International Mentored Scientist Award

Therapeutic drug monitoring (TDM) of antiretroviral drugs has optimized treatment of HIV-infected patients in resource-rich countries especially in selected ‘difficult to treat’ situations (1). The measurement of drug levels in serum samples enables timely diagnosis of low drug levels, which put patients at risk of developing treatment failure, as well as too high levels which foster toxicity of the drugs.

There is an urgent global goal to eliminate new HIV infections among children by 2015 and to keep their mothers alive, with the targets of providing antiretroviral therapy to all HIV-infected pregnant women and children. Yet, barely a year away from the 2015 deadline, HIV programs are far from reaching these targets. A substantial proportion of HIV-positive pregnant women in sub-Saharan Africa are lost to follow-up after delivery.

Bacterial vaginosis (BV), a disruption of the normal vaginal flora, has recently been associated with a greater than 3-fold increased risk of female-to-male HIV-1 transmission in a manner not accounted for by plasma HIV-1 RNA load(1). We hypothesize that compared to cervicovaginal fluid (CVF) from healthy individuals, BV CVF induces an elevated pro-inflammatory and pro-chemotactic response in cells of the foreskin which may facilitate transmission.

Trichomoniasis, caused by the protozoan parasite, Trichomonas vaginalis (TV), is the most common, curable sexually transmitted infection worldwide with a particularly high prevalence of up to 35% among women in Sub-Saharan Africa (SSA). This region of the world is also home to almost 70% of new human immunodeficiency virus (HIV) infections occurring worldwide and most of these infections occur in women. Recent studies showed that TV infection in African women is associated with a 1.5 ? 2.7-fold increased risk for HIV infection.

Protection of operating theatre personnel from bloodborne pathogens has been neglected in Uganda. Nature, frequency, risk factors, and preventive measures for perioperative exposure of theatre personnel will be identified by conducting a 6 month cross-sectional study in Mulago Hospital, Uganda. Multiple logistic regression will analyze risk factors for exposure. Case exposure rate and cumulative risk of seroconversion of HIV will be calculated. Surveys of theatre personnel will assess knowledge, attitude, and practice for risks of perioperative bloodborne infections.

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.