Food insecurity is common among poor women and HIV-infected persons, and has been associated with worse HIV and chronic disease outcomes, especially among aging populations. The proposed 5-year study aims to answer key unresolved questions, namely “What is the magnitude of the impact of food insecurity on aging outcomes in HIV?”, “Which mechanisms drive this impact?” and “What are the upstream drivers of food insecurity in an aging population?”. This research will be critical to: 1) help inform which HIV-infected persons to prioritize for new interventions; 2) select among the various programmatic options for improving food insecurity among HIV-infected women; 3) provide the best and most feasible causal evidence linking FI and aging outcomes which may garner funding to alleviate FI in this population; and 4) inform the integration of systems responding to these interlinked problems, given that funding and programs for FI, aging and HIV are largely separate.
Dr. Weiser is an internist trained in HIV epidemiology whose research program focuses on the intersection between food insecurity (FI) and health outcomes in HIV, and on interventions to reduce FI as a mechanism to improve HIV care delivery. She is a sought-after mentor and won the UCSF Academic Senate Distinction in Mentoring Award. Protected time for mentoring and for an innovative new line of research is instrumental for her to achieve her long-term career goals of becoming an international leader in patient-oriented research (POR) related to FI and HIV health, and of developing a multidisciplinary mentoring program and eventual training hub in this area. This K24 application proposes a comprehensive plan for career development, mentoring, and research, which together work towards the goal of reducing HIV health disparities, including an expansion of her research into a new direction by examining how FI affects aging outcomes in HIV. Her proposed career development plan will provide training in frailty, cognitive disorders of aging, multilevel modeling and geospatial methods, as well as in mentoring and leadership skills. She proposes a structured mentoring program including individual development plans and formal and informal teaching to help mentees reach targeted goals. She will recruit mentees from new disciplines such as geriatrics, neurology and psychology, and more mentees from underrepresented backgrounds as is critical for health disparities research. This mentoring program will help her train the next generation of researchers in FI and HIV. To stimulate innovative POR while providing opportunities for increased, more effective mentoring, she proposes to leverage the platform of the Women's Interagency HIV Study (WIHS) and expand her research into three new domains: 1) determining the impact of FI on aging outcomes including frailty and cognitive impairment; 2) understanding the mechanisms though which FI may mediate these outcomes using a novel conceptual model; and 3) investigating upstream determinants of FI using census tract data. This study is innovative in being: 1) one of the first to determine longitudinal impacts of FI on frailty and cognitive impairment and the first among HIV-infected women; 2) one of the first to assess potential mechanisms for how FI may contribute to frailty and cognitive impairment; and 3) one of the first to evaluate neighborhood-level predictors of FI using a rigorous multi-level modeling approach, and in a large sample of HIV-infected and uninfected women. To accomplish her aims and answer high impact questions at minimal cost, she will leverage data already collected in WIHS, and add measurements of FI and dietary quality for three years. She will also lead a qualitative study to understand the neighborhood- and policy-level contexts of FI and how they shape the lived experiences of health. The proposed research will help Dr. Weiser build a strong interdisciplinary network of early career investigators, provide an opportunity to address her training goals, accelerate progress towards her long- term career goals, and provide preliminary data and training opportunities for her mentees.