Applying a multidimensional measure of human mobility to understand drivers of HIV incidence in Rakai, Uganda

应用多维人口流动性衡量指标来了解乌干达拉凯艾滋病毒发病率的驱动因素

• 批准号: 10761906
• 负责人: Aleya R Khalifa
• 金额: $ 4.6万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10761906
• 关键词: Adult; Africa South of the Sahara; African; Age; Area; Avidity; Biological Assay; Biological Markers; Caliber; Case/Control Studies; Categories; Climate; Cohort Studies; Communicable Diseases; Communities; Country; Data; Data Analyses; Dedications; Dimensions; Economics; Epidemic; Epidemiologic Methods; Exhibits; Face; Frequencies; Future; Gender; Goals; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; Health Services Accessibility; Home; Household; Human; Human immunodeficiency virus test; Incidence; Individual; Institution; Intervention; Investigation; Knowledge; Learning; Link; Location; Longitudinal Studies; Longitudinal Surveys; Longitudinal cohort; Measures; Mentorship; Methods; Motivation; Movement; National Institute of Mental Health; Odds Ratio; Outcome; Parents; Participant; Partner Notification; Pathway Analysis; Pattern; Persons; Politics; Population; Population Research; Population Study; Prevalence; Prevention; Questionnaires; Religion; Research; Research Personnel; Resources; Risk; Sampling; Selection Bias; Service delivery model; Services; Sexual Partners; Subgroup; Survey Methodology; Surveys; Testing; Training; Travel; Treatment outcome; Uganda; Universities; Unsafe Sex; Viral Load result; Virus; Visit; Work; aged; barrier to care; career; cohort; community transmission; experience; follow-up; improved; longitudinal analysis; mHealth; migration; poor health outcome; population based; population health; population movement; pre-exposure prophylaxis; prevention service; programs; research data dissemination; response; self testing; service delivery; skills; social; social epidemiology; spatial epidemiology; transmission process; treatment adherence; wasting

PROJECT SUMMARY/ABSTRACT Background. As sub-Saharan African (SSA) countries embark on the last mile toward HIV elimination, HIV programs must prioritize hard-to-reach mobile populations at the greatest risk of HIV acquisition and onward transmission. Some differentiated service delivery models may work for mobile people, but targeting services to such a broad category of individuals could waste limited resources. Since it is unclear which forms of mobility most significantly increase the risk of HIV infection, this study aims to systematically characterize mobility and relate it to HIV incidence at both the individual and sexual network levels. Aims. In line with NIMH Human Mobility and HIV program objectives to determine incidence rates and examine HIV outcomes among mobile populations, this study will 1) characterize mobility and its association with HIV testing and viral load suppression, 2) estimate HIV incidence by mobile group, and 3) determine the effect of mobility on the risk of HIV acquisition in sexual networks. Elucidating these gaps will inform future targeting and tailoring of interventions to improve the health of mobile populations. Approach. Since no consistent measure for mobility exists across HIV studies in SSA, this research will use detailed mobility metrics from the Rakai Community Cohort Study (RCCS), a population-based longitudinal study in south-central Uganda where there is substantial human movement, to develop a multidimensional measure that considers the frequency, duration, motivation, and spatial dimensions to people’s movement. This measure will uncover subclasses of mobility that can be linked to HIV incidence and other prevention and treatment outcomes. RCCS data from 19,300 adults aged 15-49 will be supplemented with data from Hard-to-Reach (HTR), an embedded study within the RCCS that captures HIV outcomes and mobility patterns among 2,000 individuals who have been lost to follow-up (LTFU) in the RCCS. This presents a unique opportunity to assess the missing data biases introduced by population mobility in open, dynamic cohorts. Each Specific Aim will use the full extent of the available data, including longitudinal HIV biomarkers and detailed contact investigations conducted among HIV incident cases and their HIV-negative matched controls. Training. Ms. Khalifa’s training plan leverages her quantitative abilities and HIV research experience to advance her skills and launch her into a career as an independent investigator focused on mobility and health. Her training goals are to develop in-depth knowledge of mobility and migration, gain experience with longitudinal survey methods, learn advanced epidemiologic techniques for missing data and network analyses, and build capacity for effective research dissemination. Under the guidance of her Primary Sponsor, Ms. Khalifa will receive tailored mentorship from a team of experienced HIV researchers who work with the parent studies, conduct mobility-focused research, and have tremendous expertise in the requisite quantitative methods. Training will take place at Columbia University, a high-caliber institution with specialized research programs in population health, infectious disease, and spatial and social epidemiology.

项目概要/摘要 背景。随着撒哈拉以南非洲 (SSA) 国家踏上消除艾滋病毒的最后一英里，艾滋病毒 项目必须优先考虑那些难以接触到的流动人群，这些人群感染艾滋病毒的风险最大，并继续发展 传播。一些差异化的服务交付模式可能适用于移动人群，但目标服务是 如此广泛的个人类别可能会浪费有限的资源。由于尚不清楚哪些形式的流动性 最显着增加艾滋病毒感染的风险，本研究旨在系统地描述流动性和 将其与个人和性网络层面的艾滋病毒发病率联系起来。目标。符合 NIMH 人类标准 流动性和艾滋病毒计划目标是确定流动人口中的发病率并检查艾滋病毒结果 人口，这项研究将 1) 描述流动性及其与 HIV 检测和病毒载量抑制的关系， 2) 按流动群体估计 HIV 发病率，以及 3) 确定流动性对 HIV 感染风险的影响 在性网络中。阐明这些差距将为未来制定干预措施的目标和调整提供信息，以改善 流动人口的健康。方法。由于艾滋病毒研究中没有一致的流动性衡量标准 在 SSA 中，这项研究将使用 Rakai 社区队列研究 (RCCS) 的详细流动性指标，该研究是一项 在人口流动频繁的乌干达中南部开展基于人口的纵向研究， 制定考虑频率、持续时间、动机和空间维度的多维衡量标准 到人们的运动。这项措施将揭示与艾滋病毒发病率和相关性相关的流动性亚类。 其他预防和治疗结果。来自 19,300 名 15-49 岁成年人的 RCCS 数据将得到补充 来自 Hard-to-Reach (HTR) 的数据，这是 RCCS 内的一项嵌入式研究，捕捉艾滋病毒结果和流动性 RCCS 中失访 (LTFU) 的 2,000 名个体的模式。这呈现出一种独特的 有机会评估开放、动态队列中人口流动造成的缺失数据偏差。每个 Specific Aim 将使用全部可用数据，包括纵向 HIV 生物标志物和详细的 在艾滋病毒事件病例及其艾滋病毒阴性匹配对照中进行接触调查。训练。 Khalifa 女士的培训计划利用她的定量能力和艾滋病毒研究经验来提高她的技能 并让她成为一名专注于流动性和健康的独立调查员。她的训练目标 深入了解流动性和移民，获得纵向调查方法的经验， 学习针对缺失数据和网络分析的先进流行病学技术，并建立有效的能力 研究传播。在主要赞助商的指导下，哈利法女士将获得量身定制的指导 由经验丰富的艾滋病毒研究人员组成的团队与家长一起进行研究，开展以流动性为重点的研究 研究，并在必要的定量方法方面拥有丰富的专业知识。培训将在 哥伦比亚大学是一所高水平机构，在人口健康、传染病等领域设有专门研究项目 疾病、空间和社会流行病学。