HIV Treatment Interruptions Among Labor Migrants in South Africa

描述（由申请人提供）：虽然全球艾滋病毒/艾滋病流行病给撒哈拉以南非洲的社会和经济边缘化人群造成了不成比例的负担，但艾滋病毒治疗的扩大极大地改善了所有人获得抗逆转录病毒治疗（ART）的机会。尽管如此，要想降低ART的发病率和死亡率，持续的治疗依从性至关重要。在免费提供抗逆转录病毒治疗的情况下，边缘化人群坚持治疗的最大障碍仍然是结构性的：前往诊所的交通费用、粮食不安全、无家可归和机会成本。这些结构性因素导致移徙者治疗中断的情况比固定的移徙者更严重，因为移徙者的流动性和非正规就业使收入、交通、食物、住房和是否接近保健更加不确定。因此，移民中断抗逆转录病毒治疗的风险很高。移徙人口治疗中断对公共卫生的影响是巨大的，因为中断治疗和移徙的结合可能大大助长艾滋病毒和抗逆转录病毒药物耐药性的传播。虽然大量的文献探讨了ART治疗依从性的结构性障碍，但很少有研究专门针对劳务移民人群的治疗中断。我的长期职业目标是成为一名独立的医生调查员，汇集临床医学，人类学和公共卫生，以了解和解决撒哈拉以南非洲艾滋病毒流行的结构（社会，经济和政治）复杂性。作为人类学的MD-PhD候选人，我需要额外的公共卫生指导和培训，以帮助我制定跨学科的研究方法。我的三年培训计划将包括课程作业，监督实地研究和数据分析，手稿写作，以及出席专业会议和演讲。我将利用这次培训和我的项目共同发起人在撒哈拉以南非洲开展ART依从性相关研究的专业知识来实现我的科学目标：更深入地了解南非感染艾滋病毒的劳工移民中断ART治疗的原因。为了实现这一 目标，我将寻求实现两个具体目标：（1）使用定性研究方法描述南非艾滋病毒感染的劳动移民中ART治疗中断的原因，（2）开发一个概念模型，说明结构性因素如何导致该移民人口的治疗中断。南非是这项研究的理想场所，因为它比其他任何国家都有更多的艾滋病毒感染者，而且许多人要么是劳动力， 移民或劳动力移民的家庭成员。拟议的研究是创新的，因为它针对的是一个研究不足的人群，他们既有中断ART治疗的高风险，又是艾滋病毒传播的组成部分。这是重要的，因为它有可能通过提供更全面的了解结构性因素驱动ART治疗中断劳动力移民告知未来的干预措施和卫生政策。

DESCRIPTION (provided by applicant): While the global HIV/AIDS epidemic has disproportionately burdened socially and economically marginalized populations in sub-Saharan Africa, HIV treatment scale-up has dramatically improved access to antiretroviral therapy (ART) for all. Nonetheless, for ART to decrease morbidity and mortality, sustained treatment adherence is essential. When ART is provided free of charge, the greatest barriers to treatment adherence for marginalized populations remain structural: cost of transportation to clinic, food insecurity, homelessness, and opportunity costs. Such structural factors lead to treatment interruptions for migrants even more than for their stationary counterparts because migrants' mobility and irregular employment make income, transportation, food, housing, and proximity to health care even more uncertain. Thus, migrants are at very high risk for ART treatment interruptions. The public health ramifications of treatment interruptions in migrant populations are substantial because migrants may contribute significantly to the spread of HIV and antiretroviral drug resistance because of the combination of interruptions and migration. Though a large body of literature explores structural barriers to ART treatment adherence, few studies have focused on treatment interruptions specifically in labor migrant populations. My long-term career goal is to become an independent physician-investigator who brings together clinical medicine, anthropology, and public health to understand and address the structural (social, economic, and political) complexities of the HIV epidemic in sub-Saharan Africa. As an MD-PhD candidate in anthropology, I need additional mentorship and training in public health to help me craft an interdisciplinary research approach. My three-year Training Plan will include coursework, supervised field research and data analysis, manuscript writing, and attendance and presentations at professional meetings. I will utilize this training and my Project Co-Sponsors' expertise on conducting ART adherence-related research in sub-Saharan Africa to accomplish my scientific objective: to acquire a more robust understanding of reasons for ART treatment interruptions specific to HIV-infected labor migrants in South Africa. In pursuit of this objective, I will seek to achieve two specific aims: (1) characterize reasons for ART treatment interruptions among HIV-infected labor migrants in South Africa using qualitative research methods and (2) develop a conceptual model for how structural factors lead to treatment interruptions in this migrant population. South Africa is an ideal setting for this research becaus it has more HIV-infected citizens than any other country, and many of its citizens are either labor migrants or family/household-members of labor migrants. The proposed research is innovative because it targets an understudied population both at high risk for ART treatment interruptions and integral to the spread of HIV. It is significant because it has the potential to inform future interventions and health policies by providing a more comprehensive understanding of the structural factors driving ART treatment interruptions among labor migrants.