MEIRING NAUDE MEDAL : GRANT THERON

Dr Theron’s nomination is based on seminal work in the field of diagnostics of tuberculosis (TB), which has guided international public health policy and promoted the uptake of new tests. TB is the biggest killer of people living with HIV in the world and Dr Theron has rapidly accumulated a series of first-author publications in leading journals since 2009. These have focussed on a revolutionary new DNA-based test called Xpert, which is arguably the biggest advance in TB detection in recent memory. Dr Theron’s work has attracted editorial comment, awards, invitations to chair and speak at international conferences, and comment in international and national television, radio and print. Its findings have been incorporated into policy documents compiled by the World Health Organisation (WHO) and South African Department of Health. Dr Theron has also been selected as one of the Top 200 Young South Africans by the Mail and Guardian Newspaper, and holds Career Development Awards from The Wellcome Trust (United Kingdom), and the Medical Research Council (South Africa).

Dr Theron’s most prominent contribution has been a large four country randomised controlled trial of Xpert, which paved the way for its implementation at the point-of-care (POC) in well-resourced clinics, and showed that the test could be performed by minimally trained non-technical staff. The study was published in a leading medical journal (Theron et al., Lancet, 2013, impact factor =39) and its findings also described in a leading infectious diseases journal by the applicant (Theron et al., Lancet Infectious Diseases, 2014, IF=19). This study has been presented at the International Union Against Tuberculosis Lung Disease Congress (Paris, 2013), the WHO Xpert Global Implementers’ Forum (Geneva, 2014), the American Thoracic Society Congress (San Diego, 2014), the South African TB Conference (Durban, 2014), and the Advanced TB Diagnostics Course (Montreal, 2014). It resulted in the South African Department of Health and the City of Harare selectively placing Xpert at POC in TB hotspots, prisons, and mines. This work showed that Xpert accelerates detection and treatment initiation, but also that its impact can be severely diminished when is placed into a weak and dysfunctional healthcare system. Dr Theron also conducted the first independent evaluation of Xpert (Theron et al., AJRCCM, 2010, impact factor=11) and this study, which was done on 400 patients in Cape Town, has been cited >100 times. He also showed how Xpert (Theron et al., CID, 2011, IF=9) can be used to identify the most infectious patients and thereby reduce transmission. The manuscript received two awards from the University of Cape Town and funding to be presented overseas.

A second major contribution of Dr Theron’s work has established Xpert as a new standard for the diagnosis of extrapulmonary TB. This form of TB, which can be found in the heart, spine or elsewhere, is notoriously difficult to diagnosis, and is especially common and lethal in patients living with HIV in Southern Africa. This work has helped formulate WHO recommendations, and resulted in clinical algorithm changes and improvements to laboratory processing techniques to maximise performance. Importantly, it work showed that Xpert is not a panacea for all forms of extrapulmonary TB. While it has excellent performance for some fluids like cerebral spinal fluid, it performs worse for others, such as pleural fluid, and a biomarker-based approach should be considered in these cases.

Dr Theron is a reviewer for high impact journals such as PLOS Medicine and the Cochrane Library. He is also a recipient of a Merit Award from the University of Cape Town in recognition of excellence (less than 5% of staff are eligible) and compiles a list of new TB publications, which is e-mailed fortnightly to over 250 researchers, funders, and policymakers. He is a co-applicant on a successful RO1 grant from the National Institute of Health, which is led from the University of Cape Town, and supervises a post-doctoral student, three PhD students (including two clinician-scientists), and two MSc students. His long-term goal is to become a leading medical scientist in the field of TB and HIV who is based in South Africa.