Research

The University of Miami was recently awarded a grant from the NIH under the AllofUs Initiative (www.allofus.nih.gov). The All of Us Research Program is a historic effort to gather data from one million or more people living in the United States to accelerate research and improve health. By taking into account individual differences in lifestyle, environment, and biology, researchers will uncover paths toward delivering precision medicine.

The mission of the University of Miami’s South Florida Center for Reducing Health Disparities (SUCCESS) is that through collaborative participatory research with we can improve the health of South Florida’s most vulnerable populations. Our conceptual approach has been to test innovative technology driven approaches to deliver early detection and prevention services among hard to reach populations within their local environment. We seek to further enhance and build on our existing research to test a Community Health Worker (CHW) led multi modality early detection and/or prevention strategy for four health priority conditions: HIV, Hepatitis C, colorectal cancer (CRC), and cervical cancer. Minority groups suffer disproportionately from conditions such as HIV, Hepatitis C, colorectal and cervical cancer. Strategies that can increase rates of screening for these conditions among minorities can help narrow such disparities. Community health workers will use recent advances in home testing technology to see if having these screenings services done at home leads to more screenings than simply referring persons to more traditional medical care.

CHAMP is a street-based testing and education program that partners with Community Health Workers (CHWs) to deliver HIV services directly to the heart of high-risk communities. Our research has shown that alternative testing methods, with CHW support, can significantly improve testing rates and clinical outcomes in a controlled trial setting. Building upon these findings, CHAMP’s mission is to translate our CHW research into a sustainable community service for Miami’s diverse minority populations.

CHAMP began in 2016 with funding from the Elton John AIDS Foundation, whose support was integral in developing our strong, culturally-acceptable HIV initiative for diverse minority groups. By providing HIV testing in accessible community settings, CHAMP has functioned as a form of advocacy, increasing screening opportunities for high-risk populations and upholding the healthcare rights of the community. Since our start on World AIDS Day 2016, our team has provided thousands of local community members with HIV services, including onsite rapid testing; prevention education; access to PrEP & PEP; and linkage to care support. Our significant community impact has been recognized and supported by other organizations, including Gilead Sciences and, most recently, the Florida Department of Health. Awarded in January 2019, CHAMP is the only university-based HIV initiative in South Florida to receive DOH funding as a publicly-funded testing service. Through the wide dissemination of our program success and the high visibility of our street-based team, CHAMP continues to make tangible progress towards becoming a standard of care for resource-poor communities across the U.S.

1.0 The meaningful engagement of communities, patients and other stakeholders is key to patient centered outcomes research. One important stakeholder group in PCOR research are Community Health Workers (CHWs). Indeed at present, nearly half of all the projects funded by PCORI’s Addressing Disparities Program include interventions containing a CHW component. Over the past decade, consensus has rapidly emerged on process and procedures for standardized CHW training curricula and CHWs were also codified into the Affordable Care Act. However, there remains much less that has been developed around CHW research training and very limited materials for structured training of CHWs specifically in PCOR. Our stakeholder partnership across Florida has also identified a statewide need for a structured CHW training program in PCOR. In response to specific local stakeholder and national needs, from 2015-2017 Dr. Carrasquillo with Brendaly Rodriguez through consultation with CHWs, patients, caregivers, and a national CHW curriculum experts advisory group, developed a structured training program of a 7-hr curriculum, conducted 12 sessions across the state using a PCOR for CHWs Training Toolkit, which can be downloaded here. https://www.pcori.org/research-results/2015/statewide-partnership-training-floridas-community-health-workers-patient

Topics include:
1. What is research? How it is different than service provision to patients? What is PCOR?
2. Ethics and protection of human research participants
3. Participation in clinical trials, randomization
4. Data collection: Qualitative and Quantitative research methods basics
5. Informed Consent Process
6. Study Protocol and Data Management
7. Dissemination of study results

2.0 Based on stakeholder feedback, we proposed and obtained funds to expand the geographic breadth from a statewide project to a national partnership and to broaden the reach of the project by developing a Spanish version of the toolkit. Working with stakeholders in Florida, Texas, California and Tennessee, we will highly participatory consensus-driven decision-making approach to refine the toolkit for local use and train CHW/promotores in patient centered outcomes research (PCOR) by September 2019. https://www.pcori.org/research-results/2017/national-partnership-training-community-health-workers-patient-centered

Funded in 2014 by the National Institute on Minority Health and Health Disparities, HiSSPI is aimed at reducing the risk for a recurrent stroke. The focus of the study is on patients having had a stroke since they are at a higher risk for a recurrent and potentially much more debilitating stroke in the next five years. Our team is currently pursuing two important lines of research aimed at rigorously testing interventions to address disparities in a variety of other health conditions. One involves using Community Health Workers (CHW), which is a highly promising approach, and the second, a Pro-Mobile intervention to test mobile health solutions among minorities.

The Hispanic Secondary Stroke Prevention Initiative is a clinical trial of 300 Latino patients in our stroke registry admitted with an acute ischemic stroke and having a moderate disability or less at the time of discharge. The intervention will include CHW home visits, coaching phone calls, and group sessions.

Cell phone based interactions will include blood pressure monitoring and tailored education messages. Our goal is to determine if the proposed intervention results in improving the most important recurrent stroke risk factor which is systolic blood pressure (SBP). We will also examine other risk factors including cholesterol, medication adherence, and among diabetic patients, glycemic control.

The strength of our study is that it will leverage existing resources, including those of our recently funded stroke disparities program and our Clinical Translational Science Award (CTSA). We expect that our translational research project will provide new insights on potential approaches to treatment that can transform medical practice to improve health outcomes in Latino stroke populations.