Jennifer Velloza, PhD, recently joined UCSF as a faculty member at IGHS, the Department of Epidemiology and Biostatistics and its affiliated center, PRISE, to work at the intersection of global HIV prevention and adolescent mental health, with a focus on implementation science.
Velloza was always interested in mental health: She majored in neuroscience and behavior as an undergraduate at Columbia University. After graduating, she worked for a time in a neurology lab studying stroke in rat and mouse models. Then, realizing she did not enjoy bench work after all, she took a very different job conducting HIV testing and counseling at pharmacies in the Bronx.
Among those to whom Velloza had to break the news that they were had tested positive for HIV, a pattern emerged. These clients disproportionately had mental health challenges, often including substance abuse. Those challenges had likely increased their HIV exposure, and also made it hard for Velloza to place them in HIV care programs.
Velloza was, as it turned out, onto something. Fast-forward to her current work pairing mental health interventions with HIV prevention programs for adolescent girls in Nairobi, Kenya, and Johannesburg, South Africa.
“In those populations we’ve seen from prior studies that HIV risk is really aligned with power dynamics in relationships, norms around sexual behavior and sexual practices, condom negotiation skills and financial and food insecurity,” she said. “And all of those things are not only linked with HIV risk – they’re also linked with depression, anxiety and suicide risk.”
Find young women at risk for HIV and you will find young women who likely need mental health care. Because much international funding has gone into finding people at risk of HIV, Velloza’s goal in her global health work is to make the most of the overlap to get young South African women the mental health care they might need. This project also situates Velloza’s research in the realm of implementation science.
“Epidemiology or effectiveness studies are asking, is this thing an effective intervention? Implementation science is the study of how we get people to use that thing or how we get that thing into clinics or communities in a way that’s sustainable, cost effective and acceptable.”
The question of acceptability – whether an intervention fits in enough with cultural norms and population needs to be embraced – is especially important when it comes to mental health and HIV, which are often stigmatized. But it’s a significant consideration in all global health work, where interventions developed in one cultural context are often introduced into another.
Velloza asks about it at every turn, starting as she’s developing her research questions and continuing all the way through to a final questionnaire for participants, where many start and finish their inquiry into acceptability. Velloza also advocates for using mixed methods – pairing open-ended interviews or focus-group discussions with numerical data – as a way to gain insight.
“Quantitative data are important to identify health risks and demonstrate effectiveness of the thing you’re trying to test. But it doesn’t tell you the reason behind the numbers,” she said. “In most cases, it’s really helpful to get some context on what, why and how. Qualitative work is also a way for me to become a little bit more grounded in the communities I’m working with instead of just being over here with my dataset and my code.”
As part of PRISE – which partners with public health bodies to support high-quality implementation science methodology – Velloza will also work with the San Francisco Department of Public Health on some of its efforts to address mental health and substance use. PRISE, which launched in 2020, is also considering how best to support global implementation science research.