Social-structural and spatial determinants of HIV testing and linkage to care among high risk women in Tanzania

项目总结/摘要 社会结构性力量--贫困、耻辱、种族主义和性别不平等--加剧了艾滋病毒的不平等， 世界各地的主要人口，特别是撒哈拉以南非洲。当世界走向90- 90-90艾滋病毒级联护理目标，其中90%的艾滋病毒感染者知道自己的状况，其中90% 与护理有关，90%的护理人员受到病毒抑制，同样的社会结构力量 很可能会把关键人群不成比例地推到护理级联的每一步留下的10%中。 结构性干预措施，解决社会生态的多个层面，并赋予社区权力， 消除社会和体制障碍可以改善护理成果，降低发病率 在关键人群中。这些干预措施的复杂性有助于它们的成功，但也提出了一个 在方法上的挑战，以评估它们通过哪些机制同时在 个人、社区和机构层面。这K 01指导研究科学家的职业发展 该奖项旨在为PI提供定性，定量和地理空间相结合的培训 方法来应对这一挑战。拟议的研究将探讨社会结构力量如何影响 坦桑尼亚伊林加的高危妇女生活、工作和获得医疗保健的空间，以及这些妇女是如何获得医疗保健的。 空间影响艾滋病毒检测的获得和与护理的联系。这项工作将建立PI的技能，1）定性和 定量地理信息系统; 2）强调空间因素的潜在类别分析; 3)设计和实施基于社区的社会结构干预措施。该项目将 嵌套在现有的NIMH资助的R 01社区为基础的干预措施与高风险妇女。研究 目标是：1）确定工作场所和居住区的空间集群，其中妇女是显着的 或多或少有可能获得艾滋病毒检测或与护理有关; 2）使用潜在类别分析来确定 空间使用，最有可能经常使用这些空间的妇女的特点，以及艾滋病毒感染率的差异 测试和联系，以照顾潜在的空间类;和3）描述的空间表现形式的社会结构 从当地妇女的角度来看，阻碍艾滋病毒检测和与护理联系的因素， 这些与前两个目标中确定的空间模式如何相关。这项研究的结果将定位于 PI制定R34提案，以进行针对地理位置和空间的试点干预， 护理成果的级联和减少艾滋病毒的发病率。获得的技能将使PI过渡到 作为以社区为基础的混合方法研究和干预措施的专家， 关键人群之间的差距。

Project Summary/Abstract Social-structural forces - poverty, stigma, racism, and gender inequality - have exacerbated HIV disparities for key populations around the world and particularly in sub-Saharan Africa. As the world moves towards the 90- 90-90 HIV cascade of care goals, in which 90% of individuals living with HIV know their status, 90% of these are linked to care, and 90% of those engaged in care are virally suppressed, the same social-structural forces are likely to push key populations disproportionately into the 10% left behind at each step of the care cascade. Structural interventions that address multiple levels of the social ecology and empower communities to dismantle social and institutional barriers can improve cascade of care outcomes and decrease incidence among key populations. The complexity of these interventions contributes to their success, but also presents a methodological challenge to assess the mechanisms through which they simultaneously create change at individual, community, and institutional levels. This K01 Mentored Research Scientist Career Development Award is designed to provide the PI with training in a mixture of qualitative, quantitative, and geospatial methods to address this challenge. The proposed research will explore how social-structural forces influence the spaces where high risk women in Iringa, Tanzania live, work, and access health care, and how these spaces affect access to HIV testing and linkage to care. This work will build the PI’s skills in 1) Qualitative and quantitative geographic information systems; 2) Latent class analysis with an emphasis on spatial factors; and 3) The design and implementation of community-based social-structural interventions. The project will be nested within an existing NIMH-funded R01 community-based intervention with high-risk women. The research aims are to: 1) Identify spatial clusters of work venues and residential areas in which women are significantly more or less likely to access HIV testing or be linked to care; 2) Use latent class analysis to identify patterns of spatial use, the characteristics of women who are most likely to frequent those spaces, and differences in HIV testing and linkage to care by latent spatial class; and 3) Describe the spatial manifestations of social-structural forces that create barriers to HIV testing and linkage to care from the perspective of local women and identify how these correlate with spatial patterns identified in the first 2 aims. Findings from this study will position the PI to develop an R34 proposal for a geographically targeted and spatially tailored pilot intervention to improve cascade of care outcomes and reduce HIV incidence. The skills gained will allow the PI to transition to independence as an expert in community-based, mixed-methods research and interventions to reduce HIV disparities among key populations.