Larry Chang, MD, MPH

Baltimore, Maryland

Role:

Faculty

Associate Professor of Infectious Diseases, JHSOM; Associate Professor of International Health, Social and Behavioral Interventions Program, JHBSPH; Associate Professor of Epidemiology, JHBSPH; Associate Director, JHU Global mHealth Initiative

Dr. Larry Chang is Associate Professor of Medicine, Epidemiology, and International Health at Johns Hopkins University. He is a physician trained in internal medicine, infectious diseases, and epidemiology with an interest in interdisciplinary, innovative, and pragmatic approaches to impacting the HIV pandemic. Dr. Chang has experience in HIV treatment and prevention, implementation science, cohort, community-based trials, and mixed methods research. He is currently Co-PI of the Rakai Health Sciences Program (RHSP) in Uganda and is an active infectious diseases and HIV clinician. For the past 20 years, Dr. Chang has engaged in HIV-related research in Sub-Saharan Africa. Since 2006, he has worked closely with collaborators from RHSP in Uganda on several randomized and observational studies.

In the past, Dr. Chang has had the opportunity to lead with RHSP colleagues several peer and community health worker (CHW)-related implementation science studies including a cluster-randomized study on the impact of peers on AIDS care conducted in 2006-2008, an individually-randomized study on peer support for pre-ART care in Rakai conducted in 2011-2013, and a cluster-randomized trial of a mHealth/CHW approach to HIV treatment and prevention service promotion in an HIV hotspot fishing community. Dr. Chang is currently PI of a large study of the urbanization, non-communicable disease, and HIV syndemic in Uganda, PI of a study trying to find and evaluate hard-to-reach populations in Uganda, and Co-PI of a community-randomized trial of a CHW intervention targeting in-migrants.

In addition to his work with trials, Dr. Chang has also led or supervised several RHSP cohort-based studies, including reports on the heterogeneity of the HIV epidemic in Rakai, and the impact of combination HIV prevention on HIV incidence in the cohort. In Baltimore, Dr. Chang is Co-PI of a trial studying the impact of leveraging patient supporters and a smartphone app to promote engagement in HIV care. Dr. Chang is also involved with HIV implementation science research and capacity building as a former Director of the Johns Hopkins CFAR Implementation Science Working Group and current Director of the Inter-Centers for AIDS Research Sub-Saharan African Working Group (CFAR-SSA). Dr. Chang is also PI of a Fogarty training grant focused on capacity building to understand and end the HIV epidemic in Uganda. A related focus of Dr. Chang’s research is using mHealth (mobile technologies for health) strategies for improving global public health and clinical care. He is the Associate Director for the University-wide Johns Hopkins Global mHealth Initiative. As part of the COVID-19 response, Dr. Chang is a member of the Johns Hopkins COVID-19 Treatment Guidance Writing Group, Pharmaceutical Lead for the Johns Hopkins 2019 Novel Coronavirus Research Compendium (NCRC), and member of the Johns Hopkins Community Collaboration to Combat Coronavirus scientific steering committee.

Research Program Building and Leadership
2000-present: Member, International AIDS Society (IAS)
2006-present: Member, Infectious Diseases Society of America (IDSA)
2010-present: Interviewer, Johns Hopkins Infectious Diseases Fellowship Program
2014, 2018: Member, Johns Hopkins Department of International Health Faculty Search Committee
2018: Member, Division of Infectious Diseases Faculty Representative Panel, Department of Medicine Departmental Review

Publications
Presentations
News

Design and implementation of a community health worker HIV treatment and prevention intervention in an HIV hot spot fishing community in Rakai, Uganda

Post Date:

2017-05-22

Countries:

Uganda

Publication:

Journal of the International Association of Providers of AIDS Care

Abstract Innovative approaches are needed to increase engagement in HIV treatment and prevention services, particularly in HIV hot spots. Here, we detail our design, training approach, and early implementation experiences of a community-based HIV intervention called "health scouts." The...

Qualitative insights into implementation, processes, and outcomes of a randomized trial on peer support and HIV care engagement in Rakai, Uganda

Post Date:

2017-01-10

Countries:

Uganda

Publication:

BMC Infectious Diseases

BACKGROUND: People living with human immunodeficiency virus (HIV) who have not yet initiated antiretroviral therapy (ART) can benefit from being engaged in care and utilizing preventive interventions. Community-based peer support may be an effective approach to promote these...

Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

Post Date:

2016-08-15

Countries:

Uganda

Publication:

The Lancet HIV

Background : Understanding the extent to which HIV burden differs across communities and the drivers of local disparities is crucial for an effective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake...

Community-based interventions to improve and sustain antiretroviral therapy adherence, retention in HIV care and clinical outcomes in low- and middle-income countries for achieving the UNAIDS 90-90-90 targets

Post Date:

2016-07-30

Countries:

Uganda

Publication:

Current HIV/AIDS Reports

Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically...

Association of medical male circumcision and antiretroviral therapy scale-up with community HIV incidence in Rakai, Uganda

Post Date:

2016-07-12

Countries:

Uganda

Publication:

JAMA

Importance Medical male circumcision (MMC) and antiretroviral therapy (ART) are proven HIV prevention interventions, but there are limited data on the population-level effect of scale-up of these interventions in sub-Saharan Africa. Such evaluation is important for planning and resource allocation...

Ecological momentary assessment of illicit drug use compared to biological and self-reported methods

Post Date:

2016-03-15

Countries:

United States

Publication:

Journal of Medical Internet Research

Background: The use of mHealth methods for capturing illicit drug use and associated behaviors have become more widely used in research settings, yet there is little research as to how valid these methods are compared to known measures of capturing and quantifying drug use. ...

Effectiveness of peer support on care engagement and preventive care intervention utilization among pre-antiretroviral therapy, HIV-infected adults in Rakai, Uganda: a randomized trial

Post Date:

2015-08-14

Countries:

Uganda

Publication:

AIDS and Behavior

442 pre-ART, HIV-infected adults were randomized to peer support consisting of structured home visits to promote clinic attendance and preventive care intervention use or standard of care. At baseline, 62 % reported previously visiting an HIV clinic, 45 % reported taking cotrimoxazole...

Feasibility and acceptability of smartphone-based ecological momentary assessment of alcohol use among African American men who have sex with men in Baltimore

Post Date:

2015-06-17

Countries:

United States

Publication:

Journal of Medical Internet Research

Background: Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who havesex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better...

Impact of patient-selected care buddies on adherence to HIV care, disease progression and conduct of daily life among pre-antiretroviral HIV-infected patients in Rakai, Uganda: a randomized controlled trial

Post Date:

2015-06-01

Countries:

Uganda

Publication:

Journal of Acquired Immune Deficiency Syndromes

Background: Data are limited on effects of household or community support persons ("care buddies") on enrollment into and adherence to pre-antiretroviral HIV care. We assessed the impact of care buddies on adherence to HIV clinic appointments, HIV progression, and conduct of daily life among...

Utilizing mHealth methods to identify patterns of high risk illicit drug use

Post Date:

2015-06-01

Countries:

United States

Publication:

Drug and Alcohol Dependence

Introduction: We assessed patterns of illicit drug use using mobile health (mHealth) methods and subsequent health care indicators among drug users in Baltimore, MD. Methods: Participants of the EXposure Assessment in Current Time (EXACT) study were provided...

Durable suppression of HIV-1 after virologic monitoring-based antiretroviral adherence counseling in Rakai, Uganda

Post Date:

2015-05-26

Countries:

Uganda

Publication:

PLOS One

Objectives: HIV viral load is recommended for monitoring antiretroviral treatment and identifying treatment failure. We assessed the durability of viral suppression after viral load-triggered adherence counseling among patients with HIV viremia 6 months after ART initiation. ...

Capturing illicit drug use where and when it happens: an ecologic momentary assessment of the social, physical and activity environment of using versus craving illicit drugs

Post Date:

2015-02-15

Countries:

United States

Publication:

Addiction

Aim: To understand the environmental and contextual influences of illicit cocaine and heroin use and craving using mobile health (mHealth) methods. Design: Interactive mHealth methods of ecological momentary assessment (EMA) were utilized in the Exposure Assessment in...

Is CD4 monitoring needed among Ugandan clients achieving a virologic and immunologic response to treatment?

Post Date:

2014-11-15

Countries:

Uganda

Publication:

AIDS Patient Care and STDs

It is unclear whether ongoing CD4 monitoring is needed following immunologic and virologic response to antiretroviral therapy (ART). We investigated the proportion of clients who achieved a virologic and immunologic response and then had a subsequent CD4 count <200 cells/μL despite...

Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda

Post Date:

2014-05-15

Countries:

Uganda

Publication:

Journal of Acquired Immune Deficiency Syndromes

Objective: To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral therapy (ART) in urban Uganda. Design: Retrospective...

Field evaluation of PIMA point-of-care CD4 testing in Rakai, Uganda

Post Date:

2014-03-10

Countries:

Uganda

Publication:

PLOS One

Objective: To assess the accuracy of PIMA Point-of-Care (POC) CD4 testing in rural Rakai, Uganda. Methods: 903 HIV positive persons attending field clinics provided a venous blood sample assessed on site using PIMA analyzers per manufacturer's specifications. The...

The role of viral introductions in sustaining community-based HIV epidemics in rural Uganda: evidence from spatial clustering, phylogenics, and egocentric transmission models

Post Date:

2014-03-04

Countries:

Uganda

Publication:

PLOS One

Background: It is often assumed that local sexual networks play a dominant role in HIV spread in sub-Saharan Africa. The aim of this study was to determine the extent to which continued HIV transmission in rural communities—home to two-thirds of the African population—is driven by intra-...

The Exposure Assessment in current time (EXACT) study: implementation, feasibility and acceptability of real-time data collection in a community cohort of illicit drug users

Post Date:

2013-11-06

Countries:

United States

Publication:

AIDS Research and Treatment

Objective: We describe the study design and evaluate the implementation, feasibility, and acceptability of an ecological momentary assessment (EMA) study of illicit drug users. Design. Four sequential field trials targeting observation of 30 individuals followed for a four week period...

Leveraging information technology to address the health workforce gap

Post Date:

2013-11-01

Publication:

Bulletin of the World Health Organization

According to some estimates, the world needs more than 4 million additional physicians, nurses, pharmacists, laboratory technicians, midwives, community health workers (CHWs) and other front-line health workers. However, there is also a shortage of faculty that can provide high-quality...

A qualitative study of barriers to enrollment into free HIV care: perspectives of never-in-care HIV-positive patients and providers in Rakai, Uganda

Post Date:

2013-07-23

Countries:

Uganda

Publication:

BioMed Research International

Background: Early entry into HIV care is low in Sub-Saharan Africa. In Rakai, about a third (31.5%) of HIV-positive clients who knew their serostatus did not enroll into free care services. This qualitative study explored barriers to entry into care from HIV-positive clients who had never...

H_pe for mHealth: More "y" or "o" on the horizon?

Post Date:

2013-04-13

Publication:

Post Date:

2012-04-05

Countries:

Uganda

Chang. L. mHealth Research: A Case Study from Uganda. Special Studies and Research: Advanced Topics in Mobile Health (mHealth). Johns Hopkins Bloomberg School of Public Health. Baltimore, MD.

Adventures in Social and Behavioral Interventions

Post Date:

2012-02-27

Chang, L. Adventures in Social and Behavioral Interventions. Social and Behavioral Interventions Seminar. Johns Hopkins Bloomberg School of Public Health. Baltimore, MD.

mHealth in the Field

Post Date:

2012-02-01

Chang, L. mHealth in the Field. Anna Baetjer Society for Public Health Practice. JBGrant Global Health Society. Baltimore, MD.

Use of a Smartphone Application (eMOCHA) to Provide Targeted HIV Prevention Referrals in Rural Uganda

Post Date:

2010-11-08

Post Date:

2017-12-01

Source:

MD Magazine

. . . Researchers found that throughout the 7-year period in which rates of treatment and voluntary medical male circumcision increased significantly, HIV incidence dropped by 42% among nearly 18,000 people in Uganda . . .

Combination HIV Prevention Reduces New Infections by 42 Percent in Ugandan District

Post Date:

2017-11-29

Post Date:

2016-04-19

Harris County Public Health Environmental Services Hailed TB Elimination Champion by CDC The US Centers for Disease Control and Prevention recently named Harris County Public Health Environmental Services among its 2016 TB Elimination Champions for...

Dr. Larry Chang Promoted to Associate Professor

Post Date:

2015-12-16

Baltimore, MD—The Division of Infectious Diseases at Johns Hopkins Medicine announced yesterday the promotion of Larry William Chang, MD, MPH, to Associate Professor of Medicine. Dr. Chang is a member of the faculty at the Johns Hopkins Center for Clinical Global Health Education (CCGHE), and a...

Amid international growth, emocha gets grant to look at Maryland TB treatment

Post Date:

2015-11-23

Source:

Technical.ly Baltimore

Post Date:

2013-03-18

Source:

HealthWorksCollective

Interview with Dr. Larry Chang about the emocha mobile health platform

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Larry Chang, MD, MPH

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