Addressing Economic Stress to Improve HIV Prevention and Care Outcomes in the United States - The purpose of this career development award is to provide the candidate with the training necessary to become an independent investigator 1) advancing scientific knowledge about how social and economic factors are shaping HIV risk and outcomes among priority health populations, and 2) designing effective interventions that reduce HIV prevalence and improve health and well-being within HIV high-priority populations (HHPP). Research Aims: HHPPs experience significant economic hardships and disproportionately shoulder the burden of the HIV/AIDS epidemic in the United States. Guided by an integrated asset theory and social ecological framework, and using a multistage mixed methods approach, the candidate plans to conduct community-based participatory formative research necessary to inform the adaptation of an economic empowerment intervention to improve HIV prevention and care outcomes among HHPPs in the U.S. First, the PI will establish a robust Community Collaborative Board (CCB) comprised of leaders in the target populations. With the CCB and under the guidance of the mentorship team, the PI will finalize study design and protocol, informed by current pilot study findings. Next, the PI will undertake quantitative (surveys, N=390) and qualitative (interviews, n=36) research to achieve Aim 1: to estimate and qualitatively describe how co-occurring forms of economic hardship, defined as economic marginality, are associated with HIV outcomes among HHPPs. Integrated Aim 1 findings and CCB guidance will inform study Aim 2: adaptation of an HIV economic empowerment intervention for HHPPs experiencing economic marginality in the U.S. After adapting the intervention, Aim 3 is: to assess acceptability and feasibility of the adapted intervention and generate preliminary data to inform an R01 application by pilot testing with 42 HHPP individuals using a waitlist control design, then refining the intervention with the CCB. The proposed research builds from the infrastructure and community ties developed by a mentor’s past research in New York City, San Francisco, and Atlanta and furthers the NIH HIV strategic goal to advance evidence on how social, economic, and structural conditions shape differences in prevention, engagement in care, and long-term health for populations disproportionately affected by HIV. This research is designed to support the training goals of the PI. Training Goals: To become an independent investigator, the candidate requires additional training in four core areas: community-based participatory research; asset theory; quantitative methods; and how to adapt, test, assess, and refine socio- behavioral interventions to improve HIV outcomes among HHPPs. Hosted by The HIV Center at Columbia University and New York State Psychiatric Institute, the candidate will engage in close mentorship, coursework, directed readings, workshops, workgroups, and hands-on research to achieve these training goals.
