Improving health, removing barriers, & impacting health literacy in HIV
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Mirjam-Colette Kempf, PhD - Principal Investigator

National Institutes of Health (NIH), National Institute of Mental Health (NIMH)

5R34MH097588-03
5/11/2012-3/31/2015


Kempf-head-shotAssociate Professor, Mirjam-Collette Kempf, PhD was awarded funding from the NIH-National Institute of Mental Health to fund a R34 project titled “Telemedicine to Improve Depression and Adherence in HIV + Women in the Rural South.”

 The R34 mechanism will provide Dr. Kempf with funds to adapt an established and effective cognitive-behavioral therapy for depression and antiretroviral therapy adherence (CBT-AD) and test its feasibility and acceptability to HIV care adherence among HIV-infected minority women living in the rural South of the US. Teleconferencing/telemedicine technology will be used to overcome structural barriers to health care access (e.g. transportation, access to mental health service providers, etc.) persistent in rural areas. Participants will be recruited from three HIV care organizations serving 47 counties across Alabama, including 668 HIV-infected women in 2010. All sites are connected through telemedicine equipment facilitating the delivery of mental health service into rural areas.

 For over a decade, Dr. Kempf has studied the impact of HIV in the lives of women.  Under the mentorship of Dr. Susan Allen, Kempf analyzed data from discordant couples from Rwanda and Zambia and found that couples with HIV-infected female partners were more likely to drop out of the study then couples with HIV-infected male partners).  She saw that many of the factors associated with drop out of female participants seemed to be cultural and structural in nature and risk factors for HIV transmission among females was more likely to be related with the risk behavior of their partners’ than their own.

 When reviewing the characteristics of the HIV epidemic in the U.S.,  Dr. Kempf recognized similarities in the HIV epidemic in Africa and among  African American women in the rural South, predicting.an increasing feminization of the epidemic.Consequently, she wanted to further explore gender differences in HIV clinical outcomes- focusing her research on women who in addition had been clinically diagnosed as depressed.  Depression has been recognized as a strong predictor of HIV care non-adherence, and subsequent increased morbidity and mortality. Data show that HIV-infected women are disproportionally affected by depression in comparison to HIV-infected men.  However, interventions addressing the psychosocial needs of HIV-infected women, particularly in the rural Deep South, , are limited.

Dr. Kempf’s  School of Nursing Dean’s Scholar Award- “HIV-infected Women’s Perspective on Telemedicine delivered Mental Health Services”  is intended to address a significant barrier to HIV healthcare in rural areas – lack of transportation.  Kempf hypothesized that offering telemedicine to HIV-infected women who suffer from mental health co-morbidities will increase access to care. However, while telemedicine has been proven to be effective in  HIV negative populations to increase access to care , it is not known how it will be perceived by HIV-infected women in the rural South.  .  The specific aims of the projects are to conduct focus groups and informant interviews among HIV-infected women and HIV care providers to inform the cultural adaptation of the CBT-AD  (Cognitive Behavioral Therapy)intervention and to assess the its feasibility and efficacy via a randomized controlled trial.

 The long-term goal of Dr. Kempf’s project is to develop an effective intervention that significantly improves clinical outcomes in HIV-infected women by decreasing depression and simultaneously increasing both adherence to antiretroviral therapy (ART) and retention in care


Related Publications

Boehme AK, Davies SL, Moneyham L, Shrestha S, Schumacher J, Kempf MC.(2014). A qualitative study on factors impacting HIV care adherence among postpartum HIV-infected women in the rural southeastern USA. AIDS Care. [Epub ahead of print].

Fletcher, F. E., Buchberg, M., Schover, L. R., Basen-Engquist, K., Kempf, M. C., Arduino, R. C., & Vidrine, D. J.(2014). Perceptions of barriers and facilitators to cervical cancer screening among low-income, HIV-infected women from an integrated HIV clinic. AIDS Care. doi: 10.1080/09540121.2014.894617