Dr Mhairi Maskew [Principal Researcher - Epidemiology]

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Dr Mhairi Maskew

Mhairi Maskew, MBBCh, PhD, is a physician and epidemiologist. Mhairi has been involved in the management and analysis of large HIV treatment cohorts databases for the last 10 years. She joined the HE2RO team in 2010 and, as a Principal Researcher, currently provides leadership to projects involving big data linkages. Mhairi was previously based at Helen Joseph Hospital in Johannesburg, South Africa, as a clinician in the Themba Lethu clinic, one of South Africa’s largest antiretroviral treatment sites. During this time she also worked in the hospital’s Oncology unit where she developed an interest in HIV-related malignancies. She has since completed a PhD at the University of the Witwatersrand which explored the epidemiology of Kaposi Sarcoma and its etiologic virus, the Kaposi sarcoma Herpes-virus. Since then, Mhairi has been involved as local principal investigator on two randomised clinical trials investigating simplified clinical treatment algorithms for same-day ART treatment eligibility in South Africa. In addition, she was awarded a five-year R01 which resulted in the development of the first National HIV Cohort created from routinely collected laboratory data and some of the first national-level estimates of retention on ART robust to transfers, with a focus on adolescents. She was recently awarded a second R01 to further develop the lab-based National HIV Cohort to focus on pregnant women. Mhairi has mentored several Master’s level students and her work has been published in several international peer-reviewed journals including Lancet HIV, AIDS, JAIDS, Clinical Infectious Diseases and the International Journal of Epidemiology.

Projects

  • Analysis of National Lab Database to evaluate the HIV treatment rollout in South Africa

    By linking lab tests on detailed patient identifiers, a national, patient-level longitudinal cohort is being developed, which contains over 3 million ART initiators and over 23 million observations. This “NHLS Patient Cohort” will enable us to evaluate the national ART program using data that are nationally representative and robust to self-transfer across care settings. Through a partnership between Wits University in South Africa and Boston University in the U.S., this project will 

  • SLATE: Simplified Algorithm for Treatment Eligibility

    In its 2015 revision of the global guidelines for HIV care and treatment, the World Health Organization called for initiating lifelong antiretroviral treatment (ART) for all patients testing positive for HIV, regardless of CD4 cell count. As countries adopt the new recommendation, known as “treat all,” millions of additional patients are becoming eligible for ART worldwide. In sub-Saharan Africa, where most of these patients are located, studies continue to document high losses of 

  • Attrition from HIV Care and Treatment Before and After an Increase in the CD4 Count Eligibility Threshold

    South Africa has recently announced that as of January 2015, it will be increasing its HIV treatment CD4 eligibility threshold from 350 cells/μl to 500 cells/μl1 making more patients eligible for treatment than ever before. However efforts to increase HIV treatment coverage may be minimized if losses to follow up, which have been shown to be high along the continuum of HIV care, offset gains from getting more people onto treatment. HE2RO will conduct a prospective cohort study of adult 

  • Non-Communicable Diseases

    The past two decades have brought a number of serious threats to public health in South Africa. One of these is the growing burden of non-communicable, chronic diseases. These diseases are already responsible for a large share of premature adult mortality and morbidity, and the burden they impose on the public sector health care system and national health budget is likely to grow substantially in coming years. HE2RO and its partner, Boston University, are developing a body of work to quantify 

  • RapIT: Rapid Initiation of Antiretroviral Therapy to Promote Early HIV/AIDS Treatment in South Africa

    The RapIT study was a randomized strategy evaluation of the feasibility, effectiveness, and cost-effectiveness of rapid ART initiation using accelerated clinic procedures and point-of-care laboratory tests. Outpatient, non-pregnant, HIV-positive adults who came to two South African clinics for an HIV test or CD4 count, consented to study participation, and were eligible for ART under 2010 guidelines were randomized 1:1 to rapid ART initiation or to standard care. Those who were assigned to 

  • 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, 

  • Southern African Treatment Programme Evaluation

    Understanding HIV epidemic in the wider Southern African region provides context and valuable insight for the National treatment programme. To this end, HE2RO contributes data to the International Epidemiologic Databases to Evaluate AIDS Southern Africa network. This collaboration collects key data and implements methodology to effectively analyse data from large generated datasets to address high priorty HIV/AIDS related questions that are not answerable by a single 

  • Linkage to National Databases to Enhance Programme Evaluation

    HIV care involves a web of local clinics and laboratories throughout South Africa. In the emergency phase of the epidemic, monitoring and evaluation took a backseat to HIV care. Currently HIV care takes place at over 3,000 local clinics throughout South Africa. Laboratory test from the labs and patient records from the clinics provide potentially useful sources of data for monitoring and evaluation of the National treatment programme currently and historically. Linkage of patient records to the 

  • Pregnant Women

    Treatment outcomes among pregnant women remain a critical indicator for monitoring and evaluation of the national treatment program over time. A long-standing collaboration with researchers from the University of North Carolina has enriched the analysis of longitudinal data on pregnant women by the researchers at 

  • Paediatric and Adolescent Populations

    Children and adolescents have been identified as priority populations with the greatest potential impact on the development of the HIV epidemic. HE2RO has used multiple sources of data to evaluate the outcomes of children and adolescents initiating ART at multiple clinics across Gauteng and Mpumalanga. We also utilize prospective cohorts to identify factors associated with treatment adherence and missed clinic visits among adolescents and plan to use national level laboratory data to produce 

  • 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 

  • RapIT-NCD: Prevalence of NCD risks and conditions in patients on ART

    South Africa, like many other middle income countries, faces very high rates of NCDs and NCD risks but there are virtually no studies looking at NDCs in ART patients and none that have considered the effect of NCDs and NCD risk factors on long term retention on ART. RapIT-NCD is estimating the prevalence of NCDs and NCD risk factors in patients who are stable on ART and examining associations between NCDs and ART outcomes, including mortality, loss to follow up, viral suppression and 

Publications