Health Consequences of Food & Nutrition Insecurity for HIV+ Women & Their Infants

描述(由申请人提供)：食品和营养不安全(F&NI)与艾滋病毒流行有着千丝万缕的联系，它们之间的关系是双向的。虽然我们对HIV感染和疾病进展导致F&NI的机制有了一些了解，但F&NI增加HIV感染和疾病进展的可能性的机制直到最近才开始研究。值得注意的是，F&NI影响艾滋病毒孕妇及其婴儿健康的机制到目前为止还没有得到调查。然而，初步数据表明，F&NI减少了抗逆转录病毒的依从性、妊娠体重增加和纯母乳喂养的持续时间，所有这些都对母亲和孩子的健康产生了影响，包括垂直传播。因此，本K01应用的科学目的是阐明F&NI对HIV母亲及其婴儿健康有害的机制。我的中心假设是，F&NI通过营养、疾病和心理选择途径对艾滋病毒孕妇及其婴儿的健康有害。这一假设将以3个具体目标进行检验：(1)描述和评估肯尼亚艾滋病毒孕妇和哺乳期妇女中的F&NI和相关的可改变的决定因素；(2)描述F&NI影响肯尼亚一群艾滋病毒孕妇的母婴健康的程度和途径；(3)制定一项多层次干预计划，以减少F&NI，以改善艾滋病毒母亲及其子女的健康。定性研究(目标1和目标3)和队列研究(目标2)将利用家庭艾滋病护理和教育服务的资源，家庭艾滋病护理和教育服务是肯尼亚尼安扎省的一个艾滋病毒护理和治疗项目，我的几位K01导师的主要学习地点。我在医学和国际营养学方面的培训将对我有很好的帮助，但我需要在1)母婴F&NI评估，2)复杂纵向数据集的统计分析，3)低资源环境下艾滋病毒和艾滋病毒相关疾病的管理，4)心理社会福祉和儿童发展的评估，以及5)多水平干预措施的设计、实施和评估方面的额外指导和培训。这一培训将促进我的长期职业目标，即成为一名独立调查员，在设计和实施有效的、文化上可接受的干预措施方面拥有定性和定量的专业知识，以减少母亲和幼儿的发病率和死亡率。培训和研究意义重大，因为F&NI在撒哈拉以南非洲非常流行，艾滋病毒孕妇受到它的影响不成比例，而且对妇女及其婴儿有许多潜在的严重健康后果。更好地了解F&NI是如何有害的，将为设计更有效的干预措施提供知识，以改善艾滋病毒母亲及其感染艾滋病毒的婴儿的健康。这项创新研究将产生新的数据，以检验理论上驱动的假设，即F&NI可能通过哪些途径影响感染艾滋病毒的母亲及其婴儿的健康。

DESCRIPTION (provided by applicant): Food and nutrition insecurity (F&NI) are inextricably linked to the HIV epidemic, and their relationship is bidirec-tional. Although we have some understanding of the mechanisms by which HIV acquisition and disease pro-gression lead to F&NI, the mechanisms by which F&NI increase the likelihood of HIV acquisition and disease progression have only recently begun to be investigated. Strikingly, the mechanisms by which F&NI affect the health of HIV+ pregnant women and their infants have not been investigated to date. However, preliminary data suggest that F&NI reduce antiretroviral adherence, gestational weight gain, and the duration of exclusive breastfeeding, all of which have consequences for the health of the mother and child, including vertical trans-mission. Therefore, the scientific objectie of this K01 application is to elucidate the mechanisms by which F&NI have deleterious effects on the health of HIV+ mothers and their infants. My central hypothesis is that F&NI are detrimental to the health of HIV+ pregnant women and their infants via nutritional, disease, and psy-chosocial pathways. This hypothesis will be tested with 3 specific aims: (1) to describe and assess F&NI and associated modifiable determinants among HIV+ pregnant and lactating women in Kenya, (2) to characterize the magnitude and pathways by which F&NI impact maternal and infant health among a cohort of HIV+ preg-nant women in Kenya, (3) develop a plan for a multi-level intervention to reduce F&NI to improve health of HIV+ mothers and their children. The qualitative research (for Aims 1 and 3) and cohort study (for Aim 2) will leverage resources at Family AIDS Care and Education Services, an HIV care and treatment program in Nyanza province, Kenya, the primary study site for several of my K01 mentors. My training in medical anthro- pology and international nutrition will serve me well, but I need additional mentorship and training in 1) as- sessment of F&NI among mothers and infants, 2) statistical analysis of complex longitudinal data sets 3) the management of HIV and HIV-associated diseases in low-resource settings, 4) assessment of psychosocial well-being and childhood development, and 5) the design, implementation, and evaluation of multi-level inter- ventions. This training will further my long-term career goal of becoming an independent investigator with qualitative and quantitative expertise in the design and implementation of efficacious, culturally acceptable in- terventions that reduce morbidity and mortality of mothers and young children. The training and research are significant because F&NI is highly prevalent in sub-Saharan Africa, HIV+ pregnant women are disproportion- ately affected by it, and there are a number of potentially serious health consequences for women and their infants. A better understanding of how F&NI is deleterious will provide knowledge to design more effective in- terventions to improve the health of HIV+ mothers and their HIV-exposed infants. This innovative research will generate novel data to test theoretically driven hypotheses about the pathways by which F&NI may impact the health of HIV-infected mothers and their infants.