The HIV research and activist communities are counting down to the big AIDS conference in Melbourne (20-25 July 2014). One wonders if the ever greater buzz around ‘cure’, which has attracted so much attention in the last few years, will translate into the hot topic of AIDS 2014. This may be exciting basic science, and offer the (hardly imminent) promise of something better than decades of drug regimens for those infected, but it should not detract attention from the complex immediate situation still faced by much of sub Saharan Africa, and other countries, where access to cure is a very hypothetical lofty goal. This Quarterly discusses some of these immediate challenges.
Over the past eight years SACEMA has collaborated with the African Institute for Mathematical Sciences (AIMS) and North American scientists in running workshops now held annually at AIMS in Muizenberg, and in the United States at the University of Florida. This editorial particularly celebrates the inputs of five North American scientists who have given freely of their time and efforts in making this valuable training effort possible.
SACEMA’s experience is that low competence and poor self-efficacy in the use of statistical software packages is a major obstacle to acquiring and expanding expertise in statistical analysis. It was therefore decided to increase our efforts to strengthen hands-on capacity and confidence in data management, exploration and visualisation, using the versatile, open-source package R. We plan to offer an intensive one-week course in June 2014 which will include computer practicals with participants’ own data. The course also offers an opportunity to conduct education research.
At the 3rd International HIV Treatment as Prevention Workshop in Vancouver, Canada, in April 2013 I was asked to put forward the case that “Pre-Exposure Prophylaxis (PreP) is not an essential component of Treatment as Prevention (TasP)”. So my job was to convince the public that while PreP may be a useful, and even an important, addition to TasP it is by no means an essential component of TasP. Here I reproduce my argument and invite readers of the SACEMA Quarterly to express their own views on this important issue.
Welcome to a special edition of SACEMA quarterly epidemiological update – dedicated to SACEMA’s annual ‘research days’ event and other SACEMA related work. This is a glimpse into exciting trends in public health research, where mathematical methods are increasingly applied to a range of problems, to help leverage limited data, think about prospects for interventions, and formulate new hypotheses and experiments. The article also includes a reflection on modelling as a universal practice in all of science and all that differs are the kinds of models, and the techniques used to set them up and manipulate them.
The contributions in this issue of the SACEMA Quarterly focus on different aspects related to TB and incidence of HIV. This editorial focuses on HIV treatment as prevention by presenting the MaxART project (Maximizing ART for Better Health and Zero New HIV Infections). This project pursues the dream of reaching all people in Swaziland who are in need of treatment with an ultimate goal of preparing the country for the possibility of ending the HIV epidemic. SACEMA is one of the members of the MaxART consortium and is involved in various modelling and analysis activities that are presented here.
One of the articles in this edition concerns the modelling of the control of the tsetse-borne disease trypanosomiasis using trypanocides or insecticide-treated livestock. SACEMA has been short-listed for WHO/TDR funding of a project focussing on modelling the way in which various climate change scenarios might affect the population dynamics of tsetse flies and the trypanosomes that they transmit. For this study we have access to large, long-term, unique archives of data of the type required to address these questions. These data will be augmented during the study through field studies in Zimbabwe and Tanzania, aimed at understanding the spatiotemporal variability of disease threat and how this is likely to change at different locations and altitudes in the context of climate change. Field studies will address particularly the problem of the interface between humans and tsetse, and suggest optimal methods of disease control.
AIDS 2012 has come and gone. South African researchers and NGOs engaged in AIDS related work were ever visible, presenting new results, chairing key sessions, or delivering invited talks. Before the conference began, it was widely noted that an important shift in debate has occurred in recent years, concerning the coalescence of treatment and prevention. The real discussion is now much more about how, practically, to access the prevention benefit of treatment. This debate, at AIDS 2012, although heated at times, at least did not just go over the same old ground. Furthermore, the progress here has largely been based on the work of South Africans pushing these ideas, and amassing the evidence of early impact of our local treatment programme. It must be said that South Africans are doing some of the most important work in many aspects of HIV research, not just in applications to our specific problems, but also raising the bar internationally in the practice of good science.
The current issue of the SACEMA Quarterly focuses on research findings on South Africa that have been presented at the 19th Conference on Retroviruses and Opportunistic Infections (CROI) that was held from 5-8 March 2012 in Seattle. The role of treatment as prevention and combining different strategies to reduce the HIV incidence continue to be hot topics. The study by Ramzi Alsallaq et al. focuses on mathematical modelling on the impact of combined interventions on the short- and long-term incidence of HIV in KwaZulu-Natal. As this is just one of the large number of mathematical models predicting the incidence of HIV in South Africa, the HIV Modelling Consortium brought together mathematical modellers to do a model comparison exercise to see what the potential role is of HIV treatment as prevention in South Africa. The results are presented by Jeff Eaton at al. Finally, the article of Stephane Verguet is focussing on how best to assess the (cost-)effectiveness of different HIV treatment programs and models so that the existing limited resources can be allocated optimally.
In order to assess the effects of Treatment as Prevention (TaP) on HIV incidence, results from HIV testing over time need to be available. This links to two aspects of information retention – data storage and data usage – which are discussed and illustrated by the case of HIV testing data in this editorial.