CareConekta

Project leaders: Tamsin Phillips (UCT), Kate Clouse (Vanderbilt University)

Collaborating university: Vanderbilt University

Funding statement: This study was funded by the US National Institutes of Health (NIH) under grant R34 MH118028. Formative work that led to the development of this study was funded by NIH under grant P30 AI110527 to the TN CFAR.

Purpose of project

Population mobility is common in South Africa, but important research gaps exist describing this mobility and its impact on engagement in HIV care. Postpartum women and their infants in South Africa are known to be at high risk of dropping out of HIV care after delivery and are frequently mobile. In previous work, we developed a beta version of a smartphone application (app) – CareConekta – that detects a user’s smartphone location to allow for prospective characterization of mobility. In this R34 (ClinicalTrials.gov NCT03836625) we are adapting and testing CareConekta to conduct essential formative work on mobility and evaluate an intervention – the CareConekta app plus text notifications and phone calls and/or WhatsApp messages – to facilitate engagement in HIV care during times of mobility. During the three-year project period, our first objective is to evaluate the feasibility, acceptability, and initial efficacy of using CareConekta as an intervention to improve engagement in HIV care. Our second objective is to characterize mobility among South African women during the peripartum period and its impact on engagement in HIV care. We will enroll 200 eligible pregnant women living with HIV and receiving care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa.

^{Left to right: Kate Clouse, Sindiswa Madwayi, Megan Mrubata, Sandisiwe Noholoza, Tammy Phillips}

Routine Electronic Mother-Infant Data (Remind) to Support Retention in Postpartum HIV Treatment and Early Infant Diagnosis Services in South Africa

Project leader: Tamsin Phillips

Funding statement: Funding for this project was made possible in full by a CIPHER grant from the International AIDS Society.

Purpose of project

Maternal loss from antiretroviral therapy (ART) and incomplete early infant diagnosis (EID) are common in high HIV-burden settings. The proposed study, centred at a large primary care clinic in Gugulethu, Cape Town, will leverage existing central routine electronic data sources to identify MIPs with key gaps in PMTCT and facilitate linkage back to care. A prospective cohort of 400 peripartum women living with HIV and age 18 or older will be recruited. Them and their babies will be monitored in the routine medical record data through 9 months postpartum to identify gaps in routine PMTCT care.

The specific aims are:

1. Use a prospective cohort to validate gaps identified by the routine data in i) EID, ii) maternal linkage to postpartum HIV care and regular viral load testing, and iii) linkage of infants diagnosed with HIV to treatment
2. Implement tracing MIPs with gaps in care and examine potential impact of this approach
3. Use the Consolidated Framework for Implementation Research (CFIR) to explore factors influencing the implementation of the use of routine electronic data to identify gaps in care and the success of MIP tracing.

Improving Chronic Disease Monitoring in Resource Limited Settings: Simulation and Economic Evaluation Approaches

Project leaders: Maia Lesosky, Elton Mukonda

Funder: NRF (Thuthuka)

Description of main aims/site/purpose of project

This study focuses on the use of simulation models and economic evaluations for the assessment and comparison of a wide range of potential strategies for the management of chronic diseases which may not be feasible to investigate using traditional epidemiological studies due to cost, duration and ethical constraints. Specifically, the study focuses on how chronic disease monitoring can be considered as a complex intervention which can lead to a reduction in costs and an improvement in health outcomes if done effectively. This is a multi-component study that will include a number of approaches including literature reviews, simulation modelling, analytic studies and a formal economic evaluation.

Evaluation of Pre-Exposure Prophylaxis (PrEP) Initiation, Retention and Adherence in Pregnant and Breastfeeding Women (PrEP-PP)

Project leaders: Landon Myer, Dvora Joseph Davey

Collaborating university: University of California Los Angeles             

Funder: NIMH (R01MH116771) and Fogarty International Center (K01TW011187) 
Clinical trials identifier: NCT03826199

Purpose of project

Pregnant women at very high risk of HIV acquisition and HIV transmission to the infant. PrEP-PP (PrEP in Pregnant and Postpartum women) is an observational study that will determine the distribution of women across the PrEP cascade (i.e. PrEP initiation, continuation and adherence on PrEP) in a cohort of 1200 HIV-negative pregnant and breastfeeding adolescent girls (16+ years) and women. We are recruiting eligible, interested HIV-uninfected pregnant women from one public health facilities in Cape Town (Gugulethu). Women are recruited at their first antenatal visit and followed until 12 months postpartum. Our study will inform national and regional policymakers about the effectiveness of PrEP integration into antenatal (ANC) and postnatal care in high HIV incidence communities.

Study counsellors enrol consecutive eligible, consenting pregnant adolescent girls (>16 years) and women in ANC (1200 pregnant women). The study offers HIV-uninfected pregnant women the choice to take pre-exposure prophylaxis (PrEP), an antiretroviral pill, to take daily to prevent HIV up to 99% in women who take it daily. We follow up women every 3 months until their baby is 12 months old. We launched the study in August 2019 and are continuing to follow up 1200 women in a cohort study through 2022.

Obesogenic Origins of Maternal and Child Metabolic Health Involving Dolutegravir (ORCHID)

Project leaders:
Landon Myer (Epidemiology & Biostatistics, University of Cape Town)

Elaine Abrams (Paediatrics & Epidemiology, Mailman School of Public Health, ICAP Columbia University)

Jennifer Jao (Paediatrics & Medicine, Feinberg School of Medicine, North-western University /Lurie Children’s Hospital)

Collaborating universities: Columbia and North-western Universities

Funder: NIH

Purpose of project

The central objective of this project is to investigate the impact of DTG in pregnancy and its obesogenic effects on the metabolic health of women living with HIV (WLHIV) and their children, compared to women without HIV and their children. We will enrol 1900 pregnant women in the 1st trimester (633 WLHIV initiating DTG [iDTG] in pregnancy, 633 WLHIV continuing DTG [cDTG] use from pre-pregnancy, and 634 women without HIV) and their children, following them to two years. As part of this, mother-infant pairs will be required to attend up to 10 study visits separate from routine clinic visits, these visits include 3 antenatal visits (£14, 24-28 and 32-36 weeks) and 7 postnatal visits (<2 and 6 weeks, 3, 6, 12, 18 and 24 months). Additional data on maternal health in pregnancy and birth outcomes will be abstracted from medical records.

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Exploring the Burden and Impact of Cardio-Metabolic Complications During Pregnancy in the Context of High Obesity and HIV Burden in South Africa (CAMP)

Project leaders:
Landon Myer (UCT SPHFM)

Angela Bengtson (Brown University)

Hlengiwe Madlala (UCT SPHFM)

Collaborating university: Brown University

Funders: NIH, CFAR

Purpose of project

The central objective of this project is to generate preliminary evidence on the burden and impact of NCDs and HIV in pregnancy and postpartum in LMICs. In a cohort of 400 HIV-uninfected (n=200) and HIV-infected/on ART (n=200) pregnant women in Cape Town, South Africa, we will enrol mother-infant pairs between 24-28 weeks’ pregnancy and follow them through 6 months postpartum. Information on pregnancy outcomes will be collected via medical records. 

The Relationship Between Postpartum Weight Retention and Metabolic Outcomes in HIV-infected and -uninfected Women in Cape Town, South Africa: (P-CAMP)

Project leaders:
Hlengiwe Madlala (UCT SPHFM)

Landon Myer (UCT SPHFM)

Angela Bengtson (Brown University)

Collaborating university: Brown University

Funders: NRF Thuthuka, CFAR, Harry Crossley Clinical Research Fellowship

Purpose of project)

The objective of this proposal is to examine the impact of the double-burden of obesity and HIV on metabolic outcomes of women during the postpartum period. As part of this we will investigate body composition, energy expenditure, mitochondrial function, inflammation and oxidative stress as potential mechanistic pathways between HIV and obesity and metabolic function. This is a cross-sectional study for 6-12month postpartum HIV-infected and -uninfected women enrolled into ‘CAMP study’ at a large maternity obstetric clinic in Cape Town, South Africa (n=100 total; 25 HIV-infected women with low postpartum weight retention, 25 HIV-infected women with high postpartum weight retention, and a comparator of 50 HIV-uninfected women).

Inflammation and Immune Activation in Pregnancy: Fetal Inflammation and Maternal Obesity (iMAP)

Project leaders:

Hlengiwe Madlala (UCT SPHFM)

Landon Myer (UCT SPHFM)

Jennifer Jao (Northwestern University/Lurie Children’s Hospital)

Marie-Louise Newell (Southampton University),

Thoko Malaba (UCT SPHFM)

Collaborating universities: North-Western and Southampton Universities

Funder: NIH Fogarty International Centre

Purpose of project

Postpartum weight retention (PPWR) contributes to a range of non-communicable diseases (NCDs) in mid-life. The aim of this proposal is to examine the association between inflammatory, immune activation markers and PPWR; and correlation of these maternal markers with their levels in the fetal compartment (cord blood). This is a retrospective cohort study that will utilise repository plasma specimens of women living with HIV from the PIMS cohort which was assembled and followed up from 2015 to 2018. Markers of inflammation and immune activation during the 3 trimesters of pregnancy will be quantified. A total of 100 specimens will be randomly selected within strata of body mass index (BMI) at T1 (< versus ≥ 30 kg/m²), as T1 BMI is a strong predictor of PPWR.

Date

Time

Topic

Venue

Level

Registration link

Feb 12

9:30-12:30

8. Advanced modelling / analysis

Online

Advanced

https://forms.gle/ggWA9iNTTrumhTAR8

Mar 5

9:30-12:30

1. Introduction to R

Online

Beginner

https://forms.gle/LZkH4hfgspekqbCcA

Mar 19

9:30-12:30

9. Data visualisation with R

Online

Advanced

https://forms.gle/12a3bt887wdCyS8S8

Apr 9

9:30-12:30

2. Group summaries and comparisons + epiR part 1

TBD

Beginner

https://forms.gle/eYFsbsN6KkcAU8BcA

Apr 30

9:30-12:30

3. Group summaries and comparisons + epiR part 2

TBD

Beginner

https://forms.gle/mtefApg8UgNbBarL9

Aug 06

9:30-12:30

4. Regression models in R

MS Teams

Intermediate

https://forms.gle/nKGRRvGuCX1CZJPs6

Aug 27

9:30-12:30

5. Intermediate data handling

MS Teams

Intermediate

https://forms.gle/aFoHKjXjHMoH3ZNx9

Sept 17

9:30-12:30

6. Survival analysis in R

MS Teams

Intermediate

https://forms.gle/eifMNmD4osyfH7xL7

Jan 2022

TBD

7. Advanced data handling

TBD

Advanced

Registration circulated in Jan

Maia Lesosky, Associate Professor and Head of Division

Email:  maia.lesosky@uct.ac.za

Phone:  021 650 4532

Publications

Biostatistician and Associate Professor, Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine. Contributing Investigator with CIDRI-Africa (Wellcome Trust Centre), and with the NIHR Unit IMPALA studying respiratory outcomes across Africa. Maia has previously worked as Senior Lecturer – Medical Statistics – in the Department of Medicine at the University of Cape Town, as Extraordinary Lecturer in the Faculty of Veterinary Sciences at the University of Pretoria and as a research fellow at the University of Edinburgh, Institutes of Evolutionary Biology, Immunology and Infections Research and the Roslin Institute and at the Institute of Mathematics, Aalto University. She completed her PhD in 2009 in the Department of Mathematics and Statistics at the University of Guelph, Canada with research on statistical inverse problems. Current interests are in supervised learning as related to cytokine and other biomarker assay profiles, particularly in TB disease progression and Bayesian mixture models for longitudinal HIV viral load data. Constant distractions are statistical graphics, ‘composite’ statistical methods, algorithmic statistical methods (aka machine learning) and R programming. The Biostats Lab works with the Cape-R Users Group to promote R programming around the Cape and wider afield. Please join if you are local to Cape Town (twitter @CapeRUser). We also run a regular statistical methods seminar series on the Health Sciences Faculty – announced on web and via twitter (@EpiBiostats_UCT).

Landon Myer, Professor, Head of Department and Director of School

Email:  landon.myer@uct.ac.za

Phone:  021 406 6661

Publications

Landon Myer is Director and Head of the School of Public Health and Family Medicine at the University of Cape Town, South Africa. He has training in social anthropology, clinical medicine and epidemiology. His research focuses on women's, maternal and child health in the context of HIV. He has lead multiple clinical and health systems studies investigating the health of HIV-infected women receiving ART during pregnancy and postpartum, as well as the health and development of HIV-exposed and -infected children and adolescents.

Lara Dugas, Professor and AXA Research Chair in Non-Communicable Disease (NCD) Epidemiology (2021-2026)

Email:  Lara.Dugas@uct.ac.za

Publications

Professor Lara Dugas, PhD, MPH, FTOS received her doctorate in Exercise Physiology from the UCT. In 2007 she joined Loyola University Chicago (LUC), utilising her training in the measurement of human metabolism, including whole body energy expenditure, diet and physical activity monitoring. In 2011, she completed her Masters in Clinical Research Methods and in 2013 she obtained her MPH in Epidemiology. In 2016 she was named LUC Stritch School of Medicine Junior Scientist of the year, and in the same year became a fellow of The Obesity Society. In 2020 she was awarded an Honorary Professorship at UCT. She maintains a joint appointment between UCT and LUC. Her research explores NCD risk in African-origin populations spanning the epidemiologic transition. Her focus is the role of the gut microbiota and intermediary metabolites, focusing on short chain fatty acids on obesity and diabetes risk. She currently has two NIH-funded studies, exploring the role of the gut microbiota and NCD risk in 5 African-origin populations and 2021 was awarded the AXA Research Chair in Non-Communicable Disease (NCD) Epidemiology (2021-2026).

Tamsin Phillips, Senior Lecturer/Research Officer

Email:  tammy.phillips@uct.ac.za

Tamsin Phillips is an epidemiologist in the Division of Epidemiology and Biostatistics.  Her research focus is the continuum of care for women living with HIV. Her PhD investigated the impact of mobility and care transitions on adherence and retention in HIV care among pregnant and postpartum women in Gugulethu. She is also interested in the methodological considerations for measuring retention and adherence and the use of mobile health and smartphone technology for supporting the HIV care continuum. Tamsin recently received a VECD Fogarty Global Health Postdoctoral Fellowship through which she will explore longer-term patterns of disengage and re-engage in HIV care among postpartum women. She also teaches Introduction to Biostatistics as part of the MPH programme.

Kirsty Brittain, Lecturer/Research Officer

Email:  kirstybrittain@gmail.com

Kirsty Brittain is a Research Officer in the Division of Epidemiology and Biostatistics. Her research interests include psychosocial aspects of maternal, child and adolescent health, including adherence and engagement in HIV care, behavioural risk factors, and mental health problems. Her current work focusses on pregnant and postpartum women living with HIV, with a particular emphasis on HIV-status disclosure and experiences of stigma. She teaches Introduction to Epidemiology as part of the Master of Public Health programme.

Hlengiwe Madlala, Lecturer/Research Officer

Email:  Hlengiwe.madlala@uct.ac.za

Hlengiwe Madlala is a PhD Physiologist who recently completed her MPH and currently work as a Research Officer in the Division of Epidemiology and Biostatistics. Her research interests are co-morbidity of maternal obesity and HIV infection in pregnancy and underlying mechanisms for adverse birth outcomes. She manages a population-based cohort evaluating adverse pregnancy outcomes under the new policy of Option B+ strategy for prevention of mother-to-child transmission (PMTCT).

Elton Mukonda, Lecturer/Research Officer

Email:  elton.mukonda@uct.ac.za

Elton currently works as a Research Officer in the Division of Epidemiology and Biostatistics. He is a trained demographer and also has experience working as a statistician and data analyst. He completed his MPhil in Demography in 2015 at the Centre for Actuarial Research (CARe), University of Cape Town, with research on estimating mortality for metropolitan populations in developing countries. Current interests include economic evaluation, statistical learning, longitudinal data analysis, actuarial modelling and bayesian statistics.

Thokozile Malaba, Lecturer/Research Officer

Email:  Thoko.Malaba@uct.ac.za

Thoko Malaba is an epidemiologist in the Division of Epidemiology and Biostatistics at the University of Cape Town.  Her work focuses primarily on maternal and child health in the context of HIV, particularly the use of antiretroviral therapy in pregnancy.  She is currently involved in clinical, population-based and health systems research studies in HIV-infected women using different antiretroviral therapy regimens in pregnancy.  Her specific research interests are adverse birth outcomes and the methodological issues encountered in perinatal research studies.

Frissiano Honwana, Assistant Lecturer

Email:  Frissiano.Honwana@uct.ac.za

Frissiano Honwana is an assistant lecturer in the Division of Epidemiology and Biostatistics. He completed his Masters in Statistics at University of KwaZulu-Natal. His areas of interest are longitudinal data analysis and infectious disease modelling. Frissiano is a member of South African Statistical Association (SASA).

Jasantha Odayar, Clinical Research Officer

Email:  Jasantha.Odayar@uct.ac.za

Jasantha Odayar is an epidemiologist in the Division of Epidemiology and Biostatistics and the Centre for Infectious Disease Epidemiology and Research (CIDER).  Her interests are in improving health care services, particularly for individuals requiring long-term care, including for HIV and TB.  She manages an implementation science trial (“PACART”) comparing routine clinics to community-based adherence clubs for antiretroviral therapy (ART) delivery in HIV-positive postpartum women who initiated ART in pregnancy. 

Tracy Glass, Statistical Analyst

Email:  Tracy.Glass @uct.ac.za

Tracy Glass (PhD candidate, UCT), currently works as a data analyst at the Division of Epidemiology and Biostatistics, UCT.  She completed the Masters in Public Health in 2016, specialising in epidemiology and biostatistics. Tracy previously worked as a research intern at the Burden of Disease Research Unit (BODRU), at the South African Medical Research Council. Her current interest include disease modelling.

Stanzi le Roux, PhD candidate

Dr Stanzi le Roux is a doctoral student and clinical epidemiologist in the School of Public Health and Family Medicine, University of Cape Town. She has a background in clinical paediatrics and child health, with previous appointments at the clinical research unit in Red Cross War Memorial Children's Hospital, and the Desmond Tutu TB research Centre at Tygerberg Hospital, in Cape Town. Her research focus is maternal and child health in the context of infectious diseases in southern Africa, and she is currently completing her doctoral thesis on comparative health outcomes of HIV-exposed uninfected children.

Chukwudi Nnaji, PhD candidate

LinkedIn Profile

Twitter handle: @ChuxNesta_Nnaji

Chukwudi Nnaji is a Nigerian medical doctor, with a Bachelor of Medicine and Bachelor of Surgery (MBBS) degree. He completed his Master of Public Health (MPH) study at the University of Cape Town – with distinction in 2018, and now studying towards a Doctor of Philosophy (PhD) in Public Health at the Division of Epidemiology and Biostatistics. He is a Fellow of the Royal Society of Tropical Medicine and Hygiene (RSTMH) and currently working as an adjunct Senior Scientist/Epidemiologist at Cochrane South Africa, based at the South African Medical Research Council (SAMRC), Cape Town.

His research interests are in the areas of evidence based medicine, infectious disease epidemiology, vaccinology and vaccine implementation science. His PhD research aims to use multilevel analytical approaches to evaluate the burden, as well as individual-level and contextual enablers of missed opportunities for vaccination; while using the findings to design context-tailored quality improvement strategies for addressing identified missed opportunities for vaccination. He is supervised by Prof. Charles Wiysonge, Associate Prof. Maia Lesosky and Dr Duduzile Ndwandwe.

Annibale Cois

Email:  acois@sun.ac.za

Publications

Dr Annibale Cois is an Epidemiologist and Biostatistician, and a researcher in the Department of Global Health at Stellenbosch University. He holds an honorary position as a Senior Lecturer in the Division of Epidemiology and Biostatistics at the School of Public Health of the University of Cape Town.

His background includes Master Degrees in Electrical Engineering (University of Cagliari, Italy) and Public Health (University of Cape Town), and a PhD in Public Health (University of Cape Town).

His current research interests focus primarily on the epidemiology of non-communicable diseases and associated risk factors in low- and middle-income countries and the application of advanced statistical methods for the joint analysis of multiple heterogeneous data sources. 

Recent works include the application of latent variables techniques to the estimation and modelling of measurement error in anthropometric characteristics in large-scale surveys; the joint analysis of multiple datasets to recover long-term trends in blood pressure, body mass index and other cardiovascular risk factors; the study of seasonal patterns of cardiovascular risk factors in the South African population and their socioeconomic correlates; the application of Bayesian estimation methods for the study of population pattern of alcohol consumption.

Dvora Joseph Davey

Dr. Dvora Joseph Davey is an Honorary Senior Lecturer in the Division of Biostatistics and Epidemiology at the University of Cape Town. Dr. Davey received her Master’s Degree in Public Health from Columbia University and her PhD in Epidemiology from the University of California, Los Angeles. Dr. Davey has over eighteen years’ experience in international health with extensive experience in the design, management and evaluation of HIV prevention and care, sexual, reproductive health interventions and studies.  Her current research focuses on evaluating how best to prevent HIV in pregnant and breastfeeding women, including sexually transmitted infection (STI) diagnosis and treatment, and pre-exposure prophylaxis (PrEP) in pregnant and breastfeeding women.

Nathan Ford

Kevin Kelly

Melissa Wallace

Jabulani Ncayiyana

Publications

Jabulani Ncayiyana is an epidemiologist with research interests in infectious diseases, child and adolescent health, spatial epidemiology and implementation science.