Phylogenetics And Networks for Generalised HIV Epidemics in Africa


Africa Centre

The Africa Centre for Health and Population Studies (AC) was formed in 1998 with funding from the Wellcome Trust and support from the University of KwaZulu-Natal (UKZN) and the South African Medical Research Council (MRC). The Centre’s Governance Committee is chaired by the UKZN Deputy Vice-Chancellor Research and includes other senior managers from UKZN, the South African MRC, the local community and the Wellcome Trust. The Centre is in the process of partnering with University College London.

AC is based in northern rural KwaZulu-Natal (KZN).  The study area is located near the town of Mtubatuba in uMkhanyakude and consists of approximately 90,000 Zulu-speaking people living in 11,000 homesteads in a 435 km2 demographic surveillance area. AC’s research is embedded within the population, from where we link with health care use and access.

Our setting is one of extremely high HIV prevalence and incidence; hence we move from the community to the clinical rather than the reverse, which sets us apart from programmes elsewhere which are facility-based, with catchment population surveys when required for specific purposes. The Centre’s research draws on two important structural resources: household surveillance, with extensive GIS location information; and HIV and Health surveillance nested within the Household-based demographic surveillance. 

In addition a mutually beneficial partnership exists with the local Department of Health (DoH) in the HIV Treatment and Care Programme across the Hlabisa sub-district, which since 2004 has facilitated our presence in the 17 primary health care clinics and the district hospital and allowed an expanding clinical research agenda with the establishment of clinical cohorts.

The laboratory research is based at the Nelson Mandela Medical School at the UKZN, in Durban, which is developing a state of the art genomics laboratory to explore genetic susceptibility to disease, and how pathogens such as HIV and TB are transmitted.

The research is led by Programme Directors, covering Health Systems Research, Epidemiology Research, Genomics, and Clinical Research, with other senior, mid-career and junior scientists pursuing their careers within this structure. A major strength of AC lies in the interactions between scientific disciplines and the true multi-disciplinary nature of all our research. 

Over the last decade, the comprehensive longitudinal data generated from the AC surveillance has  been  extensively  used  to  provide empirical evidence on the demographic and social impact  of  the  HIV  epidemic  in  a  severely  affected, rural population. The partnership between AC and the DoH in the delivery of the HIV Treatment and Care Programme has allowed the evaluation of the impact of the programme at population level and informed understanding of clinical outcomes at individual level. We are now taking this research to the next level, informed by rapidly shifting priorities for the population, and health service.

AC aims to undertake world class research in pursuit of improved health for its local population, with relevance to providing global solutions.

We aim to address three overarching questions:

1. Can HIV be eliminated from the population, and if not, why not?

2. How best to minimize morbidity and mortality from HIV related disease, including TB?

3. How best can the health service manage the epidemiological transmission to non-communicable diseases?

Our research is characterised by interdisciplinary engagement that includes social and behavioural science, health economics and systems research, as well as clinical and biological approaches. Importantly, our questions are informed by the health need of the population, and we undertake this research in close collaboration with the local, provincial and national health structures.