As the Obama Administration re-jiggers US foreign assistance policy in general and global health in particular, this op-ed by Dr. Robin Wood, a leading South African physician-researcher, highlights a growing—but little-noticed—explosion in tuberculosis in Cape Town. His startling research there, focusing on TB rates among young children, is a sign of the escalating threat posed by this ancient scourge—a threat that requires high-level attention from Washington.
Below are a few key points from the op-ed, which you can read in full here.
“My research at a clinical trial site outside Cape Town is finding TB infection rates of children at the highest levels ever recorded since the onset of TB chemotherapy in the middle of the last century,” Dr. Wood writes.
“By the time children enter school at age 5, 20 percent are already infected with TB. By the time they reach the age of sexual maturity, 13 years, 50 percent are infected. And between the ages of 24 and 28 — the years of peak prevalence of HIV — 80 percent are infected.
That’s why what is happening in Washington now is so important to me, to all of those fighting TB in Africa, and really to all of us: No area of the world is immune from this contagious airborne infection, which passes on the wings of a sneeze or cough.”
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As ScienceSpeaks readers know, the Center for Global Health Policy brought Dr. Robin Wood, director of the Desmond Tutu HIV Centre at the University of Cape Town, to Washington last week for a series of policy meetings, community forums and press interviews.
The media effort has already paid off with fresh attention to the twin global threats of TB and HIV/AIDS, with three news outlets quoting Dr. Wood in stories on these deadly diseases.
This story out today, by Free Speech Radio News, delves into fears that the Obama Administration is stepping back from the global AIDS fight and quotes both Center Director Christine Lubinski and Dr. Wood on the implications of such a move. Last week, Voice of America did this story detailing Dr. Wood’s recent research on TB among South African children, and NPR quoted Dr. Wood in a story about the success of ARV roll-out in resource poor settings.
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Dr. Robin Wood, director of the Desmond Tutu HIV Centre in Cape Town, has many startling slides to illustrate the astronomical problem of tuberculosis in South Africa—from photos of desperately poor, overcrowded shantytowns in the Western Cape to graphs that document the escalating rates of HIV/TB co-infection in his native country.
But there’s one image that gets at the crux of a perplexing problem in this epidemic: A photo of a TB clinic door plastered with awards for successfully implementing the DOTS strategy, or Directly Observed Treatment, Short-course. Juxtaposed to that is a graph showing exponential growth in TB rates in the clinic’s community.
“Why is TB control failing in South Africa?” asks Dr. Wood, a renowned physician-scientist who has been on the front lines of HIV/AIDS treatment, research and prevention for two decades and has recently done cutting-edge research on the deadly intersection of HIV & TB in South Africa.
It is obviously not a failure to implement DOTS, a strategy at the heart of most TB control programs in the developing world. Instead, Dr. Wood suggested at a briefing with USAID staff today in Washington, it’s an overreliance on DOTS in settings where transmission is a “pressure infection” being transmitted at nearly unprecedented rates. He said the situation today in South Africa is similar to what happened in New York in the 1840s, when Irish immigrants with very little natural TB immunity came to the U.S., and the epidemic spread like wildfire.
“If you live in a sea of TB,” as so many South Africans do, DOTS is just not enough to control the disease, Dr. Wood said.
So what is needed? Dr. Wood isn’t calling for anything radical. (more…)
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Posted in Uncategorized, tagged global health initiative, HIV/AIDS, Kaiser Family Foundation, NIAID, Obama, Robin Wood, TB, tuberculosis, US TB strategy, USAID on September 23, 2009|
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The Kaiser Family Foundation will hold a live, interactive webcast on Tuesday, Sept. 28, at 1 p.m. EDT on the threat of tuberculosis and the U.S. strategy for combating this ancient deadly disease.
An expert panel is set to discuss this growing global health threat, including two of the U.S. government’s top infectious disease specialists and renowned South African physician Robin Wood, who has been on the frontlines of HIV/AIDS treatment, prevention, and research for the last two decades. As director of the Desmond Tutu HIV Centre at the Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Dr. Wood will be able to give his perspective on new strategies needed to combat global HIV/AIDS and TB.
The Center for Global Health Policy is bringing Dr. Wood to Washington next week for series of community forums, policy meetings, and press interviews. The trip is part of the Global Center’s efforts to make the voices of developing country physicians heard in American policy debates.
Joining Dr. Wood for the Kaiser webcast will be Christine Sizemore, of the National Institute of Allergy and Infectious Diseases; Cheri Vincent, of the U.S. Agency for International Development; and Christine Lubinski, director of the Center for Global Health Policy. Both Dr. Sizemore and Ms. Vincent play lead roles in the U.S. government’s global TB programs. The forum will be moderated by Kaiser Family Foundation Vice President Jen Kates. (more…)
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Note: From July 19-22, the Center for Global Health Policy’s staff will be live blogging from the International AIDS Society 2009 meeting in Cape Town. This post was written by Center director Christine Lubinski, who attended a two-day pre-meeting on HIV/TB co-infection.
Despite the scope and gravity of HIV/TB confection, there are glimmers of hope from the field—new diagnostics, a better vaccine, and a host of other innovations were the subject of a two-day session in Cape Town, “Catalyzing HIV/TB Research: innovation, funding, and networking,” which served as a prelude to the 2009 IAS meeting. The backdrop provided a fitting reminder of the urgency of this health crisis; South Africa is the epicenter of the co-infection epidemic, with one quarter of the world’s cases of HIV/TB co-infection.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, headlined the meeting, organized by the World Health Organization, the International AIDS Society, the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE), and other groups. Calling the most commonly used diagnostics for TB “ridiculous,” Fauci noted that it was “tragic and shameful” that generations of research advances had “bypassed TB research.” As he did at the Pacific Health Summit on MDR-TB in June, Fauci called for a transformative research response to TB and by extension, HIV/TB co-infection.
Dr. Fauci’s address was followed by a series of presentations that both highlighted the enormity of the problem and its associated morbidity and mortality, but also framed the potential that further research and more widespread implementation of interventions hold.
Dr. Robin Wood, from the Desmond Tutu HIV Research Center at the University of Cape Town, focused on the impact of ART on TB prevention. Dr. Wood reported that 67 percent of persons presenting for ART in their clinics have TB or have had TB. Analyzing the impact of ART on a high HIV prevalence township community, researchers found a 77 percent reduction in HIV/TB co-infection during the 5-year ARV rollout period. Wood noted while there is widespread speculation about the impact of community-wide ART penetration on HIV incidence, there is little doubt that small changes in HIV prevalence produce dramatic changes in TB incidence. The earlier ART is started, the greater the impact on TB, given the increased vulnerability to TB as HIV disease progresses. (more…)
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