HEU outcomes: population-evaluation and screening strategies (HOPE)

HEU 结果：人群评估和筛查策略 (HOPE)

• 批准号: 10645291
• 负责人: Grace John-Stewart
• 金额: $ 66.35万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-07 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10645291
• 关键词: Adolescence; Adolescent; Adult; Adult Children; Affect; Africa South of the Sahara; Age; Anti-Retroviral Agents; Anxiety; Assessment tool; Attention deficit hyperactivity disorder; Biological Markers; Blood; Brain imaging; Caring; Child; Clinic; Clinical Data; Cognitive; Collaborations; Communities; Complement; Computerized Medical Record; Cost Analysis; Data; Depression and Suicide; Development; Diagnostic; Early Intervention; Educational workshop; Enrollment; Epidemiology; Evaluation; Exposure to; Future; General Population; Growth; Guidelines; HIV; HIV antiretroviral; HIV-exposed uninfected infant; Health; Hearing; Income; Individual; Infant; Infection; Inflammation; Intervention; Kenya; Length; Link; Longitudinal Studies; Longitudinal cohort; Medical; Medical Records; Mental Depression; Mental Health; Monitor; Morbidity - disease rate; Mother-to-child HIV transmission; Mothers; Neurodevelopmental Deficit; Outcome; Performance; Perinatal; Persons; Pharmaceutical Preparations; Phase; Policies; Population; Pregnancy; Prevention; Public Health; Regimen; Risk; Sampling Studies; Screening procedure; Site; Spottings; Surveys; System; Treatment Protocols; Viral Load result; Woman; Work; adverse outcome; aged; autism spectrum disorder; base; clinically relevant; cofactor; cohort; cost estimate; design; diagnostic tool; efavirenz; epidemiology study; experience; fetal; follow-up; health assessment; imaging study; infancy; insight; mortality; neurodevelopment; novel strategies; open source; pilot test; population based; prenatal exposure; prevent; programs; recruit; rural setting; screening; screening program; telomere; tool; treatment guidelines; urban setting

ABSTRACT There is a substantial and growing population of children/adolescents who are HIV exposed uninfected (HEU) in sub-Saharan Africa (SSA). There is emerging evidence that fetal exposure to maternal infections and medications may result in adverse adult/adolescent mental health outcomes; it is plausible that fetal exposure to HIV or antiretrovirals (ART) could similarly influence long-term outcomes. Despite evidence for poor growth and neurodevelopmental deficits, programs to systematically monitor neurodevelopmental and mental health outcomes among HEU at a population level are lacking. Understanding whether there are increased adverse neurodevelopmental and mental health outcomes in HEU due to fetal HIV/ART exposure has been challenged by difficulties in defining appropriate comparator cohorts, changing PMTCT treatment guidelines, and lack of validated, scale-able assessment tools. Our team has a unique track record for moving novel approaches for screening and testing from pilot to implementation, conducting large scale evaluations, and conducting neurodevelopmental and mental health assessments in HIV-affected children and adolescents. We propose parallel longitudinal and population based HEU/HUU cohorts, in urban and rural settings, spanning infants/children/adolescents age 6 weeks to 18 years to determine differences in neurodevelopmental and mental health outcomes. The R61 phase will accrue a longitudinal homogenous cohort of 2000 HEU/HUU infants exposed to Option B+ PMTCT treatment regimens, with extended follow-up in the R33 phase for a total of for 4 years, and assessed for neurodevelopmental, mental health, hearing, growth outcomes and telomere length. An approach to survey older HEU/HUU (age 3-18) for neurodevelopmental and mental health outcomes and collect maternal medical, ART regimen and timing, and viral load data from medical records will be piloted in the R61 phase and expanded to 100 HIV clinics in the R33 phase. Selected neurodevelopmental/mental health screening and diagnostic tools to be used are based on open source availability, diagnostic or screening performance, cultural appropriateness, accessibility, and clinical relevance. In the national R33 survey, cost analysis will complement clinical data; and together, will be disseminated to stakeholders at a workshop to develop a framework for an integrated HEU screening program in public health settings. This proposal leverages extensive team experience in prior longitudinal MTCT cohorts, in national child and adolescent surveys, HEU recruitment, neurodevelopmental and mental health assessment, and medical record extraction and analysis at scale, to comprehensively understand burden, mechanism and outcomes in HEU. Engaging stakeholders has the potential to enhance HEU management programmatically based on findings.

抽象的 艾滋病毒暴露于未感染的艾滋病毒的儿童/青少年人数不断增长（HEU） 在撒哈拉以南非洲（SSA）。有新兴的证据表明胎儿暴露于产妇感染和 药物可能导致成人/青少年心理健康成果不利；胎儿暴露于 艾滋病毒或抗逆转录病毒（ART）可能会影响长期结局。尽管有证据表明增长不佳 以及神经发育缺陷，系统监测神经发育和精神的程序 缺乏人口水平的HEU的健康成果。了解是否有增加 由于胎儿艾滋病毒/艺术暴露，HEU的不良神经发育和心理健康成果已经存在 在定义适当的比较人群，更改PMTCT治疗指南和 缺乏经过验证的，可扩展的评估工具。 我们的团队有一个独特的记录，用于将新颖的方法从飞行员到飞行员进行筛查和测试 实施，进行大规模评估以及进行神经发育和心理健康 对受艾滋病毒影响的儿童和青少年的评估。我们提出平行的纵向和人口 基于HEU/HUU队列，在城市和农村环境中，跨越婴儿/儿童/青少年6周 至18年来确定神经发育和心理健康成果的差异。 R61阶段 将产生2000 HEU/HUU婴儿的纵向同类队列 方案，在R33阶段进行延长的随访，总共4年，并评估 神经发育，心理健康，听力，成长结果和端粒长度。调查较老的方法 HEU/HUU（3-18岁）用于神经发育和心理健康成果并收集孕产妇医学，艺术 R61阶段将企图进行治疗的方案和时机以及病毒负荷数据，并扩展到 R33期100个HIV诊所。选定的神经发育/心理健康筛查和诊断工具 使用的是基于开源可用性，诊断或筛查性能，文化适当性， 可访问性和临床相关性。在全国R33调查中，成本分析将补充临床数据；和 将共同将车间的利益相关者传播给利益相关者，以为综合HEU开发一个框架 在公共卫生环境中进行筛查计划。 该提议利用了先前的MTCT队列，国民儿童和 青少年调查，HEU招聘，神经发育和心理健康评估以及病历 大规模提取和分析，以全面了解HEU的负担，机制和结果。 参与利益相关者有可能根据发现以编程性增强HEU管理。