Public health relevance: The increasing prevalence of chronic disease, including diabetes, is a significant issue of growing concern for HIV-infected populations. The proposed research will define key issues in the co-management of HIV and diabetes and provide critical data to support the integration of structural interventions into diabetes management for vulnerable HIV-infected populations. More broadly, this career development award will foster the research independence of an investigator dedicated to bridging the study of diabetes, HIV and social determinants of health in order to improve health outcomes and reduce health disparities for vulnerable populations with diabetes and HIV.
A significant challenge facing the HIV epidemic is the increasing burden of chronic diseases, including diabetes mellitus (DM) and cardiovascular disease, requiring individuals to self-manage multiple complex conditions simultaneously. Furthermore, social and economic vulnerability is likely to intensify barriers to DM and HIV co-management. Yet limited evidence exists to understand the challenges individuals face in co- managing HIV and DM, and the specific ways that social and economic vulnerability (e.g. financial deprivation, food insecurity) influence HIV/DM co-management and subsequent health outcomes. In particular, HIV- infected women are disproportionately impacted by socioeconomic deprivation, indicating they may face even greater structural barriers to HIV/DM co-management. Responding to this challenge calls for leaders committed to and capable of conducting cross-cutting research bridging social/behavioral and clinical sciences, and HIV and DM-specific research streams. This K01 Mentored Research Scientist Development Award will build upon my previous training in health policy and previous research on HIV and economic vulnerability to enable me to become an independent investigator addressing the interplay of diabetes, HIV and social determinants of health. To achieve this goal I will obtain training and mentoring in clinical and population health aspects of DM; theories and measures of adherence and disease self- management; advanced statistical approaches including structural equation modeling; and intervention and trial design. I will be supported by a distinguished panel of mentors and advisors including HIV clinicians, social and behavioral researchers, endocrinologists and statisticians, led by Dr. Sheri Weiser, a leader in research addressing structural barriers to health in vulnerable populations. My mentored research plan will be a vehicle for these training goals and will leverage the infrastructure of the Women's Interagency HIV Study, a multi-site prospective study based in the United States (US) following the largest dedicated cohort of HIV-infected women worldwide and reflecting the age, race, and antiretroviral use profile of the US HIV epidemic among women. My research aims are: (1) To elucidate individual and contextual factors that enable or inhibit DM/HIV co-management; (2) To investigate the impact of a) HIV comorbidity on DM management (primary analysis), and b) DM comorbidity on ART adherence and HIV viral load (secondary analysis), examining the mediating or modifying role of social and economic factors; (3) To evaluate the impact of social and economic factors on DM/HIV co-management; (4) To develop and test the feasibility an intervention to improve DM/HIV co-management, targeting the factors identified in Aims 1-3. By intertwining my training goals with my proposed research, I will lay the groundwork for a long-term research agenda investigating and intervening on social and economic issues affecting DM and HIV comorbidity and co-management. My ultimate goal is to inform policies and programs spanning the clinical and community context to improve chronic disease outcomes for vulnerable populations with HIV.