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Archive for the ‘HIV/TB DC Briefing’ Category

In this video, Mark Harrington, executive director of the Treatment Action Group, discusses the resources needed to “catch up” with the HIV epidemic and the urgency of expanding treatment to save lives. Harrington explains this pressing need in the context of a shift in US global health policy and the global economic recession.

Harrington spoke at an event in Washington last week, “Changing Course: Stemming the Deadly Twin Epidemics of HIV and Tuberculosis,”  where more than 100 HIV and TB scientists, policymakers, and advocates have come together  to discuss the future of US global health policy and potential new scientific breakthroughs in the battles against HIV and TB.

You can find out more about his talk and other presentations at our online press room here.

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In this video interview, Dr. Rochelle Walensky, an associate professor of medicine at Harvard Medical School and an expert in epidemiology and outcomes research, discusses the need to scale up HIV testing and link those who test positive to appropriate care. She also talks about a new avenue to reach men who may be infected with the virus.

Dr. Walensky spoke at an event in Washington last week, “Changing Course: Stemming the Deadly Twin Epidemics of HIV and Tuberculosis,”  where more than 100 HIV and TB scientists, policymakers, and advocates have come together  to discuss the future of US global health policy and potential new scientific breakthroughs in the battles against HIV and TB.

You can find out more about Dr. Walensky’s presentation here and get more info about the event here.

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As the Obama Administration takes PEPFAR into its next phase, one of the hottest new buzzwords has been “country ownership.” Dr. Eric Goosby, Obama’s Global AIDS Ambassador, and other staff at the Office of the Global AIDS Coordinator have used this term repeatedly over the last year to describe their efforts to make PEPFAR a more sustainable program.

But many HIV advocates fear that what they mean by “country ownership” is really transferring the responsibility and leadership of PEPFAR-country programs too quickly to developing country ministries of health, many of which are ill-equipped to take on the financial, technical or medical aspects of these incredibly successful HIV treatment and prevention initiatives.

In this video, Dr. Wafaa El-Sadr, director of the International Center for AIDS Care and Treatment Programs and professor of medicine and epidemiology at Columbia University’s Mailman School of Public Health, offers her perspective on this very important debate.

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Dr. Rochelle Walensky, an associate professor of medicine at Harvard Medical School and an expert in epidemiology and outcomes research, took on two of the most contentious issues in the current debate about HIV treatment scale up: Can we afford it? And why shouldn’t we shift attention to other global health priorities, such as maternal and child health.

Dr. Walensky began her talk by noting that literally millions of lives are at stake if HIV testing and treatment uptake is not ratcheted up at the promised pace. As it is, she said, most patients in sub-Saharan Africa and other parts of the developing world do not access treatment until very late, when they are already have extremely low CD4 counts and are very ill.

Referring to the recent change in WHO guidelines to initiate ART earlier, especially where TB is rampant, Dr. Walensky pointed to an analysis that she and others did showing the impact of such a move would avert more than a quarter of a million deaths and more than 200,000 opportunistic infections, including TB infections.

In another analysis, she and others looked at ART scale up over a five year period, from 2007 to 2012. They determined that if there was zero growth in ART access, that would result in 2.4 million AIDS-related deaths in South Africa alone over five years. Rapid growth in treatment rollout, by contrast, would mean another 1.2 million people alive over that period. In 2010, halfway through her timeline, she noted, scale up is somewhere between zero growth and constant growth, a level that would lead to 2.16 million deaths.

On the hot-button issue of “cost-effectiveness,” Dr. Walensky noted that routine HIV screening, access to lifesaving drugs in resource-limited settings, and earlier initiative of ART would all save vast amounts of money in the long term and are extremely cost effective.

As for a shift in US global health priorities away from AIDS and toward child and maternal health, Dr. Walensky said “detection and treatment of HIV is at the very core” of child and maternal health and there “should be nothing contentious about these synergistic health goals.” Access to HIV treatment means prevention of mother-to-child HIV transmission, so babies are born HIV free. It also allows for safe breastfeeding, which in turn reduces the likelihood of childhood diarrhea, which is associated with contaminated water used in formula feeding. And, she said, “it keeps mothers alive,” preventing orphanhood and their associated ten-fold risk of death.

In conclusion, she said, “the lifesaving benefits of ART in HIV disease are greater than virtually any other adult disease.” And these benefits can be significantly increased through wider access to HIV testing and diagnosis, earlier access to HIV treatment, and improved drugs.

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Thank you for following our live blog today. All the materials from today’s event will be archived in the online press room.  (Update: The speakers’ PowerPoints are now available.) We have a few more video interviews to post later today, so stay tuned.

We learned from our distinguished panelists that we are on the cusp of exciting new breakthroughs in HIV prevention that could really slow the spread of this devastating epidemic, including PreP. But due to flat funding for PEPFAR and the economic recession, we face a new crisis in HIV treatment access.

We were alerted that there is more TB in the world today than ever before, and yet the Obama Administration is backing away from aggressive treatment targets approved by Congress in 2008 as part of the Lantos-Hyde Act. . Similarly with TB, there are exciting new diagnostics and drugs in the pipeline that could revolutionize TB treatment. But without adequate funding or investment to implement those, prospects for providing treatment will diminish. This will cost much more, in dollars and in lives, down the line.

Brown Professor Kenneth Mayer urged advocates to think of new ways to ramp up support and enthusiasm. He called for a sense of urgency going forward. In  June, Congress will be considering appropriations for the Obama Administrations’ budget request. The lives of millions of parents, children, health care workers, teachers, and many others are at stake.

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Lisan L. Parker, Ph.D, the Scientific Liason to the Stop TB Partnership at the TB Alliance, asked about the absence of children from TB trials. I caught up with her after the event, and she let me know about this website, which has the latest data on TB drugs in the pipeline. The Stop TB Partnership also has a blog on new developments in TB.

Dr. Burman responded to her question and acknowledged the grave consequences of children being left out of TB trials. Children are a “reservoir for infecting adults,” he said – and there are no child-friendly formulations even in the United States.

When the regimens we use today were developed, there were no children included in the clinical trials, he said.  There was an assumption that children could be treated just as adults, based on their weight.  But that was wrong.

“We have been under-dosing children for the last 40 years,” Burman said. “That’s what happens when you don’t include children in drug testing.”

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Fauci was asked by a reporter from Voice of America about the implications of reduced funding for the PEPfAR program on global health and whether it would lead to people being turned away from clinics and people dying.

“There are no resources in the world right now that will treat every single person who needs to be treated. The demand far exceeds the resources.” Fauci said PEPfAR has had  a major impact but much more needs to be done. “I am totally in favor of universal access for everyone who needs therapy but that isn’t going to happen with current resources. To deny there is a problem is unrealistic.”

Fauci also challenged those who say PepFar has been flatlined.  “Pepfar has not been cut. The increase from year to year has not been as steep as the slope has been but it has been incorporated into a much broader global health initiative. We are living in a resource limited situation.”

But patient activist Mark Harrington of the Treatment Action Group disagreed, saying White House funding for HIV and TB right now is “grossly insufficient.”

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