Health Consequences of Food & Nutrition Insecurity for HIV+ Women & Their Infants

描述（由申请人提供）：食品和营养不安全（F&NI）与艾滋病毒的流行有着千丝万缕的联系，而且它们之间的关系是双向的。尽管我们对HIV感染和疾病进展导致F&NI的机制有一些了解，但F&NI增加HIV感染和疾病进展可能性的机制直到最近才开始研究。引人注目的是，F&NI影响艾滋病毒阳性孕妇及其婴儿健康的机制迄今尚未得到调查。然而，初步数据表明，F&NI降低了抗逆转录病毒依从性、妊娠期体重增加和纯母乳喂养的持续时间，所有这些都对母亲和儿童的健康产生影响，包括垂直传播。因此，本K01应用的科学目标是阐明F&NI对艾滋病毒阳性母亲及其婴儿健康产生有害影响的机制。我的中心假设是，F&NI通过营养、疾病和心理社会途径对艾滋病毒阳性孕妇及其婴儿的健康有害。这一假设将通过3个具体目标进行检验：(1)描述和评估肯尼亚艾滋病毒阳性孕妇和哺乳期妇女的F&NI和相关可改变的决定因素；(2)表征肯尼亚艾滋病毒阳性孕妇队列中F&NI影响母婴健康的程度和途径；(3)制定多层次干预计划，以降低F&NI，改善艾滋病毒阳性母亲及其子女的健康。定性研究（目标1和目标3）和队列研究（目标2）将利用家庭艾滋病护理和教育服务的资源，这是肯尼亚尼扬扎省的一个艾滋病护理和治疗项目，也是我的几个K01导师的主要研究地点。我在医学人类学和国际营养学方面的培训对我很有帮助，但我需要额外的指导和培训，包括1)母婴F&NI的评估，2)复杂纵向数据集的统计分析，3)低资源环境下艾滋病毒和艾滋病毒相关疾病的管理，4)心理健康和儿童发展的评估，以及5)多层次干预措施的设计、实施和评估。这次培训将进一步促进我的长期职业目标，即成为一名在设计和实施有效的、文化上可接受的降低母亲和幼儿发病率和死亡率的干预措施方面具有定性和定量专业知识的独立研究者。培训和研究具有重要意义，因为F&NI在撒哈拉以南非洲非常普遍，艾滋病毒阳性孕妇受其影响不成比例，并且对妇女及其婴儿有许多潜在的严重健康后果。更好地了解F&NI如何有害将为设计更有效的干预措施提供知识，以改善艾滋病毒阳性母亲及其暴露于艾滋病毒的婴儿的健康。这项创新的研究将产生新的数据，以测试关于F&NI可能影响感染艾滋病毒的母亲及其婴儿健康的途径的理论驱动假设。

DESCRIPTION (provided by applicant): Food and nutrition insecurity (F&NI) are inextricably linked to the HIV epidemic, and their relationship is bidirec-tional. Although we have some understanding of the mechanisms by which HIV acquisition and disease pro-gression lead to F&NI, the mechanisms by which F&NI increase the likelihood of HIV acquisition and disease progression have only recently begun to be investigated. Strikingly, the mechanisms by which F&NI affect the health of HIV+ pregnant women and their infants have not been investigated to date. However, preliminary data suggest that F&NI reduce antiretroviral adherence, gestational weight gain, and the duration of exclusive breastfeeding, all of which have consequences for the health of the mother and child, including vertical trans-mission. Therefore, the scientific objectie of this K01 application is to elucidate the mechanisms by which F&NI have deleterious effects on the health of HIV+ mothers and their infants. My central hypothesis is that F&NI are detrimental to the health of HIV+ pregnant women and their infants via nutritional, disease, and psy-chosocial pathways. This hypothesis will be tested with 3 specific aims: (1) to describe and assess F&NI and associated modifiable determinants among HIV+ pregnant and lactating women in Kenya, (2) to characterize the magnitude and pathways by which F&NI impact maternal and infant health among a cohort of HIV+ preg-nant women in Kenya, (3) develop a plan for a multi-level intervention to reduce F&NI to improve health of HIV+ mothers and their children. The qualitative research (for Aims 1 and 3) and cohort study (for Aim 2) will leverage resources at Family AIDS Care and Education Services, an HIV care and treatment program in Nyanza province, Kenya, the primary study site for several of my K01 mentors. My training in medical anthro- pology and international nutrition will serve me well, but I need additional mentorship and training in 1) as- sessment of F&NI among mothers and infants, 2) statistical analysis of complex longitudinal data sets 3) the management of HIV and HIV-associated diseases in low-resource settings, 4) assessment of psychosocial well-being and childhood development, and 5) the design, implementation, and evaluation of multi-level inter- ventions. This training will further my long-term career goal of becoming an independent investigator with qualitative and quantitative expertise in the design and implementation of efficacious, culturally acceptable in- terventions that reduce morbidity and mortality of mothers and young children. The training and research are significant because F&NI is highly prevalent in sub-Saharan Africa, HIV+ pregnant women are disproportion- ately affected by it, and there are a number of potentially serious health consequences for women and their infants. A better understanding of how F&NI is deleterious will provide knowledge to design more effective in- terventions to improve the health of HIV+ mothers and their HIV-exposed infants. This innovative research will generate novel data to test theoretically driven hypotheses about the pathways by which F&NI may impact the health of HIV-infected mothers and their infants.