We did not identify age as a major factor
We did not identify age as a major factor shaping continuing HCV transmission and future seroprevalence. With every blood-borne disease, these epidemiological variables depend on how frequently individuals undergo medical procedures and the risk of acquiring HCV in each case. In our study, we used data to estimate the frequencies of undergoing medical procedures and assumed that these frequencies did not change substantially in the short term; we challenged this assumption in a field study of frequent injectors in a rural cohort. Advanced age was not a feature of frequent injectors; median age was 32 years (IQR 15–45) at baseline. A follow-up study showed that they maintained their injection practices for 8–10 years. Hence, evidence from field investigations supports our assumptions about frequent injectors. We did not validate our assumptions for the general population. Conceivably, individuals change their frequencies of undergoing medical procedures on the basis of age. However, these changes are not likely to substantially affect the frequency of HCV transmission, unless individuals are frequent injectors.
In conclusion, exclusion of bradykinin receptor antagonist is not a major limitation of our modelling work. Interventions that target the top 2–5% of frequent injectors seems like a feasible approach, would be much more effective at reducing R than would untargeted interventions, and would not depend on substantial increases in logistical and financial resources beyond those already deployed for the existing national strategy.
In 2010, published a landmark report on global health education, asserting that strengthening health care could be most effectively achieved by organisations working together in “networks, alliances, and consortia”. The report presented a compelling argument in favour of new medical schools. New schools are generally less encumbered by tradition and vested faculty interests than established ones, so they can be more agile at adapting to “rapidly changing local conditions drawing on global resources”. The Consortium of New Southern African Medical Schools (CONSAMS) was created by a group of new medical schools in southern Africa (in Namibia, Botswana, Zambia, Mozambique, and Lesotho, in conjunction with two facilitating northern partners in the USA and Finland) that sought to support each other through the sharing of faculty, resources, and innovative programmes. This article describes the challenges these new schools face and their opportunities for innovation that align with recommendations in report: curricula based on competencies derived from health-system needs and contexts; transformative learning and change agent advocacy; equitable medical school admissions policies that promote capacity-building and retention; accreditation standards appropriate to health-system needs; and interprofessional and transprofessional training to promote health-care strengthening.
Most universities and research institutions in sub-Saharan Africa are limited by inadequate resources and research expertise. The few appropriately qualified academics have a large teaching workload (in addition to a clinical workload in the case of clinicians). Additionally, young researchers who take up training opportunities overseas rarely return home because of a scarcity of career opportunities and incentives. The Southern Africa Consortium for Research Excellence (SACORE) aims to contribute to reversing labia majora trend by establishing a vibrant environment to support training and research in southern Africa. This goal was to be achieved by building a critical mass of Masters, PhD, and post-doctoral scientists, developing strong leadership in research, setting up attractive career pathways, and developing comprehensive research management and support systems. Here we share some of the initiative\'s early successes and challenges. SACORE is one of seven consortia funded under the Wellcome Trust African Institutions Initiative—a £30 million, 5-year initiative launched in 2009 and aimed at strengthening research capacity in sub-Saharan Africa. SACORE consists of three African universities (and their affiliated research institutes) with an emerging research environment (in Malawi, Zambia, and Zimbabwe; the low-income partners), three African institutions with established research environments (in South Africa and Botswana; the middle-income partners), and four UK universities with highly developed research environments (the high-income partners).