Environmental Lead Exposure and Premature Aging among Adolescents Living with HIV in Haiti

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Project Summary: The goal of this supplement’s parent grant is to improve HIV-related health outcomes of adolescents (10-19 years) and youth (20-24 years) in Haiti. A major emphasis is on research-training to extend adolescent HIV services from the clinic to the community. Evidence demonstrates that providing services in the community improves access, social acceptability, cost-effectiveness, and ultimately large-scale impact. The parent program builds on the foundation established in Haiti during three decades of NIH research and training support to Groupe Haitien d-Etude du Sarcome et des Infections Opportunistes (GHESKIO) and Weill Cornell Medicine (WCM) to address the adolescent HIV epidemic in Haiti. Dr. Elsie Jean is a post-doctoral research fellow and in the proposed mentored research training project, she will establish the prevalence of elevated blood lead levels (BLLs) among adolescents and young adults living with HIV (AYALH) in Haiti. Further, she will explore the association between BLL and signs of premature aging including kidney dysfunction and elevated blood pressure. Haiti has alarmingly high lead levels documented in adults, and our research at GHESKIO indicates 42% of AYALH have elevated blood pressure. We hypothesize lead exposure during the early and critical developmental period of adolescence could be a driver of premature aging which will only progress in severity across the life-course. Dr. Jean will also explore sources of environmental lead exposure in order to design interventions to prevent or mitigate exposure. Dr. Jean’s career goal is to conduct research to improve the long-term outcomes of AYALH and prevent chronic co-morbidities that may undermine the success of global ART scale-up. Her objective is to identify and eliminate environmental exposures that may accelerate or exacerbate the aging process among AYALH in order to prevent premature aging. Dr. Jean will expand her training and build expertise in three areas: 1) environmental epidemiology, 2) CVD epidemiology among HIV-infected populations, and 3) mixed methods research. She will complete her MPH at Quisqueya University and 3 intensive short-courses. She will also participate in regular research- in-progress presentations in the GHESKIO-Weill Cornell Fogarty Research Seminar. Dr. Jean’s research plan leverages two established cohorts in Haiti. Among participants in the Adolescent HIV Preclinical CVD Cohort, she will measure BLLs in 500 AYALH and compare the prevalence to a cohort of HIV-uninfected adolescents and young adults in the Haiti CVD Cohort. She will measure the association of elevated BLLs with elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) (mmHg) (> 120/80) and renal dysfunction (urine albumin to creatinine ratio (ACR) >30 mg/g or creatinine clearance (eGFR mL/min/1.73 m2 using CKD-Epi equation)). In a case-control study, she will conduct in-depth interviews and targeted surveys among 20 AYALH with elevated BLLs and 20 without to explore sources of exposure.