Dr. Elaine Abrams is a global thought leader in the prevention and treatment of HIV infection and associated infectious diseases in pregnant women, children, and families. A professor of epidemiology and pediatrics at Columbia University, she was a founding member of ICAP at Columbia University. As part of ICAP's core leadership team, Dr. Abrams is senior research director, supporting ICAP's global research with a growing portfolio of studies of HIV prevention, care, and treatment. As an independently funded research scientist, Dr. Abrams also leads a number of studies optimizing HIV treatment and prevention across the life course for women during pregnancy and breastfeeding and for infants, children, and adolescents. Dr. Abrams's expertise guides both US and global HIV policy and implementation planning through many avenues such as scientific leadership in the NIH-funded IMPAACT network and the WHO Pediatric Antiretroviral Working Group. During her tenure as co-chair of WHO's HIV clinical guidelines group, multiple transformative innovations were introduced facilitating an accelerated global scale-up of HIV treatment to adults and children living with HIV.
Areas of Expertise
Adolescent Health, Breastfeeding, Child Health and Development, HIV/AIDS, Maternal-to-Child Transmission, Birth Outcomes, Child and Maternal Mortality, Contraception, Reproductive Health, Teen Pregnancy, Mental Health
Select Global Activities
CombinADO, Mozambique: Adolescents are at the core of the global HIV epidemic. They are highly vulnerable to HIV acquisition and-for adolescents living with HIV (ALHIV)-at disproportionate risk for poor health outcomes across the HIV care continuum. Retention rates, adherence to antiretroviral treatment (ART), and viral suppression (VS) are alarmingly low among ALHIV, warranting urgent attention. Adolescence is a time of rapid physical and psychological development, when youth move from childhood to adulthood and experience multiple challenges as well as opportunities for growth, creativity, and learning. Youth who enter this period under adverse conditions are ill prepared to cope with the impact of living with a potentially fatal, stigmatized, transmissible infection and the need to adopt positive, health-seeking behaviors, engage with health services, and adhere to daily ART regimens. In high prevalence countries like Mozambique, the burden of living with HIV during this vulnerable developmental stage is further exacerbated by fragile health systems and nascent ALHIV-specific differentiated service delivery (DSD) models. At the same time, few specific interventions have been developed and tested that address the needs of ALHIV. In response, we propose to develop and test a culturally-appropriate, contextually-relevant, and theoretically-grounded adolescent-focused multicomponent intervention strategy, CombinADO, among ALHIV in Zambezia, Mozambique. Using a human-centered design approach, we will work with ALHIV, caregivers, health care providers, and local and national stakeholders to develop and pilot this CombinADO intervention strategy consisting of four components: 1) ALHIV peer navigation and support, 2) adolescent-friendly services, 3) mHealth technologies, and 4) health communication messaging (Phase 1). In Phase 2, we propose to evaluate the effectiveness of the CombinADO strategy on three milestones along the HIV care continuum: (a) retention in HIV care, (b) ART adherence, and (c) VS among ALHIV using a cluster randomized controlled trial design. The study builds on longstanding partnerships between ICAP at Columbia University, the Mozambique Ministry of Health and other local stakeholders, all aiming to improve the disease course as well as outcomes along the continuum of care for this highly vulnerable population, adolescents living with HIV.
Strategies to optimize antiretroviral therapy services for maternal & child health: the MCH-ART study, South Africa: The study aims to evaluate two different strategies for delivering HIV care and treatment services during the postpartum period to eligible HIV-infected women who initiate antiretroviral treatment during pregnancy and their HIV-exposed infants. The primary objective is to compare a maternal-child health (MCH)-focused ART service to general adult ART services as strategies for providing ART during the postpartum period on (i) maternal HIV viral suppression, and (ii) maternal retention in ART services, at 12 months postpartum.
ORCHID, South Africa: More than 8 million people are living with HIV in South Africa (SA), including >250,000 women who become pregnant annually, and >50% of SA women are overweight/obese.1 In SA and globally, Dolutegravir (DTG)-based antiretroviral therapy (ART) is being scaled up as part of the preferred 1st-line ART regimen. However, DTG has recently been implicated as an obesogen that is associated with increased weight and adipose tissue gain compared to other antiretroviral agents.2,3 Obesity in pregnancy is associated with poor health outcomes for both mother and child4-9 as pregnancy is a critical period during which exposures leading to alterations in metabolic health may influence not only long-term maternal health but also fetal, neonatal, and ultimately child health. For women living with HIV (WLHIV) and their children, these exposures are myriad, including HIV/ART, weight gain, & obesity. The overall goal of our study is to investigate the impact of DTG in pregnancy and its obesogenic effects on the metabolic health of women living with HIV (WLHIV) and their children, compared to women without HIV and their children. To address this goal, we will leverage: (i) existing NIH-funded research infrastructure in SA and (ii) the NIH large R01 mechanism to enroll 1900 pregnant women in the 1st trimester (633 WLHIV initiating DTG in pregnancy, 633 WLHIV continuing DTG use from pre-pregnancy, and 633 women without HIV) and their children, following them to two years. Within this cohort, we will first examine how HIV and/or DTG use (HIV/DTG) impacts longitudinal changes in weight and adipose tissue mass in pregnancy using air displacement plethysmography. We will further investigate pathways of excess gestational weight gain and adipose accrual by evaluating: a) the balance between caloric intake and resting energy expenditure, b) markers of systemic and adipose inflammation, gut integrity, and satiety/hunger, and c) subcutaneous adipose tissue (SAT) function and homeostasis. Following this, we will go on to examine how HIV/DTG use in pregnancy and postpartum affects maternal metabolic health postpartum (postpartum weight retention, adiposity, dysglycemia, insulin resistance, and dyslipidemia) as well as neonatal and child metabolic health (weight, adiposity, insulin resistance and dyslipidemia). To understand whether signature clusters of metabolites and lipid subspecies are associated with maternal and child metabolic health, we will apply widely targeted metabolomics techniques to measure maternal (in pregnancy) and cord blood metabolites, lipid subspecies, and eicosanoids. To address the different specific aims we will use a series of nested substudies, including smaller nested cohorts and efficient case-cohort designs, within the main cohort. This study will play a pivotal role in defining the obesogenic mechanisms and clinical consequences of DTG use in pregnancy in WLHIV and their children. The results of our study will provide insights into metabolic disease risk reduction in the context of HIV/ART, identify potential targets for interventions, and inform public health approaches to diminish chronic co-morbidities over the life course for WLHIV and their children.