Microenterprise to empower and improve health of HIV+ women in Uganda

描述（由申请人提供）：艾滋病毒/艾滋病在全世界的不利影响集中在妇女和穷人中。虽然扩大治疗规模改善了在资源有限环境中获得艾滋病毒抗逆转录病毒治疗的机会，但持续坚持治疗和充分优化保健成果的主要障碍是结构性的：即使免费提供治疗，粮食不安全和无力支付前往诊所的交通费等结构性障碍仍然是资源有限环境中治疗的致命弱点。此外，虽然艾滋病毒抗逆转录病毒治疗可以导致快速恢复， 由于艾滋病毒感染者的身体机能受到严重影响，单靠艾滋病毒治疗不足以扭转人们开始接受治疗时通常已经发生的经济衰退和家庭资产枯竭。越来越多地提倡为减缓贫穷采取包括小额供资在内的经济干预措施，主要的多边组织主张采取干预措施，解决男女之间的经济不平等问题，以减轻与艾滋病毒有关的性别差距。然而，目前几乎没有证据支持在妇女中广泛实施经济干预措施，更不用说艾滋病毒阳性妇女了，或者阐明这些干预措施改善健康行为或艾滋病毒结果的具体机制。我的长期职业目标是成为一名独立调查员，了解经济干预措施如何影响艾滋病毒+妇女的赋权，健康行为和健康结果。为了实现研究的独立性，我需要在性别研究，行为科学理论，定性研究和全球健康干预研究方面的额外指导和培训。我将利用这次培训并利用我的主要导师在乌干达姆巴拉拉的广泛研究基础设施的资源来实现我的科学目标：开发和评估家禽微型企业干预措施的有效性，以改善艾滋病毒+妇女的健康相关行为和健康结果。家禽微型企业计划（但不是正式的研究评估，这是在这里提出的）是由我的主要导师通过慈善计划的赠款资助的，这表明了高水平的机构承诺。我的中心假设，由初步数据支持，是干预措施将导致改善健康相关的行为，这些影响将介导的经济福祉和妇女赋权的积极变化。我将通过追求三个具体目标来检验我的中心假设：（1）使用定性研究来阐述经济收益如何改善妇女健康的理论模型;（2）开发和验证衡量妇女赋权的量表;和（3）试点测试家禽微型企业干预对经济福祉、粮食安全、妇女赋权、艾滋病毒治疗依从性的初步影响，艾滋病毒的结果。鉴于我的五篇第一作者同行评审文章与拟议的K23奖的内容直接相关，我完全有能力实现这些目标。我还将利用国际知名的艾滋病毒，妇女健康，行为科学，定性研究和经济学专家指导委员会的专业知识，同时创建自己独特的研究轨迹。我的方法是创新的，它使用混合方法来测试理论驱动的假设，家禽微型企业在多大程度上赋予艾滋病毒阳性妇女，使他们能够从事所需的健康行为。拟议的研究意义重大，因为它有望导致制定一种独特的干预措施，以改善资源有限环境中数百万艾滋病毒阳性妇女的健康。 公共卫生相关性：拟议的研究与公共卫生有关，因为它的目的是减少贫困和改善生活在撒哈拉以南非洲的1 310万艾滋病毒阳性妇女的健康，而撒哈拉以南非洲也是3.9亿粮食不安全者的家园。了解结构性干预措施是否以及如何影响艾滋病毒阳性妇女的健康，将有助于制定更有效的干预措施，以解决结构性障碍。因此，拟议的研究与《2011财政年度全国卫生研究院艾滋病毒相关研究计划》中所述的全国卫生研究院的使命有关，即评估为艾滋病毒疾病提供有效保健的障碍;支持研究促进更好地坚持艾滋病毒抗逆转录病毒治疗的方法;以及评估干预措施，以减少对感染艾滋病毒/艾滋病的妇女的不利经济后果。

DESCRIPTION (provided by applicant): The adverse impacts of HIV/AIDS worldwide are concentrated among women and among the poor. Although treatment scale-up has improved access to HIV antiretroviral therapy in resource-limited settings, the primary barriers to sustained treatment adherence and fully optimized health outcomes are structural in nature: even when treatment is provided free of charge, structural barriers such as food insecurity and inability to pay for transportation to clinic remain the Achilles' heel of treatment in resource-limited settings. Furthermore, although HIV antiretroviral therapy can lead to rapid restoration of physical function, HIV treatment alone is insufficient to reverse the economic decline and household asset depletion that have typically occurred by the time people enter treatment. Economic interventions including microfinance have increasingly been promoted for poverty alleviation, and key multilateral organizations have advocated for interventions to address economic inequalities between men and women to alleviate HIV-related gender disparities. However, there is currently little evidence to support widespread implementation of economic interventions among women, much less HIV+ women, or to elucidate the specific mechanisms through which these interventions improve health behaviors or HIV outcomes. My long-term career goal is to become an independent investigator with expertise in understanding how economic interventions affect HIV+ women's empowerment, health behaviors, and health outcomes. In order to achieve research independence I need additional mentorship and training in gender studies, behavioral science theory, qualitative research, and global health intervention research. I will draw upon this training and leverage the resources of my primary mentor's extensive research infrastructure in Mbarara, Uganda to accomplish my scientific objective: to develop and evaluate the effectiveness of a poultry microenterprise intervention to improve HIV+ women's health-related behaviors and health outcomes. The poultry microenterprise program (but not a formal research evaluation, which is proposed here) is funded by my primary mentor through a grant from a philanthropic program, indicating a high level of institutional commitment. My central hypothesis, supported by preliminary data, is that the intervention will cause improvements in health-related behaviors, and that these effects will be mediated by positive changes in economic well-being and women's empowerment. I will test my central hypothesis by pursuing 3 specific aims: (1) use qualitative research to elaborate a theoretical model about how economic gains improve women's health; (2) develop and validate a scale to measure women's empowerment; and (3) pilot test the preliminary effects of a poultry microenterprise intervention on economic well-being, food security, women's empowerment, HIV treatment adherence, and HIV outcomes. I am well-positioned to accomplish these aims, given my five first-author peer-reviewed articles directly related to the content of the proposed K23 award. I will also draw on the expertise of an internationally-renowned mentoring committee of experts in HIV, women's health, behavioral science, qualitative research, and economics while creating my own distinct research trajectory. My approach is innovative in its use of mixed methods to test theoretically-driven hypotheses about the extent to which poultry microenterprise empowers HIV+ women and enables them to engage in desired health behaviors. The proposed research is significant because it is expected to lead to the development of a unique class of interventions to improve the health of millions of HIV+ women in resource-limited settings. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because it is aimed at reducing poverty and improving the health of 13.1 million HIV+ women living in sub-Saharan Africa, which is also home to 390 million food- insecure persons. Understanding whether and how structural interventions affect the health of HIV+ women will lead to the development of more effective interventions to address structural barriers. Thus, the proposed research is relevant to the mission of the NIH, described in the FY 2011 Trans-NIH Plan for HIV-Related Research, pertaining to assessing the barriers to delivery of effective health care for HIV disease; supporting research on approaches to facilitate better adherence to HIV antiretroviral therapy; and evaluating interventions to reduce adverse economic consequences for women infected with HIV/AIDS.