Here at the Microbicides 2010 conference in Pittsburgh I got a chance to talk with Dr. Gita Ramjee, one of the top researchers in the field, about the most exciting scientific challenges being discussed at the meeting. Dr Ramjee is the Director of the HIV Prevention Research Unit at the South African Medical Research Council. She also explains in the interview why development of an effective microbicide for rectal use is so crucial, for both men and women in Africa, in particular given higher than expected rates of reported anal sex in several countries, as well as in many other regions of the world including the United States.
Posts Tagged ‘Africa’
He cited a need for increased support for maternal and child health, as well as a larger focus on women’s and girl’s development. Nations also need to develop capacity for health research and information systems. Most importantly, leaders need to make a renewed commitment to fighting the HIV epidemic, as well as use funds more efficiently.
This posting is by Rabita Aziz, Program Associate at the IDSA/HIVMA Global Center
The new report by the Center for Strategic and International Studies (CSIS) Commission on Smart Global Health Policy calls for the U.S. to double contributions to better maternal and child health, to $2 billion a year. Such investments should be focused on a few core countries in Africa and South Asia where there is a clear need, where partner governments are willingly engaged, and where concrete health gains can be made along with increasing a country’s capacities.
The report demonstrates that maternal mortality is a profound problem by offering this data: a woman’s risk of dying in pregnancy or childbirth is 1 in 7,300 in the industrialized world, 1 in 120 in Asia, and 1 in 22 in sub-Saharan Africa. Although there are clear preventative solutions in many of these cases, accessing such measures is problematic.
The report states that improving maternal mortality requires an interlinked set of interventions that are supported and sustained over time, including heightened efforts to improve local transport. In addition to addressing maternal mortality, it is imperative that efforts to end child and infant mortality are undertaken. The report states that it is estimated that a package of 16 simple and cost-effective measures could prevent nearly 3 million of the estimated 4 million deaths in the first month of life. Additionally, expanding access to immunizations can save the lives of 2 million children under the age of five.
Although the report clearly states that maintaining America’s commitment to fighting against HIV/AIDS is one element in a global health strategy, it fails to integrate this commitment within the framework of strengthening maternal and child health.
Globally, HIV/AIDS is the leading cause of death among women of reproductive age. When half of the 31.3 million people living with HIV worldwide are women, and 98 percent of them reside in developing countries, the importance of envisioning HIV/AIDS as a maternal and child health issue is clear. Integrating HIV/AIDS efforts within efforts to improve maternal and child health, and scaling them up, is key to a rights-based approach to health.
Among pregnant women in Johannesburg, South Africa’s most populous city, HIV is the main cause of death, according to a five-year study of maternal mortality at one of the city’s largest public hospitals
It is also important to recognize that HIV-negative children born to HIV-positive mothers still face high mortality risks as long as their mothers are not receiving treatment. A Ugandan study found that not only is there a 95% reduction in mortality among HIV infected adults after 16 weeks of antiretroviral treatment, but there is an 81% reduction in mortality in their uninfected children younger than 10, and an estimated 93% reduction in orphan hood.
Unfortunately, there is no mention in the report of undertaking initiatives to reduce the prevalence of HIV/AIDS among women and ensure access to treatment as a key maternal health strategy, even though it is clear that taking such measures will greatly strengthen families and communities. Prevention of mother to child transmission of HIV is imperative, as well as ensuring access to ongoing treatment for the mother.
 Mermin et al (2008) Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study Lancet 371: 752-759.
Posted in Budget, HIV/AIDS, tagged Africa, AIDS, appropriations, Botswana, CSIS, funding, global fund, HIV prevention, male circumcision, Obama, OGAC, PEPFAR, PMTCT, UNAIDS on January 26, 2010| 3 Comments »
Evaristo Marowa, UNAIDS Country Coordinator for Botswana, said today that major opportunities to prevent HIV, and save billions of dollars in the long run, will be missed if the US and the international community fail to increase AIDS funding for Botswana and other countries in southern and eastern Africa.
He made his comments in a presentation at the Global Health Council, where he also provided a powerpoint: Botswana HIV epi and responses. Dr. Marowa’s presentation comes as global AIDS advocates anxiously await next week’s release of President Obama’s budget proposal. His urgent warning about the danger of donors adopting a flat or near-flat funding approach provided an interesting counterpoint to last week’s CSIS publication on HIV prevention, which did not mention the need to increase funding in its recommendations to the US government.
Dr. Marowa is a physician with a specialty in dermatology and sexually transmitted infections (STIs). He trained at Universities in Harare, Kinshasa, Liverpool and London. Since September 2006, he has been the UNAIDS country coordinator in Botswana, and previously he worked in Tanzania, Zimbabwe, and Bangladesh.
HIV prevalence in Botswana has fallen in recent years from 38% to 24%, with declines seen particularly in young people. The country has had strong leadership on the issue at the highest levels, which Marowa called “visionary and committed.” Prevention of mother-to-child transmission has been “an astounding success,” with a transmission rate of about 4%. A large proportion of people have been tested for HIV, about 60 to 70%, and access to antiretroviral medications is also high at about 85%. PEPFAR has been a major support to these programs, providing about $90 million a year.
However, he said that a high degree of internal mobility in the population, multiple concurrent partnerships, low rates of male circumcision, low condom use, and high rates of gender-based violence, which form the basis for an ongoing HIV/AIDS crisis. Marowa also cited alcohol abuse as a contributing factor, an issue on which he said the current president was very active. (more…)
Dr. Luis Sambo, the WHO’s regional director for Africa, sought to draw attention this week to the growing threat of drug-resistant strains of HIV, tuberculosis and malaria on the continent, calling for aggressive action “before the situation gets out of hand.”
Sambo made his comments during the 59th session of the WHO regional committee meeting in Kigali, with Rwanda getting some praise for progress in improving its health services. But more broadly, Sambo said African countries needed to respond forcefully to the emergence of virulent new strains of TB and other deadly diseases. He called for a nine-point plan that includes developing human resources, strengthening lab capacity, and bolstering drug supply chains, among other steps.
All those concepts go to the very core of health-system strengthening, a fresh point of focus in the US, where the Obama Administration is reshaping US global health priorities. On that front, there was this very interesting blog post on the Center for Strategic and International Studies’ website today about broader benefits of the US global AIDS program in Kenya to that country’s health system. (more…)
Posted in Budget, global health, HIV/AIDS TB co-infection, TB, Uncategorized, tagged Africa, AIDS, appropriations, Ceres, co-infection, drug-resistant TB, funding, HIV/AIDS, Obama, South Africa, South African wine, TB, tuberculosis, USAID, vaccine, winelands, Worcester, XDR TB on August 21, 2009| 4 Comments »
How could the world dramatically lower the incidence of tuberculosis and save millions of lives?
An effective TB vaccine would revolutionize the response to TB, which kills about 5000 people each day, and eliminate the need for lengthy and often difficult drug treatment.
An effective vaccine would be of tremendous benefit all over the world, including in the United States, where there were 13,299 cases of active TB reported in 2007 and about 11 million people with latent TB.
Of course, there’s no question that much more can be done to prevent TB using existing methods, notably the Three I’s. But, imagine what an effective vaccine could do. Vaccination of newborns with a successful TB vaccine could decrease global TB incidence by 39 percent to 52 percent by 2050, and mass vaccination could result in a nearly 80 percent decrease of TB by 2050, according to a recent estimate.
What’s exciting is that the effort to develop such a vaccine is proceeding rapidly and could produce results in just a few years — that is, if the United States government and other donors provide the funding necessary for large-scale clinical trials.
Right now, that’s a very big “if.”
South Africa is a leader in TB vaccine research, and I recently had the opportunity to visit a tuberculosis vaccine facility in Worcester, 120 km northwest of Cape Town, and to take some photos. The facility has the strong support of the US-based Aeras Global TB Vaccine Foundation, and it is a terrific example of capacity building and international cooperation.
In fact, Aeras is supporting this kind of capacity building and healthcare infrastructure strengthening (including laboratories and disease detection) not only in South Africa but at partner sites in Kenya, Mozambique, Uganda, Cambodia and India as well.
The area called the Boland, where facility is located, is one of the most beautiful places I have ever visited. It is the source of world-class wine as well as those delicious Ceres fruit juices you can find in supermarkets in the US and other countries.
Unfortunately, this rural area also has one of the highest rates of TB in the world.
TB incidence in the research area is about 100 times that which we have in the United States. The level of TB incidence in this area is at 1400 cases per 100,000 people, even higher than the overall South Africa rate of 900 per 100,000.
The situation in South Africa is aggravated by unemployment, poor housing conditions (cramped and with inadequate air circulation), extreme inequity in access to medical care, and HIV/AIDS.
As we explored in Deadly Synergy, TB is having an enormous and deadly impact on people who are living with HIV/AIDS. Since 2007, HIV and TB co-infection has been the most significant cause of premature death in the province of Western Cape.
However, it is also worth noting that, globally, most people with TB disease are not HIV positive.
In fact, in the Western Cape, HIV prevalence is less than the overall rate in South Africa as a whole. Hassan Mahomed, the SATVI Clinical Director, told us that there are other factors in addition to HIV which are driving the TB problem in the area, which predates the escalation of HIV.
He told us that the long, cold and rainy winters in the area lead people to staying indoors where they can become infected by TB. He said poverty and alcoholism were also major factors, with many of the people receiving low wages for seasonal work on the many farms in the area.
Children can suffer terrible forms of TB disease, such as TB meningitis, which can lead to severe brain damage and paralysis.
While children in South Africa receive some protection from the BCG vaccine, developed about 90 years ago, this does not protect them against pulmonary TB and the protection does not last into adulthood.
But research is advancing rapidly. There are now 10 new TB vaccine candidates in clinical trials worldwide, and four of them are being tested in Worcester, at the field site of the South African Tuberculosis Vaccine Initiative (SATVI).
We happened to arrive at the site on a day when mothers were bringing in their babies to receive an already-proven vaccine against pneumococcal disease. Children in the TB vaccine study area are provided with other vaccinations free of charge, whether or not their parents choose to enroll them in the study.
I asked one of the mothers if the 150 Rand (about $19 USD) payment she receives for each clinic visit was a help to her, and she said yes but the even more important benefit was that as a study participant her baby also receives regular medical check-ups.
On our visit to the site, I got a chance to meet four month old Janenique Pienaar of Worcester. Her mother was beaming, clearly delighted that her daughter is making history as the first baby in 80 years to be vaccinated in a proof-of-concept efficacy trial (Phase IIb) of a candidate TB vaccine.
This vaccine candidate, called MVA85A/AERAS-485, would be a booster to the BCG vaccine, and it has already been shown to be safe in a number of Phase I and Phase II clinical trials.
To study this vaccine candidate, SATVI is enrolling 2783 healthy, already BCG vaccinated, babies, at about 4 months of age to participate in the trial. Half the babies will be given the new vaccine, and the other half a placebo.
The children will then be monitored for two years to compare the incidence of TB in the two groups. If successful, the vaccine would proceed to a much larger, and more costly, Phase III clinical trial in 2011.
This vaccine could be ready for wide-scale use by 2016, if the trials are successful. Unfortunately, funding for later stage clinical trials for TB vaccines is at present very much in doubt, and the funding shortfall could significantly delay progress.
While the NIH and CDC have funded some early stage TB vaccine research and epidemiology studies, funding for the kind of late-stage trials conducted in South Africa is authorized under the PEPFAR law (Lantos-Hyde) to come through USAID.
USAID is already investing significantly in AIDS and malaria vaccine research, but unfortunately it has not provided funding for TB vaccine research, whether through Aeras or another program.
The Obama Administration supported a tiny increase of only $10 million for USAID’s TB program in 2010. Congress is now on course to provide a larger increase for 2010, but it will be roughly a $150 million increase at best — far less than the increase of about $500 million we and other advocates had sought for implementation of TB programs and research.
The Aeras Global TB Vaccine Foundation needs over $30 million per year in additional funding to support a late stage clinical trial of a TB vaccine candidate.
We hope that the Administration proposes a substantial increase for TB in its 2011 budget proposal, yet the signs so far are not good.
TB is not just any disease. It’s the third leading cause of morbidity and mortality combined in women of reproductive age in developing countries. India’s national TB program estimates that some 100,000 women in India alone are rejected by their families every year because of TB.
Yet, the Administration’s draft, 6-year strategy on TB omits any reference to the TB funding levels “authorized” last year in the Lantos-Hyde bill, now US law.
That bill specified $4 billion over 5 years for TB, or $800 million per year, including for vaccine development. But, to become a reality, this funding level needs annual support from Administration and from the Budget Chairmen and Appropriators in Congress.
What we have heard from government insiders is that the Administration feels the amount of TB funding now provided through PEPFAR, which directs some of its funding to addressing TB-HIV coinfection, in effect addresses the TB funding need. Would that were the case!
President Obama just awarded the Presidential Medal of Freedom to Archbishop Emeritus Desmond Tutu. He, like Nelson Mandela, is a TB survivor, and both have called for bold action to confront TB. Tutu has appealed for funding for TB and HIV programs, even in these difficult times.
We must heed their call to action. TB is estimated to deplete the incomes of the world’s poorest communities by $12 billion per year. South Africa has made progress in the fight against TB, but there is still much to do. As Tutu has stated, “As we have overcome apartheid, so we shall defeat TB and HIV/AIDS, these ungodly twin killers.”
— David Bryden, Senior Program Policy Officer, Center for Global Health Policy