by Terry Stallard                                          9 Jul 2010

The Africa Centre for Health and Population Studies, University of KwaZulu-Natal announced substantial achievements in its recently published 2007-2010 Research Report.

RELATIONSHIPS FORMED 

Significant inroads have been made in creating a symbiotic relationship with the Department of Health with Primary Health Care being raised to a new level for previously disadvantaged rural services.

Africa Centre’s director, Professor Marie-Louise Newell, said “it has taken two years of building a mutually respectful relation to create a positive health platform in the Umkhanyakude district of KwaZulu-Natal” indicating genuine development takes patience, commitment, hard work and trust from all sides.

Based in Somkhele in the Hlabisa sub-district since 1997, this multi-faceted research station is a profound example of how science, community health-care and international research can successfully combine to combat the challenges of HIV, TB and associated health concerns.

Showing genuine care for the community has resulted in:

·         More than 10 000 people, of whom 10% are children aged 15 or younger, benefiting from the HIV Treatment and Care Programme which began in late 2004

·         A major economic boost in the area with over 500 community members employed, and a further 500 home-based carers being engaged

·         Information on intervention and prevention methods for infections such as HIV, TB and Schistosomiasis successfully made available

The Centre has, since 2000 been conducting a variety of population, clinical and social-science research in a study area covering 435km² and estimated population of 90 000.

Academic skills have been nurtured in an extensive “support programme for Undergraduates and Master’s degrees” reflecting multi-level impact in science and research fields. Currently the Centre supports its first local community member in his medical study at UKZN; and hosts about 17 PhD students of whom 12 are staff members and 3 are international students.

RESEARCH HEADWAY

The Centre has gradually built up a team of scientists of international standing, Africa Centre scientists that has begun “to unravel causal pathways of HIV transmission and acquisition” that impact effective “HIV prevention strategies” based on longitudinal data.

Aside from issues such as “school drop-out, violence, condom usage, sexual debut, age-mixing and concurrency; geographical  ‘hotspots’ around bars and gasoline stations reveal a localised prevalence of HIV which contrasts markedly with the existing widely-held views of a general epidemic”. These results reflect the need to “target socio-geographic communities at greatest risk with intervention strategies”.

“People in middle-income brackets and migrants” are more susceptible to HIV infection according to other studies conducted by the Centre.

The Africa Centre demographic and health surveillance identifies and quantifies vital “environmental, community, household and individual determinants of HIV incidence and prevalence in a rural South African population with emphasis on the local community”. The geographical information system (GIS) generates “virtual communities around each individual to create sensitive and realistic community-level estimates”.

Colin Newell, senior database scientist at the Centre, said  one of the big benefits of longitudinal surveys  are that they “enable you to visit the same people repeatedly and so follow real ‘cohorts’ of individuals, studying them as they get older. This allows you to measure real change and crucially, to pose ‘why’ questions i.e. to try to find out the actual causes of that change”.  

A provocative recent result on concurrency has indicated high levels of partnership had little impact on an individual’s risk of acquiring HIV. This has stimulated further ongoing study on multiple partnerships.

A unique study on Schistosomiasis (Bilharzia) following implementation of piped water supply in rural areas indicated a substantial reduction of infection among children who no longer had contact with open-water sources.

RESEARCH RELEVANCE

The Centre works closely with collaborators, nationally and internationally, and a recent example involving “12 studies in three different regions in sub-Saharan Africa quantified the increased mortality in children whose HIV infected mothers had died; irrespective of the infants own HIV infection status”. Further research at the Centre has shown that where HIV treatment keeps these mothers alive, child mortality levels drop. 

The “impact of anti-retroviral treatment showed a decline in HIV-related mortality between adults in the 25 – 50 year age group and a substantial decline in early childhood mortality due to the decline in mortality of mothers with an indirect effect on the survival of all their children as well as an effect of the prevention of mother-to-child transmission (PMTCT) programme”.  This is of profound significance where HIV prevalence was about “50% in women 25-29 year old and 45% in men 30-34 year old in 2003/4”.

The Wellcome Trust-funded Vertical Transmission Study (VTS) which was funded in 1999 and completed in 2006 produced over 20 publications and had high impact on mother to child transmission. Dr Frank Tanser, senior scientist for Africa Centre, said “this influenced breastfeeding guidelines adopted by the World Health Organisation (WHO) and provided strong evidence supporting the recommendations that mothers should breastfeed their infants exclusively (ie nothing but breastmilk) for the first six months”.

The mother-to-child HIV transmission study also led to the creation of training material for infant feeding more generally and a DVD is currently being disseminated provincially, nationally and internationally reflecting Africa Centre’s ability to convert research into front-line community care.

Important steps were taken to develop a TB database for the Department of Health to gain a “more integrated model of TB-HIV”. Ethics permission was obtained to link a TB data base with ART data base in conjunction with the Centre’s surveillance data to “explore networks of TB cases and the number of TB patients who require HIV treatment”.

However, Professor Newell said that overall results from their longitudinal surveillance studies show clearly that “HIV incidence in this setting does now yet show evidence of a substantial decline which emphasizes the urgent need to reduce transmission through effective prevention interventions”. The Centre is part of the National Consultation Group on HIV Incidence Estimation, a scientific advisory body convened by UNAIDS that advises the Minister of Health on how to assess HIV incidence.

Complementing population and clinical activities with social science studies, Africa Centre initiated a youth prevention programme with the local school community and further development of qualitative research “exploring fatherhood and kinship patterns”.

Africa Centre’s “significant presence and contribution to the International AIDS Society HIV Pathogenesis and Treatment conference in Cape Town, July 2009” cemented its status and focus for professional research and, culminated in it being recognised as a “National Resource within Southern Africa and beacon for national and international collaboration”.

Click here to view and read the full Research Report.