The candidate, Dr. Sheela Shenoi, completed her fellowship in Infectious Diseases in June 2009 and is currently an Instructor in the Department of Medicine, Section of Infectious Diseases, at Yale University. Her long term career goal is to conduct patient-oriented global HIV and TB research in an academic setting. The goal of her Mentored Patient-Oriented Research award is to acquire the needed skills and protected time to conduct and publish her research in order to effectively transition into an independent investigator. To accomplish this, she has crafted a comprehensive training plan in an academic U.S. and international setting. This consists of an innovative research project in rural South Africa, complimented by carefully selected courses at the Yale School of Public Health to expand expertise in quantitative and epidemiologic methods, and supervision and training by an expert team of mentors. She will balance the K23 award period between New Haven and South Africa. Dr. Shenoi's research takes place in South Africa, where TB rates are nearly three hundred times the levels in the U.S. South Africa also carries the largest global burden of HIV/TB coinfection, with consequent high rates of morbidity and mortality and severe implications for TB control and HIV antiretroviral therapy roll out programs. An emerging third epidemic of drug resistant tuberculosis has had additional devastating consequences on mortality and has put additional strain on already weakened health care systems. The WHO has promoted the """"""""3Is"""""""" for TB control: intensive case finding (ICF), infection control and isoniazid preventive therapy. While the ICF strategy can increase TB case detection, there has been little attention to its use in community settings, with drug resistant TB, or HIV coinfection. Furthermore, the effect of ICF on clinical outcomes has not been studied. In this application, the candidate proposes to evaluate the impact of a community-based ICF program designed to enhance case detection of HIV, TB, and drug resistant TB. This program is being conducted at congregate settings in a highly HIV and drug susceptible and drug resistant TB prevalent, rural area of KwaZulu Natal province, South Africa. This project aims to determine the clinical outcomes of patients with HIV, TB, and MDR/XDR TB identified by the community-based ICF strategy in comparison to the traditional hospital based self-referral case finding method. This project is of great public health importance and is being conducted in cooperation with the South African provincial Department of Health.

Public Health Relevance

(provided by the applicant): Intensive case finding has been promoted by the World Health Organization as a strategy for TB control with little evidence for improved outcomes particularly with respect to HIV coinfection and MDR/XDR TB. This project will provide data on the effect of intensive case finding on clinical outcomes and inform public health policy and practice in high prevalence TB and HIV settings globally.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AI089260-03
Application #
8462200
Study Section
Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
Program Officer
Huebner, Robin E
Project Start
2011-05-15
Project End
2016-04-30
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
3
Fiscal Year
2013
Total Cost
$135,749
Indirect Cost
$9,022
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Gilbert, Jennifer A; Shenoi, Sheela V; Moll, Anthony P et al. (2016) Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa. PLoS One 11:e0165614
Loeliger, Kelsey B; Niccolai, Linda M; Mtungwa, Lillian N et al. (2016) Antiretroviral therapy initiation and adherence in rural South Africa: community health workers' perspectives on barriers and facilitators. AIDS Care 28:982-93
Cudahy, Patrick; Shenoi, Sheela V (2016) Diagnostics for pulmonary tuberculosis. Postgrad Med J 92:187-93
Loeliger, Kelsey B; Niccolai, Linda M; Mtungwa, Lillian N et al. (2016) ""I Have to Push Him with a Wheelbarrow to the Clinic"": Community Health Workers' Roles, Needs, and Strategies to Improve HIV Care in Rural South Africa. AIDS Patient Care STDS 30:385-94
Kompala, T; Moll, A P; Mtungwa, N et al. (2016) Impact of nurse-delivered community-based CD4 services on facilitating pre-ART care in rural South Africa. BMC Health Serv Res 16:374
Upadhya, Devesh; Moll, Anthony P; Brooks, Ralph P et al. (2016) What motivates use of community-based human immunodeficiency virus testing in rural South Africa? Int J STD AIDS 27:662-71
Helou, Elie; Shenoi, Sheela; Kyriakides, Tassos et al. (2016) Characterizing Patients with Very-Low-Level HIV Viremia: A Community-Based Study. J Int Assoc Provid AIDS Care :
Gilbert, Jennifer A; Long, Elisa F; Brooks, Ralph P et al. (2015) Integrating Community-Based Interventions to Reverse the Convergent TB/HIV Epidemics in Rural South Africa. PLoS One 10:e0126267
Jacobson, Karen B; Moll, Anthony P; Friedland, Gerald H et al. (2015) Successful Tuberculosis Treatment Outcomes among HIV/TB Coinfected Patients Down-Referred from a District Hospital to Primary Health Clinics in Rural South Africa. PLoS One 10:e0127024
Jacobson, Karen Blake; Tate, Matthew; Eksteen, Francois et al. (2015) Care of the patient with XDR-TB who has failed treatment. Lancet Respir Med 3:269-70

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