Integrating spatial and non-spatial data to examine multilevel drivers of HIV risk among adolescent mothers in sub-Saharan Africa

项目摘要/摘要 撒哈拉以南非洲的艾滋病毒传播主要发生在年轻人(15-24岁)中 在微观流行地区(艾滋病毒高发区)。在青少年中，女孩占80% 在所有青少年艾滋病毒感染者(15-19岁)和青少年母亲(AM)中，艾滋病毒风险高于 没有父母教养的女孩。然而，由于在艾滋病毒预防研究中很大程度上忽视了AM， 关于在AM中发生微观流行病的地方以及如何进行结构性(例如城市化)和 影响青春期母亲艾滋病毒风险的相关艾滋病毒危险因素依然存在。此外，尽管AM的 关系配置，还没有研究考察关系因素的共同出现对AM的影响 使用类型学方法对艾滋病毒和无保护措施的性行为的脆弱性。此外，大多数关于AM的艾滋病毒研究 SSA使用单级方法来描述艾滋病毒风险，而不是结合了 空间(即结构性因素)和非空间(即关系类型、个人和家庭因素)风险 各种因素。这项探索性研究将使用修改后的社会生态框架来确定微观流行病，以及 描述影响AM的HIV风险的关系类型和多水平因素。具体目标是 以：1)描述SSA地区AM中艾滋病毒微流行的特征，2)确定AM的性关系类型， 3)评估多水平因素是否与AM的HIV风险和无保护性行为有关。至 为了达到这些目标，本研究将使用(1)基于人口的艾滋病毒影响评估的辅助数据 (PHIA)，其中包括2,879名AM(15-19岁)；和(2)可公开获得的结构级别数据，来自 将链接到PHIA群集级数据的各种来源。将采用多种定量分析方法 用于执行目标，包括空间和机器学习技术(目标1)、潜在类分析(目标2)、 和混合效果建模(目标3)。研究结果可能为AM的艾滋病毒预防干预提供有针对性的信息。 这项研究与NICHD的研究重点一致，通过检查高危人群中艾滋病毒的结构性风险因素 制定和联合国艾滋病规划署95-95-95目标。由国际和平协会制定的培训计划，赞助商菲利斯·L博士- Scherban和共同发起人Allison Groves博士和Alex Ezeh支持拟议的研究和PI的 培训目标是：1)获得社会流行病学理论框架方面的专门知识 青少年健康研究，2)发展机器学习和潜在类别分析的方法技能，以及 3)改进研究传播、交流和学术写作技巧。PI将利用以下资源 德雷克塞尔大学多恩西夫公共卫生学院，一家合作和多学科的机构， 将健康差距和全球研究放在首位。建议的研究、培训、机构和指导 团队将支持PI成为独立的社会流行病学家，专注于推动 在边缘化青少年群体中实现健康公平。

PROJECT SUMMARY/ABSTRACT HIV transmission in sub-Saharan Africa (SSA) occurs predominantly among young people (aged 15-24 years old) and within micro-epidemics (high HIV prevalence areas). Among adolescents, girls account for 80% of all adolescent HIV infections (15-19 years old) and adolescent mothers (AMs) are at higher HIV risk than non-parenting girls. However, as AMs have been largely overlooked in HIV prevention research, gaps in knowledge regarding where micro-epidemics occur among AMs and how structural (e.g., urbanization) and relational HIV risk factors impact adolescent mothers’ HIV risk remain. Further, despite differences in AMs’ relationship configurations, no studies have examined how the co-occurrence of relational factors impact AMs’ vulnerability to HIV and unprotected sex using a typological approach. Moreover, most HIV studies on AMs in SSA use a single-level approach to describe HIV risk as opposed to a multilevel framework that incorporates spatial (i.e., structural factors) and non-spatial (i.e., relationship typologies, individual and familial factors) risk factors. This exploratory study will use a modified social ecological framework to identify micro-epidemics, and to characterize relationship typologies and multilevel factors that impact AMs’ HIV risk. The specific aims are to: 1) characterize HIV micro-epidemics among AMs in SSA, 2) identify typologies of AMs’ sexual relationships, and 3) assess whether multilevel factors are associated with HIV risk and unprotected sex among AMs. To address these aims, this study will use (1) secondary data from the Population-based HIV Impact Assessment (PHIA), which includes 2,879 AMs (aged 15-19 years old); and (2) publicly available structural-level data, from various sources which will be linked to PHIA cluster-level data. Multiple quantitative analytic approaches will be used to execute aims, including spatial and machine learning techniques (Aim 1), latent class analysis (Aim 2), and mixed effects modeling (Aim 3). Study findings may inform targeted HIV prevention interventions for AMs. This study aligns with the NICHD’s research priorities by examining structural risk factors of HIV in a high-risk setting and the UNAIDS 95-95-95 goal. The training plan developed by the PI, sponsor Dr. Félice Lê- Scherban, and co-sponsors Drs. Allison Groves and Alex Ezeh, supports the proposed research and the PI’s training goals, which are to: 1) gain expertise in theoretical frameworks of social epidemiological and adolescent health research, 2) develop methodological skills in machine learning and latent class analysis, and 3) refine research dissemination, communication, and scholarly writing skills. The PI will leverage resources at Drexel University Dornsife School of Public Health, a collaborative and multidisciplinary institution that prioritizes health disparities and global research. The proposed research, training, institution, and mentorship team will support the PI’s pursuit of becoming an independent social epidemiologist focusing on advancing health equity among marginalized adolescent populations.