An implementation science approach to monitoring engagement in HIV care

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PROJECT SUMMARY/ABSTRACT Career Goal: My career goal is to become a leading epidemiologist focused on improving engagement in HIV care in low and middle income countries (LMIC). Through this K99/R00 proposal, I hope to merge my training as an epidemiologist with the field of implementation science. With this skill set, I plan to build a career focused on implementing interventions to retain or re-engage HIV-infected women in HIV care in the peripartum period. Career Development: I will focus on training in implementation science and professional development during the mentored (K99) phase of this award. Training in implementation science will focus in 3 key areas: 1) core concepts and theories 2) using technology to implement more effective HIV program monitoring systems, and 3) qualitative research to inform implementation strategies. Professional development training will include coursework, seminars, building my reputation as an emerging HIV researcher, and a detailed plan for a successful transition to a tenure-track position. Research Project: The scale-up of antiretroviral treatment (ART) to all pregnant and breastfeeding women under Option B+ has the potential to change the trajectory of the HIV epidemic. However, in order for the potential of Option B+ to be realized, women must be retained in HIV care and those who are lost to follow-up (LTFU) must be re-engaged in care. Few efforts to re-engage women in HIV care exist. Routine HIV program monitoring is an evidence-based intervention that is vital to track women's engagement in HIV care under Option B+, but is limited in its ability accurately distinguish women who are LTFU from those who have transferred to another HIV clinic. Identifying women who are LTFU is essential for timely re-engagement in HIV care. The goal of the proposed project is to evaluate whether enhancing HIV program monitoring with technology may be an implementation strategy to accurately identify women who are LTFU. The project goal will be achieved through the following four Specific Aims: K99/1) To explore attitudes towards using technology for HIV program monitoring, K99/2) To assess the feasibility and acceptability of 3 implementation strategies to improve HIV program monitoring, R00/3) To evaluate enhanced HIV program monitoring as an implementation strategy, R00/4) To evaluate the effectiveness of enhanced program monitoring to improve the accuracy of HIV program monitoring. Mentorship: A highly accomplished, multidisciplinary team of experts will mentor me in the first two years of this award and provide ongoing guidance as I transition to independence. This mentoring team includes: Dr. Mina Hosseinipour (Primary Mentor, Department of Medicine, UNC; UNC-Project Malawi), Dr. Vivian Go (Co-mentor, Department of Health Behavior, UNC) and Dr. William Miller (Co-mentor, Department of Epidemiology, Ohio State), and Dr. Lisa Hightow-Weidman (Adviser, Department of Medicine, UNC). Future Directions: The training and research in this proposal will prepare me to submit an R01 application that uses technology-enhanced HIV program monitoring to identify women who are LTFU and develops a re-engagement in HIV care intervention.