Malawi has developed an excellent, nation-wide system for monitoring HIV patients and keeping track of key epidemic markers. The success of the Malawi system lies in two things: the focus on simplicity and the use of the data collection process not only to track the epidemic and identify problems to be dealt with but also to give regular feedback and support to every clinic in the country. We in South Africa have much to learn from them.
Among the three greatest pandemics in history are the Black Death, the Spanish Flu and now HIV. The Spanish Flu was caused by a virulent strain of the H5N1 virus and killed up to fifty million people, or 2% of the world’s population, most of them in less than one month in 1918. We should study the history of past epidemics and learn how to avoid, manage and control them. South Africa is still struggling to contain the epidemic of HIV and manage the epidemic of TB, now being primarily driven by HIV.
Using trends in the rate of new HIV infections in east and southern Africa we assess the current state of the epidemic and evaluate the future prospects for controlling it. If we let an incidence of 1 per 1,000 people represent a control threshold then this has been reached, or will probably be reached by 2020, in East Africa and is reachable by 2020 in those southern African countries that do not have strong social and economic ties to South Africa, if they continue to scale up their treatment programmes. South Africa, Lesotho, Mozambique and Swaziland could reach the control threshold by 2030 with sufficient political will and commitment to ‘treatment for all’.
Controlling and eliminating is never going to be easy and this issue of the SACEMA Quarterly is devoted to some of the recent developments that have been made in our attempts to manage TB.
Models of HIV and TB are well established and it is tempting to model the combination of HIV and TB by repeating a suitable TB model a number of times corresponding to the various states of HIV. This can, however, lead to a very complex model with tens, if not hundreds of parameters, requiring considerable computing power to run. Fortunately, the time scales over which the two infections progress are very different, allowing us to greatly simplify the problem.
Abstract: Twenty years ago, in 1997, I wrote the following piece reflecting on the Mothusimpilo project, an early attempt to understand and help to manage the epidemic of HIV in South Africa. I thought it might be interesting for you to look back on where we have come from.
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.
World-wide South Africa has the largest epidemic of HIV and the biggest anti-retroviral programme. But reaching the UNAIDS 90-90-90 target by 2020 and ending AIDS by 2030 will require an expansion of surveillance and strengthening patient monitoring. Both are needed to monitor progress, identify and correct problems and to demonstrate success. Here we outline the current state of the epidemic and discuss important issues that should inform the National Strategic Plan to be launched on World AIDS Day in December.
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.
While we all believe in ‘inter-disciplinary research’, the reality often falls short of the intention. How then can we begin to learn each others languages, hear what others are saying, use our joint knowledge and understanding to throw light on important problems, and hopefully make the world a slightly better place?