ICRH Belgium Newsletter
10th of October?, 2011
Honorary Doctorate for Marleen Temmerman
On the 22nd of September, ICRH director Prof. Marleen Temmerman was awarded an honorary doctorate by the University of the Western Cape in Cape Town, South Africa.
The distinction was awarded in recognition of Marleen Temmerman’s ‘longstanding efforts on behalf of gender equality, reproductive health, rights and research capacity strengthening Africa in fields of public health’. Under the leadership of Marleen Temmerman, ICRH has been working together with the University of the Western Cape (UWC). This is the second honorary PhD for Marleen Temmerman in six months time: in June 2011 she was awarded an honorary doctorate by the Free University of Brussels (VUB).
Inter-university cooperation with the Catholic University of Bukavu
On the 1st of September, the inter-university cooperation agreement between Catholic University of Bukavu (UCB) in Bukavu, Congo and the Flemish universities of Ghent, Antwerp and Leuven was officially launched in the presence of the Congolese minister of education in Bukavu.
The institutions are collaborating on the development of knowledge of agronomy (eg soil fertility and food security), law and economics (management of the mining industry) and medicine in the post conflict situation the eastern Congo is emerging from. The project is funded by the Department of University Development Cooperation of the Flemish Interuniversity Council (VLIR).
The program should contribute to enhancing prosperity and wellbeing of the population of South Kivu, and this by developing strong economic sectors, especially mining and agriculture. A new research center focusing on health care in the post conflict situation will concentrate on non communicable diseases and reproductive health.
Like all other young universities in the Congo, UCB is facing a lack of qualified academic staff, and continues to use many teachers, visitors from other institutions of the country or abroad. A major component of cooperation is the training of PhD students as future teachers and researchers. Professor Kanigula Mubagwa, of the Faculty of Medicine, has been named coordinator for K.U.Leuven. Dr. Steven Callens, Ghent university hospital and ICRH collaborator, is the project leader for the medicine project.
The project website is http://www.kuleuven.be/internationaal/CD/
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Desafio Joint Steering Committee meeting
From 14th till 16th September 2011, the Joint Steering Committee of the Institutional University Cooperation (IUC) partner programme between the Universidade Eduardo Mondlane (UEM) and the Flemish Interuniversity Council – University Development Cooperation (VLIR-UOS) took place in Maputo, Mozambique.
The central theme of the Desafio programme is ’Reproductive Health and HIV/AIDS’ and the objective is to strengthen the UEM as a developmental actor in Mozambican society in this area, to improve reproductive health in society and contribute to the national fight against HIV/AIDS. The programme is coordinated by Prof. Dr. Marleen Temmerman (Faculty of Medicine and Health Sciences of the Ghent University) and Prof. Dr. Nafissa Bique Osman (Faculty of Medicine of the UEM).
On the occasion of the Joint Steering Committee meeting, a scientific seminar took place in which all 13 PhD students and the 6 Master graduates presented their scientific work in an oral presentation, and 17 Master students held a poster presentation. The seminar was well attended by representatives of UEM Rectorate and the involved Faculties.
During the remaining days of the meeting, Flemish and Mozambican programme members prepared the mid-term evaluation, which will take place as from the end of this year, followed by the formulation of the second phase of the programme.
More information: Laurence Hendrickx firstname.lastname@example.org
Global Strategy for Women's and Children's Health
An Independent Expert Review Group on Information and Accountability for Women's and Children's Health has been established.
The UN Commission on Information and Accountability for Women's and Children's Health was established by WHO at the request of the United Nations Secretary-General to accelerate progress on the Global Strategy for Women's and Children's Health. On the issue of global reporting, the Commission proposed a time-limited independent Expert Review Group be established and operate until 2015. The selection committee met in Geneva to select among the nominees 7 experts. ICRH director Marleen Temmerman is one of them. The others are Dr. Carmen Barroso (Brazil), Dr. Zulfiqar Bhutta (Pakistan), Dr. Richard Horton (UK), Dr. Dean Jamison (USA), Mrs. Joy Phumaphi (Botswana) and Dr. Miriam Were (Kenya). Dr. Horton and Mrs. Phumaphi have been appointed as co-chairs. The ERG’s mission is to report regularly to the United Nations Secretary-General on the results and resources related to the Global Strategy and on progress in implementing this Commission’s recommendations.
ICRH Mozambique meetings
On September 14, ICRH Mozambique held its annual General Assembly and Scientific Council meeting.ICRH Mozambique was established officially at the end of 2009, and has since then seen a considerable growth in number of staff and project volume. On 14 September, the organization presented its financial and activity report to its governing bodies: the Scientific Council and the General Assembly. Both meetings approved the reports and applauded the progress that has been made in the last year. The Scientific Council, which is chaired by Dr. Nafissa Osman, also approved the new rules and procedures of the organization. The General Assembly accepted Dr. Beatrice Crahay (Country Director of ICRH Mozambique) and Dr. Aida Libombo as new members and elected Dr. Rosa Marlene Manjate as the chair person of the Assembly.
More information: Beatrice Crahay, email@example.com
Lunch lecture on female genital mutilation and vaginal surgery
On October 27 ICRH, ICRH senior researcher Dr. Els Leye will give a lunch lecture on female genital mutilation and vaginal surgery, within the framework of the ‘Belmundo’ project of the city of Ghent.
The Ghent city Belumdo project strives to draw attention to all aspects of North-South relations by organizing numerous activities between 15 October and 15 November. The lecture of Els Leye, which will be held in Dutch, will take place in the city hall of Ghent, at 12h00. The lecture will be followed by Fadumo Abdinasir, who campaigns together with Somali, Gambian and Senegalese women against FGM.
More information: http://www.icrh.org/files/Uitnodiging.pdf
Registration: Gentinfo +32 (0)9 210 10 10.
Supercomputers and HIV epidemiology
SACEMA epidemiologist and ICRH visiting professor Dr. Wim Delva has developed, together with other researchers from Belgium, the Netherlands, South Africa and the USA, “SIMPACT”, a computer model to simulate how HIV spreads in South Africa and what the likely impact of alternative prevention and treatment strategies would be.
Most computer models that are currently used for this kind of mathematical epidemiology are based on so-called compartmental models, where the average trends in sexual behaviour of the population is modelled. However, compartmental models are unable to capture complex sexual network features such as concurrency (engaging in overlapping, ‘concurrent’ relationships) and age-disparity (large age gaps between sexual partners). SIMPACT on the other hand, explicitly simulates the formation and dissolution of sexual relationships between men and women, thus allowing for statistical analysis of the simulated network and its mediating role in the spread and control of HIV.
Initially, the researchers were running SIMPACT from ordinary laptop and desktop computers, but they quickly ran into major challenges. SIMPACT is very compute-intensive. For virtual populations exceeding a few thousand individuals, their desktop computers ran out of memory. Further, building epidemiological models with SIMPACT is an iterative process: the model parameters are adjusted after analysis of the model output until the researchers are satisfied with the simulated demographics, behaviour and epidemic trends. Lastly, SIMPACT is a stochastic simulation tool, which means that every time you run it, you get a slightly different result. This is great because it allows the user to get a sense for the uncertainty surrounding the impact estimates, due to chance. However, it also means that SIMPACT-based modelling studies involve many runs, and consequently require large amounts of computing time. A recent workshop at Ghent University has made it possible to run SIMPACT on STEVIN, the High Performance Computer infrastructure at Ghent University. STEVIN’s computing power is equivalent to that of 800 standard desktop computers.
Thanks to the HPC infrastructure, model development with SIMPACT can be done in a matter of days, whereas it would take us several years to reach a satisfactory model specification on ordinary desktop computers. STEVIN also makes it possible to perform thorough uncertainty and sensitivity analyses, which have become essential components of modern epidemiological modelling studies. Through a virtual private network connection, the UGent High Performance Computer infrastructure can be accessed from anywhere in the world. With most collaborating researchers based in South Africa, flexible access to the supercomputer is of particularly value to the SIMPACT project team.
More information: Wim Delva, firstname.lastname@example.org
APHIA II Project
Using community health workers can lead to positive sexual behaviour outcomes among people living with HIV.
In 2010 and early 2011, APHIA II OR Project, in collaboration with the International Centre for Reproductive Health (ICRH), conducted an operations research project in Mombasa District to test a community-based risk reduction strategy for PLHIV who were not on ART. In the intervention implemented in Changamwe Division, community health workers recruited and followed a cohort of people living with HIV (PLHIV) who were aged 18 and over, sexually active but not on ART over six months; and conducted one-to-one counselling.
The intervention led to significant reduction in multiple sexual partners among the target group, improved rates of disclosure of HIV status to intimate partners, improved condom use, and improved use of contraception. The researchers conclude that community health workers can successfully provide information and counselling on prevention and treatment to PLHIV who are outside the ambit of health services and recommend that HIV programs use community health workers to implement prevention interventions targeting healthy HIV positive individuals in the community, and to provide ongoing support to newly diagnosed clients, who may not yet be eligible for ART.
Source: APHIA II OR Project. 2011. “Prevention with Positives: A community-based intervention study”. Population Council, Kenya. http://www.popcouncil.org/pdfs/2011RH_APHIAII_ORSum5.pdf
Caroline joined the finance & administration team of ICRH in September 2011.
She is, together with Ellen Taets, responsible for general administrative and logistic support for ICRH activities and projects. Caroline works part-time for ICRH, and spends the other half of her professional life in the students administration office of the Ghent Conservatory of Hogeschool Gent, where she started working 13 years ago.
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HIV among out-of-school youth in Southern and Eastern Africa
ICRH co-authored a literature study that was published in AIDS Care on HIV among out-of-school youth in Southern and Eastern Africa.
The review considers out-of-school youth, a category typically eluding interventions that are school-based. Sub-Saharan Africa has the highest proportion of children and adolescents who are out of school; 26% of the primary school-age population and 37% of the lower secondary school-age population are not in school; girls are more often out of school than boys. Our review of descriptive studies concentrates on the most affected region, Southern and Eastern Africa, and spans the period between 2000 and 2010. Among the relatively small but increasing number of studies, out-of-school youth was significantly associated with risky sexual behavior, more precisely with early sexual debut, high levels of partner concurrency, transactional sex, age-mixing, low STI/HIV risk perception, a high lifetime number of partners, and inconsistent condom use. Being-in-school not only raises health literacy. The in-school (e.g., age-near) sexual network may also be protective, an effect which the better-studied (and regionally less significant) variable of educational attainment cannot measure. Our review pointed to the importance of (1) scaling up SRH-related research on out-of-school adolescents, including basic biomarker information such as serostatus, (2) standardizing the definition and age-group of this category, (3) acknowledging the proper SRH profile and corresponding needs of out-of-school youth, (4) differentiating between target/risk groups in the urban and rural areas, (5) more longitudinal cohort analyses which may reveal the sex networks and may end speculations about the causal direction of the established associations, (6) a sustained effort in verifying the cross-regional
significance of the associations.
Stroeken K, Remes P, De Koker P, Michielsen K, Van Vossole A, Temmerman M. (2011). HIV among out-of-school youth in Eastern and Southern Africa: a review. AIDS Care [Epub ahead of print].
Detection of STD pathogens
A new multiplex polymerase chain reaction for the simultaneous detection of 7 clinically relevant STDs was evaluated.
The evaluation concerned a new multiplex polymerase chain reaction (mPCR), "STDFinder assay", a novel multiplex ligation-dependent probe amplification (MLPA) assay for the simultaneous detection of 7 clinically relevant pathogens of STDs, i.e., Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Treponema pallidum, and herpes simplex virus type 1 and 2 (HSV-1 and HSV-2). An internal amplification control was included in the mPCR reaction. The limits of detection for the STDFinder assay varied among the 7 target organisms from 1 to 20 copies per MLPA assay. There were no cross-reactions among any of the probes. Two hundred and forty-two vaginal swabs and an additional 80 specimens with known results for N. gonorrhoeae and C. trachomatis, obtained from infertile women seen at an infertility research clinic at the Kigali Teaching Hospital in Rwanda, were tested by STDFinder assay and the results were confirmed by single real-time PCR using different species-specific targets. Compared to the reference standard, the STDFinder assay showed specificities and sensitivities of 100% and 100%, respectively, for N. gonorrhoeae, C. trachomatis, and M. genitalium; 90.2% and 100%, respectively, for Trichomonas vaginalis; and 96.1% and 100%, respectively, for HSV-2. No specimen was found to be positive for HSV-1 by either the STDFinder assay or the comparator method. Similarly, the sensitivity for Treponema pallidum could not be calculated due to the absence of any Treponema pallidum-positive samples. In conclusion, the STDFinder assays have comparable clinical sensitivity to the conventional mono and duplex real-time PCR assay and are suitable for the routine detection of a broad spectrum of these STDs at relatively low cost due to multiplexing.
Evaluation of a new multiplex polymerase chain reaction assay STDFinder for the simultaneous detection of 7 sexually transmitted disease pathogens. Muvunyi CM, Dhont N, Verhelst R, Crucitti T, Reijans M, Mulders B, Simons G, Temmerman M, Claeys G, Padalko E. Diagn Microbiol Infect Dis. 2011 Sep;71(1):29-37. Epub 2011 Jul 27.
Age-disparity, sexual connectedness and HIV infection in disadvantaged communities around Cape Town, South Africa: a study protocol
Wim Delva et. al. have developed a study protocol aiming to use novel research methods in order to determine whether HIV status is associated with age-disparity and sexual connectedness as well as to establish the primary behavioural and socio-demographic predictors of the egocentric and community sexual network structures.
Crucial connections between sexual network structure and the distribution of HIV remain inadequately understood, especially in regard to the role of concurrency and age disparity in relationships, and how these network characteristics correlate with each other and other risk factors. Social desirability bias and inaccurate recall are obstacles to obtaining valid, detailed information about sexual behaviour and relationship histories.
The researchers will conduct a cross-sectional survey that uses a questionnaire exploring one-year sexual histories, with a focus on timing and age disparity of relationships, as well as other risk factors such as unprotected intercourse and the use of alcohol and recreational drugs. The questionnaire will be administered in a safe and confidential mobile interview space, using audio computer-assisted self-interview (ACASI) technology on touch screen computers. The ACASI features a choice of languages and visual feedback of temporal information. The survey will be administered in three peri-urban disadvantaged communities in the greater Cape Town area with a high burden of HIV. The study communities participated in a previous TB/HIV study, from which HIV test results will be anonymously linked to the survey dataset. Statistical analyses of the data will include descriptive statistics, linear mixed-effects models for the inter- and intra-subject variability in the age difference between sexual partners, survival analysis for correlated event times to model concurrency patterns, and logistic regression for association of HIV status with age disparity and sexual connectedness.
This study design is intended to facilitate more accurate recall of sensitive sexual history data and has the potential to provide substantial insights into the relationship between key sexual network attributes and additional risk factors for HIV infection. This will help to inform the design of context-specific HIV prevention programmes.
Wim Delva, Roxanne Beauclair, Alex Welte, Stijn Vansteelandt, Niel Hens, Marc Aerts, Elizabeth du Toit, Nulda Beyers and Marleen Temmerman. Age-disparity, sexual connectedness and HIV infection in disadvantaged communities around Cape Town, South Africa: a study protocol. BMC Public Health 2011, 11:616doi:10.1186/1471-2458-11-616. The electronic version of this article can be found online at: http://www.biomedcentral.com/1471-2458/11/616
HIV testing in Europe: Mapping policies
Jessika Deblonde et. al. mapped national HIV testing policies to explore the characteristics and variations across European countries.
In the absence of treatment and in the context of discrimination, HIV testing was embedded within exceptional procedures. With increasing treatment effectiveness, early HIV diagnosis became important, calling for the normalization of testing. National HIV testing policies were mapped to explore the characteristics and variations across European countries.
Key informants within the health authorities of all EU/EEA countries were questioned on HIV testing policies, which were assessed within a conceptual framework and the level of exceptionalism and normalization was scored based on defined attributes. Results: Twenty-four out of 31 countries participated in the survey. Policies tended to support confidential voluntary testing, informed consent, and counselling. In the majority of countries, specific groups were targeted for provider-initiated testing. Taking together all attributes of HIV testing, 14 countries obtained a high score for exceptionalism, while only 3 achieved a high score on normalization. Italy, Lithuania and Romania had primarily exceptional procedures; Norway leant more towards normalization; Netherlands, the United Kingdom, and Denmark scored high in both. Conclusions: In most EU/EEA countries, policies are integrating HIV testing in health care settings, through voluntary and targeted testing strategies. Current HIV testing policies exhibited a high level of exceptionalism with varying degrees of normalization. Further research should compare HIV testing policies with practices. © 2011 Elsevier Ireland Ltd. All rights reserved.
Jessika Deblonde, Herman Meulemans, Steven Callens, Stanley Luchters, Marleen Temmerman, Françoise F. Hamers . Health Policy. 2011 Jul 26. [Epub ahead of print]
The risk factor profile of women with secondary infertility in Rwanda
This study examines the association of past sexually transmitted infections including HIV, bacterial vaginosis and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.
Between November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered (n = 219). Participants were interviewed about socio-demographic characteristics and obstetric history using structured questionnaires, and were tested for HIV and reproductive tract infections (RTIs).
The main finding of this study is that obstetric events, HIV and other STIs contribute approximately equally to secondary infertility in Rwanda. Scaling up of HIV/STI prevention, increased access to family planning services, improvement of prenatal and obstetric care and reduction of stillbirth and infant mortality rates are all likely to decrease secondary infertility in sub-Saharan Africa.
The risk factor profile of women with secondary infertility: an unmatched case-control study in Kigali, Rwanda. Nathalie Dhont, Stanley Luchters, Claude Muvunyi, Joseph Vyankandondera, Ludwig De Naeyer, Marleen Temmerman and Janneke van de Wijgert. BMC Women's Health 2011, 11:32doi:10.1186/1472-6874-11-32.
The electronic version of this article can be found online at: http://www.biomedcentral.com/1472-6874/11/32