Poverty, Mental Bandwidth, and an Unconditional Cash Transfer Intervention to Enable Health Behaviors for Pregnant People with HIV

项目总结 候选人：我是宾夕法尼亚大学传染病研究员，也是一名内科科学家 拥有公共卫生硕士学位，有5年在海地农村工作的经验。当我有一个强烈的 在贫困、粮食安全和传染病的交叉点上发表的研究的跟踪记录，我的 经验促使我从两个方面改变了我的研究。首先，我已经形成了对 贫困对决策的影响，包括贫困的心理影响理论，实证 这些影响的衡量标准，以及用来审查减贫对 健康行为和结果。第二，我计划从观测工作转向设计和 执行混合有效性-实施创新经济干预措施的临床试验，以改善 艾滋病毒的后果。背景：贫困是造成艾滋病毒短期和长期结果不佳的一个重要因素 针对携带艾滋病毒的孕妇(PrPWH)。这个问题在海地尤为突出，那里有25%的人生活在 极端贫困和只有一半的PrPWH在开始抗逆转录病毒治疗12个月后仍在接受护理。最近的研究 行为经济学已经表明，贫困会对精神负担造成更糟糕的健康结果。 因此，人们更加关注眼前的需求，而较少关注面向未来的决策。 艾滋病毒和围产期的额外负担可能会进一步加重精神带宽的负担。因此， 以PrPWH为目标的减贫干预措施在改善健康结果方面可能特别有效。 培训：为了实现研究的独立性，我需要在1)行为经济学和 健康行为的决策过程；2)进行和分析定性研究；以及 3)混合有效性--实施临床试验。导师：我的培训和研究计划将受到监督 Harsha Thirumurthy博士，他在开发和测试方面拥有丰富的指导经验和专业知识 改善艾滋病毒结果的经济干预措施。路易丝·艾弗斯博士(海地农村研究，定性设计)， 佛罗伦萨·蒙普莱尔(执行科学，定性设计，PrPWH)和希瑟·斯科菲尔德(心理 贫困中的带宽措施)将是额外的共同导师，Christophe Millien博士(海地PrPWH) 艾丽莎·斯蒂芬斯-希尔德(生物统计学)将担任顾问。研究：我将用3个目标来实现我的目标 评估一条关键途径--精神带宽--贫困(和现金转移用于消除贫困)的目标 贫困)可以影响海地农村PrPWH的健康行为：1)描述 精神带宽、艾滋病毒和围产期；2)确定无条件现金的关键特征 对PrPWH的转移干预；以及3)进行混合类型2有效性-实施 对PrPWH的无条件现金转移干预。这项研究将于#年在圣博尼法斯医院进行。 海地的布兰克斯湖。我将使用此K23的调查结果作为R01提案的基础，以进行 无条件现金转移的更大规模试验，有助于临床结果(例如，产后病毒抑制)。

PROJECT SUMMARY Candidate: I am a Fellow in Infectious Diseases at the University of Pennsylvania and a physician-scientist with a Master of Public Health degree and 5 years of experience working in rural Haiti. While I have a strong track record of published research at the intersection of poverty, food security, and infectious diseases, my experiences have motivated me to shift my research in two ways. First, I have developed an interest in poverty's effects on decision-making, including the theory of poverty's psychological impacts, the empirical measures of these impacts, and the scientific approaches used to examine the effects of poverty alleviation on health behaviors and outcomes. Second, I plan to move from observational work towards the design and execution of hybrid effectiveness-implementation clinical trials of innovative economic interventions to improve HIV outcomes. Background: Poverty is an important contributor to poor short- and long-term HIV outcomes for pregnant people with HIV (PrPWH). This problem is particularly salient in Haiti, where 25% of people live in extreme poverty and only half of PrPWH are retained in care 12 months after starting ART. Recent research in behavioral economics has shown that poverty can result in worse health outcomes by taxing mental bandwidth, resulting in a heightened focus on immediate needs and less attention to future-oriented decisions. Mental bandwidth is likely further taxed by the added burdens of HIV and the perinatal period. Consequently, anti-poverty interventions targeting PrPWH may be particularly effective at improving health outcomes. Training: To achieve research independence, I require additional training in 1) behavioral economics and the decision-making processes underlying health behaviors; 2) the conduct and analysis of qualitative studies; and 3) hybrid effectiveness-implementation clinical trials. Mentors: My training and research plans will be overseen by Dr. Harsha Thirumurthy, who has extensive mentoring experience and expertise in developing and testing economic interventions to improve HIV outcomes. Drs. Louise Ivers (research in rural Haiti, qualitative design), Florence Momplaisir (implementation science, qualitative design, PrPWH), and Heather Schofield (mental bandwidth measures in poverty) will be additional co-mentors, and Drs. Christophe Millien (PrPWH in Haiti) and Alisa Stephens-Shield (biostatistics) will be advisors. Research: I will use 3 aims to accomplish my objective of assessing a key pathway — mental bandwidth — by which poverty (and cash transfers to combat poverty) can affect health behaviors among PrPWH in rural Haiti: 1) Characterize the relationship between mental bandwidth, HIV, and the perinatal period; 2) Identify key characteristics of an unconditional cash transfer intervention for PrPWH; and 3) Conduct a Hybrid Type 2 effectiveness-implementation trial of an unconditional cash transfer intervention for PrPWH. This research will be conducted at St. Boniface Hospital in Fond-des-Blancs, Haiti. I will use the findings from this K23 as the basis for an R01 proposal to conduct a larger trial of an unconditional cash transfer powered for clinical outcomes (e.g., postpartum viral suppression).