PROJECT SUMMARY The purpose of the proposed Mentored Patient-Oriented Career Development Award (K23) is to provide the candidate with training and research experiences that will promote her development to independent researcher as an HIV interventionist, specializing in expanding HIV care to communities who utilize Traditional Healers rather than biomedical facilities. The proposed training will provide her with the opportunity to develop knowledge and skills in: 1) quantitative methods needed to analyze cross-sectional, longitudinal and cohort data; 2) mixed-methods approaches to studying HIV and modeling HIV-related health behavior; and 3) theory, design and implementation of socio-structural interventions. Training activities will include didactic coursework and specific workshops, directed readings and one-on-one tutorials with mentors, and instruction in the responsible conduct of research. The candidate will receive mentorship from a Training Team comprised of globally renowned experts in the fields of HIV epidemiology, mixed methods research, and socio-structural intervention implementation in low-resource settings. Her applied research training will take place in Mbarara, Uganda in collaboration with Mbarara University of Science and Technology. Mbarara District is a rural region, approximately 275 kilometers southwest of the capital city of Kampala, with an HIV prevalence of nearly twice the national average (12%). Prior research in Mbarara has demonstrated the importance of Traditional Healers in providing healthcare for communities in this area, but little is known about Traditional Healer practices or rates of HIV testing (or HIV infection) among their clients. Specific aims of this study are to: 1) identify key socio-structural factors that frame HIV testing behaviors among Ugandan adults who utilize Traditional Healers; 2) investigate acceptability of providing point-of-care HIV testing at Traditional Healer practice locations; and 3) develop and pilot a prospective HIV testing intervention among Traditional Healer patients to promote earlier diagnosis. Results will generate effect estimates for parameters needed to inform power calculations for a subsequent, large-scale cluster-randomized HIV testing intervention at Traditional Healer practice locations, and will position the candidate to develop an R01 application for submission to NIMH at the end of the award period. The proposed work represents a high priority research topic designated by the NIH Office of AIDS Research to “reduce incidence of HIV/AIDS … [by] developing, testing, and implementing strategies to improve HIV testing and entry into prevention services”.

PROJECT NARRATIVE HIV antiretroviral therapy has the potential to dramatically decrease HIV transmission worldwide; yet, a barrier to ending the AIDS epidemic in low-resource settings is the fact that healthcare is largely provided by traditional or spiritual healers rather than biomedical providers, and there are no strategies in place to identify HIV-infected patients among Traditional Healer patients and link them to HIV care. Findings from the proposed study include formative data on populations that utilize Traditional Healers in an HIV-endemic region of Uganda, and pilot testing of an HIV testing intervention at healer practice locations; these results could be applied towards expanding HIV testing in other low-resource, endemic settings. Developing skills in healthcare- based HIV intervention research will uniquely position the candidate as one of the only HIV interventionists with expertise in expanding HIV care to communities who utilize Traditional Healers.