Expansion of research and mentoring opportunities to reduce the burden of maternal and pediatric HIV in Botswana

摘要/摘要 我正在申请K24更新，目的是扩大我的NIH资助的研究范围， 在博茨瓦纳的博茨瓦纳-哈佛艾滋病研究所伙伴关系中提供指导机会。在过去的23年里， 我在博茨瓦纳建立了一个成功的研究项目，最近重点关注不良的出生结果 监测和新的治疗策略。我已经成功地指导或共同指导了 在我的职业生涯中，有近50名年轻的调查员，我目前的K24对我最近的指导至关重要 活动尽管面临COVID-19的挑战，我的K24研究和指导目标已经实现-并且 经常扩大-在过去5年。有了重新资助，我的K24支持的研究将有以下内容 指导研究的目标，其中涵盖了我资助的所有研究活动：（1）评估6周的艾滋病毒的吸收 博茨瓦纳的DNA聚合酶链反应检测、缺乏检测的风险因素和艾滋病毒垂直传播的风险因素 国家治疗计划;（2）评价卡替格韦-LA暴露前预防（PrEP）的摄入 （3）通过博茨瓦纳国家方案在怀孕期间提供的避孕药具; 在滨海公主医院与剖腹产相关的发病率和死亡率（按艾滋病毒状态），以及 制定干预措施，使剖腹产的医学适应症标准化，同时培训我目前的学员 成为导师;（4）进行专门的诊断和定性访谈，以优化战略 在高度选择的艾滋病毒感染儿童和青少年中进行未来分析治疗中断（ATI）， 同时在博茨瓦纳的实验室学员中培养研究独立性。我的训练计划将特别 扩大我在母胎医学和艾滋病毒治疗策略方面的专业知识，我的指导计划将包括 与波士顿和博茨瓦纳的共同导师合作，有效利用新计划中的机会 奖项，正在进行的临床试验，以及现有的数据集和标本。我的K24更新的最终目标 申请的目的是扩大能力，在博茨瓦纳进行高影响力的以病人为导向的研究， 来自非洲和美国的一代全球卫生领导人。

Summary / Abstract I am applying for a K24 renewal with the goal of expanding the scope of my NIH-funded research and expanding mentorship opportunities at the Botswana-Harvard AIDS Institute Partnership in Botswana. In the past 23 years, I have built a successful research program in Botswana with a recent focus on adverse birth outcomes surveillance and novel treatment strategies for children with HIV. I have successfully mentored or co-mentored nearly 50 young investigators in my career, and my current K24 has been essential for my recent mentoring activities. Despite the challenges of COVID-19, my K24 research and mentoring aims have been achieved – and often expanded – over the past 5 years. With re-funding, my K24-supported research will have the following mentored research aims, which span all of my funded research activities: (1) to evaluate uptake of 6-week HIV DNA PCR testing, risk factors for lack of testing, and risk factors for HIV vertical transmission in the Botswana national treatment program; (2) to evaluate the uptake of cabotegravir-LA pre-exposure prophylaxis (PrEP) offered in pregnancy through the Botswana national program; (3) to determine the incidence of maternal morbidity and mortality associated with cesarean section at Princess Marina Hospital (by HIV status), and develop interventions to standardize medical indications for caesarean section, while training my current mentee to become a mentor; and (4) to perform specialized diagnostics and qualitative interviews to optimize a strategy for a future analytic treatment interruption (ATI) among highly selected children and adolescents living with HIV, while fostering research independence in a Botswana-based laboratory mentee. My training plan will specifically expand my expertise in maternal-fetal medicine and HIV cure strategies, and my mentoring plan will involve a team approach with co-mentors in Boston and Botswana to efficiently utilize opportunities within a new Program Award, ongoing clinical trials, and existing datasets and specimens. The ultimate goal of my K24 renewal application is to expand capacity to conduct high-impact patient-oriented research in Botswana by the next generation of global health leaders from Africa and the United States.