HIV Treatment Interruptions Among Labor Migrants in South Africa

描述（由申请人提供）：虽然全球艾滋病毒/艾滋病流行病给撒哈拉以南非洲的社会和经济边缘化人口造成了不成比例的负担，但艾滋病毒治疗的扩大大大改善了所有人获得抗逆转录病毒治疗的机会。然而，为了降低ART的发病率和死亡率，坚持治疗是必不可少的。在免费提供抗逆转录病毒治疗的情况下，边缘化人群坚持接受治疗的最大障碍仍然是结构性的：前往诊所的交通费用、粮食不安全、无家可归和机会成本。这些结构性因素导致移徙者的治疗中断的程度甚至超过其固定对象，因为移徙者的流动性和不正常就业使得收入、交通、食品、住房和接近医疗保健更加不确定。因此，移民面临抗逆转录病毒治疗中断的风险非常高。治疗中断对移徙人口的公共卫生影响很大，因为由于治疗中断和移徙的结合，移徙者可能在很大程度上助长艾滋病毒的传播和抗逆转录病毒耐药性。尽管大量文献探讨了抗逆转录病毒治疗依从性的结构性障碍，但很少有研究关注治疗中断，特别是在劳动力流动人口中。我的长期职业目标是成为一名独立的医师调查员，将临床医学、人类学和公共卫生结合起来，了解和解决撒哈拉以南非洲艾滋病毒流行的结构（社会、经济和政治）复杂性。作为一名人类学博士候选人，我需要公共卫生方面的额外指导和培训，以帮助我制定跨学科的研究方法。我的三年培训计划将包括课程作业、有监督的实地研究和数据分析、手稿写作、出席专业会议并在会上发表演讲。我将利用这次培训和我的项目共同赞助者在撒哈拉以南非洲开展抗逆转录病毒治疗依从性相关研究的专业知识来实现我的科学目标：对南非感染艾滋病毒的劳工移民特有的抗逆转录病毒治疗中断的原因有更深入的了解。为了追求这个

DESCRIPTION (provided by applicant): While the global HIV/AIDS epidemic has disproportionately burdened socially and economically marginalized populations in sub-Saharan Africa, HIV treatment scale-up has dramatically improved access to antiretroviral therapy (ART) for all. Nonetheless, for ART to decrease morbidity and mortality, sustained treatment adherence is essential. When ART is provided free of charge, the greatest barriers to treatment adherence for marginalized populations remain structural: cost of transportation to clinic, food insecurity, homelessness, and opportunity costs. Such structural factors lead to treatment interruptions for migrants even more than for their stationary counterparts because migrants' mobility and irregular employment make income, transportation, food, housing, and proximity to health care even more uncertain. Thus, migrants are at very high risk for ART treatment interruptions. The public health ramifications of treatment interruptions in migrant populations are substantial because migrants may contribute significantly to the spread of HIV and antiretroviral drug resistance because of the combination of interruptions and migration. Though a large body of literature explores structural barriers to ART treatment adherence, few studies have focused on treatment interruptions specifically in labor migrant populations. My long-term career goal is to become an independent physician-investigator who brings together clinical medicine, anthropology, and public health to understand and address the structural (social, economic, and political) complexities of the HIV epidemic in sub-Saharan Africa. As an MD-PhD candidate in anthropology, I need additional mentorship and training in public health to help me craft an interdisciplinary research approach. My three-year Training Plan will include coursework, supervised field research and data analysis, manuscript writing, and attendance and presentations at professional meetings. I will utilize this training and my Project Co-Sponsors' expertise on conducting ART adherence-related research in sub-Saharan Africa to accomplish my scientific objective: to acquire a more robust understanding of reasons for ART treatment interruptions specific to HIV-infected labor migrants in South Africa. In pursuit of this objective, I will seek to achieve two specific aims: (1) characterize reasons for ART treatment interruptions among HIV-infected labor migrants in South Africa using qualitative research methods and (2) develop a conceptual model for how structural factors lead to treatment interruptions in this migrant population. South Africa is an ideal setting for this research becaus it has more HIV-infected citizens than any other country, and many of its citizens are either labor migrants or family/household-members of labor migrants. The proposed research is innovative because it targets an understudied population both at high risk for ART treatment interruptions and integral to the spread of HIV. It is significant because it has the potential to inform future interventions and health policies by providing a more comprehensive understanding of the structural factors driving ART treatment interruptions among labor migrants. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because it aims to inform interventions that will prevent HIV ART treatment interruptions and thereby reduce morbidity, mortality, and antiretroviral drug resistance. Understanding how structural factors lead to to ART treatment interruptions will help identify strategic points of intervention o promote treatment adherence and thereby optimize health outcomes. The proposed research is relevant to the mission of the NIH as laid out in the FY 2012 Trans-NIH Plan for HIV-Related Research in that it aims to identify community and systems-level factors that promote treatment adherence in a disproportionately infected population (South African labor migrants) and more specifically, in that it investigates what factors facilitate and impede seasonal labor migrants' engagement in HIV treatment.