Having completed a BS in Biomedical Engineering and a MS, PhD, and post-doctoral fellowship in Epidemiology, Dr. Kristin Wall possesses a strong, quantitatively focused foundation in epidemiological methods, mathematical modeling, and research evaluating the effectiveness of interventions to treat and prevent HIV. Dr. Wall is currently a Research Assistant Professor at Emory University and co-Investigator on multiple grants to implement and evaluate couples-focused HIV testing and family planning interventions in Zambia and Rwanda. She is also Principal Investigator on a formative evaluation of pre-exposure prophylaxis acceptability among HIV discordant couples in the United States and the Principal Investigator on a grant to implement technologies that link patient records across HIV prevention and treatment services in Zambia. This K01 application outlines a four-year training and research plan structured to systematically expand upon Dr. Wall's training and research background to develop a unique, independently funded research agenda focused on HIV intervention resource allocation. Training plan: Dr. Wall proposes to gain competency in: 1) using infectious disease models for resource allocation, 2) building resource allocation optimization programs, and 3) understanding resource allocation decisions in health policy and practice. Competency in these areas will be achieved through didactic instruction and multidisciplinary mentorship from Dr. Phaedra Corso, an NIH-funded researcher and University of Georgia Foundation Professor of Human Health with decades of experience in health economic evaluation and translation of findings into health policy; Dr. Ron Brookmeyer, an NIH-funded researcher and UCLA Professor of Biostatics with extensive experience in HIV epidemic modeling and statistics; Dr. David Holtgrave, an NIH-funded Professor at Johns Hopkins and world-renowned expert in cost-effectiveness research, resource allocation, and health policy for HIV prevention programs; Dr. Arielle Lasry, Senior Health Economist at CDC Atlanta whose research focuses on HIV epidemic modeling and optimization programming for HIV prevention and treatment resource allocation in the United States and Africa; Dr. Gordon Streeb, Professor in the Emory Department of Economics and former United States Ambassador to Zambia whose work focuses on health economics, policy, development issues in Africa; and Dr. Susan Allen, Professor and founder of the Emory-based Rwanda Zambia HIV Research Group with more than 25 years of experience working in HIV prevention and treatment in sub-Saharan Africa and a successful history of translating research findings into national policy in Zambia and Rwanda. Dr. Wall will seek mentorship within and outside of Emory, where she has already built a strong network of research collaborators. As Emory does not currently house faculty focused on resource allocation optimization for HIV programs, her unique research agenda will be highly complementary to the existing HIV-related research portfolio at Emory. Research plan: Dr. Wall proposes to develop methods to optimize the allocation of limited HIV prevention and treatment resources to improve a defined health outcome. She will apply these methods to answer a relevant, timely, high-impact research question: what is an optimal and realistic allocation of combination HIV prevention and treatment resources in Zambia to minimize the number of new infections over a given time period? Two important resource allocation considerations are the leveraged costs and effects of interventions in combination and the realistic facilitators and barriers to making funding decisions. Though important, these two considerations are rarely systematically incorporated into resource allocation analyses. Dr. Wall proposes to advance methods that are inclusive of intervention synergy and real-world barriers facing resource allocation decision-makers. Models of the Zambian HIV epidemic that output the number of new HIV infections over time given a specific resource allocation scenario will be constructed. This model will be embedded in an optimization algorithm to minimize the number of new HIV infections for the current Zambian budget. Dr. Wall will then conduct formative qualitative work to determine the political, social, cultural, and ethical factors that influence HIV program resource allocation decision-making in Zambia by conducting semi-structured interviews with Ministry of Health members and other key stakeholders. Dr. Wall hypothesizes that: 1) the optimization model will be sensitive to assumptions of intervention cost-effectiveness ratios; 2) the number of HIV infections averted under the actual allocation scenario will be significantly lower than that for the optimal scenario; and 3) factors influencing stakeholder decision-making will include international guidelines, historical allocations, and sociocultural attitudes toward individual interventions. The proposed research aligns with the NIH Office of AIDS Research, NIMH Strategic Research Priorities, and NIMH DAR areas of high priority. The project will be the first to incorporate measures of intervention synergy and study both the rational and realistic allocation of HIV program resources in Zambia. Results will be used as preliminary data for an NIH NIMH R01 (highly responsive to PA-14-131) to develop the allocation model in light of changing guidelines and formative results. These investigations could inform decision-making in Zambia that improves HIV prevention and treatment outcomes. More broadly, the results of this work will have important implications for developing evidence-based resource allocation methodologies.

Public Health Relevance

Zambia, a country in the midst of a devastating HIV/AIDS epidemic, has benefited from the development and implementation of evidence-based HIV treatment and prevention interventions. However, like many countries in sub-Saharan Africa, Zambia has yet to optimally allocate limited HIV program resources to maximize health benefits. A combination of disease modeling, optimization modeling, and quantitative and qualitative health policy methodologies will be innovatively employed to determine a rational and realistic approach to better allocate HIV prevention and treatment resources in Zambia.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Scientist Development Award - Research & Training (K01)
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AIDS Clinical Studies and Epidemiology Study Section (ACE)
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Gordon, Christopher M
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Emory University
Public Health & Prev Medicine
Schools of Public Health
United States
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Wall, Kristin M; Bayingana, Roger; Ingabire, Rosine et al. (2018) Rwandan stakeholder perspectives of integrated family planning and HIV services. Int J Health Plann Manage 33:e1037-e1049
Wall, Kristin M; Inambao, Mubiana; Kilembe, William et al. (2018) HIV testing and counselling couples together for affordable HIV prevention in Africa. Int J Epidemiol :
Joseph Davey, Dvora L; Wall, Kristin M (2017) Need to include couples' HIV counselling and testing as a strategy to improve HIV partner notification services. AIDS 31:2435-2436
Wall, Kristin; Allen, Susan (2017) Incentives to improve couples' HIV testing uptake and cost-effectiveness. Lancet Glob Health 5:e847-e848