Estimating the burden of morbidity and mortality associated with maternal HIV infection in sub-Saharan Africa 1990-2028

external supervisor

Professor Eric Ohuma, London School of Hygiene and Tropical Medicine

background

The Sustainable Development Goals (SDGs) aim to end preventable deaths of newborns and children under age five by 2030. However, no countries in sub-Saharan Africa are currently on track to meet the SDG target by 2030.

1.3 million HIV-positive pregnant women give birth every year, 91% of whom reside in sub-Saharan Africa, the region which also has the highest rates of neonatal and child morbidity and mortality. Antiretroviral therapy (ART)-naïve maternal HIV-infection is associated with an increased risk of preterm birth (less than 37 weeks), small-for-gestational-age (less than 10^th centile), low birthweight (less than 2500g) and stillbirth. ART in pregnancy reduces maternal morbidity and mortality, and greatly reduces mother-to-child transmission of HIV, but may increase the risk of adverse perinatal outcomes.

Estimating the perinatal morbidity and mortality associated with maternal HIV infection and ART is crucial to determine the total health burden of the HIV pandemic. It will also allow comparison between the burdens of disease directly (through vertical HIV transmission) and indirectly caused by HIV infection. Moreover, it enables comparison to other causes of disease, thereby enabling the prioritisation of funding, research and clinical care.

Key references:

Wedi et al Hemelaar, Lancet HIV, 3:e33-48 (2016).

Cowdell et al Hemelaar, EClinicalMedicine, 46:101368(2022).

Sexton et al Hemelaar, HIV Medicine, doi: 10.1111/hiv.13326(2022).

Murray et al Hemelaar, Communications Medicine, 3(1):103(2023).

Beck K, et al Hemelaar, Frontiers in Medicine, 11:1323813(2024).

Erlwanger A, et al Hemelaar, EClinicalMedicine, 70:102532(2024).

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING

Data sets from UNAIDS, WHO, GBD (IHME) and others will be utilised to estimate the burden of perinatal morbidity and mortality associated with maternal HIV infection and ART in sub-Saharan Africa in 1990-2028.

The project will involve estimation of the risk of adverse perinatal outcomes (e.g. preterm birth) associated with maternal HIV infection and different ART regimens, based on meta-analysis of the published literature. This data will be combined with UNAIDS estimates of the numbers of women living with HIV in each country in sub-Saharan Africa to generate numbers of adverse perinatal outcomes attributable to HIV and ART for the period 1990-2028. Figures will be compared with total estimates of perinatal outcomes, such as preterm birth and low birth weight, for each country, as estimated by WHO and the Global Burden of Disease (GBD) studies. Disability adjusted life years (DALYs) and (neonatal) mortality associated with each perinatal outcome will be calculated. These estimates will be analysed in the context of the total global burden of disease and the burden of disease caused by other risk factors in sub-Saharan Africa. The impact of interventions will be modelled. 

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

It is anticipated that the work will be conducted in Oxford and all necessary facilities, equipment, and training, including database, analytic and statistical training, will be provided in Oxford. Some training will be provided at the London School of  Hygiene and Tropical Medicine.

PROSPECTIVE  STUDENT

A student with a background in medicine, obstetrics and gynecology, infectious diseases, statistics or global health might suit this project. The ideal candidate will have a Master's degree in a relevant area (e.g. statistics/epidemiology/public health). The project has a broad scope and candidates are encouraged to contact Dr Joris Hemelaar to work out a specific project proposal.