Roughly 1.5 million women living with HIV become pregnant each year worldwide, and despite increasing access to effective HIV medications, many women struggle to maintain adequate medication adherence which is essential for maternal health and prevention of HIV transmission. Targeted delivery of evidence-based enhanced adherence support for pregnant and postpartum women most at risk of viremia could have an important impact on maternal and infant outcomes. This will be the first evaluation of risk score implementation to inform targeted service delivery to vulnerable pregnant and postpartum women who are living with HIV in sub-Saharan Africa.
The overall goal of this K01 proposal is to support Dr. Pamela Murnane's research training to develop into an independently funded epidemiologist with expertise in implementation science and decision support to improve maternal health and HIV outcomes globally. Career development and training plan: Together with a dedicated, interdisciplinary, internationally recognized mentorship team, the candidate has developed a career development and training plan including structured mentorship, coursework, conferences, seminars, and applied research experience. The training goals of this K01 proposal are:
1) to gain expertise in risk score development to design decision support tools which can facilitate targeted HIV service delivery to vulnerable populations;
2) to develop skills in qualitative research methods to inform optimal approaches to implementation of novel models of HIV care;
3) to acquire expertise in implementation science methodology to inform optimal and sustainable scale-up of services to improve maternal health and HIV care outcomes.
Research plan: Recent data from several cohorts across sub-Saharan Africa indicate that over a quarter of pregnant and postpartum women living with HIV on effective antiretroviral treatment (ART) have inadequate adherence and experience viremia. Viral suppression is essential for both maternal health and prevention of sexual and perinatal transmission. To optimize targeted delivery of evidence-based approaches to adherence support, the candidate proposes to develop a widely usable risk score to identify pregnant and postpartum women living with HIV most at risk of viremia, and to evaluate its implementation in a routine care setting in western Kenya.
The specific aims are:
1) to develop and externally validate a risk score to predict viremia in pregnant and postpartum women living with HIV and on ART in sub-Saharan Africa;
2) to explore preferences, facilitators and barriers to risk score implementation within a busy clinical setting in western Kenya, through qualitative interviews and focus groups with care providers;
3) to conduct a mixed-methods pilot study to evaluate the implementation and potential impact of a risk score to facilitate targeted, evidence-based adherence support to pregnant and postpartum women at risk of viremia in western Kenya.
Aims 2 and 3 will be conducted at Family AIDS Care and Education Services (FACES) clinics in Kisumu County, Kenya. FACES is a collaboration between the University of California San Francisco and the Kenya Medical Research Institute, and is led by the candidate's primary mentor and co-mentor. This integrated training and research plan will prepare Dr. Murnane to launch an independent research career with a R01 application designed to test the hypothesis that implementing a risk score to facilitate targeted adherence support can reduce the risk of viremia and improve maternal and infant health outcomes.