Iron and folic acid supplementation strategies during pregnancy and adverse pregnancy outcomes in Botswana - Resubmission - 1

项目总结 背景资料。死产、早产、低出生体重和其他不良妊娠结局的风险是 在包括博茨瓦纳在内的撒哈拉以南非洲国家，感染率极高，特别是在艾滋病毒阳性妇女中。 孕期每日补充铁和叶酸可通过以下方式减少不良妊娠结局 减少产妇贫血。然而，根据艾滋病毒状况确定的亚组中补充药物的有效性， 贫血、胎龄和其他临床、人口统计和地理因素仍然未知， 对补充剂指南的遵守情况各不相同(博茨瓦纳为50%)。具有成本效益的干预措施 在博茨瓦纳和其他资源有限的情况下向孕妇提供补充应该是 旨在解决成功补充的关键障碍，并惠及将受益的亚群 其中大部分来自干预。这个K01提供了一个独特的机会来解决文献中的这一差距。 候选人概述。我的长期职业目标是成为一名专门从事 在资源有限的情况下改善孕产妇和儿童健康的干预措施。我的背景是 应用流行病学方法评估成人和婴儿HIV治疗策略的效果。一个 K01奖将提供必要的额外培训和经验，以成为一名 改善HIV阳性患者妊娠结局的干预措施的设计、实施和评估 妇女和服务不足的人群。 职业发展和培训计划。我的教育计划包括有组织的课程作业， 专业会议、定向阅读和有特定目标的研究项目的时间安排与 这些活动。我的指导团队包括国际专家，他们专门研究与我的 培训目标：Scott Braithwaite博士(决策科学)、Roger Shapiro博士(艾滋病毒和妇幼保健 在博茨瓦纳)、唐娜·雪莱博士(干预措施的制定和实施)和卡罗琳·贝里博士 (定性方法)。 环境纽约大学医学院为我提供了一个特殊的环境来进行建议的 学习，获得额外的培训和指导，并成功过渡到独立调查人员。 研究策略。使用来自正在进行的出生结果监测研究的数据和基础设施 博茨瓦纳由超过13万名新生儿的数据组成，我的研究将：1)估计铁和叶酸的影响 孕期补充对因艾滋病毒状况、贫血、胎龄、 和其他关键亚群，以确定将从干预中获益最大的人群；2)评估 在怀孕期间和怀孕前补充；3)优化假设干预，以提供 使用计算机模拟进行补充；以及4)开发和测试干预的可行性，以提供 博茨瓦纳的孕妇补充剂。

PROJECT SUMMARY Background. The risk of stillbirth, preterm delivery, low birthweight and other adverse pregnancy outcomes is extremely high in Sub-Saharan African countries including Botswana, especially among HIV-positive women. Daily iron and folic acid supplementation during pregnancy could reduce adverse pregnancy outcomes by reducing maternal anemia. However, the effectiveness of supplementation in subgroups defined by HIV status, anemia, gestational age, and other clinical, demographic and geographic factors remains unknown and compliance with supplementation guidelines is variable (<50% in Botswana). Cost-effective interventions to provide supplementation to pregnant women in Botswana and other resource-limited settings should be designed to address key barriers to successful supplementation and to reach subgroups that would benefit most from intervention. This K01 provides a unique opportunity to address this gap in the literature. Candidate Overview. My long-term career objective is to become an independent investigator who specializes in interventions to improve maternal and child health in resource-limited settings. My background is in applications of epidemiologic methods to evaluate effects of HIV treatment strategies in adults and infants. A K01 award will provide the necessary additional training and experience needed to become an expert in the design, implementation, and evaluation of interventions to improve pregnancy outcomes in HIV-positive women and underserved populations. Career Development and Training Plan. My education program includes structured course work, professional conferences, directed readings, and a research project with specific aims timed to coincide with these activities. My mentorship team includes international experts who specialize in areas related to my training goals: Dr. Scott Braithwaite (decision science), Dr. Roger Shapiro (HIV and maternal and child health in Botswana), Dr. Donna Shelley (intervention development and implementation), and Dr. Carolyn Berry (qualitative methods). Environment. NYU School of Medicine provides an exceptional environment for me to conduct the proposed study, obtain additional training and mentorship, and successfully transition to an independent investigator. Research Strategy. Using the data and infrastructure from an ongoing birth outcomes surveillance study in Botswana consisting of data from over 130,000 births, my study will: 1) estimate the effect of iron and folic acid supplementation during pregnancy on adverse pregnancy outcomes by HIV status, anemia, gestational age, and other key subgroups to identify populations that would benefit most from intervention; 2) assess barriers to supplementation during and prior to pregnancy; 3) optimize a hypothetical intervention to provide supplementation using computer simulation; and 4) develop and test the feasibility of an intervention to provide supplementation to pregnant women in Botswana.