The Impact of Mobility on HIV Care in New York City and the Dominican Republic

描述（由申请人提供）：候选人是哥伦比亚大学医学中心（CUMC）传染病讲师，她的长期目标是成为一名独立的研究者，研究国际和国内拉丁裔社区的社会和结构因素与艾滋病毒治疗结果之间的相互作用。她的短期目标是扩大她在国际研究方面的经验，完善她在生物统计方法方面的技能，并进一步了解流动社区中流动性与艾滋病毒护理结果之间的相互作用。她在基础科学和临床研究方面有着丰富的经验，并在过去四年中一直在为多米尼加共和国（DR）的这个项目建立框架。CUMC位于纽约-多米尼加共和国空中桥梁的一端，这是两国之间循环迁移的模式。我们的目标是在我们位于纽约华盛顿高地（WH）和圣多明各（SD）的艾滋病治疗中心了解多米尼加人的流动性和艾滋病治疗之间的相互作用。我们的主要假设是，个人流动性导致抗逆转录病毒治疗中断，进而导致抗逆转录病毒治疗失败。我们将使用比较人种学对两个地点（WH和SD）的多米尼加患者人口的流动性进行定性评估，并利用这些知识制定适合社区的、基于证据的流动性衡量标准。然后，我们将进行病例对照研究，以评估移动性作为两个地点治疗失败的预测因子。我们还将研究那些有和没有抗逆转录病毒药物耐药性的失败患者的差异。这项研究将在国际公认的艾滋病研究者斯科特·哈默博士的指导下，在中国中医药大学和多米尼加的合作机构进行。艾滋病毒和移民专家Jennifer Hirsch博士和资源有限环境下艾滋病毒治疗结果专家Louise Kuhn博士。CUMC为多米尼加以外最大的多米尼加人社区提供服务，多米尼加的合作机构与CUMC有着长期成功的临床研究和现有的研究计划。

DESCRIPTION (provided by applicant): The candidate is an instructor in infectious diseases at Columbia University Medical Center (CUMC), and her long-term goal is to become an independent investigator studying the interaction between social and structural factors and HIV treatment outcomes in international and domestic Latino communities. Her short-term goals are to expand her experience in international research, refine her skills in biostatistical methods, and further the understanding of the interaction between mobility and HIV care outcomes in mobile communities. She has an extensive track record of basic science and clinical research, and has been building the framework for this project in the Dominican Republic (DR) for the past four years. CUMC sits at one end of the New York-Dominican Republic air-bridge, a pattern of circular migration between the two countries. Our goal is to understand the interactions between mobility and HIV treatment amongst Dominicans in our own HIV treatment center in Washington Heights, New York (WH), and in Santo Domingo (SD), DR. Our primary hypothesis is that individual mobility leads to interruptions in antiretroviral therapy, and, in turn, to antiretroviral treatment failure. We will undertake a qualitative assessment of mobility using comparative ethnography in the Dominican patient population at both sites (WH and SD), and use that knowledge to develop a community-appropriate and evidence based measure of mobility. We will then conduct case-control studies to assess mobility as a predictor of treatment failure at both sites. We will also examine differences in those failing with and without antiretroviral drug resistance. This research will take place at CUMC and collaborating institutions in the DR with the mentorship of Dr. Scott Hammer, an internationally recognized HIV investigator. Dr. Jennifer Hirsch, a specialist in HIV and migration, and Dr. Louise Kuhn, an expert in HIV treatment outcomes in resource-limited settings. CUMC serves the largest community of Dominicans outside of the DR, and the collaborating institutions in the DR have long histories of successful clinical research and existing research initiatives with CUMC. RELEVANCE: By using multidisciplinary techniques to examine the interaction between mobility and HIV treatment outcomes on both sides of the New York-Dominican Republic airbridge, the researchers will generate novel findings of significance to both countries and to other regions where circular migration is common. The research may also be relevant to the impact of mobility on treatment outcomes of other chronic illnesses.