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

项目摘要 接触艾滋病毒的婴儿经历不良分娩结局的比率很高，包括死产、早产、小 胎龄和新生儿死亡率。这些出生结局在亚健康人群中具有相当大的发病率和死亡率。 撒哈拉非洲(SSA)，那里获得新生儿重症监护服务的机会有限。衣原体和淋病 性传播感染(STI)是在SSA感染艾滋病毒的妇女中高度流行的疾病。这些性传播疾病 如果在怀孕期间不治疗，会增加不良分娩结局的风险。而在产前 在一些高收入人群中，建议在怀孕期间进行衣原体和淋病筛查，包括 在美国，它还不是SSA常规护理的一部分。综合征管理，SSA目前的护理标准， 包括经验性的、症状驱动的性传播感染治疗。然而，这种方法漏掉了高达70%的性传播感染， 同时让75%的有症状的孕妇接受不适当的治疗并推广抗生素 抵抗。产前衣原体和淋病筛查的临床影响和成本-效果 在资源有限的情况下，携带艾滋病毒的孕妇还没有得到很好的研究。我是一种传染病 具有模拟建模和成本效益研究经验的医生和临床医生-研究员。我 我致力于使用基于模型的研究来改善资源有限的妇女和儿童的健康 设置。要成为一名独立调查员，我需要以下方面的进一步培训和指导：1)高级 建模技术，2)成本计算和模型输入推导，以及3)实现母婴， 和生殖健康干预措施。我已经概述了一个说教计划，组织了一个多学科的指导 小组，并与侧重于博茨瓦纳妇幼健康的调查人员建立了新的合作。我的 主要导师是Andrea Ciaranello博士，他是与以下相关的建模和成本效益分析专家 母婴健康。我的指导团队还包括高级建模方法方面的专家(Dr。 (David Paltiel)，博茨瓦纳儿童的不良生育结局(罗杰·夏皮罗博士)，以及#年产科护理 撒哈拉以南非洲(布莱尔·怀利博士)。在他们的指导下，我将解决两个具体目标： 1.建立艾滋病病毒携带者及其婴儿的详细微观模拟模型 妊娠、分娩和产后期，包括临床和经济细节 母婴艾滋病毒、衣原体和淋病感染以及不良生育后果 2.评估衣原体和淋病的临床影响、成本和成本效益 孕期筛查策略，纳入艾滋病毒携带者及其婴儿的结局 在博茨瓦纳 拟议的培训和研究目标将为#年改善母婴健康成果的努力提供信息。 并将为独立调查员的职业生涯奠定基础，该调查员可以将建模应用于 解决艾滋病毒、母婴健康和全球医疗保健政策交叉点上的关键问题。

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.