The Impact of Mobility on HIV Care in New York City and the Dominican Republic

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DESCRIPTION (provided by applicant): The candidate is an instructor in infectious diseases at Columbia University Medical Center (CUMC), and her long-term goal is to become an independent investigator studying the interaction between social and structural factors and HIV treatment outcomes in international and domestic Latino communities. Her short-term goals are to expand her experience in international research, refine her skills in biostatistical methods, and further the understanding of the interaction between mobility and HIV care outcomes in mobile communities. She has an extensive track record of basic science and clinical research, and has been building the framework for this project in the Dominican Republic (DR) for the past four years. CUMC sits at one end of the New York-Dominican Republic air-bridge, a pattern of circular migration between the two countries. Our goal is to understand the interactions between mobility and HIV treatment amongst Dominicans in our own HIV treatment center in Washington Heights, New York (WH), and in Santo Domingo (SD), DR. Our primary hypothesis is that individual mobility leads to interruptions in antiretroviral therapy, and, in turn, to antiretroviral treatment failure. We will undertake a qualitative assessment of mobility using comparative ethnography in the Dominican patient population at both sites (WH and SD), and use that knowledge to develop a community-appropriate and evidence based measure of mobility. We will then conduct case-control studies to assess mobility as a predictor of treatment failure at both sites. We will also examine differences in those failing with and without antiretroviral drug resistance. This research will take place at CUMC and collaborating institutions in the DR with the mentorship of Dr. Scott Hammer, an internationally recognized HIV investigator. Dr. Jennifer Hirsch, a specialist in HIV and migration, and Dr. Louise Kuhn, an expert in HIV treatment outcomes in resource-limited settings. CUMC serves the largest community of Dominicans outside of the DR, and the collaborating institutions in the DR have long histories of successful clinical research and existing research initiatives with CUMC. RELEVANCE: By using multidisciplinary techniques to examine the interaction between mobility and HIV treatment outcomes on both sides of the New York-Dominican Republic airbridge, the researchers will generate novel findings of significance to both countries and to other regions where circular migration is common. The research may also be relevant to the impact of mobility on treatment outcomes of other chronic illnesses.