Epidemiology and Biostatistics

CareConekta

Project leaders: Tamsin Phillips (UCT), Kate Clouse (Vanderbilt University)

Collaborating university: Vanderbilt University

Funding statement: This study was funded by the US National Institutes of Health (NIH) under grant R34 MH118028. Formative work that led to the development of this study was funded by NIH under grant P30 AI110527 to the TN CFAR.

Purpose of project

Routine Electronic Mother-Infant Data (Remind) to Support Retention in Postpartum HIV Treatment and Early Infant Diagnosis Services in South Africa

Project leader: Tamsin Phillips

Funding statement: Funding for this project was made possible in full by a CIPHER grant from the International AIDS Society.

Purpose of project

Maternal loss from antiretroviral therapy (ART) and incomplete early infant diagnosis (EID) are common in high HIV-burden settings. The proposed study, centred at a large primary care clinic in Gugulethu, Cape Town, will leverage existing central routine electronic data sources to identify MIPs with key gaps in PMTCT and facilitate linkage back to care. A prospective cohort of 400 peripartum women living with HIV and age 18 or older will be recruited. Them and their babies will be monitored in the routine medical record data through 9 months postpartum to identify gaps in routine PMTCT care.

The specific aims are:

1. Use a prospective cohort to validate gaps identified by the routine data in i) EID, ii) maternal linkage to postpartum HIV care and regular viral load testing, and iii) linkage of infants diagnosed with HIV to treatment
2. Implement tracing MIPs with gaps in care and examine potential impact of this approach
3. Use the Consolidated Framework for Implementation Research (CFIR) to explore factors influencing the implementation of the use of routine electronic data to identify gaps in care and the success of MIP tracing.

Improving Chronic Disease Monitoring in Resource Limited Settings: Simulation and Economic Evaluation Approaches

Project leaders: Maia Lesosky, Elton Mukonda

Funder: NRF (Thuthuka)

Description of main aims/site/purpose of project

This study focuses on the use of simulation models and economic evaluations for the assessment and comparison of a wide range of potential strategies for the management of chronic diseases which may not be feasible to investigate using traditional epidemiological studies due to cost, duration and ethical constraints. Specifically, the study focuses on how chronic disease monitoring can be considered as a complex intervention which can lead to a reduction in costs and an improvement in health outcomes if done effectively. This is a multi-component study that will include a number of approaches including literature reviews, simulation modelling, analytic studies and a formal economic evaluation.

Exploring the Burden and Impact of Cardio-Metabolic Complications During Pregnancy in the Context of High Obesity and HIV Burden in South Africa (CAMP)

Project leaders:
Landon Myer (UCT SPH)

Angela Bengtson (Brown University)

Hlengiwe Madlala (UCT SPH)

Collaborating university: Brown University

Funders: NIH, CFAR

Purpose of project

The central objective of this project is to generate preliminary evidence on the burden and impact of NCDs and HIV in pregnancy and postpartum in LMICs. In a cohort of 400 HIV-uninfected (n=200) and HIV-infected/on ART (n=200) pregnant women in Cape Town, South Africa, we will enrol mother-infant pairs between 24-28 weeks’ pregnancy and follow them through 6 months postpartum. Information on pregnancy outcomes will be collected via medical records. 

The Relationship Between Postpartum Weight Retention and Metabolic Outcomes in HIV-infected and -uninfected Women in Cape Town, South Africa: (P-CAMP)

Project leaders:
Hlengiwe Madlala (UCT SPH)

Landon Myer (UCT SPH)

Angela Bengtson (Brown University)

Collaborating university: Brown University

Funders: NRF Thuthuka, CFAR, Harry Crossley Clinical Research Fellowship

Purpose of project)

The objective of this proposal is to examine the impact of the double-burden of obesity and HIV on metabolic outcomes of women during the postpartum period. As part of this we will investigate body composition, energy expenditure, mitochondrial function, inflammation and oxidative stress as potential mechanistic pathways between HIV and obesity and metabolic function. This is a cross-sectional study for 6-12month postpartum HIV-infected and -uninfected women enrolled into ‘CAMP study’ at a large maternity obstetric clinic in Cape Town, South Africa (n=100 total; 25 HIV-infected women with low postpartum weight retention, 25 HIV-infected women with high postpartum weight retention, and a comparator of 50 HIV-uninfected women).

Inflammation and Immune Activation in Pregnancy: Fetal Inflammation and Maternal Obesity (iMAP)

Project leaders:

Hlengiwe Madlala (UCT SPH)

Landon Myer (UCT SPH)

Jennifer Jao (Northwestern University/Lurie Children’s Hospital)

Marie-Louise Newell (Southampton University),

Thoko Malaba (UCT SPH)

Collaborating universities: North-Western and Southampton Universities

Funder: NIH Fogarty International Centre

Purpose of project

Postpartum weight retention (PPWR) contributes to a range of non-communicable diseases (NCDs) in mid-life. The aim of this proposal is to examine the association between inflammatory, immune activation markers and PPWR; and correlation of these maternal markers with their levels in the fetal compartment (cord blood). This is a retrospective cohort study that will utilise repository plasma specimens of women living with HIV from the PIMS cohort which was assembled and followed up from 2015 to 2018. Markers of inflammation and immune activation during the 3 trimesters of pregnancy will be quantified. A total of 100 specimens will be randomly selected within strata of body mass index (BMI) at T1 (< versus ≥ 30 kg/m²), as T1 BMI is a strong predictor of PPWR.