Population mobility and retention in HIV care among postpartum women in South Africa

 描述(由申请人提供)：拟议的4年职业发展奖将结合指导、培训和研究活动，使我能够发展成为艾滋病毒实施科学领域的独立调查员所需的技能。在这个K奖的最后几年，我将提交一份竞争性的R01申请，以设计和实施一项干预措施，以留住艾滋病毒阳性的产后妇女。我之前的工作发现，南非艾滋病毒阳性孕妇在分娩后不久就退出护理的风险特别高，但还需要进一步的研究，以开发有针对性的、有效的 改善护理连续性的干预措施。我的研究试图解决的关键悬而未决的问题是，缺乏关于这一人群中流动性特征的信息，以及人口流动性对产后艾滋病毒护理中留存的影响。与K相关的培训计划是我职业发展计划的重要组成部分，包括导师会议、教学课程、定向阅读和讨论、研讨会和专业协会会议。作为一名流行病学家，我在定量分析方面能力很强，但我需要在社会和行为理论、选定的定性研究方法和地理信息系统(GIS)方面的额外培训，以解决将为未来干预提供信息的现有研究问题。我的K支持的研究计划有3个目标：1)利用现有的数据库确定“诊所购物”的频率，并确定与诊所转换相关的因素；2)描述孕妇和产后艾滋病毒阳性妇女的流动性和卫生保健利用情况；3)确定流动性对艾滋病毒护理的保留和对抗逆转录病毒治疗的坚持的影响。项目活动将在南非约翰内斯堡进行，为目标1利用现有的艾滋病毒诊所数据，为目标2和目标3利用初级保健诊所维特科本保健和福利中心收集的基本数据。相关性：我的工作解决了与人口流动和在艾滋病毒护理中保留艾滋病毒护理有关的重大知识差距，这些人群是艾滋病毒护理退出风险最高的特定人群(围产期妇女)。消除这些差距将加快创建新的干预措施，以改善对非洲妇女的持续护理。我的项目目标和培训目标一致，使我能够在经验丰富的指导委员会的指导下，发展成为一名独立调查员的技能和经验。

 DESCRIPTION (provided by applicant): The proposed 4-year career development award will combine mentorship, training and research activities to enable me to develop the skills necessary to become an independent investigator in the field of HIV implementation science. In the latter years of this K award, I will submit a competitive R01 application to design and conduct an intervention to retain HIV-positive, postpartum women in care. My prior work found that pregnant HIV-positive women in South Africa are at particularly high risk of dropping out of care soon after delivery, but additional research is needed in order to develop targeted, effective interventions to improve continuity of care. Key unresolved questions that my research seeks to address are the lack of information about the characteristics of mobility within this population and the impact of population mobility on retention in postpartum HIV care. The K-related training program is a critical component of my career development plan, and includes mentorship meetings, didactic coursework, directed readings and discussions, seminars, and professional society meetings. As an epidemiologist, I am highly competent in quantitative analysis, but I require additional training in social and behavioral theory, selected qualitative research methods and geographic information systems (GIS) in order to address existing research questions that will inform future interventions. My K-supported research proposal has 3 AIMS: 1) to determine the frequency of "clinic shopping" and identify factors associated with clinic switching using existing databases; 2) to characterize mobility and health care utilization among pregnant and postpartum HIV-positive women; and 3) to determine the effect of mobility on retention in HIV care and adherence to ART. Project activities will take place in Johannesburg, South Africa, using existing HIV clinic data for Aim 1 and primary data collection at Witkoppen Health and Welfare Centre, a primary care clinic, for Aims 2 and 3. RELEVANCE: My work addresses a substantial knowledge gap related to population mobility and retention in HIV care among a specific population (peripartum women) at highest risk of dropping out of HIV care. Addressing these gaps will accelerate the creation of novel interventions to improve continuity of care for women in Africa. My project aims and training objectives align to enable me to develop the skills and experience to become an independent investigator with the guidance of my highly experienced mentorship committee.