CHERISH (Children HIV Exposed Uninfected Research to Inform Survival and Health)

CHERISH（儿童艾滋病毒暴露未感染研究，以告知生存和健康）

基本信息

批准号：
10876119
负责人：
Mary-Ann Davies
金额：
$ 51.95万
依托单位：
STELLENBOSCH UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-29 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10876119
关键词：
Adolescent Adult Africa South of the Sahara Age Anti-Retroviral Agents Biostatistical Methods Birth Botswana Breast Feeding Cessation of life Child Child Health Childhood Cohort Studies Collaborations Communicable Diseases Complex Country Disparity Drug Exposure Electronics Ensure Epidemic Epidemiologic Methods Epidemiology Evaluation Exposure to Funding Future Government Growth HIV HIV/AIDS Health Health system High Prevalence Home Hospitalization Income Individual Infant Infection Intervention Investments Life Light Link Longitudinal cohort Malnutrition Measurement Measures Mediating Modality Modeling Modernization Monitor Morbidity - disease rate Mothers National Institute of Child Health and Human Development Nutritional Observational epidemiology Outcome Pathway interactions Patients Pharmaceutical Preparations Population Pregnancy Premature Birth Prevalence Prevention Province Public Health Research Resources Risk Rural Scientific Advances and Accomplishments Sentinel Site South Africa Southern Africa Statistical Methods Subgroup System Touch sensation United States United States National Institutes of Health Universities Woman adverse birth outcomes antenatal antiretroviral therapy cohort data centers design disparities in morbidity early childhood feeding follow-up health data in utero infancy innovation medication safety multiple data sources neurodevelopment novel pediatric human immunodeficiency virus postnatal prenatal exposure socioeconomics success survival disparity syndemic trend

项目摘要

Project Summary Despite more than one in five children in South Africa being HIV exposed uninfected (HEU), there are no systems in South Africa to evaluate in a sustainable long-term manner the outcomes of children exposed to HIV and antiretroviral drugs in utero. Through rigorous observational epidemiologic and modern biostatistical methods, the CHERISH study (Children HIV Exposed Uninfected Research to Inform Survival and Health) presents an opportunity to determine whether at a population and individual level survival, hospitalization, growth and neurodevelopmental outcomes are equivalent in children who are HEU and children who are HIV unexposed uninfected (HUU) in the era of universal maternal antiretroviral therapy. In the Western Cape Province of South Africa, where maternal antenatal HIV prevalence is 19%, the Western Cape Provincial Health Data Center curates electronic individual-linked health data from multiple sources according to unique patient identifiers with routine birth linkage of maternal and infant unique identifiers. We will leverage this resource and build on existing NIH investments in the Western Cape to establish a Western Cape province- wide cohort of births from 2018-2024 (R61 ±360,000; R33 ±585,000), in synchrony with two sentinel-sites (R61 ±36,000; R33 ±58,500), a static detailed cohort (R61 & R33 ±450) and dynamic light-touch cohort (R61 ±450; R33 ±1,800). Specifically we propose during the R61 to establish and optimize sustainable measurement of key in utero and postnatal exposures and outcomes in children who are HEU and HUU in the Western Cape at 4 levels: province-wide population cohort; urban and rural sentinel sites (supported by NIH funding until 2020, to be expanded through CHERISH); static detailed urban cohort (NICHD-funded B-Positive cohort, follow-up to be extended through CHERISH); dynamic light-touch urban and rural cohorts (to be newly established by CHERISH). During the R33 we will harness these cohorts to pursue three scientific aims: to compare 1) infant and under 3-year survival, 2) infant and under 3-year all-cause and infectious-cause hospitalization and 3) growth and neurodevelopmental outcomes at age 3-5 years in children who are HEU and HUU; Furthermore, for each aim we will identify factors amenable to intervention that mediate the effects of HIV and ARV exposure on survival, hospitalization, growth and neurodevelopment. The province-wide cohort will inform the population-level impact of HIV/ARV-exposure on child survival and morbidity in children who are HEU compared to HUU with similar socioeconomic, nutritional and environmental constraints to health in an HIV high-prevalence setting. The sentinel-site, static and dynamic cohorts will apply advanced statistical methods to identify causal pathways and sub-groups of children who are HEU with survival and morbidity disparities to inform design of targeted interventions feasible for health systems in HIV high prevalence settings. This presents a sustainable, innovative and adequately sized cohort model that with modest ongoing investment can continue to accumulate mother-child pairs with lifelong follow-up and opportunities to evaluate changes in in utero exposure to HIV and its prevention and treatment modalities as the epidemic evolves.

项目摘要尽管南非有超过五分之一的儿童未感染艾滋病毒（HEU），但没有南非的系统以可持续的长期评估儿童的结果子宫内的HIV和抗逆转录病毒药物。通过严格的观察性流行病学和现代生物统计学方法，珍贵的研究（儿童艾滋病毒暴露了未感染的研究，以告知生存和健康）有机会确定在人口和个人一级生存，住院，在HEU和艾滋病毒的儿童中，成长和神经发育结果等效在普遍的母体抗逆转录病毒疗法时代，未接触的未感染（HUU）。在西开普省南非省，孕产妇的艾滋病毒患病率为19％，西开普省健康数据中心根据唯一来源策划了来自多个来源的电子链接健康数据具有母体和婴儿独特标识符常规出生连接的患者识别剂。我们将利用这个资源并建立在西开普省现有的NIH投资以建立西开普省的现有投资从2018 - 2024年开始的广泛分娩（R61±360,000； R33±585,000），与两个哨兵点（R61）同步 ±36,000; R33±58,500），一个静态详细的队列（R61＆R33±450）和动态轻触摸队列（R61±450; R33±1,800）。特别是我们在R61期间提出的，以建立和优化可持续测量西开普省的Heu和Huu的子宫和产后暴露和成果的关键在4个级别：范围范围的人口队列；城市和粗糙的哨兵站点（由NIH资金支持直到 2020年，通过珍惜扩大）；静态详细的城市队列（NICHD资助的B阳性队列，跟进将通过珍惜扩展）；动态轻触的城市和粗糙的队列（要新近由珍惜建立）。在R33期间，我们将利用这些队列追求三个科学目的：比较1）婴儿和3年的生存率，2）婴儿和3年全因和感染性因素住院和3）HEU的儿童3-5岁时的成长和神经发育结果和胡此外，对于每个目标，我们都将确定可介绍效果的干预措施的因素 HIV和ARV暴露于生存，住院，生长和神经发育。范围内队列将告知艾滋病毒/ARV暴露对儿童生存和发病率的人口级别的影响与Huu相比，HEU具有类似的社会经济，营养和环境限制与健康的限制在艾滋病毒的高价值环境中。哨兵位点，静态和动态队列将应用高级统计识别有生存和发病率的HEU儿童的因果途径和子组的方法为艾滋病毒卫生系统可行的目标干预措施的设计提供差异设置。这是一个可持续，创新且尺寸适当的队列模型，该模型持续不断投资可以继续累积母子对，并进行终身跟进和评估的机会子宫对艾滋病毒的暴露及其预防和治疗方式的变化是流行病的发展。