Key research areas and achievements of the Africa Centre for Health and Population Studies
The Centre tackles the most pressing population and reproductive health issues to provide vital data to understand diseases in a rural population.
Key research areas
One of the Centre's key research areas is understanding and quantifying how communities, households and individuals are affected by simultaneous epidemics of HIV and other diseases (including tuberculosis and lifestyle diseases such as obesity, cardiovascular disease and diabetes), and how best to tackle these in a resource-poor setting. The antiretroviral therapy (ART) programme has also helped establish a platform for clinical research on HIV and tuberculosis in adults and children.
Researchers are studying the role of social support in improving the level of HIV testing and adherence to treatment, access to HIV testing and ART, and the impacts of these therapies on family and household members. Current studies are investigating the role of men in the health of the household, as well as partnership patterns and how these affect sexual behaviour. Researchers are also developing a school-based behavioural intervention, evaluating its potential to reduce HIV transmission in a community setting.
The Centre's health systems research combines information from its HIV care programme and surveillance system with local administrative data to compare the resource requirements of different models of ART delivery, the effectiveness of different interventions to retain health workers in rural South Africa, and the cost-effectiveness of interventions to reduce the spread of HIV. The Centre has also hosted important clinical trials, including evaluating the impact of ART on mother-to-child transmission of HIV during pregnancy and breastfeeding, and on the viability of microbicides as a preventative measure against HIV.
The Africa Centre has helped to advance understanding of the dynamics of HIV transmission in rural Africa. A key study demonstrated the importance of exclusive breastfeeding in preventing transmission of HIV from mother to child. This resulted in UNICEF, the World Health Organization and UNAIDS revising their guidelines on the feeding of infants of HIV-infected mothers. Several studies have uncovered important factors affecting the risk of HIV acquisition. For instance, one year of additional education was found to reduce the risk of acquiring HIV by 7 per cent, after the effects of other determinants of infection were taken into account. This strand of research has disproved commonly held beliefs about the underlying causes of the HIV epidemic in Southern Africa, and helped to inform the design of interventions.
The Centre has carried out various studies examining the impact of HIV on households and the community. For example, a study combining demographic data with geographical information systems demonstrated the differing patterns of HIV transmission in a single rural population. This highlighted the need for specific preventative interventions for communities at high risk of HIV, alongside more general strategies for the whole population.
By mid-2009, the HIV treatment and care programme included more than 9000 people receiving ART. Around 20 000 were also monitored before they are eligible for treatment, with about 250 people starting treatment each month. The programme performs about 1000-1500 voluntary counselling and testing sessions monthly in mixed clinics, and an equal number via a recently established mobile testing service.
The Centre is aiming for comprehensive ART coverage in the region to reverse the substantial increase in HIV-related deaths. Using data from the demographic surveillance system, researchers have shown that ART roll-out led to a significant decline in HIV-related mortality in 25-49 year olds, the age category most affected by HIV. Other research has found that between 2001 and 2006, deaths in children under two years old declined by 57 per cent following the roll-out of programmes to prevent mother-to-child transmission of HIV and to delay disease progression and deaths in adults.