Mentored Scientist Award

Despite advances in HIV treatment and intervention, persistent differences in HIV treatment and care outcomes remain among women living with HIV who use drugs (WWH-WUD) in the United States. Substance use, shaped by and reinforcing psychosocial factors—including stress, depression, trauma, and stigma—undermines antiretroviral adherence, care engagement, and viral suppression. Risk-reduction interventions for women are urgently needed to address these differences; however, rigorous evaluation requires objective measures that capture the heterogeneous, episodic (e.g., non-daily), and co-occurring substance use patterns common in this population. Most interventions for WWH-WUD rely on self-report or short-window urine and blood assays, which underestimate exposure intensity and fail to capture sustained or intermittent use, thereby obscuring meaningful risk-reduction–aligned changes. In contrast, hair toxicology quantifies cumulative drug concentrations over weeks to months, making it well-suited to characterize real-world exposure patterns. The proposed study leverages archived hair specimens collected during a pilot randomized controlled trial focused on the feasibility and acceptability of an intervention for women to improve HIV care among WWH-WUD in the San Francisco Bay Area (N=33); laboratory quantification of drug metabolites was outside the scope of the parent study and constitutes an independent line of investigation.

Using validated assays, we will quantify cumulative drug concentrations in hair at baseline, 3-, and 6-month visits, reflecting sequential ~90- day exposure windows. We will (1) examine associations between psychosocial factors (e.g., depression, stress, trauma, stigma) and cumulative drug concentrations to identify modifiable intervention targets and (2) quantify longitudinal changes in cumulative drug levels and assess whether trajectories differ by intervention assignment. By integrating objective, cumulative drug measurement into longitudinal intervention research, this project advances methodological rigor, generates foundational data for a future R01, and supports my transition to an independent research program centered on developing and testing interventions for women to reduce substance use and improve HIV treatment outcomes among WWH-WUD.