Mobility-Responsive Implementation Strategies to Enhance HIV Care Continuity among Female Sex Workers in South Africa

About This Grant

Mobility is a well-recognized antecedent of HIV care disengagement in South Africa, but more research is needed to understand how different types and patterns of mobility impact HIV care continuity among marginalized populations like female sex workers (FSW), who experience suboptimal antiretroviral therapy (ART) adherence and viral load suppression. Emerging evidence indicates that everyday mobility, or day-to-day movements within a contained geographic area, may be a more prominent driver of HIV care discontinuity than cross-jurisdictional mobility (typically associated with internal migration) among FSW, but these mobility dynamics and their impacts on HIV self-management and treatment-seeking remain understudied. This four-year K01 Mentored Research Scientist Development Award will facilitate the multidisciplinary training and mentorship of Dr. Joseph G. Rosen (a social and behavioral HIV prevention scientist whose scholarship has historically focused on people who use drugs), facilitating his transition to independent research that develops and tests implementation strategies to optimize HIV care continuity among mobile and displaced populations. Under the primary mentorship of Dr. Susan Ramsey, a clinical psychologist with expertise in development and evaluation of HIV care engagement interventions, the K01 training proposal includes: (i) tailored co-mentorship and experiential learning with a cohesive, multidisciplinary team of seasoned HIV researchers with complementary expertise in mobility (Dr. Mark Lurie), spatial epidemiology (Dr. Thomas Stopka), ethnography (Dr. Jaclyn Hughto), intervention development and strategy specification (Dr. Sheree Schwartz), and FSW-tailored HIV treatment delivery (Dr. Harry Hausler); (ii) didactics, coursework, and directed readings in areas of transitional scholarship for Dr. Rosen, specifically mobility and HIV treatment; and (iii) mentored primary research in South Africa, propelling Dr. Rosen's pursuits to establish an independent, thriving program of interdisciplinary, mixed-methods HIV treatment research leveraging implementation science principles and methods from social epidemiology. The goal of the proposed K01 research is to characterize patterns of everyday mobility among FSW in South Africa and identify mobility-responsive implementation strategies enhancing their HIV care continuity. Specific aims are to: (1) characterize the spatial distribution of inter-venue mobility among FSW and their prospective association with indicators of HIV care disengagement; (2) identify patterns and drivers of day-to-day mobility, as well as their perceived impact on HIV care-seeking and self-management practices, among FSW; and (3) specify a package of implementation strategies that sustain ART adherence and enhance HIV care continuity in the context of mobility among FSW. By the conclusion of this K01, Dr. Rosen will be positioned to lead independent research testing mobility-responsive implementation strategies (identified and prioritized in the proposed K01) to optimize HIV care continuity among mobile FSW through a hybrid type I effectiveness-implementation, fractional factorial trial.