According to the Connecticut Department of Public Health, as of January 2014, there were 10,474 people in Connecticut diagnosed as living with HIV disease, 33 percent of them intravenous drug users.
Since 2002, Michael Copenhaver, associate professor in the Department of Allied Health Sciences and principal investigator at the Center for Health, Intervention, and Prevention (CHIP), has been involved in health promotion research that evaluates evidence-based behavioral treatment interventions for high-risk drug users.
Currently, he is engaged in a five-year study funded through the NIH National Institute on Drug Use (NIDA). The project is designed to evaluate an adapted version of the CDC Holistic Health Recovery Program for HIV+ drug users. The adapted version was developed by Copenhaver as a cost-effective, community-friendly model that can be integrated into real-world settings, such as drug treatment programs.
During his postdoctoral studies, Copenhaver was part of a team at Yale University that tested the original intervention program, which Copenhaver calls the “gold standard.” He developed the adapted intervention program, entitled Holistic Health for HIV, because the original was so comprehensive, it was found to be overly complicated and too costly for the average clinic to properly utilize.
Where the first program required participants to complete twelve, two-hour sessions over six months, the adapted version requires four weekly group sessions, lasting 50 minutes each. In addition, the long program covers many psychological issues unrelated to HIV and drug use. The short version focuses specifically on steps to reduce risky behaviors and encourage HIV medication adherence.
The program is being tested at the APT Foundation of New Haven, a private substance abuse treatment clinic. Participants are HIV-infected opioid-dependent drug users receiving methadone treatment. Brian Sibilio, research assistant at CHIP, is the project director. Professional counselors facilitate the program.
Participants are interviewed before and after completing the program and at three, six and nine months into the program. The goal is to prevent HIV transmission and improve the quality of life through behavioral intervention that teaches healthy habits. Using the IMB (information, motivation, behavioral skills) model of change, participants are encouraged to move from where they are in their life, to where they want to be with their health or their family relationships or simply to improve their life.
Counselors motivate participants to reduce their risky behavior through various learning modes including PowerPoint presentations, video clips and discussions. They are taught specific skills such as safer needle use and negotiating condom use with partners, as well as ways to improve adherence to their medication protocol.
Copenhaver says, “In most instances, strict adherence to HIV medications reduces the HIV viral load to very low levels. There is good evidence that this reduces the likeliness of transmission. To reduce the risk of rapidly transmitting the virus into the community, it’s vital to reach this population.”
A third of the way through the project, the team has recruited approximately 75 of their goal of 250 participants, and those in the program are very motivated. Follow-up assessment retention rates are at 87 to 91 percent, which is considered excellent.
“Changing behavior is a slow and difficult process,” says Copenhaver. “But we are seeing change, even if it is incremental. There is hope for wide-scale improvement in HIV transmission. Small individual changes can save many lives. That’s what motivates me.”
In another project funded through a NIH Career Development Award, Copenhaver is mentoring graduate and postdoctoral students, nationally and internationally, who are involved in HIV-prevention research, assisting them with research and grant writing. “It’s a nice way to get the next generation up and running with community-based research wherever there is the greatest need,” he says. “I’m working with them so that they can land their own grants.”
Copenhaver was also involved in a recently completed five-year multi-state project funded by the NIH, evaluating HIV prevention in prison settings across the nation, both adult and juvenile. The Connecticut portion of the study was a collaborative effort between the courts; corrections; juvenile justice; state agencies for substance abuse treatment; UConn Department of Allied Health Sciences, School of Social Work and School of Medicine; and Yale University. The project combined multiple evidence-based practices to ensure better treatment and outcomes among drug-involved prisoners, including post-release treatment.
“We were looking at changes that need to be made organizationally to make sure it filters to inmates and those same individuals following incarceration,” Copenhaver says. “We need to determine what needs to be in place when they transition from prison to the community. This could lead to important policy changes within the criminal justice and health care system.”
Copenhaver has incorporated his research expertise into his leadership role as chair of the Allied Health Sciences committee developing a new PhD program in health promotion science. “This is an exciting time for our department and a critical opportunity for us to do even more to promote health and well-being,” he says.