The United Nations Millennium Development Goals (MDGs) illustrate key areas in which the lives of women and children worldwide are in need, including improving maternal health and a reduction in childhood mortality. The success of meeting both these goals depends on reducing rates of vertical transmission of HIV. Sub-Saharan Africa is one of the areas targeted by the MDGs and bears a substantial degree of HIV disease burden, with well over 22 million people living with HIV at the end of 2008, a significant number of whom are women of reproductive age. Depression has been associated with non-adherence to the series of health behaviors known as preventing mother-to-child transmission (PMTCT) of HIV. Women in resource limited settings are likely to face additional barriers to PMTCT adherence, including stigma and structural barriers. While structural barriers may be circumvented by relying on community resources (known as social capital), depression and stigma may make it difficult to access these resources. Thus, understanding the role of modifiable factors that contribute to PMTCT adherence is critical to meeting the goals of the MDGs. Candidate: I am a clinical psychologist and recently transitioned to faculty at Massachusetts General Hospital/Harvard Medical School. I am applying for a five-year K23 Career Development Award to obtain training and mentorship in order to become an independent investigator at the R01 level, and an expert in depression and adherence to health behaviors important to the health of HIV infected women in resource limited settings.
Both my primary mentor (Safren) and co-mentor (Bangsberg) have protected time to devote to my mentorship via K24 Mid-Career Investigator Awards in Patient-Oriented Research. Both are experts in the field of antiretroviral therapy adherence in international settings. Dr. Safren is aso an expert in depression and behavioral intervention development. In addition, I have assembled a team of consultants with expertise in other critical aspects of my proposal, including women's reproductive health (Smit), PMTCT (Peltzer), stigma (Kalichman), social networks and health (Christakis), and biostatistics (Ghebremichael). Research: The goals of the proposed project are to (1) investigate the relationships among perinatal depression, stigma, social capital utilization PMTCT adherence, and (2) to test a pilot intervention to treat perinatal depression and improve adherence to ARVs among HIV infected women in a resource limited setting. Training: My research activities will be supported by structured meetings with my mentors and coursework in advanced statistical methods, psychiatric epidemiology, and healthcare in developing countries at the Harvard School of Public Health, the timing of which will complement my proposed research activities. My exceptional mentoring team, strong institutional support, innovative research questions, and my commitment to addressing issues relevant to the health of HIV infected women and their children leave me well positioned to achieve my goal of becoming an independent investigator.
While approximately 40,000 children become infected with HIV in South Africa alone each year, transmission of HIV from mother to infant can be reduced dramatically through a variety of techniques known as "PMTCT" (preventing mother to child transmission). Not all women complete appropriate PMTCT protocols and factors such as stigma and depression may play a significant role in non-adherence. Mathematical modeling studies have proposed that without increasing rates of adherence to these protocols, we will not see significant reductions in mother-to-child HIV transmission and therefore cannot reduce rates of infant mortality;thus, identifying the role of and intervening upon modifiable pathways of non-adherence is critical.
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