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Years: 2016-2017, 2019-2020

Training Site: University of the Witwatersrand (Wits)

Country: South Africa

Mentors: Ian Sanne, FCP(SA), FRCP(lon); Jonathan Golub, MD

2016 Title:“The use of a national level HIV/TB cohort to evaluate the impact of changes to national ART and TB guidelines on HIV-related TB in South Africa

Project Objectives:  To assess temporal trends in TB incidence, with a focus on HIV-related TB, at the national, provincial, and health district level. To characterize the spatial-temporal risk of HIV-related drug-sensitive and drug-resistant TB, accounting for heterogeneities in population density, location of public sector healthcare facilities, mines, HIV prevalence and ART coverage.

2019 Title: “Feasibility and impact of primary HPV DNA screening for cervical cancer prevention in South Africa”

Project Objectives: The goal of this research is to evaluate the effectiveness, feasibility, and cost of primary HPV DNA screening for cervical cancer in South Africa’s public health system. South Africa has one of the highest age-standardized incidence rates of cervical cancer globally. The country is also home to the world’s largest population of women living with HIV, all of whom are at increased risk of HPV-related anogenital disease. Without substantial public health investment to improve access to and uptake of cervical cancer screening and treatment, South Africa is unlikely to achieve its goals of 20% reductions in incidence and mortality by 2030.

Hypothesis 1: HPV testing alone followed by same-day treatment will be the most effective cervical cancer prevention strategy for South Africa.

Aim 1: To estimate the effectiveness of alternative HPV testing strategies for detection and treatment of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) among South African women.

Hypothesis 2a: Existing GeneXpert infrastructure will be insufficient for Xpert HPV testing and additional machines will be required to achieve 70% screening coverage.

Aim 2a: To evaluate the feasibility of incorporating Xpert HPV testing into the existing GeneXpert infrastructure in South Africa.

Hypothesis 2b: Point-of-care HPV testing will have a lower cost per case of CIN2+ treated.

Aim 2b: To estimate the cost-effectiveness of point-of-care vs centralized laboratory-based Xpert HPV testing for cervical cancer screening in South Africa.

NIH Support:  Fogarty scholar doctoral / fellow postdoctoral training award

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