CASCADE: A North Carolina cohort to address the cascading effects of the HIV and substance use syndemic

About This Grant

The US Deep South bears the highest burden of HIV, and the South is lagging behind in achieving Ending the HIV Epidemic (EHE) goals. People who use drugs (PWUD) like cocaine, meth, heroin, and fentanyl, are more likely to fall out at each step of the HIV care cascade. Contextual factors contribute to poorer HIV and substance use outcomes, neuroimmune dysfunction, and related chronic illness. The overarching goal of CASCADE (Carolina Addiction Science Coalition for Accelerating Discovery and Engagement) is to investigate the impacts of established and emerging drug use patterns and addiction treatment on the HIV prevention/care cascade in the South. As a community-academic-health system partnership, this proposal is a collaboration between Wake Forest University Health Sciences in Winston-Salem and Charlotte and multiple community organizations throughout Central and Western North Carolina. Leveraging the robust infrastructure of Atrium Health, one of the largest nonprofit health systems in the South, along with HIV and substance use service programs, we will enroll a status-neutral cohort of 1,000 persons who use stimulant and/or opioid drugs – 500 people with HIV (PWH) and 500 people at risk for HIV. Using an observational-implementation hybrid approach, our aims are to: (1) Recruit and retain the CASCADE Cohort to collect multilevel data harmonized with other NIDA-funded HIV cohorts for emerging and high-priority research; (2) Using a social-ecological framework, examine the effects of individual, community, and contextual factors on status-neutral HIV and substance use outcomes over time, investigate the neuroimmune mechanisms through which psychosocial stress affects neuropsychiatric outcomes, and identify structural modifiers (e.g., rural/urban setting) and potential resiliency factors (e.g., coping); and (3) Conduct mixed-methods assessments using implementation mapping to identify structural factors, organizational practices, and other contextual factors that influence the uptake of evidence-based HIV and substance use treatments in healthcare settings, and co-create and disseminate a set of multilevel strategies informed by user-centered design to improve service delivery. Through our application of cutting-edge biostatistics and data science methodologies, our findings will yield novel insights to accelerate scientific discoveries while also enhancing translation to clinical care and facilitating rapid dissemination. As the first NIDA HIV Cohort in the South, we will partner with our Community and Scientific Advisory Board, consisting of members from community organizations, health system administrators, public health officials, scientific leaders, and persons with lived experiences, to inform guidelines and practices in the Carolinas and beyond. CASCADE aligns with national priorities by addressing the growing burden of chronic illness and substance use through a pragmatic, science-based approach.