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

项目摘要 背景死胎、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，特别是艾滋病毒抗体阳性妇女中，艾滋病毒感染率极高。 怀孕期间每日补充铁和叶酸可以减少不良妊娠结局， 减少产妇贫血。然而，补充剂在由艾滋病毒状况定义的亚组中的有效性， 贫血、胎龄和其他临床、人口统计学和地理因素仍然未知， 对补充指南的遵守情况各不相同（博茨瓦纳<50%）。成本效益高的干预措施， 为博茨瓦纳和其他资源有限的地区的孕妇提供补充剂， 旨在解决成功补充的关键障碍，并覆盖将受益的亚群体， 大部分来自干预。K 01为解决文献中的这一空白提供了一个独特的机会。 候选人概述。我的长期职业目标是成为一名独立调查员， 在资源有限的环境中采取干预措施，改善孕产妇和儿童健康。我的背景是 流行病学方法的应用，以评估艾滋病毒治疗策略在成人和婴儿中的效果。一 K 01奖将提供必要的额外培训和经验，需要成为专家， 设计、实施和评价干预措施，以改善艾滋病毒阳性孕妇的妊娠结局。 妇女和得不到充分服务的人口。 职业发展和培训计划。我的教育计划包括结构化的课程工作， 专业会议，定向阅读，以及一个有特定目标的研究项目，时间安排与 这些活动。我的导师团队包括国际专家，他们专门从事与我的工作相关的领域。 培训目标：Scott Braithwaite博士（决策科学）、Roger Shapiro博士（艾滋病毒与妇幼保健 博茨瓦纳）、Donna Shelley博士（干预措施的制定和实施）和Carolyn Berry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拟议的 研究，获得额外的培训和指导，并成功地过渡到一个独立的调查员。 研究战略。使用来自一项正在进行的出生结果监测研究的数据和基础设施， 博茨瓦纳的数据来自13万多名新生儿，我的研究将：1）估计铁和叶酸的影响 妊娠期间补充维生素C对不良妊娠结局的影响，按HIV状况、贫血、胎龄 和其他关键亚组，以确定从干预中受益最多的人群; 2）评估 在怀孕期间和怀孕前补充; 3）优化假设干预， 补充使用计算机模拟;和4）开发和测试干预的可行性，以提供 为博茨瓦纳的孕妇提供补充剂。

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.