Linking Refugees to HIV Clinical Care in Uganda

将难民与乌干达的艾滋病毒临床护理联系起来

• 批准号: 9301036
• 负责人: Kelli Nicole O'Laughlin
• 金额: $ 18.25万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-20 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9301036
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Africa South of the Sahara; Authorization documentation; Award; Behavioral Sciences; Biometry; Caring; Client; Clinic; Clinical Investigator; Clinical Research; Collaborations; Complex; Country; Cultural Sensitivity; Data; Dedications; Dimensions; Enrollment; Environment; Epidemic; Exposure to; Face; Faculty; Failure; Fellowship; Foundations; Geographic Information Systems; Goals; HIV; HIV Infections; HIV diagnosis; Health; Health Policy; Health Services Accessibility; Health behavior; Healthcare; Home environment; Human; Human immunodeficiency virus test; Individual; Interdisciplinary Study; Intervention; Intervention Studies; Intervention Trial; K-Series Research Career Programs; Knowledge; Language; Link; Mental Health; Mental disorders; Mentors; Methodology; Newly Diagnosed; Politics; Population; Populations at Risk; Positioning Attribute; Prevalence; Psychiatrist; Publishing; Qualitative Methods; Randomized; Refugees; Research; Research Methodology; Research Personnel; Research Training; Resources; Risk; Rural; Secondary to; Services; Site; Social Network; Social support; Surveys; System; Techniques; Training; Training Support; Trauma; Uganda; United Nations; Violence; Vulnerable Populations; Walking; Work; World Health Organization; analytical method; base; clinical care; cohort; design; experience; health service use; improved; innovation; medical schools; method development; permissiveness; programs; prospective; psychosocial; public health relevance; randomized trial; remote location; skills; social; successful intervention; theories; therapy development; tool; trial design

 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.