Poverty, Mental Bandwidth, and an Unconditional Cash Transfer Intervention to Enable Health Behaviors for Pregnant People with HIV

贫困、心理带宽和无条件现金转移干预，以促进艾滋病毒孕妇的健康行为

• 批准号: 10674907
• 负责人: Aaron G Richterman
• 金额: $ 19.01万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10674907
• 关键词: Affect; Attention; Biometry; Caring; Characteristics; Clinical; Communicable Diseases; Decision Making; Disease Progression; Economics; Future; Goals; HIV; Haiti; Health; Health behavior; Health behavior and outcomes; Hospitals; Hybrids; Intervention; Master of Public Health; Measures; Mediating; Mentors; Outcome; Pathway interactions; Pennsylvania; Perinatal transmission; Persons; Physicians; Population; Postpartum Period; Poverty; Pregnancy; Process; Psyche structure; Psychological Impact; Publishing; Research; Rural; Rural Population; Scientist; Taxes; Testing; Training; Universities; Viral; Work; behavioral economics; clinical trial implementation; combat; design; drug resistance development; effectiveness/implementation hybrid; effectiveness/implementation trial; experience; food security; implementation science; improved; innovation; interest; perinatal period; poor health outcome; poverty alleviation; pregnant; prevent; public health relevance; theories; transmission process

PROJECT SUMMARY Candidate: I am a Fellow in Infectious Diseases at the University of Pennsylvania and a physician-scientist with a Master of Public Health degree and 5 years of experience working in rural Haiti. While I have a strong track record of published research at the intersection of poverty, food security, and infectious diseases, my experiences have motivated me to shift my research in two ways. First, I have developed an interest in poverty's effects on decision-making, including the theory of poverty's psychological impacts, the empirical measures of these impacts, and the scientific approaches used to examine the effects of poverty alleviation on health behaviors and outcomes. Second, I plan to move from observational work towards the design and execution of hybrid effectiveness-implementation clinical trials of innovative economic interventions to improve HIV outcomes. Background: Poverty is an important contributor to poor short- and long-term HIV outcomes for pregnant people with HIV (PrPWH). This problem is particularly salient in Haiti, where 25% of people live in extreme poverty and only half of PrPWH are retained in care 12 months after starting ART. Recent research in behavioral economics has shown that poverty can result in worse health outcomes by taxing mental bandwidth, resulting in a heightened focus on immediate needs and less attention to future-oriented decisions. Mental bandwidth is likely further taxed by the added burdens of HIV and the perinatal period. Consequently, anti-poverty interventions targeting PrPWH may be particularly effective at improving health outcomes. Training: To achieve research independence, I require additional training in 1) behavioral economics and the decision-making processes underlying health behaviors; 2) the conduct and analysis of qualitative studies; and 3) hybrid effectiveness-implementation clinical trials. Mentors: My training and research plans will be overseen by Dr. Harsha Thirumurthy, who has extensive mentoring experience and expertise in developing and testing economic interventions to improve HIV outcomes. Drs. Louise Ivers (research in rural Haiti, qualitative design), Florence Momplaisir (implementation science, qualitative design, PrPWH), and Heather Schofield (mental bandwidth measures in poverty) will be additional co-mentors, and Drs. Christophe Millien (PrPWH in Haiti) and Alisa Stephens-Shield (biostatistics) will be advisors. Research: I will use 3 aims to accomplish my objective of assessing a key pathway — mental bandwidth — by which poverty (and cash transfers to combat poverty) can affect health behaviors among PrPWH in rural Haiti: 1) Characterize the relationship between mental bandwidth, HIV, and the perinatal period; 2) Identify key characteristics of an unconditional cash transfer intervention for PrPWH; and 3) Conduct a Hybrid Type 2 effectiveness-implementation trial of an unconditional cash transfer intervention for PrPWH. This research will be conducted at St. Boniface Hospital in Fond-des-Blancs, Haiti. I will use the findings from this K23 as the basis for an R01 proposal to conduct a larger trial of an unconditional cash transfer powered for clinical outcomes (e.g., postpartum viral suppression).

项目摘要 候选人：我是宾夕法尼亚大学传染病研究员，同时也是一名医生兼科学家 拥有公共卫生硕士学位和5年在海地农村工作的经验。虽然我有一个强大的 在贫困、粮食安全和传染病的交叉点上发表的研究记录，我 这些经历促使我从两个方面改变我的研究。首先，我对 贫困对决策的影响，包括贫困的心理影响理论， 这些影响的衡量标准，以及用来审查减贫对 健康行为和结果。其次，我计划从观察工作转向设计， 执行创新经济干预措施的混合有效性实施临床试验，以改善 艾滋病毒成果。背景：贫困是导致艾滋病毒短期和长期效果不佳的重要因素 艾滋病病毒感染者（PrPWH）这一问题在海地尤为突出，该国25%的人口生活在 在开始抗逆转录病毒治疗12个月后，只有一半的PrPWH患者仍在接受护理。 行为经济学已经表明，贫困可以通过加重精神负担而导致更糟糕的健康结果。 这导致更加注重眼前的需要，而较少注意面向未来的决定。 由于艾滋病毒和围产期的额外负担，心理带宽可能会进一步增加。因此，委员会认为， 针对PrPWH的扶贫干预措施可能对改善健康结果特别有效。 培训：为了实现研究的独立性，我需要在1）行为经济学和 健康行为的决策过程; 2）定性研究的进行和分析;以及 3)混合有效性-实施临床试验。导师：我的培训和研究计划将受到监督 Harsha Thirumurthy博士，他在开发和测试方面拥有丰富的指导经验和专业知识 采取经济干预措施，改善艾滋病毒防治成果。Louise Ivers博士（海地农村研究，定性设计）， 佛罗伦萨Momplaisir（实施科学，定性设计，PrPWH）和石楠斯科菲尔德（心理 贫困的带宽措施）将是额外的共同导师，Christophe Millien博士（海地的PrPWH） 和Alisa Stephens-Shield（生物统计学）将担任顾问。研究：我将使用3个目标来实现我的目标 评估一个关键途径-心理带宽-的目标， 贫困）可以影响海地农村PrPWH的健康行为：1）描述 心理带宽，艾滋病毒，和围产期; 2）确定无条件现金的关键特征 为PrPWH进行转移干预;以及3）进行混合2型有效性实施试验， 对PrPWH进行无条件现金转移干预。这项研究将在圣博尼法斯医院进行， 海地的丰代布兰克我将使用K23的调查结果作为R 01提案的基础， 无条件现金转移用于临床结果的更大试验（例如，产后病毒抑制）。