The Alama Project: Autism outcomes and neurobehavioral markers in young children born to mothers with HIV in Kenya - PROJECT SUMMARY An estimated 14.8 million children – 90% of whom live in Africa – are HIV-exposed and uninfected (CHEU). Despite advances in understanding health outcomes of CHEU, the neurodevelopmental impact of HIV exposure has not been well characterized. Several small studies conducted in high income countries (HIC) suggest a higher prevalence of autism in CHEU. CHEU may be at elevated risk for autism due to HIV exposures, which are associated with adverse birth outcomes, iron-deficiency anemia, and maternal and child infectious morbidity. These risks have been shown to be associated with autism outcome in HIC, but no study to date has examined autism in CHEU in Africa where the vast majority of these children live. Investigating autism in CHEU has high potential to identify mediating risks on the causal pathway between HIV exposure and autism outcome and inform the selection of modifiable targets for precision detection and intervention strategies in low- and middle- income countries (LMIC). However, there is a lack of neurodevelopmental expertise and tools to carry out research in these settings. Scalable diagnostic and neurobehavioral tools for detection and study of mechanistic neural processes are necessary to advance autism research in these settings. Eye tracking is a powerful, low- cost, feasible neurobehavioral tool used in HIC for both autism detection and investigation of neurocognitive processes. To achieve improved health outcomes in LMIC, a key research priority must include capacity building in state-of-the science diagnostic and neurobehavioral methods for autism detection. The objective of this proposal is to examine autism diagnostic outcome and eye-tracking markers in CHEU while building capacity for neuro-health research in Kenya. We will accomplish this by leveraging a longitudinally assessed cohort of CHEU and children who are HIV unexposed and uninfected (CHUU) with well characterized HIV-related and contextual exposures (R01HD104552) and synergistically expanding our team’s ongoing neuro-health capacity building efforts (R21MH127570). This work will be guided by a Community and Scientific Advisory Panel and situated within the Academic Model Providing Access to Care (AMPATH) program. In Aim 1, we will compare autism diagnostic outcomes between young CHEU and CHUU across a large cohort (N=850) of Kenyan children. In Aim 2, we will determine whether neurobehavioral eye-tracking markers predict autism outcome in CHEU and CHUU. Through a series of tiered training and mentorship activities integrated with the proposed research activities of Aims 1 and 2, in Aim 3 we will build global scientific partnerships and upskill a Global Neuro-Health Collaborative in Kenya with the clinical and research expertise, tools, and resources necessary to solve high impact setting-specific health challenges. This study is innovative as it will be the first to apply rigorous diagnostic and eye-tracking methodologies to investigate autism outcomes in CHEU in LMIC. The proposed work has high potential to inform precision detection and intervention strategies to mitigate deleterious outcomes of both HIV exposure and autism.
