The purpose of the proposed Mentored Research Scientist Development Award (K01) is to provide the candidate with training and research experiences that will promote her development as an independent researcher, with particular emphasis in the field of healthcare-based HIV intervention research with alcohol- using populations in sub-Saharan Africa. This training will provide her with the opportunity to develop knowledge and skills in: 1) alcohol and substance abuse epidemiology, assessment and prevention; 2) theoretically-driven behavioral interventions to reduce harmful alcohol-use and intimate partner violence (IPV), in the context of new and existing HIV infections; and 3) advanced statistical analytic techniques such as structural equation modeling. Training activities will include didactic coursework and specific workshops, directed readings and one-on-one tutorials with mentors, and instruction in the responsible conduct of research. The candidate will receive mentorship from a Training Committee comprised of globally renowned experts in the fields of alcohol and other substance abuse, HIV prevention, healthcare-based alcohol screening and brief interventions (SBI) and epidemiology research. Her applied research training will take place in Rakai, Uganda within the existing infrastructure of the Rakai Health Sciences Program (RHSP), a 25 year old HIV research and service provision organization. Rakai District is bordered by Lake Victoria and home to several fishing communities with extremely high prevalence of alcohol use and HIV. Rates of IPV are high in Rakai and associated with alcohol and HIV in women the causal pathways between alcohol, IPV, and HIV are unknown. The proposed research will be embedded in the Rakai Community Cohort Study (RCCS), one of the oldest and well-established population-based cohort studies in the world (5U01AI100031-03; 5R01HD070769; 5R01MH099733).
Specific aims are to conduct secondary RCCS data analysis to: 1) estimate current prevalence and determinants of alcohol use in adult women and 2) examine associations and direct and indirect pathways between alcohol, IPV and HIV infection in adult women.
Other aims are to 3) conduct qualitative interviews (n=20) with female HIV counseling and testing (HCT) clients, and focus groups (n=2) with HCT counselors and supervisors to assess perceptions of integrating an alcohol and IPV SBI into RHSP's standard HCT model; and 4) use quantitative and qualitative findings from Aims 1-3 to adapt and pilot test an alcohol and IPV SBI with 80 abused, alcohol-using women, drawn from RCCS, who seek post-test HIV counseling. Results will generate effect estimates for parameters needed to inform power calculations for a subsequent, large-scale effectiveness trial and will position the candidate to develop an R34 or R01 application for submission to NIAAA. The proposed work supports the FY2014 Trans-NIH Plan for HIV-Related Research to reduce new infections by conducting intervention research that addresses the impact of alcohol and other drugs on sexual encounters that may contribute to HIV transmission and acquisition.
Women's harmful consumption of alcohol has been significantly associated with increased risk for intimate partner violence victimization and HIV infection but the temporal direction of these associations remains unknown, and there is no best practice evidence on HIV care and treatment interventions that concurrently address female client's experiences of violence and alcohol or other substance use. Findings from the proposed research will be critical to the development, implementation, and evaluation of theoretically-driven, empirically informed HIV behavioral interventions that address the multiplicity of risks faced by alcohol-using women in a sub-Saharan African context than can be further applied to other settings. Developing skills in healthcare-based HIV intervention research will uniquely position the candidate as one of the only gender- based violence epidemiologists with expertise in applying brief, integrated intervention methodology to HIV reduction programs focused on alcohol-using populations.
| Wagman, Jennifer A; Samet, Jeffrey H; Cheng, Debbie M et al. (2018) Female Gender and HIV Transmission Risk Behaviors Among People Living with HIV Who Have Ever Used Injection Drugs in St. Petersburg, Russia. AIDS Behav 22:2830-2839 |
| Wagman, Jennifer A; Gray, Ronald H; Nakyanjo, Neema et al. (2018) Process evaluation of the SHARE intervention for preventing intimate partner violence and HIV infection in Rakai, Uganda. Eval Program Plann 67:129-137 |
