Elizabeth (Elli) Schwartz, BSPH
ELIZABETH SCHWARTZ
Nominated From: University of Minnesota
Research Site: Makerere University Infectious Diseases Institute
Research Area: HIV, Opportunistic Infections
Primary Mentor: Radha Rajasingham, MD
Research Project
Enhanced Diagnostics for Pulmonary Opportunistic Infections among Hospitalized People with Advanced HIV Disease in Uganda
Despite global advances in HIV testing and treatment, advanced HIV disease (CD4 count <200 cells/mcL) remains a major public health concern, affecting an estimated 2.5 million adults in sub-Saharan Africa. People with advanced HIV remain at high risk for avoidable opportunistic infections, hospitalization, and death, with inpatient mortality ranging from 20% to 44%. In resource-limited settings, comprehensive diagnostic testing is often not performed due to cost constraints and system-level supply shortages. As a result, healthcare workers are forced to make critical treatment decisions based on limited diagnostic information. This approach results in frequent presumptive tuberculosis diagnoses, risking underdiagnosis and undertreatment of other clinically significant pulmonary opportunistic infections, such as Pneumocystis pneumonia, histoplasmosis, aspergillosis, and bacterial pneumonia. Point-of-care diagnostic assays for these opportunistic infections and inflammatory biomarkers like serum C-reactive protein remain underutilized in this population and may offer opportunities to improve triage and facilitate diagnosis among hospitalized people with advanced HIV. This study will be conducted in two phases among adults hospitalized in Uganda with advanced HIV disease and symptoms of pulmonary infection. In the first phase, we will describe baseline characteristics, microbiologic diagnoses, and clinical outcomes under the standard of care. In the second phase, we will implement and evaluate the feasibility and performance of a diagnostic algorithm of point-of-care diagnostics designed to facilitate the cost-effective identification of pulmonary opportunistic infections. Across both phases, we will obtain serial serum C-reactive protein measurements to evaluate the utility of serum C-reactive protein as an initial triage tool and a dynamic biomarker of treatment response. Overall, findings from this study will address critical gaps in the diagnosis of pulmonary opportunistic infections among hospitalized adults with advanced HIV disease in Uganda.
Research Significance
This study will generate critical data on the prevalence of pulmonary opportunistic infections, the feasibility and performance of a diagnostic algorithm, and the dynamics of serum C-reactive protein among hospitalized adults with advanced HIV disease in Uganda. This work has the potential to support more timely diagnosis and treatment of pulmonary opportunistic infections and improve patient outcomes in resource-limited settings. Results from this study will inform the development of a larger prospective evaluation of the diagnostic algorithm and may ultimately contribute to evidence-based guidelines for the care of hospitalized adults with advanced HIV disease. In the future, the diagnostic algorithm could be adapted to other resource-limited settings with similar healthcare infrastructure and epidemiologic profiles, such as Kenya, Tanzania, and Malawi, by incorporating local data on opportunistic infection prevalence and costs. Importantly, this project is embedded within a longstanding, bidirectional research partnership between the University of Minnesota and Makerere University’s Infectious Diseases Institute, ensuring that the research is locally informed, collaboratively conducted, and positioned to support sustainable improvements in advanced HIV disease care.
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