"I only seek treatment when I am ill": experiences of hypertension and diabetes care among adults living with HIV in urban Tanzania.

BACKGROUND: For adults living with HIV (ALHIV) and comorbidities, access to comprehensive healthcare services is crucial to achieving optimal health outcomes. This study aims to describe lived experiences, challenges, and coping strategies for accessing care for hypertension and/or diabetes (HTN/DM) in HIV care and treatment clinics (CTCs) and other healthcare settings. METHODOLOGY: We conducted a qualitative study that employed a phenomenological approach between January and April 2022 using a semi-structured interview guide in six HIV CTCs in Dar es Salaam, Tanzania. We purposively recruited 33 ALHIV with HTN (n = 16), DM (n = 10), and both (n = 7). Thematic content analysis was guided by the 5As framework of access to care. FINDINGS: The majority of the participants were females, between the ages of 54-73, and were recruited from regional referral hospitals. HIV CTCs at regional referral hospitals had more consistent provision of HTN screening services compared to those from district hospitals and health centers. Participants sought HTN/DM care at non-CTC health facilities due to the limited availability of such services at HIV CTCs. However, healthcare delivery for these conditions was perceived as unaccommodating and poorly coordinated. The need to attend multiple clinic appointments for the management of HTN/DM in addition to HIV care was perceived as frustrating, time-consuming, and financially burdensome. High costs of care and transportation, limited understanding of comorbidities, and the perceived complexity of HTN/DM care contributed to HTN/DM treatment discontinuity. As a means of coping, participants frequently monitored their own HTN/DM symptoms at home and utilized community pharmacies and dispensaries near their residences to check blood pressure and sugar levels and obtain medications. Participants expressed a preference for non-pharmaceutical approaches to comorbidity management such as lifestyle modification (preferred by young participants) and herbal therapies (preferred by older participants) because of concerns about side effects and perceived ineffectiveness of HTN/DM medications. Participants also preferred integrated care and focused patient education on multimorbidity management at HIV CTCs. CONCLUSION: Our findings highlight significant barriers to accessing HTN/DM care among ALHIV, mostly related to affordability, availability, and accessibility. Integration of NCD care into HIV CTCs, could greatly improve ALHIV health access and outcomes and align with patient preference.

Variations of a group coaching intervention to support early-career biomedical researchers in Grant proposal development: a pragmatic, four-arm, group-randomized trial.

BACKGROUND: Funded grant proposals provide biomedical researchers with the resources needed to build their research programs, support trainees, and advance public health. Studies using National Institutes of Health (NIH) data have found that investigators from underrepresented groups in the biomedical workforce are awarded NIH research grants at disproportionately lower rates. Grant writing training initiatives are available, but there is a dearth of rigorous research to determine the effectiveness of such interventions and to discern their essential features. METHODS: This 2 × 2, unblinded, group-randomized study compares the effectiveness of variations of an NIH-focused, grant writing, group coaching intervention for biomedical postdoctoral fellows and early-career faculty. The key study outcomes are proposal submission rates and funding rates. Participants, drawn from across the United States, are enrolled as dyads with a self-selected scientific advisor in their content area, then placed into coaching groups led by senior NIH-funded investigators who are trained in the intervention's coaching practices. Target enrollment is 72 coaching groups of 4-5 dyads each. Groups are randomized to one of four intervention arms that differ on two factors: [1] duration of coaching support (regular dose = 5 months of group coaching, versus extended dose = regular dose plus an additional 18 months of one-on-one coaching); and [2] mode of engaging scientific advisors with the regular dose group coaching process (unstructured versus structured engagement). Intervention variations were informed by programs previously offered by the NIH National Research Mentoring Network. Participant data are collected via written surveys (baseline and 6, 12, 18, and 24 months after start of the regular dose) and semi-structured interviews (end of regular dose and 24 months). Quantitative analyses will be intention-to-treat, using a 2-sided test of equality of the effects of each factor. An inductive, constant comparison analysis of interview transcripts will be used to identify contextual factors -- associated with individual participants, their engagement with the coaching intervention, and their institutional setting - that influence intervention effectiveness. DISCUSSION: Results of this study will provide an empirical basis for a readily translatable coaching approach to supporting the essential grant writing activities of faculty, fellows, and other research trainees, including those from underrepresented groups.

A Summary Report from the Research Partnership on Women in Science Careers.

BACKGROUND: In response to the landmark report "Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering," the NIH Office of Research on Women's Health issued a request for applications that funded 14 R01 grants to investigate causal factors to career success for women in STEM. Following completion of the 4-year grants, the grant PIs formed a grassroots collaborative, the Research Partnership on Women in Science Careers. OBJECTIVE: To summarize the work of the Research Partnership, which resulted in over 100 publications. METHODS: We developed six themes to organize the publications, with a "Best Practices" for each theme at the end of each section: Barriers to Career Advancement; Mentoring, Coaching, and Sponsorship; Career Flexibility and Work-Life Balance; Pathways to Leadership; Compensation Equity; and Advocating for Change and Stakeholder Engagement. RESULTS: Women still contend with sexual harassment, stereotype threat, a disproportionate burden of family responsibilities, a lack of parity in compensation and resource allocation, and implicit bias. Strategies to address these barriers using the Bronfenbrenner ecological model at the individual, interpersonal, institutional, academic community, and policy levels include effective mentoring and coaching, having a strong publication record, addressing prescriptive gender norms, positive counter-stereotype imaging, career development training, networking, and external career programs such as the AAMC Early and Mid-Career Programs and Executive Leadership in Academic Medicine (ELAM). CONCLUSIONS: Cultural transformation is needed to address the barriers to career advancement for women. Implementing the best practices noted of the work of the Research Partnership can help to achieve this goal.

Tender heroes and twilight lovers: re-reading the romance in mass-market pulp novels, 1950-1965.

In mid-century popular presses published paperbacks about lesbians, gay men, and characters with male and female lovers.  Barbara Grier was the first to catalog novels featuring lesbian subplots by classifying stories based on the extent and style of lesbian content.  I perform a content analysis of 49 novels, motivated by these questions:  How did novels with lesbian and gay characters differ from heterosexual romances?  What do differences reveal about cultural understandings of love, gender, and sexuality?  I find uniformity in the structural logic of novels.  However, there are different narrative strategies, and protagonists' gender and sexuality predict a novel's trajectory.

Using longitudinal qualitative research to understand the experiences of minoritized people.

This paper demonstrates how Longitudinal Qualitative Research (LQR) is an innovative method to understand the lived experiences of members of minoritized groups when temporality is a structuring element of their experiences. Most qualitative research in psychology is cross-sectional, which limits our understanding of individuals whose experiences are context-dependent and linked to the temporal norms of specific social environments. LQR is unique for allowing researchers to compare change and stability over time and reveal how social challenges and barriers impact perspective shifts and long-term decision-making. To demonstrate the usefulness of LQR as an inclusive methodology, we discuss an ongoing study of career decision-making among a diverse cohort of biomedical scientists. We have used annual interviews to follow biomedical science trainees from the beginning of their PhD into the initial stages of their careers. We present case studies of minoritized scientists to illustrate the methods for long-term engagement used to elicit sensitive and critical information during their training. We show how LQR is a viable methodology for a variety of research questions and can be accomplished using large or small sample sizes and limited resources. Our primary goal is to show how LQR is useful to understand the experiences of minoritized individuals in contexts that have historically excluded them.

Partnering and Programming for a Black, Indigenous, and People of Color Sexual and Gender Minority Pathway to HIV Research.

BACKGROUND: There is an urgent need to conduct innovative research on the health needs of populations whose intersecting identities, such as being Black, Indigenous, and other People of Color (BIPOC) and sexual and gender identity (SGM) persons, put them at greater risk of HIV infection. More so, as important as it is to train on the best practices, it is as important to train aspiring BIPOC SGM scholars in intersectional HIV science so that they can address the HIV-related issues of BIPOC SGM populations. METHODS: In line with guidelines to increase diversity in the HIV workforce, we sought to (1) solidify the interest of BIPOC SGM trainees engaging in intersectional HIV science by piloting a 2-week Summer Intensive Program, (2) leverage the relationships and resources of our community partner to enhance our recruitment from HBCUs and MSIs, and (3) identify opportunities for postprogram training and mentoring activities. RESULTS: Our data suggest that participants gained a great deal from the instructional sessions. Participants commented on the quality of the sessions, effectiveness of the instructional faculty, and a confirmed interest in HIV science. CONCLUSIONS: We succeeded in promoting interest in and commitment to HIV science among early career BIPOC SGM scholars. An instructional program of this intensity is best suited to those with some experience in graduate school and existing interest in HIV science. As a program serving multiply minoritized populations, clarification of host institution policies and procedures, as well as administrative support, are essential for ensuring a smooth experience for scholars visiting from outside institutions.

Patient reported experience measures on HIV viral load testing at public health facilities in Dar es Salaam, Tanzania: A convergent mixed method study.

While viral load (VL) testing is critical to effective treatment of human immunodeficiency virus (HIV), little is known about patients' experiences with, and barriers to VL-testing in the context of HIV infection. We assessed patient reported experience measures (PREMs) on VL-testing in public HIV clinics in Tanzania. In a cross-sectional convergent mixed method study, we collected information on VL test related PREMs, clinical and sociodemographic factors. PREMs were measured using a 5-point Likert scale. Focus Group Discussions (FGDs) explored on experience, access, and barriers to VL-testing. Descriptive statistics summarized patients' factors and PREMs. Logistic regression was used to explore association of patient factors, PREMs and satisfaction with VL-testing services. Thematic analysis was used for qualitative data. A total of 439 (96.48%) respondents completed the survey, 331 (75.40%) were female, median (IQR) age was 41(34, 49) years. A total of 253(57.63%) had a VL test at least once in the past 12 months, of whom 242(96.0%) had VL<1000 copies/ml. Investigating barriers to VL-testing, most participants (>92.0%) reported good or very good health services responsiveness (HSR). A scale of very good was chosen by the majority for being treated with respect 174(39.6%), listened to 173(39.4%), following advice 109(24.8%), being involved in decisions 101(23.0%), and for communication 102(23.3%). Satisfaction on VL-testing services was significantly associated with respondents following care providers' advice, (aOR) = 2.07 [95%CI 1.13-3.78], involvement in decisions aOR = 4.16 [95%CI 2.26-7.66], and communication aOR = 2.27 [95%CI 1.25-4.14]. FGDs findings converged with the survey data, with identified barriers to VL test including lack of autonomy in decision making, little awareness on the benefits of the test, long waiting time, stigma, competing priorities for those with comorbidities and transport costs. Satisfaction on VL-testing was largely a result of involvement in decision making, following care provider's advice and good communication; entities needing universal improvement across the country.

Identifying leaks in the STEM recruitment pipeline among sexual and gender minority US secondary students.

PURPOSE: Research establishes the critical need to address the underrepresentation of women and racial/ethnic minorities in science, technology, engineering, and mathematics (STEM). While emergent research addresses similar challenges for sexual and gender minorities (SGM), this research remains scant and focuses on adult experiences. This analysis examines subgroup differences and the impact of bullying on STEM engagement outcomes among a national sample of SGM secondary students in the U.S. METHOD: This report provides descriptive and multivariable regression analysis of national survey data (n = 539) on the experiences of pre-college students who identify as SGM, including the effects of within-school anti-SGM bullying on STEM identity, perceptions of STEM climate, and STEM intentions. RESULTS: Roughly 50% of the sample intended to enter a STEM field (compared to 25% in previous general samples). Bullying in school was negatively associated with STEM identity and perceptions of STEM climate. Sense of belonging is positively associated with perceptions of STEM climate and STEM intentions. Being non-binary and being a transgender man were associated with decreased sense of belonging and negative perception of STEM climate. CONCLUSION: This report is the first to identify factors influencing STEM engagement among SGM secondary students and suggests that issues of STEM engagement are already present in adolescence. Moreover, the findings also establish the relationship between anti-SGM bullying and STEM outcomes highlighting the importance of this marginalization experience. Future research should further examine sub-group differences and the persistence of these effects. These findings highlight the need for research and intervention addressing STEM outcomes in SGM populations. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03511131.

Culturally aware mentorship: Lasting impacts of a novel intervention on academic administrators and faculty.

National efforts to address the diversity dilemma in Science, Technology, Engineering, and Math (STEM) often emphasize increasing numbers of historically underrepresented (HU) students and faculty, but fall short in instituting concrete changes for inclusion and belonging. Therefore, increasing the pool of senior faculty who wish to become guides and advocates for emerging scientists from HU populations is an essential step toward creating new pathways for their career advancement. As a step toward achieving this goal, we created a novel eight-hour intervention on Culturally Aware Mentoring (CAM), a program of the National Research Mentoring Network (NRMN) targeted to faculty and administrators. A previous report of surveys at the end of the CAM sessions revealed substantial awareness and knowledge gains, with participants expressing intentions to use and implement new skills they had learned. In this paper, we provide the results of our thematic analysis of qualitative interviews with academic administrators and faculty, 18-24 months after participation in CAM. Interviews were designed to determine: 1) What changes in self-perceptions and interactions occurred as a result of participation in CAM? 2) What specific components of CAM are associated with changes in individual beliefs and practices? 3) How did participants actively make changes after the CAM workshop? 4) What barriers or challenges do participants encounter after the CAM intervention? The results demonstrate the lasting influences of CAM on participants' awareness of cultural differences, their assumptions about and approaches toward interactions with colleagues and students, and their efforts to change their behaviors to promote inclusive practices in their mentoring and teaching of HU students in STEM. Our findings provide evidence that CAM can be incorporated into existing mentor training programs designed to improve the confidence and capacity of senior research faculty mentors to make culturally-informed, scholar-centered decisions to more deliberately recognize and respond to cultural differences within their mentoring and collegial relationships.

The ASPET Mentoring Network: Enhancing Diversity and Inclusion through Career Coaching Groups within a Scientific Society.

Over the past decades, two persisting priorities in science, technology, engineering, and mathematics (STEM) training have been: 1) increasing the knowledge of and access to careers beyond academic scientist; and 2) increasing the diversity of the STEM workforce. Previous studies show that a uniquely constructed career coaching group provides strong support and progress for both priorities. This report extends this design into a more sustainable model that is positioned within the professional context of rising young scientists. This new model is based in the American Society for Pharmacology and Experimental Therapeutics (ASPET)-the ASPET Mentoring Network. Groups of PhD students and postdocs were assigned to an ASPET professional (academic or other career) member (the coach) with an initial meeting held the day before the society's annual meeting. The coaching groups interacted during the meeting and then virtually for a year. Extensive survey and interview evaluation data gathered from the first three cohorts (12 coaching groups) in 2016- 2018 provided strong evidence of the perceived and real benefits of the network. This new version of career coaching groups is both feasible and linked to career success due to its close association with a scientific society, peers, and coaches who share scientific identities and aspirations.

The National Longitudinal Study of Young Life Scientists: Career differentiation among a diverse group of biomedical PhD students.

Young biomedical PhD scientists are needed in a wide variety of careers. Many recent efforts have been focused on revising training approaches to help them choose and prepare for different careers. However, very little is known about how biomedical PhD students decide on and "differentiate" into careers, which limits the development of new training models. This knowledge gap also severely limits efforts to increase the representation of women and some racial/ethnic groups in academic research careers. Previous studies have used cross-sectional surveys of career interests and ratings, and have not been designed to identify career intentions. They also are limited by single-time data and response bias, having typically asked participants to recount decisions made years in the past. This report draws on annual, in-depth interviews with 147 biomedical PhD students from the start of the PhD to graduation. Qualitative content analysis methods were used to fully understand scientific development and career intentions over time. Longitudinal analysis reveals a striking level of fluidity and complexity in career intentions over time. Contrary to previous studies and the dominant narrative, data do not show generalized shifts away from academic careers. In addition to those who are consistent in this intention from the start, nearly as many students shift toward research academic careers as away from them, and only modest differences exist by gender and race/ethnicity. Thus, the dominant narrative misses the high fraction of individuals who acquire or sustain their intention to purse an academic research career during training. Efforts to increase diversity in academia must capitalize on and support those who are still considering and evolve toward an academic career. Efforts to revise research training should incorporate knowledge of the tremendous fluidity in when and how career differentiation occurs.

Evaluation of Professional Setbacks and Resilience in Biomedical Scientists During the COVID-19 Pandemic.

This survey study evaluates whether resilience was associated with professional and career setbacks among biomedical scientists during the COVID-19 pandemic.

'AN INCREDIBLY STEEP HILL:' HOW GENDER, RACE, AND CLASS SHAPE PERSPECTIVES ON ACADEMIC CAREERS AMONG BEGINNING BIOMEDICAL PHD STUDENTS.

This paper analyzes perspectives on academic careers among 60 beginning PhD students in the biomedical sciences. It presents seven perspectives on academic careers articulated by the students in the sample and explains the way that race/ethnicity, gender, and students' family education backgrounds are tied to those perspectives. The findings show that traditionally underrepresented students find the academic career path less navigable than students from well-represented groups. Among underrepresented students, even those from higher family education backgrounds, experiences related to race/ethnicity and gender often inform perceptions of the academic career even before they start their graduate research training. As the composition of the graduate population changes to include more women and underrepresented racial and ethnic minority men, it is important to note that not all graduate students enter with the same perspectives and views of the academic career and that there are meaningful differences in perspectives across demographic lines. Graduate programs can play a critical role in providing information and support for graduate students as they navigate their career choices, particularly at the earliest stages of training. By becoming sensitive to students' perspectives on career options, and understanding how differences in perspectives arise, mentors and others can align advising strategies with the experiences and views of students.

How Women in Biomedical PhD Programs Manage Gender Consciousness as They Persist Toward Academic Research Careers.

PURPOSE: Women remain underrepresented as biomedical faculty and are more likely than white and Asian men to lose interest in faculty careers in graduate school. However, some women maintain interest in academic research careers during PhD training and are the most likely candidates for faculty positions. This study explored how these women described and interpreted gender issues at early stages in their training. METHOD: Annual interviews from 2009 to 2014 with 22 female PhD students aspiring to research faculty careers were analyzed using an iterative, content analysis approach rooted in the interview data. Focusing on career intentions and experiences with gender, race, and ethnicity, authors arrived at 11 themes which describe a range of gendered experiences and strategies. RESULTS: Of the 22 women, 19 (86%) acknowl edged systemic gender inequities in science and/or reported instances of bias, while 15 of them also said they had not yet experienced unequal treatment. All 22 described using at least one "gender-explicit strategy," where they based decisions on gender or in response to perceived biases. "Gender-agnostic strategies" emerged for 12 (55%) who doubted that gender will affect their career. CONCLUSIONS: Findings show that women biomedical PhD students continue to face conditions that can lead to unequal treatment; gender biases continue to persist. Students displayed a range of perceptions and strategies in response to these conditions at this early training stage. Following these students over time will determine whether these or other strategies are required and sufficient to enable persistence toward academic careers.