Intimate partner violence and cardiovascular risk among adolescent girls living with HIV in Tanzania

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Project Summary: The goal of the parent grant of this supplement proposal is to strengthen patient- oriented HIV clinical investigation training for physician-scientists and other exceptional clinicians in Mwanza, in northwestern Tanzania. The program builds upon two decades of collaboration and capacity building by the partner institutions: Mwanza Intervention Trials Unit (MITU), which is a unit of Tanzania's National Institute for Medical Research (NIMR), the London School of Hygiene and Tropical Medicine (LSHTM), Weill Bugando School of Medicine, which is also located in Mwanza, and Weill Cornell Medical College. In the proposed research training supplement, Ms. Flora Madaha, the Fogarty D43 Master's trainee, will conduct a mentored research project exploring the association of intimate partner violence (IPV) and premature cardiovascular disease (CVD) risk factors among adolescent girls and young women (AGYW) living with HIV in rural Tanzania. Ms. Madaha is a social and behavioral scientist completing her Masters in Medical Sociology in Tanzania. Her career goal is to conduct research to understand the drivers of poor health among AGYW living with HIV in Tanzania and develop health interventions to improve long-term outcomes. Her objective in this research training proposal is to expand her training in violence research to apply this to a population of AGYW living with HIV and explore the impact of IPV on premature CVD and other chronic comorbidities across the life-course. Ms. Madaha's training plan includes building expertise in 3 key areas: 1) adolescent HIV epidemiology; 2) qualitative research, and 3) study design. In addition to intensive mentorship from her mentorship team, Drs. Okello, Downs, and Kapiga, she will complete Masters coursework at St. Augustine University of Tanzania in the executive program in Mwanza, and complete two intensive short-courses at LSHTM titled Gender and Violence: Methods and Meaning and HIV Epidemiology. Her career development plan includes participation and regular research-in-progress presentations in the MITU-Weill Cornell Fogarty Research Seminar. She will also submit the results of her research project at relevant national and international conferences. Ms. Madaha's research plan is to measure the prevalence and risk factors associated with experiencing any type of IPV (physical, sexual, or emotional) among 300 AGYW living with HIV ages 15-24 years. She will measure participants' past year and lifetime experience of IPV and factors associated including: 1) HIV-related outcomes (e.g. anti-retroviral therapy (ART) regimen and adherence, HIV viral load), 2) mental health (e.g. depression, anxiety, post-traumatic stress), and 3) chronic co-morbidities captured using the Life's Essential 8 score to formulate a composite score of health behaviors and clinical parameters associated with cardiovascular health. She will also conduct in-depth interviews to assess participants' attitudes, beliefs, and knowledge related to gender empowerment and violence prevention to inform future interventions.