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Principal Investigator: Caitlin Dugdale
Organization: MASSACHUSETTS GENERAL HOSPITAL
Fiscal Year: 2024
Award: $172,748
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Project Summary
HIV-exposed infants experience high rates of adverse birth outcomes, including stillbirth, preterm birth, small
for gestational age, and neonatal death. These birth outcomes carry substantial morbidity and mortality in sub-
Saharan Africa (SSA) where access to neonatal intensive care services is limited. Chlamydia and gonorrhea
are sexually transmitted infections (STIs) that are highly prevalent among women with HIV in SSA. These STIs
are associated with increased risks of adverse birth outcomes if untreated in pregnancy. While antenatal
screening for chlamydia and gonorrhea is recommended in pregnancy in some high-income settings, including
the US, it is not yet a part of routine care in SSA. Syndromic management, the current standard of care in SSA,
consists of empiric, symptom-driven treatment of STIs. However, this approach misses up to 70% of STIs,
while exposing 75% of symptomatic pregnant women to inappropriate treatment and promoting antibiotic
resistance. The clinical impact and cost-effectiveness of antenatal chlamydia and gonorrhea screening among
pregnant women with HIV has not been well-studied in resource-limited settings. I am an infectious disease
physician and clinician-investigator with experience in simulation modeling and cost-effectiveness research. I
am committed to using model-based research to improve the health of women and children in resource-limited
settings. To become an independent investigator, I require further training and mentorship in: 1) advanced
modeling techniques, 2) costing and model input derivation, and 3) principles of implementing maternal, child,
and reproductive health interventions. I have outlined a didactic plan, assembled a multidisciplinary mentorship
team, and established a new collaboration with investigators focused on maternal-child health in Botswana. My
primary mentor is Dr. Andrea Ciaranello, an expert in modeling and cost-effectiveness analysis related to
maternal-child health. My mentorship team additionally includes experts in advanced modeling methods (Dr.
David Paltiel), adverse birth outcomes among children in Botswana (Dr. Roger Shapiro), and obstetrical care in
sub-Saharan Africa (Dr. Blair Wylie). With their guidance, I will address two Specific Aims:
1. To develop a detailed microsimulation model of women with HIV and their infants through
pregnancy, delivery, and the postpartum period that incorporates clinical and economic details of
maternal and infant HIV, chlamydia, and gonorrhea infection, as well as adverse birth outcomes
2. To evaluate the clinical impact, cost, and cost-effectiveness of chlamydia and gonorrhea
screening strategies in pregnancy, incorporating outcomes for women with HIV and their infants
in Botswana
The proposed training and research aims will inform efforts to improve maternal-child health outcomes in
Botswana and will provide a foundation for a career as an independent investigator who can apply modeling to
address critical questions at the intersection of HIV, maternal-child health, and global healthcare policy.
Terms: <0-11 years old><AIDS><AIDS Virus><Acquired Immune Deficiency><Acquired Immune Deficiency Syndrome><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome><Acquired Immunodeficiency Syndrome Virus><Address><Affect><Africa South of the Sahara><After Care><After-Treatment><Aftercare><Alternative Therapies><Alternative intervention><Antibiotic Agents><Antibiotic Drugs><Antibiotic Resistance><Antibiotic Therapy><Antibiotic Treatment><Antibiotics><Antimicrobial Resistance><Award><Awareness><Bechuanaland><Birth><Botswana><Calibration><Child><Child Health><Child Youth><Children (0-21)><Chlamydia><Chronologic Fetal Maturity><Clinical><Collaborations><Communicable Diseases><Computer Simulation><Computer based Simulation><Conjunctivitis><Cost Analyses><Cost Analysis><Cost Effectiveness Analysis><Cost effectiveness research><Cross-Product Ratio><Data><Derivation><Derivation procedure><Economic Income><Economical Income><Economics><Event><Female Health><Fetal Age><Foundations><Gestation><Gestational Age><Goals><Gonococcal Infection><Gonorrhea><HIV><Health Policy><Human Immunodeficiency Viruses><Income><Infant><Infection><Infectious Disease Pathway><Infectious Diseases><Infectious Disorder><Investigators><LAV-HTLV-III><Link><Literature><Low Birth Weight Infant><Low-resource area><Low-resource community><Low-resource environment><Low-resource region><Low-resource setting><Lymphadenopathy-Associated Virus><Maternal Health><Maternal and Child Health><Mentors><Mentorship><Methodology><Methods><Miscellaneous Antibiotic><Miyagawanella><Modeling><Molecular><Morbidity><Morbidity - disease rate><Mother-to-child HIV transmission><Mothers><Neonatal><Neonatal Intensive Care><Neonatal Mortality><Newborn Infant Intensive Care><Nucleic Acid Amplification Tests><Nucleic Acid Testing><Odds Ratio><Outcome><Parturition><Perinatal><Perinatal Infection><Peripartum><Physicians><Pneumonia><Position><Positioning Attribute><Postpartum Period><Pregnancy><Pregnancy Complications><Pregnant Women><Premature Birth><Prematurely delivering><Preterm Birth><Publishing><Recommendation><Relative Odds><Research><Research Personnel><Researchers><Resistance to antibiotics><Resistant to antibiotics><Resource-constrained area><Resource-constrained community><Resource-constrained environment><Resource-constrained region><Resource-constrained setting><Resource-limited area><Resource-limited community><Resource-limited environment><Resource-limited region><Resource-limited setting><Resource-poor area><Resource-poor community><Resource-poor environment><Resource-poor region><Resource-poor setting><Risk><Risk Ratio><Risk Reduction><Sensitivity and Specificity><Sepsis><Sexually Transmitted Diseases><Sexually Transmitted Disorder><Sexually Transmitted Infection><Small for Gestational Age Infant><Sub-Saharan Africa><Subsaharan Africa><Symptoms><Syphilis><Techniques><Testing><Toxic effect><Toxicities><Training><Venereal Diseases><Venereal Disorders><Venereal Infections><Virus-HIV><Woman><Women's Health><Women's prevalence><Work><adverse birth outcomes><antenatal><antepartum><anti-microbial resistant><antibiotic drug resistance><antibiotic resistant><assess cost><bacterial disease treatment><bacterial infectious disease treatment><bedsonia><blood infection><bloodstream infection><budget impact><care services><care systems><career><clinical care><co-infection><coinfection><complications during pregnancy><computational simulation><computerized simulation><cost><cost assessment><cost effective><cost effectiveness><cost efficient analysis><cost evaluation><cost-effective analysis><cost-effectiveness evaluation><death among neonates><death among newborns><death in neonates><death in newborn><economic><economic analysis><economic assessment><economic evaluation><economic impact><evaluate cost><evaluate cost-effectiveness><evidence base><examine cost><expectant mother><expecting mother><experience><female outcomes><female prevalence><global health><great pox><health care policy><healthcare policy><high risk><improved><incomes><kids><low birth weight><low birthweight><model-based simulation><models and simulation><mortality><mortality among neonates><mortality among newborns><mortality in neonates><mortality in newborns><multidisciplinary><multiple data sources><neonatal care><neonatal death><neonatal demise><newborn death><newborn mortality><novel><obstetric care><outcomes among females><outcomes among women><outcomes in females><outcomes in women><point of care><post treatment><post-partum><pregnancy-related complications><pregnant mothers><premature childbirth><premature delivery><preterm delivery><prevalence among females><prevalence among women><prevalence in females><prevalence in women><prevalent among females><prevalent among women><prevalent in females><prevalent in women><prevent><preventing><reduce risk><reduce risks><reduce that risk><reduce the risk><reduce these risks><reduces risk><reduces the risk><reducing risk><reducing the risk><reproductive health intervention><resistance to anti-microbial><resistant to antimicrobial><risk-reducing><routine care><screening><screening program><screenings><sexually acquired infection><small for gestational age><standard of care><stillbirth><stillborn><tool><women's outcomes><youngster>