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Microenterprise to empower and improve health of HIV+ women in Uganda

微型企业为乌干达艾滋病毒妇女赋权并改善她们的健康

基本信息

批准号：
9096240
负责人：
ALEXANDER C TSAI
金额：
$ 18.37万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9096240
关键词：
AIDS/HIV problem Address Adherence Advocate Affect Africa South of the Sahara Age Applications Grants Award Behavior Behavioral Sciences Cause of Death Charge Clinic Complement Data Decision Making Development Disease Domestic Fowls Economics Effectiveness Evaluation Research Food Funding Gender Goals Grant HIV HIV antiretroviral Health Health Services Research Health behavior Health behavior outcomes Healthcare Home environment Household Improve Access Inequality Intervention Intervention Studies Lead Life Link Measures Mediating Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Mission Nature Outcome Peer Review Personal Satisfaction Persons Physical Function Population Positioning Attribute Poverty Psychiatry Public Health Qualitative Research Randomized Research Research Infrastructure Research Personnel Research Support Resources Rural Self Efficacy Testing Theoretical model Time Training Transportation Treatment outcome Uganda United States National Institutes of Health Woman Women&apos s Health antiretroviral therapy base career effective intervention empowered empowerment food security gender disparity global health improved innovation journal article men poverty alleviation programs reproductive research study restoration scale up skills theories treatment adherence

项目摘要

DESCRIPTION (provided by applicant): The adverse impacts of HIV/AIDS worldwide are concentrated among women and among the poor. Although treatment scale-up has improved access to HIV antiretroviral therapy in resource-limited settings, the primary barriers to sustained treatment adherence and fully optimized health outcomes are structural in nature: even when treatment is provided free of charge, structural barriers such as food insecurity and inability to pay for transportation to clinic remain the Achilles' heel of treatment in resource-limited settings. Furthermore, although HIV antiretroviral therapy can lead to rapid restoration of physical function, HIV treatment alone is insufficient to reverse the economic decline and household asset depletion that have typically occurred by the time people enter treatment. Economic interventions including microfinance have increasingly been promoted for poverty alleviation, and key multilateral organizations have advocated for interventions to address economic inequalities between men and women to alleviate HIV-related gender disparities. However, there is currently little evidence to support widespread implementation of economic interventions among women, much less HIV+ women, or to elucidate the specific mechanisms through which these interventions improve health behaviors or HIV outcomes. My long-term career goal is to become an independent investigator with expertise in understanding how economic interventions affect HIV+ women's empowerment, health behaviors, and health outcomes. In order to achieve research independence I need additional mentorship and training in gender studies, behavioral science theory, qualitative research, and global health intervention research. I will draw upon this training and leverage the resources of my primary mentor's extensive research infrastructure in Mbarara, Uganda to accomplish my scientific objective: to develop and evaluate the effectiveness of a poultry microenterprise intervention to improve HIV+ women's health-related behaviors and health outcomes. The poultry microenterprise program (but not a formal research evaluation, which is proposed here) is funded by my primary mentor through a grant from a philanthropic program, indicating a high level of institutional commitment. My central hypothesis, supported by preliminary data, is that the intervention will cause improvements in health-related behaviors, and that these effects will be mediated by positive changes in economic well-being and women's empowerment. I will test my central hypothesis by pursuing 3 specific aims: (1) use qualitative research to elaborate a theoretical model about how economic gains improve women's health; (2) develop and validate a scale to measure women's empowerment; and (3) pilot test the preliminary effects of a poultry microenterprise intervention on economic well-being, food security, women's empowerment, HIV treatment adherence, and HIV outcomes. I am well-positioned to accomplish these aims, given my five first-author peer-reviewed articles directly related to the content of the proposed K23 award. I will also draw on the expertise of an internationally-renowned mentoring committee of experts in HIV, women's health, behavioral science, qualitative research, and economics while creating my own distinct research trajectory. My approach is innovative in its use of mixed methods to test theoretically-driven hypotheses about the extent to which poultry microenterprise empowers HIV+ women and enables them to engage in desired health behaviors. The proposed research is significant because it is expected to lead to the development of a unique class of interventions to improve the health of millions of HIV+ women in resource-limited settings.

说明(申请人提供)：艾滋病毒/艾滋病在世界范围内的不利影响集中在妇女和穷人中。虽然扩大治疗规模改善了在资源有限的情况下获得艾滋病毒抗逆转录病毒治疗的机会，但持续坚持治疗和充分优化健康结果的主要障碍本质上是结构性的：即使免费提供治疗，粮食不安全和无法支付送往诊所的交通费等结构性障碍仍然是资源有限情况下治疗的致命弱点。此外，尽管艾滋病毒抗逆转录病毒治疗可以导致迅速恢复仅靠艾滋病毒治疗不足以扭转人们在接受治疗时通常出现的经济衰退和家庭资产枯竭的情况。包括小额供资在内的经济干预措施越来越多地用于减贫，一些重要的多边组织主张采取干预措施，解决男女之间的经济不平等问题，以减轻与艾滋病毒有关的性别差距。然而，目前几乎没有证据支持在妇女中广泛实施经济干预措施，更不用说艾滋病毒+妇女了，也没有证据表明这些干预措施改善健康行为或艾滋病毒结果的具体机制。我的长期职业目标是成为一名独立的调查员，在了解经济干预如何影响艾滋病毒+妇女的赋权、健康行为和健康结果方面具有专业知识。为了实现研究的独立性，我需要在性别研究、行为科学理论、定性研究和全球健康干预研究方面提供额外的指导和培训。我将利用这一培训，并利用我的主要导师在乌干达姆巴拉拉的广泛研究基础设施的资源来实现我的科学目标：开发和评估家禽微型企业干预的有效性，以改善艾滋病毒+妇女的健康相关行为和健康结果。家禽微型企业项目(但不是正式的研究评估，这里建议)是由我的主要导师通过一个慈善项目的赠款资助的，这表明了高水平的机构承诺。我的中心假设得到了初步数据的支持，即干预将导致健康相关行为的改善，这些影响将通过经济福祉和妇女赋权方面的积极变化来实现。我将通过追求三个具体目标来检验我的中心假设：(1)使用定性研究来阐述关于经济收益如何改善妇女健康的理论模型；(2)开发并验证衡量妇女赋权的量表；以及(3)初步测试家禽微型企业干预对经济福祉、粮食安全、妇女赋权、艾滋病毒治疗依从性和艾滋病毒结果的初步影响。考虑到我的五篇第一作者同行评议的文章直接与拟议的K23奖的内容相关，我有能力实现这些目标。我还将借鉴国际知名的艾滋病毒、妇女健康、行为科学、定性研究和经济学专家指导委员会的专业知识，同时创建自己独特的研究轨迹。我的方法是创新的，它使用混合方法来测试理论驱动的假说，这些假说是关于家禽微型企业赋予HIV+妇女权力并使她们能够从事期望的健康行为的程度。拟议的研究具有重要意义，因为预计它将导致制定一类独特的干预措施，以改善资源有限环境中数百万艾滋病毒+妇女的健康。