Extreme heat, pollution, wildfire smoke, and aging among people living with or at risk for HIV

University Of California, San Francisco, San Francisco CA

Investigators

Linked publications & trials

Abstract

I am a Professor of Medicine and trained HIV social scientist with over 25 years of experience researching the impact of barriers to HIV and chronic disease prevention, treatment, and care in different populations. I am requesting funding for a five-year renewal of my K-24 award, the first cycle of which helped me establish a productive patient-oriented research (POR) and mentoring program focused on HIV and aging, leading to over 150 publications; three new R-01s, one D-43, and one R-21; and 13 R-01s (plus 6 pending) and 16 K awards for my mentees. Through my K-24 training and research, including recent work on material-need insecurities, I have learned that heatwaves, wildfires, and other ecologic stressors are among the most underrecognized drivers of poor health in populations living with chronic conditions that compromise their health. This K-24 renewal would allow me to expand my POR program and mentorship to encompass research on ecological stressors, health, aging, and HIV. Building upon the HIV and aging research conducted during the first K-24 cycle, I am proposing to 1) examine how exposures to heatwaves and fine particulate matter from wildfire smoke and other sources relate to frailty and cognitive function over time, 2) test whether relationships differ by HIV serostatus, and 3) identify mechanisms of effect and factors that increase vulnerability to and resilience against the detrimental health and aging impacts of heatwaves and poor air quality. This project will leverage data from the Multicenter AIDS Cohort Study/Women’s Interagency HIV Study Combined Cohort Study (MWCCS). Mentees will have access to data from this and my many other projects to build their own research portfolios in this domain. This project is innovative in its use of novel methodological approaches to isolate measures of wildfire smoke from overall air quality and its longitudinal examination of aging-related health outcomes in relation to concurrent and repeated exposures among people living with and at risk for HIV. To realize the proposed study aims and more effectively mentor others on these topics, I will pursue training to enhance my understanding of key concepts in relation to ecological stressors and health, methods of measuring time-varying exposures and cognitive impairment, and state-of-the-science causal inference methods for identifying risk and mitigating factors that accelerate aging. I will also create a structured mentoring program on predictors of aging and barriers to chronic disease management that will include seminars and workshops in causal inference methods for environmental epidemiology, a bi-monthly Research Accelerator with works-in-progress meetings, and seed grants to support mentee productivity. With the aging population in the U.S., understanding factors that contribute to cognitive decline and frailty is highly relevant for the American public. This K-24 renewal will be instrumental to developing a strong multidisciplinary mentoring program focused on addressing the understudied risk factors for poor disease and aging outcomes to identify areas of intervention that may help improve the health and longevity of the American population.