Learn more about our current global research projects.

Learn more about our current local research projects.

Learn more about our past global and local research projects.

Boston

Evaluating Peer Recovery Coaches to Improve Treatment Outcomes and Reduce Health Care Costs among Patients with Substance Use Disorders

peer recovery global review

Systematic Review on Peer-Delivered Recovery Support Services for Substance Use in Low- and Middle-Income Countries

CHW Interpersonal Skills NRSA

Effectiveness and implementation of pre-training interpersonal skills assessment of community health workers in South Africa to predict post-training competence in mental health care

HEAL Covid-19 Supplement

Understanding the Impact of COVID-19 on Methadone Retention and Adherence in an Underserved, Minority Population w/OUD

WASHINGTON DC

Research Projects at Salvation Army Harbor Light Residential Substance Use Treatment Center in Northeast Washington DC

Project Khanya

Hybrid Effectiveness-Implementation Trial for ART Adherence and Substance Use in HIV Care in South Africa

FOREward Together

Training Peer Recovery Coaches to Promote Retention and Adherence to Medications for Opioid Use Disorder among Low-Income Adults

HEAL Stigma Supplement

How Peers Can Shift Stigma to Retain Low-Income, Minority Individuals in Opioid Treatment

peer act!vate

Utilizing Peer Recovery Advocates to Implement an Evidence-based Intervention to Decrease Substance use among Low-income Minority Adults

Project Start together

Supporting Treatment for Anti-Retroviral Therapy Together

syndemics oud project

Syndemic Factors Influencing Retention in MAT for Opioid Use Disorder in Baltimore, MD

Stigma & Racial Discrimination R36

The Intersecting Effect of Substance Use Stigma, Methadone Treatment Stigma, and Racial Discrimination on Methadone Treatment Outcomes

Khanya: Stepped Care, Peer-Delivered Intervention to Improve ART Adherence and SUD in Primary Care

Globally, a substance use treatment gap exists, with only 1-4% of individuals who need treatment in the most resource-limited contexts receiving minimally adequate treatment. Given the impact of untreated substance use on poor HIV outcomes along the care continuum, efforts are needed to sustainably integrate behavioral interventions into primary care settings to reach individuals at highest risk for poor antiretroviral therapy (ART; i.e., HIV medication) and substance use outcomes. This project attempts to help fill this gap in care by implementing a peer-delivered, stepped care intervention ("Khanya"), which was previously successfully piloted in Khayelitsha, Western Cape, South Africa. Khanya integrates Life-Steps, a single-session problem solving and motivational intervention for ART adherence, with brief behavioral skills to reduce substance use (i.e., behavioral activation, mindfulness, relapse prevention).

In this study, a Type 2 hybrid effectiveness-implementation trial will be used to evaluate the effectiveness and implementation of a stepped-care Khanya. 150 people living with HIV (PLWH) with substance use will be recruited from an integrated primary care site and randomized to enhanced standard of care (i.e., facilitated referral to a public substance use treatment program) or Khanya. In the first step of Khanya, all participants will receive one session of Life-Steps + enhanced standard of care. Only participants who continue to demonstrate poor ART adherence after step 1 will be "stepped-up" to Khanya Step 2, which consists of six Khanya sessions.

The overall aims of this study are (1) to evaluate the effectiveness of Khanya over 12 months on (a) ART adherence, (b) substance use, and (c) HIV clinical outcomes; (2) to evaluate the implementation of Khanya on (a) reach and uptake, (b) adoption, and (c) peer fidelity to the intervention; and (3) to estimate the cost of implementing and sustaining Khanya compared to enhanced standard of care.

Location: Cape Town, South Africa; Funding: NIDA R01DA056102; 2022 - 2027; PI: Magidson. Partnering with University of Cape Town (UCT). Opportunities for staff and graduate students to be involved in study coordination.

Project Khanya: Hybrid Effectiveness-Implementation Trial for ART Adherence and Substance Use in HIV Care in South Africa

South Africa is home to the largest number of HIV-infected individuals in the world. Although SA has one of the largest global antiretroviral therapy (ART) programs, a barrier to achieving successful HIV treatment and prevention outcomes is untreated substance use disorder (SUD). Integrating evidence-based interventions to address both HIV treatment adherence and SUDs in HIV care has potential to improve HIV treatment and prevention in SA. This study is a five-year implementation science trial funded by the National Institute of Drug Abuse to adapt and implement a brief, paraprofessional-delivered integrated intervention for SUD and HIV treatment adherence in Cape Town, South Africa. We are evaluating whether an adapted intervention, delivered by paraprofessionals in this setting, is feasible and acceptable and can reduce SUD symptoms, improve HIV treatment adherence, and reduce HIV viral load.

Location: Cape Town, South Africa; Funding: NIDA (K23DA041901; 2016-2021; PI: Magidson). Partnering with University of Cape Town (UCT). Opportunities for staff and graduate students to be involved in study coordination, secondary data analysis, and future grant submissions.

Publication of results:

“Someone who is in this thing that I am suffering from”: The role of peers and other facilitators for task sharing substance use treatment in South African HIV care

“Too much boredom isn’t a good thing”: Adapting behavioral activation for substance use in a resource-limited South African HIV care setting.

Adapting a behavioral intervention for alcohol use and HIV medication adherence for lay counselor delivery in Cape Town, South Africa: A case series.

Project Khanya: A randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa.

Project Khanya: Results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa.

Project START Together: Supporting Treatment for Anti-Retroviral Therapy Together

The START Together project is a Canadian Institutes of Health Research (CIHR) funded study that aims to develop and evaluate a couple-based intervention targeting antiretroviral therapy (ART) medication adherence for HIV-infected women and their male partners living in KwaZulu-Natal, South Africa. This intervention has the potential to simultaneously improve HIV-infected women’s adherence to life-saving ART as well as engage men into HIV-related care, both of which are major barriers to meeting global goals of eradicating new HIV infections. This study uses a mixed methods research design to develop and test the START Together Program. Qualitative interviews will first be conducted with women and men from the target population to develop and refine the intervention (ensuring it is culturally appropriate) before pilot-testing it with a small number of South African couples to evaluate its efficacy. We have completed the study formative work and are preparing for the pilot study to test the intervention.

Location: KwaZulu-Natal, South Africa; Funding: CIHR Postdoctoral Fellowship (Dates: 2018- 2020; PI: Belus; Mentors: Drs. Ruanne Barnabas (UW), Heidi van Rooyen (HSRC) and Jessica Magidson (UMD)); UMD Dean’s Research Initiative. Partnering institutions and colleagues at the Human Sciences Research Council (HSRC) in South Africa and the University of Washington in the US. Opportunities for involvement in study coordination, data management and analysis (qualitative and quantitative), and future grant submissions.

Peer-Delivered Recovery Support Services in LMICs

This systematic review aims to examine the evidence on characteristics, feasibility, acceptability, and effectiveness of peer-delivered recovery support services for individuals living with problematic substance use in low- and middle- income countries (LMICs). This review will be conducted and reported according to PRISMA guidelines and will include a search of the published literature across PubMed, PsycINFO, Embase, Global Health, and Global Index Medicus. Studies will be double-screened for eligibility criteria; key data will be extracted from included studies and quality assessment measures will be used to describe methodological limitations. Data will be analyzed and reported using narrative synthesis.

Peer Recovery to Improve Polysubstance Use and Mobile Telemedicine Retention

This randomized Type 1 hybrid effectiveness-implementation trial (n=180) aims to evaluate a peer-delivered behavioral activation intervention delivered on a mobile treatment unit (Peer Activate-MTU) in rural Maryland compared to enhanced treatment as usual over 12 months. Primary outcomes are OUD treatment retention and poly substance use (effectiveness), implementation outcomes (guided by RE-AIM), and cost-effectiveness. This project is designed to lead to a potentially scalable model for improving OUD treatment retention and polysubstance use in underserved, rural areas.

Location: Eastern Shore of MD; Funding: NIDA (R01DA057443; 2022-2027). Partnering with University of Maryland, Baltimore (PIs: Kattakuzhy, Magidson). Opportunities for staff and graduate students to be involved in study coordination, primary data collection, secondary data analysis, and future grant submissions

Peer-Delivered Behavioral Intervention to Improve Adherence to MAT Among Low-Income Individuals with Opioid Use Disorder

The opioid use disorder (OUD) crisis is an epidemic of poor access to care, including lack of access to evidence-based behavioral interventions alongside medication for OUD. This project aims to evaluate how peer recovery coaches, trained individuals with their own lived experience with OUD, can improve retention in care for underserved, minority individuals with OUD. In this two-phase, five-year project as part of the NIH HEAL Initiative, we will evaluate the effectiveness and implementation of a peer-delivered behavioral activation intervention delivered at the University of Maryland Drug Treatment Center, in close collaboration with UMB Psychiatry.

Location: Baltimore, MD; Funding: NIH HEAL Initiative (R61AT010799, R33DA057747B; PI: Magidson). Opportunities for staff and students to be involved in study coordination, data collection, qualitative analyses, and secondary data analysis.

Publication of results:

Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial

Syndemic barriers to successful treatment outcomes for individuals receiving medication for opioid use disorder

Defining patient-centered successful methadone treatment outcomes among low-income, minority individuals at a community-based outpatient treatment center.

Adapting a peer-delivered Behavioral Activation intervention to support retention in methadone maintenance treatment for a low-income, minority population.

"Sometimes you have to take the person and show them how": adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention

Syndemic Factors Influencing Retention in MAT for Opioid Use Disorder in Baltimore, MD

This is a mixed methods study partnering with the University of Maryland Drug Treatment Center (UMDTC), a community-based, outpatient substance use treatment center in West Baltimore. This project aims to determine the prevalence and types of psychosocial and structural syndemic factors among individuals initiating Methadone Maintenance Therapy (MMT) for OUD and the relation between syndemic factors and subsequent 6-month retention in an MMT program. 

Location: Baltimore, MD; Funding: Dean’s Research Initiative; PIs: Kleinman, Magidson, Greenblatt; Opportunities for students to be involved in study coordination, qualitative analyses, and secondary data analysis. 

Publication of results:

Syndemic barriers to successful treatment outcomes for individuals receiving medication for opioid use disorder

Psychosocial challenges affecting patient-defined medication for opioid use disorder treatment outcomes in a low-income, underserved population: Application of the social-ecological framework

Training Peer Recovery Coaches to Promote Retention and Adherence to Medications for Opioid Use Disorder among Low-Income Adults

The Foundation for Opioid Response Efforts has awarded over $555,000 to Michigan State University in a partnership with GMAP at UMD to develop a training manual for peer recovery coaches serving low-income, minority communities in Detroit as well as Baltimore. FORE supports partners in advancing patient-centered, innovative, evidenced-based solutions to the opioid crisis. The approach will serve as a guide to coaches in providing positive reinforcement and helping those in treatment to schedule and engage in valued activities. Researchers will examine the effectiveness of the intervention, supervision and training models, and share results with policymakers and treatment programs.

Location: Detroit, MI and Baltimore, MD; Funding: Foundation for Opioid Use Recovery Efforts (FORE) grant (2020-2022). Partnership with Michigan State University (PIs: Felton, Magidson). Opportunities for staff and students to be involved in study coordination, data collection, qualitative analyses, and secondary data analysis.

Publication of results:

“How can I hug someone now [over the phone]?”: Impacts of COVID-19 on peer recovery specialists and clients in substance use treatment

Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South Africa

Internalized substance use stigma has been identified as a barrier to engagement in HIV care and substance use treatment, including in South Africa, the country with the highest number of people living with HIV globally and a high burden of untreated and under treated substance use disorder. While HIV can be a manageable chronic disease for people adherent to antiretroviral therapy (ARTs), substance use is associated with poorer ART adherence and poorer engagement in care for people living with HIV.

Integrating peer recovery coaches (PRCs)—or persons with lived substance use disorder experience—into larger healthcare teams may be a promising way to reduce internalized substance use stigma among people living with HIV who are disengaged from care, and consequently, increase retention in HIV care and substance use treatment. Yet, despite the prevalent assumption that PRCs reduce internalized substance use stigma, no studies have examined this quantitatively, and none have examined this in the context of HIV care. Further, although PRC models have been rapidly scaled in the US, little research has examined PRC models in low- and middle-income countries.

Therefore, this study aims to examine if integrating a PRC into existing healthcare worker teams tasked with re-engaging HIV patients in care reduces substance use stigma among these patients who also use substances. Using quantitative and qualitative methods, the study will also evaluate if changes in stigma are related to re-engagement in HIV care and substance use treatment. To increase the feasibility of this dissertation study, it is integrated into the Siyakhana – Peer R21 study (R21DA053212).

Location: Cape Town, South Africa; Funding: NIDA (R36DA057167; 2022-2024; PI: Regenauer). Additional funding: Dr. Dennis F. Marion Research Endowed Scholarship (Awardee: Regenauer); UMD College of Behavioral and Social Sciences’ Dean’s Research Initiative (DRI) 2022-2023 (PI: Regenauer); and DRI 2023-2024 (PI: Regenauer). Partnering with the South African Medical Research Council (SAMRC). Potential opportunities for undergraduate and graduate students to be involved in transcription, coding, and data management.

Evaluating Peer Recovery Coaches to Improve Treatment Outcomes and Reduce Health Care Costs among Patients with Substance Use Disorders

This project aims to evaluate the clinical and cost effectiveness of integrating recovery coaches into primary care for outpatient management of substance use disorders.

Location: Boston, MA; Funding: Partners Healthcare Population Health Management Delivery System Innovation Pilot Grant; 2016-2017. Partnering with the Massachusetts General Hospital (MGH) Substance Use Disorder Initiative (PIs: Wakeman, Magidson). Opportunities for staff and graduate students to be involved in secondary data analysis, and future grant submissions.

Research Projects at Salvation Army Harbor Light Residential Substance Use Treatment Center in Northeast Washington, DC

UMD Psychology has a longstanding clinical and research partnership with Salvation Army Harbor Light Residential Substance Use Treatment Center in Northeast Washington, DC. Prior NIH-funded trials at this site include:

Effectiveness trial evaluating a group-based behavioral activation intervention to reduce substance use treatment dropout and depressive symptoms (NIDA; 2010-2012; PI: Magidson)

Project evaluating factors explaining the relationship between depression and HIV medication adherence among individuals living with HIV/AIDS (NIDA: 2012-2013; PI: Magidson)

Collaborations at Salvation Army Harbor Light could allow for opportunities for staff and graduate students to be involved in clinical interviewing, primary data collection, secondary data analysis, and future pilot projects and grant submissions.

Peer Act!vate: Utilizing Peer Recovery Advocates to Implement an Evidence-Based Intervention to Decrease Substance use among Low-income Minority Adults

This is an implementation science study in collaboration with UMB Nursing and Michigan State University to evaluate the use of peer recovery coaches to address substance use in a community health center in Baltimore.  This project aims to adapt behavioral activation for use by peer recovery coach advocates and to pilot the modified approach and training procedures at Paul’s Place, a community health center in Baltimore, MD.

Location: Baltimore, MD; Funding: UMB-UMCP Research Innovation Seed Grant; 2018-2020. Partnering with Michigan State University and UMB Nursing (PIs: Felton, Doran, Magidson). Opportunities for staff and graduate students to be involved in study coordination, primary data collection, secondary data analysis, and future grant submissions

 Publication of results:

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City.

Implementing a peer recovery coach model to reach underserved, minority individuals not engaged in substance use treatment.

Home-Based Community Health Worker Support for Mental Health among People Living with HIV in South Africa: A Hybrid Effectiveness Implementation Trial

Major goals:  We propose to develop and evaluate a home-based model for community health workers to address common mental health conditions among people living with HIV in South Africa. We propose formative qualitative work to guide adaptation of the intervention and implementation strategies, iterative refinement, and a pilot hybrid effectiveness-implementation trial to evaluate the adapted approach.

Project Number: R21TW012347-01A1
Name of PD/MPI: Magidson, J / Carney, T / Myers, B
Source of Support: NIH
Primary Place of Performance: South African Medical Research Council (SAMRC)
Project/Proposal State and End date: 08/01/2024 – 06/30/2026
Total Award Amount (including Indirect Costs): $371,079

Hybrid Effectiveness-Implementation Trial to Evaluate a Scalable, Peer-Delivered Intervention for Depression among People with Substance Use Disorder in a Certified Community Behavioral Health Clinic

Major goals: We will evaluate a peer-delivered behavioral activation intervention to address both depression and substance use in a historically underserved setting in Detroit, MI. Leveraging a well-established partnership with a community-based, PRS-led CCBHC, the Detroit Recovery Project, we will evaluate depressive symptoms, substance use, evaluate potential mechanisms of this approach (environmental reward) using geospatial mapping, and evaluate implementation outcomes and cost effectiveness. A community advisory board will guide all aspects of the trial to promote the potential for sustainability.

Project Number: R01MH137237
Name of PD/MPI: Felton, J / Magidson, J
Source of Support: NIH
Primary Place of Performance: Henry Ford Health System, Detroit, MI
Project/Proposal State and End date: 08/01/2024 – 04/30/2029
Total Award Amount (including Indirect Costs): $3,428,831; $733,482 (Subcontract UMD)

PUSH: Peer Behavioral Activation Utilization to Address Structural Racism and Discrimination and Improve HIV Outcomes in High-Risk, Substance-Using Populations

Background: New long-acting injectable antiretroviral therapies for HIV treatment and prevention provide a potential biomedical intervention to overcome adherence challenges typical for oral medications. However, ensuring adherence is crucial, and given its recent development, interventions are lacking to support adherence to long-acting injectable treatments for HIV treatment and prevention. There is an urgent need to create acceptable, scalable, cost-effective interventions to enhance adherence for long acting injectables, particularly among individuals who are actively using substances and have multiple marginalized identities.

Study design: This hybrid Type 1 effectiveness-implementation trial (N=186) is adapting and evaluating a peer-delivered behavioral activation intervention to promote adherence to long-acting injectable HIV treatment and prevention among minoritized individuals with substance use in community sites in DC and Baltimore, compared to enhanced treatment as usual. Further, we are also conducting a cost effectiveness evaluation and rapid ethnographic assessment of structural factors that interfere with engagement in care.

Aims: We are evaluating the effectiveness of the peer intervention on long-acting injectable adherence for HIV treatment and prevention over 12 months and exploring the moderating role of structural and racial discrimination-related factors on care engagement; evaluating the implementation outcomes of the intervention, including a rapid ethnographic assessment of how structural and racial discrimination factors may affect implementation; and assessing the cost and cost effectiveness of the approach.

Location: DC and Baltimore

Funding: NIDA (R01DA061324; 2024-2029)

Principal Investigators: Elana Rosenthal, Jessica Magidson

Partners/collaborators: University of Maryland, Baltimore, Weill Cornell

Opportunities: Staff and graduate students can be involved in study coordination, primary data collection, secondary data analysis, and future grant submissions.