Global WACh

August 5, 2019

Dr. Arianna Means awarded 2019 CFAR NIA to improve identification and treatment of malnutrition for HIV-exposed children

We are pleased to announce Dr. Arianna Means (Acting Assistant Professor, Global Health) received a 2019 UW/Center for AIDS Research (CFAR) New Investigator Award!  This award offers start-up funds to junior investigators to conduct independent HIV/AIDS research that supports their future scholarly endeavors.  Dr. Means’ project titled “Improved identification and treatment of acute malnutrition for HIV-exposed children in Kenya,” focuses on using implementation science methods to evaluate adherence to HIV nutrition guidelines among HIV-infected and HIV-exposed uninfected (HEU) children under two years of age and identify opportunities for strategic improvement.

Malnutrition is a serious complication of HIV-exposure. Malnourished HIV-infected and HEU children are at increased risk of growth stunting, developmental delays, and death.  These poor outcomes highlight the importance of routine nutritional screening for children receiving HIV services, as well as HIV testing for children with acute malnutrition.  Adherence to malnutrition screening and treatment guidelines is low in Kenya, and barriers to providing guideline adherent care for HIV-exposed children are unknown.  Dr. Means sees two critical missed opportunities to prevent malnutrition-related mortality among this population: 1) early identification of acute malnutrition and HIV, and 2) appropriate treatment upon identification.

The new study will include an examination of clinical records and focus group discussions with healthcare providers, and systems analysis to gain information regarding the extent to which HIV-exposed children with or at risk of malnutrition receive guideline adherent care and about the multi-level factors influencing their care.  An implementation science framework used to guide the data analysis will help describe opportunities to address bottlenecks to service delivery.  Having providers’ participation will be important in identifying and ranking potential interventions to use in a future trial aimed to improve coordinated HIV and nutrition care for HIV-exposed pediatric populations in sub-Saharan Africa.  Improved coordination of care has the potential to reduce HIV associated child mortality as well as long-term inequities across HIV-exposed and unexposed populations.

Dr. Means will work with co-investigators, Dr. Christine McGrath (Assistant Professor, Global Health), who offers expertise in malnutrition and growth in HIV-exposed children, and Dr. Benson Singa (Affiliate Assistant Professor, Global Health; Research Scientist, KEMRI), who has extensive experience in leading implementation of UW-collaborative pediatric studies.  Dr. Means also will receive mentorship and guidance from senior investigators, Dr. Judd Walson (Professor, Global Health, Medicine, Pediatrics, Epidemiology), Dr. Gabrielle O’Malley (Associate Professor, Global Health; Director of Implementation Science, I-TECH), Dr. Grace John-Stewart (Professor, Global Health, Medicine, Epidemiology, Pediatrics).