Modeling the Effects of HIV, Chlamydia, and Gonorrhea in Mother-Infant Pairs in Botswana.

模拟艾滋病毒、衣原体和淋病对博茨瓦纳母婴的影响。

基本信息

批准号：
10392407
负责人：
Caitlin Dugdale
金额：
$ 17.24万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
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：
2020-03-02 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10392407
关键词：
Acquired Immunodeficiency Syndrome Address Affect Africa South of the Sahara Aftercare Antibiotic Resistance Antibiotic Therapy Antibiotics Antimicrobial Resistance Award Awareness Birth Botswana Child Child Health Chlamydia Clinical Collaborations Communicable Diseases Computer Simulation Conjunctivitis Cost Analysis Cost Effectiveness Analysis Cost effectiveness research Data Derivation procedure Economics Event Foundations Gestational Age Goals Gonorrhea HIV Health Policy Income Infant Infection Intervention Link Literature Low Birth Weight Infant Maternal Health Maternal and Child Health Mentors Mentorship Methodology Methods Modeling Molecular Morbidity - disease rate Mother-to-child HIV transmission Mothers Neonatal Neonatal Intensive Care Nucleic Acid Amplification Tests Odds Ratio Outcome Perinatal Perinatal Infection Physicians Pneumonia Positioning Attribute Postpartum Period Pregnancy Pregnancy Complications Pregnant Women Premature Birth Publishing Research Research Personnel Resource-limited setting Risk Sensitivity and Specificity Sepsis Sexually Transmitted Diseases Small for Gestational Age Infant Symptoms Syndrome Syphilis Techniques Testing Toxic effect Training Woman Women&apos s Health Work adverse birth outcomes antenatal base budget impact care systems career clinical care co-infection cost cost effective cost effectiveness cost-effectiveness evaluation economic evaluation economic impact evidence base experience high risk improved models and simulation mortality multidisciplinary multiple data sources neonatal care neonatal death novel obstetric care point of care prevent reproductive health intervention routine care screening screening program standard of care stillbirth tool

项目摘要

Project Summary HIV-exposed infants experience high rates of adverse birth outcomes, including stillbirth, preterm birth, small for gestational age, and neonatal death. These birth outcomes carry substantial morbidity and mortality in sub- Saharan Africa (SSA) where access to neonatal intensive care services is limited. Chlamydia and gonorrhea are sexually transmitted infections (STIs) that are highly prevalent among women with HIV in SSA. These STIs are associated with increased risks of adverse birth outcomes if untreated in pregnancy. While antenatal screening for chlamydia and gonorrhea is recommended in pregnancy in some high-income settings, including the US, it is not yet a part of routine care in SSA. Syndromic management, the current standard of care in SSA, consists of empiric, symptom-driven treatment of STIs. However, this approach misses up to 70% of STIs, while exposing 75% of symptomatic pregnant women to inappropriate treatment and promoting antibiotic resistance. The clinical impact and cost-effectiveness of antenatal chlamydia and gonorrhea screening among pregnant women with HIV has not been well-studied in resource-limited settings. I am an infectious disease physician and clinician-investigator with experience in simulation modeling and cost-effectiveness research. I am committed to using model-based research to improve the health of women and children in resource-limited settings. To become an independent investigator, I require further training and mentorship in: 1) advanced modeling techniques, 2) costing and model input derivation, and 3) principles of implementing maternal, child, and reproductive health interventions. I have outlined a didactic plan, assembled a multidisciplinary mentorship team, and established a new collaboration with investigators focused on maternal-child health in Botswana. My primary mentor is Dr. Andrea Ciaranello, an expert in modeling and cost-effectiveness analysis related to maternal-child health. My mentorship team additionally includes experts in advanced modeling methods (Dr. David Paltiel), adverse birth outcomes among children in Botswana (Dr. Roger Shapiro), and obstetrical care in sub-Saharan Africa (Dr. Blair Wylie). With their guidance, I will address two Specific Aims: 1. To develop a detailed microsimulation model of women with HIV and their infants through pregnancy, delivery, and the postpartum period that incorporates clinical and economic details of maternal and infant HIV, chlamydia, and gonorrhea infection, as well as adverse birth outcomes 2. To evaluate the clinical impact, cost, and cost-effectiveness of chlamydia and gonorrhea screening strategies in pregnancy, incorporating outcomes for women with HIV and their infants in Botswana The proposed training and research aims will inform efforts to improve maternal-child health outcomes in Botswana and will provide a foundation for a career as an independent investigator who can apply modeling to address critical questions at the intersection of HIV, maternal-child health, and global healthcare policy.

项目概要感染艾滋病毒的婴儿出现不良分娩结果的几率很高，包括死产、早产、小产胎龄和新生儿死亡。这些出生结果在亚健康人群中具有相当高的发病率和死亡率。撒哈拉非洲 (SSA) 获得新生儿重症监护服务的机会有限。衣原体和淋病是性传播感染 (STI)，在 SSA 感染艾滋病毒的女性中非常流行。这些性传播感染如果在怀孕期间未经治疗，会增加不良分娩结果的风险。产前时建议在某些高收入环境中在怀孕期间进行衣原体和淋病筛查，包括在美国，它尚未成为 SSA 常规护理的一部分。症状管理，SSA 当前的护理标准，包括对性传播感染进行经验性、症状驱动的治疗。然而，这种方法漏掉了高达 70% 的性传播感染，同时使 75% 有症状的孕妇接受不适当的治疗并提倡使用抗生素反抗。产前衣原体和淋病筛查的临床影响和成本效益在资源有限的环境中，感染艾滋病毒的孕妇尚未得到充分研究。我是传染病具有模拟建模和成本效益研究经验的医生和临床研究者。我我致力于利用基于模型的研究来改善资源有限的妇女和儿童的健康设置。要成为一名独立调查员，我需要进一步的培训和指导：1）高级建模技术，2) 成本计算和模型输入推导，以及 3) 实施孕产妇、儿童、和生殖健康干预措施。我制定了一个教学计划，组建了多学科指导团队，并与博茨瓦纳的妇幼健康研究人员建立了新的合作关系。我的主要导师是 Andrea Ciaranello 博士，他是建模和成本效益分析方面的专家母婴健康。我的导师团队还包括高级建模方法方面的专家（Dr. David Paltiel）、博茨瓦纳儿童的不良出生结果（Roger Shapiro 博士）以及博茨瓦纳的产科护理撒哈拉以南非洲（Blair Wylie 博士）。在他们的指导下，我将实现两个具体目标： 1. 通过以下方式开发详细的艾滋病病毒感染者及其婴儿的微观模拟模型怀孕、分娩和产后期，包括临床和经济细节母婴艾滋病毒、衣原体和淋病感染以及不良出生结局 2. 评估衣原体和淋病的临床影响、成本和成本效益妊娠期筛查策略，纳入艾滋病毒感染妇女及其婴儿的结果在博茨瓦纳拟议的培训和研究目标将为改善母婴健康结果的努力提供信息博茨瓦纳，将为独立调查员的职业生涯奠定基础，他可以将建模应用于解决艾滋病毒、母婴健康和全球医疗保健政策交叉领域的关键问题。