1028- South Africa- Exploring substance use and its treatment in the context of achieving sustained ART adherence among female sex workers

The goal of this project is to increase understanding of substance use, how it impacts HIV care, and how to address it in a critical population, specifically female sex workers (FSW) in South Africa. The study leverages data and infrastructure from a previously implemented trial which tested an adaptive intervention aimed at achieving viral suppression among FSW living with HIV. Mathematical models suggest that nearly half of the 200,000 annual HIV infections among adults in SA are acquired by FSW, their clients, or partners of their clients and thus treating these unmet needs could result in better health outcomes for women and the population as a whole. The study draws on data collected through the previous trial’s cohort of FSW to assess patterns of substance use within this group and builds on these findings by conducting formative qualitative interviews with sex workers and key informants to better understand patterns of substance use and barriers and potential facilitators to engage in harm reduction strategies to reduce use. The study includes a discrete choice experiment (DCE) to identify preferences around packages and types of substance use support services for FSW living with HIV who use substances. The study is embedded within the current programmatic infrastructure at TB HIV Care (THC). THC is a South African non-profit organization that works directly with the Department of Health as one of the country’s largest HIV service providers for key populations including FSW and people who use drugs.

The student will work collaboratively with partners on this exciting project funded by the NIH. The position will be based in Durban (eThekwini), KZN where the study will take place. The student will engage in formative work in collaboration with the local study team conducting in-depth interviews with substance use programming implementers and FSW who use substances. The student will participate in analysis of these qualitative data to inform the DCE for which they will also provide implementation support. The student may also have the opportunity to participate in implementation development workshops which are planned as part of the study to bring together researchers and program implementers with expertise in substance use to develop evidence-based substance use programming for further testing in follow-on studies. This project offers an intersection of professional and academic opportunities that is an integral opportunity to gain critical skills in development and management of a study embedded in a service delivery program in a middle-income country. If able to travel, working in the field with local counterparts gives the applicant the opportunity to develop skills in study management that will help them critically analyze how they would design future projects.

The professional work environment at the site is positive and fosters productivity across team members, study and program staff. The workplace operates in a mature, respectful manner and collaboration and teamwork occurs across the study and programme staff at TB HIV Care. The research team – both at the TB HIV Care site and at Columbia University and here at Johns Hopkins – is supportive, unified, and communicative.

This placement would be a good fit for someone who is motivated and can take the lead on projects. Regular mentoring and supervision will be provided by investigators in South Africa and the US, however it will be the responsibility of the student to use the ideas and advice provided by the investigative team to move aspects of the project along, requesting additional support along the way when needed. Students with an interest substance use and mental health, innovative survey designs, and working with key populations are encouraged to apply.

Epidemiology and biostats (620 series or above preferred); completion of qualitative series; courses in survey research methods and implementation science a plus, but not required.

Experience working with marginalized populations and on sensitive topics preferred.
A minimum of 20 weeks is required unless COVID-19 related travel restrictions prohibit this duration, although students who wish to stay longer are encouraged to do so and expenses will be covered to support this. Students who continue to work with the project for longer than 20 weeks will likely have more of an opportunity to assist with data analysis and manuscript development.

Name: Sheree Schwartz, Department of Epidemiology, sschwartz@jhu.edu

I would describe my communication and mentorship styles as... 

I am supportive, available to provide thoughtful feedback and guidance at any point either in-person, by phone or via email. I work closely with the research and study team to ensure goals are met and individuals are supported to engage at the highest level. We work as a unified team and provide support and mentorship across multiple levels.

A complementary student would have a working style and mentorship expectations that are..

A complementary student will be interested in the work, hardworking, and able to work independently and collaboratively. We are looking for students that are excited about the work, willing to learn, and interested in integrating within TB HIV Care and research team. Students who do well with a hands-on mentorship style while also being able to take initiative and ownership of their responsibilities within the project will be a good fit for this placement.

The monthly stipend is sufficient to cover housing, food and use of public transport if able to safely travel due to COVID-19. Students wishing to travel internally for personal reasons may incur out of pocket expenses.

We will work with the student to develop a budget to cover monthly expenses including housing, transportation, groceries, and other basic living expenses. Any living expenses not covered by the GHEFP grant will be covered by the project. Flights to and from South Africa will be covered by the project.