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    Wayne Steward, PhD, MS

    TitleAssociate Professor
    SchoolUCSF School of Medicine
    DepartmentMedicine
    Address550 16th Street, 3rd Floor
    San Francisco CA 94158
    Phone415-476-6372

       Biography 
       Education and Training
      University of California, San FranciscoPostdoctoral StudiesGraduate Division

       Overview 
       Overview
      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.


       ORNG Applications 
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       Global Health

       Bibliographic 
       Publications
      Publications listed below are automatically derived from MEDLINE/PubMed and other sources, which might result in incorrect or missing publications. Researchers can login to make corrections and additions, or contact us for help.
      List All   |   Timeline
      1. Hazelton PT, Steward WT, Collins SP, Gaffney S, Morin SF, Arnold EA. California's "Bridge to Reform": Identifying Challenges and Defining Strategies for Providers and Policymakers Implementing the Affordable Care Act in Low-Income HIV/AIDS Care and Treatment Settings. PLoS One. 2014; 9(3):e90306.
        View in: PubMed
      2. Truong HH, Grasso M, Chen YH, Kellogg TA, Robertson T, Curotto A, Steward WT, McFarland W. Balancing theory and practice in respondent-driven sampling: a case study of innovations developed to overcome recruitment challenges. PLoS One. 2013; 8(8):e70344.
        View in: PubMed PMC3749182
      3. Koester KA, Collins SP, Fuller SM, Galindo GR, Gibson S, Steward WT. Sexual healthcare preferences among gay and bisexual men: a qualitative study in San Francisco, California. PLoS One. 2013; 8(8):e71546.
        View in: PubMed PMC3747218
      4. Steward WT, Miège P, Choi KH. Charting a moral life: the influence of stigma and filial duties on marital decisions among Chinese men who have sex with men. PLoS One. 2013; 8(8):e71778.
        View in: PubMed PMC3739721
      5. Tsai AC, Weiser SD, Steward WT, Mukiibi NF, Kawuma A, Kembabazi A, Muzoora C, Hunt PW, Martin JN, Bangsberg DR. Evidence for the reliability and validity of the internalized AIDS-related stigma scale in rural Uganda. AIDS Behav. 2013 Jan; 17(1):427-33.
        View in: PubMed PMC3505811
      6. Galindo GR, Walker JJ, Hazelton P, Lane T, Steward WT, Morin SF, Arnold EA. Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation. Implement Sci. 2012; 7:116.
        View in: PubMed PMC3527231
      7. Shade SB, Chakravarty D, Koester KA, Steward WT, Myers JJ. Health information exchange interventions can enhance quality and continuity of HIV care. Int J Med Inform. 2012 Oct; 81(10):e1-9.
        View in: PubMed
      8. Myers JJ, Koester KA, Chakravarty D, Pearson C, Maiorana A, Shade SB, Steward WT. Perceptions regarding the ease of use and usefulness of health information exchange systems among medical providers, case managers and non-clinical staff members working in HIV care and community settings. Int J Med Inform. 2012 Oct; 81(10):e21-9.
        View in: PubMed
      9. Steward WT, Koester KA, Collins SP, Maiorana A, Myers JJ. The essential role of reconfiguration capabilities in the implementation of HIV-related health information exchanges. Int J Med Inform. 2012 Oct; 81(10):e10-20.
        View in: PubMed
      10. Arnold EA, Hazelton P, Lane T, Christopoulos KA, Galindo GR, Steward WT, Morin SF. A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (PrEP) in clinical settings to prevent HIV infection. PLoS One. 2012; 7(7):e40603.
        View in: PubMed PMC3394704
      11. Maiorana A, Steward WT, Koester KA, Pearson C, Shade SB, Chakravarty D, Myers JJ. Trust, confidentiality, and the acceptability of sharing HIV-related patient data: lessons learned from a mixed methods study about Health Information Exchanges. Implement Sci. 2012; 7:34.
        View in: PubMed PMC3428648
      12. Steward WT, Bharat S, Ramakrishna J, Heylen E, Ekstrand ML. Stigma is associated with delays in seeking care among HIV-infected people in India. J Int Assoc Provid AIDS Care. 2013 Mar-Apr; 12(2):103-9.
        View in: PubMed PMC3482419
      13. Carrico AW, Riley ED, Johnson MO, Charlebois ED, Neilands TB, Remien RH, Lightfoot MA, Steward WT, Weinhardt LS, Kelly JA, Rotheram-Borus MJ, Morin SF, Chesney MA. Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of antiretroviral therapy utilization. J Acquir Immune Defic Syndr. 2011 Feb 1; 56(2):146-50.
        View in: PubMed PMC3494991
      14. Steward WT, Chandy S, Singh G, Panicker ST, Osmand TA, Heylen E, Ekstrand ML. Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India. Psychol Health Med. 2011 Jan; 16(1):74-85.
        View in: PubMed PMC3075869
      15. Ekstrand ML, Chandy S, Heylen E, Steward W, Singh G. Developing useful highly active antiretroviral therapy adherence measures for India: the Prerana study. J Acquir Immune Defic Syndr. 2010 Mar; 53(3):415-6.
        View in: PubMed PMC2831235
      16. Remien RH, Higgins JA, Correale J, Bauermeister J, Dubrow R, Bradley M, Steward WT, Seal DW, Sikkema KJ, Kerndt PR, Mayer KH, Truong HM, Casey CY, Ehrhardt AA, Morin SF. Lack of understanding of acute HIV infection among newly-infected persons-implications for prevention and public health: The NIMH Multisite Acute HIV Infection Study: II. AIDS Behav. 2009 Dec; 13(6):1046-53.
        View in: PubMed PMC2787764
      17. Atkinson JH, Higgins JA, Vigil O, Dubrow R, Remien RH, Steward WT, Casey CY, Sikkema KJ, Correale J, Ake C, McCutchan JA, Kerndt PR, Morin SF, Grant I. Psychiatric context of acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: IV. AIDS Behav. 2009 Dec; 13(6):1061-7.
        View in: PubMed PMC2785895
      18. Steward WT, Remien RH, Higgins JA, Dubrow R, Pinkerton SD, Sikkema KJ, Truong HM, Johnson MO, Hirsch J, Brooks RA, Morin SF. Behavior change following diagnosis with acute/early HIV infection-a move to serosorting with other HIV-infected individuals. The NIMH Multisite Acute HIV Infection Study: III. AIDS Behav. 2009 Dec; 13(6):1054-60.
        View in: PubMed PMC2785897
      19. Kelly JA, Morin SF, Remien RH, Steward WT, Higgins JA, Seal DW, Dubrow R, Atkinson JH, Kerndt PR, Pinkerton SD, Mayer K, Sikkema KJ. Lessons learned about behavioral science and acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: V. AIDS Behav. 2009 Dec; 13(6):1068-74.
        View in: PubMed PMC2787956
      20. Kerndt PR, Dubrow R, Aynalem G, Mayer KH, Beckwith C, Remien RH, Truong HM, Uniyal A, Chien M, Brooks RA, Vigil OR, Steward WT, Merson M, Rotheram-Borus MJ, Morin SF. Strategies used in the detection of acute/early HIV infections. The NIMH Multisite Acute HIV Infection Study: I. AIDS Behav. 2009 Dec; 13(6):1037-45.
        View in: PubMed PMC2785898
      21. Morin SF, Shade SB, Steward WT, Carrico AW, Remien RH, Rotheram-Borus MJ, Kelly JA, Charlebois ED, Johnson MO, Chesney MA. A behavioral intervention reduces HIV transmission risk by promoting sustained serosorting practices among HIV-infected men who have sex with men. J Acquir Immune Defic Syndr. 2008 Dec 15; 49(5):544-51.
        View in: PubMed PMC2659703
      22. Wolfe WR, Weiser SD, Leiter K, Steward WT, Percy-de Korte F, Phaladze N, Iacopino V, Heisler M. The impact of universal access to antiretroviral therapy on HIV stigma in Botswana. Am J Public Health. 2008 Oct; 98(10):1865-71.
        View in: PubMed PMC2636454
      23. Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, Ekstrand ML. HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med. 2008 Oct; 67(8):1225-35.
        View in: PubMed PMC2603621
      24. Steward WT, Charlebois ED, Johnson MO, Remien RH, Goldstein RB, Wong FL, Morin SF. Receipt of prevention services among HIV-infected men who have sex with men. Am J Public Health. 2008 Jun; 98(6):1011-4.
        View in: PubMed PMC2377307
      25. Choi KH, Hudes ES, Steward WT. Social discrimination, concurrent sexual partnerships, and HIV risk among men who have sex with men in Shanghai, China. AIDS Behav. 2008 Jul; 12(4 Suppl):S71-7.
        View in: PubMed
      26. Neilands TB, Steward WT, Choi KH. Assessment of stigma towards homosexuality in China: a study of men who have sex with men. Arch Sex Behav. 2008 Oct; 37(5):838-44.
        View in: PubMed
      27. Carrico AW, Johnson MO, Moskowitz JT, Neilands TB, Morin SF, Charlebois ED, Steward WT, Remien RH, Wong FL, Rotheram-Borus MJ, Lightfoot MA, Chesney MA. Affect regulation, stimulant use, and viral load among HIV-positive persons on anti-retroviral therapy. Psychosom Med. 2007 Nov; 69(8):785-92.
        View in: PubMed
      28. Myers JJ, Rose CD, Shade SB, Koester KA, Maiorana A, Malitz F, Steward WT, Morin SF. Sex, risk and responsibility: provider attitudes and beliefs predict HIV transmission risk prevention counseling in clinical care settings. AIDS Behav. 2007 Sep; 11(5 Suppl):S30-8.
        View in: PubMed
      29. Carrico AW, Johnson MO, Morin SF, Remien RH, Charlebois ED, Steward WT, Chesney MA. Correlates of suicidal ideation among HIV-positive persons. AIDS. 2007 May 31; 21(9):1199-203.
        View in: PubMed
      30. Steward WT, Koester KA, Myers JJ, Morin SF. Provider fatalism reduces the likelihood of HIV-prevention counseling in primary care settings. AIDS Behav. 2006 Jan; 10(1):3-12.
        View in: PubMed
      31. Morin SF, Steward WT, Charlebois ED, Remien RH, Pinkerton SD, Johnson MO, Rotheram-Borus MJ, Lightfoot M, Goldstein RB, Kittel L, Samimy-Muzaffar F, Weinhardt L, Kelly JA, Chesney MA. Predicting HIV transmission risk among HIV-infected men who have sex with men: findings from the healthy living project. J Acquir Immune Defic Syndr. 2005 Oct 1; 40(2):226-35.
        View in: PubMed
      32. Morin SF, Carrillo H, Steward WT, Maiorana A, Trautwein M, Gómez CA. Policy perspectives on public health for Mexican migrants in California. J Acquir Immune Defic Syndr. 2004 Nov 1; 37 Suppl 4:S252-9.
        View in: PubMed
      33. Myers JJ, Steward WT, Charlebois E, Koester KA, Maiorana A, Morin SF. Written clinic procedures enhance delivery of HIV "prevention with positives" counseling in primary health care settings. J Acquir Immune Defic Syndr. 2004 Oct 1; 37 Suppl 2:S95-S100.
        View in: PubMed
      34. Morin SF, Koester KA, Steward WT, Maiorana A, McLaughlin M, Myers JJ, Vernon K, Chesney MA. Missed opportunities: prevention with HIV-infected patients in clinical care settings. J Acquir Immune Defic Syndr. 2004 Aug 1; 36(4):960-6.
        View in: PubMed
      35. McKee SA, O'Malley S, Steward WT, Neveu S, Land M, Salovey P. How to word effective messages about smoking and oral health: emphasize the benefits of quitting. J Dent Educ. 2004 May; 68(5):569-73.
        View in: PubMed
      36. Morin SF, Vernon K, Harcourt JJ, Steward WT, Volk J, Riess TH, Neilands TB, McLaughlin M, Coates TJ. Why HIV infections have increased among men who have sex with men and what to do about it: findings from California focus groups. AIDS Behav. 2003 Dec; 7(4):353-62.
        View in: PubMed
      37. Salovey P, Rothman AJ, Detweiler JB, Steward WT. Emotional states and physical health. Am Psychol. 2000 Jan; 55(1):110-21.
        View in: PubMed
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