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.

项目总结/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 项目必须优先考虑艾滋病毒感染风险最大的难以接触到的移动的人群 传输一些差异化的服务交付模式可能适用于移动的人群，但服务的目标是 如此广泛的个人类别可能会浪费有限的资源。由于不清楚哪种形式的流动 最显着增加艾滋病毒感染的风险，这项研究旨在系统地描述流动性， 将其与个人和性网络两级的艾滋病毒发病率联系起来。目标。与NIMH Human一致 流动性和艾滋病毒方案的目标，以确定发病率和审查艾滋病毒的成果，在移动的 本研究将1）描述流动性及其与HIV检测和病毒载量抑制的相关性， 2)估计移动的群体的艾滋病毒发病率，以及3）确定流动性对艾滋病毒感染风险的影响 性网络。阐明这些差距将为今后确定干预措施的目标和量身定制提供信息， 移动的人群的健康。Approach.由于艾滋病毒研究中没有一致的流动性衡量标准， 在撒哈拉以南非洲，这项研究将使用来自Rakai社区队列研究（RCCS）的详细流动性指标， 在乌干达中南部人口流动频繁的地区进行人口纵向研究， 制定一个多维度的衡量标准，考虑频率、持续时间、动机和空间维度 人们的运动。这一措施将揭示与艾滋病毒发病率有关的流动性亚类， 其他预防和治疗成果。来自19，300名15-49岁成年人的RCCS数据将补充 来自难以接触（HTR）的数据，这是RCCS中的一项嵌入式研究，旨在获取艾滋病毒结果和流动性 RCCS中2,000名失访（LTFU）患者的模式。这是一个独特的 有机会评估开放、动态队列中人口流动所带来的缺失数据偏差。每个 具体目标将使用现有数据的全部范围，包括纵向艾滋病毒生物标志物和详细的 在HIV事件病例及其HIV阴性匹配对照中进行接触调查。训练 女士哈利法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徙，获得纵向调查方法的经验， 学习缺失数据和网络分析的先进流行病学技术，并建立有效的 研究传播。在她的主要赞助商的指导下，Khalifa女士将获得量身定制的指导 来自一个经验丰富的艾滋病研究人员团队，他们与家长研究一起工作， 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的机构，在人口健康、传染病、 疾病，以及空间和社会流行病学。