Strengthening Families Living with HIV in Kenya

项目摘要/摘要 艾滋病毒是一种具有生物医学影响的社会疾病，对家庭和社区造成严重破坏。 超越了仅在诊所就能解决的问题。大部分研究和干预资金都用于 用于临床护理以抑制病毒传播。行为、社会、经济和心理 全球筹资优先事项在很大程度上没有涉及艾滋病毒进展的后果和决定因素。 携带艾滋病毒的家庭经历了更多的暴力、贫困、食品不安全、功能障碍、社会排斥和街头- 与非艾滋病毒携带者家庭相比，他们的子女更容易迁徙。需要进行研究才能确定 最有效、低成本和可扩展的机制，以解决临床上未解决的各种因素 关心。该项目对我们的干预措施Kuja Pamoja(“走到一起”)进行了调整，以增强与 爱滋病毒。我们在肯尼亚农村更广泛的人口中开发了Kuja Pamoja，以防止 儿童和支持前街头儿童重新融入社区。Kuja Pamoja-HIV将利用一组- 发展社会资本的储蓄模式(如信任、互惠期望和规范影响力)。 然后利用积累的社会资本来应对广泛的决定因素(例如经济和粮食 不安全、家庭暴力和功能障碍、社会排斥和艺术坚持)、心理健康(例如减少 抑郁、焦虑和创伤后应激障碍)和行为健康(例如，改善对护理和艺术的保留 坚持)。在感染艾滋病毒的家庭中，我们的目标是改善精神健康和病毒抑制 感染艾滋病毒的青少年和成年人。该项目将开发一种新的护理模式，可以在低收入人群中推广 环境和改善与艾滋病毒有关的成果。如果成功，该模型将提供一个改善健康的模板 其他领域的护理提供和成果--例如妇幼保健、慢性病状况和 肺结核。 这个项目也有助于我的职业发展。久负盛名的导师团队和 辅导员将通过指导我完成课程、阅读、会议和其他工作来促进我的职业生涯 专业研究网络的来源，以确保我获得基本的研究技能、心理健康和 临床知识，以及对健康决定因素的更好理解。具体地说，我将经历 在实施科学、干预地图、心理健康、改善干预方面的指导课程工作 经济和粮食安全，以及在统计分析和流行病学研究设计方面的高级技能。我 将与NIH资助的知名研究人员会面。通过这些活动，我将获得导师和 正规的资助人培训、纵向数据分析、队列保留、干预措施的发展和 绘图、实施科学和提高对家庭暴力和心理健康的理解。这个 职业发展部分加上研究项目将导致具有竞争力的R01的发展 申请。

PROJECT SUMMARY/ABSTRACT HIV is a social disease with biomedical implications, wreaking havoc on families and communities far beyond what can be addressed in clinics alone. The majority of research and intervention funding goes towards clinical care to suppress viral transmission. Behavioral, social, economic and psychological consequences and determinants of HIV progression go largely unaddressed in global funding priorities. Families with HIV experience more violence, poverty, food insecurity, dysfunction, social exclusion and street- migration by their children than families who are not living with HIV. Research is required to determine the most effective, low-cost and scalable mechanisms to address the wide range of factors unaddressed by clinical care. This project adapts our intervention, Kuja Pamoja (“Come Together”), to empower families living with HIV. We developed Kuja Pamoja in the broader population in rural Kenya to prevent street-migration of children and support community reintegration of former street children. Kuja Pamoja-HIV will utilize a group- savings model to develop social capital (e.g. trust, expectations of mutual benefit and normative influence). Accrued social capital is then leveraged to address a wide range of determinants (e.g. economic and food insecurity, family violence and dysfunction, social exclusion, and ART adherence), mental health (e.g. reduce depression, anxiety and post-traumatic stress), and behavioral health (e.g. improved retention in care and ART adherence). Among families living with HIV, we aim to improve mental health and viral suppression among adolescents and adults with HIV. The project will develop a new care model that can scale across low-income settings and improve HIV-related outcomes. If successful, the model will provide a template to improve health care delivery and outcomes in other areas – e.g. Maternal/child health, chronic disease conditions, and tuberculosis. The project also contributes to my career development. A well-established team of mentors and advisors will serve to advance my career by guiding me through coursework, reading, conferences, and other sources of professional research networking to ensure that I gain essential research skills, mental health and clinical knowledge, and improved understanding of the determinants of health. Specifically, I will undergo mentored coursework in implementation science, intervention mapping, mental health, interventions to improve economic and food security, and advanced skills in statistical analysis and epidemiological research design. I will meet with established researchers with NIH funding. Through these activities, I will receive mentorship and formal training in grantsmanship, longitudinal data analysis, cohort retention, intervention development and mapping, implementation science and improved comprehension of family violence and mental health. The career development portion plus the research project will lead to the development of a competitive R01 application.