The genesis and evolution of the African Field Epidemiology Network

In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Health Organization (WHO) Regional Office for Africa launched the Integrated Disease Surveillance and Response (IDSR) strategy in an effort to strengthen surveillance and response. However, 36 sub-Saharan African countries have been described as experiencing a human resource crisis by the WHO. Given this human resource situation, the challenge remains for these countries to achieve, among others, the health-related Millennium Development Goals (MDGs). This paper describes the process through which the African Field Epidemiology Network (AFENET) was developed, as well as how AFENET has contributed to addressing the public health workforce crisis, and the development of human resource capacity to implement IDSR in Africa. AFENET was established between 2005 and 2006 as a network of Field Epidemiology Training Programs (FETPs) and Field Epidemiology and Laboratory Training Programs (FELTPs) in Africa. This resulted from an expressed need to develop a network that would advocate for the unique needs of African FETPs and FELTPs, provide service to its membership, and through which programs could develop joint projects to address the public health needs of their countries. A total of eight new programs have been developed in sub-Saharan Africa since 2006. Programs established after 2006 represent over 70% of current FETP and FELTP enrolment in Africa. In addition to growth in membership and programs, AFENET has recorded significant growth in external partnerships. Beginning with USAID, CDC and WHO in 2004-2006, a total of at least 26 partners have been added by 2011. Drawing from lessons learnt, AFENET is now a resource that can be relied upon to expand public health capacity in Africa in an efficient and practical manner. National, regional and global health actors can leverage it to meet health-related targets at all levels. The AFENET story is one that continues to be driven by a clearly recognized need within Africa to develop a network that would serve public health systems development, looking beyond the founders, and using the existing capacity of the founders and partners to help other countries build capacity for IDSR and the International Health Regulations (IHR, 2005).Pan Afr Med J. 2011; 10(Supp 1):

Associations between HIV Antiretroviral Therapy and the Prevalence and Incidence of Pregnancy in Rakai, Uganda

Background. Use of antiretroviral therapy (ART) may be associated with higher pregnancy rates. Methods. The prevalence and incidence of pregnancy was assessed in 712 HIV+ pre-ART women of reproductive age (WRA) (15–45) and 244 HIV+ WRA initiating ART. Prevalence rate ratios (PRR), incidence rate ratios (IRR), and 95% confidence interval (CI) were assessed. Results. The incidence of pregnancy was 13.1/100 py among women in pre-ART care compared to 24.6/100 py among women on ART (IRR = 0.54; 95% CI 0.37, 0.81, p < 0.0017). The prevalence of pregnancy at ART initiation was 12.0% with CD4 counts 100–250 compared with 3.2% with CD4 <100 (PRR = 3.24, CI 1.51–6.93), and the incidence of pregnancy while on ART was highest in women with a good immunologic response. Desire for more children was a very important factor in fertility. Conclusion. ART was associated with increased pregnancy rates in HIV+ women, particularly those with higher CD4 counts and good immunologic response to therapy, suggesting a need to strengthen reproductive health services for both women and their partners that could address their fertility decisions/intentions particularly after ART initiation

Emploi des services liés au VIH et à la contraception moderne chez les femmes en âge de procréer, Rakai, Uganda.

Voluntary counseling and testing (VCT) and HIV care (HIVC) can be an opportunity for reproductive health messages and services integration. The objective of this study is to assess the association between uptake of HIV-related services and use of modern contraception among reproductive-age women. Data are derived from community cohort data, where HIV+ respondents were referred to the Rakai Health Sciences program&apos;s HIVC clinic. Use of modern contraceptive and VCT receipt were by self-report. Multinomial logistic regression was used to estimate relative risk ratios (RRR) of contraception use by HIVC and VCT. Receipt of VCT was significantly associated with higher use of condoms for FP, adj.RRR 1.78 (1.07, 2.95), and other modern contraceptives, adj.RRR=1.56(1.15, 2.11). Increasing level of HIVC was associated with decreasing level of unmet need for contraception. Use of condoms for family planning is common among HIV-related services attendees. Utilization of other modern contraceptive methods needs to be increasedLe Conseil et le Test Volontaire (CTV) et le soin du VIH (SVIH) peuvent constituer une opportunité pour des messages de santé de reproduction et d&apos;intégration des services. Cette étude a pour objectif d&apos;évaluer l&apos;association entre l&apos;intérêt aux services liés aux VIH et l&apos;emploi de la contraception chez les femmes en âge de procréer. Les données ont été recueillies à partir des données de la cohorte de la communauté, là où les répondantes séropositives ont été orientées vers la clinique du SVIH du programme des Sciences de Santé de Rakai. L&apos;emploi du contraceptif et du CTV était à travers l&apos;auto-déclaration. On s&apos;est servi de la régression logistique multinomiale pour évaluer le rapport du risque relatif (RRR) de l&apos;utilisation de la contraception par le SVIH et le CTV. La réception du CTV est liéé à l&apos;emploi élevé des préservatifs pour la PF, l&apos;adj.RRR=1,78, 2,95) et d&apos;autres contraceptifs modernes, adj. RRR=1,56(1,15, 2,11). Le niveau croissant du SVIH était lié au niveau diminuant des besoins non satisfait de la contraception. L&apos;emploi des contraceptifs pour la planification familiale est commun chez les gens qui profitent des services liés au VIH. Il faut augmenter l&apos;emploi des autres méthodes contraceptives moderne

The safety and acceptance of the PrePex device for non-surgical adult male circumcision in Rakai, Uganda. A non-randomized observational study.

To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda.In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and dorsal slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing.The PrePex device was contraindicated in 5.7% of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the dorsal slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8% of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7% at week 4, 84.8% week 5, 97.6% week 6 and 98.6% week 7, compared to 98.7% at week 4 with dorsal slit (p<0.0001).The PrePex device was well accepted, but healing was slower than with dorsal slit surgery. Severe complications, primarily following PrePex self-removal, required rapid access to emergency surgical facilities. The need to return for removal and delayed healing may increase Program cost and client burden

Positive Influences and Challenges for the Deaf Community Navigating Access to HIV Information, Testing, and Treatment in Kampala, Uganda: A Qualitative Study

Although sub-Saharan Africa has the highest HIV burden globally, few studies have investigated disabilities and HIV in this region. We conducted a secondary analysis of text data from in-depth interviews (2014-2015) to describe HIV perceptions among a subsample of 73 deaf individuals participating in the Crane survey, Kampala, Uganda. Being deaf was defined as being profoundly or functionally deaf, having deafness onset 5 + years ago, and preferring sign language to communicate. Among participants ever tested for HIV (47%), most (88%) had a negative test. Thematic analysis revealed overcoming challenges/barriers followed by socioeconomic status, support systems, HIV, stigma, abuse, and health conditions as major themes. An unanticipated finding was the role of sex work to support basic living needs. The data showed related themes among participants, suggesting a complex context in which deaf participants experience HIV prevention and treatment. It is important to tailor HIV interventions for deaf and disabled persons

Figure 2 shows photographs of selected adverse events with the PrePex device.

<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100008#pone-0100008-g002" target="_blank">Figure 2a</a>, device self removal with edema and superficial ulceration on day 2 post placement. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100008#pone-0100008-g002" target="_blank">Figure 2b</a>, device self removal with edema on day 1 post placement. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100008#pone-0100008-g002" target="_blank">Figure 2C</a>, wound dehiscence on day 17 post device placement. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100008#pone-0100008-g002" target="_blank">Figure 2d</a>, self removal of the device with edema and necrosis on day 9.</p

Details of adverse events with the PrePex device during the study.

<p>Details of adverse events with the PrePex device during the study.</p