Using participatory methods and geographic information systems (GIS) to prepare for an hiv community‐based trial in Vulindlela,South Africa (Project Accept–HPTN 043)

Recent attempts to integrate geographic information systems (GIS) and participatory techniques, have given rise to terminologies such as participatory GIS and community‐integrated GIS. Although GIS was initially developed for physical geographic application, it can be used for the management and analysis of health and health care data. Geographic information systems, combined with participatory methodology, have facilitated the analysis of access to health facilities and disease risk in different populations. Little has been published about the usefulness of combining participatory methodologies and GIS technology in an effort to understand and inform community‐based intervention studies, especially in the context of HIV. This article attempts to address this perceived gap in the literature. The authors describe the application of participatory research methods with GIS in the formative phase of a multisite community‐based social mobilization trial, using voluntary counseling and testing and post‐test support as the intervention. © 2008 Wiley Periodicals, Inc.     

Nanomedicines for Malaria Chemotherapy: Encapsulation <Emphasis Type="BoldItalic">vs</Emphasis>. Polymer Therapeutics

Malaria is one of the oldest infectious diseases that afflict humans and its history extends back for millennia. It was once prevalent throughout the globe but today it is mainly endemic to tropical regions like sub-Saharan Africa and South-east Asia. Ironically, treatment for malaria has existed for centuries yet it still exerts an enormous death toll. This contradiction is attributed in part to the rapid development of resistance by the malaria parasite to chemotherapeutic drugs. In turn, resistance has been fuelled by poor patient compliance to the relatively toxic antimalarial drugs. While drug toxicity and poor pharmacological potentials have been addressed or ameliorated with various nanomedicine drug delivery systems in diseases like cancer, no clinically significant success story has been reported for malaria. There have been several reviews on the application of nanomedicine technologies, especially drug encapsulation, to malaria treatment. Here we extend the scope of the collation of the nanomedicine research literature to polymer therapeutics technology. We first discuss the history of the disease and how a flurry of scientific breakthroughs in the latter part of the nineteenth century provided scientific understanding of the disease. This is followed by a review of the disease biology and the major antimalarial chemotherapy. The achievements of nanomedicine in cancer and other infectious diseases are discussed to draw parallels with malaria. A review of the current state of the research into malaria nanomedicines, both encapsulation and polymer therapeutics polymer-drug conjugation technologies, is covered and we conclude with a consideration of the opportunities and challenges offered by both technologies.     

The Preventive Misconception: Experiences from CAPRISA 004

Overestimating personal protection afforded by participation in a preventive trial, e.g. harboring a “preventive misconception” (PM), raises theoretical ethical concerns about the adequacy of the informed consent process, behavioral disinhibition, and adherence to prevention interventions. Data from the CAPRISA 004 1 % tenofovir gel trial were utilized to empirically evaluate these concerns. We found it necessary to re-think the current definition of PM during evaluation to distinguish between true misconception and reasonable inferences of protection based on increased access to evidence-based prevention interventions and/or clinical care. There was a significant association between PM and decreased condom use (p < 0.0001) and between PM and likelihood to present with an STI symptom (p = 0.023). There was, however, limited evidence in support of PM representing a lack of meaningful informed consent, or to suggest that it impacts adherence. Moreover, considering current insufficiencies in female-initiated HIV prevention interventions, PM is perhaps of limited concern in microbicide trials.     

Necrotising ulcerative gingivitis/periodontitis as indicators of HIV-infection.

Necrotising ulcerative gingivitis/periodontitis (NUG/NUP) are well-documented oral manifestations of HIV infection/AIDS. However, no information is available regarding the predictive value of NUG in the diagnosis of HIV-infection in South Africa. OBJECTIVES: The purpose of this study was to determine a possible correlation between NUG/NUP and HIV infection in the as yet undiagnosed patients. METHODS: Eighty-six systemically asymptomatic patients were diagnosed with NUG/NUP. All patients were treated with 400 mg of metronidazole and 500 mg paracetamol, three times a day for five days. Mechanical debridement under local anesthesia was performed five days after the initial consultation. The possible involvement of HIV-infection was explained and patients were advised to have a blood test taken. RESULTS: Fifty-six patients consented and received pre- and post-test counselling. Of the fifty-six patients, thirty-nine were found to be HIV positive with CD+ T cell counts ranging between 9 and 1,205 cells/mm3. There was a statistically significant correlation between CD4+ T cells below 500 cells/mm3 (p = 0.000) as well as with CD4+ T cells below 200 cells/mm3 (p = 0.001) and NUP/NUG. CONCLUSION: From these results it is concluded that in the GaRankuwa and surrounding areas, NUG/NUP in otherwise systemically healthy individuals is strongly correlated with HIV infection, with a predictive value of 69.6 per cent (p = 0.01). It is recommended that patients presenting with these conditions be encouraged to undergo testing to establish their HIV status for appropriate referrals and management.