Concurrent partnerships have been suggested as a possible driver of the HIV epidemic in Southern Africa. To date, estimates of concurrency in published literature have been problematic due to poor definitions and measurement. We conducted a sexual behaviour survey in Cape Town that characterized concurrency by estimating the point prevalence, cumulative prevalence, incidence and degree distribution of concurrent partnerships. We also described the duration of overlaps for relationships begun in the previous year and the relative risk of having concurrent partnerships for different race and sex groups.
A new software tool that can simulate the spread of HIV and estimate the impact and cost-effectiveness of various prevention and treatment interventions.
The publication in May, with much fanfare, of the results of the HPTN 052 Randomised Control Trial of when to start HIV-positive people on ART was music to SACEMA’s ears. The trial involved HIV discordant couples. In the treatment arm, the HIV positive partner was started immediately on anti-retroviral therapy (ART); in the control arm, people were started on ART when their CD4 cell count fell below 250/µL, as currently advised by the World Health Organization. The study showed that early treatment cut transmission by 96% and the incidence of tuberculosis by 82%. Now that it is beyond dispute that treatment dramatically reduces individual infectiousness, the remaining concerns about Treatment as Prevention are operational, since we now need to determine how such large treatment programs be safely and effectively managed, and cost, since this would require a substantial up-front investment even though it will be cost-saving in the long run.
The Conference on Retroviruses and Opportunistic Infections (CROI) is one of the biggest events on the HIV related calendar. One of the hot topics was ‘Pre-Exposure Prophylaxis’ (PrEP). However, questions remain about how this strategy, which provides antiretroviral treatment to HIV negative people – really fits into a world in which the majority of HIV infected persons lack access to treatment. Some other highlights of CROI are also discussed. Although HIV/AIDS dominates the agenda in local epidemiology, SACEMA is not an HIV research organization, and we are pleased to present three articles on very different topics: perioperative cardiovascular disease; a methodological perspective involving carcass surveillance; and an item on how medical research can fail so impressively. We trust you will find something of interest in this edition.
In the first edition of the SACEMA Quarterly (March 2009) Brian Williams provided a discussion on the various arguments for and against the in a Lancet article suggested approach of ‘treatment as prevention’ of HIV (early treatment of HIV infected individuals will prevent transmission of the virus) (1). As this ‘test-and-treat’ strategy continues to be Read More
After two decades of setbacks with microbicide trials, recently two studies demonstrated a proof of concept for microbicides for the first time. With now a demonstrated proof of concept, understanding the potential cost-effectiveness of vaginal microbicides within the currently existing set of HIV prevention interventions becomes crucial. As there it not yet a safe and effective microbicide available, the challenge is to evaluate the potential of the microbicide technology for a hypothetical intervention. Results are reported of a recent study that looked at a potential 1-year intervention targeting a population of women in reproductive age in South Africa and estimated the incremental cost-effectiveness over a year of microbicides when distributed in conjunction with condoms.
In the April 2010 issue of the SACEMA Quarterly an article was published describing a simple mathematical model developed by the UNAIDS Reference Group for Estimates, Modelling and Projections to help countries estimate the proportion of new infections that occur through key transmission modes (1). Indicated was that this type of in-country analysis could be Read More
From 2002 until 2005 a male circumcision (MC) trial was conducted in Orange Farm. The trial showed a protective effect of MC of about 60%. Following this trial there was an ethical obligation of the funder to offer this effective treatment to the entire community. This project, which was named the Bophelo Pele Male Circumcision Read More
An article published in the June 2009 edition of the SACEMA Quarterly reported on the positive association between genital herpes (most often caused by Herpes Simplex Virus type 2 (HSV-2)) and HIV acquisition (1). It has been argued that HSV-2 could have a major role in fuelling the spread of HIV and that significant numbers Read More
The central theme of this first SACEMA Quarterly Epidemiological Update of 2010 is the rate of occurrence of new HIV infections – also known as HIV incidence. The issue is examined through three distinct perspectives: 1) Recent advances in measuring the HIV incidence in a population, and/or how it changes over time, 2) estimating the relative importance of various ‘modes of transmission’ in contributing to new cases of HIV infection, and 3) the use of antiretroviral treatment of infected individuals to curb their infectivity and hence reduce HIV incidence.