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Archive for the ‘HIV/AIDS’ Category

The U.S. government is working to bridge the gap in funding needed to continue the encouraging CAPRISA vaginal microbicide research trial with a combination of funding from USG, the South African government and possibly private donors.

Sources say this is in response to a New York Times piece that ran on September 3 entitled “HIV Prevention Gel Hits Snag: Money.” In the article, author Celia Dugger reports that donors have only committed approximately $58 million of the $100 million needed to carry one of the two confirmatory studies from launch to completion.  

Researchers reported the CAPRISA 004 trial results at the 18th International AIDS Conference in Vienna in July. The South African study showed that of the nearly 900 women enrolled in the study, women who received one percent tenofovir gel had 39 percent fewer HIV infections compared to women who received the placebo gel.

Speeding the gel to widespread use is contingent upon the conclusions of this follow-up research. ScienceSpeaks has heard that donors are quickly rising to the occasion to fill the more than $40 million deficit.

According to Jeff Spieler, Senior Technical Advisor for Science and Technology at the United States Agency for International Development (USAID), they are hopeful that a major portion of that money is almost good to go. If Congress earmarks enough money for USAID in microbicide research and development in fiscal year 2011, USAID will commit $18 million over three years toward the confirmatory trial. The South African Department of Science and Technology will then put in $13.5 million, leaving the gap in funding of approximately $8.5 million.

“Hopefully other donors will fund that gap,” Spieler said.

Other encouraging news is that the U.S. Food and Drug Administration is likely to consider the microbicide gel arm of the Vaginal and Oral Interventions to Control the Epidemic (VOICE) trial as a CAPRISA confirmatory trial, according to Spieler.

One arm of the VOICE trial is looking at once-daily vaginal gel dosing of the same microbicide used in the CAPRISA trial. But unlike CAPRISA, the administration of the gel is not coitally dependent.

“If the women use the product correctly, then there is no reason to think women wouldn’t get the same or better results as those achieved in CAPRISA 004,” Spieler said.

The rub is in whether or not the trial participants consistently use the gel every day, regardless if they have sex or not.

The VOICE trial results should come out in the end of 2012 or early 2013.

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The Center for Global Development’s Nandini Oomman has a new report, “Zeroing In: AIDS Donors and Africa’s Health Workforce.” The report looks at how global AIDS’ donors have impacted the strength of the health workforce in Africa. CGD’s blog has both a post and audio “wonkcast” on the report.

Change.org’s Global Poverty Blog is doing a series on the Millennium Development Goals (MDGs) in advance of the upcoming summit in New York. They aim to “provide in-depth analysis of each of the MDGs, their progress and their shortcomings.”

The ONE blog is also starting their coverage of the UN Summit on the MDGs with a report on the power of women to (more…)

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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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Director of  The Center for Global Health Policy Christine Lubinski recalls her recent trip to South Africa and Zambia, where she and other Center staff hosted five congressional staff members on tours of U.S. government funded programs to address HIV and TB. 

Additional resources are essential to scale up prevention and treatment to ultimately reach the tipping point of the HIV epidemic in Zambia, said Dr. Jeff Stringer, director of the Center for Infectious Disease Research in Zambia (CIDRZ). And he said the Zambians are unprepared to manage their HIV program without substantial outside help—either programmatically or financially. 

Dr. Jeff Stringer, director of CIDRZ, speaks to a table full of congressional staffers visiting Zambia.

CIDRZ is a Zambian non-profit affiliated with the University of Alabama at Birmingham (UAB).  About 80 percent of their funding comes from the U.S. government—a combination of research and programmatic funds.  CIDRZ is a major provider of HIV care and treatment in Zambia through the support of 78 Ministry of Health sites that have enrolled more than one-quarter of a million people in ongoing care with almost 164,000 individuals on antiretroviral therapy (ART).  CIDRZ may be the largest single-country ART program supported by the President’s Emergency Plan for AIDS Relief anywhere.

But even after more than a decade in Zambia, Stringer argued it will be another decade before the government of Zambia can effectively manage their own HIV response, and even then they will not have the resources to pay for it without donor support.     (more…)

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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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