South Africa

Focus: Community based strategies to confront epidemics of tuberculosis, HIV/AIDS and drug resistant tuberculosis 

Affiliation: Philanjalo, KwaZuluNatal Department of Health, Yale Schools of Medicine and Public Health, University of Kwazulu Natal

Contacts: Gerald Friedland MD, gerald.friedland@yale.edu; Sheela Shenoi MD, MPH, sheela.shenoi@yale.edu; Anthony Moll MBChB, 4tonymoll@gmail.com

Site and Background: The training site is in Tugela Ferry, located in the Umzinyathi District of KwaZuluNatal, a traditional Zulu area and the third poorest district in South Africa. Philanjalo a local South African NGO founded by Dr. Tony Moll our host partner, in 1998 to address the rapidly growing epidemic of HIV/AIDS. Yale joined Philanjalo and the KZN Department of Health (DOH) and University of KwaZuluNatal in 2002 to strengthen and integrate HIV and TB care and treatment at this site. In 2005, we uncovered the third and disastrous epidemic of extensively drug resistant (XDR) TB. These convergent epidemics have been characterized by rapid and high mortality rates, overwhelmed TB and HIV care systems, ongoing health care and community transmission and epidemic propagation, all associated with extreme poverty, weak infrastructures, inadequate prevention strategies, late presentation to care, limited TB diagnostics and treatment options. 

In response, we have worked collaboratively to characterize the convergent epidemics and have developed and implemented a comprehensive continuum of innovative integrated HIV and TB health care and community based strategies combined with operational research to strengthen clinical and public health programs, reduce the associated high rates of morbidity and mortality and decrease incidence and transmission of HIV and drug susceptible and drug resistant TB. We rapidly demonstrated acceptance, feasibility and utility and have successfully advocated for widespread scale up and dissemination. Current examples include the first national community based MDR TB treatment program and first integrated HIV and TB intensive case finding (ICF) program in rural South Africa. We are gratified now that we have preliminary evidence supporting the success of these efforts.
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Current and Planned Projects include:

  1. Expansion of community based integrated HIV and TB intensive case finding- Supported by CDC/PEPFAR, NIH K23 Award ( Shenoi ) KwaZuluNatal Department of Health, Gilead,  Irene Diamond and Doris Duke Foundations ( Friedland)
  2. Development, implementation and evaluation of isoniazid prophylactic therapy for out of treatment HIV positive community members. Supported by CDC Implementation Science award  ( Moll, Shenoi)
  3. Study of community based implementation of rapid point of care CD4 cell count (PIMA) technology, Supported by NIAID R21 grant (Friedland/Shenoi)
  4. Mathematical Modeling to determine impact and cost effectiveness of community based strategies (PhD candidate Gilbert and School of Public Health Faculty)

Webpages for sites and research programs:

Qualifications of potential trainees: Post-third year medical school students; medical school graduates, residents, infectious diseases fellows, Ph.D. candidates beyond first one to two years of their pre-doctoral program; post-PhD and Master’s of Science/MPH level fellows with previous international health related experience and interest in applying operational research and implementation science strategies to address TB and HIV epidemics in a resource limited rural setting. We are willing to accept candidates from Africa who seek such training if qualifications satisfactory by the GHES Fellowship program.