Grant: Project Grant

THE ISSUE: Climate change increases extreme weather events (EWE), such as extreme heat, floods, and droughts that directly and indirectly impact health outcomes. Yet knowledge gaps remain regarding climate change impacts on HIV prevention and care. OUR IDEA: This novel study focuses on Tanzania, among the world's largest HIV epidemics with 1.7 million people living with HIV, and among the 15% most vulnerable countries to climate risks. We aim to identify climate-related drivers of HIV prevention and care in Tanzania to inform future interventions. OUR APPROACH: This 3-year mixed-methods study will leverage retrospective and prospective data from 2 existing cohorts (Prospective Urban and Rural Epidemiological Study [PURE], Kilimanjaro Christian Medical Centre [KCMC]) with people of diverse ages, genders, and HIV serostatus in rural and urban Moshi, Kilimanjaro region. Our central hypothesis is that climate change-related factors will lead to poorer HIV prevention and care outcomes via migration, stigma, health practices, violence, and infectious disease mechanistic pathways. We aim to enhance understanding of a) linkages between structural drivers including EWE and resource scarcity (food, water, and sanitation insecurity); b) pathways from resource scarcity to HIV prevention and care outcomes; c) factors that heighten vulnerability to or enhance resilience against the effects of resource scarcity on HIV outcomes in order to inform climate resilient, gender transformative HIV prevention/care interventions. Phase 1: Preparation, including developing and pilot testing the survey and longitudinal interview guide. Phase 2: Retrospective analysis of PURE and KCMC data, and prospective data collection with PURE and KCMC cohorts at 4 timepoints over 2 years. Longitudinal interviews at 2 timepoints. Phase 3: Mixed-methods integration, community dialogue, and think tank. IMPACT: Novel knowledge of mechanistic pathways from climate-related factors to HIV prevention and care.