Stanford
King Center on Global Development Global Development

HIV Wastewater Epidemiology in South Africa Initiative

For decades, HIV has remained one of the world’s deadliest infectious diseases, with millions of cases still undiagnosed and untreated – especially in sub-Saharan Africa. But a team of Stanford researchers believes the answer to finding these hidden infections could be in an unexpected place: wastewater.

The HIV Wastewater Epidemiology in South Africa Initiative is launching a collaboration with South African scientists to explore whether wastewater surveillance can detect unrecognized HIV transmission and drug resistance. If successful, this approach could serve as a cost-effective, anonymous way to track outbreaks and target interventions in high-risk communities.

Through refined HIV wastewater screening methods in collaboration with the South African Medical Research Council, the team will focus on mapping HIV concentrations across KwaZulu-Natal to identify underserved populations and monitor intervention success. Additionally, it seeks to build a regional consortium to expand wastewater-based epidemiology (WBE) expertise and collaboration in southern Africa, enhancing public health monitoring and response to HIV.

Team

  • Alexandria Boehm, principal investigator, laboratory lead at Stanford
  • Julie Parsonnet, co-principal investigator, epidemiology lead at Stanford
  • Alessandro Zulli, postdoctoral researcher
  • Fareed Abdullah, advisor on South Africa HIV and TB policy, director of the Office of AIDS and TB Research at the South African Medical Research Council (SAMRC)
  • Rabia Johnson, laboratory lead at the South African Medical Research Council (SAMRC)
  • Renée Street, epidemiology lead at the South African Medical Research Council (SAMRC)

Selected Work

Papers

M. K. Wolfe, M. R. J. Varkila, A. Zulli, J. Parsonnet, A. B. Boehm. 2024. Detection and quantification of human immunodeficiency virus-1 (HIV-1) total nucleic acids in wastewater settled solids from two California communities. Applied and Environmental Microbiology, 90:e01477-24. Link.

M. K. Wolfe, A. T. Yu, D. Duong, M. S. Rane, B. Hughes, V. Chan-Herur, M. Donnelly, S. Chai, B. J. White, D. J. Vugia, A. B. Boehm. 2023. Use of Wastewater for Mpox Outbreak Surveillance in California. New England Journal of Medicine, 388:570-575. Link. DOI: 10.1056/NEJMc2213882.

E. M. G. Chan, A. B. Boehm. 2025. Respiratory virus season surveillance in the United States using wastewater metrics, 2023-2024. ACS ES&T Water, 5(2), 985-992. Link.

M. K. Wolfe, D. Duong, B. Shelden, E. M. G. Chan, V. Chan-Herur, S. Hilton, A. H. Paulos, X.-R. S. Xu, A. Zulli, B. J. White, A. B. Boehm. 2024. Detection of hemagglutinin H5 influenza A virus sequence in municipal wastewater solids at wastewater treatment plants with increases in influenza A in spring, 2024. Environmental Science & Technology Letters, 11, 6, 526-532. Link.

A. Zulli, M. Varkila, J. Parsonnet, M. K. Wolfe, A. B. Boehm. 2024. Observations of respiratory syncytial virus (RSV) nucleic-acids in wastewater solids across the United States in the 2022-2023 season: Relationships with RSV infection positivity and hospitalization rates. ES&T Water, 4(4), 1657-1667. Link.