Formal scientific experimental investigations tend to rely on comparing situations where differences are to some extend directly controlled, or at least known. However, it is clearly impossible to investigate, in such a manner, every detail of life, or even a slightly narrower aspect like ‘healthcare’ – by examining each choice and evaluating its role in a ‘total package’ of ‘lifestyle’, ‘care’ or ‘policy’. The current edition of the SACEMA Quarterly features several pieces grappling explicitly with this challenge of understanding a bigger picture than any particular ‘scientific investigation’ can formally take on.
TB disease has been known by various names for thousands of years, and has of late been described in exquisite biological detail. Yet we still struggle to reliably answer the question: Does a particular person have ‘active’ TB? The available diagnostic tests have several limitations and perform poorly especially in developing countries where they are most needed. We need new point of care diagnostic tests, be able to accurately distinguish between TB infection and TB disease and have tests which accurately predict cure.
The main contributions in this edition of the Quarterly give us a good indication of the kinds of questions that warrant modelling, and with which non-modellers can also better engage if they are willing to at least frame their thinking explicitly in model-like terms.
SACEMA researchers Alex Welte and Eduard Grebe have written a provocative general-audience reflection on the system of ‘peer review’ in academic publishing. They argue that pre-publication peer review is a not needed anymore and the focus should be on post-publication peer review.
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.
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.
As I write, our annual clinic on the Meaningful Modelling of Epidemiological Data (MMED) is in progress, so is the 7th SA AIDS conference, and I just returned from a meeting in Geneva how best to provide advice to teams planning to estimate HIV incidence from large household surveys. In short, it seems to be a time to reflect, to reconsider what we are trying to do, and whether we are making any useful contributions. We hope these quarterly epidemiological update offerings are food for thought.
SACEMA has been involved in the development of a modelling framework for ‘HIV Affected Children’ (children who are not infected themselves, but who have family members, in particular parents, that are infected). The article describes the process, benefits, and challenges of developing this framework that could be used to estimate the magnitude of negative consequences of adult HIV infection for the health and well-being of children.
On the occasion of AIDS 2014, the twentieth International AIDS Conference in Melbourne, SACEMA released a policy brief on the ongoing debate about appropriate initiation of antiretroviral therapy for HIV positive people.
Once more we are hearing about ‘exponential growth’ – popularly some sort of synonym for ‘rapid growth’ or ‘explosive growth’ – but actually a technical term with a quite specific meaning. This time the talk is about the ongoing Ebola outbreak in West Africa, understandably causing increasing disruption (is devastation too strong a word?) in the region, and alarm much further afield.