HIV and schistosomiasis: studies in Tanzania.

Schistosomiasis is a helminthic worm infection that affects 260 million people worldwide, 90% of whom live in sub-Saharan Africa. In Tanzania, where the research in this thesis was conducted, two species of schistosomes are highly endemic (Schistosoma haematobium and S. mansoni), with more than 50% of adults infected with one or both schistosome species in many regions. In and of itself, schistosomiasis causes significant morbidity and mortality, with an estimated 200,000 deaths annually and 3.31 million disability-adjusted life-years. The possibility that it additionally impacts HIV transmission and disease progression render treatment and control of this neglected tropical disease even more urgent. This thesis focuses on HIV prevention and disease management in sub-Saharan Africa. It will first describe population-based epidemiological work in Tanzania associating HIV with S. haematobium and with S. mansoni. Subsequent chapters focus on treatment of S. haematobium infection in women, where it causes genital tract disease, and on the effects of schistosome infection on immunological response to treatment in people living with HIV infection. The final chapter focuses on implementation science work with high potential to improve HIV prevention and early diagnosis in Tanzania.