DESCRIPTION (provided by applicant): Food and nutrition insecurity (F&NI) are inextricably linked to the HIV epidemic, and their relationship is bidirec-tional. Although we have some understanding of the mechanisms by which HIV acquisition and disease pro-gression lead to F&NI, the mechanisms by which F&NI increase the likelihood of HIV acquisition and disease progression have only recently begun to be investigated. Strikingly, the mechanisms by which F&NI affect the health of HIV+ pregnant women and their infants have not been investigated to date. However, preliminary data suggest that F&NI reduce antiretroviral adherence, gestational weight gain, and the duration of exclusive breastfeeding, all of which have consequences for the health of the mother and child, including vertical trans-mission. Therefore, the scientific objectie of this K01 application is to elucidate the mechanisms by which F&NI have deleterious effects on the health of HIV+ mothers and their infants. My central hypothesis is that F&NI are detrimental to the health of HIV+ pregnant women and their infants via nutritional, disease, and psy-chosocial pathways. This hypothesis will be tested with 3 specific aims: (1) to describe and assess F&NI and associated modifiable determinants among HIV+ pregnant and lactating women in Kenya, (2) to characterize the magnitude and pathways by which F&NI impact maternal and infant health among a cohort of HIV+ preg-nant women in Kenya, (3) develop a plan for a multi-level intervention to reduce F&NI to improve health of HIV+ mothers and their children. The qualitative research (for Aims 1 and 3) and cohort study (for Aim 2) will leverage resources at Family AIDS Care and Education Services, an HIV care and treatment program in Nyanza province, Kenya, the primary study site for several of my K01 mentors. My training in medical anthro- pology and international nutrition will serve me well, but I need additional mentorship and training in 1) as- sessment of F&NI among mothers and infants, 2) statistical analysis of complex longitudinal data sets 3) the management of HIV and HIV-associated diseases in low-resource settings, 4) assessment of psychosocial well-being and childhood development, and 5) the design, implementation, and evaluation of multi-level inter- ventions. This training will further my long-term career goal of becoming an independent investigator with qualitative and quantitative expertise in the design and implementation of efficacious, culturally acceptable in- terventions that reduce morbidity and mortality of mothers and young children. The training and research are significant because F&NI is highly prevalent in sub-Saharan Africa, HIV+ pregnant women are disproportion- ately affected by it, and there are a number of potentially serious health consequences for women and their infants. A better understanding of how F&NI is deleterious will provide knowledge to design more effective in- terventions to improve the health of HIV+ mothers and their HIV-exposed infants. This innovative research will generate novel data to test theoretically driven hypotheses about the pathways by which F&NI may impact the health of HIV-infected mothers and their infants.

HIV-infected pregnant women and their HIV-exposed infants are at high risk for food and nutrition insecurity, but strikingly, the extent and mechanisms by which food and nutrition insecurity affect their physical and mental well-being have not been investigated. The proposed research and training will shed light on the nutritional, disease, and psychosocial pathways by which food and nutrition insecurity harm HIV-infected women and their infants. This information will be used to develop interventions that promote physical and mental health among HIV-infected mothers and their HIV-exposed infants and prevent new HIV infections by decreasing behaviors associated with increased risk of vertical transmission (e.g. mixed breastfeeding and poor antiretroviral adher- ence).