Posts Tagged ‘NIH’

If there’s any question about the value of U.S. investments in scientific research on HIV/AIDS, Anthony Fauci probably put it to rest today by noting that in the period since HIV first emerged, “we went from a 26-week lifespan to a 40-year-plus life span” for those infected with the virus. Talk about measureable outcomes.

That dramatic change—from death sentence to chronic manageable disease—is thanks, in large part, to the 30-plus antiretroviral drugs developed through scientific inquiry over the last three decades. Fauci’s remarks came at congressional briefing today, entitled “AIDS Research at NIH: New Opportunities to Change the Course of the Epidemic,” sponsored by the HIV Medicine Association, IDSA’s Center for Global Health Policy, and several other groups.

Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases, and other presenters, including two IDSA physician-scientist experts, spoke of the vital need to maintain and increase U.S. support to combat the HIV/AIDS epidemic, whether through an eventual vaccine or biomedical and behavioral prevention strategies.

There is a presumption in some quarters, Fauci said, “that we really have our arms around this and things are stable.”  But with 2.7 million new infections each year, the epidemic is still spiraling.

“In the U.S.,” Fauci added, “yes, things are stable, but they are stable at a completely unacceptable level.” There are about 1.1 million people living with HIV in the U.S., with 56,300 new infections each year–a number that has stayed intractably level for the last decade.

Right now, “we are not winning the game,” Fauci said, which means it is imperative to continue the search for a cure.

“Some have thought this is an impossible goal,” he said. But while there have been many disappointments in the vaccine arena, Fauci said there is great hope of a “functional cure,” in which HIV patients are treated aggressively and early enough that they  go into permanent remission and no longer requirement ARV therapy.

“This is eminently feasible,” he said, describing novel prevention approaches now under study, including microbicides and “test and treat” strategies.

Dr. Wafaa El-Sadr, director of Columbia University’s International Center for AIDS Care and Treatment Programs, said that with ARVs, an estimated 3 million lives have been saved.

“I call that success,” she said. But noting there’s still much “unfinished business,” she said, “we should be energized to continue this work” both in expanding access to treatment, finding new drugs, and researching new prevention tools.

She noted that in parts of the U.S., including D.C., the prevalence of HIV surpasses the rates in some African populations, but that here, it is a very localized epidemic, with African Americans disproportionate impacted. That requires distinct approaches to treatment and prevention.

“We have to reconceptualize our approach to the epidemic,” she said, and look for more structural, socio-economic interventions. But to do that, and be successful, requires more research. She pointed to a study she’s involved with that is trying to identify the risk factors for HIV among women. Once the study gives them some answers, she said, they will need to do another study to figure out what interventions work to mitigate those risk factors.

Dr. El-Sadr also described the “test and link-to-care” study underway in Washington, D.C., and the Bronx, which will look at whether it’s possible to significantly reduce transmission with such an approach.

“This is the epitome of a complex study,” she said, “but it’s the future of what HIV prevention will look like.”

“… We have an emergency in this country and an emergency around the world,” she concluded.  “There’s a need to continue an ambitious, innovative, courageous research agenda.”

Dr. Adaora Adimora, a professor of medicine and epidemiologist at the University of North Carolina, took the audience in a different direction, with a talk about why it is vitally important to cultivate and support minority researchers in this field.

She joked that the subtitle of her presentation should have been: “Why can’t white men solve all our problems?” But  Dr. Adimora quickly turned serious in noting that HIV disproportionately affects minorities, particularly those who are disadvantaged and therefore  vulnerable to forces that put them in the path of the virus.

“Minority investigators bring a unique perspective” on the health issues that affect their community, and are likely to think of research questions and connections that other researchers do not.

For example, until the early 1990s, the HIV-STD field focused research questions on “numbers of parents and sexual behaviors,” she said. “Poverty was recognized as a risk factor but it wasn’t clear how being poor could get you an STD, including HIV. Through the efforts of researchers, many of whom are minorities, this view broadened to include the importance of social forces and the pathways that link these social forces to HIV and other STDs.”

And understanding these pathways is critical to developing successful interventions, she added.

Lack of funding is the main reason that minority researchers leave the field, she said, noting that an early NIH grant was the key to her own successful career in research.

“It’s unlikely my career would have survived” if not for that grant because, she said, she would have had to devote all her time to seeing patients. “An increase in grant funding is critical to ensure that more talented investigators of all races and ethnicities are not lost,” she said.

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The National Institutes of Health (NIH) has teamed up with several other US government agencies to launch a new initiative to strengthen medical education in sub-Saharan Africa. This new program, called the Medical Education Partnership Initiative, is a joint effort by PEPFAR, the CDC, the Department of Defense, and other agencies. It is an effort to fulfill PEPFAR’s mandate to train 140,000 new health care workers.

The NIH says it will also serve a related objective: strengthening developing country medical education systems and enhancing clinical and research capacity in Africa.

The NIH and other funders are seeking proposals to develop or expand models of medical education from foreign institutions and their partners in PEPFAR-supported Sub-Saharan African countries. The goal is to “contribute to the sustainability of country HIV/AIDS responses by expanding the pool of well-trained clinicians,” the NIH says in a press release.

“As we transition from an emergency response to a more sustainable approach, we are supporting partner countries in leading the response to their epidemics,” Ambassador Eric Goosby, U.S. Global AIDS Coordinator, said in the NIH statement. “Shortages of trained doctors are a key constraint, and we are proud to support partner nations in expanding the number and quality of clinicians available and facilitate strong faculties of medicine so they can meet their people’s needs over the long term.”

The initiative expects to award African institutions with as many as nine programmatic grants focused on PEPFAR priority areas; they also plan to make six awards that support non-communicable diseases and priority health areas related to and beyond HIV/AIDS. The program will support one coordinating center.

The application deadline is May 12. Click here to find out more.

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A new issue brief from The Foundation for AIDS Research and the Treatment Action Group makes a compelling case for increased US investment in NIH research.

The issue brief, “A Sound Investment: The Multiplier Effect of AIDS Reserach,” details the broad benefits of AIDS research–not just in advancing HIV treatment but also providing new tools for fighting other health threats, from cancer to heart problems. The report also details scientific opportunities on the horizon in HIV/AIDS treatment and prevention, such as Pre-Exposure Prophylaxis and male circumcision. Additional research investments are need to ensure that these new tools come online as quickly as possible–and are made available to prevention infections and save lives. 

Click here to read the full report.

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Although some details are still murky, a first-blush analysis of  Obama Administration’s fiscal year 2011 budget doesn’t look good for US efforts to combat the HIV and tuberculosis epidemics. From treatment to prevention, these global health threats could get short-changed under the White House plan.

Let’s start with PEPFAR, the President’s Emergency Plan for AIDS Relief. For the second year in a row, the Administration has called for a single-digit increase for this program, about 2.6 percent, or $141 million. That small increase comes despite lofty campaign promises, congressional mandates, plus a pledge that PEPFAR would serve as the “cornerstone” of the Administration’s new Global Health Initiative (more on the GHI later).

The White House’s PEPFAR budget is not adequate to preserve vital momentum in HIV treatment scale-up, nor is it enough to fund important new HIV prevention innovations in the developing world.

The numbers for TB are even more disheartening. The Administration only requested a $5 million increase over 2010 funding, a paltry amount for a disease that last year killed more than 1.8 million people, including 500,000 women. Moreover, the Centers for Disease Control’s TB program, with its critical clinical trials network, would be cut by more than $1 million, further undermining US capacity to evaluate new diagnostic, treatment and prevention tools for TB. This comes in the face of evidence that drug-resistant TB is a growing threat and if left unchecked, could spiral into a broader global health catastrophe.

Here’s a more detailed analysis of all global health funding from the Global Health Council:  GHC FY11 CBJ GH Funding Chart (Draft). The Kaiser Family Foundation also has this helpful breakdown. The Global Center, the GHC, and other groups will continue to analyze the budget as more details come out.

One bright spot in the Administration’s request was in biomedical research at the National Institutes of Health, which would see a $1 billion boost under today’s plan, including $98 million for HIV/AIDS research at NIH, a significant increase at a time of constrained resources.

There’s no question the U.S. faces tough choices amid spiraling deficits and a difficult economy, but underfunding much needed global health programs, which account for a fraction of the federal budget, is not the answer to America’s fiscal woes. Investment in these programs will reap immense dividends down the line–in financial, diplomatic, and public health arenas alike.

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Lawmakers have finalized the fiscal year 2010 budget for foreign assistance, setting funding for key programs to fight global HIV and TB and reaching a landmark deal to revise the needle-exchange ban.

The agreement—expected to pass the House before the end of this week and the Senate before the end of next week—includes some modest increases for bilateral HIV and TB, as well as for the Global Fund to Fight AIDS, Tuberculosis and Malaria. But the funding levels still fall far short of what’s needed to combat these twin epidemics and of what was authorized in the Lantos-Hyde Act passed by Congress last summer.

The deal, for example, would allocate $5.359 billion for global AIDS, $1.05 billion for the Global Fund, and $225 million for TB. It also includes a slight boost for NIH. The gloal AIDS figure does not include bilateral HIV/AIDS funds for USAID or the CDC’s Global AIDS Program; with those pots of money tallied, the total US bilateral AIDS funding for 2010 stands at $5.828 billion. (See chart below for more details on how this comparies to last year, etc.)

The real headline, though, is this: Key congressional negotiators agreed to ease the ban on federal funding for needle exchange programs. This is a long-overdue move that will remove an unnecessary and harmful barrier to effective HIV prevention efforts. It’s also a big surprise.

Earlier this year, the House approved lifting the ban, but included so many restrictions as to make federal funding for such programs essentially unfeasible (i.e., not near any schools, parks, arcades, etc.). The Senate voted to keep the ban in place.

The new agreement revises the ban so it would only prohibit the use of federal funds for needle exchange programs in a location “that local public health or law enforcement agencies determine to be inappropriate.”

Here’s the chart, which lays out the approved spending levels for FY2009, the funding levels authorized in the PEPFAR II, the President’s request for FY2010, and last night’s Congressional agreement.

Dollars in millions

  FY09 PEPFAR II Obama FY 10 Final
Global AIDS $5.159bil $6.5bil $5.259bil $5.359bil
Global Fund $600 $2bil $600 $1.05 bil
Tuberculosis $163 $650 $173 $225
NIH $30.566 N/A $30.758 $31.008


Notes:  The reauthorization bill did not contain specified year by year funding levels with the exception of the Global Fund which was authorized at $2 billion.   The amounts listed under PEPFAR II for bilateral Global AIDS and TB are extrapolated from the overall five-year funding levels authorized in the bill. In addition, as noted above, the global AIDS figure does not include money directed to USAID or CDC for their bilateral HIV programs.

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Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, delivered a forceful message on the need for a “storm” of attention and resources devoted to developing new TB treatment and prevention efforts.

“It is imperative that we transform the way we diagnose, treat, prevent, and control TB — through biomedical research and public health measures — to the same extent that we have done and will continue to do with HIV/AIDS,” Fauci writes in this commentary on MSNBC’s website today. “We are beginning to see the winds of change, but what we really need is a storm.”

In an echo of the speech he delivered this summer at the Pacific Health Summit in Seattle, Fauci, a powerful leader in infectious disease research, outlined the need for a robust new TB research agenda. “The TB research effort will require a sustained and long-term commitment from government, academia, industry and philanthropy.”

Click here to read the whole piece and here to read our earlier post on Fauci’s remarks in Seattle.

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 This post is by Center Director Christine Lubinski, who attended today’s meeting at the NIH of the Consortium of Universities for Global Health. 

How best to nurture and capitalize on a spike in interest in global health studies? Figuring that out is one goal of this week’s two-day meeting of the Consortium of Universities for Global Health (CUGH).

Haile Debas, MD, of the University of California, San Francisco, and current chair of the leadership group for CUGH, reported on the evolution and next steps for a consortium that now boasts the participation of 58 universities and a coalition of funders, including the Bill & Melinda  Gates  Foundation, the Rockefeller Foundation, NIAID, and the  Fogarty International Center

CUGH is moving forward to incorporate as a 501C3 in the District of Columbia and has identified a number of key priorities, including global health education, university collaboration, the creation of a platform for universities to facilitate work overseas, policy development and advocacy promoting global health, an annual scientific meeting, and international partnerships for human and institutional capacity building.

Dr. Debas also noted that CUGH would begin building collaborative relationships with AAMC, the Association of Schools of Public Health, the Global Health Council and others.  He described CUGH’s policy goals as promoting the role and need of university-based global health programs to Congress, the executive branch, the private sector and the public.

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