Phylogenetic analysis of Trypanosoma vivax supports the separation of South American/West African from East African isolates and a new T-vivax-like genotype infecting a nyala antelope from Mozambique

In this study, we addressed the phylogenetic and taxonomic relationships of Trypanosoma vivax and related trypanosomes nested in the subgenus Duttonella through combined morphological and phylogeographical analyses. We previously demonstrated that the clade T. vivax harbours a homogeneous clade comprising West African/South American isolates and the heterogeneous East African isolates. Herein we characterized a trypanosome isolated from a nyala antelope (Tragelaphus angasi) wild-caught in Mozambique (East Africa) and diagnosed as T. vivax-like based on biological, morphological and molecular data. Phylogenetic relationships, phylogeographical patterns and estimates of genetic divergence were based on SSU and ITS rDNA sequences of T. vivax from Brazil and Venezuela (South America), Nigeria (West Africa), and from T. vivax-like trypanosomes from Mozambique, Kenya and Tanzania (East Africa). Despite being well-supported within the T. vivax clade, the nyala trypanosome was highly divergent from all other T. vivax and T. vivax-like trypanosomes, even those from East Africa. Considering its host origin, morphological features, behaviour in experimentally infected goats, phylogenetic placement, and genetic divergence this isolate represents a new genotype of trypanosome closely phylogenetically related to T. vivax. This study corroborated the high complexity and the existence of distinct genotypes yet undescribed within the subgenus Duttonella.

Dust and smoke transport from Africa to South America: Lidar profiling over Cape Verde and the Amazon rainforest

Quasi-simultaneous vertically resolved multiwavelength aerosol Raman lidar observations were conducted in the near field (Praia, Cape Verde, 15 degrees N, 23.5 degrees W) and in the far field (Manaus, Amazon basin, Brazil, 2.5 degrees S, 60 degrees W) of the long-range transport regime between West Africa and South America. Based on a unique data set (case study) of spectrally resolved backscatter and extinction coefficients, and of the depolarization ratio a detailed characterization of aerosol properties, vertical stratification, mixing, and aging behavior during the long-distance travel in February 2008 (dry season in western Africa, wet season in the Amazon basin) is presented. While highly stratified aerosol layers of dust and smoke up to 5.5 km height were found close to Africa, the aerosol over Manaus was almost well-mixed, reached up to 3.5 km, and mainly consisted of aged biomass burning smoke. Citation: Ansmann, A., H. Baars, M. Tesche, D. Muller, D. Althausen, R. Engelmann, T. Pauliquevis, and P. Artaxo (2009), Dust and smoke transport from Africa to South America: Lidar profiling over Cape Verde and the Amazon rainforest, Geophys. Res. Lett., 36, L11802, doi: 10.1029/2009GL037923.

Evidence for Neoproterozoic continental arc magmatism in the Santa Quitéria Batholith of Ceará State, NW Borborema Province, NE Brazil: Implications for the assembly of West Gondwana

Recent field investigations and geochronological studies of Neoproterozoic rocks in the northwestern part of the Borborema Province, Ceará State, NE Brazil provide important clues pertaining to the nature of convergence between the Borborema Province and the West African-São Luis craton during the assembly of West Gondwana. U-Pb zircon data indicate that the earliest evidence of convergent magmatism along the northwest margin of the Borborema Province occurred around 777 Ma, and was followed by the development of a large continental arc batholith (Santa Quitéria batholith) between ca. 665 and 591 Ma within the central part of Ceará State. These findings, along with supporting geophysical data, suggest that convergence between the Borborema Province and the West African-São Luis craton involved closure of an oceanic realm with subduction polarity to the southeast beneath the northwestern part of the province. Consequently, it seems likely that the Pharusian Ocean was continuous from the Hoggar Province in West Africa into South America during the late Neoproterozoic and additional data suggests that it may have even been connected with the Goianides Ocean of the Brasília Belt farther to the southwest.

The taxonomic and phylogenetic relationships of Trypanosoma vivax from South America and Africa

The taxonomic and phylogenetic relationships of Trypanosoma vivax are controversial. It is generally suggested that South American, and East and West African isolates could be classified as subspecies or species allied to T. vivax. This is the first phylogenetic study to compare South American isolates (Brazil and Venezuela) with West/East African T. vivax isolates. Phylogeny using ribosomal sequences positioned all T. vivax isolates tightly together on the periphery of the clade containing all Salivarian trypanosomes. The same branching of isolates within T. vivax clade was observed in all inferred phylogenies using different data sets of sequences (SSU, SSU plus 5.8S or whole ITS rDNA). T. vivax from Brazil, Venezuela and West Africa (Nigeria) were closely related corroborating the West African origin of South American T. vivax, whereas a large genetic distance separated these isolates from the East African isolate (Kenya) analysed. Brazilian isolates from cattle asymptomatic or showing distinct pathology were highly homogeneous. This study did not disclose significant polymorphism to separate West African and South American isolates into different species/subspecies and indicate that the complexity of T. vivax in Africa and of the whole subgenus Trypanosoma (Duttonella) might be higher than previously believed. © 2006 Cambridge University Press.

Origin of the hemoglobin S gene in a northern Brazilian population: the combined effects of slave trade and internal migrations

Com o objetivo de investigar a origem da mutação bS na população da região norte do Brasil, foram analisados polimorfismos de DNA no complexo de genes b da hemoglobina em 30 pacientes com anemia falciforme na população de Belém, a capital do Estado do Pará. Sessenta e sete por cento dos cromossomos bS analisados apresentaram o haplótipo Bantu, 30% o haplótipo Benin e 3% o haplótipo Senegal. A origem da mutação bS na população de Belém, estimada de acordo com a distribuição de haplótipos, não está de acordo com a esperada com base em dados históricos sobre o tráfico de escravos para a região norte, os quais indicam uma reduzida contribuição de escravos da região do Benin. Essas diferenças podem ser atribuídas ao tráfico interno de escravos, bem como ao posterior fluxo de populações imigrantes, particularmente de nordestinos. A distribuição de haplótipos em Belém não difere significativamente da observada em outras regiões brasileiras, muito embora os dados históricos sugiram que a maioria dos escravos procedentes da região do Atlântico-Oeste africano, onde predomina o haplótipo Senegal, foi trazida para o norte do Brasil, enquanto que o nordeste (Bahia, Pernambuco e Maranhão) recebeu o maior contingente de escravos oriundos da região centro-oeste africana, onde o haplótipo Benin é o mais comum. Nós sugerimos que as diferenças regionais quanto à procedência dos escravos africanos também foram modificadas pelo tráfico de escravos estabelecido entre as diferentes regiões brasileiras e posteriormente pelos movimentos migratórios.

Phylogeography of Rift Valley Fever Virus in Africa Reveals Multiple Introductions in Senegal and Mauritania

Rift Valley Fever (RVF) virus (Family Bunyaviridae) is an arthropod-borne RNA virus that infects primarily domestic ruminants and occasionally humans. RVF epizootics are characterized by numerous abortions and mortality among young animals. In humans, the illness is usually characterized by a mild self-limited febrile illness, which could progress to more serious complications. RVF virus is widespread and endemic in many regions of Africa. In Western Africa, several outbreaks have been reported since 1987 when the first major one occurred at the frontier of Senegal and Mauritania. Aiming to evaluate the spreading and molecular epidemiology in these countries, RVFV isolates from 1944 to 2008 obtained from 18 localities in Senegal and Mauritania and 15 other countries were investigated. Our results suggest that a more intense viral activity possibly took place during the last century compared to the recent past and that at least 5 introductions of RVFV took place in Senegal and Mauritania from distant African regions. Moreover, Barkedji in Senegal was possibly a hub associated with the three distinct entries of RVFV in West Africa.

In vitro activity of extracts and isolated polyphenols from West African medicinal plants against Plasmodium falciparum

The aim of the study was to screen 11 selected traditional medicinal plants from West Africa for their in vitro antiplasmodial activity in order to determine the activity of single and of combination of plant extracts and to examine the activity of isolated pure compounds. Ethanolic and aqueous extracts of the 11 selected plants and pure compounds from Phyllanthus muellerianus and Anogeissus leiocarpus were tested in vitro against Plasmodium falciparum 3D7. Proliferation inhibitory effects were monitored after 48 h. Among the plants and pure compounds investigated in this study, geraniin from P. muellerianus, ellagic, gentisic, and gallic acids from A. leiocarpus, and extracts from A. leiocarpus, P. muellerianus and combination of A. leiocarpus with P. muellerianus affected the proliferation of P. falciparum most potently. Significant inhibitory activity was observed in combination of A. leiocarpus with P. muellerianus (IC50 = 10.8 mu g/ml), in combination of A. leiocarpus with Khaya senegalensis (IC50 = 12.5 mu g/ml), ellagic acid (IC50 = 2.88 mu M), and geraniin (IC50 = 11.74 mu M). In general growth inhibition was concentration-dependent revealing IC50 values ranging between 10.8 and -40.1 mu g/ml and 2.88 and 11.74 mu M for plant extracts and pure substances respectively. Comparison with literature sources of in vivo and in vitro toxicity data revealed that thresholds are up to two times higher than the determined IC50 values. Thus, the present study suggests that geraniin from P. muellerianus; ellagic acid, gallic acid, and gentisic acid from A. leiocarpus; and combination of extracts from A. leiocarpus with either P. muellerianus or K. senegalensis could be a potential option for malaria treatment.

The role of the West African Monsoon in the tropical to mid-latitudes climate

The interaction between atmosphere–land–ocean–biosphere systems plays a prominent role on the atmospheric dynamics and on the convective rainfall distribution over the West Africa monsoon area during the boreal summer. In particular, the initialization of convective systems in the Sub – Sahelian region has been directly linked to soil moisture heterogeneities identified as the major triggering, development and propagation of convective systems. The present study aims at investigating African monsoon large scale convective dynamics and rainfall diurnal cycle through an exploration of the hypothesis behind the mechanisms of a monsoon phenomenon as an emergence of a collective dynamics of many propagating convective systems. Such hypothesis is based on the existence of an internal self – regulation mechanism among the various components. To achieve these results a multiple analysis was performed based on remote sensed rainfall dataset, and global and regional modelling data for a period of 5 seasons: 2004 - 2008. Satellite rainfall data and convective occurrence variability were studied for assessing typical spatio – temporal signatures and characteristics with an emphasis to the diurnal cycle footprint. A global model and regional model simulation datasets, specifically developed for this analysis and based on Regional Atmospheric Modelling System – RAMS, have been analysed. Results from numerical model datasets highlight the evidence of a synchronization between the destabilization of the convective boundary layer and rainfall occurrence due to the solar radiation forcing through the latent heat release. This supports the conclusion that the studied interacting systems are associated with a process of mutual adjustment of rhythms. Furthermore, this rainfall internal coherence was studied in relation to the West African Heat Low pressure system, which has a prominent role in the large scale summer variability over the Mediterranean area since it is acting as one of dynamic link between sub tropical and midlatitudes variability.

Friend of the police: Polizei in Nord-Ghana (Upper West Region) /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 93

Korruption, Gewalt, Machtmissbrauch – im medialen, aber auch im wissenschaftlichen Diskurs wird die afrikanische Polizei oft als dysfunktionale staatliche Institution dargestellt. Dabei erscheinen Polizisten und zivile Akteure als klar voneinander abgegrenzte Akteursgruppen, wobei die Polizisten einseitig das staatliche Gewaltmonopol durchsetzen. Ein Blick auf den Alltag polizeilichen Handelns in Nordghana eröffnet jedoch eine andere Perspektive: Wegen der niedrigen Legitimität, konkurrierenden alternativen Rechtsinstanzen und den Widersprüchen innerhalb ihrer Institution sind Polizisten mit massiven Unsicherheiten konfrontiert. Ihre Praktiken können als situative Anpassungen der Polizeiarbeit an dieses Umfeld verstanden werden. Dabei übertragen Polizisten oft Kernaufgaben ihrer Institution an zivile Akteure, die sogenannten „friends of the police“. Auch zivile Akteure verfügen jedoch durch physischen Widerstand, Beziehungen, Status und Geld über beträchtliche Beeinflussungsmöglichkeiten. Die öffentliche Ordnung ergibt sich erst aus den Verhandlungen zwischen den Polizisten und unterschiedlichen zivilen Akteuren unter Einbeziehung ihrer sozialen Ressourcen und moralischer Vorstellungen.

Heiltraditionen und Biodiversität: Die traditionelle Medizin der Baatombu Nordbenins

Im Zentrum der vorliegenden Untersuchung steht die Nutzung von Medizinalpflanzen vor dem Hintergrund einer zurückgehenden Phytodiversität in Nordbenin. Die Dissertation ba-siert auf ethnologischen Forschungen, die in das interdisziplinäre Forschungsprojekt BIOTA (Biodiversity Monitoring Transect Analysis in Africa) eingebunden sind. Das BIOTA-Projekt untersucht die Wirkung menschlichen Handelns (insbesondere Nutzung) auf die Biodiversi-tät und versucht aus diesen Erkenntnissen Maßnahmen zum Erhalt der biologischen Vielfalt abzuleiten. Die vorliegende Studie basiert auf einem 13-monatigen Feldforschungsaufenthalt im Zeitraum von April 2004 bis August 2006 in der nordbeninischen Gemeinde Ouassa-Pehunco. Meine Informanten sind überwiegend traditionelle Heiler, mit denen ich standardi-sierte und offene Interviews durchführte, deren Behandlungsverfahren und Heilzeremonien ich teilnehmend beobachtete sowie dokumentierte und auf deren Initiative hin ich mich bei dem Aufbau eines Medizinalpflanzengartens einbrachte (cf. Kap. 1). In diesem Forschungsfeld situiere ich mich mit der Frage nach dem Einfluss einer verän-derten Pflanzenvielfalt auf die traditionelle medizinische Versorgung der Baatombu Nordbe-nins. Die Beantwortung dieser Frage erfolgt in mehreren Schritten. 1. Die Phytodiversität nimmt, wie von naturwissenschaftlicher Seite bestätigt, in der Region ab. 2. Lokale Heilkun-dige nehmen diesen Rückgang an verfügbaren Heilpflanzen ebenso wahr. 3. Die Abnahme der Pflanzenbestände führen die Heiler vor allem auf den Baumwollanbau und die demogra-fischen Entwicklungen der Region zurück - dies entspricht ebenfalls den Auffassungen von Naturwissenschaftlern, die eine Verdichtung der landwirtschaftlichen Bodennutzung fest-stellten. 4. Heilkundige und Heilpflanzenverkäuferinnen vermerken eine zunehmende Nach-frage nach lokaler Pflanzenmedizin aufgrund der steigenden Bevölkerungszahlen. 5. Die pflanzenbasierte Gesundheitsversorgung der lokalen Bevölkerung ist jedoch relativ gesi-chert, da die Heiler sich alternativ wirkender Medizinalpflanzen bedienen, ihre Therapiefor-men der veränderten Lage anpassen (z.B. geringere Dosierungen) und sie regelmäßig genutz-te Pflanzen im Medizinalpflanzengarten Guson wieder anpflanzen. Ein wichtiger Aspekt der Arbeit ist, dass die Heilpraktiken der Baatombu nicht allein auf naturheilkundlichem Erfahrungswissen beruhen, sondern in magisch-religiöse Vorstellungen eingebettet sind (cf. Kap. 2). Demzufolge untersuche ich die lokalen Krankheits- und Ge-sundheitsvorstellungen und die symbolischen Klassifikationen von Heilpflanzen und Krank-heiten (cf. Kap. 3). Ich stellte fest, dass nach Auffassung von Heilkundigen soziokulturelle Faktoren wie der Zeitpunkt und der Ort einer Sammlung sowie entsprechende Ernte-Rituale die medizinische Wirksamkeit von Pflanzen maßgeblich bedingen (cf. Kap. 5). Die Umwelt-klassifikation der Heiler (Landschafts- und Vegetationstypen) richtet sich demzufolge nach dem medizinischen Wert, den sie einer Heilpflanze zuschreiben (cf. Kap.4). Basierend auf diesen Erkenntnissen wurde von einigen engagierten Heilern und mit Un-terstützung von BIOTA, der GTZ und der Deutschen Botschaft der Medizinalpflanzengarten Guson eingerichtet, der eine Antwort auf die regionale Ressourcenverknappung darstellt und in seiner Anlage dem lokalen ökologischen und heilkundlichen Wissen der Heiler entspricht (cf. Kap. 6). Den Anwendungsbezug der Forschung nutzten die Heiler, um sich als Interes-sensgemeinschaft für den Erhalt der benötigten pflanzlichen Ressourcen einzusetzen.

Correcting mortality for loss to follow-up: a nomogram applied to antiretroviral treatment programmes in sub-Saharan Africa

Background The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. Methods and Findings We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in a treatment programme is a weighted average of mortality among patients lost to follow-up and patients remaining in care. The nomogram gives a correction factor based on the percentage of patients lost to follow-up at a given point in time, and the estimated ratio of mortality between patients lost and not lost to follow-up. The mortality observed among patients retained in care is then multiplied by the correction factor to obtain an estimate of programme-level mortality that takes all deaths into account. A web calculator directly calculates the corrected, programme-level mortality with 95% confidence intervals (CIs). We applied the method to 11 ART programmes in sub-Saharan Africa. Patients retained in care had a mortality at 1 year of 1.4% to 12.0%; loss to follow-up ranged from 2.8% to 28.7%; and the correction factor from 1.2 to 8.0. The absolute difference between uncorrected and corrected mortality at 1 year ranged from 1.6% to 9.8%, and was above 5% in four programmes. The largest difference in mortality was in a programme with 28.7% of patients lost to follow-up at 1 year. Conclusions The amount of bias in mortality estimates can be large in ART programmes with substantial loss to follow-up. Programmes should routinely report mortality among patients retained in care and the proportion of patients lost. A simple nomogram can then be used to estimate mortality among all patients who started ART, for a range of plausible mortality rates among patients lost to follow-up.

BIVARIATE BINOMIAL SPATIAL MODELLING LOA loa PREVALENCE IN TROPICAL AFRICA

We present a state-of-the-art application of smoothing for dependent bivariate binomial spatial data to Loa loa prevalence mapping in West Africa. This application is special because it starts with the non-spatial calibration of survey instruments, continues with the spatial model building and assessment and ends with robust, tested software that will be used by the field scientists of the World Health Organization for online prevalence map updating. From a statistical perspective several important methodological issues were addressed: (a) building spatial models that are complex enough to capture the structure of the data but remain computationally usable; (b)reducing the computational burden in the handling of very large covariate data sets; (c) devising methods for comparing spatial prediction methods for a given exceedance policy threshold.

UNDERSTANDING FARMERS’ PERCEPTIONS AND THE EFFECTS OF SHEA TREE Vitellaria paradoxa DISTRIBUTION IN AGROFORESTRY PARKLANDS OF THE UPPER WEST REGION, GHANA

Agroforestry parklands represent a vast majority of the agricultural landscape under subsistent-oriented farming in semi-arid West Africa. Parklands are characterized by the growth of well- maintained trees (e.g., shea) on cultivated fields as a result of both environmental and human influences. Shea (Vitellaria paradoxa) provides a cultural and economic benefit to the local people of Ghana, especially women. Periods between traditional fallow rotation systems have reduced recently due to agricultural development and a demand for higher production. As a result, shea trees, which regenerate during fallow periods, has decreased over the landscape. The aim of this study was to determine beneficial spatial distributions of V. paradoxa to maintain high yields of staple crops, and how management of V. paradoxa will differ between male and female farmers as a result of farmer based needs and use of shea. Vegetation growth and grain yield of maize (Zea mays) associated with individual trees, clumped trees, and open fields were measured. Soil moisture and light availability were also measured to determine how V. paradoxa affected resource availability of maize in either clumped or scattered distributions of V. paradoxa. As expected, light availability increased as measurement locations moved farther away from all trees. However, soil moisture was actually greater under trees in clumps than under individual trees. Maize stalk height and cob length showed no difference between clumped and single trees at each measurement location. Grain yield per plot and per cob increased as measurement locations moved farther from single trees, but was actually greater near clumped trees that in the open field subplots. Cob length and maize stalk height increased with greater light availability, but grain yield per cob or per plot showed no relationship with light, but were not affected by soil moisture. Conversely, grain yield increased with increasing soil moisture, but had no relationship with light availability. Initial farming capital is the largest constraint to female farmers; therefore the collection of shea can help provide women with added income that could meet their specific farming needs. Our data indicate that overall effects of maintaining clumped distributions of V. paradoxa provided beneficial microclimates for staple crops when compared to single trees. It is recommended that male and female farmers allow shea to grow in clumped spatial distributions rather than maintaining scattered, individual trees.

A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa--the International epidemiologic Databases to Evaluate AIDS (IeDEA)

INTRODUCTION There are limited data on paediatric HIV care and treatment programmes in low-resource settings. METHODS A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). RESULTS A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult-paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4-6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. CONCLUSIONS In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

INTRODUCTION HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.