Dr. Shava is currently a research associate with Botswana Harvard AIDS institute partnership. She is a 2018 HU CFAR Developmental awardee.

How did you become interested in the field of HIV research?

I have always been very interested in approaches to preventing HIV in women and involved in HIV prevention trials network (HPTN) studies within the Botswana clinical trials unit. As a study physician conducting the amp study (HPTN 081) and the HPTN 084 study I had the opportunity to interact with participants at increased risk of acquiring HIV. Whilst interacting with a few of our participants who were female sex workers, i became interested in what HIV prevention services were available and accessible to them given the barriers to testing and PrEP that existed. HIV self-testing had not been rolled out in the country at the time. I wanted to determine the acceptability and feasibility of HIV self-testing for this group who is at very high risk for acquiring HIV.

Currently, i am a research associate with the Botswana Harvard aids institute partnership and a co-investigator and study coordinator overseeing a large COVID-19 vaccine effectiveness study being conducted across Botswana that has enrolled over 8000 participants.

Tell us about the research supported by your 2018 HU CFAR developmental award, the scientific knowledge derived and any challenges you encountered.

The title of my CFAR-funded research was acceptability and uptake of HIV self-testing among female sex workers in Botswana. The aims of this study were:

a) to assess the acceptability of, obstacles to, and preferred approaches to HIV self- testing in FSW, using qualitative methods. The qualitative study conducted among 30 fsw and 5 health care providers showed that oral HIV self-testing is a highly suggested that it would be helpful for healthcare professionals to clearly explain how to perform HIV self-testing.

b) to evaluate the up take of HIV self-testing among FSW in Botswana, in a pilot study. The quantitative study conducted among 200 FSW, showed that uptake and use of HIV self-testing by female sex workers in the Gaborone, Botswana region were very high. In addition, most women who were offered an extra test kit to take home ended up sharing that test kit with a partner, family member or friend. Therefore, HIV self-testing (and test kit distribution) by FSW appears to be a viable HIV testing approach in Botswana. We also found that nearly 60% of female sex workers who were interested in joining the study were HIV-positive.

One of the challenges that we anticipated and faced in conducting this study was participant loss to follow up. We thus designed the study with the option of telephone interviews in instances where an in-person follow up visit was not possible.

Congratulations on the successful completion of this study! In your opinion, what is the most significant public health implication of your research?

It informs a public health intervention for a marginalized population which faces various structural barriers when accessing healthcare, particularly HIV prevention care. At the time of conducting the study, very little was known about the HIV prevention behaviours amongst the female sex worker population in Botswana despite the population continuing to have a high burden of HIV (60%) whilst general population was experiencing a decline(<20%). Knowledge of ones HIV status is important for effective HIV prevention/care and HIV testing is key in achieving the first 95 of the unaids 95-95-95 targets. It is equally important that there is linkage to care following HIV self-testing results whether for PrEP or HIV management.

And your most significant personal research accomplishments?

The Harvard University Center for aids research (HU CFAR) developmental award funded this research which has helped to inform the use of HIV self-testing in Botswana and has yielded two first-authored publications in PLoS one.

Additionally, i was awarded the HPTN international scholars program grant which provided me with protected salary/effort to lead an analysis of longitudinal sexual risk behaviour among people who inject drugs in the HPTN 058 trial. This work resulted in a first-authored publication in JAIDS. I have also conducted a secondary data analysis of the tsepamo/birth outcomes study in Botswana, looking at HIV syphilis Coinfection in antenatal women and the effect on birth outcomes and this work was also published in JAIDS.

I currently have eight scientific publications in peer review journals, four of which are first author publications. My mentors have been very instrumental in my success thus far by providing leadership and guidance as needed. I am also starting to work on mentoring young researchers as a means of giving back and as a way of transferring skills.

Moving forward i believe this HIV self-testing work has laid a good foundation for me to continue to lead HIV prevention and infectious diseases research among vulnerable and marginalized populations in Botswana and elsewhere.

What advice do you have for an individual who is now in the early stage of their career as an HIV researcher?

I would say make the most of opportunities within reach and available to you. Reach out to those who have the know-how, and have walked the path that you are choosing, most researchers are willing to give back in this way. Finally, if you try you might succeed, and if dont you definitely will not.

Selected publications

1: shava e, bogart lm, manyake k, mdluli c, maribe k, monnapula n, nkomo b, mosepele m, moyo s, mmalane m, barnighausen t, makhema j, lockman s. Feasibility of oral hiv self-testing in female sex workers in gaborone, botswana. Plos one. 2021 nov 8;16(11): e0259508. Doi: 10.1371/journal. Pone.0259508. Pmid: 34748576; pmcid: pmc8575243.

2: shava e, manyake k, mdluli c, maribe k, monnapula n, nkomo b, mosepele m, moyo s, mmalane m, barnighausen t, makhema j, bogart lm, lockman s. Acceptability of oral hiv self-testing among female sex workers in gaborone, botswana. Plos one. 2020 jul 27;15(7): e0236052. Doi: 10.1371/journal. Pone.0236052. Pmid: 32716966; pmcid: pmc7384658.

Source: hu cfar may 2022 newsletter