Linking Refugees to HIV Clinical Care in Uganda

将难民与乌干达的艾滋病毒临床护理联系起来

• 批准号: 10058757
• 负责人: Kelli Nicole O'Laughlin
• 金额: $ 7.2万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-20 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10058757
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Africa South of the Sahara; Authorization documentation; Award; Behavioral Sciences; Biometry; Caring; Client; Clinic; Clinical Investigator; Clinical Research; Collaborations; Complex; Consumption; Country; Cultural Sensitivity; Data; Dedications; Dimensions; Enrollment; Environment; Epidemic; Exposure to; Face; Faculty; Failure; Fellowship; Foundations; Geographic Information Systems; Global Positioning System; Goals; HIV; HIV Infections; HIV diagnosis; Health; Health Policy; Health Services Accessibility; Health behavior; Healthcare; Home environment; Human; Human immunodeficiency virus test; Individual; Interdisciplinary Study; Intervention; Intervention Studies; Intervention Trial; K-Series Research Career Programs; Knowledge; Language; Link; Mental Health; Mental disorders; Mentors; Methodology; Newly Diagnosed; Politics; Population; Populations at Risk; Positioning Attribute; Prevalence; Psychiatrist; Publishing; Qualitative Methods; Randomized; Refugees; Research; Research Methodology; Research Personnel; Research Training; Resources; Risk; Rural; Secondary to; Services; Site; Social Network; Social support; Structure; Surveys; Techniques; Training; Training Support; Trauma; Uganda; United Nations; Violence; Vulnerable Populations; Walking; Work; World Health Organization; analytical method; base; clinical care; cohort; design; experience; health service use; improved; innovation; medical schools; method development; programs; prospective; psychosocial; randomized trial; remote location; skills; social; successful intervention; theories; therapy development; tool; trial design

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.

项目摘要 背景：估计有340万难民生活在撒哈拉以南非洲，这是世界上一个 全球71%的艾滋病毒携带者都在这里难民平均流离失所17年， 由于暴力和迫害，弱势群体面临感染艾滋病毒的风险。竞争生存 需要、语言和文化障碍以及社交网络中断，难民面临着独特的挑战 获得艾滋病护理。撒哈拉以南非洲难民定居点的艾滋病毒流行率往往不为人知， 对这一人群的研究有限。候选人：在我的研究奖学金期间，我进行了一项基于临床的 在乌干达Nakivale难民安置点进行的常规艾滋病毒检测研究表明， 被诊断为艾滋病毒感染者与护理有关。我正在申请K23职业发展奖， 成为独立调查员的技能，重点是了解难民艾滋病毒护理的联系 并制定干预措施，以改善对这一独特人群的护理。导师：Ingrid博士 巴塞特（导师）是在资源有限的环境中与艾滋病毒护理联系的专家，赢家哈佛 医学院青年导师奖。我还将由共同导师Paul Spiegel博士（副 联合国难民事务高级专员办事处方案支助和管理司司长 难民署，难民健康结构方面专家）、埃德加穆洛戈博士（艾滋病毒研究员， 教师在乌干达），和博士劳拉博加特（专家在行为科学，艾滋病毒干预研究， 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），亚历山大蔡博士（精神病学家，艾滋病毒心理社会干预研究专家， Julius Kasozi博士（难民署驻乌干达办事处，难民保健和乌干达保健专家 Michael VanRooyen博士（哈佛人道主义倡议主任）、Norma Ware博士（定性 方法）和Robert帕克博士（生物统计学，HIV试验设计）。研究：社会生态学 框架，我将1）使用定性方法来了解艾滋病毒护理的障碍和克服的方法 2）前瞻性地招募一批艾滋病毒感染的难民，以评估 社会-生态因素与纳基瓦莱艾滋病毒护理失败有关; 3）使用干预绘图 制定、实施和评估试点干预措施的方法，以改善与艾滋病毒护理的联系， 纳基瓦尔培训：本研究得到了健康行为理论和生态环境培训的支持， 在资源有限的环境中提供艾滋病毒护理，深入关注心理健康，分析技术包括 调查和地理信息系统方法以及干预措施的开发。该项目将提供 开发R 01应用程序以进行随机HIV关联干预试验所需的培训和试点数据， 乌干达的三个难民营。我致力于评估干预措施，以改善护理， 难民，从一个特殊的辅导团队的支持，强大的机构承诺，以及创新的 根据研究计划，我有能力成为一名专注于难民健康的独立临床调查员。

项目成果

Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda.

难民中家庭艾滋病毒检测的可行性和可接受性：乌干达西南部纳基瓦莱难民安置点的试点研究。

• DOI: 10.1186/s12879-018-3238-y
• 发表时间: 2018
• 期刊: BMC infectious diseases
• 影响因子: 3.7
• 作者: O'Laughlin,KelliN;He,Wei;Greenwald,KelsyE;Kasozi,Julius;Chang,Yuchiao;Mulogo,Edgar;Faustin,ZikamaM;Njogu,Patterson;Walensky,RochelleP;Bassett,IngridV
• 通讯作者: Bassett,IngridV

A cohort study to assess a communication intervention to improve linkage to HIV care in Nakivale Refugee Settlement, Uganda.

• DOI: 10.1080/17441692.2020.1847310
• 发表时间: 2021-12
• 期刊: Global public health
• 影响因子: 3.3
• 作者: O'Laughlin KN;Xu A;Greenwald KE;Kasozi J;Parker RA;Bustamante N;Parmar P;Faustin ZM;Walensky RP;Bassett IV
• 通讯作者: Bassett IV

A systematic review evaluating HIV prevalence among conflict-affected populations, 2005-2020.

• DOI: 10.24875/aidsrev.200001311
• 发表时间: 2021-06-02
• 期刊: AIDS REVIEWS
• 影响因子: 2.2
• 作者: Mishra, Divya;O'Laughlin, Kelli;Spiegel, Paul
• 通讯作者: Spiegel, Paul

Predictors of HIV infection: a prospective HIV screening study in a Ugandan refugee settlement.

• DOI: 10.1186/s12879-016-2021-1
• 发表时间: 2016-11-23
• 期刊: BMC infectious diseases
• 影响因子: 3.7
• 作者: O'Laughlin KN;Rabideau DJ;Kasozi J;Parker RA;Bustamante ND;Faustin ZM;Greenwald KE;Walensky RP;Bassett IV
• 通讯作者: Bassett IV

A qualitative approach to understand antiretroviral therapy (ART) adherence for refugees living in Nakivale Refugee Settlement in Uganda.

• DOI: 10.1186/s13031-018-0145-1
• 发表时间: 2018
• 期刊: Conflict and health
• 影响因子: 3.6
• 作者: O'Laughlin KN;Rouhani SA;Kasozi J;Greenwald KE;Perkons NR;Faustin ZM;Bassett IV;Ware NC
• 通讯作者: Ware NC