Jamaica CARES Project: Enhancing HIV Care Continuity Among Priority Populations in Jamaica - Jamaica’s HIV/AIDS epidemic among people living with HIV is the most severe in the Caribbean in terms of its breadth and consequences. HIV prevalence among people living with HIV is estimated at 33%, which is significantly higher than the 1.8% observed in the general population. Social pressures and safety concerns are key drivers of poor mental health and HIV care engagement, leading to higher rates of depression, anxiety, and low viral suppression (21%). The goals of the proposed research are to 1) gain an understanding of the influences and mechanisms of individual and environmental factors influencing adherence to treatment protocols; and 2) develop a practical model to support improved clinical outcomes for adult males living with HIV. Candidate: I am a nurse-scientist with training in behavioral science and public health research. I am applying for a K23 Career Development Award to build expertise in intervention development and testing, with the goal of becoming an independent investigator focused on improving clinical health outcomes among individuals with elevated HIV prevalence in the Caribbean and the United States. My objective is to apply evidence-based strategies to support treatment adherence and improve health metrics in targeted populations. Mentoring: I have assembled a multidisciplinary mentoring team with robust experience in HIV clinical research, intervention development, and longitudinal study design. Drs. Sheri Weiser and Carol Dawson-Rose will serve as co-primary mentors, bringing complementary expertise in HIV treatment strategies, behavioral intervention development, and program implementation research contexts. My co-mentors, scientific advisor, and collaborator contribute domain-specific and methodological expertise from both the United States and Jamaica. They include: Dr. Mallory Johnson (clinical psychologist, intervention design and evaluation; feasibility implementation, HIV medication adherence); Dr. Tor Neilands (psychology, quantitative methods, design and analysis of longitudinal data); Dr. Sharlene Jarrett (clinical psychologist, mental health and HIV treatment in the Jamaican context); Carmen Logie (clinical social worker, and mixed methods researcher); Dr. Jae Sevelius (clinical psychologist, stigma measurements, and cognitive interviewing); Dr. Anita Stewart (psychologist, measurement adaptation and testing expert); and Dr. Mark Padilla (medical anthropologist, Caribbean researcher). Training: I propose to pursue structured training to build expertise in the adaptation and validation of psychosocial measurement tools, advanced methods in quantitative data collection and analysis, and the design and evaluation of HIV-related intervention models. This will be accomplished through a combination of one-on-one consultations with senior investigators, formal coursework, applied workshops, guided literature review, and implementation of a focused research project conducted in collaboration with partners in Jamaica. Research: The goals of the proposed research are to 1) examine individual and contextual factors that influence engagement in HIV care among adult males living with HIV in Jamaica; 2) design and operationalized a targeted intervention to improve care continuity and HIV medication adherence; and 3) assess the feasibility and implementation logistics of the proposed intervention using a piloted framework. This work will lay the foundation for a future R01 application aimed at full-scale testing and evaluation. Summary: National and international public health strategies have emphasized the importance of reducing HIV transmission by 2030 through evidence-based care engagement initiatives. The proposed research and training plan will prepare me to lead scientifically rigorous studies aimed at identifying and addressing key behavioral and logistical factors that influence HIV treatment adherence in the Caribbean, the United States, and globally. This work is intended to support improved
