Moving Beyond the Individual- A Data-driven Approach to Improving the Evidence on the Role of Community and Societal Determinants of HIV among Adolescent Girls and Young Women in Sub-Saharan Africa

PROJECT SUMMARY/ABSTRACT Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA), the epicenter of the global HIV epidemic, have carried the primary burden of new HIV infections in this area for at least 30 years. Research has prioritized characterizing the individual predictors of HIV infection among AGYW by creating risk assessment tools that identify high-risk sub-populations for targeted HIV prevention efforts. Despite substantial efforts, there remains a disproportionate burden of disease among this vulnerable population, suggesting a need to identify and assess targets of intervention beyond the individual. The primary goals of this R36 dissertation proposal, Moving Beyond the Individual: A Data-driven Approach to Informing the Evidence on the Role of Community and Societal Determinants of HIV among Adolescent Girls and Young Women in Sub- Saharan Africa, are to create a comprehensive data source that will facilitate new ways of assessing HIV risk among AGYW, generating improved knowledge about individual, interpersonal, community, and societal risk factors; to characterize the interplay among these variables; and to assess the impact of interventions that target community and societal drivers of infection to inform improved prevention efforts. To achieve these goals, we propose three aims that will leverage publicly available, population-based data from five countries in SSA (Cameroon, Eswatini, Malawi, Rwanda, and Uganda) and apply advanced data science and epidemiologic methodologies. Aim 1 is to integrate publicly available data from the Population-based HIV Impact Assessment Project (individual, interpersonal, community), the Population and Housing Census (community), and UNAIDS Law and Policy Indicators (societal) to create a large, multi-level public health dataset. Aim 2 is to characterize and graphically depict the pathways among individual, interpersonal, community, and societal risk factors of HIV infection among AGYW using causal discovery algorithms to identify underlying disease pathways. Aim 3 is to estimate the impact of intervening on community and societal drivers of HIV infection among AGYW using parametric g-computation to model proposed intervention effects. To examine these aims, we will take a novel, intersectional approach to assess HIV behavioral science inquiries by leveraging causal discovery algorithms and g-computation. Findings from this research will advance the National Institute of Mental Health Division of AIDS Research’s priority to improve the knowledge base informing interventions, thereby advancing the development of interventions that go beyond the individual to reduce the burden of HIV among AGYW. The research and mentorship of this R36 proposal have been carefully crafted to optimize the ongoing doctoral training and research experience of the Principal Investigator of this study while fostering her development as an African American independent research scientist in the future.