The frontline of HIV1 diffusion in the Central African region: a geographical and epidemiological perspective.

The geographical analysis of the main data on the HIV1 epidemic in Central Africa shows a frontline which has not moved significantly since 1985. The absence of a progressive increase between the countries, demonstrating a discontinuity in space, combined with the observed human and physical continuity within the areas, raises several questions. Are the low-rate areas facing only a simple delay in the diffusion, or is there a real difference between the epidemiological patterns of HIV1 in the two areas? The last hypothesis would impose a revision of the concept of an homogeneous pattern in the epidemiology of HIV1 in Africa. The need for further research is emphasized with the aim of precisely targeting preventive intervention.

PIP: Interventions against HIV and AIDS are typically designed and implemented to target 1 or more of 3 epidemiological patterns found in countries worldwide. Given the heterogeneity of infection and prevalence observed within certain regions and communities, the available knowledge of HIV epidemic patterns needs to be broadened through a multidisciplinary approach which includes an analysis of geographical concepts and boundaries. Geographical analysis of main data on the HIV-1 epidemic in central Africa reveals a frontline which has not moved significantly since 1985. This phenomenon leads one to question reasons for the absence of a progressive increase between countries in the context of human and physical continuity across areas Speculation exists over whether diffusion to low-rate areas is simply delayed or whether a real difference exists between epidemiological patterns. Evidence indicates that the HIV epidemic is heterogeneous throughout Africa and follows different diffusion patterns from 1 ecosystem to another. While HIV is spread regionally primarily through heterosexual networks, it is also feasible that other unexplored routes of transmission may play a role at least during the early phases of the epidemic and may be associated with other causative cofactors. A threshold phenomenon could also be at work in which epidemic waves are set forth after building to critical values of seroprevalence among fringe groups. These phenomenon most likely combine to explaining the observed differing patterns of diffusion in central Africa. Research is needed to better understand prevailing patterns of infection and develop appropriate preventive interventions.

[The role of a health information system as an aid in making regional public health decisions. Experience in Botswana (Southern Africa)]. / Rôle d'un système d'information sanitaire comme aide à la décision régionale en santé publique. Une expérience au Botswana (Afrique Australe).

Decision-making procedures within a health system vary according to the administrative and political organisation of each country. All health levels have, daily or irregularly, decisions to make. To provide reliable, objective and understandable information to decision makers is a difficult, expensive and sometimes misleading exercise. Basic data can be gathered through surveys or institutional routine. Through a concrete example within a Primary Health Care context, the possibilities and the advantages of the utilisation of routinely collected information, regionally processed, are described with the positive interactions within the whole health system. Validation, processing, relativization of the results and their use in supervision, epidemiological and performance surveillance are discussed, emphasizing the privileged aspect of Botswana.

[Study of the utilization of health services in a rural region of southern Africa. Contribution of the computer]. / Etude de l'utilisation des services de santé dans une région rurale d'Afrique australe. Contribution de l'informatique.

Primary health care systems have to be regularly evaluated to ensure their proper management and plans to assess whether community health needs are satisfactorily met. Data required for such an evaluation are complex but an approach can be made through the indicators of health services utilisation. The processing of such informations can and should be computerised, regarding the constantly decreasing cost and the drastic help of this technic. The author presents his experience in a remote region of Southern Africa which has a regular and reliable record of services' utilisation. Three examples of the utility of such processed information are given.