Dissecting the causal impact of prenatal HIV exposure and the postnatal environment on development in Malawian Infants

PROJECT SUMMARY/ABSTRACT Infant health and neurodevelopment in early life may be impaired by a wide range of prenatal and postnatal factors including maternal infection and inflammation, and the socio-behavioral postnatal environment. Identifying the independent impact of these exposures is critical for defining key interventions to improve infant

health and development. This proposal addresses a long-standing challenge in examining multifactorial outcomes such as neurocognitive development that require incorporating both biological and psychosocial exposures. The Principal Investigator, Dr. Andrea Buchwald, is an infectious disease epidemiologist at

University of Maryland School of Medicine with expertise in biostatistical methods and global health. She will use multidisciplinary methodology to address this challenge, examining the independent contributions of prenatal and postnatal exposures on child health and development in a cohort including HIV exposed and

uninfected infants. Using data from an on-going cohort study in Malawi, Dr. Buchwald will be uniquely able to develop an innovative statistical approach to examine the contribution of both biological and socio-behavioral factors on infant health and development. Mothers with and without HIV infection were enrolled in their second

trimester of pregnancy and infants are being followed up through five years of age for health and development outcomes. Dr. Buchwald will use a multidisciplinary approach, combining machine learning and structural equation modeling, to address the following aims: Aim 1: Estimate the independent contributions of in utero exposure to HIV and postnatal environmental factors

on infant health and neurocognitive development. Aim 2: Identify immunological profiles at birth predictive of infant health and neurocognitive development. The results of this research will help us to identify key intervention targets for improving child health and development, to inform intervention design and implementation.

Dr. Buchwald’s goal is to become an independent investigator in in pediatric infectious disease, with expertise in utilizing cross-disciplinary methodology to address the multifactorial nature of infectious disease. Towards this goal, she proposes a comprehensive career development plan that will enhance her existing

skills in infectious disease epidemiology while providing mentored training in 1) data integration of large datasets, 2) socio-behavioral methodology, 3) analyzing large biological datasets, and 4) leadership skills. Dr. Buchwald has assembled a highly accomplished multidisciplinary team of mentors with unique

areas of expertise including global health research, maternal/child health, neonatal immunology, bioinformatics, structural equation modeling, and neurodevelopment. Her mentors have a track record of successfully mentoring trainees and junior faculty and the University of Maryland School of Medicine will

provide the ideal environment for Dr. Buchwald to establish a productive independent research career.