Mentoring Junior Investigators: Comprehensive HIV Prevention

描述(由申请人提供)：这是为卡罗尔·戈林博士颁发的以患者为中心的研究(K24)职业生涯中期奖的建议。尽管努力遏制艾滋病毒的传播，但美国南部的发病率仍在继续上升。针对危险性行为和坚持抗逆转录病毒治疗的行为方案可以改善个人与艾滋病毒传播相关的健康行为，但有限。人际和社区层面的因素，如贫困、社会规范、犯罪率和监禁率、人际压力和二元能力，往往推动或制约艾滋病毒的脆弱性，并可能阻碍行为方案的效果。迫切需要一批初级调查人员，特别是那些来自代表人数不足的群体的调查人员，他们有兴趣和技能协作解决这些因素。作为北卡罗来纳大学CFAR社会和行为科学核心的主任，戈林博士越来越多地被要求指导无数寻求与她合作获得此类技能的有前途的年轻研究人员。拟议的职业发展奖将给予戈林博士专门的时间，通过指导北卡罗来纳大学在艾滋病毒预防和依从性研究方面的几名有才华的初级同事，来扩大和建立她以患者为导向的艾滋病毒/艾滋病预防研究。戈林博士的目标是通过实现四个近期目标，在美国南部创建一个正式的北卡罗来纳大学艾滋病毒预防计划，以：1)通过正式和非正式的培训和合作，提高她评估健康的结构性决定因素和艾滋病毒预防干预计划的成本效益的能力；2)通过检查艾滋病毒流行的人际和社区层面决定因素在影响艾滋病毒预防计划有效性方面的作用，扩大她以患者为中心的调查(探索动机、自我效能和危险性行为之间的联系)；3)评估“有动力参与并坚持护理和治疗”(IMPACT)艾滋病毒预防计划的成本效益；以及4)提高她为初级调查人员提供有效和出色指导的能力。本申请中提出的以患者为导向的研究为戈林博士和她的被辅导者提供了一种职业发展的工具，它将：1)检查人际和结构性因素对异性恋HIV感染者SafeTalk计划有效性的调节作用；2)探索Impact研究中异性参与者及其社交网络成员的观点，以评估帮助或阻碍他们使用坚持或安全性行为策略的二元和社区因素。3)评估Impact计划的成本效益；4)在北卡罗来纳州高贫困、高艾滋病毒流行率的人口普查地区，探索艾滋病毒阴性妇女及其男性伴侣中艾滋病毒风险的潜在邻里和二元背景。她的长期职业目标是将她正在开发的艾滋病毒预防计划发展成为一个成熟的中心，为美国东南部的弱势社区创建、检测和传播有效、全面的艾滋病毒预防干预措施。

DESCRIPTION (provided by applicant): This is a proposal for a midcareer investigator award in patient-oriented research (K24) for Dr. Carol Golin. Despite efforts to curb HIV spread, incidence continues to increase in the southern U.S. Behavioral programs that address risky sexual behavior and ARV adherence can improve HIV transmission-related health behaviors of individuals, but are limited. Interpersonal and community-level factors, such poverty, social norms, crime and incarceration rates, interpersonal stress, and dyadic capacity often drive or constrain vulnerability to HIV, and may impede effects of behavioral programs. There is an urgent need for a pipeline of beginning investigators, especially those from underrepresented groups, with the interest and skills to collaboratively address these factors. As Director of the UNC CFAR Social and Behavioral Science Core, Dr. Golin is increasingly called upon to mentor numerous promising young investigators seeking to work with her to obtain such skills. The proposed career development award will give Dr. Golin the dedicated time to expand and build her patient- oriented research in HIV/AIDS prevention by mentoring several talented junior colleagues at UNC in HIV prevention and adherence research. Dr. Golin aims to create a formal UNC Program on HIV Prevention in the US South by achieving four immediate goals, to: 1) enhance her capacity to evaluate structural determinants of health and cost-effectiveness of HIV prevention intervention programs through formal and informal training and collaboration; 2) extend her patient-oriented investigations (exploring the interface between motivation, self- efficacy, and risky sexual behavior) by examining the role of interpersonal and community-level determinants of the HIV epidemic in influencing the effectiveness of HIV prevention programs; 3) evaluate the cost- effectiveness of the "Individuals Motivated to Participate and Adhere to Care and Treatment" (imPACT) HIV prevention program; and 4) enhance her capacity to provide effective and outstanding mentoring to junior investigators. The patient-oriented research proposed in this application, which provides a vehicle for career development for Dr. Golin and her mentees, will: 1) Examine the moderating effects of interpersonal and structural factors on the SafeTalk program's effectiveness among heterosexual HIV-infected individuals; 2) Explore the views of heterosexual participants in the imPACT study and their social network members to assess dyadic and community factors that helped or impeded their use of adherence or safer sex strategies.; 3) Evaluate the cost-effectiveness of the imPACT program; 4) Explore potential neighborhood and dyadic contexts for HIV risk among HIV-negative women and their male partners living in high poverty, high HIV prevalence census tracts in in NC. Her long-term career objective is to grow the HIV Prevention Program she is developing to a fully established Center for creating, testing, and disseminating effective, comprehensive HIV prevention interventions for vulnerable communities throughout the Southeastern U.S.