Mentoring Clinical Investigators in Patient Oriented Research on Human Mobility and HIV

摘要 人口流动在推动艾滋病毒的获得和传播方面发挥着重要作用， 导致艾滋病毒护理级联结果不佳。来自大型临床试验的新证据表明， 对成功实施公认的艾滋病毒根除战略提出了重大挑战 例如普遍检测和治疗，因为它可以将地理上传播的流行病联系起来，导致 艾滋病毒进入社区，减少接触干预措施，并破坏艾滋病毒护理参与。目前迫切 需要更好地了解导致艾滋病毒感染差异的地理空间和时间方面的流动性 我们还需要采取可行和可扩展的干预措施，以改善移动的人口的艾滋病毒防治结果。然而， 这些领域的研究刚刚起步。非常需要扩大科学工作队伍， 人口流动性和艾滋病毒来应对这些挑战，特别是对医学界代表性不足的科学家来说。 Carol Camlin博士是妇产科和生殖科系的副教授 科学在加州大学，旧金山弗朗西斯科，和行为科学家与培训的社会 人口统计学她的跨学科研究计划主要集中在人类流动性和艾滋病毒的研究 预防和护理成果。在这份以病人为导向的中期职业研究者奖的申请中， 研究（K24），Camlin博士提出了一个全面的指导，研究和职业发展计划 这将推进减少因人口流动而导致的艾滋病毒结果全球差异的目标。 该提案的总体目标是：1）扩大Camlin博士的POR在人类流动性方面的范围 通过地理空间和社会网络建模方法的培训，2）奠定基础 开展高质量、大规模、理论驱动的干预措施，以改善艾滋病毒护理级联结果 在撒哈拉以南非洲的移动的艾滋病毒感染者中;和2）让研究员和初级教师参与新的 多学科方案审查，以推进非洲移动的人口艾滋病毒预防和治疗目标。 虽然K24为新的研究提供了有限的资源，但在支持和保护的时间内， 由K24提供，Camlin博士将能够利用她目前研究的现有基础设施：1） 确定肯尼亚和乌干达地区移动的人口和艾滋病毒“风险流”的地理空间网络（Aim 1）; 2）量化高度移动的人居住的起点和终点诊所之间的“距离衰减”， 艾滋病毒感染者（PLHIV）在环境中，并评估其对艾滋病毒护理参与的影响（目标2）;综合 利用实施科学框架在该领域的累积研究结果和新发展，以及 召集一个多学科专家小组，审查并优先考虑有希望的干预措施;并制定和 评估两种原型策略的潜在可行性、可接受性和适当性，以改善艾滋病毒 移动的艾滋病毒感染者的护理参与（目标3.）在K24的支持下，该项目奠定了基础， 持续开展高影响力的研究，以应对流动性对消除艾滋病毒工作构成的挑战。

ABSTRACT Human mobility plays a substantial role in driving the acquisition and transmission of HIV and contributing to poor HIV care cascade outcomes. New evidence from large clinical trials shows that mobility presents a major challenge to the successful implementation of well-recognized HIV eradication strategies such as universal testing and treatment, as it can link geographically-spread epidemics, lead to introductions of HIV into communities, reduce exposure to interventions, and disrupt HIV care engagement. There is an urgent need to better understand the geospatial and temporal dimensions of mobility that lead to disparities in HIV outcomes, and for feasible and scalable interventions to improve HIV outcomes in mobile populations. Yet, research in these areas is nascent. There is a great need for an expanded scientific workforce with training in human mobility and HIV to tackle these challenges, particularly for scientists under-represented in medicine. Dr. Carol Camlin an Associate Professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of California, San Francisco, and a behavioral scientist with training in social demography. Her cross-disciplinary research program has focused on the study of human mobility and HIV prevention and care outcomes. In this application for the Midcareer Investigator Award in Patient-Oriented Research (K24), Dr. Camlin proposes a comprehensive mentoring, research and career development plan which will advance the goal to reduce global disparities in HIV outcomes that result from human mobility. The overall goals of this proposal are to: 1) Expand the scope of Dr. Camlin's POR in human mobility and HIV through pursuit of training in geospatial and social network modeling methods, 2) Lay the groundwork for conducting high-quality, large-scale, theory driven interventions to improve HIV care cascade outcomes among mobile PLHIV in SSA; and 2) Engage fellows and junior faculty in the development of new multidisciplinary POR to advance HIV prevention and treatment goals among mobile populations in Africa. While the K24 provides limited resources for new research, with the support and protected time provided by the K24, Dr. Camlin will be able to leverage the existing infrastructure of her current studies to: 1) identify the geospatial networks of mobile populations and HIV “risk flows” in areas of Kenya and Uganda (Aim 1); 2) quantify the `distance decay' between clinics in origins and destinations of highly mobile persons living with HIV (PLHIV) in the settings, and assess its influence on HIV care engagement (Aim 2); synthesize cumulative findings and new developments in the field using an implementation science framework, and convene a multidisciplinary panel of experts to review and prioritize promising interventions; and develop and evaluate the potential feasibility, acceptability and appropriateness of two prototype strategies to improve HIV care engagement among mobile PLHIV (Aim 3.) With K24 support, this project lays the groundwork for sustained high impact research to address the challenges posed by mobility to efforts to eradicate HIV.