Promoting Diversity, Equity, and Inclusivity in Research Training to Optimize HIV Prevention and Treatment

摘要 图尔卡纳县位于肯尼亚西北部。它是47个县中第二大县，人口 约100万人 。图尔卡纳人主要是半游牧民族，经常迁徙寻找水源， 食物和牧草。因此，他们的受教育机会有限，贫困程度高，食物匮乏。 不安全感。早婚、一夫多妻制和性别不平等等社会文化习俗进一步限制了 为女孩提供教育机会。肯尼亚的田园社区代表着被边缘化的人口 存在健康差距，健康素养、获得和可获得卫生服务的机会有限。健康状况 图尔卡纳县的提供者继续教育和研究的机会有限，而且 在肯尼亚的生物医学、临床、行为和社会科学研究中代表性不足。 2018年肯尼亚基于人口的艾滋病毒影响评估报告称，图尔卡纳县的艾滋病毒流行率 6.8%，高于全国4.9%的患病率。图尔卡纳县是肯尼亚 没有走上实现艾滋病规划署95-95-95目标的轨道。在图尔卡纳县，只有62%的艾滋病毒携带者 (PLWH)知道自己的状态，89%的人正在接受ART，40%的人在 2018年。《2021年肯尼亚艾滋病毒进展报告》指出，图尔卡纳县的女童数量位居第二 18岁以下从事商业性工作的年轻人和注射毒品的年轻人， 使他们感染艾滋病毒的风险增加。因此，艾滋病毒是图尔卡纳县的主要死亡原因。 这凸显了研究的必要性，以确定导致低吸毒率艾滋病毒预防干预措施的因素。 以及坚持对PLWH的治疗。 此补充剂应用程序旨在促进来自以下地区的卫生服务提供者的多样性、公平性和包容性 图尔卡纳县通过在研究方法和支持方面培训不同的卫生提供者群体进行研究 他们进行有指导的研究项目，以满足当地的卫生需求并优化艾滋病毒预防， 图尔卡纳县PLWH的诊断和治疗。 1.在目标1中，我们将在图尔卡纳县建设6个有前途的保健提供者开展艾滋病毒工作的能力 通过提供面对面和虚拟的研究培训和高质量的指导来进行研究。在目标2中，我们 将建设以图尔卡纳县为基地的卫生提供者的能力，以传播其结果 研究成果。在目标3中，我们将为图尔卡纳县的60个不同的医疗服务提供者提供机会 通过已建立的华盛顿大学电子学习平台获取研究技能，以增强 进行与当地相关的研究的能力。 据我们所知，这是第一笔针对图尔卡纳县的培训拨款，图尔卡纳县是一个高度 不成比例地受到艾滋病毒影响的边缘化人口。投资培训卫生服务提供者 在图尔卡纳的研究将在研究的保留和相关性以及获得的研究技能方面有所裨益 将被用来直接造福这一地区。留在图尔卡纳的学员将能够指导其他学员 来自该地区，放大了这一培训计划的影响。此外，利用电子学习平台是 效率高，不会将必要的卫生保健提供者从执业岗位上移除，并允许更大和更大的 不同的卫生提供者群体，以获得基本的研究技能。 这项申请将补充目前正在进行的培训和能力建设活动，作为 D43奖“通过研究将预防和治疗非传染性疾病与艾滋病毒护理结合起来 肯尼亚培训-INTEGRATE(TW009580)，由John Kinuthia博士(KNH)和Carey Farquhar博士(哥伦比亚大学)领导 华盛顿)。综合方案旨在解决实施科学和技术方面的重大差距 开展妇幼保健院非传染性疾病防治的流行病学研究 通过公共卫生硕士/博士项目在实施科学和流行病学方面的长期培训：博士培训 内罗毕大学(UON)(3年)和西雅图公共卫生硕士培训(1年)；1年博士后导师 在肯尼亚提供研究金，并在肯尼亚举办短期面对面和在线研究方法培训。

ABSTRACT Turkana County is located in the Northwest of Kenya. It is the second largest of 47 counties and has a population of ~1 million people . The Turkana people are mainly semi-nomadic with frequent migration in search of water, food and pasture. Consequently, they have limited education opportunities, high poverty levels and food insecurity. Socio-cultural practices such as early marriages, polygamy, and gender inequities further limit education opportunities for girls. Pastoral communities in Kenya represent a marginalized population that experience health disparities and have limited health literacy, access to and availability of health services. Health providers in Turkana County have limited continuing educational and research opportunities and are underrepresented in biomedical, clinical, behavioral and social science research in Kenya. The 2018 Kenya Population-Based HIV Impact Assessment reported that HIV prevalence in Turkana County was 6.8%, which was higher than the national prevalence of 4.9%.Turkana is among the counties in Kenya that are not on track to achieve the UNAIDS 95-95-95 targets. In Turkana County, only 62% of people living with HIV (PLWH) were aware of their status, 89% of those were receiving ART, and 40% achieved viral suppression in 2018. The 2021 Kenya HIV progress report indicated that Turkana County had the 2nd highest number of girls below 18 years who were engaging in commercial sex work and young people who inject drugs, practices that puts them at increased risk of HIV infections. As a result, HIV is the leading cause of mortality in Turkana County. This underscores the need for studies to identify factors contributing to low uptake HIV prevention interventions and adherence to treatment for PLWH. This supplement application aims to promote diversity, equity, and inclusion among health providers from Turkana County in research by training a diverse group of health providers in research methods and supporting them to conduct mentored research projects that address local health needs and optimize HIV prevention, diagnosis, and treatment for PLWH in Turkana county. 1. In Aim 1, we will build the capacity of 6 promising health providers in Turkana County to conduct HIV research by providing in-person and virtual research training and high-quality mentorship. In Aim 2, we will build the capacity of health providers based in Turkana County to disseminate the results of their research findings. In Aim 3, we will provide opportunities to 60 diverse health providers in Turkana County to gain research skills through the established University of Washington e-learning platform to enhance the capacity to conduct locally relevant research. This is the first training grant to our knowledge that is focusing on Turkana County, a county with highly marginalized population that is disproportionately affected by HIV. Investing in training of health providers in Turkana will have benefits in terms of retention and relevance of research and the research skills gained will be used to benefit this region directly. Trainees who remain in Turkana will be able to mentor other trainees from the region, amplifying the impact of this training program. Additionally, utilizing an e-learning platform is efficient, does not remove necessary health providers from their practice posts and allows for a larger and diverse group of health providers to acquire basic research skills. This application will complement the training and capacity-building activities currently underway as part of the D43 award “Integrating prevention and treatment of non-communicable diseases and HIV care through research training in Kenya-INTEGRATE (TW009580) led by Drs. John Kinuthia (KNH) and Carey Farquhar (University of Washington). The INTEGRATE program seeks to address the critical gaps in implementation science and epidemiology research in the prevention and care of non-communicable diseases among PLWH by offering long-term training through an MPH/PhD program in implementation science and epidemiology: PhD training at University of Nairobi (UoN) (3 years) and MPH training in Seattle (1 year); 1-year mentored post-doctoral fellowship in Kenya and short-term in-person and online training on research methodology in Kenya.