My career goal is to become a global leader in multidisciplinary HIV/AIDS research in resource- limited settings with a focus on research integrating HIV clinical care and secondary HIV prevention strategies. My short term goal is to establish myself as an independent investigator as a tenure-track junior faculty member at Johns Hopkins and to develop a productive and sustainable program of research in Uganda. Research Project. My proposed research consists of two phases: Phase 1-Perform secondary behavioral outcomes analyses on a dataset of a trial conducted to assess the effect of peer health workers on AIDS care outcomes in Rakai, Uganda. Concurrently, I will perform cost-effectiveness analysis of this peer health worker intervention. Phase 2- Perform comprehensive formative research and then implement a community-based trial of a peer health worker intervention to integratively (i) improve patient retention, (ii) increase basic care package utilization, and (iii) decrease risky sexual behaviors among PLHIV not yet on antiretroviral therapy. The peer health worker intervention will center on home visits to individual patients. Subsequently, I will perform cost-effectiveness analysis of this intervention. Career Development Plan. My proposed training and mentoring activities will center on (i) behavioral intervention research and ii) cost-effectiveness analysis research of HIV prevention and care interventions. My proposed applied research, which will be closely coordinated with my training activities, will focus on the impact of peer health workers, a group of community health workers who are people living with HIV, on integrated patient retention, care, and secondary HIV prevention efforts in Rakai, Uganda. Research Environment. I will be well supported within the well funded and respected Division of Infectious Diseases at Johns Hopkins. I will also have the excellent and proven research infrastructure of the Rakai Health Sciences Program in Uganda to support the design and implementation of my research plan.

Public Health Relevance

These study findings may serve as a model for the design of large scale peer health worker-led interventions to improve the care, retention, and secondary HIV prevention of people living with HIV in low-resource settings. These studies may serve as a model for integrating prevention and care interventions, an area in which there is a critical need for innovative, inexpensive, and effective interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23MH086338-03
Application #
8204538
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Stirratt, Michael J
Project Start
2010-01-01
Project End
2014-12-31
Budget Start
2012-01-01
Budget End
2012-12-31
Support Year
3
Fiscal Year
2012
Total Cost
$182,790
Indirect Cost
$13,540
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Grabowski, Mary K; Lessler, Justin; Redd, Andrew D et al. (2014) The role of viral introductions in sustaining community-based HIV epidemics in rural Uganda: evidence from spatial clustering, phylogenetics, and egocentric transmission models. PLoS Med 11:e1001610
Reynolds, Steven J; Sempa, Joseph B; Kiragga, Agnes N et al. (2014) Is CD4 monitoring needed among ugandan clients achieving a virologic and immunologic response to treatment? AIDS Patient Care STDS 28:575-8
Burkey, Matthew D; Weiser, Sheri D; Fehmie, Desiree et al. (2014) Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda. J Acquir Immune Defic Syndr 66:41-7
Nakigozi, Gertrude; Atuyambe, Lynn; Kamya, Moses et al. (2013) A qualitative study of barriers to enrollment into free HIV care: perspectives of never-in-care HIV-positive patients and providers in Rakai, Uganda. Biomed Res Int 2013:470245
Chang, Larry W; Serwadda, David; Quinn, Thomas C et al. (2013) Combination implementation for HIV prevention: moving from clinical trial evidence to population-level effects. Lancet Infect Dis 13:65-76
Chang, Larry W; Kagaayi, Joseph; Nakigozi, Gertrude et al. (2013) Cost analyses of peer health worker and mHealth support interventions for improving AIDS care in Rakai, Uganda. AIDS Care 25:652-6
Labrique, Alain; Vasudevan, Lavanya; Chang, Larry William et al. (2013) H_pe for mHealth: more "y" or "o" on the horizon? Int J Med Inform 82:467-9
Chang, Larry W; Njie-Carr, Veronica; Kalenge, Sheila et al. (2013) Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 25:874-80
Chang, Larry W; Kagaayi, Joseph; Arem, Hannah et al. (2011) Impact of a mHealth intervention for peer health workers on AIDS care in rural Uganda: a mixed methods evaluation of a cluster-randomized trial. AIDS Behav 15:1776-84
Arem, Hannah; Nakyanjo, Neema; Kagaayi, Joseph et al. (2011) Peer health workers and AIDS care in Rakai, Uganda: a mixed methods operations research evaluation of a cluster-randomized trial. AIDS Patient Care STDS 25:719-24

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