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Rebecca Zash, M.D.

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Mentoring
Available: 12/05/18, Expires: 12/05/20

Since 2013, I have been working with the Botswana Harvard AIDS Institute Partnership (BHP) in Botswana. BHP is a research organization that was founded more than 20 years ago by Dr. Max Essex as a collaboration between Harvard University and the Botswana Ministry of Health. The focus of BHP has been to conduct high quality, public-health driven research and build research capacity in Botswana to address the HIV epidemic and other emerging public health challenges. As one of the leading research institutions in Africa, research areas include virology, immunology, molecular biology, epidemiology, socio/behavior and clinical trials. My work within BHP has been focused on HIV in pregnancy. Some of the earliest clinical trials showing that antiretroviral therapy (ART) could be used successfully to prevent mother-to-child transmission of HIV were done at BHP. Improvements in access to ART among pregnant women around the world resulted in huge declines in pediatric HIV infections and this has been one of the biggest public health successes of the last decade. However, women with HIV continue to have more infants with poor outcomes like stillbirth, preterm delivery and low birthweight compared to HIV-uninfected women. Our research in Botswana has shown that this increased risk in adverse birth outcomes occurs even among women on ART with well-controlled HIV good immune systems—and that some of the increased risk of poor outcomes may be related to the ART itself. Our findings have also highlighted the lack of research into the safety of medications in pregnancy, particularly in low and middle income countries. Current research projects aim to understand the risk factors and mechanisms for adverse pregnancy outcomes among HIV-infected women on ART in order to figure out interventions to improve birth outcomes and decrease childhood morbidity and mortality. Additionally, our research focuses methodologically on how to collect high-quality data on medication safety in pregnancy and birth defects in resource limited settings. We are seeking students who are hard-working, team-players and able to work well with people from a variety of backgrounds and cultures and can spend a minimum of 2 months in country. We can also mentor students who want to take a 5th year to complete a more in-depth, comprehensive project. Our current research opportunities broadly include projects within our ongoing studies: 1. A large Birth Surveillance Study with information on >50% of all birth in Botswana. Data collected is broad and includes almost all information available in the maternal antenatal medical record as well as information on the birth and outcome of the baby. 2. Birth Defects information data collected from ~50% of all births in Botswana since 2014 and development of training for health care professionals in Botswana around birth defects 3. A cohort of pregnant women followed prospectively during pregnancy to evaluate the role of hypertension, endothelial dysfunction and chronic inflammation on pregnancy and birth outcomes 4. A study of the placentas (histology and stereology) of HIV-infected and HIV-uninfected women 5. A project to evaluate how best to communicate research findings on adverse effects of ART in pregnancy to healthcare professionals and people living with HIV in Botswana 6. A pilot project to evaluate feasibility of patient-centered decision making around ART regimen and contraception in the Botswana setting If you are interested, please contact Rebecca Zash and submit your resume with a brief description of your interests.


Research
The research activities and funding listed below are automatically derived from NIH ExPORTER and other sources, which might result in incorrect or missing items. Faculty can login to make corrections and additions.
  1. K23HD088230 (ZASH, REBECCA MARIE) Jul 1, 2017 - Jun 30, 2022
    NIH/NICHD
    Decreasing Adverse Birth Outcomes among HIV-infected Women on Antiretroviral Therapy
    Role: Principal Investigator

Bibliographic
Publications listed below are automatically derived from MEDLINE/PubMed and other sources, which might result in incorrect or missing publications. Faculty can login to make corrections and additions.
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PMC Citations indicate the number of times the publication was cited by articles in PubMed Central, and the Altmetric score represents citations in news articles and social media. (Note that publications are often cited in additional ways that are not shown here.) Fields are based on how the National Library of Medicine (NLM) classifies the publication's journal and might not represent the specific topic of the publication. Translation tags are based on the publication type and the MeSH terms NLM assigns to the publication. Some publications (especially newer ones and publications not in PubMed) might not yet be assigned Field or Translation tags.) Click a Field or Translation tag to filter the publications.
  1. Duffy CR, Hart JM, Modest AM, Hacker MR, Golen T, Li Y, Zera C, Shainker SA, Mehrotra P, Zash R, Wylie BJ. Lymphopenia and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Among Hospitalized Obstetric Patients. Obstet Gynecol. 2020 May 19. PMID: 32433451.
    Citations:    
  2. Davey S, Ajibola G, Maswabi K, Sakoi M, Bennett K, Hughes MD, Isaacson A, Diseko M, Zash R, Batlang O, Moyo S, Lockman S, Lichterfeld M, Kuritzkes DR, Makhema J, Shapiro R. Mother-to-Child HIV Transmission with in utero Dolutegravir vs. Efavirenz in Botswana. J Acquir Immune Defic Syndr. 2020 Mar 16. PMID: 32195745.
    Citations:    
  3. Liff I, Zash R, Mingochi D, Gaonakala FT, Diseko M, Mayondi G, Johnson K, James K, Makhema J, Shapiro R, Wylie BJ. Mid-trimester cervical length not associated with HIV status among pregnant women in Botswana. PLoS One. 2020; 15(3):e0229500. PMID: 32160214.
    Citations:    
  4. Caniglia EC, Zash R, Swanson SA, Wirth KE, Diseko M, Mayondi G, Lockman S, Mmalane M, Makhema J, Dryden-Peterson S, Kponee-Shovein KZ, John O, Murray EJ, Shapiro RL. Methodological Challenges When Studying Distance to Care as an Exposure in Health Research. Am J Epidemiol. 2019 09 01; 188(9):1674-1681. PMID: 31107529.
    Citations:    
  5. Shava E, Moyo S, Zash R, Diseko M, Dintwa EN, Mupfumi L, Mabuta J, Mayondi G, Chen JY, Lockman S, Mmalane M, Makhema J, Shapiro R. Brief Report: High Rates of Adverse Birth Outcomes in HIV and Syphilis Coinfected Women in Botswana. J Acquir Immune Defic Syndr. 2019 08 15; 81(5):e135-e140. PMID: 31295173.
    Citations:    
  6. Zash RM. What will it take to refute the possible safety signal for dolutegravir and neural tube defects? BJOG. 2019 10; 126(11):1346. PMID: 31283097.
    Citations:    
  7. Zash R, Holmes L, Diseko M, Jacobson DL, Brummel S, Mayondi G, Isaacson A, Davey S, Mabuta J, Mmalane M, Gaolathe T, Essex M, Lockman S, Makhema J, Shapiro RL. Neural-Tube Defects and Antiretroviral Treatment Regimens in Botswana. N Engl J Med. 2019 08 29; 381(9):827-840. PMID: 31329379.
    Citations:    
  8. Slogrove AL, Powis KM, Zash R. Methodological Considerations in Evaluating Pregnancy Outcomes in Women Living With HIV. J Acquir Immune Defic Syndr. 2019 06 01; 81(2):e63-e64. PMID: 30839382.
    Citations:    
  9. Shava E, Moyo S, Zash R, Diseko M, Dintwa EN, Mupfumi L, Mabuta J, Mayondi G, Chen JY, Lockman S, Mmalane M, Makhema J, Shapiro R. High rates of adverse birth outcomes in HIV and syphilis co-infected women in Botswana. J Acquir Immune Defic Syndr. 2019 Apr 29. PMID: 31107303.
    Citations:    
  10. Kershaw C, Williams M, Kilaru S, Zash R, Kalenga K, Masole F, Shapiro R, Barak T. Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana. Ann Glob Health. 2019 03 04; 85(1). PMID: 30873803.
    Citations:    
  11. Zash R, Rough K, Jacobson DL, Diseko M, Mayondi G, Mmalane M, Essex M, Petlo C, Lockman S, Makhema J, Shapiro RL. Effect of Gestational Age at Tenofovir-Emtricitabine-Efavirenz Initiation on Adverse Birth Outcomes in Botswana. J Pediatric Infect Dis Soc. 2018 Aug 17; 7(3):e148-e151. PMID: 29688554.
    Citations:    Fields:    Translation:Humans
  12. Zash R, Makhema J, Shapiro RL. Neural-Tube Defects with Dolutegravir Treatment from the Time of Conception. N Engl J Med. 2018 09 06; 379(10):979-981. PMID: 30037297.
    Citations: 1     Fields:    Translation:Humans
  13. Bailey H, Zash R, Rasi V, Thorne C. HIV treatment in pregnancy. Lancet HIV. 2018 08; 5(8):e457-e467. PMID: 29958853.
    Citations:    Fields:    
  14. Zash R, Jacobson DL, Diseko M, Mayondi G, Mmalane M, Essex M, Gaolethe T, Petlo C, Lockman S, Holmes LB, Makhema J, Shapiro RL. Comparative safety of dolutegravir-based or efavirenz-based antiretroviral treatment started during pregnancy in Botswana: an observational study. Lancet Glob Health. 2018 07; 6(7):e804-e810. PMID: 29880310.
    Citations: 1     Fields:    
  15. Hill A, Clayden P, Thorne C, Christie R, Zash R. Safety and pharmacokinetics of dolutegravir in HIV-positive pregnant women: a systematic review. J Virus Erad. 2018 Apr 01; 4(2):66-71. PMID: 29682297.
    Citations:    
  16. Zash RM, Williams P, Holmes LB. What is the risk of major congenital abnormalities among women on antiretroviral therapy? AIDS. 2018 01 28; 32(3):403-404. PMID: 29309347.
    Citations:    Fields:    
  17. Caniglia EC, Zash R, Jacobson DL, Diseko M, Mayondi G, Lockman S, Chen JY, Mmalane M, Makhema J, Hernán MA, Shapiro RL. Emulating a target trial of antiretroviral therapy regimens started before conception and risk of adverse birth outcomes. AIDS. 2018 Jan 02; 32(1):113-120. PMID: 29112066.
    Citations:    Fields:    Translation:Humans
  18. Zash R, Jacobson DL, Diseko M, Mayondi G, Mmalane M, Essex M, Petlo C, Lockman S, Makhema J, Shapiro RL. Comparative Safety of Antiretroviral Treatment Regimens in Pregnancy. JAMA Pediatr. 2017 10 02; 171(10):e172222. PMID: 28783807.
    Citations: 8     Fields:    Translation:Humans
  19. Ajibola G, Zash R, Shapiro RL, Batlang O, Botebele K, Bennett K, Chilisa F, Widenfelt EV, Makhema J, Lockman S, Holmes LB, Powis KM. Detecting congenital malformations - Lessons learned from the Mpepu study, Botswana. PLoS One. 2017; 12(3):e0173800. PMID: 28339500.
    Citations:    Fields:    Translation:HumansPHPublic Health
  20. Zash RM, Souda S, Leidner J, Binda K, Hick C, Powis K, Makhema J, Mmalane M, Essex M, Lockman S, Shapiro RL. High Proportion of Deaths Attributable to HIV Among Postpartum Women in Botswana Despite Widespread Uptake of Antiretroviral Therapy. AIDS Patient Care STDS. 2017 Jan; 31(1):14-19. PMID: 28051898.
    Citations: 1     Fields:    Translation:Humans
  21. Johnson KM, Zash R, Haviland MJ, Hacker MR, Luckett R, Diseko M, Mayondi G, Shapiro R. Hypertensive disease in pregnancy in Botswana: Prevalence and impact on perinatal outcomes. Pregnancy Hypertens. 2016 Oct; 6(4):418-422. PMID: 27939493.
    Citations:    Fields:    Translation:Humans
  22. Zash RM, Williams PL, Sibiude J, Lyall H, Kakkar F. Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges. Expert Opin Drug Saf. 2016 Nov; 15(11):1501-1513. PMID: 27552003.
    Citations: 2     Fields:    Translation:Humans
  23. Zash RM, Shapiro RL, Leidner J, Wester C, McAdam AJ, Hodinka RL, Thior I, Moffat C, Makhema J, McIntosh K, Essex M, Lockman S. The aetiology of diarrhoea, pneumonia and respiratory colonization of HIV-exposed infants randomized to breast- or formula-feeding. Paediatr Int Child Health. 2016 Aug; 36(3):189-97. PMID: 27595698.
    Citations: 2     Fields:    Translation:HumansCells
  24. Zash R, Souda S, Leidner J, Ribaudo H, Binda K, Moyo S, Powis KM, Petlo C, Mmalane M, Makhema J, Essex M, Lockman S, Shapiro R. HIV-exposed children account for more than half of 24-month mortality in Botswana. BMC Pediatr. 2016 07 21; 16:103. PMID: 27439303.
    Citations: 5     Fields:    Translation:Humans
  25. Shapiro R, Dryden-Peterson S, Powis K, Zash R, Lockman S. Hidden in plain sight: HIV, antiretrovirals, and stillbirths. Lancet. 2016 May 14; 387(10032):1994-5. PMID: 27203765.
    Citations: 2     Fields:    Translation:Humans
  26. Zash R, Souda S, Chen JY, Binda K, Dryden-Peterson S, Lockman S, Mmalane M, Makhema J, Essex M, Shapiro R. Reassuring Birth Outcomes With Tenofovir/Emtricitabine/Efavirenz Used for Prevention of Mother-to-Child Transmission of HIV in Botswana. J Acquir Immune Defic Syndr. 2016 Apr 01; 71(4):428-36. PMID: 26379069.
    Citations: 11     Fields:    Translation:Humans
  27. Dryden-Peterson S, Lockman S, Zash R, Lei Q, Chen JY, Souda S, Petlo C, Dintwa E, Lebelonyane R, Mmalane M, Shapiro RL. Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT. J Acquir Immune Defic Syndr. 2015 Mar 01; 68(3):245-9. PMID: 25501611.
    Citations: 7     Fields:    Translation:Humans
  28. Zash RM, Ajose-Popoola O, Stordal K, Souda S, Ogwu A, Dryden-Peterson S, Powis K, Lockman S, Makhema J, Essex M, Shapiro RL. Risk factors for mortality among human immunodeficiency virus-exposed and unexposed infants admitted to a neonatal intensive care unit in Botswana. J Paediatr Child Health. 2014 Mar; 50(3):189-95. PMID: 24372811.
    Citations:    Fields:    Translation:Humans
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Funded by the NIH National Center for Advancing Translational Sciences through its Clinical and Translational Science Awards Program, grant number UL1TR002541.