This K01 Mentored Research Scientist Development Award will provide advanced training for the candidate to become an independent investigator focusing on HIV prevention strategies that link epidemiology, behavioral science, and economic development. The long-term goal of the investigator is to develop, implement, and evaluate innovative and multidisciplinary interventions to reduce the incidence of HIV infection among women and girls in the developing world. The proposed scope of work includes both training and research components that capitalize on the rich interdisciplinary research environment at the University of California, Berkeley as well as the institutions of the candidate's advisory committee. The training component forms the foundation of the proposal and includes two senior mentors, a panel of advisors with complementary expertise, didactic education, skill development, and mentored research such that at the completion of the award the candidate will be well-positioned for an independent research career. The training plan has been developed in parallel with the mentored research plan such that when new education and skills are obtained they can be immediately applied to the relevant aspects of the research program. Four training objectives will be accomplished during the course of this award: (1) obtain education in the responsible conduct of research, economics, and international development policy;(2) obtain practical skills in agricultural and resource economics, intervention development, and the conduct and analysis of experimental epidemiological studies;(3) complete a mentored research program to design and pilot an HIV prevention intervention;and (4) become an independent investigator through building the publication record, mentoring by subject matter experts, and generating pilot data for a future proposal. The goal of the research component is to examine how the economic context shapes women's vulnerability to HIV infection in rural Tanzania and to pilot an intervention to economically empower women farmers and reduce HIV infection. The promotion of women's economic empowerment is increasingly viewed as a promising approach to HIV prevention in Sub-Saharan Africa as the lack of access to and control over economic resources heightens susceptibility to HIV infection. This proposal takes an innovative approach to HIV prevention by focusing on agriculture, which is inextricably linked to poverty and food security in the developing world. However, few interventions have systematically integrated agricultural livelihoods, food security, and HIV prevention.
The research aims are to: (1) investigate the potential for a sustainable agriculture-based livelihood intervention to reduce the risk of HIV infection among women farmers in Tanzania;(2) determine the effect of household income, food insecurity, and land ownership on sexual risk-taking among female-headed farming households in Tanzania;and (3) conduct a pilot study of a sustainable agriculture- based livelihood intervention for women farmers in Tanzania to improve household income and food security and reduce sexual risk-taking. This study will provide quantitative and qualitative evidence to determine whether a future trial is merited for the intervention. There is a clear need for empirical evidence about the effects of economic insecurity on HIV vulnerability. In addition, the development of multi-sectoral responses to prevention that can address the entwined economic, social, and contextual risks with which African women contend is imperative. This proposal has been designed to address both of these needs and the results will have important implications for future responses to the HIV pandemic.

Public Health Relevance

Promoting women's economic security is increasingly viewed as a promising approach to HIV prevention in Sub-Saharan Africa. In this study we will examine the association between economic factors and HIV risk in women farmers in Tanzania, and will then develop and pilot an agriculture-based livelihoods intervention to reduce women's risk of HIV infection. This research will lead to a better understanding of how economics shape women's vulnerability to HIV infection and whether supporting productive agricultural livelihoods can reduce this risk among rural women.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Scientist Development Award - Research & Training (K01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Gordon, Christopher M
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University of California Berkeley
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United States
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Nance, Nerissa; Ralph, Lauren; Padian, Nancy et al. (2018) Unintended pregnancy and subsequent postpartum long-acting reversible contraceptive use in Zimbabwe. BMC Womens Health 18:193
Czaicki, Nancy L; Dow, William H; Njau, Prosper F et al. (2018) Do incentives undermine intrinsic motivation? Increases in intrinsic motivation within an incentive-based intervention for people living with HIV in Tanzania. PLoS One 13:e0196616
McCoy, Sandra I; Njau, Prosper F; Fahey, Carolyn et al. (2017) Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania. AIDS 31:815-825
McCoy, Sandra I; Fahey, Carolyn; Buzdugan, Raluca et al. (2016) Targeting elimination of mother-to-child HIV transmission efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe. AIDS 30:1829-37
McCoy, Sandra I; Buzdugan, Raluca; Mushavi, Angela et al. (2015) Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study. BMC Public Health 15:420
Ralph, Lauren J; McCoy, Sandra I; Shiu, Karen et al. (2015) Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies. Lancet Infect Dis 15:181-9
McCoy, Sandra I; Buzdugan, Raluca; Padian, Nancy S et al. (2015) Implementation and Operational Research: Uptake of Services and Behaviors in the Prevention of Mother-to-Child HIV Transmission Cascade in Zimbabwe. J Acquir Immune Defic Syndr 69:e74-81
Singer, Amanda W; Weiser, Sheri D; McCoy, Sandra I (2015) Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review. AIDS Behav 19:1510-26
McCoy, Sandra I; Njau, Prosper F; Czaicki, Nancy L et al. (2015) Rationale and design of a randomized study of short-term food and cash assistance to improve adherence to antiretroviral therapy among food insecure HIV-infected adults in Tanzania. BMC Infect Dis 15:490
McCoy, Sandra I; Buzdugan, Raluca; Ralph, Lauren J et al. (2014) Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe. PLoS One 9:e105320

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