for vulnerable minority populations.
Ifeyinwa Asiodu, RN, PhD, School of Nursing, Department of Family Health Care Nursing
Proposal title: COVID-19 vaccine acceptance and uptake among Black birthing people
Abstract: Pregnant and postpartum people may face increased vulnerability to infections and severe illness. COVID-19 infection among pregnant people increases the risk of severe COVID, intubation, and potential death and infant outcomes such as preterm birth. The burden of disease associated with COVID-19 is not equally distributed. Birthing people of color, especially Black women, have experienced higher rates of COVID-19 infection and deaths, yet are less likely to be vaccinated. The purpose of this research project is to describe and examine experiences and factors related to receiving the COVID-19 vaccination. A qualitative, critical ethnographic design, informed by the life course perspective, will be used to interview up to 50 vaccinated, Black pregnant and postpartum people. Results from this study will be used to inform and improve current strategies related to COVID-19 vaccine acceptance and uptake among Black birthing people and alleviate concerns associated with COVID-19 and future public health emergencies.
About Dr. Asiodu: As a researcher, registered nurse, and lactation consultant, Dr. Asiodu’s research is focused on the intersection of racism, systemic and structural barriers, life course perspective, and human milk and lactation. Dr. Asiodu uses a critical ethnographic lens to inform her work. The long-term goal of her research is to reduce infant feeding disparities and increase access to high quality human milk feeding care, lactation support, and equitable contraception services for Black communities. She is also actively engaged in local, state and national human milk feeding (e.g. breastfeeding, chestfeeding, and donor human milk), reproductive health, maternal and child health, and public health organizations geared toward achieving birth and human milk feeding equity and justice.
Jean Calvo, DDS, MPH, School of Dentistry, Department of Orofacial Sciences
Proposal title: Understanding barriers to accessing oral health equity for children with special health care needs
Abstract: Children with special healthcare needs (CSHCN), including physical, intellectual, and developmental disabilities, experience a disproportionate burden of oral disease that is exacerbated by inequitable access to dental care. Many CSHCN require dental treatment with general anesthesia (GA). Disappointingly, nearly 75% of children who are treated for dental care with GA develop new dental caries within 1-year. Additionally, CSHCN are more likely to experience multiple dental treatments with GA. Lack of both access to and implementation of preventive dental care in CSHCN results in inequitable oral health experience and outcomes. This study uses a mixed-methods qualitative-quantitative approach to analyze patient, family, and community level barriers/supports to dental care access. This study aims to; identify barriers for the CSHCN population to receiving routine preventive dental care following treatment with GA and design an innovative patient-centered intervention to increase the percentage of CSHCN who have a dental home and access preventive dental services.
About Dr. Calvo: Dr. Calvo helps oversee residency training and leads a course on pediatric dentistry and public health topics. She is helping to expand the pediatric dental residency program by increasing residents' training in public health, collaborating with behavioral health colleagues to improve dental visits for children with autism spectrum disorder, and mentoring students and residents in the field of pediatric dental research focused on public health. Dr. Calvo is devoted to increasing access to dental care for all children and is particularly passionate about providing care to underserved children, such as those with complex medical conditions or other special health care needs.
Deborah Karasek, PhD, School of Medicine, Department of Ob/Gyn Reproductive Sciences
Proposal title: Economic policy levers to advance perinatal equity: Exploration of the earned income tax credit and the child tax credit
Abstract: Economic policies such as the earned income tax credit (EITC) have been shown to positively impact perinatal health, especially for racial/ethnic minoritized pregnant people at higher risk or adverse outcomes due to structural inequities. The implementation of the child tax credit (CTC) in 2021 has the promise to reduce child and family poverty and thereby improve population health. While EITC is delivered in a lump sum, families receive CTC monthly. The impact of the CTC on maternal and infant health equity is likely substantial yet remains to be studied. The goal of this proposal is to 1) evaluate the impact the timing of income receipt from EITC to on maternal and perinatal health and 2) explore novel data linkages to provide preliminary evidence for future studies of the CTC.
About Dr. Karasek: Dr. Karasek is an epidemiologist studying social, economic and psychosocial determinants of health and health equity. Her research applies a health equity lens to explore how economic insecurity, neighborhood housing conditions, and social policy impact the health and wellbeing of pregnant women and their families.
Jennifer Smith, PhD, School of Medicine, Department of Epidemiology and Biostatistics
Proposal title: Integration of antenatal neglected tropical disease surveillance with ongoing malaria testing in Tanzania
Abstract: Globally, the poorest populations bear the largest burden of disease from parasitic infections including malaria and neglected tropical diseases (NTD), like soil transmitted helminths (STH) and schistosomiasis. Relatively high uptake of antenatal care suggests that surveillance in pregnant women may be a convenient and accurate way to gather high resolution data on about disease transmission in the community at large, and improve intervention coverage in this vulnerable group. The proposed project will integrate antenatal surveillance for schistosomiasis and STH with ongoing malaria testing at two health facilities in Tanzania, where an NIH funded clinical trial tracking malaria infections in a cohort of children will be underway. Malaria and NTD test results during antenatal care will be compared to those in children to assess the use of antenatal surveillance for measuring malaria trends and to generate high resolution spatial data on schistosomiasis to improve targeted and tailored intervention strategies.
About Dr. Smith: Dr. Smith’s research focuses on the epidemiology of infections diseases of public health significance in developing countries, including schistosomiasis, soil-transmitted helminthiases, lymphatic filariasis and trachoma. For the last several years, Dr. Smith’s research has been focused on malaria, particularly surveillance and response in elimination settings. She has significant experience in conducting field studies in resource-limited and rural settings as well as leading and managing multi-cultural teams of researchers. Dr. Smith also provides technical assistance to a number of non-governmental organizations to support study design, data analyses, mapping and manuscript writing.
Paul Wesson, PhD, School of Medicine, Department of Epidemiology and Biostatistics
Proposal title: Investigating psychiatric and neighborhood-level inequities in the HIV continuum of care in San Francisco
Abstract: As San Francisco (and similar “Fast Track Cities”) continues to make overall gains in preventing new HIV infections and improving treatment outcomes for people living with HIV, population health researchers must be vigilant against emerging and widening disparities among disadvantaged populations. People with severe mental illness (SMI) face up to a 10-fold higher probability of HIV acquisition compared to people without SMI, although evidence is mixed regarding worse outcomes in the HIV continuum of care for this population. This study seeks to fill this gap in the literature through leveraging a recently constructed retrospective cohort of people living with HIV (PLWH) in San Francisco to statistically model and test for differences in HIV care engagement outcomes for PLWH with SMI compared to PLWH without SMI. Results from this analysis and others using this cohort will inform targeted interventions to reduce emerging inequities in HIV care.
About Dr. Wesson: Dr. Wesson is an epidemiologist focused on quantifying the health burdens of (and disparities related to) hard-to-reach and socially marginalized populations, particularly as they relate to infectious diseases. His research expertise includes developing and using data driven methods for sampling hard-to-reach and “hidden” populations, population size estimation methods, and using advanced epidemiologic and statistical techniques to study the social determinants of health. As an HIV researcher, Dr. Wesson’s research agenda relates to the unique challenges of sampling hard-to-reach populations for HIV surveillance, and leverages information from the sampling process (and survey data) to generate estimates of the population size.
Charles Windon, MD, School of Medicine, Department of Neurology
Proposal title: Increasing diversity of autopsy cohorts for Alzheimer’s Disease and related dementia research at the UCSF Memory and Aging Center through comprehensive education and novel community partnerships
Abstract: Increased diversity of autopsy cohorts for Alzheimer’s Disease (AD) and related dementia (ADRD) research is a critical component of advancing our understanding of neurodegenerative conditions, particularly as the aging population becomes increasingly diverse. Unfortunately, the autopsy cohorts of most Alzheimer’s Disease Research Centers (ADRCs) remain devoid of racial, ethnic and socioeconomic diversity, and are not fully representative of the true population. Estimates from some ADRCs indicate that >90% of their brain donors are Non-Latino White individuals with high levels of educational attainment and socioeconomic status. Previous research, which has been largely qualitative, has revealed barriers to autopsy participation may vary among groups that have traditionally been underrepresented. Common themes identified through this qualitative research include: lack of knowledge about the value of assessment of postmortem brains for dementia research; lack of knowledge and misconceptions about the logistics of brain donation and autopsy; religious concerns about brain removal; the history of racism in research; and the role of family decision making in the brain donation process. These shared themes cross racial, ethnic, and socioeconomic boundaries in many studies, though some barriers are more significant among specific groups. Addressing these identified barriers and diversifying autopsy cohorts will therefore require a unique approach that is not only multi-faceted but also leverages relationships with vital community stakeholders. The project in this proposal seeks to increase representation of African Americans of all socioeconomic backgrounds in the Memory and Aging Center (MAC) autopsy cohort using a unique approach. The framework built through this project can then be used in future efforts that focus on recruitment of additional populations, particularly members of the Latino, Asian American Pacific Islander, and Native American communities, who are also underrepresented in the MAC autopsy cohort.
About Dr. Windon: Dr. Windon is an assistant professor of clinical neurology at the UCSF Memory and Aging Center (MAC) where he participates in the clinical care of those with neurodegenerative disease and in the research evaluations of patients with a multitude of neurological conditions. Dr. Windon is also involved in the community outreach program at the MAC, with a particular interest in outreach to underserved communities, especially the African American community within the San Francisco Bay Area. Dr. Windon seeks to further our understanding of neurodegenerative disease and the significance of biological markers of disease among underserved populations that have traditionally not been included in research, with the goal of providing better care and better opportunities for therapy. Dr. Windon will work with co-PI, Dr. Salvatore Spina, on the proposed project.
Sofia Zamudio-Haas, DrPH, School of Medicine, Department of Medicine
Proposal title: Culturally tailored, HIV health communication materials for trans women
Abstract: Transgender populations, in particular transgender women, have largely been left out of advancements in HIV care and treatment. Transgender women continue to shoulder the heaviest burden of HIV incidence and prevalence, despite available medications. A lack of culturally tailored, population-specific health communication is a key structural barrier that contributes to HIV disparities. This PHHE project supplements an Ending the HIV Epidemic (ETE) implementation science study to develop, test, and refine Spanish and English health information messages for trans women. Drawing on interviews conducted as part of the ETE study, we will analyze gaps in information, barriers, and facilitators to care and develop HIV testing, PrEP and ART messages. We will test these messages in focus groups with transgender women, refining and piloting materials as part of the EHE study. Findings will be published and used to develop an R34 proposal to scale-up and test effective multimedia HIV health information messages for this marginalized group.
About Dr. Zamudio-Haas: Dr. Zamudio-Haas’ research interests lie in increasing access and uptake of HIV prevention and treatment services for most affected populations in the US and globally, including gender and sexual minorities, people who inject drugs, and young women and girls. Engaging participatory and community-led methods, as well as quality improvement strategies, her work focuses on generating innovations and adapting care programs to meet the needs of marginalized populations, with the goal of reducing HIV health disparities. Her current work focuses on increasing access to culturally tailored and population specific HIV prevention and care services for transgender women.
2021 Scholars
The pilot awards go to support innovative research or programming already underway and led by the scholars.
Jessica Beaman MD MPH, Department of Medicine
Proposal title: Understanding Barriers to Abortion Provision in the United States
Abstract: The inequities in access to abortion care have disproportionately affected individuals who live at or below the federal poverty level, those in rural communities, younger individuals, and communities of color and have left the vast majority of individuals in our country without access to local abortion services. This study seeks to identify the barriers and discriminatory practices that physicians encounter when seeking to integrate abortion care into their careers in an effort to identify solutions to mitigate these challenges. This understanding could lead to interventions aimed at increasing the number of physicians providing abortion care in our country so that the medical community can provide more equitable access to this timely and essential service.
About Dr. Beaman: Dr. Beaman is a clinician-educator and general internist in the Division of General Internal Medicine at San Francisco General Hospital. Her areas of interest for her clinical work, research and advocacy are focused on women’s health, family planning, abortion access, and reproductive justice. She is committed to exploring avenues for expanding access to family planning and abortion care in the primary care setting. Dr. Beaman is a primary care provider who sees patients at the Richard T. Fine People’s Clinic at SFGH.
Carrie Chan MSN, CPNP, School of Nursing, Department of Family Health Care Nursing
Proposal title: PrEP Facilitators, Barriers, and Preferences: Perspectives from San Francisco Bay Area Youth
Abstract: Youth at high risk for HIV acquisition face unique barriers to HIV pre-exposure prophylaxis (PrEP) initiation and continuation that have been exacerbated by the COVID-19 pandemic. This project aims to triangulate youth barriers, facilitators, and preferences through formative qualitative research. Results from preliminary data will be used to develop a PrEP care delivery model based on youth perspectives.
About Ms. Chan: Ms. Chan joined UCSF as a faculty member in the Primary Care Pediatric Nurse Practitioner Program in 2018. She has practiced clinically at Stanford Children's Health since 2012 where she also currently serves as Manager of Advanced Practice. In 2019, she joined a small group of pediatric providers to launch the Stanford Virtual PrEP Program for Adolescents and Young Adults.
Maria Esteli Garcia, MD MPH MAS Department of Medicine
Proposal title: Engaging community stakeholders to achieve mental health equity for patients with language barriers in San Francisco during the COVID-19 pandemic
Abstract: Depression leads to increased morbidity and mortality; patients with limited English proficiency (LEP) face additional challenges when obtaining treatment for depressive symptoms. While systematic depression screening and a focus on initial treatment in primary care may help reduce these disparities in depression care, a community-engaged approach is needed to ensure population mental health equity. The proposed study is expected to improve depression care for patients with LEP by engaging community mental health providers, leaders, and advocates to understand how depression care provision has changed during the COVID-19 pandemic and to address gaps in existing care for patients with LEP.
About Dr. Garcia: As a clinician investigator, Dr. Garcia focuses on co-morbid mental health and chronic diseases and their disproportionate impact on vulnerable and marginalized populations and conducts research on mental health integration in primary care, with a focus on racially, ethnically and linguistically diverse populations. Dr. Garcia is an internist who sees patients at UCSF Mt. Zion.
Orlando Harris, PhD, RN, FNP, MPH, School of Nursing, Department of Community Health Systems
Proposal title: “Our Lives Matter”: Exploring Barriers and Facilitators to COVID-19 vaccination and the Impact of the Pandemic on Black/African American Sexual Minority Men
Abstract: There is an urgent convergence of two pandemics that is disproportionately affecting marginalized racial (Black/African American) and sexual minority men, HIV and SARS-CoV-2 (COVID-19). The current COVID-19 pandemic has disrupted HIV treatment and prevention services, with the full impact of that disruption still unknow. Through in-depth semi-structured individual interviews with Black/African American sexual minority men we will qualitatively explore the impact of COVID-19 and shelter-in-place orders on access to care, resource security, well-being, and identify multilevel factors affecting COVID-19 vaccination acceptance and uptake.
About Dr. Harris: Dr. Harris is a researcher who uses community-based participatory research methods both in the United States and the Caribbean, leveraging multi-methods data to inform culturally relevant interventions that improves the lives of vulnerable sexual and gender minorities. His research aims to give voice to sexual and gender minorities in Jamaica and the wider Anglophone Caribbean in order to reduce disparities in health among marginalized communities.
Jennifer James, PhD, MSW, MSSP, School of Nursing, Institute of Health and Aging
Proposal Title: Community engaged research on aging, incarceration, and health: The development of an Inside- Outside Prison Advisory Board
Abstract: The COVID-19 pandemic has brought to light structural issues in the delivery of healthcare and the prevention of disease for incarcerated older adults. The disparate impact of the pandemic on people who are incarcerated is a critical issue of health equity and there is a need for community-based research to both understand current challenges and identify evidence-based interventions. We propose to develop an innovative, community-academic partnership through creation of an “Inside-Outside Prison Advisory Board” which will include currently and formerly incarcerated people, family and loved ones, and correctional healthcare professionals who will, together, serve as an advisory board that engages in community based participatory research to: (1) better understand the experience of people who are aging in prison, especially during a global pandemic, and (2) generate testable ideas for how to curb transmission and mitigate risk of COVID-19 for older patients in correctional facilities
About Dr. James: Dr. James is a qualitative researcher and Black Feminist scholar whose research lies at the intersection of race, gender and health, with a specific focus on experiences of cancer and chronic illness. Her work is currently in two main areas. First, how patients understand genomic risk for breast cancer and make breast cancer screening decisions. Second, she is studying experiences of aging, health and illness for people who are or have been incarcerated.
Marianna Kong MD, Department of Family and Community Medicine
Proposal Title: Reducing inequities through team-based telehealth in safety net populations
Abstract: With telehealth becoming a standard modality of care during the COVID-19 pandemic, dedicated interventions to address equity are crucial for vulnerable populations (including patients who are non-English proficient, identify as racial/ethnic minorities, or are low-income) for whom disproportionate access to telehealth threatens to exacerbate existing health inequities. This project will evaluate the impact of new team-based telehealth workflows in primary care to offer telehealth meaningfully to patients in a safety net setting by having care team members 1) engage and coach patients around using televisits, and 2) ensure televisits incorporate preventive and chronic disease care (such as cancer screenings, smoking cessation and diabetes care). Using an equity lens to study the impact of these workflows on access to care, preventive/chronic care measures, patient experience, and clinician/staff experience will contribute to the identification and dissemination of best practices for providing telehealth care to vulnerable populations in an equitable fashion.
About Dr. Kong: Dr. Kong is a primary care provider in the San Francisco Department of Public Health at the Silver Avenue Family Health Center and leads the Clinic First initiatives at the Center for Excellence in Primary Care, which aim to disseminate best practices in primary care teaching clinic transformation.
Boon Lead Tee, MD, MS Assistant Professor, UCSF School of Medicine, Department of Neurology, Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI)
Proposal title: "Population-specific validation of neuropsychological tests for Chinese American individuals"
Abstract Dr. Tee: Dr. Tee's project focuses on examining the neuropsychological and neuroanatomical interpretations of the numerous cognitive tests adopted for the Chinese American population at the UCSF Memory and Aging Center. Additionally, she will investigate continuous quantitative methods to characterize the multilingual and multi-cultural features of Chinese American population.
About: Dr. Boon Lead Tee is a neurologist who specializes in various dementia syndromes, particularly primary progressive aphasia that predominantly manifests with speech and language impairments. She is developing linguistically and culturally adapted cognitive assessment tools for Chinese populations that suffer from neurodegenerative diseases and studying their neural basis variability across populations. Dr. Tee completed her medical and master’s degree at National Taiwan University and her residency at National Taiwan University Hospital/En-Chu-Kong Hospital. She is an Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI).
Ariana Thompson-Lastad PhD, Department of Family and Community Medicine
Proposal title: Group Medical Visits and Produce Prescriptions: Addressing Food Insecurity and Social Isolation in Perinatal Care
Proposal Abstract: This proposal is to provide supplementary support for health equity-focused research that I am conducting as part of the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) K12 program. The proposed research focuses on understanding the implementation of and potential synergy between group perinatal care (GPC) and produce prescriptions in perinatal care, with an emphasis on upstream factors (food insecurity and social isolation) that affect a wide range of maternal health outcomes.
About Dr. Thompson-Lastad: Dr. Thompson-Lastad is a medical sociologist at the UCSF Osher Center for Integrative Medicine, where her research focuses on addressing social and structural determinants of health in primary care, and advancing health equity through integrative health care. Her current projects includes collaborations with community health centers to understand the implementation and outcomes of group medical visits and other innovative models of care.
Alfa Yansane PhD, School of Dentistry, Department of Preventive & Restorative Dental Sciences
Proposal title: Uncovering Oral Health Disparities within Machine Learning Algorithms
Abstract: Uneven progress has been made in the improvement of oral health care and one of the mechanisms that allows such disparities to persist is algorithmic bias in AI and Machine Learning. There is a dearth of knowledge regarding biases found within the predictive analytics methodology. As such, the objectives of this project are to estimate the level of disparities in the predictions made by AI and machine learning models.
About Dr. Yansane: Dr. Yansane is an Assistant professor of Biostatistics in the Department of Preventive and Restorative Dental Sciences at University of California, San Francisco (UCSF) School of Dentistry. He received his MA in Biostatistics from Harvard University in 2007, and a PhD in Biostatistics from Harvard University in 2012. His current research interests and areas of study include statistical modeling for clinical information within the electronic health record, oral health delivery systems, patient safety, and oral health quality.
