Preventing disruptions in progress towards ending HIV/AIDS: Lessons from the COVID-19 pandemic

PROJECT SUMMARY Public health emergencies, including conflict, natural disasters, and local and global epidemics and pandemics, have the potential to disrupt progress towards ending the HIV/AIDS epidemic. Understanding the impact that these disruptive events have on the HIV epidemic over time is essential to mitigating their effects. In the present study, using the COVID-19 pandemic in South Africa as a case example, we will establish applied methods for estimating disruptions in HIV outcomes and identifying modifiable intervention targets. Specifically, the research plan focuses on 1) building a database that harmonizes multiple national surveillance systems across South Africa to enable the generation of robust HIV, mental health, and social determinant of health (SDoH) estimates; 2) conducting an interrupted time series analysis to examine short- and long-term trends in HIV prevention and care outcomes, mental health, and SDoH prior to and during COVID-19 in South Africa; and 3) extending an existing agent-based model (ABM) to identify social factors predictive of HIV outcomes during COVID-19 and simulate the impact of changes on predictive factors to identify targets for hypothetical interventions. This application in response NOSI NOT-AI-21-057 (HIV/AIDS in the Era of COVID-19) is extremely timely as the effects of the COVID-19 pandemic continue to evolve and predictions indicate future emerging epidemics and other disruptive events are imminent. Through this award, I will extend my prior experience in program implementation in South Africa and training in epidemiologic methods to 1) acquire a foundation of knowledge in techniques for harmonizing data across multiple national surveillance systems; 2) develop proficiency in advanced data science methods, including an interrupted time series design analysis and agent-based modeling; 3) cultivate expertise on the impact of disruptive events on the HIV epidemic, including the role of social and contextual factors, and methods for identifying effective, policy-relevant intervention programs; and 4) build the foundation for an academic career in global health research by strengthening international collaborations and grantsmanship, research dissemination, and policy engagement skills. To accomplish these goals, I will complete coursework, workshops, and independent study; participate in mentored training and mentored original research; engage with South African policy makers; attend and present at multiple meetings and conferences annually; and complete numerous manuscripts and grant applications. Completion of this training program will allow me to develop the language, concepts, and principles necessary to work with multidisciplinary teams of modeling and implementation experts, which will be instrumental in securing subsequent funding to develop methods for forecasting disruptions and identifying effective, policy-relevant interventions in real time. Importantly, this award will also allow me to launch a robust, independent academic research career focused on conducting rigorous epidemiological research to prevent future disruptive events from perpetuating health disparities in generalized HIV epidemic settings.