# Wastewater surveillance to enhance the public health response to HIV and TB in Eswatini

> **NIH NIH DP1** · BAYLOR COLLEGE OF MEDICINE · 2024 · $560,000

## Abstract

PROJECT SUMMARY
 Eswatini was among the first countries to achieve the UNAIDS 95, 95, 95 targets resulting in substantial
declines in HIV incidence and TB prevalence. Despite this achievement adolescent girls still have a 1.5% annual
incidence of HIV infection and the case detection gap for children with TB is estimated to be well over 60%.
 This highlights the need for new strategies that complement current approaches to HIV and TB prevention
and detection. This study will explore HIV and TB wastewater surveillance as a strategy to reignite the drive
toward elimination. These pathogens are well suited to wastewater surveillance due to long infectious periods
during which patients are asymptomatic and unlikely to present to health facilities for testing. Wastewater
measures of TB and HIV from specific sampling areas will ultimately help target public health community case
detection interventions. In the first phase of this project, we will establish the pipeline for wastewater surveillance
of HIV and TB in Eswatini, building off our experience at Baylor College of Medicine in Houston. The second
phase will validate and quantify detection of HIV and TB from multiple sites, establishing variability, a range of
quantification, and correlation between the HIV and TB levels detected in wastewater with hospital epidemiology,
public health reporting data, and HIV recency testing data. The third phase will establish whether proven public
health interventions to increase case detection and treatment initiation for people with TB and HIV will result in
reductions in HIV and TB in wastewater samples from those same communities. If successful, this approach has
the potential to be a game changing, cost-effective and highly innovative tool in the fight against HIV and TB.
 The candidate is ideally suited to lead this grant, having a background of proven success in pioneering
wet-bench virology and immunology as well as seven years of experience leading epidemiologic and clinical
research in Eswatini. This project merges these two areas of experience, and success will require the ability to
introduce and adapt wastewater sampling to new pathogens with an in-depth understanding of HIV and TB
transmission, epidemiology, and prevention strategies. The team assembled for this project is further evidence
of the candidate's ability to assemble strong collaborative teams, drawing together partners from numerous
health and environmental programs in Eswatini and colleagues at Baylor College of Medicine.
 The data generated from this project has the potential to add precision to HIV and TB prevention and
case detection strategies and create a platform for wastewater surveillance of other emerging pathogens in
Eswatini. Early pathogen detection systems in low-resource environments will ultimately improve health security
globally. This strategy, candidate and partners are perfectly positioned to catalyze the elimination of TB and HIV
transmission in Eswatini and set the s...

## Key facts

- **NIH application ID:** 10916829
- **Project number:** 1DP1HD115427-01
- **Recipient organization:** BAYLOR COLLEGE OF MEDICINE
- **Principal Investigator:** Alexander William Kay
- **Activity code:** DP1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $560,000
- **Award type:** 1
- **Project period:** 2024-09-01 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10916829

## Citation

> US National Institutes of Health, RePORTER application 10916829, Wastewater surveillance to enhance the public health response to HIV and TB in Eswatini (1DP1HD115427-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10916829. Licensed CC0.

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