OHTN Research Chair in Program Science for African, Caribbean and Black Communities
LaRon Nelson’s research aims to improve the “public health toolkit” to support African, Caribbean and Black (ACB) people in Ontario living with and at risk of HIV. His research focuses on high impact field-based public health strategies that involve targeted outreach to marginalized communities and the innovative use of technology to improve HIV prevention and the care cascade. His research will evaluate the implementation of a new model of client-centred care in Peel region and explore strategies to support HIV pre-exposure prophylaxis (PrEP) in ACB communities.
Key Research Findings
- Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men in three U.S. cities (HIV Prevention Trials Network 073) – This demonstration project of a public health strategy to support pre-exposure prophylaxis (PrEP) adoption and adherence among ACB-American men who have sex with men showed high uptake and adherence of HIV PrEP among men who were supported by a novel client-centered care coordination (C4) approach. The unique C4 public health strategy (PHS) is grounded in self-determination theory and responds to ACB-American men who have sex with men’s needs for autonomy and competence support in healthcare decision-making. Using the C4 PHS, PrEP uptake was 79% (in a context where PrEP uptake was optional) and retention in PrEP with C4 services was 92% at 12 months. These findings suggest that the C4 PHS is a promising approach for supporting PrEP scale up in this population and has helped inspire the next-generation of care coordination approaches evident in LaRon’s proposed work in Ontario.
- Economic, Legal and Social Hardships Associated with HIV Risk among Black Men who have Sex with Men in Six US Cities – This work has shown that economic hardships (such as job loss) can increase risk taking; and that childhood religious teaching that discouraged homosexuality are also associated with HIV risk in adulthood for Black MSM.
- Gender Equitable Attitudes Predict Condom Use in Adolescent Parents in Toronto—The purpose of this study was to determine whether and how gender equitable attitudes were associated with condom use among ACB adolescent and young adult parents. Gender equitable attitudes predicted condom use in the overall sample (AOR=1.13; 95% CI 1.03, 1.25, p<0.05). Men who used condoms at last intercourse had higher gender equitable attitude scores than men who did not use condoms (M=58 vs. 53, p=0.02). Women’s gender equitable attitude scores were not associated with condom use behaviours. Attitudes that support gender equity attitudes predict condom use among adolescent parents, particularly among young fathers. Sexual risk reduction programs targeting youth may benefit from incorporating components that promote gender equity norms.
LaRon Nelson begins his role as OHTN Research Chair in the fall of 2016. His planned projects include:
- Client-Centered Care Coordination Community (C5) Public Health Strategy for Use with African Caribbean and Black Individuals in Peel Region – LaRon Nelson and his team will work with Peel HIV/AIDS Network, Peel Sexual Health Clinics and other area care providers to create an integrated system to support the prevention and care needs of African Caribbean and Black people at risk of or newly diagnosed with HIV. The system will use a mobile app to coordinate care and will be tailored to the specific needs and challenges faced by African Caribbean and Black community members. The team will evaluate the delivery of this program including sociocultural, organizational and regulatory factors affecting its use and associated costs. Once established and adapted, the team will evaluate the impact of the intervention on HIV risk reduction and linkages to care. In later phases of the project, the C5 Public Health Strategy will be used to deliver information about pre-exposure prophylaxis (PrEP) tailored to community needs and to support PrEP delivery and adherence.
Work Environment and Collaborations:
LaRon E. Nelson is a Scientist at the Centre for Urban Health Solutions, St. Michael’s Hospital and the Dean’s Endowed Fellow in Health Disparities & Assistant Professor of Nursing, University of Rochester. He is also Associate Director of International Research in the Center for AIDS Research at the University of Rochester Medical Center. As Chair, he is mentoring an interdisciplinary network of early stage investigators and pre-doctoral scholars in implementation science. This includes supporting them to strategically target their research operating grant applications to address priorities outlined in the En Avant report on research priorities. The mentees will implement and evaluate intervention programs that address issues such as substance use/addiction, multiple intersecting stigmas, racism, policing/ incarceration, and optimizing HIV prevention/treatment in serodiscordant couples.
LaRon Nelson also works collaboratively with OHTN Senior Scientist, Winston Husbands and the leadership of the African and Caribbean Council on HIV/AIDS in Ontario (ACCHO) to build community-based research capacity in Ontario and to address community research priorities. He has built strong relationships with community partners in Peel Region to support the implementation and evaluation of new HIV prevention and treatment interventions in that region.
LaRon Nelson holds an OHTN Applied HIV Research Chair ($625,000; 2016-2021).
Video Lectures and Interviews
- HIV Program Science in African, Caribbean and Black Communities in Ontario (41 min) – May 31, 2016