As epidemiologists we constantly think about indicators and metrics. Given the well-known limitations of simplifying complex dependencies to one-dimensional indicators, isn’t it surprising that many academics have bought into the practice of measuring the quality and impact of their work by a handful of metrics? While books have been written about the need for more and better indicators of impact and excellence in academia, surprisingly little attention is given to the challenge and value of being engaged and excelling in non-academic activities. Some ideas around this are presented in this editorial.
As a PhD student in Ecology and Evolutionary Biology, I have spent more than half of the past four years of my dissertation work in Madagascar, where I study the transmission dynamics of zoonotic viruses which jump the species barrier from bat reservoirs to human hosts. I combine field, laboratory, and modeling methods, with each technique offering unique insights into the larger truth.
This study attempted to evaluate several HIV treatment monitoring strategies based on the 2013 and 2016 WHO Guidelines by developing a mathematical model that mimics the natural history of people on ART in South Africa. The results indicate that, from both a public health and an economic perspective, the replacement of HIV monitoring from the current CD4 count testing to only viral load (VL) testing, is not supported. The best economic results were achieved in the hybrid strategies combining CD4 and VL tests. More cost modelling studies are required to evaluate the cost-benefit of the 2016 WHO Guidelines.
Recent advances in ART have improved the success of treating infected individuals and have provided valuable tools to prevent infection. Early ART also offers one of the most practicable components in attempting to achieve functional cures, but diagnosing and treating HIV early remains a challenge.
This study clearly shows the diversity of sex workers (SWs) and their varying HIV treatment needs in the workplace and at home. Standard treatment guidelines could therefore fall short of their intention to reduce vulnerability to poor health outcomes if a non-differentiated approach to care is followed. Trained staff who are sensitised to the local medical, emotional and legal needs of SWs are able to create user friendly services that encourage these vulnerable women to utilise services.
Interventions to curb age-disparate relationships (ADR) are ongoing in spite of conflicting evidence that ADR are a risk factor for HIV transmission. There is a real need to explore the prevalence of ADR and understand what they mean for HIV transmission. We must first understand and describe these relationships; second, establish a causal relationship with HIV. We recently published a paper that explores those objectives in a population of 1,922 adult men and women living in Likoma Island, Malawi.
Early initiation of antiretroviral therapy (ART) significantly improves the survival of people living with HIV (PLWH) and reduces HIV transmission to uninfected partners. Mathematical models suggest that treatment-as-prevention programmes could lead to HIV elimination. How the clinical efficacy of ART in preventing HIV transmission translates to real-life settings depends in large part on the capacity of HIV programmes to engage and retain PLWH. The effects of ART on HIV incidence may also depend on changes in sexual network dynamics during the course of ART scale-up which are discussed in this article.
The history of sub-Saharan Africa has been defined and determined to a large extent by the struggle against tropical diseases, many of them vector borne, including malaria, leishmaniasis, trypanosomiasis and many others. To add to this burden our continent has now to deal with the ravages of HIV and the consequent rise in tuberculosis. In this issue of the SACEMA Quarterly we discuss some of the key problems and ways in which we might be able to address and mitigate some of the challenges that we face in this regard.
This article reports on the role of the community health worker (CHW) and the Primary Health Care Re-engineering Model. CHWs are well placed to strengthen service delivery, build links for different government departments in the community, and be linkages for patients to access health care as well as other support systems. The CHW provides on-the-ground support to the patient/community member and links them to health and social service departments. The passion of the CHWs to help their community is valuable and should be supported and nurtured. The CHW is a valuable resource for the development and maintenance of the South African public health system. For linkage to care in health service delivery to be effective and sustainable, the support, guidance, and development of this cadre of worker is essential.
The use of laboratory assays to identify recent infections among samples collected in cross-sectional surveys provides a potentially powerful way to measure HIV incidence. Ongoing evaluations of candidate laboratory assays have highlighted improvements and shortcomings of individual assays in correctly identifying and classifying people as recently infected. We tested two candidate assays, Sedia Limiting Antigen (LAg) and BioRad avidity assays (BioRad) against samples from a prospective cohort study in which incidence was measured directly. BioRad and LAg avidity assays have false recent rates that are up to 8 times lower than those for the BED assay, providing the potential for improved estimates of HIV incidence.