Having been involved in SACEMA since the start, and as director since 2010, Alex Welte is stepping aside to focus on research at the end of June 2016. In this article he shares his reflections on his time at SACEMA, so far.
With the release of the WHO Consolidated Strategic Information Guidelines , countries are provided with a template, in the form of a depiction of the “Care Cascade”, permitting them to quantify the state of care as it currently stands. The Care Cascade begins by characterising all infected individuals in a population, before illustrating the cascading loss of patients at each stage of care between diagnosis and viral suppression. Countries are now beginning to produce estimates of their national cascades in order to evaluate the efficiency of current care programmes. This article discusses data issues related to cascade reporting and suggests ways to improve reporting.
To fast-track the HIV response and end AIDS by 2030, the Joint United Nations Programme on HIV/AIDS (UNAIDS) called for 90-90-90 targets for 2020. Achieving these targets has resource implications – it will require increase in spending and efficient utilization of HIV funding and lead to savings by preventing illness, deaths, and new HIV infections. Thus, how countries decide to allocate and prioritize their HIV funding will directly impact whether end of AIDS is achieved. This article examines the pattern, source, determinants, and impact of HIV spending on care and treatment from 2009 to 2013 in 38 LMICs, which are home to 73% of PLHIV.
It is known that in high TB incidence settings the rate of recurrent TB disease is much higher than the rate for first-time disease. It is not clear why the rate of reinfection disease can be elevated compared to the rate of primary disease. We set about attempting to estimate the actual values of the risk of reinfection and the rate of progress to disease for the high-incidence community of Ravensmead-Uitsig in Cape Town.
Botswana has made substantial progress towards meeting the UNAIDS 90-90-90 target by 2020 under which 90% of people living with HIV will know their status, 90% of these will be on anti-retroviral therapy (ART), and 90% of these will have viral loads below 400/µL. In this paper we use a previously published model for Botswana to assess the future impact of their HIV control programme on new HIV infections, AIDS related mortality and the costs of doing this. We show that while treatment will have a major impact on incidence and mortality and will lead to net cost savings, prevention will lead to further small reductions in incidence and mortality, but will entail significant cost increases.
A new formal ‘R Package’ to support incidence estimation is available on the Comprehensive R Archive Network (CRAN). This is the canonical way that the R community distributes stable packages to share functionality, and it is the heart and soul of the R coding environment. The new release through CRAN will make a substantial range of functionalities around incidence survey design and survey data analysis seamlessly and flexibly available to any skilled R programmer/analyst.
It is believed that most tumours are heterogeneous and many cancers contain small populations of highly tumorigenic and intrinsically drug resistant cancer stem cells (CSCs). Gaining deeper insights into the development of stem cells in general and CSCs in particular with the aim of interfering with the emerging CSC population for the purpose of bringing about its eradication poses challenges to biomedical research and engenders approaches from various viewpoints including by mathematical modelling. We used an ordinary differential equation formulation to study a nonlinear model that was based on normal and abnormal cells, including CSC, behaviour in the bone marrow and peripheral blood.
We are changing the guard at SACEMA. Alex Welte, who has managed “the shop” so effectively for the last five years has decided to step down. His successor, Dr Juliet Pulliam of the University of Florida, is expected to succeed him in late June 2016. It is appropriate, then, to look back at Alex’s substantial contribution to our organisation.
The remarkable expansion in access to ART globally since 2004 has transformed HIV from a life-threatening into a chronic illness. Improved survival as a result of ART has starkly highlighted the lack of preparedness amongst health systems to deal with the complex needs of children living with HIV as they grow older and enter adolescence. While the drive to increase coverage to ART needs to continue, there is also an urgent need for policymakers and healthcare providers to focus beyond the goal of prolonging survival and to concentrate ensuring that adolescents living with HIV achieve an optimum quality of life.
Soil transmitted helminths infections can have a negative impact on the health of children affecting nutritional status and development. Therefore, most endemic countries have started implementing mass chemotherapy programmes through school infrastructures. The success of a national deworming programme may be influenced by environmental conditions or the access to water, sanitation and hygiene. The question is which of these factors lead to success or failure of a programme. We therefore tried to get a better understanding of the determinants of geographical variations in programme impact in Kenya.