Current World Health Organization guidelines recommend that infants exposed to HIV at birth should receive cotrimoxazole (TMZ-SMZ) as empiric prophylaxis against Pneumocystis pneumonia for one year without confirmation of H1V infection. However, 70-90% of exposed infants will not become HIV positive but would still take prophylaxis presumptively for one year. CoTrimoxazole in Zambian Infants (TZI) is a three year prospective study measuring population level effects of the WHO's proposal on common pediatric infectious diseases. TZI is funded by USAID and has been actively recruiting patients since July 1, 2003. TZI-MALARIA is a nested case control study within TZI focusing on TMP-SMZ's impact on infant malaria rates, drug resistance, and its effect on the acquistion of malaria immunity during infancy. TZI-MALARIA asks three questions: 1) Will TMP-SMZ exposure reduce rates of asymptomatic parasitemia and clinical malaria during the period of prophylaxis? 2) Will former recipients ofprophylaxis experience higher than expected rates of asymptomatic parasitemia and clinical malaria in the monthsfollowing the cessation of TMP-SMZ prophylaxis? 3) Will TMP-SMZ exposure increase rates of resistance to sulfadoxine-pyrimethamine, a leading antimalarial that is cross-tolerant with TMP-SMZ? These questions will be answered by comparing cumulative rates of malaria during and after the period of prophyalxis, and conducting genetic analsis for SP-resistance markers as a comparison between two groups of infants: Cases - infants exposed to HIV at birth and receiving prophylaxis (but later proven HIV negative at 12 months); and Controls - temporally and geographically matched HIV-unexposed, HIV negative infants, not receiving TMP-SMZ prophylaxis. TZI-MALARIA constitutes the core activity of a five year K23 career development plan. This program integrates class work, mentored research, practical field experience, additional project development, teaching, and other activities derived from the academic environment of Boston University's School of Public Health and my parent organization, the Center for International Health and Development.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AI062208-02
Application #
6944065
Study Section
Microbiology and Infectious Diseases B Subcommittee (MID)
Program Officer
Laughon, Barbara E
Project Start
2004-09-01
Project End
2009-08-31
Budget Start
2005-09-01
Budget End
2006-08-31
Support Year
2
Fiscal Year
2005
Total Cost
$127,359
Indirect Cost
Name
Boston University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Gill, Christopher J; DeSilva, Mary Bachman; Hamer, Davidson H et al. (2015) Novel Approaches for Visualizing and Analyzing Dose-Timing Data from Electronic Drug Monitors, or ""How the 'Broken Window' Theory Pertains to ART Adherence"". AIDS Behav 19:2057-68
Gill, Christopher John; MacLeod, William B; Phiri-Mazala, Grace et al. (2014) Can traditional birth attendants be trained to accurately identify septic infants, initiate antibiotics, and refer in a rural African setting? Glob Health Sci Pract 2:318-27
Sabin, Lora L; Knapp, Anna B; MacLeod, William B et al. (2012) Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP). PLoS One 7:e35560
Gill, Christopher J; Guerina, Nicholas G; Mulenga, Charity et al. (2012) Training Zambian traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival Project (LUNESP). Int J Gynaecol Obstet 118:77-82
Gill, Christopher J; Phiri-Mazala, Grace; Guerina, Nicholas G et al. (2011) Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study. BMJ 342:d346
Sabin, Lora L; DeSilva, Mary Bachman; Hamer, Davidson H et al. (2010) Using electronic drug monitor feedback to improve adherence to antiretroviral therapy among HIV-positive patients in China. AIDS Behav 14:580-9
Gill, Christopher J; Sabin, Lora L; Hamer, Davidson H et al. (2010) Importance of dose timing to achieving undetectable viral loads. AIDS Behav 14:785-93
Litzow, Jennifer M; Gill, Christopher J; Mantaring, Jose B V et al. (2009) High frequency of multidrug-resistant gram-negative rods in 2 neonatal intensive care units in the Philippines. Infect Control Hosp Epidemiol 30:543-9
Gill, Christopher J; Mantaring, Jose B V; Macleod, William B et al. (2009) Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines. Clin Infect Dis 48:13-21
Gill, C J; Mwanakasale, V; Fox, M P et al. (2008) Effect of presumptive co-trimoxazole prophylaxis on pneumococcal colonization rates, seroepidemiology and antibiotic resistance in Zambian infants: a longitudinal cohort study. Bull World Health Organ 86:929-38

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