Other University Affiliates
Dr. Kate Shearer [Researcher - Epidemiology]

Dr. Shearer is an epidemiologist and faculty member in the Division of Medicine at the Johns Hopkins University School of Medicine. She completed her MPH in Global Epidemiology at Emory University’s Rollins School of Public Health and her PhD in Infectious Disease Epidemiology at the Johns Hopkins Bloomberg School of Public Health. Dr. Shearer is based in Johannesburg, South Africa and is involved in research projects in Ethiopia, Malawi, Mozambique, South Africa, and Zimbabwe. Her current research is primarily focused on uptake of TB preventive therapy.
Projects
-
Low Prevalence of Depressive Symptoms among Stable Patients on Antiretroviral Therapy in Johannesburg, South Africa
Depression is a leading cause of morbidity worldwide. It affects more than 300 million individuals globally and depressive disorders are currently the 4th leading cause of Years Lived with Disability (YLD) in South Africa. People living with HIV are disproportionately affected by mental health disorders and while the lifetime prevalence of depression in the general population of South Africa is estimated as 9.7%, estimates from HIV-infected populations have ranged from 14-62%, with variability -
Using Routinely Collected Laboratory Data to Characterise Trends in the TB Epidemic
The overall aim of this study is to harness routinely collected laboratory data to characterize the spatial distribution of tuberculosis in South Africa. In collaboration with partners at the University of the Witwatersrand and the National Health Laboratory Service, we are conducting retrospective analyses of de-identified data to highlight areas with greater burden of TB disease and investigate whether burden is changing over time. Results from this work will be informative for planning for -
Analysis of Drug Resistant Tuberculosis Population and Outcomes in South Africa, using the Electronic Drug Resistant Tuberculosis Register (EDRWeb)
The South African Electronic Drug Resistant Tuberculosis Register (EDRWeb) is a national reporting database. We propose a retrospective analysis of this de-identified, established database of routinely reported patient-level data to describe the population and outcomes of drug-resistant TB as recorded within the EDRweb in order to inform treatment guidelines and practice for South Africa. Operational implementation across a broad number of sites is likely to differ from cohorts at -
The Costs and Outcomes of Tuberculosis Treatment at Primary Health Care Clinics in an Urban Township, South Africa
The actual implementation of DOTS across South Africa varies widely. Implementation of DOTS may differ between the intensive phase of treatment (first 2-3 months, with daily injections for the retreatment regimen and a 4-drug fixed combination pill for both first-line regimens) and the continuation phase of treatment (consisting of a daily, 2-drug fixed combination pill). In either phase, the treatment supervisor may be a nurse or counselor at a healthcare facility, a lay healthworker from the -
Retention and Attrition from HIV Care
With the rapid expansion of access to antiretroviral therapy (ART) in sub-Saharan Africa, the number of HIV-positive people on treatment has increased dramatically. In South Africa, scale-up of services has put pressure on the ability of treatment programs to maintain care for existing patients while continuing to expand access to new patients. With increased demand and limited capacity, many HIV-positive patients never access care, and many who do discontinue treatment. HE2RO staff, -
Second and Third-Line Antiretroviral Regimens
As South Africa continues its rapid expansion of access to first-line antiretroviral therapy (ART), more patients will need to be switched to second-line therapy as these first-line regimens fail. However, with little experience with second-line treatments in resource-limited settings, it is not clear how well patients will do on these medications if their first regimen fails. As the cost of second-line medications is much higher than first-line, it is critical to evaluate whether these -
First Line Regimen Durability and Adverse Events
Understanding the implications of the side effect profile of individual antiretroviral drugs as well as the durability of drug regimens has considerable significance in settings where resources and drug options for HIV remain limited. HE2RO has explored these questions through longitudinal patient datasets with a particular interest in the effects of tenofovir upon introduction into the national programme. These analyses are ongoing as guidelines continue to evolve and current projects include -
Adult Treatment Outcomes and Opportunistic Infections
As the HIV epidemic matured in South Africa and the national treatment programme reached 10 years since inception, the team at HE2RO has used longitudinal patient databases to evaluate treatment outcomes among adults initiating ART. We consider diverse factors that may influence the effect of ART and also the impact of changing national guidelines in an on-going
Publications
-
The right combination – treatment outcomes among HIV-positive patients initiating first-line fixed-dose antiretroviral therapy in a public sector HIV clinic in Johannesburg, South Africa
-
Predictors of mortality and treatment success during treatment for rifampicin-resistant tuberculosis within the South African National TB Programme, 2009 to 2011: a cohort analysis of the national case register.
-
The relation between efavirenz versus nevirapine and virologic failure in Johannesburg, South Africa
-
Attrition through Multiple Stages of HIV Care in South Africa
-
Knowledge of the Spectrum of Breast Disease Presenting at a Public, Tertiary Hospital in Johannesburg, South Africa is Critical to Ensuring Holistic Care
-
Impacts of disaggregating programmatic outcomes by documentation of citizenship in South Africa
-
Disaggregating programmatic outcomes by documentation of citizenship in South Africa
-
Predictors and impact of suboptimal immune response in HIV-infected patients in South Africa
-
Cotrimoxazole use and immune system recovery among newly initiating HIV-infected patients in an urban outpatient HIV clinic in Johannesburg, South Africa
-
Long-term outcomes of over one thousand patients on second-line antiretroviral therapy in South Africa
-
Eight years experience with attrition and mortality on antiretroviral therapy in South Africa
-
Long-term Virologic Response in a Cohort of HIV-infected Patients in South Africa
-
Predictors of Time to Switch to Second Line ART after First Line Failure in Johannesburg, South Africa
-
Costs of inpatient treatment for multi-drug resistant TB in South Africa
-
The Relation Between Efavirenz. vs. Nevirapine and Virologic Failure in Johannesburg, South Africa
-
Current CD4 Count, More than Baseline, Predicts Loss to Follow-up from HIV Care
-
Antiretroviral treatment outcomes after the introduction of tenofovir in the public-sector in South Africa
-
The need for quantitative bias analysis in HIV/AIDS research: The case of nevirapine vs. efavirenz on virologic failure in Johannesburg, South Africa
-
Risk of Mortality and Loss to Follow-up amongst HIV-Positive Patients Prescribed Stavudine vs. Tenofovir: A matched cohort analysis
-
Incidence of Herpes Zoster among HIV-infected Patients on Antiretroviral Therapy in Johannesburg, South Africa – Who Should We Vaccinate?
-
Attrition through Multiple Stages of HIV Care in South Africa: A Challenge for Test-and-Treat
-
Prior knowledge of HIV-infection at first ANC visit and its impact on ART initiation compared to women newly diagnosed at first visit in Lusaka, Zambia
-
Incident pulmonary tuberculosis on antiretroviral therapy: seven years of experience at the Themba Lethu Clinic in Johannesburg, South Africa
-
Reduced loss to ART initiation among patients initiating cotrimoxazole prophylaxis therapy in Johannesburg, South Africa
-
HIV treatment outcomes after seven years in a large public-sector HIV treatment program in Johannesburg, South Africa
-
Short-term impacts of a change in ART initiation threshold for patients co-infected with TB in Johannesburg, South Africa