Food and nutrition insecurity (F&NI) are inextricably linked to the HIV epidemic, and their relationship is bidirec-tional. Although we have some understanding of the mechanisms by which HIV acquisition and disease pro-gression lead to F&NI, the mechanisms by which F&NI increase the likelihood of HIV acquisition and disease progression have only recently begun to be investigated. Strikingly, the mechanisms by which F&NI affect the health of HIV+ pregnant women and their infants have not been investigated to date. However, preliminary data suggest that F&NI reduce antiretroviral adherence, gestational weight gain, and the duration of exclusive breastfeeding, all of which have consequences for the health of the mother and child, including vertical trans-mission. Therefore, the scientific objectie of this K01 application is to elucidate the mechanisms by which F&NI have deleterious effects on the health of HIV+ mothers and their infants. My central hypothesis is that F&NI are detrimental to the health of HIV+ pregnant women and their infants via nutritional, disease, and psy-chosocial pathways. This hypothesis will be tested with 3 specific aims: (1) to describe and assess F&NI and associated modifiable determinants among HIV+ pregnant and lactating women in Kenya, (2) to characterize the magnitude and pathways by which F&NI impact maternal and infant health among a cohort of HIV+ preg-nant women in Kenya, (3) develop a plan for a multi-level intervention to reduce F&NI to improve health of HIV+ mothers and their children. The qualitative research (for Aims 1 and 3) and cohort study (for Aim 2) will leverage resources at Family AIDS Care and Education Services, an HIV care and treatment program in Nyanza province, Kenya, the primary study site for several of my K01 mentors. My training in medical anthro- pology and international nutrition will serve me well, but I need additional mentorship and training in 1) as- sessment of F&NI among mothers and infants, 2) statistical analysis of complex longitudinal data sets 3) the management of HIV and HIV-associated diseases in low-resource settings, 4) assessment of psychosocial well-being and childhood development, and 5) the design, implementation, and evaluation of multi-level inter- ventions. This training will further my long-term career goal of becoming an independent investigator with qualitative and quantitative expertise in the design and implementation of efficacious, culturally acceptable in- terventions that reduce morbidity and mortality of mothers and young children. The training and research are significant because F&NI is highly prevalent in sub-Saharan Africa, HIV+ pregnant women are disproportion- ately affected by it, and there are a number of potentially serious health consequences for women and their infants. A better understanding of how F&NI is deleterious will provide knowledge to design more effective in- terventions to improve the health of HIV+ mothers and their HIV-exposed infants. This innovative research will generate novel data to test theoretically driven hypotheses about the pathways by which F&NI may impact the health of HIV-infected mothers and their infants.

Public Health Relevance

HIV-infected pregnant women and their HIV-exposed infants are at high risk for food and nutrition insecurity, but strikingly, the extent and mechanisms by which food and nutrition insecurity affect their physical and mental well-being have not been investigated. The proposed research and training will shed light on the nutritional, disease, and psychosocial pathways by which food and nutrition insecurity harm HIV-infected women and their infants. This information will be used to develop interventions that promote physical and mental health among HIV-infected mothers and their HIV-exposed infants and prevent new HIV infections by decreasing behaviors associated with increased risk of vertical transmission (e.g. mixed breastfeeding and poor antiretroviral adher- ence).

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
1K01MH098902-01
Application #
8404102
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Kamath, Susannah M Allison
Project Start
2012-07-17
Project End
2017-05-31
Budget Start
2012-07-17
Budget End
2013-05-31
Support Year
1
Fiscal Year
2012
Total Cost
$175,828
Indirect Cost
$13,024
Name
Cornell University
Department
Nutrition
Type
Other Domestic Higher Education
DUNS #
872612445
City
Ithaca
State
NY
Country
United States
Zip Code
14850
Schuster, Roseanne C; de Sousa, Octávio; Rivera, Jacqueline et al. (2016) Performance-based incentives may be appropriate to address challenges to delivery of prevention of vertical transmission of HIV services in rural Mozambique: a qualitative investigation. Hum Resour Health 14:60
Williams, Anne M; Chantry, Caroline; Geubbels, Eveline L et al. (2016) Breastfeeding and Complementary Feeding Practices among HIV-Exposed Infants in Coastal Tanzania. J Hum Lact 32:112-22
Koss, Catherine A; Natureeba, Paul; Nyafwono, Dorcas et al. (2016) Brief Report: Food Insufficiency Is Associated With Lack of Sustained Viral Suppression Among HIV-Infected Pregnant and Breastfeeding Ugandan Women. J Acquir Immune Defic Syndr 71:310-5
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Schuster, Roseanne C; McMahon, Devon E; Young, Sera L (2016) A comprehensive review of the barriers and promoters health workers experience in delivering prevention of vertical transmission of HIV services in sub-Saharan Africa. AIDS Care 28:778-94
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Bartelink, Imke H; Savic, Rada M; Dorsey, Grant et al. (2015) The effect of malnutrition on the pharmacokinetics and virologic outcomes of lopinavir, efavirenz and nevirapine in food insecure HIV-infected children in Tororo, Uganda. Pediatr Infect Dis J 34:e63-70
Young, Sera; Natamba, Barnabas; Luwedde, Flavia et al. (2015) "I Have Remained Strong Because of That Food": Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy. AIDS Behav 19:1535-47
Natamba, Barnabas K; Achan, Jane; Arbach, Angela et al. (2014) Reliability and validity of the center for epidemiologic studies-depression scale in screening for depression among HIV-infected and -uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study. BMC Psychiatry 14:303

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