Migration to Urban Slums, Sexual Networks, and HIV in Ghana

描述(由申请人提供)：这项研究的长期目标是使用基于网络的人类迁徙和艾滋病毒传播动态的动态数学模型来设计和评估艾滋病毒预防干预措施，如并发消息。本研究项目有三个具体目的。第一个目标是审查加纳现有的移民和艾滋病毒数据。这项文献回顾和实证研究将1)突出加纳的移徙模式和艾滋病毒差距；2)强调我们对移徙和艾滋病毒传播之间复杂联系的认识上的差距；3)揭示标准横断面数据收集的局限性。因此，这项研究的第二个目标是设计和实施一项关于性网络、迁徙历史和HIV性危险行为的小规模试点调查。该小组还将确定为今后的跨学科工作收集艾滋病毒生物标记物的可行性。第三个目标是根据网络样本建立一个数学模型，以量化移徙对艾滋病毒传播的影响。这项试点建模工作将是K99/R00赠款周期接近尾声时R01应用程序的基础。K99/R00的支助将使PI能够进行大量的公共卫生培训(流行病学公共卫生硕士)，以及关于传染病建模和社会网络理论和分析的正式培训。国际和平研究所计划在全球卫生领域开展学术生涯；因此，这种额外的培训和在国际环境中进行研究的经验将有助于确保这一努力的成功。过去的研究表明，移民表现出比非移民更高的性行为风险，感染艾滋病毒的风险更高；然而，移民可能促进艾滋病毒传播的机制尚不清楚。这项工作假设，迁徙可以显著增强艾滋病毒的传播，因为1)迁徙改变了促进并发性的伙伴关系形成和持续时间的时间和顺序，以及2)并发性将个体联系在一起，在允许病原体快速有效地传播的网络中创建大型连接的“组件”。限制人们行动不是一种可行的艾滋病毒预防干预措施，但改变行为(即一次一个伴侣)和早期抗逆转录病毒治疗(ART)以减少对移民的传染性是防止更多艾滋病毒感染的实际政策。

DESCRIPTION (provided by applicant): The long-term objective of this research is to use dynamic network-based mathematical models of human migration and HIV transmission dynamics for designing and evaluating HIV prevention interventions, such as the message of concurrency. There are three specific aims of this research project. The first aim is to review existing data on migration and HIV in Ghana. This literature review and empirical research will 1) highlight migration patterns and HIV disparities in Ghana 2) emphasize gaps in our knowledge of the complex association between migration and HIV transmission, and 3) reveal the limitations of standard cross- sectional data collection. Thus the second aim of this research is to design and implement a small-scale pilot survey of sexual networks, migration history, and HIV sexual risk behaviors. The PI will also determine the feasibility of collecting HIV biomarkers for HIV for future cross-discipline work. The third aim is to develop a mathematical model based on the network sample in order to quantify the impact of migration on the spread of HIV. This pilot modeling work will be the basis of an R01 application toward the end of the K99/R00 grant cycle. The support of a K99/R00 will enable the PI to engage in substantial public health training (MPH in epidemiology) as well as formal training in infectious disease modeling and social network theory and analysis. The PI has plans for an academic career in global health; therefore, this additional training and experience conducting research in an international setting will help ensure success in this endeavor. Past work has suggested that migrants exhibit riskier sexual behavior than non-migrants and have a higher risk of acquiring HIV; nonetheless, the mechanism in which migration may enhance HIV spread is unclear. This work hypothesizes that migration may significantly enhance HIV transmission because 1) migration changes the timing and sequence of partnership formation and duration which promotes concurrency, and 2) concurrency links individuals together to create large connected "components" in a network that allow a pathogen to travel rapidly and efficiently. Restricting people from moving is not a viable HIV prevention intervention, but messages of behavioral change (i.e. one partner at a time) and earlier antiretroviral therapy (ART) to reduce infectiousness for migrants are practical policies to prevent additional HIV infections.