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August 10, 1994, Vol 272, No. 6 >
ARTICLE | August 10, 1994

The Public Health Implications of AIDS Research in Africa FREE

Kevin M. De Cock, MD, MRCP, DTM&H; Ehounou Ekpini, MD; Emmanuel Gnaore, MD; Auguste Kadio, MD; Helene D. Gayle, MD, MPH
[+] Author Affiliations

The opinions expressed in this article are those only of the authors.

Reprints not available.


JAMA. 1994;272(6):481-486. doi:10.1001/jama.1994.03520060081036
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References

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic has led to greatly increased international collaboration for medical research, mainly epidemiologic in nature, in Africa. Greater understanding of HIV/AIDS has resulted, and considerable training and technology transfer have occurred. However, analytic and descriptive research in countries heavily affected by AIDS has been slow to turn to assessment of interventions, and practical benefits to those countries' public health and policies have lagged behind scientific knowledge. This article considers the public health implications of selected HIV/AIDS research in sub-Saharan Africa and discusses opportunities for interventions and more applied research. Topics covered include HIV testing and its role, surveillance, control of sexually transmitted diseases, the vulnerability of youth and women, tuberculosis, HIV/AIDS care, and the inadequacy of resources currently committed to HIV/AIDS prevention and control in resource-poor countries. Research on HIV/AIDS in Africa has yielded crucial information but now should prioritize interventions and their evaluation. Specific goals that might limit the effects of the HIV/AIDS epidemic in resource-poor countries are achievable given vision, commitment, and resources.

(JAMA. 1994;272:481-486)

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Spielberg F, Mulanga Kabeya C, Ryder RW, et al.  Comparative evaluation of rapid, visually read HIV antibody screening assays at Mama Yemo Hospital, Kinshasa, Zaire. Lancet . 1989;;1:580-584.
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Brattegaard K, Kouadio J, Adorn M-L, Doorly R, George JR, De Cock KM.  Rapid and simple screening and supplemental testing for HIV-1 and HIV-2 infections in West Africa. AIDS . 1993;;7:883-885.
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Evans LA, Moreau J, Odehouri K, et al.  Simultaneous isolation of HIV-1 and HIV-2 from an AIDS patient. Lancet . 1988;;2:1389-1392.
34 +
George JR, Ou C-Y, Parekh B, et al.  Prevalence of HIV-1 and HIV-2 mixed infections in Côte d'Ivoire. Lancet . 1992;;340:337-339.
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Allen S, Serufilira A, Bogaerts J, et al.  Confidential HIV testing and condom promotion in Africa: impact on HIV and gonorrhea rates. JAMA . 1992;;268:3338-3343.
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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
World Health Organization.  Acquired immunodeficiency syndrome (AIDS): data as of 31 December 1993. Wkly Epidemiol Rec . 1994;;69:5-8.
2 +
US Bureau of the Census. HIV/AIDS Surveillance Data Base . Washington, DC: US Bureau of the Census; December 1993;.
3 +
Traore-Ettiegne V, Ghijs PD, Diallo MO, et al. High prevalence of HIV infection and other STD in female prostitutes in Abidjan. In: Program and abstracts of the Ninth International Conference on AIDS; June 7-11,1993; Berlin, Germany. Abstract WS-C08-3.
4 +
De Cock KM, Barrere B, Diaby L, et al.  AIDS: the leading cause of adult death in the West African city of Abidjan, Ivory Coast. Science . 1990;;249:793-796.
5 +
Nelson AM, Hassig SE, Kayembe M, et al.  HIV-1 seropositivity and mortality at University Hospital, Kinshasa, Zaire, 1987. AIDS . 1991;;5:583-586.
6 +
Mulder DW, Nunn AJ, Kamali A, Nakiyingi J, Wagner H-U, Kengeya-Kayondo JF.  Two-year HIV-1-associated mortality in a Ugandan rural population. Lancet . 1994;;343:1021-1023.
7 +
The World Bank.  AIDS: a threat to development.  In: Investing in Health: World Development Report 1993 . New York, NY: Oxford University Press; 1993;:99-107.
8 +
Piot P, Kapita BM, Were JBO, Laga M, Colebunders RL.  AIDS in Africa: the first decade and challenges for the 1990s. AIDS . 1991;;5( (suppl) ):S1-S5.
9 +
Cameron DW, Padian NS.  Sexual transmission of HIV and the epidemiology of other sexually transmitted diseases. AIDS . 1990;;4( (suppl) ):S99-S103.
10 +
Ryder RW, Nsa W, Hassig SE, et al.  Perinatal transmission of the human immunodeficiency virus type 1 to infants of seropositive women in Zaire. N Engl J Med . 1989;;320:1637-1642.
11 +
Lepage P, Van de Perre P, Msellati P, et al.  Mother-to-child transmission of HIV-1 and its determinants: a cohort study in Kigali, Rwanda. Am J Epidemiol . 1993;;137:589-599.
12 +
St. Louis ME, Kamenga M, Brown C, et al.  Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic, and placental factors. JAMA . 1993;;269:2853-2859.
13 +
Andreasson PA, Dias F, Naucler A, Andersson S, Biberfeld G.  A prospective study of vertical transmission of HIV-2 in Bissau, Guinea-Bissau. AIDS . 1993;;7:989-993.
14 +
Adjorlolo-Johnson G, De Cock KM, Ekpini E, et al.  Prospective comparison of mother-to-child transmission of HIV-1 and HIV-2 in Abidjan, Ivory Coast. JAMA . 1994;;272:462-466.
15 +
Van de Perre P, Simonnon A, Msellati P, et al.  Postnatal transmission of human immunodeficiency virus type 1 from mother to infant: a prospective cohort study in Kigali, Rwanda. N Engl J Med . 1991;;325:593-598.
16 +
M'Boup S, Kanki PJ, Mhalu FS.  Laboratory diagnosis of HIV-1 and HIV-2 in Africa. AIDS . 1991;;5( (suppl) ):S93-S101.
17 +
De Cock KM, Brun-Vézinet F.  Epidemiology of HIV-2 infection. AIDS . 1989;;3( (suppl I) ):S89-S95.
18 +
De Cock KM, Brun-Vézinet F, Soro B.  HIV-1 and HIV-2 infections and AIDS in West Africa. AIDS . 1991;;5( (suppl I) ):S21-S28.
19 +
Garnett GP, Anderson RM.  No reason for complacency about the potential demographic impact of AIDS in Africa. Trans R Soc Trop Med Hyg . 1993;; 87( (suppl I) ):19-22.
20 +
Laga M, Nzila N, Goeman J.  The interrelationship of sexually transmitted diseases and HIV infection: implications for the control of both epidemics in Africa. AIDS . 1991;;5( (suppl) ):S55-S63.
21 +
De Cock KM, Soro B, Coulibaly IM, Lucas SB.  Tuberculosis and HIV infection in sub-Saharan Africa. JAMA . 1992;;268:1581-1587.
22 +
Eckholm E.  Political chaos in Zaire imperils AIDS studies. New York Times . (October 29) , 1991;:B6.
23 +
Gurtler LG, Hauser PH, Eberle J, et al.  A new subtype of human immunodeficiency virus type 1 (MPV-5180) from Cameroon. J Virol . 1994;;68:1581-1585.
24 +
De Leys R, Vanderborght B, Vanden Haesevelde M, et al.  Isolation and partial characterization of an unusual human immunodeficiency retrovirus from two persons of West-Central African origin. J Virol . 1990;;64:1207-1216.
25 +
Loussert-Ajaka I, Ly TD, Chaix ML, et al.  HIV-1/HIV-2 ELISA seronegativity in HIV-1 subtype O infected patients. Lancet . 1994;;343:1393-1394.
26 +
De Cock KM, Porter A, Kouadio J, et al.  Cross-reactivity on Western blots in HIV-1 and HIV-2 infections. AIDS . 1991;;5:859-863.
27 +
Tedder RS, O'Connor T, Hughes A, N'Jie H, Corrah T, Whittle H.  Envelope cross-reactivity in Western blot for HIV-1 and HIV-2 may not indicate dual infection. Lancet . 1988;;2:927-930.
28 +
De Cock KM, Porter A, Kouadio J, et al.  Rapid and specific diagnosis of HIV-1 and HIV-2 infections: an evaluation of testing strategies. AIDS . 1990;;4:875-878.
29 +
Tamashiro H, Maskill W, Emmanuel J, Fauquex A, Sato P, Heymann D.  Reducing the cost of HIV antibody testing. Lancet . 1993;;342:87-90.
30 +
Spielberg F, Mulanga Kabeya C, Ryder RW, et al.  Comparative evaluation of rapid, visually read HIV antibody screening assays at Mama Yemo Hospital, Kinshasa, Zaire. Lancet . 1989;;1:580-584.
31 +
Brattegaard K, Kouadio J, Adorn M-L, Doorly R, George JR, De Cock KM.  Rapid and simple screening and supplemental testing for HIV-1 and HIV-2 infections in West Africa. AIDS . 1993;;7:883-885.
32 +
Rayfield M, De Cock K, Heyward W, et al.  Mixed human immunodeficiency virus (HIV) infection in an individual: demonstration of both HIV type 1 and type 2 proviral sequences by using polymerase chain reaction. J Infect Dis . 1988;;158:1170-1176.
33 +
Evans LA, Moreau J, Odehouri K, et al.  Simultaneous isolation of HIV-1 and HIV-2 from an AIDS patient. Lancet . 1988;;2:1389-1392.
34 +
George JR, Ou C-Y, Parekh B, et al.  Prevalence of HIV-1 and HIV-2 mixed infections in Côte d'Ivoire. Lancet . 1992;;340:337-339.
35 +
Allen S, Serufilira A, Bogaerts J, et al.  Confidential HIV testing and condom promotion in Africa: impact on HIV and gonorrhea rates. JAMA . 1992;;268:3338-3343.
36 +
The World Bank.  Testing and screening.  In: Investing in Health: World Development Report 1993 . New York, NY: Oxford University Press; 1993;:103.
37 +
Chin J.  Public health surveillance of AIDS and HIV infections. Bull World Health Organ . 1990;; 68:529-536.
38 +
Diallo MO, Ackah AN, Lafontaine M-F, et al.  HIV-1 and HIV-2 infections in men attending sexually transmitted disease clinics in Abidjan, Côte d'Ivoire. AIDS . 1992;;6:581-585.
39 +
Batter V, Nsuami M, Baangi M, St. Louis M, Ryder R. Stable HIV-1 seroprevalence in childbearing women (cbw) in Kinshasa, Zaire, masks a dynamic epidemic. In: Program and abstracts of the Ninth International Conference on AIDS; June 7-11, 1993; Berlin, Germany. Abstract WS-C18-1.
40 +
Chin J.  Global estimates of AIDS cases and HIV infections: 1990. AIDS . 1990;;4( (suppl) ):S277-S283.
41 +
World Health Organization.  Provisional clinical case definition for AIDS. Wkly Epidemiol Rec . 1986;; 61:72-73.
42 +
Buehler JW, De Cock KM, Brunet J-B.  Surveillance definitions for acquired immunodeficiency syndrome. AIDS . 1993;;7( (suppl) ):S73-S81.
43 +
De Cock KM, Selik R, Soro B, Gayle H, Colebunders RL.  AIDS surveillance in Africa: a re-appraisal of case definitions. BMJ . 1991;;303:1185-1188.
44 +
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