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The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV

Award Number: R01HD103466
ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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ABSTRACT For the first time on a national level, we propose to utilize routinely-collected laboratory data to develop a cohort of pregnant women living with HIV in South Africa in a way that is uniquely robust to transfer across facilities. South Africa is home to more people living with HIV than any other country, and nearly one in three pregnant women attending antenatal care is living with HIV. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with >95% ART coverage during pregnancy and delivery, and mother-to-child transmission of HIV greatly reduced. However, our work has demonstrated that women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after delivery, leading to the potential for viral transmission, morbidity and mortality. It is difficult to evaluate the success of policies of expanded access to ART care, and assess continuity of care, due to the lack of a national longitudinal HIV care database. In addition, patient movement between unlinked facilities means that self-transfer often is misclassified as loss to care. To address this major shortcoming, our team at the Health Economics and Epidemiology Office (HE2RO) partnered with the South African National Health Laboratory Services in 2015 to use existing HIV-related laboratory data to create the South African National HIV Cohort. Now, through this five-year award, we propose to expand this successful project to use routinely- collected laboratory data to develop a cohort of pregnant women living with HIV in South Africa. We propose three specific aims. First, we will develop and validate a novel national cohort of pregnant women accessing HIV care. Using laboratory test data matched to facility type, we will identify entry to antenatal care to build the cohort, then describe key treatment milestones, including 1) engagement in antenatal care, 2) initiation of ART, 3) HIV viremia, and 4) continuity of HIV care in the postpartum period. Second, we will measure the effect of system-wide factors impacting continuity of care among pregnant women. We will assess policies of expanded treatment access on continuity of care using regression-discontinuity analyses. We then will assess mobility and its effect on continuity of care during and after pregnancy. Third, we will identify individual-level risk factors for loss from HIV care in order to develop targeted interventions to improve engagement in HIV care.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $285,986 )
2024	2024	WITS HEALTH CONSORTIUM (PTY) LTD	31 PRINCESS OF WALES TERRACE	JOHANNESBURG				ZAF	Child Health and Human Development Extramural Research	000	5	3/27/2024	NON-COMPETING CONTINUATION	$285,986
														Subtotal = $285,986

Issue Date FY: 2023 ( Subtotal = $466,279 )
2023	2023	WITS HEALTH CONSORTIUM (PTY) LTD	31 PRINCESS OF WALES TERRACE PARKTOWN	JOHANNESBURG				ZAF	Child Health and Human Development Extramural Research	000	4	3/15/2023	NON-COMPETING CONTINUATION	$312,510
2023	2023	WITS HEALTH CONSORTIUM (PTY) LTD	31 PRINCESS OF WALES TERRACE PARKTOWN	JOHANNESBURG				ZAF	Child Health and Human Development Extramural Research	001	4	3/16/2023	SUPPLEMENT FOR EXPANSION	$153,769
														Subtotal = $466,279

Issue Date FY: 2022 ( Subtotal = $322,794 )
2022	2022	WITS HEALTH CONSORTIUM (PTY) LTD	31 PRINCESS OF WALES TERRACE PARKTOWN	JOHANNESBURG				ZAF	Child Health and Human Development Extramural Research	000	3	5/19/2022	NON-COMPETING CONTINUATION	$322,794
														Subtotal = $322,794

Issue Date FY: 2021 ( Subtotal = $335,338 )
2021	2021	WITS HEALTH CONSORTIUM (PTY) LTD	31 PRINCESS OF WALES TERRACE PARKTOWN	JOHANNESBURG				ZAF	Child Health and Human Development Extramural Research	000	2	4/2/2021	NON-COMPETING CONTINUATION	$335,338
														Subtotal = $335,338

Issue Date FY: 2020 ( Subtotal = $348,982 )
2020	2020	WITS HEALTH CONSORTIUM (PTY) LTD	31 PRINCESS OF WALES TERRACE PARKTOWN	JOHANNESBURG		2193		ZAF	Child Health and Human Development Extramural Research	001	1	6/16/2020	NEW	$0
2020	2020	WITS HEALTH CONSORTIUM (PTY) LTD	31 PRINCESS OF WALES TERRACE PARKTOWN	JOHANNESBURG		2193		ZAF	Child Health and Human Development Extramural Research	000	1	4/3/2020	NEW	$348,982
														Subtotal = $348,982

Grand Total All Awards = $1,759,379

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The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV

Award Number: R01HD103466

ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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