Steven Safren

Professor

Locator Code:
0751

 
About

About

I am the Director of the UM Center for HIV and Research in Mental Health (NIMH-funded Developmental AIDS Research Center D-ARC) and the Health Promotion and Care research program (https://hpac.psy.miami.edu/) where we study health behavior change, with a particular emphasis on mental health and substance use components of HIV prevention and treatment domestically and globally. I joined the Department of Psychology at the University in of Miami in 2015 after 18 years working in the Harvard Medical School system at Massachusetts General Hospital where I was a Professor and Director of the Behavioral Medicine Service, and led behavioral science studies at Fenway Health. I have been PI or protocol chair of 16 federally funded studies (via NIMH, NIDA, and NIAID), and, in addition to studies where I am PI, I have regularly served as co-PI, co-investigator, or mentor on studies related to HIV prevention and treatment. Much of my work on HIV focuses on prevention and treatment with gay, bisexual, and other men who have sex with men (MSM), though I have worked extensively with other populations including individuals with depression and those who have struggled with substance use disorders. Finally, during my time at MGH, I worked on studies of cognitive-behavioral therapy for ADHD in adulthood and adolescence. With respect to my HIV work, I collaborate extensively with other investigators both in the Psychology Department, as well as the University of Miami Miller School of Medicine, and the School of Nursing and Health Sciences, and am Co-Director of the Behavioral/Social Sciences and Community Outreach Core for the UM Center for AIDS Research (CFAR).
Career

Education

1998Ph.D. Psychology (Clinical) SUNY at Albany
1995 Psychology (Clinical) SUNY at Albany
1991B.A. Psychology Brandeis University

Professional Experience

2015 - Professor, University of Miami, Psychology
2012 - 2015Professor, Harvard Medical School
2006 - 2015Director, Behavioral Medicine Service, Massachusetts General Hospital
1998 - 1999Post-Doctoral Fellow, Massachusetts General Hospital, Harvard Medical School
Research

Research

  1. Adherence to antiretroviral therapy for HIV treatment. At the end of the 1990s, highly active antiretroviral therapy (ART) had recently transformed HIV from a terminal disease to a chronic illness.  Adherence was quickly identified as a complicated but critical component for this treatment success.  I developed and tested the first randomized controlled trial (RCT) of an adherence to ART treatment intervention, called “Life-Steps” which followed a cognitive-behavioral / problem-solving approach, and is now used all over the world, including by MSF (Doctors without Borders) treatment clinics in S. Africa.  This work has developed into projects addressing mental health problems such as depression and problematic abuse in the context of inadequate ART adherence, both domestically, and in global settings such as S. Africa, the U.S. Mexico border, and Zimbabwe.  Some relevant publications related to this line of work include:
  1. Safren SA, Otto, MW, Worth J, Salomon E. Johnson W, Mayer K, Boswell S. (2001).Two strategies to increase adherence to HIV antiretroviral medication: Life-Steps and medication monitoring. Behavioural Research and Therapy, 39, 1151-1162.
  2. Safren SA, O’Cleirigh CO, Tan JY, Raminani SR, Reilly LC, Otto MW, Mayer KH. (2009). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.  Health Psychology, 28, 1-10. PMCID: PMC2643364
  3. Safren SA, O’Cleirigh CM, Bullis JR, Otto MS, Stein MD, Pollack MH. (2012).  Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-infected Injection Drug Users: A Randomized Controlled Trial.  Journal of Consulting and Clinical Psychology, 80, 404-415. PMCID: PMC3365619
  4. Safren SA, Bedoya CA, O'Cleirigh C, Biello KB, Pinkston MM, Stein MD, Traeger L, Kojic E, Robbins GK, Lerner JA, Herman DS, Mimiaga MJ, & Mayer KH. Treating Depression and Adherence (CBT-AD) in Patients with HIV in Care: A Three-arm Randomized Controlled Trial.  Lancet HIV. 2016; 3(11): 529-538. PMCID: PMC5321546

 

  1. Primary and secondary behavioral HIV prevention interventions for gay, bisexual and other men who have sex with men (MSM): domestic and global work.  I have led and completed primary and secondary preventions trials for gay, bisexual, and other men in various settings.  Currently, I have an ongoing primary prevention trial in India (see below), and two ongoing trials in Miami – one as MPI with Dr. Matthew Mimiaga on using behavioral activation to address problematic stimulant use in the context of HIV acquisition risk, and the other, as a co-I with Dr. John Pachankis that addresses sexual minority stress.  Example publications and completed work include the following.  
  1. Safren SA, O’Cleirigh C, Skeer M, Driskell J, Goshe BM, Covahey C, Mayer KH. (2011). Demonstration and evaluation of a peer-delivered, individually-tailored, HIV prevention intervention for HIV-infected MSM in their primary care setting.  AIDS and Behavior, 15, 949-958.
  2. Safren SA, O’Cleirigh CM, Skeer MR, Elsesser SA, Mayer KH. (2013). Project Enhance: A randomized controlled trial of an individualized HIV prevention intervention for HIV-infected men who have sex with men conducted in a primary care setting.  Health Psychology, 32(2), 171-179. PMCID: PMC3651590
  3. Thomas B., Mimiaga MJ, Menon S, Chandrasekaran V, Murugesan P, Swaminathan S, Mayer KH, Safren SA.  Unseen and unheard: Predictors of sexual risk behaviour and HIV infection among men who have sex with men (MSM) in Chennai, India.  AIDS Education and Prevention. 2009; 21(4): 372-383. PMCID: PMC3623672
  4. Safren SA, Thomas BE, Mayer KH, Biello KB, Mani J, Vijaylakshmi R, Periyasamy M, Swaminathan S, Mimiaga MJ.(2014).  A pilot RCT of an intervention to reduce HIV sexual risk and increase self-acceptance among MSM in Chennai, India.  AIDS and Behavior, AIDS and Behavior. 2014; 18(10): 1904-1912. PMCID: PMC4175143

 

  1. Antiretroviral therapy for prevention: Treatment as Prevention and Pre-exposure Prophylaxis (PrEP) studies – domestic and international. I have been involved in a number of trials that have addressed the issue of ART for HIV prevention.  First, I was a key behavioral scientist on HPTN052 which definitively found that early ART prevents sexual HIV transmission in serodiscordant couples.  I designed the adherence counseling using my Life-Steps intervention as the base, and lead the development of the psychosocial assessments, and published on the predictors of  non-adherence in those who started ART early.  I was also the protocol chair of HPTN063, an observational study of high risk MSM, heterosexual women, and heterosexual men in Brazil, Thailand, and Zambia to lay the ground work for treatment as preventions studies linked to care in diverse cultural settings.  This has both qualitative and quantitative components, and we are, given the various components involved in actual “HIV risk behavior” modeling outcomes on projected infections.
    Pre-exposure prophylaxis (PrEP), taking ART to prevent the acquisition of HIV, has been demonstrated efficacious in men who have sex with men in the U.S. and Latin America, and in serodiscordant couples in Africa, but adherence and uptake are key components of success.  Along with my mentee, Christina Psaros, we designed, based on Life-Steps, the PrEP adherence counseling for the adherence ancillary study for the Gates funded Partners in PrEP study in Africa.  That study found 0 infections in those who were randomized PrEP.  With Dr. Kenneth Mayer, we completed a PrEP adherence intervention for men who have sex with men in Boston, which found high levels of protection using either PrEP or condoms during sex.  Along with my mentee, Dr. Psaros, we are the behavioral scientists on HPTN 083, a study of long acting injectable PrEP in MSM, leading the adherence components of this trial (and has an NIMH supported qualitative component).  
  1. Safren SA, Biello KB, Smeaton L, Mimiaga MJ, Walawander A, Lama JR, Rana A, Nyirenda M, Kayoyo VM, Samaneka W0, Joglekar A, Celentano, D, Martinez A, Remmert, JE, Lalloo UG, Kumarasamy N, Hakim J, Campbell TB, for the PEARLS (ACTG A5175) Study Team. (2014). Psychosocial predictors of non-adherence and treatment failure in a large scale multi-national trial of antiretroviral therapy for HIV: Data from the ACTG A5175/PEARLS trial.  PLOS ONE, 9(8), 1-10. PMCID: PMC4143224
  2. Safren SA, Mayer KH, Ou S, McCauley M, Grinsztejn B, Hosseinipour M, Kumarasamy N, Gamble T, Hoffman I, Celentano D, Chen YQ, Cohen M for the HPTN 052 study team.  Adherence to Early Antiretroviral Therapy: Results from HPTN 052, A Phase III, Multinational Randomized Trial of ART to Prevent HIV-1 Sexual Transmission in Serodiscordant Couples.  JAIDS. 69(2), 234-40. PMCID: PMC4445420
  3. Psaros C, Haberer JE, Katabira E, Ronald A, Tumwesigye E, Campbell JD, Wangisi J, Mugwanya K, Kintu A, Enyakoit M, Thomas K, Donnell D, Krows M, Kidoguchi L, Ware N, Baeten JM, Celum C, Bangsberg DR, Safren SA.(2014). An intervention to support HIV pre-exposure prophylaxis (PrEP) adherence in HIV serodiscordant couples in Uganda. Journal of Acquired Immune Deficiency Syndrome, 66(5), 522-529. PMCID: PMC4191829
  4. Mayer KH, Safren SA, Elsesser SA, Psaros C, Tinsley J, Marzinke M, Clarke W, Hendrix C, Taylor SW, Haberer J, & Mimiaga MJ. Optimizing pre-exposure antiretroviral prophylaxis adherence in men who have sex with men: Results of a pilot randomized controlled trial of “Life-Steps for PrEP.” AIDS and Behavior. 2017; 21(5): 1350-1360. PMCID: PMC5380582

 

  1. Work with other illnesses and mentee work.  In the area of HIV, I have a variety of additional mentee work that I collaborate or have collaborated on, including ongoing studies with Dr. Sannisha Dale, here at UM examining self-care among Black women living with HIV and histories of trauma, retention in care in U.S. Hispanic immigrants (primary mentor on Levison K award), and global substance use / mental health in individuals living with HIV (primary mentor on Magidson K award).  Some example collaborative/mentee work include the following.  
  1. Blashill AJ, Goshe BM, Robbins GK, Mayer KH, Safren SA. Body image disturbance and health behaviors among sexual minority men living with HIV. Health Psychology. 2014; 33(7): 677-680. PMCID: PMC4094355
  2. Dale SK, Pierre-Louis C, Bogart LM, O’Cleirigh C, Safren SA. Still IRise: The need for self-validation and self-care in the midst ofadversities faced by Black women with HIV. Cultural Diversity andEthnic Minority Psychology. 2017. PMCID: PMC5726949.
  3. Dale SK, Safren SA. Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for BlackWomen with HIV. Cognitive and Behavioral Practice. 2017.
  4. Dale SK, Safren SA. Resilience Takes A Village: Black Women Utilize Support from their Community to Foster Resilience against Multiple Adversities. AIDS Care. In press. 

 

  1. Adult and adolescent ADHD.   I developed and tested the first U.S. based psychosocial (cognitive behavioral) treatment for ADHD in adults.  This work was funded first by an R01 for our pilot study, and R01 for our efficacy study, and then an R34 for an adaptation for adolescents.
  1. Safren SA, Otto MW, Sprich S, Perlman CL, Wilens TE, Biederman, J. Cognitive behavioral therapy for ADHD in medication-treated adults with continued symptoms.  Behaviour Research and Therapy. 2005; 43(7): 831-842.
  2. Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW.  Cognitive behavioral therapy versus relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: A randomized controlled trial.  Journal of the American Medical Association. 2010; 304(8) 875-880. PMCID: PMC3641654
  3. Sprich SE, Safren SA, Finkelstein D, Remmert JE, Hammerness P.  A randomized controlled trial of cognitive behavioral therapy for ADHD in medication-treated adolescents. Journal of Child Psychology and Psychiatry. 2016; 57(11): 1218-1226. PMCID: PMC5026858

Complete List of Published Work in MyBibliography: http://www.ncbi.nlm.nih.gov/myncbi/browse/collection/40810297/?sort=date&direction=descending

Selected Ongoing Funded Research

1R01MH100627 (NIMH) (Safren, Mimiaga, O’Cleirigh) 7/21/2014-6/30/2019

Fostering Resilience to Psychosocial and HIV Risk in Indian MSM

This is an efficacy / effectiveness trial of a psychosocial intervention that increases self-acceptance and reduces HIV and STI risk in MSM in India. 

Role: Principal Investigator (MPI with Conall O’Cleirigh and Matthew Mimiaga)

 

R01MH103770 (NIMH) (Safren/O’Cleirigh, MPIs) 07/01/2015-06/30/2020

Nurse-Delivered CBT for Depression-Adherence in HIV Primary Care South Africa

This is an effectiveness trial of cognitive behavioral therapy for adherence and depression, to be delivered by nurse interventionists in South Africa. 

Role: Principal Investigator (MPI)

 

R01MH109413-01 (NIMH) (Pachankis) 02/15/2016 - 12/31/2020

 A unified intervention for young gay and bisexual men's minority stress, mental health, and HIV risk

This study uses a unified mental health treatment intervention to addressing sexual minority stress and HIV risk behavior among MSM.

Role: Site PI / Co-Investigator

 

K24DA040489 (NIDA) (Safren) 08/01/16-07/31/21
K24 MH094214-01 (NIMH)  (Safren) 08/01/16-07/31/21

Addressing Psychosocial Comorbidities in HIV treatment and Prevention

This K24 continuation is to mentor junior investigators in behavioral interventions related to HIV treatment and prevention, with a specific focus on psychosocial syndemics relevant to HIV prevention and care.

Role: Principal Investigator

 

R01DA042805 (NIDA) (Safren, Mimiaga MPIs) 4/1/17-1/31/22

Integrated behavioral activation and HIV risk reduction counseling for MSM with stimulant abuse

This study will test the efficacy, in a three-armed randomized controlled trial, a behavioral intervention to reduce high-risk sex in MSM with stimulant use disorder, who are at risk for HIV acquisition.

Role: MPI

 

5P30A1073961-09 (NIAID) (Pahwa) 6/1/2012-5/31/2022

The Miami Center for AIDS Research                                                            

The Miami CFAR is geared towards the prevention, treatment and ultimately, the cure of HIV/AIDS.

Role: Co-Director of the Behavioral/Social Sciences Community Outreach Core, Co-Director of Mentoring Program

Books and treatment manuals by Dr. Safren

  1. Martell C, Safren SA, Prince S.  Cognitive behavioral therapy with gay, lesbian, and bisexual clients.  New York: Guilford Press, 2003.
  2. Safren SA, Perlman CA, Sprich S, Otto MW. Mastery of your adult ADHD.  Client Workbook.  Oxford University Press, 2005.
    -- Translated by various publishers to Dutch, German, Portuguese, Turkish, Swedish, Korean, and Japanese and Polish.
  1. Safren SA, Sprich S, Perlman CA, Otto MW.  Mastery of your adult ADHD, Therapist Manual.  Oxford University Press, 2005.
    -- Also translated to Dutch, German, Portuguese, Turkish, Swedish, Korean, and Japanese and Polish.
  1. Safren SA, Gonzalez JS, Soroudi N. Coping with Chronic Illness: Cognitive behavioral therapy for adherence and depression in individuals with chronic illness, Client Workbook.  2007, Oxford University Press.
  2. Safren SA, Gonzalez JS, Soroudi N. Coping with Chronic Illness: Cognitive behavioral therapy for adherence and depression in individuals with chronic illness, Therapist Guide.  2007, Oxford University Press.
  3. Vranceanu AM, Greer JA, Safren SA (editors).  The MGH Handbook of Behavioral Medicine.  NY: Humana Press (Springer).  2017. 
  4. Safren SA, Sprich S, Perlman CA, Otto MW.  Mastery of your adult ADHD, Client Workbook, 2nd Edition.  Oxford University Press, 2017.
  5. Safren SA, Sprich S, Perlman CA, Otto MW.  Mastery of your adult ADHD, Therapist Manual, 2nd Edition.  Oxford University Press, 2017.
  6. Naar S & Safren SA.  Motivational interviewing and CBT: Combining strategies for maximum effectiveness.  NY: Guilford Press.  2017.
    -- Translated by various publishers to Korean, Swedish, and Polish
  1. Pachankis, J, Safren SA. (Editors).  Handbook of Evidenced Based Mental Health Practice with Sexual and Gender Minority Clients.  NY: Oxford University Press, in press.
  2. Sprich SE & Safren SA. Mastery of your adolescent ADHD.  Therapist Manual.  Book submitted to Oxford University Press.  Under agreement.  Anticipated published in 2019 or 2020.
  3. Sprich SE & Safren SA. Mastery of your adolescent ADHD.  Client Guide.  Book submitted to Oxford University Press.  Under agreement.  Anticipated published in 2019 or 2020.