Cultivating HIV scientists for Africa: The INTEREST Conference, Kigali, Rwanda

 
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Sub-Saharan Africa is home to 26 million (70 percent) of the global total of 37 million people living with HIV infection. To control the epidemic in Africa, it is essential that solutions for Africa be generated and implemented in Africa. The INTEREST Conference – known as the “African CROI” – is a great example of international cooperation intended to advance the fight against HIV in Africa by cultivating African scientists and stimulating innovative solutions on the continent.

The science of humanitarian response in crisis settings

 
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Humanitarian needs around the globe have risen dramatically over the past decades and today we are arguably witnessing the greatest level of human suffering that the world has experienced in the past 70 years. Although the humanitarian response system is saving more lives, preventing more illness, caring for more wounded, and feeding more people than ever, we are struggling to keep pace with the growing demands of more complex crises and the changing nature of conflict. The Centre for Research on the Epidemiology of Disasters (CRED) estimated that more than 172 million people were affected by armed conflict in 2012. UNHCR estimates that there are currently 65.6 million forcibly displaced people, of which 22.5 are refugees, who have crossed an international border. Moreover, CRED estimated that from 1994 to 2013, 218 million people on average each year were affected by destructive natural disasters around the world.

The medical journal Lancet published a special series of articles in 2017 to draw attention to the gaps in knowledge for addressing health needs in humanitarian crises. We summarize a few of these articles here and conclude that more implementation science and improved data systems will both be important for filling the knowledge gaps.

From the Red Book to the Blue Book: Advancing HIV surveillance among key populations

 
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The World Health Organization (WHO) recently published new global guidelines on how to do biobehavioral surveys related to HIV infection in a document known as the Blue Book. The Blue Book replaces the previous Red Book of guidelines for such surveys. The updated guidance keeps the global health community abreast of the evolving HIV epidemic, which has led to 37 million people currently living with HIV infection. Biobehavioral surveys provide population-level estimates for the burden of HIV disease and HIV-related risk factors, and they allow estimation of the coverage of prevention and treatment services for key populations that are at increased risk for HIV. Advances in available data and changes in the epidemic rendered the survey tools and guidelines in the Red Book out-of-date. In this blog post, we’re going to highlight how the new Blue Book addresses these critical gaps to deliver a manual better suited to the era of ending AIDS.

20 years of advances in global health data: Now there’s an app for that

 
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Bill Gates appreciates the importance of high-quality data to guide decisions. He was the keynote speaker at the 20th anniversary symposium of the Global Burden of Disease (GBD) study in Seattle recently. Gates was followed by Jim Kim, President of the World Bank. These two very heavy hitters – one, the richest man in the world, and one who runs the largest investment bank for developing nations – are huge fans of high-quality data that can be used to make decisions and guide investments in global health and development. I’m using the occasion of this anniversary to share more about the GBD study with our readers and to highlight the innovative use of data to improve global health.

The science of beating HIV and AIDS

 
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The International AIDS Society (IAS) Conference on HIV Science (IAS 2017) in Paris last week brought together over 6,000 scientists, clinicians, public health practitioners and officials to review the state of the science intended to control and eventually end the HIV/AIDS epidemic. The central thrust of the global effort to control the epidemic is achieving the 90-90-90 targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS). These targets state that, by 2020, 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained antiretroviral therapy (ART), and 90% of individuals on ART have durable viral suppression. We know that HIV-infected persons with viral suppression, while not cured, do not transmit HIV infection – hence the focus on treatment, which is prevention.

While some countries have made encouraging progress, we are far short of the global 90-90-90 targets, and worse, there were 1.8 million new HIV infections in 2016. We need science to inform the way forward to reach the targets. In this post, I will report on some of the conference presentations around two major themes: 1) generating and applying evidence to optimize the use of current tools, and 2) developing new and improved methods for HIV prevention, care and treatment.

Book Review: Rigor Mortis – Harris says the rigor in science is dead

 
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Richard Harris is a long-time, well-regarded science reporter for National Public Radio, so one has to wonder how he (or the publisher) came up with the title of his new book on the current state of biomedical science: “Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions.” Why is it that so many non-fiction books these days have a short, dramatic title intended to catch your eye on an airport bookrack, followed by a subtitle with an alarming description suited for a checkout-line tabloid? Perhaps I just answered my question. Rigor Mortis is itself a play on words: the medical term refers to the stiffness of a body observed in death; here it indicates that rigor in science is dead. I agree with Harris that there are some fundamental issues in the practice of science that need correction, but it would be unfortunate if Harris’s criticisms are used in support of a retreat from science.

Academia takes on global health

 
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The Consortium of Universities for Global Health (CUGH) held their 8th Annual Conference in Washington DC this week. More than 1,700 people from every corner of the globe gathered for three days to explore how the world’s academic institutions can best contribute to improving global health. This year’s meeting was particularly interesting given the contrast between current prospects for financial support for global health and the trajectory of support over the last 15 years. That contrast made several of the key topics discussed at CUGH even more salient to me.

Should PEPFAR be renamed the “President’s Epidemiologic Plan for AIDS Relief”?

 
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The effective use of data within PEPFAR has played a central role in getting us to the point where we can finally talk about controlling the HIV epidemic and creating an AIDS-free generation. PEPFAR’s transition from an emergency approach to one driven by real-time use of granular, site-level data to guide programmatic investments has contributed to achieving epidemic control. In view of this improved use of data, perhaps the “Emergency” in PEPFAR should now be changed to “Epidemiologic.”