Blood-borne infection screening in an Afghan antenatal population

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DESCRIPTION (provided by applicant): This award will provide Dr. Catherine Todd with protected time and expertise to develop international research in risk reduction of blood-borne viral infections (BBV) and sexually-transmitted infections (STI) during reproductive care in limited-resource settings. Dr. Todd is an obstetrician/gynecologist who completed a family planning fellowship and worked as an international consultant, with the majority of time spent in Afghanistan. She is currently Assistant Professor in the Division of International Health & Cross-Cultural Medicine at the University of California, San Diego. Her career and training goals are to: 1. Gain knowledge in advanced epidemiologic study design, particularly observational and intervention research; 2. Acquire survey development and psychometric methodology skills; 3. Improve understanding of the intersection of reproductive health and infectious disease research in international settings; 4. Learn BBV/STI diagnostic methods suited to resource-poor environments; 5. Acquire advanced quantitative data analysis proficiency; 6. Conduct a study investigating prevalence and correlates of and barriers to screening for human immunodeficiency virus (HIV), syphilis, and hepatitis B (HBV) in an Afghan antenatal population; and 7. Learn international health programming theory to design and pilot an intervention implementing antenatal screening. The training plan includes coursework and mentoring by experts in infectious disease epidemiology, international maternal health, and psychometric scale methods. A key component is a needs assessment study and a pilot intervention to implement antenatal testing. The aims of the proposed research are to: 1) Determine prevalence and correlates of HIV, syphilis, and HBV in an antenatal population in Kabul, Afghanistan, 2) Assess patient knowledge and perceptions on screening value for HIV, syphilis, and HBV in obstetric care, 3) Assess knowledge and practice of medical personnel and their influence on HIV, syphilis, and HBV prevention counseling, screening, and iatrogenic infection prevention practice, and 4) Determine feasibility and acceptance of antenatal screening at hospital admission for obstetric patients and providers in Kabul, Afghanistan. Though little is known about BBV prevalence in Afghanistan, multiple factors increase the risk of an epidemic, particularly the antenatal population; implementing testing may circumvent this. Pilot data generated from this study will be used to test the intervention in a larger Afghan population.