The Efficacy and Impact of Routine HIV and TB Testing in Durban, South Africa

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South Africa currently has more HIV infected citizens than any other country in the world. Identification of HIV-infected individuals and rapid detection of tuberculosis co-infection is paramount for improving access to treatment, decreasing morbidity, and controlling the spread of the epidemic. Despite promotion of free voluntary counseling and testing (VCT) sites by the government and the near universal offer of antiretroviral therapy, only 1 in 5 South Africans aware of VCT sites have been tested. The candidate seeks to evaluate the hypothesis that routine HIV testing will increase testing uptake and linkage to care at McCord Hospital, an urban center in Durban in the South African province with the highest HIV prevalence. Four interrelated specific aims are proposed: 1) To evaluate a newly established routine HIV testing program in the Outpatient Department (OPD) to examine level of patient acceptance, HIV prevalence and stage, linkage to care and reasons for testing refusal, 2) To expand routine HIV testing to the inpatient medical service to examine the parameters outlined in Aim 1 and compare them to those in the outpatient setting, 3) To use pooled HIV plasma RNA testing to diagnose acute HIV infection and estimate HIV incidence in the urgent care and inpatient settings, and 4) To evaluate the yield of universal sputum tuberculosis screening for patients newly diagnosed with HIV. The candidate will gain the epidemiologic and biostatistical foundation to achieve these aims through courseworkat the Harvard School of Public Health, and through the mentorship of 2 senior clinical investigators with strong records of cultivating junior investigators. This work fulfills goals stated by the NIH Office of AIDS Research, including creating international cohorts to further HIV prevention research, assessing the impact of interventions on HIV-related outcomes, and fostering scientific collaborations between American scientists and their counterparts in the developing world. Routine HIV testing has the potential to decrease stigma, increase acceptance of HIV testing, and increase the number of people identified with HIV infection and linked to care. Completion of the research and didactic aspects of this project will provide the candidate with the experience to make the transition from infectious disease fellow to independent clinical investigator in the field of international HIV care.