Sub-Saharan Africa (SSA) has made tremendous strides in the provision and uptake of antiretroviral therapy (ART) among HIV-infected persons. Despite these advancements, the region continues to experience low rates of adherence and retention along the cascade of HIV care. Initiating effective ART adherence dialogue with patients while incorporating patient-specific interventions along the continuum of care is key to improving patient engagement in HIV care. Unfortunately, system-level factors such as long waiting times, staff shortages, lack of continuity in provider- patient relationship, poor provider communication skills, and inconvenient clinic hours create barriers to ART adherence. Addressing these system-level barriers is fundamental to provide a conducive patient-centered care system that help patients adhere to ART and overcome other interpersonal and individual barriers to care. My long-term goal is to become an independent implementation science researcher who successfully develops, implements and evaluates multilevel interventions to address system-level barriers to patient engagement in HIV care. This K43 will provide me with the additional training and preliminary data necessary to achieve these research goals. My training will focus on: 1. Implementation science, 2. Advanced quantitative research methods, and 3. Economic evaluation of health interventions. To accomplish this, I will draw from the expertise of my mentorship team lead by primary mentors Drs. Ira Wilson (Brown University, USA) and Abraham Siika (Moi University, Kenya), both of whom have a wealth of experience mentoring junior investigators. My mentorship team is comprised of health professionals who have expertise in clinical research, implementation science, patient-centered care, epidemiology, biostatistics, and economic evaluation of interventions in HIV care settings. The award and completion of this K43 grant will provide me with a strong foundation to compete for an R01 in collaboration with other experienced investigators to extend my research to focus on multi- level approaches to promote patient engagement in care within a patient-centered framework that incorporates other chronic diseases. My prior training, research experience, and mentorship team, places me in a strategic position to achieve my research goals.
PUBLIC RELEVANCY Given the achievements in ART availability in SSA, attention directed towards enhancing patient engagement in HIV care is urgently needed. This mixed methods study will provide useful data on approaches to engage HIV patients in care by addressing system-level factors. This is in line with the current global efforts to eliminate new HIV infections.