This proposal describes a 5-year training and research program that will allow Dr. Aadia Rana to achieve her goal of becoming an independent patient-oriented investigator with expertise in HIV health services and health disparities, integrating research and public health practice. The proposed program will build on the candidate's prior experience in HIV clinical research by enhancing her skills in mixed methods, health services, and clinical trials research involving behavioral interventions. The training plan will take advantage of an exceptional mentoring team and institutional environment that involves close collaboration between Alpert Medical School of Brown University, the University of Mississippi Medical Center, and the Mississippi Department of Health. Postpartum minority HIV-infected women in the southern United States face substantial challenges in access and retention in HIV care. This novel research proposal utilizes a population-based approach in evaluating retention in care among postpartum minority women in the rural South, and integrates a mixed-methods approach to examine the socioeconomic, demographic, and structural determinants of retention in care in this vulnerable population.
The specific aims of this proposal are: 1) To comprehensively describe linkage and retention to HIV care following delivery, and the socioeconomic, demographic and structural determinants of linking and retaining in HIV care among postpartum women in Mississippi;2)To prospectively evaluate the cascade of diagnosis, linkage, and retention in HIV medical care and the socioeconomic, psychosocial, and structural determinants of linking and retaining in HIV care among postpartum HIV-infected women in Mississippi;3) To characterize the psychosocial facilitators and barriers to successful linkage and retention to care following delivery using qualitative methods. We will then incorporate the results of all of these studies in a future trial piloting an intervention integrating clinic and public health systems aimed at improving retention in HIV care among perinatal HIV-infected in Mississippi. This research will lay the groundwork for a larger research program on HIV care that will include rigorous evaluation of interventions aimed at improving the delivery of HIV care in disadvantaged populations with consideration for cost-effectiveness.
The proposed research is relevant to public health because it will lead to an increased understanding of retention in care among postpartum minority women in the rural South. Improving linkage and retention to care following delivery will have significan impact on the success of the treatment as prevention strategy to decrease incidence of HIV infection and impact medical outcomes for women who experience disparities in access to care in the South. The objectives of this mixed methods research project are in line with the trans- NIH goal of reducing new HIV infections, addressing health disparities in HIV care, and improving outcomes for patients with HIV.