Examining Human Behavior in Dengue Prevention Efforts in Iquitos, Peru

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DESCRIPTION (provided by applicant): This application is being submitted in response to Program Announcement PAR-10-066, "International Research Scientist Development Award (IRSDA) (K01)." The objectives of this IRSDA are to expand my training and knowledge in the field of vector-borne diseases and provide me with the dedicated time for training, grant-writing and mentorship toward the goal of developing expertise and becoming an independent investigator in the field of behavioral interventions to prevent vector-borne diseases. I will build upon my experience and expertise in studying the diffusion processes of preventive reproductive health behaviors within different types of networks, such as how different strategies influence the adoption of these preventive behaviors, by obtaining the additional training needed to examine these processes in vector-borne disease prevention. This new set of skills and knowledge will be obtained through a well-defined four-year career development plan consisting of directed readings, short courses, and mentored research. I have a solid foundation in social science research methods and techniques, strong content knowledge on behavior change at the individual and community level, and have been producing steadily since the culmination of my PhD, when I moved back to Peru, my country of birth and upbringing, as a research assistant professor and to direct Tulane's Health Office for Latin America. Three years ago I found my niche as a social scientist working on dengue prevention, but I need training and mentorship in this new field to me. Thus, coursework and readings will focus heavily on vector-borne diseases (VBD), vector ecology, dengue epidemiology, and behavioral interventions used in VBD prevention, but I also need additional training in certain social science research skills: survey development and evaluation, spatial data analysis, and use of qualitative data analysis software. In addition to the solid support of my home institution, Tulane University, a superb and experienced group of mentors and collaborators have committed themselves to helping me achieve my goal and provide guidance for my proposed Mentored Research. This multidisciplinary team of mentors, most of whom I am already working closely with, is ideal for guiding me through the multiple issues I face in carrying out the research plan, as well as providing guidance in my training and career development plans. We are in constant communication via Skype, conference calls and regularly scheduled face-to-face meetings, and all have agreed on an annual face-to-face meeting for updates on my progress. The aims of the research plan are all linked to studying human behavior within three funded dengue research projects all being conducted (or soon to be) in the city of Iquitos, Peru, where all dengue serotypes have been documented. The specific aims are: 1) to validate and modify two surveys to measure people's movement patterns and "activity space," which will be used for Dr. Scott et al.'s NIH-funded grant designed to test the hypothesis that spatial dimensions of dengue virus transmission are defined by daily patterns of human movement in Iquitos, Peru; 2) to assess the role of human movement in confounding the effect of household- level interventions to prevent dengue transmission, using data from Dr. McCall (Wellcome Trust-funded) and Dr. Wesson (Gates Foundation funded) cluster-randomized controlled intervention trials; and 3) to determine the individual and household-level socio-demographic and economic factors associated with the correct and consistent use of two different approaches to dengue prevention: a) insecticide-treated curtains and b) lethal ovitraps (using data from the two intervention trials in Aim 2). All aims fit within the activities and goals of the three existing projects (of which I am an integral team member), but are all original ideas presented to my mentors that have been very well received. Preparation and submission of an R01 grant proposal is the expected culminating activity for this award: I foresee development of a proposal associated to the assessing the role of human movement in evaluation of dengue (or other VBD) interventions in settings outside of Iquitos. On a personal level, accomplishment of all activities associated to this IRSDA would be a solid start to my becoming an independent investigator whose social science expertise in VBD prevention and control could start being applied in other regions of the world, as well as to other VBD beyond dengue - although there is plenty of more work to be done in dengue research. On a larger scale, the impact of the proposed research plan is substantive. Dengue has a higher morbidity and mortality rate than any other arthropod-borne virus and is the most rapidly advancing VBD in the world. The findings from this study will have a wide impact on dengue prevention and control programs in Iquitos and throughout Latin America. If all proposed aims for this project are achieved, vector control strategies could be improved, evaluation of new interventions would be more accurate, and a new tool for assessing human movement - which would need to be adapted for other settings - would be available for use in public health, as well as other fields. In addition, understanding the individual, social and economic factors associated with use of interventions will be helpful in the development of cost-effective methodologies with optimal opportunity for successful implementation. PUBLIC HEALTH RELEVANCE: Dengue has a higher morbidity and mortality rate than any other arthropod-borne virus and is the most rapidly advancing vector-borne disease in the world. The findings from this study will have a wide impact on dengue prevention and control programs in Iquitos and throughout Latin America; thus this research is highly relevant to public health.