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African section of e-journal Rural and Remote Health

Authors:
Jennifer Richmond at James Cook University
Jennifer Richmond
Ian D Couper at Stellenbosch University
Ian D Couper
Paul Worley at Flinders University
Paul Worley
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July 2007, Vol. 97, No. 7 SAMJ
B
RIEWE
480
Notwithstanding these encouraging results we remain
actively involved in further validation studies not limited to
the BED-CEIA but will also explore the suitability of testing
algorithms involving, for example, antibody avidity testing.
There is emerging consensus that validated laboratory
based tests are the method of choice to estimate national
HIV incidence and assess the impact of national prevention
programmes.
1. Parekh B, Kennedy S, Dobbs T, et al. Quantitative detection of increasing HIV type 1
antibodies after seroconversion: A simple assay for detecting recent HIV infection and
estimating incidence. AIDS Res Hum Retroviruses 2002; 18(4): 295-307.
2. Centers for Disease Control (CDC), Surveillance and Survey and Laboratory Working
Groups. Expert meeting on the validation of the BED HIV-1 incidence assay for HIV-1
incidence surveillance. CDC, Atlanta, USA, 9-10 May 2006.
3. UNAIDS. Statement on the Use of the BED-assay for the Estimation of HIV-1 Incidence for
Surveillance or Epidemic Monitoring. Report of a meeting of the UNAIDS Reference Group
for Estimates, Modelling and Projections, Athens, Greece, 13-15 December 2005. Geneva:
UNAIDS, 2005.
4. Centers for Disease Control (CDC), Surveillance and Survey and Laboratory Working
Groups. Guidelines for the Use of the BED Capture Enzyme Immunoassay for Incidence Estimation
and Surveillance. Atlanta, USA: CDC, 2006.
5. McDougal JS, Parekh, BS, Peterson ML, et al. Comparison of HIV-1 incidence observed
during longitudinal follow-up with incidence estimated by cross-sectional analysis using the
BED capture enzyme immunoassay. AIDS Res Hum Retroviruses 2006; (10): 945-952.
6. Karita E, Price M, Hunter E, et al. Investigating the utility of the HIV-1 BED capture enzyme
immunoassay using cross-sectional and longitudinal seroconverter specimens from Africa.
AIDS 2007; 21: 403-408.
7. Rehle T, Dorrington R, Shisana O, et al. National HIV incidence estimates: direct measures
compared with mathematical modelling. Paper presented at the 3rd South African AIDS
Conference, Durban, 5-8 June 2007.
African section of e-journal Rural and
Remote Health
To the Editor: We read with interest the SAMJ article ‘Scope
and geographical distribution of African medical journals active
in 2005’ by Siegfried et al.,1 and would like to bring to your
readers’ attention the recent launch of an African section of the
e-journal Rural and Remote Health (RRH). This regional section
has a particularly African flavour, owing to its own editorial
board and peer-review panel, but is under the umbrella of the
international journal.
We hope that the African section will add to the initiatives
described by Siegfried et al. and address some of the issues
raised in their article. RRH is an international, peer-reviewed,
open-access journal. It is Medline-listed. It aims to offer wider
world exposure for quality African research in the area of rural
and remote health care education, policy and practice. We
believe the issues of rural and remote health are relevant to
most of Africa.
Because RRH is an electronic journal it affords authors timely
publication on an article-by-article basis. In addition, the
electronic format means that RRH is not geographically bound,
and therefore offers rural and remote authors and users an all-
of-Africa approach to publication.
In a recent RRH editorial to coincide with the launch of the
African section, we recognised the impact of inadequate access
to information on the problems of health and health care in
Africa.2 We also discussed the issue of inequity in access to the
Internet, which has been highlighted for urgent attention by
the Commission for Africa,3 and recent initiatives to improve
the current situation of variable access.4,5 We offer the African
section of RRH as a small contribution towards this.
The Journal can be accessed at www.rrh.org.au. Users should
select ‘African section’ from the main menu on the home page.
Jennifer Richmond
Production Editor, RRH
Australian Rural Health Education Network
Canberra, ACT
Australia
Ian Couper
Editor, African section, RRH
Professor of Rural Health
Department of Family Medicine
University of the Witwatersrand
Johannesburg
couperid@medicine.wits.ac.za
Paul Worley
Editor-in-chief, RRH
Professor and Director
Rural Clinical School
Flinders University, South Australia
1. Siegfried N, Busgeeth K, Certain E. Scope and geographical distribution of African medical
journals active in 2005. S Afr Med J 2006; 96: 533-538.
2. Couper ID, Worley PS. Health and information in Africa: the role of the journal Rural and
Remote Health. Rural and Remote Health 6 (online), 2006: 644. http://rrh.deakin.edu.au (last
accessed 14 September 2006).
3. Dare L, Buch E. The future of health care in Africa. BMJ 2005; 331: 1-2.
4. Katikireddi SV. HINARI: bridging the global information divide. BMJ 2004; 328: 1190-1193.
5. Beveridge M, Howard A, Burton K, Holder W. The Ptolemy project: a scalable model for
delivering health information in Africa. BMJ 2003; 327: 790-793.
Pg 474-480.indd 480 6/20/07 8:07:56 AM
ResearchGate has not been able to resolve any citations for this publication.
Quantitative Detection of Increasing HIV Type 1 Antibodies after Seroconversion: A Simple Assay for Detecting Recent HIV Infection and Estimating Incidence
Article
Full-text available
  • Apr 2002
We have devised a simple enzyme immunoassay (EIA) that detects increasing levels of anti-HIV IgG after seroconversion and can be used for detecting recent HIV-1 infection. Use of a branched peptide that included gp41 immunodominant sequences from HIV-1 subtypes B, E, and D allowed similar detection of HIV-specific antibodies among various subtypes. Because of the competitive nature of the capture EIA, a gradual increase in the proportion of HIV-1-specific IgG in total IgG was observed for 2 years after seroconversion. This was in contrast to results obtained with the conventional EIA using the same antigen in solid phase, which plateaus soon after seroconversion. The assay was used to test 622 longitudinal specimens from 139 incident infections in the United States (subtype B) and in Thailand (subtypes B and E). The assay was also performed with an additional 8 M urea incubation step to assess the contribution of high-avidity antibodies. Normalized optical density (OD-n) was calculated (ODspecimen/ODcalibrator), using a calibrator specimen. An incremental analysis indicated that a cutoff of 1.0 OD-n and a seroconversion period of 160 days offered the best combination of sensitivity and specificity for classifying incident or long-term infections. The urea step increased the seroconversion period to 180 days with similar sensitivity and specificity. Separate analysis of B and E subtype specimens yielded the same optimal OD-n threshold and similar seroconversion periods. The assay was further validated in African specimens (subtypes A, C, and D) where the observed incidence was within 10% of the expected incidence. This assay should be useful for detecting recent HIV-1 infection and for estimating incidence among diverse HIV-1 subtypes worldwide.
View
The Ptolemy project: A scalable model for delivering health information in Africa
Article
Full-text available
  • Nov 2003
  • Br Med J
How is Africa to build up the medical research it needs? Doctors in African research communities are starved of access to the journals and texts their colleagues in more developed countries regard as fundamental to good practice and research. Isolation, burden of practice, and resource limitations make education and research difficult, but the rapid spread of access to the internet reduces these obstacles and provides an increasingly attractive means to disseminate information and build partnerships in education and research. The role of electronic health information in building local capacity to find, publish, and implement solutions has been emphasised recently in Science,1 Nature,2 the Lancet,3,4 and the BMJ.5 The Global Forum for Health Research gives priority to interventions designed to build research capacity in developing countries and correct the disparity in health research.6 The Coalition for Global Health Research (Canada) has recently reported how a major effort now can make a substantial difference.7 Access to reliable health information has been described as “the single most cost-effective and achievable strategy for sustainable improvement in health care.”8 We are interested in helping to build research, teaching, and clinical capacity for neglected yet substantial problems such as injury, which kills 5.1 million people annually.9-11
View
HINARI: Bridging the global information divide
Article
Full-text available
  • Jun 2004
  • Br Med J
Health care is unequally distributed between the developed and developing worlds, which is matched by unequal distribution of health information. The information gap between rich and poor countries is so great it has been argued that “providing access to reliable health information for health workers in developing countries is potentially the single most cost effective and achievable strategy for sustainable improvement in health care.”1 So far, the most successful initiative to bridge this gap is the Health InterNetwork Access to Research Initiative (HINARI).
View
The future of health care in Africa
Article
Full-text available
  • Aug 2005
  • Br Med J
Depends on making commitments work in and outside Africa A s the group of eight leading industrialised nations (G8) meets for its summit at Gleneagles, Scotland, next week Africa is at a crossroads. It faces a double edged crisis: its healthcare workforce is rapidly depleting, and its health systems are weak, fragile, and hanging on a precipice. A direct consequence of this is that the indicators for health development in the continent are dismal. About one in six African children die before their fifth birthday, with half of these dying from diseases preventable by vaccines; and one woman dies every two minutes from complications of pregnancy and delivery.1 From all such indications and current evidence, it would appear that very few countries in the continent will achieve the millennium development goals.2 The goal to reduce deaths among children aged under 5 (figure) is just one example. Progress in reducing mortality in children aged under 5 years, comparing sub-Saharan Africa with low and middle income countries in the rest of the world. Red represents sub-Saharan Africa, blue low income countries, green middle income countries (with solid lines indicating path to goal, dotted lines progress to date, and dashed lines projected progress at current rate) Chronic underinvestment, interventions by global partnerships that focus only on single diseases, and sporadic financing by both national governments and their partners have left African health systems prostrate. They are unable to deliver drugs, tools, and …
View
Scope and geographical distribution of African medical journals active in 2005
Article
Full-text available
  • Jul 2006
To identify all African medical journals actively publishing in 2005, and to create a geodatabase of these to evaluate and monitor future journal activity. A search was done for relevant African medical journals on electronic databases, library catalogues and internet sites, and a list was compiled of active journals. A survey was conducted via questionnaire of editors of all listed African medical journals defined as having an editorial base on the continent. One hundred and fifty-eight African medical journals were identified, published in 33 countries. One hundred and fifty-three editors were surveyed via email, post and/or fax. There was a 39% response rate from editors based in 17 countries. Fifty-one journals were published in English, 7 in French and 1 in Portuguese. Most journals were owned by an association or a society and were funded from a combination of sources. Journals covered general medical and specialist medical interest equally. Most (41 of 59 journals) had a circulation below 1 000, and most (52/59) published 4 or fewer issues a year. Almost all the journals included original research, and articles were peer reviewed. Few were indexed on Medline (N = 18) and EMBASE (N = 10). Plotting journal location using Geographic Information Systems (GIS) software provided a snapshot view of current journal activity. This study is likely to represent the most comprehensive list of current African medical journals. It confirms growth in African health care research and journal activity on the continent. Limited inclusion in international databases and accessibility to African researchers remain challenges in achieving publication of high-quality African research in high-quality African journals.
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Investigating the utility of the HIV-1BED capture enzyme immunoassay using cross-sectional and longitudinal seroconverter specimens from Africa
Article
  • Mar 2007
The identification of populations at risk of HIV infection is a priority for trials of preventive technologies, including HIV vaccines. To quantify incidence traditionally requires laborious and expensive prospective studies. The BED IgG-Capture enzyme immunoassay (EIA) was developed to estimate HIV-1 incidence using cross-sectional data by measuring increasing levels of HIV-specific IgG as a proportion of total IgG. To evaluate this assay, we tested 189 seroconversion samples taken at 3-monthly intervals from 15 Rwandan and 26 Zambian volunteers with known time of infection and cross-sectional specimens from 617 Kenyan and Ugandan volunteers with prevalent infection. The BED-EIA-estimated incidence in Uganda was unexpectedly high, at 6.1%/year [95% confidence interval (CI) 4.2-8.0] in Masaka and 6.0%/year (95% CI 4.3-7.7) in Kakira. Prospective incidence data in Masaka from the same population was 1.7%/year before and 1.4%/year after the study. Kenyan estimates were 3.5%/year in Kilifi (95% CI 2.1-4.9) and 3.4%/year in Nairobi (95% CI 1.5-5.3). From the Rwandan and Zambian data, the sensitivity of the assay was 81.2% and the specificity was 67.8%. After approximately one year, subjects misclassified as recently infected tended to have lower plasma viral loads compared with those not misclassified as recent (median copies/ml 14 773 versus 93 560; P = 0.02). Clinical presentation, sex and HIV subtype were not significantly associated with BED-EIA misclassification in seroconverter samples. These data suggest that this assay does not perform reliably in all populations. Further research is warranted before using this assay to estimate incidence from prevalent HIV samples.
View
Surveillance and Survey and Laboratory Working Groups. Expert meeting on the validation of the BED HIV-1 incidence assay for HIV-1 incidence surveillance
  • May 2006
Centers for Disease Control (CDC), Surveillance and Survey and Laboratory Working Groups. Expert meeting on the validation of the BED HIV-1 incidence assay for HIV-1 incidence surveillance. CDC, Atlanta, USA, 9-10 May 2006.
Surveillance and Survey and Laboratory Working Groups. Guidelines for the Use of the BED Capture Enzyme Immunoassay for Incidence Estimation and Surveillance
  • Jan 2006
Centers for Disease Control (CDC), Surveillance and Survey and Laboratory Working Groups. Guidelines for the Use of the BED Capture Enzyme Immunoassay for Incidence Estimation and Surveillance. Atlanta, USA: CDC, 2006.
Comparison of HIV-1 incidence observed during longitudinal follow-up with incidence estimated by cross-sectional analysis using the BED capture enzyme immunoassay
  • Jan 2006
  • 945-952
  • J S Mcdougal
  • Parekh
  • Bs
  • M L Peterson
McDougal JS, Parekh, BS, Peterson ML, et al. Comparison of HIV-1 incidence observed during longitudinal follow-up with incidence estimated by cross-sectional analysis using the BED capture enzyme immunoassay. AIDS Res Hum Retroviruses 2006; (10): 945-952.