# Feasibility of conducting HIV surveillance in community wastewater

> **NIH NIH R21** · STANFORD UNIVERSITY · 2023 · $231,713

## Abstract

PROJECT SUMMARY
At the start of the COVID-19 pandemic in late 2019, an estimated 1.2 million people—including 158,500
(13%) with undiagnosed infection—were living with HIV in the United States. Since then, HIV control
efforts have been complicated by disruptions to HIV testing, care-related services, and case surveillance
activities in state and local jurisdictions. However, the full impact of the COVID-19 pandemic on HIV
transmission, incidence and outcomes has been difficult to quantify.
Wastewater-based epidemiology (WBE) is a non-invasive and unbiased surveillance approach that can be
used to estimate infectious disease occurrence in the population by detecting pathogen DNA or RNA in
pooled community samples of wastewater. Here we propose to apply a novel WBE HIV surveillance
method to measure HIV-1 nucleic acids in wastewater to estimate HIV incidence in sewersheds during the
COVID-19 pandemic. This research study will pursue three specific aims: (1) to develop and validate a
quantification method for HIV-1 nucleic acids (RNA and DNA) in urine, feces and wastewater settled
solids, (2) in 30 people living with HIV, to c orrelate HIV nucleic acid (RNA and DNA) shedding in urine and
feces with plasma viral load, and (3) using archived samples of wastewater rom Santa Clara and San
Francisco Counties during the COVID pandemic, to determine trends in wastewater HIV-1 nucleic acid
levels and compare findings with community case rates of HIV.
The overarching goal of this project is to establish an HIV quantification method for wastewater-based
surveillance using digital droplet, reverse transcription-PCR analysis that can be used to monitor HIV in
the community. We hypothesize that wastewater surveillance can identify populations disproportionately
affected by HIV, facilitating allocation of resources to those at highest risk, thereby maximizing HIV
control. Investigating rates of changes in HIV nucleic acid in wastewater in relation to COVID-19 may also
improve our understanding of how pandemic disease and its control strategies can impact HIV surveillance
and patient care. Knowledge gained from this project will help establish a framework for wastewater-based
surveillance for HIV in the US and globally that can reduce health disparities, improve health outcomes
and prevent HIV transmission.

## Key facts

- **NIH application ID:** 10762254
- **Project number:** 1R21AI179550-01
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Julie Parsonnet
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $231,713
- **Award type:** 1
- **Project period:** 2023-08-23 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10762254

## Citation

> US National Institutes of Health, RePORTER application 10762254, Feasibility of conducting HIV surveillance in community wastewater (1R21AI179550-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10762254. Licensed CC0.

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