Linking Refugees to HIV Clinical Care in Uganda

 描述（由申请人提供）：估计有340万难民生活在撒哈拉以南非洲地区，该地区拥有全球71%的艾滋病毒感染者。难民平均流离失所17年，是一个易受伤害的群体，由于暴力和迫害，他们有感染艾滋病毒的风险。由于相互竞争的生存需求、语言和文化障碍以及社交网络中断，难民在获得艾滋病毒护理方面面临独特的挑战。撒哈拉以南非洲难民定居点的艾滋病毒流行率往往是未知的，对这一人群的艾滋病毒研究也很有限。候选人：在我的研究奖学金期间，我在乌干达的Nakivale难民定居点进行了一项基于诊所的常规艾滋病毒检测研究，结果表明只有54%的新诊断的艾滋病毒感染者与护理有关。我正在申请K23职业发展奖，以获得成为独立调查员的技能，专注于了解难民与艾滋病毒护理的联系，并制定干预措施，以改善对这一独特人群的护理。指导：Ingrid Bassett博士（导师）是资源有限环境中艾滋病毒护理联系方面的专家，也是哈佛医学院青年导师奖的赢家。我还将接受以下共同导师的指导：Paul Spiegel博士（联合国难民事务高级专员办事处方案支助和管理司副司长，难民健康结构方面的专家）、埃德加穆洛戈博士（艾滋病毒研究员，乌干达教师）和劳拉·博加特博士（行为科学、艾滋病毒干预研究和定性方法方面的专家）。顾问包括Richard Mollica博士（哈佛难民创伤项目主任），亚历山大蔡博士（精神病学家，乌干达艾滋病毒感染者心理社会干预研究专家），Julius Kasozi博士（难民署驻乌干达办事处，难民健康和乌干达健康政策专家），Michael VanRooyen博士（哈佛人道主义倡议主任），Norma Ware博士（定性方法）和Robert帕克博士（生物统计学，HIV试验设计）。研究：在社会生态框架内，我将1）使用定性方法来了解艾滋病毒护理的障碍和克服Nakivale难民障碍的方法; 2）前瞻性地招募一批艾滋病毒感染的难民，以评估哪些社会生态因素与Nakivale的艾滋病毒护理失败相关;和3）使用干预绘图方法来制定，实施和评估试点干预措施，以改善与纳基瓦莱艾滋病毒护理的联系。培训内容：该研究得到了健康行为理论和资源有限环境中艾滋病毒护理生态环境培训的支持，深入关注心理健康，分析技术，包括调查和地理信息系统方法，以及干预措施的开发。该项目将提供培训和试验数据，以开发R 01应用程序，在乌干达的三个难民定居点进行随机艾滋病毒联系干预试验。我致力于评估干预措施，以改善对难民的照顾，从一个特殊的辅导团队，强大的机构承诺和创新的研究计划的支持，我很有能力成为一个独立的临床研究人员专注于难民健康。

 DESCRIPTION (provided by applicant): There are an estimated 3.4 million refugees living in sub-Saharan Africa, a region of the world which hosts 71% of the global population living with HIV. Displaced for an average of 17 years, refugees are a vulnerable population at risk of exposure to HIV due to violence and persecution. With competing survival needs, language and cultural barriers, and disrupted social networks, refugees face unique challenges accessing HIV care. HIV prevalence in refugee settlements in sub-Saharan Africa is often unknown and HIV research in this population is limited. Candidate: During my research fellowship, I conducted a clinic-based routine HIV testing study in Nakivale Refugee Settlement in Uganda demonstrating that only 54% of newly diagnosed HIV-infected clients linked to care. I am applying for a K23 Career Development Award to acquire the skills to become an independent investigator focused on understanding linkage to HIV care for refugees and developing interventions to improve engagement in care for this unique population. Mentoring: Dr. Ingrid Bassett (Mentor) is an expert on linkage to HIV care in resource-limited settings and winner of the Harvard Medical School Young Mentor Award. I will also be guided by Co-Mentors, Dr. Paul Spiegel (the Deputy Director of the Division of Programme Support and Management at the United Nations High Commissioner for Refugees [UNCHR], expert in the structural dimensions of refugee health), Dr. Edgar Mulogo (HIV researcher, faculty in Uganda), and Dr. Laura Bogart (expert in behavioral science, HIV intervention research, and qualitative methods). Committed advisors include Dr. Richard Mollica (Director of the Harvard Program in Refugee Trauma), Dr. Alexander Tsai (psychiatrist, expert on psychosocial intervention research for HIV- infected people in Uganda), Dr. Julius Kasozi (UNHCR in Uganda, expert in refugee health and Uganda health policy), Dr. Michael VanRooyen (Director of the Harvard Humanitarian Initiative), Dr. Norma Ware (qualitative methods), and Dr. Robert Parker (biostatistics, HIV trial design). Research: Within the social-ecological framework, I will 1) use qualitative methods to understand barriers to HIV care and means to overcome barriers for refugees in Nakivale; 2) prospectively enroll a cohort of HIV-infected refugees to assess which social-ecological factors correlate with failure to link to HIV care in Nakivale; and 3) use intervention mapping methodology to develop, implement, and evaluate a pilot intervention to improve linkage to HIV care in Nakivale. Training: The research is supported by training in health behavior theory and ecologic context of HIV care in resource-limited settings with an in-depth focus on mental health, analytic techniques including survey and geographic information system methods, and intervention development. The project will provide training and pilot data needed to develop an R01 application for a randomized HIV linkage intervention trial in three refugee settlements in Uganda. With my dedication to evaluating interventions to improve care for refugees, support from an exceptional mentoring team, strong institutional commitment, and an innovative research plan, I am well-positioned to become an independent clinical investigator focused on refugee health.