Preventing, detecting, and treating incident maternal HIV infection for PMTCT

预防、检测和治疗预防母婴传播的孕产妇艾滋病毒感染事件

• 批准号: 9621907
• 负责人: Alison L Drake
• 金额: $ 7.53万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-06 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9621907
• 关键词: AIDS prevention; Accounting; Acute; Address; Africa South of the Sahara; Age; Archives; Area; Behavioral; Biological; Biological Assay; Caring; Characteristics; Childhood; Chronic; Clinic; Clinical Treatment; Coupled; Data; Development; Diagnosis; Drug resistance; Effectiveness; Eligibility Determination; Ensure; Failure; Frequencies; Generations; Guidelines; HIV; HIV Infections; HIV risk; Health Personnel; High Prevalence; High Risk Woman; Human immunodeficiency virus test; Incidence; Infant; Infection; Intervention; Kenya; Lactation; Marital Status; Maternal Health; Maternal and Child Health; Measures; Monitor; Mother-to-child HIV transmission; National Institute of Allergy and Infectious Disease; Performance; Perinatal; Persons; Plasma; Policies; Population; Postnatal Care; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevalence; Prevention; Preventive Intervention; RNA; Recommendation; Regimen; Risk; Risk Factors; Sampling; Screening procedure; Sexually Transmitted Diseases; Site; Syphilis; Testing; Time; United States National Institutes of Health; Validation; Viral; Viral Load result; Woman; antenatal; antiretroviral therapy; cohort; data archive; design; frontier; high risk; implementation science; implementation strategy; improved; pre-exposure prophylaxis; pregnant; prevent; programs; reproductive; screening; service delivery; tool; treatment response; young woman

PROJECT SUMMARY/ABSTRACT Risk of HIV acquisition during pregnancy and postpartum is high in sub-Saharan Africa, with incidence rates exceeding 3 per 100 person-years. Incident maternal HIV infections contribute substantially to mother-to-child HIV transmission (MTCT), accounting for 30-46% of all pediatric infections. As coverage of prevention of MTCT (PMTCT) interventions expands, an increasing proportion of HIV infected infants will be attributed to undetected incident maternal HIV, making this an important frontier to address to achieve elimination of MTCT (eMTCT). Strategies to prevent, detect, and treat incident maternal HIV infections will be critical to move towards an HIV-free generation. Recent data suggest transmitted drug resistance (TDR) may be rising among young women of reproductive age. High TDR during pregnancy and/or the postpartum period could compromise effectiveness of maternal antiretroviral therapy (ART), and subsequently increase MTCT risk. Characterizing TDR among peripartum women with recent HIV infections will be important to ensure appropriate ART regimens are utilized in PMTCT programs. In addition, complementary efforts to identify high risk women to target with HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), may bolster testing and treatment approaches for eMTCT. PrEP has been shown to be very effective in non-pregnant women, and safe to use during pregnancy and lactation, but delivering PrEP during and after pregnancy remains a challenge. To optimize PrEP implementation, strategies should maximize prevention efforts by identifying women with the highest risks of maternal HIV acquisition while minimizing unnecessary infant exposure. Simple screening tools for health care workers to identify women most likely to benefit from PrEP would aid programs in service delivery, but have not been externally validated. Data and archived samples collected in an ongoing K01 study in Kenya, which aims to determine the optimal time to conduct repeat maternal HIV testing, will be leveraged to conduct the proposed study. The specific aims are to: 1) externally validate an HIV risk score tool among a cohort of 4650 pregnant/postpartum women, 2) measure maternal HIV viral load and prevalence of TDR among 100 women with incident HIV infection during pregnancy/postpartum, and 3) identify biological and behavioral correlates of maternal HIV infection during pregnancy and postpartum. Together, data from the K01 and R03 studies will provide preliminary data to prepare for a large, implementation science trial to detect and treat incident maternal HIV infections though a repeat maternal HIV testing strategy coupled with targeted screening to determine eligibility for PrEP.

项目总结/摘要 在撒哈拉以南非洲，怀孕和产后感染艾滋病毒的风险很高， 每100人年超过3次。孕产妇艾滋病毒感染事件在很大程度上助长了母婴传播 艾滋病毒传播（母婴传播），占所有儿科感染的30-46%。作为预防 母婴传播（防止母婴传播）干预措施扩大，越来越多的艾滋病毒感染婴儿将归因于 未被发现的孕产妇艾滋病毒事件，使这成为实现消除母婴传播的一个重要前沿问题 （eMTCT）。预防、检测和治疗孕产妇艾滋病毒感染的战略将是至关重要的， 迈向无艾滋病一代。最近的数据表明，传播性耐药性（TDR）可能正在上升， 育龄的年轻女性。妊娠期和/或产后期高TDR可能 降低了母亲抗逆转录病毒疗法（ART）的有效性，随后增加了母婴传播的风险。 描述最近感染艾滋病毒的围产期妇女的TDR对于确保 在防止母婴传播方案中使用适当的抗逆转录病毒疗法。此外，还作出补充努力， 风险妇女以艾滋病毒预防干预措施为目标，如暴露前预防（PrEP）， eMTCT的检测和治疗方法。PrEP已被证明是非常有效的非怀孕 妇女，在怀孕和哺乳期间使用安全，但在怀孕期间和怀孕后提供PrEP 仍然是一个挑战。为了优化PrEP的实施，战略应通过以下措施最大限度地提高预防工作 确定产妇感染艾滋病毒风险最高的妇女，同时尽量减少不必要的婴儿 exposure.卫生保健工作者的简单筛查工具，以确定最有可能从PrEP中受益的女性 将有助于服务交付的计划，但尚未得到外部验证。数据和存档样本 在肯尼亚正在进行的K 01研究中收集，该研究旨在确定进行重复的最佳时间 将利用孕产妇艾滋病毒检测来进行拟议的研究。具体目标是：1）外部 在4650名孕妇/产后妇女队列中验证艾滋病毒风险评分工具，2）测量孕产妇艾滋病毒 在100名怀孕/产后发生HIV感染的妇女中， （3）确定孕妇在怀孕期间和产后感染HIV的生物学和行为学相关因素。 K 01和R 03研究的数据将共同提供初步数据， 实施科学试验，通过反复感染孕产妇艾滋病毒来检测和治疗孕产妇艾滋病毒感染事件 测试策略加上有针对性的筛选，以确定是否符合PrEP的要求。