Is ALT control really necessary for routine ART monitoring in resource poor settings?

2006 AIDS Conference in Toront

The Macroeconomic Consequences of Renouncing to Universal Access to Antiretroviral Treatment for HIV in Africa: A Micro-Simulation Model

AIM: Previous economic literature on the cost-effectiveness of antiretroviral treatment (ART) programs has been mainly focused on the microeconomic consequences of alternative use of resources devoted to the fight against the HIV pandemic. We rather aim at forecasting the consequences of alternative scenarios for the macroeconomic performance of countries. METHODS: We used a micro-simulation model based on individuals aged 15-49 selected from nationally representative surveys (DHS for Cameroon, Tanzania and Swaziland) to compare alternative scenarios : 1-freezing of ART programs to current levels of access, 2- universal access (scaling up to 100% coverage by 2015, with two variants defining ART eligibility according to previous or current WHO guidelines). We introduced an "artificial" ageing process by programming methods. Individuals could evolve through different health states: HIV negative, HIV positive (with different stages of the syndrome). Scenarios of ART procurement determine this dynamics. The macroeconomic impact is obtained using sample weights that take into account the resulting age-structure of the population in each scenario and modeling of the consequences on total growth of the economy. RESULTS: Increased levels of ART coverage result in decreasing HIV incidence and related mortality. Universal access to ART has a positive impact on workers' productivity; the evaluations performed for Swaziland and Cameroon show that universal access would imply net cost-savings at the scale of the society, when the full macroeconomic consequences are introduced in the calculations. In Tanzania, ART access programs imply a net cost for the economy, but 70% of costs are covered by GDP gains at the 2034 horizon, even in the extended coverage option promoted by WHO guidelines initiating ART at levels of 350 cc/mm(3) CD4 cell counts. CONCLUSION: Universal Access ART scaling-up strategies, which are more costly in the short term, remain the best economic choice in the long term. Renouncing or significantly delaying the achievement of this goal, due to "legitimate" short term budgetary constraints would be a misguided choice

Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd

A simplified nonlinear controller for transient stability enhancement of multimachine power systems using SSSC device

International audienceIn this paper, a simplified nonlinear method is proposed to enhance the transient stability of multimachine power system by using a Static Synchronous Series Compensator (SSSC). The rate of dissipation of transient energy is used to determine the additional damping provided by a SSSC. The proposed algorithm is based on the direct Lyapunov method. The simplicity of the proposed scheme and its robustness with respect to large disturbances constitute the main positive features. Simulation results in the case of 3-machines power system show the effectiveness of the proposed method under large disturbances (3-phase and single phase short-circuits)

Délimiter des forêts communautaires : une approche par contraintes multiples

La délimitation des forêts communautaires est une des premières étapes dans la mise en place de celles-ci. Ce processus étapes dans la mise en place de celles-ci. Ce processus que coutumières. Cet article présente une méthodologie de délimitation participative, techniquement accessible aux communautés villageoises et respectant ces différentes contraintes. L’approche suivie intègre d’une part les obligations légales (limites des permis forestiers, dispositions réglementaires…) et d’autre part l’occupation actuelle de l’espace par les populations villageoises ainsi que les attentes de celles-ci, tout en veillant à limiter les conflits éventuels. Deux cas de délimitation de forêts communautaires pilotes au Gabon sont abordés, le cas du village de La Scierie et le cas du regroupement de villages de Ebe Messe Melane

Challenges of mastering the energy sector and sustainable solutions for development in Africa

International audienceThe African continent is currently experiencing a period of sustained economic and population growth that requires massive investment in the energy sector to effectively meet the energy needs in the context of sustainable development. At the same time, COP21 agreements now call all the states to use clean energy. Yet a great energy potential is available, but the electrification rate of the continent currently accounts for only 3% of the world's energy production. Also, the demand for both quality and quantity energy requires the mastery of applied mathematical tools to efficiently solve problems arising in the energy system. In this article, the major problems affecting the energy sector in Africa are identified, some solutions to the challenges are recalled and some new ones are proposed, with emphasis given to applied mathematics tools as well as energy policy. As case studied, a new control strategy of Static Synchronous Series Compensator (SSSC) devices-which are modern power quality Flexible Alternating Current Transmission Systems (FACTS)-is proposed for Power Flow Control.Le continent africain connait actuellement une période de croissance économique et dé-mographique soutenue qui requiert un investissement massif dans le secteur de l'énergie en vue d'un développement durable. Dans le même temps, les accords de la COP21 interpellent désor-mais les états à recourir aux énergies propres. Malgré son potentiel énergétique énorme, le taux d'électrification en Afrique reste très faible (3%) notamment au sud du sahara. D'autre part, la de-mande d'énergie en qualité et en quantité nécessite un recours aux outils mathématiques modernes pour résoudre les problèmes des réseaux électriques. Dans cet article, les principaux problèmes af-fectant le secteur de l'énergie en Afrique sont identifiés, certaines solutions aux défis de la maîtrise de ce secteur sont rappelées et de nouvelles solutions sont proposées, en mettant l'accent sur les outils de mathématiques appliquées ainsi que sur la politique énergétique. A titre d'illustration des nouvelles solutions mathématiques, une nouvelle stratégie de contrôle du compensateur statique, synchrone et série (SSSC) qui fait partie des systèmes modernes et flexible de transmission du courant alternatif (FACTS) est proposée pour le contrôle du flux de puissance

Safety and Effectiveness of Amphotericin B Deoxycholate for the Treatment of Visceral Leishmaniasis in Uganda.

Between September 2003 and April 2004, the supply of antimonial drugs to Amudat Hospital, in north-eastern Uganda, was interrupted and all cases of visceral leishmaniasis presenting at the hospital could only be treated with amphotericin B deoxycholate (AmB). This allowed the safety and effectiveness of the AmB to be evaluated, in comparison with an historical cohort of patients treated, at the same hospital, with meglumine antimoniate (Sb(V)). Demographic and clinical data were collected before and after treatment. Adverse effects were recorded passively in all the subjects, and actively, using a standardized questionnaire, in a sub-group of the patients given AmB. The in hospital case-fatality 'rates' were 4.8% [95% confidence interval (CI) = 2.4%-8.8%] among the 210 patients treated with AmB and 3.7% (CI = 1.4%-7.9%) among the 161 patients treated with Sb(V) (P>0.20). Adverse effects requiring treatment interruption were rare in both cohorts. Treatment failures (i.e. non-responses or relapses) were observed in 2.9% (CI = 1.2%-6.4%) of the patients treated with AmB and 1.2% (CI = 0.1%-4.4%) of the patients treated with Sb(V) (P>0.20). For the treatment of visceral leishmaniasis in Uganda, AmB therefore had a similar effectiveness and safety profile to that of meglumine antimoniate

Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study.

BACKGROUND In 2016, the UN General Assembly set a global target of 3 million oral pre-exposure prophylaxis (PrEP) users by 2020. With this target at an end, we aimed to assess global trends in the adoption of WHO PrEP recommendations into national guidelines and numbers of PrEP users, defined as people who received oral PrEP at least once in a given year, and to estimate future trajectories of PrEP use. METHODS In this global summary and forecasting study, data on adoption of WHO PrEP recommendations and numbers of PrEP users were obtained through the Global AIDS Monitoring system and WHO regional offices. Trends in these indicators for 2016-19 by region and for 2019 by country were described, including by gender and priority populations where data were available. PrEP user numbers were forecasted until 2023 by selecting countries with at least 3 years of PrEP user data as example countries in each region to represent possible future PrEP user trajectories. PrEP user growth rates observed in example countries were applied to countries in corresponding regions under different scenarios, including a COVID-19 disruption scenario with static global PrEP use in 2020. FINDINGS By the end of 2019, 120 (67%) of 180 countries with data had adopted the WHO PrEP recommendations into national guidelines (23 in 2019 and 30 in 2018). In 2019, there were about 626 000 PrEP users across 77 countries, including 260 000 (41·6%) in the region of the Americas and 213 000 (34·0%) in the African region; this is a 69% increase from about 370 000 PrEP users across 66 countries in 2018. Without COVID-19 disruptions, 0·9-1·1 million global PrEP users were projected by the end of 2020 and 2·4-5·3 million are projected by the end of 2023. If COVID-19 disruptions resulted in no PrEP user growth in 2020, the projected number of PrEP users in 2023 is 2·1-3·0 million. INTERPRETATION Widespread adoption of WHO PrEP recommendations coincided with a global increase in PrEP use. Although the 2020 global PrEP target will be missed, strong future growth in PrEP use is possible. New PrEP products could expand the PrEP user base, and, with greater expansion of oral PrEP, further adoption of WHO PrEP recommendations, and simplified delivery, PrEP could contribute to ending AIDS by 2030

Perception and adaptation strategies of forest dwellers to climate variability in the tropical rainforest in eastern Cameroon: The case of the inhabitants of the Belabo-Diang Communal Forest

The design of appropriate adaptation strategies to the impacts of climate change requires a contextual study of local perceptions due to the non-homogeneity of climate in a given agro-ecological area. The research objective of the current study aims to examine the evolution of climate parameters from 1983 to 2019 linked to the perceptions of local populations and appropriate adaptation measures in the Belabo-Diang Communal Forest of Cameroon. The methodological approach includes collecting and analyze climate data from 1983 to 2019; and surveying existing local perceptions and adaptive strategies among 540 households using semi-structured questionnaires. A significant increase in temperature of about 1 °C over 36 years (1983–2019) and a non-significant decrease in precipitation (95.36 mm) over the same period were observed. Local perceptions related to climate change vary according to the sector of activity and are mainly associated with more heat in the dry season (90%), late onset of rains (84%), drought recurrence (82%), less rainfall during the year (80%), and increase in the duration of drought (80%). For 82–100% of households, according to the activity sector, no appropriate adaptation measures to climate change were applied depending on activities. The adaptation measures used by less than 0–20% of respondents, include mainly the abandonment or change of activity, and modification of the agricultural calendar. With the lack of appropriate and adequate adaptation measures by the riparian populations, this study appears necessary to inform policy-makers of the need to develop and implement more appropriate strategies to enable the riparian people living in forest area of Cameroon to better adapt to these effects of climate changes