HIV/HAART AND PREGNANCY/CONTRACEPTION IN RAKAI, UGANDA
Heena Pushkar Brahmbhatt, Assistant Professor
Johns Hopkins University, 3400 N Charles St, Baltimore, Md 21218
Grant 1R01NR011474-01A1 from National Institute Of Nursing Research
Abstract: Over 13 million women in sub-Saharan Africa were estimated to be infected with HIV/AIDS by end of 2007. The goal of this study is to assess the interactions between HIV infection, fertility outcomes and contraceptive use in the context ART availability and use among individuals and couples in Rakai, Uganda. Under the proposed RO1, we plan to analyze data collected annually on a sample of the approximately 12,000 Rakai Community Cohort Survey (RCCS) participants surveyed annually since 1994. Our specific aims are to assess (i) determinants of contraceptive use and impact of fertility desires and intention on contraceptive use and pregnancy rates, (ii) impact of hormonal contraceptives on HIV disease progression as well as the impact of ARTs on fertility outcomes, contraceptive use and high risk behaviors, and (iii) fertility outcomes and contraceptive use among HIV-concordant and serodiscordant couples. Rates of contraceptive use, pregnancy, and pregnancy loss will be assessed through annual surveys and rate ratios estimated using Poisson regression. Log-binomial regression methods will be used to assess determinants of contraceptive use. Survival analyses and Kaplan-Meier survival curves will be used to assess the impact of hormonal contraceptives on HIV progression indicators (time from infection to death, time-to- AIDS, time to CD4 <250/mm3, and CD4 decline, viral set point and clinical symptoms). Proportional rate models will be used to estimate the within woman change in frequency of pregnancy and pregnancy loss before and after ART use. To account for repeat measurements within individuals we will use random-effects models for continuous variables and Markovian and random-effects logistic regression for binary outcomes with GEE estimation of robust variance. The RCCS provides unique longitudinal, community based data on HIV status, sociodemographic, behavioral and health characteristics. There is an urgent need for data on effective, long-term contraceptives for HIV-infected women and impact of HIV treatment on fertility outcomes, contraceptive use and high risk behaviors. It is critical that factors influencing reproductive health outcomes and contraceptive use in the backdrop of HIV infection and ART availability and use are better understood so as to inform policy and programs to guide individuals and couples make safer decisions regarding their sexual health and child bearing. With a very high total fertility rate (6.7), low levels of contraceptive use (15.6%) and high levels of unmet need (35%) in Uganda, there is a pressing need to understand factors affecting decisions regarding HIV prevention, contraceptive use and pregnancy outcomes and the extent to which these factors are modified by ART availability and use. The RCCS has data to answer these pressing public health questions regarding contraceptive choices and fertility outcomes among HIV+ and HIV- individuals and couples
Keywords: 0-11 years old; AIDS; AIDS Seroconversion; AIDS Seropositivity; AIDS Virus; AIDS prevention; AIDS/HIV; AIDS/HIV prevention; AIDS/HIV problem; Accounting; Acquired Immune Deficiency; Acquired Immune Deficiency Syndrome; Acquired Immune Deficiency Syndrome Virus; Acquired Immuno-Deficiency Syndrome; Acquired Immunodeficiency Syndrome; Acquired Immunodeficiency Syndrome Virus; Active Follow-up; Affect; Africa; Africa South of the Sahara; Age; Alcohol Drinking; Alcohol consumption; Analysis, Data; Anti-HIV Positivity; Anti-Retroviral Agents; Antiretroviral Agents; Antiretroviral Therapy, Highly Active; Blood Serum; Censuses; Cessation of life; Characteristics; Child; Child Youth; Children (0-21); Chorioamnionitis; Clinical; Cohort Studies; Communities; Concurrent Studies; Condom; Condoms, Unspecified; Contraception; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Contraceptives; Counseling; Couples; Data; Data Analyses; Data Banks; Data Bases; Databank, Electronic; Databanks; Database, Electronic; Databases; Death; Developed Countries; Developed Nations; Developing Countries; Developing Nations; Disease Progression; Equilibrium; EtOH drinking; Family; Family Planning; Family Planning Services; Fecundability; Fecundity; Female; Fertility; Fertility Control; Fertility Rates; Frequencies (time pattern); Frequency; Gestation; Goals; HAART; HIV; HIV Antibody Positivity; HIV Infections; HIV Positive; HIV Positivity; HIV Prevention; HIV Seroconversion; HIV Seropositivity; HIV/AIDS; HIV/AIDS prevention; HIV/AIDS problem; HTLV-III; HTLV-III Infections; HTLV-III Seroconversion; HTLV-III Seropositivity; HTLV-III-LAV Infections; Health; Health Sciences; Health, Reproductive; High Prevalence; Highly Active Antiretroviral Therapy; Hormonal; Human Immunodeficiency Viruses; Human T-Cell Leukemia Virus Type III; Human T-Cell Lymphotropic Virus Type III; Human T-Lymphotropic Virus Type III; Human, Child; Immunologic Deficiency Syndrome, Acquired; Incidence; Individual; Industrialized Countries; Industrialized Nations; Infant; Infection; Infection of amniotic sac and membranes; Inhibition of Fertilization; Intention; Interview; Knowledge; LAV-HTLV-III; Less-Developed Countries; Less-Developed Nations; Life; Link; Live Birth; Logistic Regressions; Low Birth Weight Infant; Lymphadenopathy-Associated Virus; Marital Relationships; Measurement; Measures; Mediation; Methods; Modeling; Mothers; Negotiating; Negotiation; Opportunistic Infections; Outcome; Participant; Persons; Policies; Population; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Pregnancy loss; Premature Birth; Preterm Birth; Prevalence; Prevention; Prevention Measures; Prevention strategy; Preventive strategy; Programs (PT); Programs [Publication Type]; Prophylactic treatment; Prophylaxis; Public Health; Rates, Fertility; Regressions, Logistic; Relationships, Marital; Relative; Relative (related person); Reproductive Health; Risk; Risk Behaviors; Risky Behavior; Role; Rural Community; SUBGP; Sampling; Serum; Services; Sexual Health; Sexual Partners; Social Marketing; Stigmata; Sub-Saharan Africa; Subgroup; Subsaharan Africa; Survey Instrument; Surveys; Survival Analyses; Survival Analysis; Symptoms; T-Lymphotropic Virus Type III Infections, Human; Testing; Third-World Countries; Third-World Nations; Time; Transmission; Uganda; Under-Developed Countries; Under-Developed Nations; Unspecified Abortion; Unwanted pregnancy; VLBW (human); Viral; Virus-HIV; Woman; abortion; aged; alcohol ingestion; alcohol intake; alcohol product use; alcohol use; alcoholic beverage consumption; alcoholic drink intake; anti-retroviral; anti-retroviral therapy, highly active; antibody positive AIDS test; antigen positive AIDS test; antiretroviral; at risk behavior; balance; balance function; base; bear children; bearing children; behavioral health; child bearing; childbearing; children; clinical data repository; clinical data warehouse; cohort; condoms; contraceptive use; data repository; ethanol consumption; ethanol drinking; ethanol ingestion; ethanol intake; ethanol product use; ethanol use; etoh use; experience; follow-up; high risk behavior; improved; intimate partner violence; low birth weight infant human; low birthweight; male; men; men`s; optimism; postiive attitude; premature childbirth; premature delivery; preterm delivery; prevent; preventing; programs; public health medicine (field); public health relevance; relational database; seropositive (AIDS test); sex; sex partner; sex risk; sexual coercion; sexually active; social role; social stigma; stigma; transmission process; trend; unintended pregnancy; youngster
Relevance: RELEVANCE With a very high total fertility rate (6.7), low levels of contraceptive use (15.6%) and high levels of unmet need (35%) in Uganda, there is a pressing need to understand factors affecting decisions regarding HIV prevention, contraceptive use and pregnancy outcomes and the extent to which these factors are modified by ART availability and use. The RCCS has data to answer these pressing public health questions regarding contraceptive choices and fertility outcomes among HIV+ and HIV- individuals and couples
Project start date: 2009-06-12
Project end date: 2012-04-30
Budget start date: 12-JUN-2009
Budget end date: 30-APR-2010
PFA/PA: PA-07-070
1R01NR011474-01A1 (2009): $278933
Sponsored Links Excellgen http://Excellgen.com
Grants awarded to Heena Pushkar Brahmbhatt
MORBIDITY/MORTALITY AND DISABILITY IN CHILDREN STUDY
Heena Pushkar Brahmbhatt, Assistant Professor
Johns Hopkins University, W400 Wyman Park Building, Baltimore, Md 21218
Grant 5K01TW007403-04 from Fogarty International Center
Abstract: Over 3 million African children are HIV-infected, but there is limited information on the development, health and social conditions of HIV-positive (HIV+) and HIV-negative (HIV-) children born to HIV-infected mothers. This study will assess the effects of HIV infection on child health and survival, in a cohort of 72 HIV+ and 228 HIV- but affected children born to HIV-infected mothers followed over 3. Children born during the study and their mothers/caretakers will be seen at birth, 4-6 weeks, 6 and 12 months, and annually thereafter. The specific aims are To assess the effects of HIV infection in the child and/or the mother on1) birth outcomes (birth weight, gestational age), 2) child health (morbidity), 3) growth and development (anthropometry), 4) neurodevelopmental disability (cognitive, motor, and behavioral disorders), and 5) mortality. The effects of antiretroviral therapy on each of these outcomes will also be assessed. Statistical methods will include Kaplan-Meier survival methods with log-rank tests for time to event analyses; proportional hazards models to estimate adjusted relative hazards for child outcomes with time-independent/dependent covariates; and regression methods for repeated measurements using population-average (marginal) and growth (conditional) models. The models will integrate the individual´s baseline information, time-dependent risk factors, and recurrent event history into covariates for predicting future events, and provide a form of trajectory analyses. The study is nested within a decade-long community cohort in rural Rakai District, Uganda, which provides extensive information on maternal HIV status, sociodemographic, behavioral and health characteristics; and detailed data on households. The Rakai Program has an extensive field, clinical, laboratory and data management infrastructure. The multidisciplinary research team has the requisite expertise in epidemiology, clinical research, assessment of morbidity and disabilities, and in statistical analyses. In 2004, the Rakai Program received PEPFAR support for ARV provision and in 2005 was awarded a RO1 to assess ARV effects on HIV epidemiology and behaviors (1 R01 HD050180-01). However, the RO1 does not provide resources for detailed pediatric evaluations, particularly of neurodevelopmental disabilities, which will be a primary and original focus of this training and research application. Embedding the proposed study within the Rakai cohort draws upon unique resources and allows substantial cost savings. This study will provide critical information to guide interventions for improved care of HIV infected and HIV affected children in rural Uganda
Keywords: 0-11 years old; 6H-Dipyrido(3, 2-b[{..}]2`, 3`-e)(1, 4)diazepin-6-one, 11-cyclopropyl-5, 11-dihydro-4-methyl-; AIDS; AIDS Seroconversion; AIDS Seropositivity; AIDS Virus; AIDS/HIV; AIDS/HIV problem; Acquired Immune Deficiency; Acquired Immune Deficiency Syndrome; Acquired Immune Deficiency Syndrome Virus; Acquired Immuno-Deficiency Syndrome; Acquired Immunodeficiency Syndrome; Acquired Immunodeficiency Syndrome Virus; Affect; Africa; Africa South of the Sahara; African; Age; Anemia; Anthropometry; Anti-HIV Positivity; Anti-Retroviral Agents; Antiretroviral Agents; Award; Behavior; Behavior Disorders; Biological; Birth; Birth Rate; Birth Weight; Breast Feeding; Breastfeeding; Caring; Cessation of life; Characteristics; Child; Child Mortality; Child Youth; Child health care; Childhood; Children (0-21); Clinical; Clinical Research; Clinical Study; Cognition; Cognitive; Communities; Cost Savings; Coupled; Data; Death; Developed Countries; Developed Nations; Development; Disease regression; Enrollment; Epidemic; Epidemiology; Evaluation; Event; Female; Fetal Age; Fetal Maturity, Chronologic; Future; Generalized Growth; Gestational Age; Growth; Growth and Development; Growth and Development function; HIV; HIV Antibody Positivity; HIV Infections; HIV Positive; HIV Positivity; HIV Seroconversion; HIV Seropositivity; HIV/AIDS; HIV/AIDS problem; HTLV-III; HTLV-III Infections; HTLV-III Seroconversion; HTLV-III Seropositivity; HTLV-III-LAV Infections; Health; Health, Child; Hearing; History; Household; Human Immunodeficiency Viruses; Human T-Cell Leukemia Virus Type III; Human T-Cell Lymphotropic Virus Type III; Human T-Lymphotropic Virus Type III; Human, Child; Immunologic Deficiency Syndrome, Acquired; Individual; Industrialized Countries; Industrialized Nations; Infant; Infection; Infrastructure; Injection of therapeutic agent; Injections; Interdisciplinary Research; Interdisciplinary Study; Intervention; Intervention Strategies; LAV-HTLV-III; Laboratories; Life; Longitudinal Studies; Lymphadenopathy-Associated Virus; Malaria; Masks; Measurement; Measures; Medical; Methods; Modeling; Morbidity; Morbidity - disease rate; Mortality; Mortality Vital Statistics; Mothers; Motor; Multidisciplinary Collaboration; Multidisciplinary Research; Neurodevelopmental Disability; Nevirapine; Numbers; Outcome; Paludism; Parturition; Plasmodium Infections; Population; Prevalence; Prevention; Prevention Measures; Preventive; Programs (PT); Programs [Publication Type]; Prophylactic treatment; Prophylaxis; Proportional Hazards Models; Purpose; QOL; Quality of life; Rate; Recording of previous events; Recurrence; Recurrent; Regression; Relative; Relative (related person); Research; Research Infrastructure; Research Resources; Research Training; Resources; Risk Behaviors; Risk Factors; Risky Behavior; Rural; Sampling; Saving, Cost; Services; Sight; Social Conditions; Social Problems; Societal Conditions; Source; Southern Africa; Statistical Methods; Stigmatization; Study, Interdisciplinary; Sub-Saharan Africa; Subsaharan Africa; T-Lymphotropic Virus Type III Infections, Human; TRNSF; Testing; Time; Tissue Growth; Transfusion; Transmission; Uganda; Vascular blood supply; Viramune; Virus-HIV; Vision; Week; Woman; anti-retroviral; antibody positive AIDS test; antigen positive AIDS test; antiretroviral; antiretroviral therapy; at risk behavior; base; behavioral disorder; behavioral health; blood supply; child physical development; children; cohort; data management; disability; enroll; experience; hazard; hearing perception; improved; interventional strategy; long-term study; ontogeny; pediatric; prevent; preventing; programs; reproductive; rural area; seropositive (AIDS test); social; social disturbance; sound perception; transmission process; vascular supply; youngster
Project start date: 2005-09-16
Project end date: 2010-08-31
Budget start date: 1-SEP-2008
Budget end date: 31-AUG-2010
PFA/PA: PAR-04-058
5K01TW007403-04 (2008): $0
HIV/HAART AND PREGNANCY/CONTRACEPTION IN RAKAI, UGANDA
Heena Pushkar Brahmbhatt, Assistant Professor
Johns Hopkins University, 3400 N Charles St, Baltimore, Md 21218
Grant 5R01NR011474-02 from National Institute Of Nursing Research
Abstract: Over 13 million women in sub-Saharan Africa were estimated to be infected with HIV/AIDS by end of 2007. The goal of this study is to assess the interactions between HIV infection, fertility outcomes and contraceptive use in the context ART availability and use among individuals and couples in Rakai, Uganda. Under the proposed RO1, we plan to analyze data collected annually on a sample of the approximately 12,000 Rakai Community Cohort Survey (RCCS) participants surveyed annually since 1994. Our specific aims are to assess (i) determinants of contraceptive use and impact of fertility desires and intention on contraceptive use and pregnancy rates, (ii) impact of hormonal contraceptives on HIV disease progression as well as the impact of ARTs on fertility outcomes, contraceptive use and high risk behaviors, and (iii) fertility outcomes and contraceptive use among HIV-concordant and serodiscordant couples. Rates of contraceptive use, pregnancy, and pregnancy loss will be assessed through annual surveys and rate ratios estimated using Poisson regression. Log-binomial regression methods will be used to assess determinants of contraceptive use. Survival analyses and Kaplan-Meier survival curves will be used to assess the impact of hormonal contraceptives on HIV progression indicators (time from infection to death, time-to- AIDS, time to CD4 <250/mm3, and CD4 decline, viral set point and clinical symptoms). Proportional rate models will be used to estimate the within woman change in frequency of pregnancy and pregnancy loss before and after ART use. To account for repeat measurements within individuals we will use random-effects models for continuous variables and Markovian and random-effects logistic regression for binary outcomes with GEE estimation of robust variance. The RCCS provides unique longitudinal, community based data on HIV status, sociodemographic, behavioral and health characteristics. There is an urgent need for data on effective, long-term contraceptives for HIV-infected women and impact of HIV treatment on fertility outcomes, contraceptive use and high risk behaviors. It is critical that factors influencing reproductive health outcomes and contraceptive use in the backdrop of HIV infection and ART availability and use are better understood so as to inform policy and programs to guide individuals and couples make safer decisions regarding their sexual health and child bearing. With a very high total fertility rate (6.7), low levels of contraceptive use (15.6%) and high levels of unmet need (35%) in Uganda, there is a pressing need to understand factors affecting decisions regarding HIV prevention, contraceptive use and pregnancy outcomes and the extent to which these factors are modified by ART availability and use. The RCCS has data to answer these pressing public health questions regarding contraceptive choices and fertility outcomes among HIV+ and HIV- individuals and couples
Keywords: 0-11 years old; AIDS; AIDS Seroconversion; AIDS Seropositivity; AIDS Virus; AIDS prevention; AIDS/HIV; AIDS/HIV prevention; AIDS/HIV problem; Accounting; Acquired Immune Deficiency; Acquired Immune Deficiency Syndrome; Acquired Immune Deficiency Syndrome Virus; Acquired Immuno-Deficiency Syndrome; Acquired Immunodeficiency Syndrome; Acquired Immunodeficiency Syndrome Virus; Active Follow-up; Affect; Africa; Africa South of the Sahara; Age; Alcohol Drinking; Alcohol consumption; Analysis, Data; Anti-HIV Positivity; Anti-Retroviral Agents; Antiretroviral Agents; Antiretroviral Therapy, Highly Active; Blood Serum; Censuses; Cessation of life; Characteristics; Child; Child Youth; Children (0-21); Chorioamnionitis; Clinical; Cohort Studies; Communities; Concurrent Studies; Condom; Condoms, Unspecified; Contraception; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Contraceptives; Counseling; Couples; Data; Data Analyses; Data Banks; Data Bases; Databank, Electronic; Databanks; Database, Electronic; Databases; Death; Developed Countries; Developed Nations; Developing Countries; Developing Nations; Disease Progression; Equilibrium; EtOH drinking; Family; Family Planning; Family Planning Services; Fecundability; Fecundity; Female; Fertility; Fertility Control; Fertility Rates; Frequencies (time pattern); Frequency; Gestation; Goals; HAART; HIV; HIV Antibody Positivity; HIV Infections; HIV Positive; HIV Positivity; HIV Prevention; HIV Seroconversion; HIV Seropositivity; HIV/AIDS; HIV/AIDS prevention; HIV/AIDS problem; HTLV-III; HTLV-III Infections; HTLV-III Seroconversion; HTLV-III Seropositivity; HTLV-III-LAV Infections; Health; Health Sciences; Health, Reproductive; High Prevalence; Highly Active Antiretroviral Therapy; Hormonal; Human Immunodeficiency Viruses; Human T-Cell Leukemia Virus Type III; Human T-Cell Lymphotropic Virus Type III; Human T-Lymphotropic Virus Type III; Human, Child; Immunologic Deficiency Syndrome, Acquired; Incidence; Individual; Industrialized Countries; Industrialized Nations; Infant; Infection; Infection of amniotic sac and membranes; Inhibition of Fertilization; Intention; Interview; Knowledge; LAV-HTLV-III; Less-Developed Countries; Less-Developed Nations; Life; Link; Live Birth; Logistic Regressions; Low Birth Weight Infant; Lymphadenopathy-Associated Virus; Marital Relationships; Measurement; Measures; Mediation; Methods; Modeling; Mothers; Negotiating; Negotiation; Opportunistic Infections; Outcome; Participant; Persons; Policies; Population; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Pregnancy loss; Premature Birth; Preterm Birth; Prevalence; Prevention; Prevention Measures; Prevention strategy; Preventive strategy; Programs (PT); Programs [Publication Type]; Prophylactic treatment; Prophylaxis; Public Health; Rates, Fertility; Regressions, Logistic; Relationships, Marital; Relative; Relative (related person); Reproductive Health; Risk; Risk Behaviors; Risky Behavior; Role; Rural Community; SUBGP; Sampling; Serum; Services; Sexual Health; Sexual Partners; Social Marketing; Stigmata; Sub-Saharan Africa; Subgroup; Subsaharan Africa; Survey Instrument; Surveys; Survival Analyses; Survival Analysis; Symptoms; T-Lymphotropic Virus Type III Infections, Human; Testing; Third-World Countries; Third-World Nations; Time; Transmission; Uganda; Under-Developed Countries; Under-Developed Nations; Unspecified Abortion; Unwanted pregnancy; VLBW (human); Viral; Virus-HIV; Woman; abortion; alcohol ingestion; alcohol intake; alcohol product use; alcohol use; alcoholic beverage consumption; alcoholic drink intake; anti-retroviral; anti-retroviral therapy, highly active; antibody positive AIDS test; antigen positive AIDS test; antiretroviral; at risk behavior; balance; balance function; base; bear children; bearing children; behavioral health; child bearing; childbearing; children; clinical data repository; clinical data warehouse; cohort; condoms; contraceptive use; data repository; ethanol consumption; ethanol drinking; ethanol ingestion; ethanol intake; ethanol product use; ethanol use; etoh use; experience; follow-up; high risk behavior; improved; intimate partner violence; low birth weight infant human; low birthweight; male; men; men`s; optimism; postiive attitude; premature childbirth; premature delivery; preterm delivery; prevent; preventing; programs; public health medicine (field); public health relevance; relational database; seropositive (AIDS test); sex; sex partner; sex risk; sexual coercion; sexually active; social role; social stigma; stigma; transmission process; trend; unintended pregnancy; youngster
Relevance: RELEVANCE With a very high total fertility rate (6.7), low levels of contraceptive use (15.6%) and high levels of unmet need (35%) in Uganda, there is a pressing need to understand factors affecting decisions regarding HIV prevention, contraceptive use and pregnancy outcomes and the extent to which these factors are modified by ART availability and use. The RCCS has data to answer these pressing public health questions regarding contraceptive choices and fertility outcomes among HIV+ and HIV- individuals and couples
Project start date: 2009-06-12
Project end date: 2012-04-30
Budget start date: 1-MAY-2010
Budget end date: 30-APR-2011
PFA/PA: PA-07-070
5R01NR011474-02 (2010): $296559