Project 461713

THE ISSUE: Globally, there are 38 million people living with HIV (PLHIV)-two-thirds of whom live in sub-Saharan Africa. HIV prevalence is highest in the regions most impacted by climate change and extreme weather events (EWE). Yet pathways from climate change to HIV care cascade outcomes among PLHIV are understudied. OUR IDEA: This novel study with youth living with HIV (YLHIV) (aged 16-24) in Central and Eastern Uganda will examine pathways between ecosocial factors, resource scarcity, and the HIV care cascade, and identify protective factors. Our goal is to elucidate climate-related and other ecosocial drivers of HIV care among YLHIV to identify target mechanisms to inform future interventions. OUR APPROACH: Our 4 year mixed-methods study will examine pathways between structural factors (ecologic [e.g., drought], socioeconomic, gender norms), resource scarcity (food, water and sanitation insecurity), and HIV care cascade outcomes (e.g., retention in care, antiretroviral therapy uptake and adherence, viral suppression) among YLHIV aged 16-24 in 2 climate-affected regions in Uganda: Kampala's informal settlements and Namayingo's fishing villages. We will examine pathways via violence, stigma, infectious diseases, migration, and health practices. Phase 1: Qualitative research to develop longitudinal interview guides and pilot data collection tools. Phase 2: Longitudinal survey with a clinic-based sample of YLHIV (n=500, 250 per location) in Kampala and Namayingo at 4 time-points over 2 years corresponding with rainy and dry seasons. Longitudinal interviews with 40 participants (20 per location) at 2 time-points (once in a rainy and once in a dry season). Phase 3: Mixed-methods integration, community dialogue, and think tanks informed by the BRACE framework (Building Resilience Against Climate Effects). IMPACT: New knowledge of a) climate-related factors and HIV care cascade outcomes and b) mechanisms to inform future climate resilience and HIV tailored interventions.