The SCoOp

The community newsletter of RTI International’s Substance Use, Gender, and Applied Research (SUGAR) Program and the CoOp Studies

Dear Friends and Colleagues,

I hope you’ve had a chance for reflection as we enter the New Year and you’re keeping yourself well. It has been a difficult year for the world, with many having lost loved ones, their jobs, or their homes, or struggling with food security and other concerns. There’s certainly no better time to challenge the injustice and inequality in the world than right now as the COVID-19 vaccine rollout begins and the world starts to rebuild our economy and trust in health systems. It has been a long six months since our last newsletter, and although a lot has changed in the world, I am grateful that many things remain the same. Most of my days are spent on Zoom or Skype meetings, and though our team is still isolated from one another, we keep in touch through afternoon birthday celebrations and themed meetings.

Silly hat Zoom meeting to keep spirits high!

I miss my travel to support our hard-working group and colleagues in South Africa. It will be the first time in 20 years that I have not been there in almost a year for true hands-on applied research! Finally, we have been blessed with new connections since our last newsletter. First, we welcomed our fall interns. Kevin Smith is a third-year doctoral student in Health Behavior at the UNC Gillings School of Global Public Health and Isa van der Drift is a joint SUGAR and RTI Global Gender Center intern and a recent graduate from UNC-Chapel Hill. She was also a 2019−2020 WomenNC scholar “femtored” by our own Jackie Ndirangu. Also, we have new project updates to share, so please keep reading.

Wishing you a safe and healthy New Year!

Mpho/Dr. Wendee


To reduce alcohol and other drug misuse, risk behavior, health disparities, and gender inequality


We develop and test the efficacy, effectiveness, and impact of interventions for people who misuse alcohol and other drugs and other key populations for HIV and other health outcomes in community-based and real-world settings.


Under the direction of Dr. Wendee Wechsberg, the SUGAR Program maintains projects in South Africa and North Carolina, Delaware, and Georgia, USA, where we partner RTI’s scientific expertise with community agencies and community collaborative boards of citizens and professionals to improve the lives of people who use alcohol and other drugs.


To learn more about the SUGAR Program or the CoOp Studies, please contact Dr. Wendee Wechsberg at

Research Updates from the SUGAR Team

Ongoing Projects

Couples Health CoOp Plus (CHC+)

(MPIs: Wendee Wechsberg, Felicia Browne, Tara Carney)

Young couple in Cape Town, South Africa





This study uses a multilevel approach to help achieve the new Undetectable=Untransmittable (U=U) goals through increasing pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) initiation, adherence and retention, while also addressing stigma in clinics toward young couples who use alcohol and other drugs and seek HIV services. Currently, we are conducting formative activities virtually with service providers to refine both the CHC+ and stigma-reduction interventions. We also are planning to conduct activities with couples early in 2021 for further refinement.

This study is funded by National Institute on Drug Abuse grant R01 DA049612.

PrEPARE Pretoria: Prevention Empowering and PRotEcting Young Women in South Africa

(PI: Wendee Wechsberg; PD: Jacqueline Ndirangu)

This project aims to increase uptake of PrEP and sexual reproductive health services among young women aged 16 to 24 and reduce stigma in clinics. We have completed study activities in 2 clinics and continue to conduct 3-, 6-, and 9-month follow-ups in 4 clinics. We also started recruitment in 2 new clinics. Currently, we enrolled over half of our participants across the 8 clinics. We also conducted a virtual Community Advisory Board and a Youth Advisory Board meeting. All study activities are being conducted under strict COVID prevention measures.

This study is funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development grant R01 HD094629.

PrEPARE Pretoria Diversity Supplement

(Diversity Investigator: Waru Gichane)






This supplemental study aims to help improve the sexual and reproductive health of adolescent girls and young women in low- and middle-income countries. The study will examine the impact of PrEP on pregnancy and birth outcomes; PrEP adherence and persistence during pregnancy; provider attitudes, beliefs, and clinical recommendations regarding PrEP use during pregnancy; and COVID-19−related impact on PrEP use and pregnancy.

This study is funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development grant R01 HD094629-04S1.

Improving the Integration of Mental Health and Substance Use Treatment into Ryan White-Funded Care Sites in Atlanta Using an Implementation Science Approach

(PI: Courtney Peasant Bonner; Implementing Partners: SisterLove, Inc., and Positive Impact Healthcare Clinics)






This R34 study is partnering with Ryan White clinics and SisterLove, Inc., to adapt a stigma-reduction training, develop a prescribing platform to help providers offer pharmacotherapy for mental health disorders and/or alcohol use disorder, and test the feasibility of these tools in Ryan White clinics in the Atlanta, Georgia area. We conducted the first meeting with our Atlanta Community Collaborative Board and have started recruiting participants.

This study is funded by National Institute of Mental Health grant R34 MH124628.

Implementing PrEP into Non-Title X Settings to Reduce HIV Disparities among African American Women in the Atlanta MSA

(Supplement PI: Courtney Peasant Bonner, Implementing Partner: SisterLove, Inc.)

This supplemental project aims to increase providers’ PrEP knowledge and self-efficacy to increase PrEP access among African American women. We will adapt a PrEP training to promote PrEP prescribing among reproductive healthcare providers who serve African American women. The training will be delivered online to allow for individualization of content and will be pretested with providers in the Atlanta area. We are in the start-up phase of this study and will conduct our first Community Collaborative Board meeting at the beginning of 2021.

This study is funded by UNC Center for AIDS Research grant P30 AI050410.

Carolina CoOp

(Supplement PI: Felicia Browne; Implementation Partner: Mecklenburg County Public Health)

This supplemental project is an implementation pilot in collaboration with Mecklenburg County Public Health in North Carolina that aims to reach and retain African American adults in HIV prevention and treatment and ultimately to reduce HIV disparities. Although study activities were delayed for this project due to COVID-19, the team is excited to proceed with virtual focus group discussions for pre-implementation phase activities to adapt and refine the tailored intervention and looks forward to the implementation stage.

This study is funded by UNC Center for AIDS Research grant P30 AI050410.

Mitigating the Outcomes Associated with the Injection Drug Use Epidemic in Southern Appalachia

(PI: William Zule)

This project had recruited 350 participants prior to suspending field work temporarily in March 2020 because of COVID-19. In response to COVID-19, we have redesigned the study to conduct all activities virtually. We anticipate restarting recruitment in February 2021.

This study is funded by National Institute on Drug Abuse grant UG3 DA044823.

Young Women-Focused HIV Prevention: Seek & Test in North Carolina Clinics (NC Young Women’s CoOp)

(MPI [contact]: Wendee Wechsberg; MPI: Felicia Browne)

Site-based activities for this project ended early in March 2020 because of COVID-19 while 6- and 12-month follow-ups were still being conducted. To understand the impact of COVID-19, we conducted a brief telephone survey with a subsample of participants. Outcomes and costing analyses and dissemination of the findings are underway. We are fortunate to have completed the field work in collaboration with the Durham County Department of Public Health, Wake County Human Services, and Guilford County Department of Public Health, and thank them for all they have done to protect the health of the public.

This study is funded by National Institute on Drug Abuse grant R01 DA041009.

Cape Town Young Women’s Health CoOp

(PI: Wendee Wechsberg; Co-PD: Felicia Browne, RTI International; Co-PD: Tara Carney, South African Medical Research Council)

This cluster-randomized trial reached 500 young women and had a 95% follow-up at 6- and 12-month appointments. Outcome analyses and manuscript development are ongoing. We held a Community Collaborative Board meeting in September 2020 to share some of the preliminary findings, and we look forward to disseminating the findings in other innovative ways.

This study is funded by National Institute on Drug Abuse grant R01 DA041227.

Understanding Co-occurring Conditions and Integrated Healthcare among Young Women in South Africa

(Diversity Investigator: Courtney Peasant Bonner)

This study examines the need for integrating mental health, substance use, and HIV prevention services for young women in Cape Town and seeks to explore the experiences of young women participating in our research studies to inform future research methods. Our findings were published in the South African Medical Journal.

This study is funded by National Institute on Drug Abuse grants R01 DA041227-06S1 and R25 DA03160.

Safe4both Integration of Mobile Technologies with Case Management (CM) Systems Provide Education, Workflow Among Multiple Stakeholders to Implement Plan of Safe Care (POSC) for SubstanceUse Disorder Moms and Infants

(PI: Tony Ma, Benten Technologies; Co-I: Yukiko Washio, RTI International)

This project is designed to improve the efficiency and timeliness of collaborative care management for the case manager and the postpartum mother with a substance use disorder by providing an electronic Plan of Safe Care (ePOSC) accessible via mobile phone or tablet.

The study is funded by National Institute on Drug Abuse grant R43 DA048673.

Individual Breastfeeding Support with Contingent Incentives among Low-income Mothers

(PI: Yukiko Washio)

This project uses an established behavioral approach to incentivize breastfeeding behavior on a monthly basis for 6- and 12-month follow-ups among postpartum mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children. We will track medical incidents, infant weights, and the costs associated with the intervention. We are now actively recruiting African American and Puerto Rican mothers from Philadelphia and Delaware.

This study is funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development grant R01 HD094877.

New Publications from SUGAR Staff

Bonner, C.P., Carney, T., Browne, F.A., Ndirangu, J.W., Howard, B.N., & Wechsberg, W.M. (2021). Substance use and depressive and anxiety symptoms among out-of-school adolescent girls and young women in Cape Town, South Africa. South African Medical Journal, 111(1):40-45. doi: 10.7196/SAMJ.2020.v111i1.14520.

Fredericksen, R., Whitney, B.M., Trejo, E., Nance, R., Fitzsimmons, E., Altice, F., ... Wechsberg…et al. (2020). Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-Site cohort. PMC Europe Research Square. doi: 10.21203/

Gichane, M.W., Wamoyi, J., Atkins, K., Balvanz, P., Maman, S., Majani, E., & Pettifor, A. (2020). The influence of cash transfers on engagement in transactional sex and partner choice among adolescent girls and young women in Northwest Tanzania. Culture, Health, and Sexuality. September 16, 1−15. doi: 10.1080/13691058.2020.1811890.

Gichane, M.W., Wechsberg, W.M., Ndirangu, J., Browne, F.A., Bonner, C.P., Grimwood, A., Shaikh, N., Howard, B.N., & Zule, W.A. (2020). Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa. Drug and Alcohol Dependence, 215, 108206. doi: 10.1016/j.drugalcdep.2020.108206.

Hayashi, Y., & Washio, Y. (2020). Text-message dependency, executive function, and impulsivity in college students: A cluster analysis. Cyberpsycholology, Behavior, and Social Networking, 23(11), 794−799. doi: 10.1089/cyber.2019.0743.

Kranzler, H.R., Washio, Y., Zindel, L.R., Lynch, K.G., Hand, D., Tyndale, R.F., Oncken, C., & Schnoll, R. (2020). Pregnant smokers receiving opioid agonist therapy have an elevated nicotine metabolite ratio: A replication study. Nicotine and Tobacco Research, 22(10), 1923−1927. doi: 10.1093/ntr/ntaa066.

Layland, E.K., Carter, J.A., Perry, N.S., Cienfuegos-Szalay, J., Nelson, K,M., Bonner, C.P., & Rendina, H.J. (2020). A systematic review of stigma in sexual and gender minority health interventions. Translational Behavioral Medicine, 10(5), 1200−1210.

Muthoni, C.N., Kneipp, S.M., Gichane, M.W., Caiola, C.E., Pettifor, A.E., & Williams, J.R. (2020). A systematic review of HIV interventions for young women in Sub-Saharan Africa. AIDS and Behavior, 24(12), 3395−3413. doi: 10.1007/s10461-020-02914-1.

Wamoyi, J., Balvanz, P., Atkins, K., Gichane, M., Majani, E.,Pettifor, A., & Maman, S. (2020). Conceptualization of empowerment and pathways through which cash transfers work to empower young women to reduce HIV risk: A qualitative study in Tanzania. AIDS and Behavior, 24(11), 3024−3032. doi: 10.1007/s10461-020-02850-0.

Wechsberg, W.M., Browne, F.A., Ndirangu, J., Bonner, C.P., Minnis, A.M., Nyblade, L., Speizer, I.S., Howard, B.N., Myers, B., & Ahmed, K. (2020). The PrEPARE Pretoria Project: Protocol for a cluster-randomized factorial-design trial to prevent HIV with PrEP among adolescent girls and young women in Tshwane, South Africa. BMC Public Health, 20(1), 1403. doi: 10.1186/s12889-020-09458-y.

How to reach us or to join our Community Collaborative Boards (CCBs) or Youth Advisory Board (YAB)

North Carolina Community

Collaborative Board, USA

Dr. Wendee Wechsberg

Atlanta Community

Collaborative Board, USA

Dr. Courtney Peasant Bonner

Pretoria Community Collaborative Board and Youth Advisory Board, South Africa

Ms. Jacqueline Ndirangu

Cape Town Community Collaborative Board, South Africa

Dr. Tara Carney

Dr. Bronwyn Myers


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