Wayne Steward

Associate Professor

My research program focuses on understanding and intervening with structural and environmental factors affecting the utilization of HIV-related treatment and prevention services. This work includes studies of health policies and systems of care, as well as projects investigating the impact of stigma among people living with or affected by HIV.

In the domain of health policies and systems, the first and largest investigator-initiated project examines the effectiveness of implementing patient-centered medical homes (PCMH) in HIV care settings. A PCMH incorporates improved health information systems, re-designed provider teams, and tools to enhance patient engagement, with a goal of facilitating higher quality and more cost-effective care. I collaborated with the California HIV/AIDS Research Program (CHRP), a special state appropriation that funds peer-reviewed scientific research addressing the HIV epidemic in the state, to develop an initiative to implement and evaluate PCMH in five clinical sites statewide. As protocol chair for the research (and now as the principal investigator of a policy center research grant that supports the cross-site research activities), I currently lead a multi-component, longitudinal study that is examining the impact of the PCMH interventions on the quality of care in the funded sites. A second research project, based in South Africa and funded by the Health Resources and Services Administration (HRSA), is using a cluster randomized design to examine the impact of two clinic-based interventions on HIV-positive clients’ engagement in HIV care, adherence to anti-retroviral medications, and transmission prevention practices. One of the interventions uses text messaging to remind clients of appointments and of the need to adopt health-promoting behaviors. The second utilizes peer navigators who work individually with clients to identify and address barriers to care, adherence, and/or prevention. As co-investigator, my primary role has been the development and implementation of the peer navigator intervention and the research components that focus on it.

I have also partnered as a collaborator in multidisciplinary teams studying HIV stigma in India and China. My contribution to these projects has focused on forms of stigma that affect people living with or at risk of HIV. A now-concluded NIMH-funded study in southern India examined the impact of prejudice on health and wellbeing of HIV-infected men and women. As co-investigator, I collaborated on the development of instruments to assess HIV stigma in Indian contexts and took the lead in publishing multiple papers that used the scales to document how stigma affects HIV disclosure, mental health, and care-seeking behaviors. A new, ongoing NIMH-funded study is examining the impact of an intervention on reducing stigmatizing attitudes among healthcare workers. As co-investigator, I have contributed content to the intervention modules. And a recently concluded project in China focused on prejudice against men who have sex with men (MSM). As co-investigator of this NIMH-funded project, I led the development of quantitative assessments to measure MSM stigma. The measures are were administered to participants in Beijing, China, and used to examine how stigma affects the men’s HIV risk behaviors and the kinds of HIV-related services they are willing to access.

Two additional projects utilize community collaborations to respond more effectively to the HIV epidemic. Through a CHRP-supported policy research center grant, I lead a UCSF team of researchers who work in close consultation with two local HIV services organizations (the San Francisco AIDS Foundation (SFAF) and Project Inform) and a parallel research center in southern California to identify policy issues likely to affect care and services in the state. We then design and implement focused research projects intended to answer key questions of relevance to those policy issues. Recent studies have focused on the feasibility of implementing pre-exposure prophylaxis (PrEP), a biomedical prevention intervention, and the challenges of transitioning patients in HIV care to new forms of healthcare coverage as part of the reforms under the Affordable Care Act. I also collaborated with SFAF to lead an evaluation of its Magnet clinic, a sexual health services center and community space for gay men. The study sought to understand if the visibility of this centrally located clinic influenced community norms around HIV testing and sexual health.

Finally, my research program includes several large projects conducted under the auspices of HRSA’s Special Projects of National Significance (SPNS). This unique component of the Ryan White HIV/AIDS Program is intended to evaluate new systems and programs, with a goal of understanding how similar interventions can be effectively implemented across Ryan White-supported clinical care settings. Each SPNS initiative supports multiple demonstration projects, as well an independently funded cross-site evaluation center. For five years, I was co-Principal Investigator of the evaluation center for an initiative focused on implementing HIV-related electronic health information exchanges (HIE) in six regions of the United States. In this capacity, I led the development of assessments to measure HIE implementation; was responsible for overseeing evaluation activities in four of the six regions; and led analyses to understand organizational characteristics that facilitated successful HIE implementation. I am currently the co-principal investigator of the evaluation center for a six-state initiative to improve linkage to and retention in high quality HIV care. My responsibilities for this four-year endeavor include directing activities to guide state grantees in the roll-out of linkage interventions and collaborating on the development of the mixed methods cross-state evaluation. Finally, I was recently awarded a cooperative agreement to lead the evaluation center for a 15-site initiative that seeks to transform primary care practices to more efficiently deliver HIV care in community healthcare settings. As principal investigator of this four-year project, I am responsible for overseeing the development and execution of a multi-site evaluation that combines quantitative and qualitative methodologies.
PhD, - Psychology, Yale University