Multidisciplinary research backed by a $15 million, five-year grant from the National Institutes of Health will allow experts at the University of Miami Miller School of Medicine to gain a deeper understanding of how HIV infection affects women of childbearing age.
The UM-led Study of Treatment and Reproductive Outcomes (STAR) will also be conducted at multiple research sites across the southern United States, a region where women are disproportionately affected by the virus.
The researchers plan to go beyond how living with HIV can affect pregnancy, taking a holistic approach with a special focus on mental health and dental care in this population.
“The aim is to really look at many issues that affect women of reproductive age,” said Maria Luisa Alcaide, M.D., the STAR Contact Principal Investigator and associate professor of clinical infectious diseases at the Miller School.
Despite nearly four decades of HIV infection in the United States, women of childbearing age living with HIV remain understudied in this country. This initiative aims to reverse that.
In addition, Miami-Dade and Broward counties lead the country in the number of new HIV infections overall, according to 2018 figures from the CDC.
The Miller School is uniquely positioned to coordinate the effort as the largest academic medical center in South Florida. In addition, “we have one of the largest clinics that take care of women living with HIV,” Dr. Alcaide said.
“We are really an epicenter in terms of academic medicine and access to clinical trials,” said JoNell Potter, Ph.D., a co-investigator on the study and professor of clinical obstetrics and gynecology at the Miller School.
The University of Miami remains on the forefront of advances to fight HIV infection overall, with input from researchers at the AIDS Institute, the Center for AIDS Research, as well as the new Center for HIV and Research in Mental Health (CHARM).
The STAR study is “really a holistic approach,” Dr. Potter said. The researchers plan to look at the impact of social determinants of health, including how housing insecurity, food insecurity, poverty and access to care affect this population.
“We hope to really be able to understand the life of a woman living with HIV who is young – what that looks like, what their needs are, and how different circumstances affect her health and mental health outcomes,” Dr. Potter added.
Helping to reveal how anxiety, depression and other mental health conditions affect women of childbearing age living with HIV is another STAR co-author, Deborah Jones, Ph.D., M.Ed., a professor of psychiatry and behavioral sciences at the Miller School.
“We are a multidisciplinary team,” Dr. Jones said. “The NIH is really interested in teams of people who work together from different specialties. Gone are the days when someone says, ‘I’m an OB-GYN so I’m just going to focus on that,’ without thinking about psychology, infectious disease or other specialties.” Nutritionists and dentists are also part of the STAR teams in Miami and at the other study sites in Atlanta; Washington, D.C.; Birmingham, Alabama/Jackson, Mississippi; and Chapel Hill, North Carolina.
Co-author Margaret A. Fischl, M.D., professor of medicine at the Miller School, is working with Dr. Alcaide and Dr. Jones on another NIH-funded HIV study. That seven-year initiative will track cardiovascular and pulmonary disease as well as other non-infectious conditions that people with HIV – both women and men – experience as they age.
Now that HIV has evolved primarily into a chronic disease, standards of care are needed to guide prevention, diagnosis and management of young women living with HIV. “We want to learn how we can help these young women lead healthy, productive lives – and reach their life expectancy and beyond,” Dr. Potter said.
The ultimate goal, as with any HIV research, “is aiming toward ending the epidemic,” Dr. Jones said. “We always have to say that success for us is we’re out of a job.”
STAR enrollment is set to start in spring 2020. For more information or to refer a potential candidate, contact the Miller School Infectious Diseases Research Unit at (305) 243-5435.
The NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development is funding the STAR study.