The long-term goal of the activities described in this application for a Midcareer Investigator Award in Patient-Oriented Research (K24) is to improve behavioral and social research on HIV/AIDS through the use of qualitative methods. To this end, I propose a five-year program of mentoring and research using qualitative methods for social and behavioral research on HIV/AIDS in sub-Saharan Africa. Specific goals are to: (1) mentor students, postdoctoral fellows, junior faculty, and other qualified investigators in the U.S. and Africa who will use qualitative methods in behavioral and social HIV/AIDS research;and (2) conduct a comparative, qualitative study of ongoing approaches to expanding HIV/AIDS treatment and care from hospital-based clinics into African communities (here termed "scale-out"). The program will take place at Harvard University, Cambridge, MA, USA;Jos University, Jos, Nigeria;and Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Building upon resources at all three institutions, the mentoring program includes one-on-one mentoring sessions;seminars on qualitative methods, research design, and manuscript-writing made available through video-conferencing in all three countries;networking conferences that will bring U.S. and African-based mentees together in real time;and a formal evaluation. Framing retention in HIV care as an access problem created by the long distances patients have had to travel to keep clinic appointments, the research program investigates ongoing efforts to reduce the distance barrier and bring care closer to patients'homes. The proposed qualitative study will document and analyze the processes through which these efforts are being implemented in Nigeria and Tanzania, and investigate their impact on patient experiences of care. Results will inform future efforts to implement scale-out as they unfold around the world.
Qualitative methods are ideally suited to understanding patient experience and breaking ground in new areas of inquiry but to date have been underrepresented in research on public health. The proposed program of mentoring and research will equip future public health researchers to design and carry out qualitative studies.
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