Development and implementation of an HIV/AIDS trials management system: A geographical information systems approach

Introduction. Researchers, practitioners and policymakers make decisions at all levels – from local to international. Accessible, integrated and up-to-date evidence is essential for successful and responsive decision-making. A current trials register of randomised and clinically controlled trials of HIV/AIDS interventions can provide invaluable information to decision-making processes. Using the newly emerging geographical information systems (GIS) technology, we have developed a tool which assists such decisions. Objective. To demonstrate how the tool provides consistent, quantitative information in an accessible format, making it a key tool in evidence-based decision-making. Methods. We identified all HIV/AIDS trials in relation to publications for the period 1980 - 2007, using both electronic and manual search methods. To facilitate searching the trials register, studies were coded by using a comprehensive but user-friendly coding sheet. We captured the geographical co-ordinates for each trial and used the ArcGIS 9 mapping software to design and develop a geodatabase of trials. Results. The geodatabase delivered the complete requirements for a data-driven information system, featuring the following functions: (i) a clear display of the spatial distribution of HIV/AIDS trials around the world; (ii) identification of and access to information about any particular trial on a map; and (iii) a global resource of potential information on the safety and efficacy of prevention and treatment measures. Conclusions. The building of a functioning HIV/AIDS trials management system can provide policymakers, researchers and practitioners with accessible, integrated and up-to-date evidence that is essential to successful and dynamic decision-making. Southern African Journal of HIV Medicine Vol. 9 (2) 2008: pp. 58-6

How far will we need to go to reach HIV-infected people in rural South Africa?

Background: The South African Government has outlined detailed plans for antiretroviral (ART) rollout in KwaZulu-Natal Province, but has not created a plan to address treatment accessibility in rural areas in KwaZulu-Natal. Here, we calculate the distance that People Living With HIV/AIDS (PLWHA) in rural areas in KwaZulu-Natal would have to travel to receive ART. Specifically, we address the health policy question 'How far will we need to go to reach PLWHA in rural KwaZulu-Natal?'. Methods: We developed a model to quantify treatment accessibility in rural areas; the model incorporates heterogeneity in spatial location of HCFs and patient population. We defined treatment accessibility in terms of the number of PLWHA that have access to an HCF. We modeled the treatment-accessibility region (i.e. catchment area) around an HCF by using a two-dimensional function, and assumed that treatment accessibility decreases as distance from an HCF increases. Specifically, we used a distance-discounting measure of ART accessibility based upon a modified form of a two-dimensional gravity-type model. We calculated the effect on treatment accessibility of: (1) distance from an HCF, and (2) the number of HCFs. Results: In rural areas in KwaZulu-Natal even substantially increasing the size of a small catchment area (e.g. from 1 km to 20 km) around an HCF would have a negligible impact (~2%) on increasing treatment accessibility. The percentage of PLWHA who can receive ART in rural areas in this province could be as low as ~16%. Even if individuals were willing (and able) to travel 50 km to receive ART, only ~50% of those in need would be able to access treatment. Surprisingly, we show that increasing the number of available HCFs for ART distribution ~ threefold does not lead to a threefold increase in treatment accessibility in rural KwaZulu-Natal. Conclusion: Our results show that many PLWHA in rural KwaZulu-Natal are unlikely to have access to ART, and that the impact of an additional 37 HCFs on treatment accessibility in rural areas would be less substantial than might be expected. There is a great length to go before we will be able to reach many PLWHA in rural areas in South Africa, and specifically in KwaZulu-Natal.David P Wilson and Sally Blowe

Design Of A Heritage Register For The South African Heritage

In April 2000 the South African Heritage Resource Agency (SAHRA) succeeded the previous National Monuments Council that was responsible for the management and maintenance of heritage sites in South Africa. SAHRA is legally based on the National Heritage Resource Act (NHRA) of 1999, which re-defines heritage in a revolutionary way. Until then "heritage" had always been defined as physical objects, such as buildings, tombstones or artefacts. South Africa's rich history is connected to such physical objects, but it is also based on space and the definition of space with regard to the historical separation of South Africa's population groups. The NHRA has moved the term "heritage" to a new level, in that it includes space that serves as memories to forced removals, to race barriers and signs of apartheid. Historical sites that are defined as a space are distinctly different from other heritage objects in that some of them are in their emptiness a memory. One of the challenges faced by SAHRA is the definition of such sites and how to manage them

Liquor outlet density, deprivation and implications for foetal alcohol syndrome prevention in the Bergriver municipality in the Western Cape, South Africa

Foetal alcohol syndrome (FAS) is the most common preventable birth defect in the world, and some South African communities have amongst the highest reported rates. In August 2008, global positioning systems and geographic information systems (GIS) were used to collect data on legal and illegal alcohol outlets in the Bergriver municipality. A total of 112 outlets were recorded and towns with the densest distributions (outlet/km2) were Piketberg and Eendekuil. Spearman coefficients were used to estimate the relationship between alcohol outlet distributions within the study area and the South African Index of Multiple Deprivation. Although not statistically significant, the data are suggestive of an inverse relationship between legal alcohol outlets and deprivation less deprived areas had higher density of legal alcohol outlets while the opposite relationship applied for illegal alcohol outlets. GIS provides spatial documentation of determinants of FAS risks amenable to geographically based prevention strategies, as well as providing baseline data to evaluate the effectiveness of liquor legislation aimed at controlling access to alcohol. Results are being repurposed into health education materials that encourage community action to address the social determinants of health outcomes such as FAS.