Linking Refugees to HIV Clinical Care in Uganda

项目总结 背景资料：估计有340万难民生活在撒哈拉以南非洲这一世界地区 那里收容了全球71%的艾滋病毒携带者。难民平均流离失所17年，是一种 由于暴力和迫害，易受艾滋病毒感染风险的弱势人群。在竞争中生存 需求、语言和文化障碍以及扰乱的社会网络，难民面临着独特的挑战 获得艾滋病毒护理。撒哈拉以南非洲难民定居点的艾滋病毒流行率通常是未知的，艾滋病毒 对这一人群的研究是有限的。应聘者：在我担任研究员期间，我主持了一个以诊所为基础的 乌干达Nakivale难民定居点的常规艾滋病毒检测研究表明，只有54%的新移民 被诊断为艾滋病毒感染的客户与护理联系起来。我正在申请K23职业发展奖，以获得 成为一名独立调查员的技能，专注于了解与难民艾滋病毒护理的联系 并制定干预措施，以提高对这一独特人口的护理参与度。指导：英格丽博士 巴西特(Mentor)是在资源有限的环境下与艾滋病毒护理联系的专家，也是哈佛大学 医学院青年导师奖。我还将得到共同导师保罗·斯皮格尔博士(代理)的指导 联合国人权事务高级专员方案支助和管理司司长 难民[联合国难民事务高级专员办事处]，难民健康结构方面的专家)，埃德加·穆罗戈博士(艾滋病毒研究员， 乌干达教员)和Laura Bogart博士(行为科学、艾滋病毒干预研究和 定性方法)。坚定的顾问包括理查德·莫利卡博士(哈佛项目主任 难民创伤)，Alexander Tsai博士(精神病学家，艾滋病毒心理社会干预研究专家- 乌干达感染者)，Julius Kasozi博士(难民署驻乌干达，难民健康和乌干达健康专家 政策)、Michael VanRooyen博士(哈佛人道主义倡议主任)、Norma Ware博士(定性 方法)和罗伯特·帕克博士(生物统计学，艾滋病毒试验设计)。研究：在社会-生态环境中 框架，我将1)使用定性的方法来了解艾滋病毒护理的障碍和克服的方法 在Nakivale为难民设置障碍；2)预期招募一群感染艾滋病毒的难民，以评估 在Nakivale，社会生态因素与未能与艾滋病毒护理挂钩有关；以及3)使用干预地图 开发、实施和评估试点干预措施以改善与艾滋病毒护理的联系的方法 纳基维尔。培训：该研究得到了健康行为理论和生态环境培训的支持 在资源有限的情况下进行艾滋病毒护理，深入关注精神健康，分析技术包括 调查和地理信息系统的方法，以及干预开发。该项目将提供 开发随机HIV连锁干预试验的R01应用所需的培训和试点数据 乌干达的三个难民定居点。我致力于评估干预措施，以改善对 难民，来自卓越指导团队的支持，强大的机构承诺，以及创新的 根据我的研究计划，我很有能力成为一名专注于难民健康的独立临床调查员。

PROJECT SUMMARY Background: There are an estimated 3.4 million refugees living in sub-Saharan Africa, a region of the world which hosts 71% of the global population living with HIV. Displaced for an average of 17 years, refugees are a vulnerable population at risk of exposure to HIV due to violence and persecution. With competing survival needs, language and cultural barriers, and disrupted social networks, refugees face unique challenges accessing HIV care. HIV prevalence in refugee settlements in sub-Saharan Africa is often unknown and HIV research in this population is limited. Candidate: During my research fellowship, I conducted a clinic-based routine HIV testing study in Nakivale Refugee Settlement in Uganda demonstrating that only 54% of newly diagnosed HIV-infected clients linked to care. I am applying for a K23 Career Development Award to acquire the skills to become an independent investigator focused on understanding linkage to HIV care for refugees and developing interventions to improve engagement in care for this unique population. Mentoring: Dr. Ingrid Bassett (Mentor) is an expert on linkage to HIV care in resource-limited settings and winner of the Harvard Medical School Young Mentor Award. I will also be guided by Co-Mentors, Dr. Paul Spiegel (the Deputy Director of the Division of Programme Support and Management at the United Nations High Commissioner for Refugees [UNCHR], expert in the structural dimensions of refugee health), Dr. Edgar Mulogo (HIV researcher, faculty in Uganda), and Dr. Laura Bogart (expert in behavioral science, HIV intervention research, and qualitative methods). Committed advisors include Dr. Richard Mollica (Director of the Harvard Program in Refugee Trauma), Dr. Alexander Tsai (psychiatrist, expert on psychosocial intervention research for HIV- infected people in Uganda), Dr. Julius Kasozi (UNHCR in Uganda, expert in refugee health and Uganda health policy), Dr. Michael VanRooyen (Director of the Harvard Humanitarian Initiative), Dr. Norma Ware (qualitative methods), and Dr. Robert Parker (biostatistics, HIV trial design). Research: Within the social-ecological framework, I will 1) use qualitative methods to understand barriers to HIV care and means to overcome barriers for refugees in Nakivale; 2) prospectively enroll a cohort of HIV-infected refugees to assess which social-ecological factors correlate with failure to link to HIV care in Nakivale; and 3) use intervention mapping methodology to develop, implement, and evaluate a pilot intervention to improve linkage to HIV care in Nakivale. Training: The research is supported by training in health behavior theory and ecologic context of HIV care in resource-limited settings with an in-depth focus on mental health, analytic techniques including survey and geographic information system methods, and intervention development. The project will provide training and pilot data needed to develop an R01 application for a randomized HIV linkage intervention trial in three refugee settlements in Uganda. With my dedication to evaluating interventions to improve care for refugees, support from an exceptional mentoring team, strong institutional commitment, and an innovative research plan, I am well-positioned to become an independent clinical investigator focused on refugee health.