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useful quantitative and qualitative measurements. Miller and colleagues’ discussion of metrics based on qualitative viral load measurements was limited to viral suppression among all people irrespective of their HIV status. 2 Although this indicator does gauge overall risk of HIV transmission, it does not specifically capture how well programmes engage people who already live with HIV along the continuum of care. For example, programmes in concentrated epidemics could achieve the same proportion as programmes in generalised epidemics because of differences in HIV prevalence rather than differences in programme effectiveness. In this respect, the inclusion of patients eligible for antiretroviral therapy in the denominator for measuring programme performance will be an important global consideration. Reliably estimating the number of people living with HIV is complex. It involves estimating the prevalence, incidence, testing coverage, and the proportion of people who might have been missed using standard testing algorithms.4 This estimation is particularly difficult in concentrated and low-level epidemics. Nonetheless, most countries are already estimating the number of people with HIV as part of national strategic information.5 A new consolidated monitoring and evaluation method is being developed by WHO and partners to standardise the collection, analysis, and interpretation of data along the continuum of care. Discussions will consider epidemic type, health infrastructures, available human resources, and strengths and weaknesses of different indicators. Estimating the proportion of people eligible for ART who have achieved viral suppression may merit discussion from countries and policy makers as one of the indicators of programme scale and performance. In settings where all people with HIV are eligible for treatment, this proportion might also be useful when estimating the www.thelancet.com/infection Vol 14 January 2014
population-level effectiveness of antiretroviral therapy on disease mortality and incidence. We declare that we have no conflicts of interest.
Amitabh B Suthar, Jesus M Garcia Calleja, *Gundo A Weiler
[email protected] Department of HIV/AIDS, WHO, Geneva 27, CH-1211, Switzerland 1
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WHO. The use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. http://www.who.int/hiv/pub/guidelines/ arv2013/ (accessed June 30, 2013). Miller WC, Powers KA, Smith MK, Cohen MS. Community viral load as a measure for assessment of HIV treatment as prevention. Lancet Infect Dis 2013; 13: 459–64. UNITAID. HIV/AIDS diagnostics technology landscape: 3rd edn. http://www.unitaid.org/ images/marketdynamics/publications/ UNITAID-HIV_Diagnostic_Landscape-3rd_ edition.pdf (accessed Nov 30, 2013). WHO. Meeting report on framework for metrics to support effective as treatment as prevention. http://apps.who.int/iris/ bitstream/10665/75387/1/9789241504331_ eng.pdf (accessed April 24, 2013). Landis RC, Branch-Beckles SL, Crichlow S, Hambleton IR, Best A. Ten year trends in community HIV viral load in Barbados: implications for treatment as prevention. PLoS One 2013; 8: e58590.
A tribute to Professor Peter Martins Ndumbe I was among the hundreds of people who attended the burial ceremony of Professor Peter Martins Ndumbe on July 6, 2013, in his native Ofrikpabi village in the southwest region of Cameroon. Professor Ndumbe died on May 14 in South Africa after a long illness. He was a fine scientist of exceptional rigour and self-discipline, virtues which propelled him to the pinnacle of scientific distinction as a professor of medicine, an infectious disease and public health specialist, and a research microbiologist and virologist. As Dean of the Faculty of Medicine and Biomedical Sciences of the University of Yaounde I, Dean of the Faculty of Health Sciences of the University of Buea in Cameroon, and most recently as programme manager (research, publications, and library services) at
WHO’s Regional Office for Africa in Brazzaville, Republic of Congo, Professor Ndumbe has left an enduring legacy of landmark contributions in the fight against diseases of poverty in Africa. Peter Ndumbe was a member of several national and international professional and academic societies. He was a member of the Scientific and Technical Advisory Committee of UNICEF, the UN Development Programme, the World Bank, and the WHO Special Programme for Research and Training in Tropical Diseases. He was a founding member and chair of the Task Force on Immunisation for the African Region since 2004, with the responsibility to seek out new vaccines against tuberculosis, malaria, and HIV. I first met Peter in 1991 through my mentor Professor Jonathan Mann at Harvard University. We then met again during several international gatherings including the meetings of the alumni of the London School of Hygiene and Tropical Medicine, and later in 2004 as a junior colleague during his tenure as Dean of the Faculty of Medicine and Biomedical Sciences of the University of Yaounde I. Needless to say that, as with many of the people he mentored, he was instrumental in my direct appointment as a senior lecturer in the Department of Medical Microbiology and Infectious Diseases, and later to the rank of professor. Peter was a doctor who genuinely cared for and listened to the needs of vulnerable patients, particularly women and children in Africa. There is no doubt that Africa has lost one of its intellectual giants. Peter is survived by two children, many family members, and hordes of friends in the world of science, medicine, and academia who will mourn him.
For the tribute website created by friends and family see http://www.peterndumbe.lastmemories.com
I declare that I have no conflicts of interest.
François-Xavier Mbopi-Kéou
[email protected] International Society for Infectious Diseases, Brookline, MA, USA, and Ministry of Public Health and Faculty of Medicine & Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
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