Dr. Elaine Abrams is a leading global thought leader in the prevention and treatment of HIV infection and related infectious diseases in pregnant women, children and families. As a professor of epidemiology and pediatrics at Columbia University, she was a founding member of ICAP at Columbia University. As part of the core management team at ICAP, Dr. Abrams Senior Research Director and supports ICAP's global research with a growing portfolio of studies on HIV prevention, treatment and treatment. As an independently funded scientist, Dr. Abrams also conducted a series of studies to optimize HIV treatment and prevention throughout the life course of women during pregnancy and breastfeeding, as well as for infants, children and adolescents. The expertise of Dr. Abrams leads both US and global HIV policy and implementation planning through many avenues, including scientific leadership in the NIH-funded IMPAACT network and the WHO Pediatric Antiretroviral Working Group. During her tenure as co-chair of WHO's HIV Clinical Guidelines Group, several transformative innovations were introduced that accelerated the global expansion of HIV treatment in adults and children living with HIV.
areas of expertiseAdolescent health, breastfeeding, child health and development, HIV / AIDS, mother-to-child transmission, birth outcomes, child and maternal mortality, contraception, reproductive health, teenage pregnancy, mental health
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Combined , Mozambique: Young people are at the center of the global HIV epidemic. They are very susceptible to HIV infection and, for adolescents living with HIV (ALHIV), a disproportionate risk of poor health outcomes across the HIV care continuum. Retention rates, antiretroviral treatment adherence (ART), and virus suppression (VS) are alarmingly low in ALHIV and require urgent attention. Adolescence is a time of rapid physical and psychological development in which adolescents move from childhood to adulthood and experience diverse challenges as well as opportunities for growth, creativity and learning. Adolescents entering this stage in adverse conditions are ill-prepared to deal with the ramifications of living with a potentially fatal, stigmatized, communicable infection and the need to adopt positive, health-oriented behaviors, to seek out health services and contact to keep up with the daily ART treatments. In high prevalence countries such as Mozambique, the burden of living with HIV during this vulnerable stage of development is exacerbated by fragile health systems and emerging ALHIV-specific models of differentiated service delivery (DSD). At the same time, few specific interventions that address the needs of ALHIV have been developed and tested. In response, we propose to develop and test a culturally appropriate, context-relevant and theoretically sound, youth-focused multi-component intervention strategy, CombinADO, under ALHIV in Sambezia, Mozambique. Using a people-centered design approach, we will work with ALHIV, caregivers, healthcare providers, and local and national stakeholders to develop and pilot this CombinADO intervention strategy, which has four components: 1) ALHIV peer navigation and support, 2) Youth-friendly services, 3) mHealth technologies, and 4) health communication messages (phase 1). In phase 2, we propose evaluating the effectiveness of the CombinADO strategy at three milestones along the HIV treatment continuum: (a) staying on HIV treatment, (b) ART adherence, and (c) VS using ALHIV a randomized, controlled cluster study design. The study builds on longstanding partnerships between the ICAP at Columbia University, the Mozambican Department of Health and other local stakeholders, all of which aim to monitor disease progression and outcomes along the continuum of care for this high-risk population, youth living with HIV improve. Strategies for optimizing antiretroviral therapy offers for maternal and child health: the MCH-ART study , South Africa: The study aims to identify two different strategies for providing HIV care and treatment services during the postpartum period to eligible HIV-infected women starting antiretroviral treatment during pregnancy and their HIV-exposed infants evaluate. The primary objective is to compare maternal and child health (MCH) focused ART performance with general adult ART performance as strategies for delivering ART during the postpartum period in (i) maternal HIV virus suppression and (ii) maternal continued ART services 12 months after birth. ORCHIDS , South Africa: There are more than 8 million people living with HIV in South Africa (SA), including> 250,000 women who become pregnant annually and> 50% of SA women are overweight / obese.1 In South Africa and worldwide, dolutegravir (DTG) -based antiretroviral therapy (ART) is being rolled out as part of the preferred ART regimen of first choice. However, DTG has recently been linked as obese, which is linked to increased weight and adipose tissue when compared to other antiretrovirals.2,3 Obesity in pregnancy is linked to poor maternal and child health outcomes4-9, as one Pregnancy a critical factor is the period during which exposures that lead to changes in metabolic health can affect not only the long-term health of the mother but also the health of the fetus, newborn and ultimately the child. For women living with HIV (WLHIV) and their children, these exposures are innumerable, including HIV / ART, weight gain, and obesity. The overall aim of our study is to examine the influence of DTG in pregnancy and its obesogenic effects on the metabolic health of women with HIV (WLHIV) and their children compared to women without HIV and their children. To achieve this goal, we will leverage: (i) the existing NIH-funded research infrastructure in South Africa and (ii) the NIH's large R01 mechanism to enroll 1,900 pregnant women in the 1st trimester (633 WLHIV, the DTG in initiate pregnancy, 633 WLHIV, continue the DTG). Use before pregnancy and 633 women without HIV) and their children, followed by them for up to two years. Within this cohort, we first use air displacement plethysmography to investigate how HIV and / or DTG consumption (HIV / DTG) affects the longitudinal changes in weight and adipose tissue mass during pregnancy. We will further investigate the pathways of excessive weight gain in pregnancy and fat loss by assessing: a) the balance between caloric intake and resting energy expenditure, b) markers of systemic and obese inflammation, bowel integrity and satiety / hunger, and c) subcutaneous fat tissue function (SAT) and homeostasis. We will then examine how HIV / DTG use during pregnancy and postpartum affects metabolic health in postpartum mothers (postpartum weight retention, obesity, dysglycemia, insulin resistance, and dyslipidemia) and the metabolic health of newborns and children ( Weight, obesity, insulin resistance and dyslipidemia). To understand whether characteristic clusters of metabolites and lipid subspecies are associated with maternal and infant metabolic health, we will apply targeted metabolomics techniques to maternal (during pregnancy) and cord blood metabolites, lipid subspecies, and eicosanoids measure up. To address the various specific goals, we will use a number of nested sub-studies within the main cohort, including smaller nested cohorts and efficient case cohort designs. This study will play a crucial role in defining the obesogenic mechanisms and clinical consequences of DTG use in pregnancy in WLHIV and their children. The results of our study will provide insights into reducing the risk of metabolic diseases in the context of HIV / ART, identify potential targets for intervention, and inform public health approaches to reduce chronic co-morbidities over the life of WLHIV and their children.Back to top