HIV Through the Lifecycle (Offline)

Our Challenge

While we applaud gains over the past 20 years to end the HIV/AIDS epidemic, we also recognize our work is far from done. Globally 36 million people are infected with HIV, and two million are adolescents aged 10-19 years old. Gender inequality and economic instability put women at high risk for sexual violence, substance abuse and HIV. Women may not able to delay sex or insist on protection to prevent them from being infected.

HIV/AIDS is the second leading cause of death in adolescents globally and, programmatically, adolescents are often an afterthought. Teenagers have unique needs that need to be met with with age-appropriate behavioral and medical interventions, and our systems are not always serving them well. They are often excluded from medical research because they are a difficult group to work with ethically and practically. While AIDS-related deaths are decreasing in children, youth (age 20-24) and adults, they are increasing in adolescents. Without intervention in early life, the implications of living with HIV can persist throughout the duration of a person’s lifecycle and into the next generation.

Our Response

Our Center has cultivated expertise in HIV/AIDS since its inception, particularly as it relates to women, adolescents, and children in resource-limited settings. We now leverage expertise in HIV to commit to a vision of transforming HIV testing and treatment approaches through integrated, innovative, impactful research. We aim to serve as a hub for information, expertise, and collaboration in HIV research across the lifecycle.

Our Priority Areas at each stage of the WACh Lifecycle

We are committed to preventing mother-to-child HIV transmission by prioritizing biologic determinants of conveyance, mHealth interventions, and systematic evaluations of the programs currently in place.

Our priority for women also recognizes an obligation to address HIV acquisition in pregnant and postpartum women. We center our research efforts for this population on PrEP in pregnancy and repeat HIV testing.

Meeting the unique needs of adolescents living with HIV necessitates improvements to the quality, level of engagement, and adherence to HIV care. We make these improvements by conducting research using simulated patient training, qualitative studies, continuing quality improvement, program evaluations, mHealth, social media, and service delivery evaluation.

We know that interventions in childhood have significant impact on the quality of HIV care throughout the reminder of a child’s life. That’s why our research in this population area is focused on expediting diagnosis, understanding pathogenesis, optimizing treatment and long-term outcomes, and reducing mortality.

These research efforts focus on HIV testing models, financial incentives, immunologic and virologic determinants of acquisition and disease, co-infections, HIV-exposed uninfected children adherence and disclosure within care, treatment interruption, and accelerated ART.

Our Leadership

Our work on HIV Through the Lifecyle is led by Drs. Jennifer Slyker and Grace John-Stewart.

Jennifer Slyker is a molecular epidemiologist and Assistant Professor in the University of Washington’s Department of Global Health. Dr. Slyker’s research includes biomedical studies of viral transmission and pathogenesis, and implementation science studies focused on improving pediatric HIV testing strategies in Kenya.

Grace John-Stewart is a Professor of Global Health, Medicine, Epidemiology, and Pediatrics at the University of Washington. Her interests include prevention of mother-to-child transmission of HIV, improving outcomes for children with HIV, and addressing relevant co-infections that affect women and children with HIV. Her research is based in Kenya and includes molecular epidemiologic studies, clinical trials, implementation science studies, and program evaluations focused on HIV and maternal child health.

Jennifer Slyker, PhD, MPH

Grace John-Stewart, MD, MPH, PhD

Our Research

Pintye J, Drake A, Kinuthia J, Unger J, Matemo D, Heffron R, Barnabas R, Kohler P, McClelland RS, John-Stewart G. A risk assessment tool for identifying pregnant and postpartum women who may benefit from pre-exposure prophylaxis (PrEP).  Clin Infect Dis 2016.

Beima-Sofie K, Brandt L, Hamunime N, Shepherd M, Feris L, Uusiku J, John-Stewart G, O’Malley G. Pediatric HIV disclosure intervention improves knowledge and clinical outcomes in HIV infected children in Namibia. JAIDS 2016.

Wagner A, Mugo C, Njuguna I, Maleche-Obimbo E, Sherr K, Inwani I, Wamalwa D, John-Stewart G, Slyker J.  Active referral of HIV-infected adults in care reveals high prevalence of undiagnosed HIV. JAIDS 2016.

Asbjornsdottir K, Hughes J, Wamalwa D, Langat A, Slyker J, Moraa H, Overbaugh J, Benki-Nugent S, Tapia K, Maleche-Obimbo E, Rowhani-Rahbar A, John-Stewart G. Differences in virologic and immunologic responses to antiretroviral therapy among HIV-1 infected infants and children. AIDS 2016.

PUSH Study (NIH R01)
Grace John-Stewart
The Pediatric Urgent Start of HAART (PUSH) study is a randomized trial to determine whether rapid initiation of antiretroviral therapy (within 48 hours of diagnosis) reduces mortality compared to standard of care.

FIT Study (CFAR International Pilot Award, IAS CIPHER Award)
Jennifer Slyker, Irene Njuguna (CIPHER PI)
The Financial Incentives to Increase Pediatric HIV Testing (FIT) Study is a randomized trail that will evaluate whether cash incentives motivate parents to test their children for HIV.

DASH Study (NIAID Administrative Supplement to UW CFAR)
Jennifer Slyker, Pamela Kohler
The DASH study will utilize continuous quality improvement (CQI) methodology to improve adolescent HIV testing services.

PrEP in pregnancy (PrIMA)
Grace John-Stewart, Jared Baeten
Oral pre-exposure antiretroviral prophylaxis (PrEP) is an attractive strategy for HIV prevention in pregnancy/postpartum, given its effectiveness and safety. Targeting PrEP to women at greatest risk of HIV may maximize benefits, minimize potential risks, and optimize cost-effectiveness. The PrEP study proposes a cluster-randomized clinical trial in 20 Maternal Child Health clinics in western Kenya to compare 2 models of PrEP delivery in pregnancy.

Grace John-Stewart, Jared Baeten, John Kinuthia, Kenneth Mugwanya
In fulfillment of the US President’s Emergency Plan for AIDS Relief (PEPFAR), this project will determine best practices for providing the HIV prevention tool, PrEP, to young women and adolescent girls in clinics and health systems in Kenya. PrEP is a daily anti-HIV medication that can be taken by someone at risk of acquiring HIV to prevent them from becoming HIV positive.

Thrasher Research Fund Early Career Grant
Anjuli Wagner
“Diagnostic performance and acceptability of Saliva-Based HIV Testing (SBT) in children”

Thrasher Research Fund
Grace John-Stewart
“Preventing Mycobacterium tuberculosis infection in HIV-exposed infants”

Center for AIDS Research (CFAR) New Investigator Award, 2016
Anjuli Wagner
“Video counseling and saliva testing to improve outpatient pediatric HIV testing”

Center for AIDS Research (CFAR) New Investigator Award, 2016
Keshet Ronen
“Social media for ART adherence and retention in adolescents and young adults”

Impact of HIV, immune activation, and ART on child neurodevelopment in Kenya (NIH/NINDS K01)
Sarah Benki-Nugent
This study aims to determine whether antiretroviral therapy (ART) in infancy preserves long-term neurocognition in HIV-infected children. It will also determine correlates of neurocognitive deficits in children diagnosed later in childhood who initiate ART and are followed thereafter.

K01 Mentored Research Scientist Development Award: “Optimizing repeat HIV testing during pregnancy and postpartum for PMTCT”
Alison Drake
Current prevention of mother-to-child HIV transmission (PMTCT) programs are designed to detect and treat women with chronic HIV infections. However, women who miss antenatal HIV testing, are in the process of seroconverting, or who acquire HIV after initial testing have infections that go undetected. As PMTCT coverage expands and women with chronic HIV receive triple-drug antiretroviral therapy, an increasing proportion of infants will be infected with HIV due to undetected acute maternal HIV. This study aims to identify the optimal time(s) to conduct repeat maternal HIV testing for PMTCT.

NIH K24 Award: “Pediatric HIV-1 in Africa: Pathogenesis and Management”
Grace John Stewart
Africa is home to over 90% of pediatric HIV-1 infected children who require life-long therapy and may face growth and cognitive challenges. This K24 award will enable mentorship of new leaders to contribute research advances focused on pediatric HIV-1 infected and exposed children, including pediatricians, internists, epidemiologists, and nurses.

NIH/NIAID K23 Mentored Patient-Oriented Research Career Development Award Sylvia LaCourse
This grant will allow for examination of the impact of maternal HIV on Mycobacterium tuberculosis (Mtb) infection among peripartum women and their infants in western Kenya.

NIH R01(Mobile WACh-X)
Grace John-Stewart
Unmet need for contraception in the postpartum period is high in Kenya, and contributes to poor maternal and child health outcomes. This study utilizes a bidirectional SMS dialogue platform for HIV-positive women who seek contraceptive care in Nyanza Province, Kenya.

F32 Postdoctoral Individual National Research Service Award
Emily Deischel

R01 Transition
Grace John-Stewart