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Archive for the ‘HIV/AIDS TB co-infection’ Category

Eleven current and former Fogarty International and Doris Duke clinical research fellows made their way to Capitol Hill Thursday for congressional office visits with key legislators.

Four Fogarty fellows and the Center's Christine Lubinski meet with a staff member from the Senate Foreign Relations Committee.

The Center for Global Health Policy staff escorted the group to meetings with the offices of 15 policymakers. The fellows highlighted their research experience abroad through the Fogarty and Doris Duke programs, the first of which is funded through the National Institutes of Health, emphasizing the value of U.S. investment in global HIV and tuberculosis programs.

The Fogarty International and Doris Duke clinical research fellowships send medical students and young physicians with an interest in global health to sites in the developing world to perform a year of hands-on clinical research training. The U.S. fellows who participated in the Hill visits had spent their year abroad either in Uganda, South Africa, Thailand or Malawi. Their research projects ranged from monitoring antiretroviral treatment adherence among female South African patients with the use of text messaging and SMS, to evaluating treatment outcomes for Kaposi’s sarcoma patients undergoing combination chemotherapy for advanced or persistent disease in Malawi.

The Fogarty program, which started in 2003, uses what is called “twinning” to match the visiting U.S. scholars with in-country medical students and physicians, helping the fellows to integrate into the system more quickly.  Four foreign nationals joined in the day of Hill meetings. These fellows hailed from South Africa, Kenya, Zambia and Peru.

The scholars brought various issues to the table when meeting with legislators, like the linkages between HIV and cancer risks and the impact of HIV on maternal and child health.. They also spoke about the intrinsic value of international physician fellowship programs, which support U.S. foreign assistance by increasing the training of in-country physicians and building health infrastructure abroad. They also support the treatment and research education of U.S. doctors that take what they learn abroad and bring it back to improve patient care in the U.S., including a new awareness of how to treat refugees and new immigrants from other countries.

“These experiences broaden how doctors will approach patient care and the ethos of training,” said Doris Duke fellow Andrea Dean, a medical student at Brown University who spent her fellowship year in South Africa.

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The Center’s David Bryden describes a visit to the Bwafwano Community Home Based Care organization in Zambia during a recent Congressional delegate trip to Africa.

Children clap and sing as the congressional delegates arrive at the Bwafwano Program.

“Hello, hello! We welcome you to our school!” about 100 clapping children sang as our congressional study tour arrived at the Bwafwano Community Home Based Care organization, run by Executive Director Beatrice Chola. The Bwafwano program provides health and related services to children, including those living with HIV/AIDS. 

There followed a presentation of dancing and singing by a group of about 15 women who were part of the voluntary caregivers group that helps support the local children, a short speech by an HIV positive teenage girl about how she is persevering despite health challenges, and a presentation by Mrs. Chola about current successes and challenges.

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A new, automated nucleic acid–amplification test might take the time to diagnose TB infection, even a drug resistant strain, down to 90 minutes. That’s according to a study published in The New England Journal of Medicine Wednesday.

A Zambian clinical worker tests for TB using a sputum smear microscopy, which routinely misses about 50 percent of all TB cases.

The Xpert MTB/RIF tests for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), a powerful anti-TB drug. Trial researchers tested 1730 patients suspected of TB infection over a nine month period at four trial sites in Lima, Peru; Baku, Azerbaijan; Cape Town and Durbin, South Africa; and Mumbai, India. The test successfully identified 98 percent of all culture-confirmed TB cases, including more than 90 percent of those whose sputum smears tested negative for acid-fast bacilli. The Xpert also accurately detected more than 97 percent of patients with rifampin-resistant bacteria in less than two hours. 

The results were slightly less impressive for those who were HIV/TB coinfected, showing a 93.9 percent TB detection rate, compared with 98.4 percent in patients that were HIV-negative. In contrast, the most common means of testing for TB at present – the sputum smear microscopy – is not reliable among HIV positive patients.

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Throughout August, the ONE Blog had a series illustrating the impact of the Global Fund on programs that fight AIDS, tuberculosis, and malaria. The video accompanying this post comes from that series. ONE is running a campaign to ask President Obama to commit $6 billion to the Global Fund over the next 3 years.

Ken Mayer – co-chair of our Scientific Advisory Committee and occasional author on this blog – reviews ARV therapy as a method for HIV prevention in this month’s issue of the American Journal of Public Health. The study finds that the “life-saving agents” can be a key component of (more…)

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The Center’s Rabita Aziz describes a visit to Livingstone General Hospital’s antiretroviral therapy (ART) ward in Zambia during a recent Congressional delegate trip to Africa.

In a dark room so small and cramped that the door won’t even close, Ndabila Singango, a provincial clinical mentor employed by the Center for Infectious Disease Research of Zambia (CIDRZ), tests and counsels HIV/AIDS patients at the Livingstone General Hospital. The hospital, built more than 60 years ago and used only by white colonists before Zambia gained independence, is the only hospital in all of Southern Province, which has a population of 1.6 million. With an HIV prevalence rate of 30 percent in Livingstone, it is not surprising that 80 percent of admissions to the hospital are HIV-related.

Gertrude, an HIV positive mother with newborn twins, explained that the lesions on her face appeared two weeks ago.

The ART ward of the hospital sees an average of 70 patients daily, and provides ART to 3500. When we met one such patient, Gertrude, she was breastfeeding one of her three-month old twins while the other – strapped to her back – slept peacefully.

Gertrude learned that she was infected with HIV/AIDS three years ago when she felt ill and was advised to take an HIV test. She had not disclosed her HIV status to her husband as she feared reprisal from him and the community. Like many African women, Gertrude was unable to negotiate the terms of sex, and therefore did not use protection.

When she started ART in November of 2008, Gertrude’s CD4 count was at 129. Six months of therapy later, it rose to just 130. (more…)

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The One Blog this week posted a video (accompanies this post) from David Rochkind, an award-winning photographer working on a project to illustrate the impact of tuberculosis on the world. In the video, Mariana Bernofsky tells of her experiences as a pregnant woman with TB in Balti, Moldova. More of Rochkind’s work is available on his blog.

Sten Vermond, a member of our Scientific Advisory Committee, recently published a review in Clinical Infectious Diseases of two promising strategies for “treatment as prevention:” preexposure prophylaxis and “test and treat.” He and co-authors argue that the HIV epidemic can be controlled by maximizing the potential of these existing methods, developing new strategies for prevention, and then combining them effectively.

A new World Health Organization (WHO) recommendation that mothers who are HIV-positive and on ARV treatment can breastfeed their children for up to twelve months without passing on the infection has created confusion among (more…)

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The following is a guest posting from Joanna Breitstein of the TB Alliance, reporting from Addis Ababa, Ethiopia.

While there were few new TB treatment prospects a few years ago, today there are 10 drugs in the global development pipeline. Noting the sea of change, Wednesday’s Open Forum conference focus shifted from developing drugs to speeding them through development and to the patients that need them. “Having new treatments in and of itself is not enough to impact the TB epidemic,” said Dr. Mel Spigelman, CEO and President of the TB Alliance.

Dr. Mel Spigelman, CEO and President of the TB Alliance.

More than 160 regulators, scientists, National Treatment Program (NTP) managers, and other TB stakeholders gathered in Addis Ababa, Ethiopia, to attend the conference and address key issues in developing new drugs for treatment of TB. The two-day meeting was the fourth in a series on the subject, with a special focus on regulatory affairs.

A large focus of the meeting was the Critical Path to TB drug Regimens (CPTR), a new initiative that includes an innovative clinical design structure for TB drug trials, which enables researchers to test regimens instead of just individual compounds, offering the potential to dramatically shorten the drug development timetable.

“The CPTR approach will become the gold standard for rapid, safe, and effective testing and development of new TB drug combinations,” said Jan Gheuens, of the Bill & Melinda Gates Foundation. Researchers noted that there are already several new pre-clinical TB drug combinations in development that look more promising than the current standard of treatment.

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