Moving Beyond the Individual- A Data-driven Approach to Improving the Evidence on the Role of Community and Societal Determinants of HIV among Adolescent Girls and Young Women in Sub-Saharan Africa

项目总结/摘要 撒哈拉以南非洲（SSA）的少女和年轻妇女（AGYW），全球艾滋病毒的中心 艾滋病毒/艾滋病流行病，在这一地区承担了新的艾滋病毒感染的主要负担至少30年。研究 * 优先确定AGYW中艾滋病毒感染的个人预测因素， 评估工具，以确定高风险的亚群，有针对性的艾滋病毒预防工作。尽管作出了重大的 尽管作出了种种努力，但这一弱势群体的疾病负担仍然不成比例，这表明， 需要确定和评估个人以外的干预目标。R36的主要目标 超越个人：一种数据驱动的方法，以告知证据上的 社区和社会决定因素在次区域少女和青年妇女中的作用 非洲撒哈拉地区建立一个全面的数据源，以促进评估艾滋病毒风险的新方法 在AGYW中，提高对个人、人际、社区和社会风险的认识 因素;描述这些变量之间的相互作用;并评估干预措施的影响， 以社区和社会感染驱动因素为目标，为改进预防工作提供信息。实现这些 我们提出了三个目标，这些目标将利用来自五个国家的公开的、基于人口的数据， SSA（喀麦隆，斯威士兰，马拉维，卢旺达和乌干达），并应用先进的数据科学和 流行病学方法。目标1是整合基于人口的艾滋病毒/艾滋病方案的公开数据， 影响评估项目（个人、人际、社区）、人口和住房普查 联合国艾滋病规划署法律和政策指标（社会），以建立一个大的，多层次的公共卫生 数据集。目标2是描述和图形化描绘个人，人际， 使用因果发现算法， 确定潜在的疾病途径。目标3是评估干预对社区和社会的影响 艾滋病毒感染的驱动因素AGYW使用参数g-计算模型提出的干预效果。 为了检验这些目标，我们将采取一种新颖的交叉方法来评估艾滋病毒行为科学 通过利用因果发现算法和g计算进行查询。这项研究的结果将 推进国家精神卫生研究所艾滋病研究科的优先提高知识 基础信息干预，从而推动超越个人的干预措施的发展 减少青年女青年中艾滋病毒的负担。这项R36提案的研究和指导已经 精心制作，以优化主要研究者正在进行的博士培训和研究经验 这项研究的同时，促进她的发展，作为一个非洲裔美国独立的研究科学家， 未来

PROJECT SUMMARY/ABSTRACT Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA), the epicenter of the global HIV epidemic, have carried the primary burden of new HIV infections in this area for at least 30 years. Research has prioritized characterizing the individual predictors of HIV infection among AGYW by creating risk assessment tools that identify high-risk sub-populations for targeted HIV prevention efforts. Despite substantial efforts, there remains a disproportionate burden of disease among this vulnerable population, suggesting a need to identify and assess targets of intervention beyond the individual. The primary goals of this R36 dissertation proposal, Moving Beyond the Individual: A Data-driven Approach to Informing the Evidence on the Role of Community and Societal Determinants of HIV among Adolescent Girls and Young Women in Sub- Saharan Africa, are to create a comprehensive data source that will facilitate new ways of assessing HIV risk among AGYW, generating improved knowledge about individual, interpersonal, community, and societal risk factors; to characterize the interplay among these variables; and to assess the impact of interventions that target community and societal drivers of infection to inform improved prevention efforts. To achieve these goals, we propose three aims that will leverage publicly available, population-based data from five countries in SSA (Cameroon, Eswatini, Malawi, Rwanda, and Uganda) and apply advanced data science and epidemiologic methodologies. Aim 1 is to integrate publicly available data from the Population-based HIV Impact Assessment Project (individual, interpersonal, community), the Population and Housing Census (community), and UNAIDS Law and Policy Indicators (societal) to create a large, multi-level public health dataset. Aim 2 is to characterize and graphically depict the pathways among individual, interpersonal, community, and societal risk factors of HIV infection among AGYW using causal discovery algorithms to identify underlying disease pathways. Aim 3 is to estimate the impact of intervening on community and societal drivers of HIV infection among AGYW using parametric g-computation to model proposed intervention effects. To examine these aims, we will take a novel, intersectional approach to assess HIV behavioral science inquiries by leveraging causal discovery algorithms and g-computation. Findings from this research will advance the National Institute of Mental Health Division of AIDS Research’s priority to improve the knowledge base informing interventions, thereby advancing the development of interventions that go beyond the individual to reduce the burden of HIV among AGYW. The research and mentorship of this R36 proposal have been carefully crafted to optimize the ongoing doctoral training and research experience of the Principal Investigator of this study while fostering her development as an African American independent research scientist in the future.