International Mentored Scientist Award

Publications:

• PubMed# 18520684
• PubMed# 19303366

The use of family planning has been shown to have strong potential to reduce new HIV infections due to unwanted fertility in Uganda. Most prevention of mother to child transmission PMTCT efforts to date have prioritized the provision of antiretroviral prophylaxis to HIV infected pregnant women, leaving voluntary contraception an underutilized approach despite evidence that preventing unintended pregnancies in the HIV infected women is an effective strategy for reducing HIV positive births and is cost effective.

Determining the prevalence of sexual concurrent partnerships among married couples and the structure and characteristics of the resultant sexual networks is crucial in designing appropriate HIV prevention interventions. In this study we seek to: (a) identify the types and extent of concurrent sexual partnerships and, (b) elucidate the structure and characteristics of sexual networks that result from concurrent sexual partnerships among married fishermen couples in Kisumu, Kenya.

Nevirapine (NVP) is the primary antiretroviral (ART) available in Zimbabwe. However, its use as first line ART is complicated by interactions with rifampicin (RIF), the primary drug available for tuberculosis (TB). In some cases ART treatment is delayed or avoided in TB co-infected patients. Previous studies of the effect of RIF on NVP pharmacokinetic (PK) exposure has been inconclusive, failing to generate specific recommendations regarding co-treatment. Moreover, PK and safety data for NVP with RIF have not been generated in our population in Zimbabwe.

In the KwaZulu-Natal (KZN) province of South Africa (SA), where antenatal HIV prevalence is 39.5%, there has been substantial impact of programs to prevent mother-to-child transmission (PMTCT) of HIV.However, despite the recognized benefits of early ART initiation for HIV-infected infants and maternal health care, there is substantial loss to follow-up of HIV-infected mothers and their infants after delivery. Barriers to effective utilization of postnatal HIV care and treatment services include logistical factors, competing demands, and psychological factors such as fear of stigmatization.

Transgender women are the population most affected by the HIV/AIDS epidemic in Peru because of issues that occur at individual, interpersonal, socio-cultural, and structural levels, as our team has demonstrated in previous research. A combination, multilevel intervention approach is needed incorporating strategies in order to address internalized oppression, self-regulation abilities, and sexual self-knowledge, along with biomedical approaches to HIV prevention. This proposal aims to conduct a one year qualitative study leading to an NIH grant to develop such an intervention strategy.

In Sub-Saharan Africa, high hypothetical acceptability of vaginal microbicide trials among women has often been dampened by low male partner support. Formative work recently carried out among women in Kisumu, Kenya indicate that despite a high willingness (80%) to participate in upcoming vaginal microbicide trials, more than a third of the interviewees either did not think their partners would support their trial participation or were unsure of his support.

Most HIV-infected subjects exhibit a progressive rise in CD4 T-cell counts after initiation of highly active antiretroviral therapy (HAART). However, a subset of individuals exhibit very poor CD4 T cell recovery despite effective control of viremia. Increased activation-induced programmed cell death of CD4 T cells has been proposed as a mechanism underlying poor immune recovery. We propose to perform a nested case control study utilizing a rural cohort of HIV-infected adults whose CD4 T-cell counts have remained low (<50 cell increase) despite HAART for at least six months.

Human papillomavirus (HPV) is associated with cervical, vulvar, anal and penile cancers. High incidence rates of these cancers are observed in Africa compared to other parts of the world. Severa studies have implicated that the sexual behavior of the male partner is or even more important than women?s personal sexual behavior in predicting her risk of HPV associated cancers. Little is known about the natural history of HPV infections among men; thus hampering efforts to control infection in both men and women.

There are more than 3 million children 15 years estimated to be living with HIV, with almost 90% residing in sub-Saharan Africa (SSA). This presents a growing challenge to health providers and caregivers concerning the disclosure of HIV serostatus to infected children. Studies conducted in SSA have indicated that only 2% to 37.8% of HIV-infected children 15 years know their HIV status. Despite formal recommendations for disclosure, there are no tested models for supporting caregivers and HIV-infected children in SSA through the process of disclosure.