MIrjam Kempf, PhD
Reaching out to rural women with HIV; Improving clinical outcomes through Telemedcine
Associate 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, 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 (Kempf, M. C., 2008). 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., Kempf recognized similarities in the HIV epidemic in Africa and the rural South among females and that a feminization of the epidemic was on its way, with African American women being one of the fastest growing groups affected by HIV. Consequently, she wanted to further explore how the clinical outcomes of HIV disease differed among men and women- focusing her research on women who in addition had been clinical diagnosed as depressed. Depression has been recognized as a strong predictor of HIV care non-adherence, and consequently of increased morbidity and mortality. Data shows 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 of the United States where HIV prevalence remains high, are limited.
Based on the findings from several pilot projects and collaborative work with Erica Aaron, a nurse practitioner and HIV care provider at Drexel University, PA and Dr. Linda Moneyham, Professor at the UAB, School of Nursing Kempf was able to further explore these disparities and the development of effective solutions.
In particular, her School of Nursing Dean’s Scholar Award- “HIV-infected Women’s Perspective on Telemedicine delivered Mental Health Services” allowed her to examine one of the main barriers of HIV healthcare in rural areas – lack of transportation. Kempf believes that offering telemedicine to HIV-infected women who suffer from mental health co-morbidities could help increase access to care. However, while telemedicine has been proven to be affective in other settings to increase access to care (i.e. HIV-negative populations), it is not known how telemedicine will be perceived by HIV-infected women in the rural South.
The long-term goal of Dr. Kempf project is to develop an effective intervention that significantly improves clinical outcomes in HIV-infected women by decreasing depression morbidity and simultaneously increasing both adherence to antiretroviral therapy (ART) and retention in care. The aims of the projects will be to conduct focus groups and informant interviews among HIV-infected women and HIV care providers to inform the cultural adaptation of the CBT-AD intervention and to assess the its feasibility and efficacy via a randomized controlled trial.