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OGHE Research Presentation – Rittenhouse 2022.06.27Katelyn Rittenhouse is a fourth-year Resident Physician at the University of North Carolina at Chapel Hill in the Department of Obstetrics and Gynecology. Dr. Rittenhouse is from Lancaster, PA, and she completed her undergraduate studies in Philadelphia prior to migrating south to UNC for her medical training. During medical school, she completed a one-year NIH Fogarty Fellowship with the UNC Global Women’s Health group working in Lusaka, Zambia studying HIV-associated preterm birth and functioning as Project Manager for the Zambian Prematurity Prevention Study (ZAPPS). She has continued this work during her residency training through the OGHE Global Health Scholars Program under the mentorship of Drs. Jeffrey Stringer and Joni Price.


Preterm birth (PTB) is the leading global cause of neonatal death. In sub-Saharan Africa, PTB rates are among the highest in the world. Additionally, maternal HIV, which is endemic in sub-Saharan Africa, and exposure to antiretroviral therapy has been associated with increased PTB risk. 

The Zambian Prematurity Prevention Study (ZAPPS) is an ongoing prospective antenatal cohort at the University Teaching Hospital in Lusaka, Zambia. ZAPPS participants are enrolled in early pregnancy, receive comprehensive antenatal care, lab testing, biologic specimen collection, and ultrasound to establish gestational age through a study-run clinic. 

Using ZAPPS data and specimens, our research aims to better understand the impact of both local and systemic inflammation on HIV-associated PTB. Our data demonstrate that pregnant women living with HIV exhibit increased local inflammation, higher relative abundance of anaerobic species, and increased microbial diversity in their lower genital tract during the mid trimester, as compared to their HIV-uninfected counterparts. We also demonstrate that vaginal inflammation and increasing vaginal microbiome diversity are associated with PTB in our urban Zambian cohort. These data support our working theory that HIV infection leads to immune activation and altered microbiome, and they may at least partially explain elevated PTB risk in this population. Further study of these relationships is ongoing.