International Epidemiologic Databases to Evaluate AIDS

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Southern Africa

IeDEA Southern Africa website: www.iedea-sa.org
Link to Southern Africa Publications in PubMed

Matthias Egger, Principal Investigator
University of Berne, Switzerland

Mary-Anne Davies, Principal Investigator
University of Cape Town, South Africa

South Africa

Southern Africa is where almost 30 of the approximately 40 million HIV-infected people in the world live, in an area estimated to have 2 of the global population.  While an estimated 2 million men, women, and children are yet in urgent need of antiretroviral treatment in this region, close to 200,000 individuals are now believed by the World Health Organization to be receiving treatment. Answers are urgently needed to clinical and operational research questions regarding the most effective implementation and monitoring of wide-scale antiretroviral treatment delivery.

Specific Aims:

  1. To measure the effectiveness of antiretroviral therapy in southern Africa, and to describe factors that influence outcomes;
  2. To improve the prognosis of people living with HIV and AIDS eligible for or initiating highly active antiretroviral treatment in southern Africa through timely and operative regional epidemiological evaluations; and 
  3. To increase the capacity for delivering antiretroviral therapy in this region by increasing the capacity for monitoring exposures and outcomes at the individual and population levels.

Research Objectives:

  1. To describe issues related to the provision of health care to children and adults in southern Africa with a focus on the delivery of ART, waiting times and program level influences on survival and other outcomes, including losses to follow up; 
  2. To describe antiretroviral treatment issues in adults (including pregnant women) and children, with an emphasis on the monitoring of treatment response and prognostic factors, including exposure to drugs to prevent mother to child transmission of HIV, and adverse events associated with antiretroviral treatment; and 
  3. To describe issues related to important complications of HIV infection and antiretroviral therapy use, with a focus on tuberculosis, the immune reconstitution and inflammatory syndrome, and prophylaxis against life-threatening opportunistic infections.

Research Design and Methods:
The OASIS Collaboration includes 17 clinics and clinical cohorts in 6 countries in the region, involving 35,070 HIV-1 infected adults and children.  We will use innovative and state-of-the-art statistical approaches to analyze data from this observational cohort study, including techniques which account for the longitudinal and hierarchical structure of the data.  An operational structure is proposed that emphasizes the long-term collaborative and capacity-building approach of the collaboration.


HIV testing among pregnant women who attend antenatal care in Malawi.

Malawi adopted the Option B+ strategy in 2011. Its success in reducing MTCT depends on coverage and timing of HIV testing. We assessed HIV status ascertainment and its predictors during pregnancy. HIV status ascertainment was 82.3% (95%-CI 80.2-85.9) in the pre-Option B+ period and 85.7% (95%-CI 83.4-88.0) in the Option B+ period. Higher HIV ascertainment was independently associated with higher age, attending ANC more than once, and registration in 2010.

CD41 T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa.

Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally.

The Cost-Effectiveness of Monitoring Strategies for Antiretroviral Therapy of HIV Infected Patients in Resource-Limited Settings: Software Tool.

The cost-effectiveness of routine viral load (VL) monitoring of HIV-infected patients on antiretroviral therapy (ART) depends on various factors that differ between settings and across time. Low-cost point-of-care (POC) tests for VL are in development and may make routine VL monitoring affordable in resource-limited settings. We developed a software tool to study the cost-effectiveness of switching to second-line ART with different monitoring strategies, and focused on POC-VL monitoring.

Age-specific and sex-specific weight gain norms to monitor antiretroviral therapy in children in low-income and middle-income countries.

Viral load and CD4% are often not available in resource-limited settings for monitoring children's responses to antiretroviral therapy (ART). We aimed to construct normative curves for weight gain at 6, 12, 18, and 24 months following initiation of ART in children, and to assess the association between poor weight gain and subsequent responses to ART.

Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries.

The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries.