Physician Investigator (Cl) Division of Global Health at MassGeneral Hospital for Children, Mass General Research Institute

Associate Professor of Pediatrics Harvard Medical School

Assistant Physician Medicine-General Internal Medicine, Massachusetts General Hospital

Associate Pediatrician Pediatrics, Massachusetts General Hospital

Research Associate Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health

MD Medical College of Virginia 2003

anti-hiv agents; antiretroviral therapy, highly active; botswana; breast feeding; child development; hiv infections; hiv protease inhibitors; hiv-1; infectious disease transmission, vertical; pregnancy complications, infectious; premature birth; prenatal exposure delayed effects

I have leveraged my training in Internal Medicine and Pediatrics to advance the health of women living with HIV (WLHIV) and their children through research, advocacy, and engagement with global policymakers and implementers. I have focused my research efforts on improving the health of pregnant and postpartum WLHIV and their children. I am equally interested in finding better ways to treat children living with HIV, as I am in optimizing the health of children exposed to HIV in utero but who remain uninfected. I have investigated adverse birth outcomes among WLHIV that contribute to poor infant outcomes, including preeclampsia and preterm delivery. At the moment, my research portfolio funding is predominantly focused on children who are HIV-exposed uninfected (CHEU), as this group is currently estimated to represent a population of 14.8 million infants, children and adolescents worldwide, compared with the 160,000 infants and children newly infected with HIV in 2018. While researchers have reported conflicting results about the population of CHEU, study design and differing methodologies account for much of the variance in findings. Therefore, I have been funded by the National Institute of Child Health and Human Development (NICHD) to establish harmonized data collection practices around key outcomes of children who are HIV-exposed uninfected (R21 HD093531). This grant funding has allowed me to establish a Scientific Expert Panel and Technical Working Groups composed of internationally renowned specialist in the fields of pediatric HIV, global child health, epidemiology, and biostatistics. We are completing work on uniform and harmonizable instruments to evaluate infectious morbidity and all-cause mortality among CHEU, using an appropriate comparator group of children who are HIV-unexposed and uninfected. These instruments will be publicly available and employable in both high- and low-resourced settings. I am also the Principal Investigator or co-Investigator on funded projects in Botswana, Kenya, South Africa, and the United States working on studies that are investigating optimization of the health of children HIV-exposed uninfected, as well as those living with HIV. In 2018 I was appointed to the United States Department of Health and Human Services Panel on Antiretroviral Therapy and Medical Management of Children Living. Since 2016, I have been working with the WHO, UNAIDS, UNICEF, and the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) to put forth a global public health agenda for CHEU. My collaborations with UNAIDS has resulted in the inception of global and country-level online modeling of the population CHEU. Funding from WHO, CIPHER, and NICHD allowed me to co-organize the HEU Children and Adolescent Workshops as a pre-conference event to the International AIDS conferences since 2017.At the moment, this is the only international forum where researchers, clinicians, policymakers, implementers and civil society meet to learn about the latest research and discuss policy implications. These conferences have resulted in the formation of two WHO technical working groups to which I have been appointed. The first is focused on adaptation of WHO’s Nurturing Care Framework to address the needs to children affected by HIV.  Our group will issue a tecnical advisory in 2020, advising governments on recommended approaches within existing care infrastructure to implement aspects of WHO’s Nurturing Care Framework.  The second technical working group is exploring policy options and interventions for adolescent mothers living with HIV and their HIV-infected and exposed children globally.