Despite being one of the most economically advanced African nations, South Africa continues to face many public health challenges. Tuberculosis (TB) is one of the leading causes of death in South Africa. According to the 2021 World Health Organization (WHO) Global TB Report, South Africa is ranked eighth among the 30 high-burden countries that contribute to 86% of the estimated incident TB cases globally. Additionally, South Africa remains the global epicenter of the HIV/AIDS epidemic. UNAIDS estimates that approximately 7.8 million people in South Africa are currently living with HIV.
Drug-resistant malaria is also a growing health concern in the country, while schistosomiasis, endemic in rivers in the eastern part of the country, continues to have a debilitating impact on rural South African populations.
NIAID-Funded Activities
For more than 20 years, NIAID has collaborated with and supported many research projects and training initiatives with institutions in South Africa, mostly focused on HIV/AIDS and TB, with additional projects on other emerging and re-emerging infectious diseases. NIAID also supports a large number of research networks that have sites in South Africa.
Select NIAID-Supported Research in South Africa:
The U.S. – South Africa Program for Collaborative Biomedical Research
The U.S. – South Africa Program for Collaborative Biomedical Research was established through a Memorandum of Understanding between the South Africa Medical Research Council (SAMRC) and NIH in 2013. The program supports collaborations between U.S. and South African scientists on research related to TB, HIV, and HIV-associated comorbidities, including cancer and other infectious diseases. NIAID coordinates the trans-NIH engagement in this bilateral research program.
Regional Prospective Observational Research in Tuberculosis (RePORT) South Africa
RePORT South Africa is a jointly funded, multi-organizational, collaborative effort that supports regional TB research aimed at developing diagnostics and quantifying the impact of undiagnosed cases with the ultimate goal of improving outcomes in TB. RePORT South Africa has five clinical sites that recruits participants from six provinces across South Africa, including regions with extremely high incidences of TB and high rates of TB in people living with HIV.
RePORT South Africa is a seminal member of RePORT International which consists of multiple regional RePORT networks to encourage coordinated, global TB/HIV research in biomarkers, diagnostics, prevention (vaccines) and treatment strategies. The consortium represents regional cohorts in Brazil, China, India, Indonesia, South Africa and the Philippines that are linked through the implementation of a common protocol and laboratory standards to promote interoperability for data sharing and specimen collection.
Scientific Advances
One-Month Tuberculosis Prophylaxis as Effective as Nine-Month Regimen for People Living with HIV
Results from a NIAID-funded trial found that a one-month antibiotic regimen to prevent active TB was at least as safe and effective as the standard nine-month therapy for people living with HIV. 3000 adults and adolescents in South Africa and nine other countries who enrolled in the trial were more likely to complete the short-course regimen—consisting of daily doses of the antibiotics rifapentine and isoniazid for four weeks—than a nine-month regimen of daily isoniazid.
Outcomes of HIV-Positive-to-HIV-Positive Renal Transplantation
South Africa has a unique patient population of HIV-positive to HIV-positive organ transplant recipients. NIAID-supported investigators conducted a study to evaluate outcomes of renal transplantation in HIV-positive patients who received organs from HIV-positive donors and found favorable clinical outcomes and the absence of transmitted drug resistance support the use of HIV-positive-to-HIV-positive renal transplantation as a treatment option. Investigators found that superinfection is not a risk, and survival and graft loss rates are similar to HIV-negative donors.
Landmark TB Trial Identifies Shorter-Course Treatment Regimen
An international, randomized controlled trial found that a four-month daily regimen with high-dose rifapentine plus moxifloxacin is as safe and effective as the standard six-month daily regimen at curing drug-susceptible TB. The Phase 3, open-label trial, called Study 31/A5349, was led by the CDC’s Tuberculosis Trials Consortium (TBTC) with collaboration from the AIDS Clinical Trials Group (ACTG) within DAIDS, NIAID. More than 2,500 participants enrolled at 34 clinical sites including South Africa, Kenya, Malawi, Uganda, and Zimbabwe. Shorter regimens enable patients to be cured faster and may reduce treatment costs, improve patient quality of life, increase therapy completion, and reduce development of drug resistance.