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.