Assessing the implementation effectiveness and safety of 1% tenofovir gel provision through family planning services in KwaZulu-Natal, South Africa: study protocol for an open-label randomized controlled trial.

CAPRISA, 2014.Background: The Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial demonstrated a 39% reduction in HIV infection, with a 54% HIV reduction in women who used tenofovir gel consistently. A confirmatory trial is expected to report results in early 2015. In the interim, we have a unique window of opportunity to prepare for and devise effective strategies for the future policy and programmatic scale-up of tenofovir gel provision. One approach is to integrate tenofovir gel provision into family planning (FP) services. The CAPRISA 008 implementation trial provides an opportunity to provide post-trial access to tenofovir gel while generating empiric evidence to assess whether integrating tenofovir gel provision into routine FP services can achieve similar levels of adherence as the CAPRISA 004 trial. Methods/design: This is a two-arm, open-label, randomized controlled non-inferiority trial. A maximum of 700 sexually active, HIV-uninfected women aged 18 years and older who previously participated in an antiretroviral prevention study will be enrolled from an urban and rural site in KwaZulu-Natal, South Africa. The anticipated study duration is 30 months, with active accrual requiring approximately 12 months (following which an open cohort will be maintained) and follow-up continuing for approximately 18 months. At each of the two sites, eligible participants will be randomly assigned to receive tenofovir gel through either FP services (intervention arm) or through the CAPRISA research clinics (control arm). As part of the study intervention, a quality improvement approach will be used to assist the FP services to expand their current services to include tenofovir gel provision. Discussion: This protocol aims to address an important implementation question on whether FP services are able to effectively incorporate tenofovir gel provision for this at-risk group of women in South Africa. Provision of tenofovir gel to the women from the CAPRISA 004 trial meets the ethical obligation for post-trial access, and helps identify a potential avenue for future scale-up of microbicides within the public health system of South Africa. Trial registration: This trial was registered with the South Africa Department of Health (reference: DOH-27-0812-4129) and ClinicalTrials.gov (reference: NCT01691768) on 05 July 2012

Modelling of channel transmission loss processes in semi-arid catchments of southern Africa using the Pitman Model

Water availability is one of the major societal issues facing the world. The ability to understand and quantify the impact of key hydrological processes, on the availability of water resources, is therefore integral to ensuring equitable and sustainable resource management. Channel transmission losses are an under-researched hydrological process that affects resource availability in many semi-arid regions such as the Limpopo River Basin in southern Africa, where the loss processes amount to approximately 30 % of the water balance. To improve the understanding of these loss processes and test the capability of modelling routines, three approaches using the Pitman model are applied to selected alluvial aquifer environments. The three approaches are an explicit transmission loss function, the use of a wetland function to represent channel-floodplain storage exchanges and the use of a dummy reservoir to represent floodplain storage and evapotranspiration losses. Results indicate that all three approaches are able to simulate channel transmission losses with differing impacts on the regional flows. A determination of which method best represents the channel transmission losses process requires further testing in a study area that has reliable observed historical records

Parameter and input data uncertainty estimation for the assessment of water resources in two sub-basins of the Limpopo River Basin

The demand for water resources is rapidly growing, placing more strain on access to water and its management. In order to appropriately manage water resources, there is a need to accurately quantify available water resources. Unfortunately, the data required for such assessment are frequently far from sufficient in terms of availability and quality, especially in southern Africa. In this study, the uncertainty related to the estimation of water resources of two sub-basins of the Limpopo River Basin – the Mogalakwena in South Africa and the Shashe shared between Botswana and Zimbabwe – is assessed. Input data (and model parameters) are significant sources of uncertainty that should be quantified. In southern Africa water use data are among the most unreliable sources of model input data because available databases generally consist of only licensed information and actual use is generally unknown. The study assesses how these uncertainties impact the estimation of surface water resources of the sub-basins. Data on farm reservoirs and irrigated areas from various sources were collected and used to run the model. Many farm dams and large irrigation areas are located in the upper parts of the Mogalakwena sub-basin. Results indicate that water use uncertainty is small. Nevertheless, the medium to low flows are clearly impacted. The simulated mean monthly flows at the outlet of the Mogalakwena sub-basin were between 22.62 and 24.68 Mm3 per month when incorporating only the uncertainty related to the main physical runoff generating parameters. The range of total predictive uncertainty of the model increased to between 22.15 and 24.99 Mm3 when water use data such as small farm and large reservoirs and irrigation were included. For the Shashe sub-basin incorporating only uncertainty related to the main runoff parameters resulted in mean monthly flows between 11.66 and 14.54 Mm3. The range of predictive uncertainty changed to between 11.66 and 17.72 Mm3 after the uncertainty in water use information was added