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Keywords:

  • HIV;
  • epidemiology
  • VIH;
  • épidémiologie
  • VIH;
  • epidemiología

Summary

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References

There is increasing consensus on the importance of strengthening global health research to meet health and development goals. Three key global health research aims are to ensure that research (i) addresses priority health needs, (ii) contributes to policy development, and (iii) adds value to investments in developing countries through South–South collaboration and capacity-strengthening in the South. The ALPHA network (Analysing Longitudinal Population-based HIV/AIDS data on Africa) is an illustrative example of how these global health research aims can be translated into action. The network facilitates additional collaborative HIV epidemiological research among six independent research projects in Africa studying population-based cohorts. Under the first of the earlier mentioned aims, the network addresses key epidemiology research issues in HIV/AIDS which are crucial to making progress and monitoring progress in the response against HIV/AIDS. Under the second aim, the network’s scientific programme of research has contributed to strengthening the evidence base on HIV epidemiology in Africa and has informed policy development in areas such as targeted HIV prevention, social support, monitoring epidemic response and epidemic forecasting. Under the third aim, investment in the network has added value to the research investment in the individual projects through capacity development among African researchers as well as through the collaborative research outputs of the individual projects. Lessons from the network are relevant to collaborations facing similar challenges in other areas of global health research. These include the importance of establishing transparent and efficient governance for research collaborations, developing advance consensus on data sharing, ensuring effective communication for networking and demonstrating the added value of research investment in South–South collaborations.

Point de vue: Transposition en action des objectifs mondiaux de la recherche en santé: l’exemple du réseau ALPHA

Il y a de plus en plus un consensus sur l’importance du renforcement de la recherche en santé mondiale afin d’atteindre les objectifs de santé et de développement. Trois principaux objectifs de recherche en santé mondiale sont de s’assurer que la recherche: (1) traite des besoins de santé prioritaires, (2) contribue à l’élaboration des politiques et (3) ajoute de la valeur aux investissements dans les pays en développement à travers la collaboration sud-sud et le renforcement des capacités dans le sud. Le réseau ALPHA (Analyse longitudinale des données VIH/SIDA basées sur la Population en l’Afrique) est un exemple illustratif de la manière dont ces objectifs de recherche en santé mondiale peuvent être traduits en action. Le réseau facilite la collaboration additionnelle en recherche épidémiologique sur le VIH entre six projets de recherche indépendants en Afrique étudiant des cohortes basées sur la population. Au titre du premier des objectifs ci-dessus, le réseau traite des grandes questions de recherche en épidémiologie sur le VIH/SIDA qui sont cruciaux pour faire avancer et surveiller les progrès dans la lutte contre le VIH/SIDA. Dans le cadre du second objectif, le programme scientifique du réseau de recherche contribue au renforcement de la base de données probantes sur l’épidémiologie du VIH en Afrique et en a informé l’élaboration des politiques dans des domaines tels que la prévention ciblée du VIH, le soutien social, le suivi de la réponse épidémique et la prévision des épidémies. Dans le cadre du troisième objectif, l’investissement dans le réseau a une valeur ajoutée dans l’investissement dans la recherche dans les différents projets à travers le développement des capacités des chercheurs africains ainsi que dans les résultats de la recherche collaborative des projets individuels. Les leçons tirées du réseau sont pertinentes pour les collaborations faisant face à des défis similaires dans d’autres domaines de la recherche en santé mondiale. Ceux-ci comprennent l’importance d’établir une gouvernance transparente et efficace pour des collaborations de recherche, le développement d’un consensus préalable sur le partage des données assurant une communication efficace pour le réseau et de démontrer la valeur ajoutée de l’investissement dans la recherche dans les collaborations sud-sud.

Punto de vista: Traduciendo en acción los objetivos de investigación en salud: los ejemplos de la red ALPHA

Existe un consenso sobre la importancia de fortalecer la investigación en salud global para alcanzar los objetivos de salud y desarrollo. Tres objetivos claves en la investigación de la salud global son el asegurar que la investigación (1) aborde necesidades prioritarias de salud, (2) contribuya al desarrollo de políticas, y (3) tenga un valor añadido para inversiones en países en vías de desarrollo a través de colaboraciones Sur-Sur y fortalecimiento de capacidades del Sur. La red ALPHA (por sus siglas en inglés Analyzing Longitudinal Population-based HIV/AIDS data on Africa) es un ejemplo ilustrativo de como estos objetivos de investigación en salud global pueden traducirse en acción. La red facilita la investigación adicional colaborativa en epidemiología del VIH, entre seis proyectos independientes en África, estudiando cohortes basadas en la población. Dentro del primer objetivo planteado, la red aborda cuestiones claves en la investigación epidemiológica del VIH/SIDA que son cruciales para progresar y monitorizar el progreso como respuesta frente al VIH/SIDA. Bajo el segundo objetivo, el programa científico de investigación de la red ha contribuido a fortalecer la base de evidencia sobre la epidemiología de VIH en África, y ha informado acerca del desarrollo de políticas en áreas tales como la prevención dirigida del VIH, el apoyo social, la monitorización de la respuesta epidémica, y la predicción de epidemias. Bajo el tercer objetivo, la inversión en la red a dado un valor añadido a la inversión en la investigación en los proyectos individuales a través del desarrollo de capacidades entre los investigadores africanos al igual que mediante los resultados de investigación colaborativa de los proyectos individuales. Las lecciones de la red son relevantes para colaboraciones que se estén enfrentando a retos similares en otras áreas de investigación en salud global. Esto incluye la importancia de establecer procesos de gobernabilidad transparentes y eficientes en las colaboraciones en investigación, desarrollando de antemano un consenso sobre el manejo de datos, asegurando una comunicación efectiva para el trabajo en red, y demostrando el valor añadido de la inversión en investigación en colaboraciones Sur-Sur.


Introduction

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References

The 2008 conference on global health research in Bamako, Mali (Global Ministerial Forum on Research for Health 2008), was a significant milestone in building consensus on how to strengthen research to meet health and development goals (McKee 2008). Three key aims are to ensure that research (i) addresses priority health needs, (ii) contributes to policy development, and (iii) adds value to investments in developing countries through South–South collaboration and capacity-strengthening in the South. The ALPHA network (Analysing Longitudinal Population-based HIV/AIDS data on Africa) is an illustrative example of how these research aims can be translated into action. The network facilitates additional HIV epidemiology research among six independent research projects in Africa studying population-based cohorts. In this article, we show how the network has translated the earlier mentioned three research aims into action, by (i) addressing priority research issues in HIV epidemiology, (ii) strengthening the evidence base on HIV epidemiology to inform policy development, and (iii) adding value to research investments in the projects through collaboration between them and through building capacity among African researchers. Lessons from the network are relevant for collaborations in other health research areas facing similar challenges.

Background – why research on HIV epidemiology in Africa is important

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References

An effective response to HIV is a global priority, and sub-Saharan Africa faces the greatest challenge as the region with the biggest share of the global HIV burden and the least resources (financial, human and infrastructure). On account of resource constraints, it is imperative to ensure that responses to HIV/AIDS are based on the best possible evidence, including epidemiological evidence. Quantifying the size of the HIV burden is important to indicate the severity of the epidemic. Measuring the changes in burden over time indicates how the HIV epidemic evolves, which is important for understanding HIV population dynamics, and can reflect the extent of progress in HIV prevention and care. Also, quantifying the size of the burden draws attention to the scale of the problem, thereby helping to mobilise resources for HIV prevention, care and mitigation. Monitoring HIV risk factors and the extent and impact of HIV/AIDS is necessary for national and international planning purposes to ensure an effective response and mitigate the impact of HIV/AIDS on individuals, families and societies.

The generation of reliable estimates of HIV incidence is key to understanding HIV epidemic trends. This is particularly true in the era of increasing access to antiretroviral therapy (ART) because prolonged survival results in increased HIV prevalence. There is as yet no reliable means of assessing HIV incidence other than direct measurement by repeated population surveys (WHO 2009, Todd et al. 2009). Population-based studies show how HIV affects an entire community, minimising the problems of selection bias inevitable in studies of individuals recruited in clinics or from occupational groups. Data from these community-based cohort studies have thus become vitally important in determining the course of the epidemic and its demographic impact.

The ALPHA network

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References

The ALPHA network was formed in 2005 in response to the need for research collaboration on HIV epidemiology in sub-Saharan Africa. The network, now comprises six long-standing research projects (Table 1) in Africa, is funded by the Wellcome Trust and administered by the London School of Hygiene and Tropical Medicine. In studying community-based cohorts, the member projects share the following features: (i) regular collection of individually linked data on socio-demographic factors and HIV serostatus, (ii) willingness to share a mutually agreed minimum data set, and (iii) commitment to building skills and capacity among African researchers. Strength of the network is that the projects represent diverse settings in different phases of the HIV epidemic. While each project has its own particular areas of expertise and independent research agenda addressing issues of local, national and international relevance, the network adds value through comparative analysis of site-specific data and, where possible and meaningful, analysis of pooled data to strengthen the available evidence and reveal further insights into HIV epidemiology.

Table 1.   The ALPHA network research projects
Name of research projectInstitutional affiliationStart yearSite locationSero-survey timingDemographic surveillanceCohort size in 2008*Approx person-years obs*HIV prevalence (trend) in adult population
  1. *Demographic surveillance totals include children for whom HIV status is not measured in most studies.

Masaka General Population CohortUK Medical Research Council/Uganda Virus Research Institute1989Twenty villages in Masaka district, UgandaAnnual since 1989Annual7 000115 0008.5% (1990) 6.5% (2000) 7.7% (2005)
Rakai Health Science ProgramUganda Virus Research Institute, Makarere University1994Fifty communities in Rakai district, UgandaAnnual since 1995Annual14 000168 00017.7% (1995) 12.8% (2003)
TAZAMA project: Kisesa cohortTanzania National Institute for Medical Research1994Six villages in Magu district, Mwanza region, Tanzaniaapproximately every 3 years since 1994approximately half yearly28 000350 0006.0% (1994) 8.3% (2000) 7.3% (2006, provisional)
Karonga Prevention StudyLondon School of Hygiene and Tropical Medicine1988Twenty five community clusters near Chilumba, Karonga district, MalawiRetrospect 1988, pilot 2005, baseline 2007Continuous since 200232 000150 0003.8% (1988) 7.5% (2007, provisional)
Manicaland HIV/STD Prevention ProjectBiomedical Research and Training Institute, Harare, Imperial College London1998Twelve communities, stratified by socio-economic setting Manicaland, Zimbabwe1999, 2002, 2004Same as sero-survey30 00090 00022.9% (1999) 20.0% (2002) 18.0% (2004) (av. all strata)
Umkhanyakude cohortAfrica Centre for Health and Population Studies/University of KwaZulu Natal2003Umkhanyakude district in northern KwaZulu Natal, South Africa2003, 2005 and 2006Half yearly86 000430 00022% (2003)

Achieving the network’s aims in line with those to strengthen global health research

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References

The aims of the network were developed at its inception in 2005. They match aims identified in Bamako to strengthen global research to meet health and development goals (Anonymous 2008) (Table 2).

Table 2.   ALPHA network aims and those to strengthen global health research
ALPHA network aimsAims in strengthening global health research
Address priority research issues in HIV epidemiology by adding value to data analysisEnsure research addresses priority health needs
Strengthen the evidence base on HIV epidemiology to inform policy developmentEnsure research contributes to policy development
Build capacity in epidemiological research (data analysis and interpretation) through South–South collaboration and capacity-strengthening in the SouthMaximise the value of research investments in developing countries through South–South collaboration and capacity-strengthening in the South

Address priority research issues in HIV epidemiology by adding value to data analysis

The network’s main activity is a scientific programme of workshops, developed by consensus among the projects. Each workshop focuses on a particular theme in HIV epidemiology and is hosted by one of the projects (Table 3). The workshops for member projects and invited ‘guest’ researchers involve lectures and group discussions about current concepts and analytical methods relevant to the particular theme. Facilitators, including experienced researchers and analysts from member projects, demonstrate data management and analyses using data from the host project processed using standard statistical packages. The preparation of data sets with an agreed common format enables easy application of statistical procedures. Facilitators assist participants with similar analyses using their own data. Results of analyses are compared across projects and, when possible, data are pooled and meta-analyses are undertaken. Creating and analysing pooled data sets strengthen analytical conclusions and increase the representativeness of data from individual studies. The background data on demographic, residential and socio-economic factors which are ‘adjusted for’ in risk factor and intervention analyses can also be studied in depth. Participants discuss and describe the implications of the findings. Articles are finalised later with mentor support (including site visits and e-mail consultation) and through visits between member projects. Articles from each workshop have been presented at conferences and published in special journal issues on the workshop themes (Ghys et al. 2007; Gregson et al. 2009).

Table 3.   Scientific programme of workshops with main research findings
Venue, date (host)Theme: topicsResearch outputsResearch findingsImplications for health policy
Mwanza, Tanzania, October 2005 (TAZAMA)Measuring age patterns of HIV incidence and prevalence: (i) methods for analysing longitudinal data; (ii) cumulative infection risk and age patterns of risk.Presentations at International AIDS Society conference (Toronto 2006 and Mexico 2008). Four publications.In addition to the usual peak of HIV incidence among 20–30-year olds, in several sites, a secondary peak in incidence was documented in older age groups, mainly in widowed and divorced persons (Zaba et al. 2008).National HIV/AIDS Programmes need to redesign HIV prevention messages to target these subgroups at increased HIV risk.
Direct measurement of incidence from individual sero-conversions in cohorts was used to validate new mathematical techniques for estimating age-specific incidence (Hallett et al. 2008).More accurate estimates of age-specific incidence enable better tracking of the epidemic and its response to interventions targeting particular age groups.
Somkhele, South Africa, June 2006 (Africa Centre for Health and Population Studies/University of KwaZulu Natal)Impact of HIV on household and family structure: (i) household typology; (ii) children’s living arrangements; (iii) family change analysis.Presentation at HEARD conference Durban (2006). One publication.Study populations show considerable heterogeneity in social and residential arrangements.Social support policies need to reflect the social context of the impact of HIV/AIDS and of household responses.
Child-headed households were extremely rare in all study populations.Social support programmes need to consider a shift of current high levels of funding support from child-headed households towards families (Hosegood 2009).
Entebbe, Uganda, November 2006 (MRC/UVRI Uganda Research Unit on AIDS) N.B. Workshop included ‘guest researchers’ from several occupational and clinic-based cohorts (Murray et al. 2007; Peters et al. 2007) and some studies from outside Africa (Rangsin et al. 2007; Nelson et al. 2007)HIV mortality and patterns of survival: (i) censoring problems in different types of cohort; (ii) parametric regression techniques; (iii) ‘net’ HIV mortality; (iv) age-specific mortality patterns for all infected persons.Presentation at International AIDS Society conference (Mexico, 2008). Thirteen articles published in special issue of journal ‘AIDS’.A new methodology to adjust for background mortality when measuring changes in survival (Marston et al. 2007) showed that the worse prognosis of HIV infection occurring at an older age is because of a direct effect of HIV rather than to non-HIV-related causes at older ages.National HIV/AIDS Programmes need to ensure that older age groups are also included as a target for HIV prevention and care interventions and that people are aware of the extra risk of HIV infection with increasing age.
Longer survival post-infection in African countries, Thailand and Haiti (Todd et al. 2007) was possibly associated with the dominant viral subtype.Understanding host responses to viral subtypes in different parts of the world is important for HIV vaccine development.
Sites had similar age-specific HIV mortality patterns, with longer survival associated with an epidemic in declining phase.National HIV forecasting and planning needs to take into consideration a country’s HIV epidemic phase.
Nyanga, Zimbabwe, September 2007 (Manicaland HIV/STD Prevention Project)Sexual behaviour (especially timing of events, e.g. sexual debut): (i) using longitudinal data to evaluate reporting consistency; (ii) trends in age at first sex and age at first marriage.Eleven articles published in special issue of journal ‘Sexually Transmitted Infections’.Data from longitudinal cohorts rather than cross-sectional surveys enable evaluation of consistency of reporting of sexual behaviour. In some study sites, age at sexual debut was reported more consistently than age at first marriage, and the inconsistent reports represented random noise rather than progressive bias that changed over time (Gregson et al. 2009; Wringe et al. 2009; Marston et al. 2009).Trends in age at first sex derived from cross-sectional surveys (e.g. Demographic and Health Survey) can be taken at face value without further adjustment. Accurate determination of these trends is important because they are used to measure the success of campaigns promoting teenage abstinence.
Mzuzu, Malawi, November 2008 (Karonga Prevention Study)Uptake and impact of voluntary counselling and testing (VCT) for HIV and of antiretroviral therapy (ART)Four presentations at IUSSP Marrakech 2009 international conference; and 14 articles in preparation for special journal issue.After age standardisation, VCT uptake was higher amongst the ever-married, educated, more urban population groups.Intensified efforts are needed to ensure access to VCT among those never married, less well educated or living in rural areas.
The main barrier to ART access was VCT uptake, although many of those testing positive did not take up referral to ART clinics.Priorities in expanding ART access include making HIV testing more widely and readily available and strengthening referral after VCT for ART.
In all sites, HIV-related deaths fell as a proportion of all deaths after the introduction of ART.Evidence of ART impact in diverse settings adds weight to calls for urgent ART scale-up.

Strengthen the evidence base on HIV epidemiology to inform policy development

The scientific programme of ALPHA workshops has generated research findings with important policy implications (Table 3). The network also contributed to the development and refinement of the model used by UNAIDS to generate its 2007 estimates of worldwide HIV prevalence by providing a standardised set of data representing inputs from a diverse range of sites in sub-Saharan Africa (UNAIDS & WHO 2007). The UNAIDS global estimates and projections of HIV infections are used to track progress in the global response to the HIV epidemic and inform strategic decisions on response priorities, including in generating and allocating resources (UNAIDS 2009). The network has so far generated 13 collaborative research publications and assisted member projects with 21 site-specific publications, with others in preparation. A full list of articles published on work carried out by the network is available on the ALPHA website (http://www.lshtm.ac.uk/cps/alpha).

Build capacity in epidemiological research (data analysis and interpretation)

In view of the human resource and infrastructure constraints in sub-Saharan Africa, conducting epidemiological surveillance and analysis must involve building capacity and skills to enable long-term sustainable monitoring. Workshop participants have shared expertise in developing practical skills in data management, including cleaning and preparing data before analysis, epidemiological and demographic analysis methods, advanced programming techniques using the stata package (Stata Corp., TX, USA) and interpreting and presenting findings. Other means of developing these skills have included exchange visits between research groups, mentoring by experienced researchers and support for project staff to present their findings at scientific conferences. Research funders, e.g. the Wellcome Trust, recognise the value of building networks, especially in developing countries where the critical mass of researchers needed to develop new programmes may not be present in one location (Wellcome Trust and Tanzania National Institute of Medical Research 2008).

Meeting challenges – lessons for international research collaborations

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References

Lessons from the network are relevant for international research collaborations in other areas of health research facing similar challenges, e.g. in governance, data sharing, communication for networking and funding. Regarding governance, efficient network functioning requires agreement between collaborators on management and scientific direction. ALPHA network governance relies on a Scientific Advisory Committee (comprising project leaders and external advisors) which approves the scientific programme, monitors progress and advises on dissemination of research results. Formal constitution of the SAC ensures transparency of processes and consideration of concerns of all projects.

Expectations varied among the projects as to the order in which findings (from individual projects vs. from the network) could be published. Because data sharing can be a contentious issue, explicit agreements are necessary among collaborators (Wellcome Trust & WHO 2008). The ALPHA projects’ lead investigators signed agreements specifying which data would be shared among the projects and how the data contributed would be used. Technical challenges in constructing the pooled data set included ensuring comparability of data collected in different ways from the different projects. A documentation system was developed which provided an explanation of the nature of the data in the pooled data set, and a record of the processes through which the pooled data were abstracted from data held by the individual projects. This enabled updating of the pooled data set whenever project data were updated. The lesson is that technical challenges in international research collaborations can be met by pooling expertise, as well as data, from collaborating sites.

Effective communication for networking requires good coordination. The ALPHA network secretariat coordinates the collaborative activities among the six projects, provides administrative services for network activities and facilitates communication. Complementing the personal interaction among researchers at workshops, interaction between researchers is also facilitated by telephone, e-mail and the network website (http://www.lshtm.ac.uk/cps/alpha/). Overcoming communication infrastructure problems in developing countries may require investment in computers and internet access to facilitate networking among researchers in remote rural areas.

Developing countries often face a Catch-22 situation in research funding. They often need a certain level of research capacity to attract research funding from developed countries, but developing research capacity itself depends on external funding from developed countries, and so is not easily achievable. Research groups in developing countries need to take advantage of the opportunities for South–South collaboration linked to existing North–South partnerships. The ALPHA network represents a good example of value for money because investment in the network’s activities has added value to the research investment in individual member projects.

The future – what next for the ALPHA network?

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References

The ALPHA network has contributed to a strengthened evidence base in HIV epidemiology to inform policy and has built capacity in epidemiological analysis. The first 4 years’ activity provides a sound platform to address further important topics in HIV epidemiology. In future, proposed topics to be addressed may include the impact of HIV on fertility; the impact of HIV on child mortality; sexual partnership dynamics and the impact of antiretroviral therapy on HIV transmission and on HIV-related mortality. The intention is that for each workshop, involvement of the national HIV/AIDS programme of the host country will facilitate the process of developing and disseminating the policy implications arising from the workshop findings. The network faces challenges in maintaining funding, identifying new ways to maximise the value of research investments, developing shared resource data set documentation, capitalising on achievements in capacity building, enlarging to embrace new projects and widening the range of international stakeholders beyond UNAIDS to include other agencies, e.g. UNICEF and UNFPA.

Conclusion

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References

The ALPHA network is an example of how to translate global health research aims into action, providing useful lessons for those facing similar challenges in other health areas beyond HIV. Research funders have a crucial role in investing in epidemiological research, such as that conducted by the ALPHA network, which supports South–South collaboration and capacity development in the South and contributes to meeting health and development goals.

References

  1. Top of page
  2. Summary
  3. Introduction
  4. Background – why research on HIV epidemiology in Africa is important
  5. The ALPHA network
  6. Achieving the network’s aims in line with those to strengthen global health research
  7. Meeting challenges – lessons for international research collaborations
  8. The future – what next for the ALPHA network?
  9. Conclusion
  10. References
  • Anonymous (2008) The state of health research worldwide. Lancet 372, 1519.
  • Ghys P, Zaba B & Prins M (2007) Survival and mortality of people infected with HIV in low and middle income countries – results from the extended ALPHA network. AIDS 21(Suppl. 6), S1S4.
  • Global Ministerial Forum on Research for Health (2008) The Bamako call to action on research for health. Strengthening research for health, development and equity. http://www.bamako2008.org/dmdocuments/CTA_3.pdf .
  • Gregson S, Todd J & Zaba B (2009) Sexual behaviour change in countries with generalised HIV epidemics? Evidence from population-based cohort studies in sub-Saharan Africa. Sexually transmitted infections 85, i1i2.
  • Hallett TB, Zaba B, Todd J et al. on behalf of the ALPHA Network (2008) Estimating incidence from prevalence in generalised HIV epidemics: methods and validation. PLoS Medicine 5, 611622.
  • Hosegood V (2009) Demographic impact of HIV and AIDS on the family and household life-cycle: implications for strengthening families. AIDS Care 21, 1321.
  • Marston M, Todd J, Glynn JR & Zaba B (2007) “Net” mortality methods with comparison and summary of HIV-specific “Net survival”. AIDS 21, S65S71.
  • Marston M, Slaymaker E, Cremin I et al. (2009) Trends in marriage and time spent single in sub-Saharan Africa: a comparative analysis of six population-based cohort studies and nine Demographic and Health Surveys. Sexually transmitted infections 85, i64i71.
  • McKee M (2008) Global research for health. Should tackle health needs and inform policy. British Medical Journal 337, 12491250.
  • Murray J, Sonnenberg P, Nelson G, Bester A, Shearer S & Glynn JR (2007) Cause of death and presence of respiratory disease at autopsy in an HIV-1 seroconversion cohort of Southern African gold miners. AIDS 21(Suppl. 6), S97S104.
  • Nelson KE, Costello C, Suriyanon V, Sennun S & Duerr A (2007) Survival after HIV-1 subtype E (CRF01 A_E) among blood donors and their spouses in northern Thailand. AIDS 21(Suppl. 6), S47S54.
  • Peters PJ, Meinzen-Derr J, Karita E et al. for the Rwanda-Zambia HIV Research Group (2007) HIV-infected Rwandan women have a high frequency of long-term survival. AIDS 21 (Suppl. 6), S31S37.
  • Rangsin R, Piyaraj P, Sirisanthana T, Sirisopana N, Short O & Nelson KE (2007) The natural history of HIV-1 subtype E infections in young men in Thailand with up to 14 years of follow-up. AIDS 21(Suppl. 6), 6.
  • Todd J, Glynn JR, Marston M et al. (2007) Time from HIV sero-conversion to death prior to ART: a collaborative analysis of eight studies in six developing countries. AIDS 21, S55S63.
  • Todd J, Lutalo T & Kaleebu P (2009) Estimating incidence of HIV infection in Uganda (Letter). Journal of the American Medical Association 301, 159160.
  • UNAIDS (2009) Reference Group on Estimates, Modelling and Projections. http://www.epidem.org/ (accessed 10 September 2009).
  • UNAIDS & WHO (2007). AIDS Epidemic Update: December 2007. WHO, Geneva.
  • Wellcome Trust and Tanzania National Institute of Medical Research (2008) Meeting report. Cohorts and prospective studies – a North-South networking meeting. Arusha, Tanzania. 7–9 January 2008.
  • Wellcome Trust & WHO (2008) Sharing Public Health Data: a code of conduct. Paper presented at 2008 conference on global health research in Bamako, Mali.
  • WHO (2009) WHO Working Group on HIV Incidence. (http://www.who.int/diagnostics_laboratory/links/hiv_incidence_assay/en/index1.html) (accessed 10 September 2009).
  • Wringe A, Cremin I, Herbst K et al. (2009) A comparative assessment of the quality of age at event reporting in three HIV cohort studies in sub-Saharan Africa. Sexually transmitted infections 85, i56i63.
  • Zaba B, Todd J & Biraro S et al. . (2008) ALPHA Network. Diverse Age Patterns of HIV Incidence Rates in Africa. Abstract TUAC0201, XVII International AIDS Conference, Mexico, August 2008.