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

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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.