A Career Development Award in HIV-Associated Preterm Birth and its Prevention This application to the Fogarty International Research Scientist Development Award (IRSDA) will provide Dr. Joan Price with the support she needs to advance to the next stage in her career development. Dr. Price is an obstetrician-gynecologist at the University of North Carolina (UNC) with a long-held commitment to global women's health. She has lived full-time in Lusaka, Zambia since July 2016 where she has established a solid career foundation for clinical, epidemiologic, and implementation research around HIV and obstetric outcomes. The IRSDA will provide a structured framework to gain experience in each of these fields, supporting both didactic and experiential learning opportunities for rapid career progression toward research independence. She has also assembled a strong multidisciplinary team of investigators committed to her career development. Dr. Price's IRSDA research will take advantage of two newly-funded trials of progesterone to prevent preterm birth (PTB) among HIV infected women in Zambia. She proposes three aims, each linked to a robust career development plan focused on epidemiologic and health economics methods. First, she will investigate whether the timing of ART initiation is associated with PTB within the trial cohorts and whether the progesterone intervention shows improved efficacy in the subgroup of women newly starting ART in pregnancy. She will bring her obstetrical expertise to the trials and ensure that key data (e.g., ultrasound biometry, PTB phenotyping) are collected for her analyses. With formal training in causal inference coupled with expert mentorship, she will use marginal structural models to address the numerous potential confounders and biases that have long been associated with similar analyses. Second, Dr. Price will perform serum assessment of exogenous progesterone concentrations to evaluate the extent to which this biomarker correlates with risk of preterm birth. This activity will provide an opportunity to apply her learning in survival analysis. Third, Dr. Price will measure the healthcare- associated costs of caring for a preterm infant and of delivering a public-sector progesterone supplementation program. Once these are obtained, she will construct a decision analysis model and estimate the incremental cost-effectiveness of progesterone to prevent PTB among women with a proven indication (prior PTB, short cervix) and women with the indication being tested in the ongoing trials (HIV). Each of these separate research aims will take advantage of the ongoing parent trials, but none are dependent upon the final trial outcome. The results will contribute to the growing field of HIV and adverse birth outcomes, afford a foundation of career development, and provide important preliminary data for Dr. Price as she pursues independent NIH funding.
Preterm birth is the leading cause of neonatal mortality worldwide but can be prevented in certain high risk populations with antenatal progesterone supplementation. In this application, I propose a series of related studies organized around implementing this intervention in Zambia.
|Chi, Benjamin H; Mutale, Wilbroad; Winston, Jennifer et al. (2018) Infant Human Immunodeficiency Virus-free Survival in the Era of Universal Antiretroviral Therapy for Pregnant and Breastfeeding Women: A Community-based Cohort Study From Rural Zambia. Pediatr Infect Dis J 37:1137-1141|