Monthly Archives: April 2011

KENYA: Infant AIDS Vaccine Progress

Infants enrolled in October 2010 in an HIV vaccine trial are doing well, say researchers in Kenya.

“We have already vaccinated 28 infants with the vaccine and up to now we haven’t seen any adverse reaction in any of the infants – it is important to know that the vaccine is safe,” said Walter Jaoko, the lead researcher in the study.

The Phase I trial of the HIV vaccine candidate, modified vaccine virus Ankara (MVA.HIVA), is intended to test the safety and efficacy of the vaccine candidate in infants. It contains small particles of HIV genes, but researchers say it cannot cause HIV infection since it does not contain the whole virus.

The trial is sponsored by the UK’s Medical Research Council and the European and Developing Countries Clinical Trials Partnership. The Kenya AIDS Vaccine Initiative will enrol a total of 72 infants and monitor them for one year; the trial is also being conducted in the Gambia, where 48 infants will participate.

During the trial, babies born to healthy HIV-negative and HIV-positive mothers are injected with MVA.HIVA at 20 weeks.

“All infants that we have in the study are there with the full consent of the parents and the entire factors of the study were fully disclosed to them [parents],” said Jaoko. “Half of the children in the study received both the trial vaccine together with the routine immunization while another half only received their regular vaccine. This is meant to help compare the infants vaccinated with the trial vaccine and those who haven’t received it on their immune response.”

All HIV-positive mothers whose children were enrolled for the trials were provided with antiretroviral therapy, as well as infant feeding counselling during pregnancy and breastfeeding to reduce the risk of HIV transmission to their children.

Should the vaccine prove efficacious, researchers say a trial would be conducted on another vaccine to be combined with MVA. The resultant vaccine would then be administered to children at birth like any other vaccine and could greatly help prevent HIV infection in children in future.

“We are hopeful that this study will help get a vaccine that can be used to prevent HIV in children in future,” said Jaoko.

The MVA.HIVA vaccine has been previously tested on adults in the UK and Africa and showed no adverse reactions.

An estimated half a million children, many of them in poor countries, are infected with HIV; without intervention, about half of infants infected with HIV die before their second birthday.
[Courtesy of IRIN News]

GLOBAL Health: Stillbirths could be Halved

DAKAR, 27 April 2011 (IRIN) – Preventing stillbirths can cost just US$2.32 per mother if governments, the private sector and international institutions adopt a package of 10 health interventions, rather than allowing stillbirths to be an almost invisible problem.

If ten recommended interventions were 99 percent implemented in 68 priority [low and middle-income] countries, the number of stillbirths could be halved, said Professor Zulfiqar Ahmed Bhutta of the Aga Khan University Medical Centre in Karachi, Pakistan, author of one of a series of papers on stillbirth published in The Lancet medical journalpapers.

Even if the interventions were 60% covered, stillbirths could be reduced by one-quarter. Some 2.64 million foetuses die after the 28th week of pregnancy, mostly in low- and middle-income countries. Interventions include: basic and comprehensive emergency obstetric care; skilled care at birth; detection and management of foetal growth restriction; detection and management of hypertension in pregnancy; elective induction in post-term pregnancies; insecticide-treated bed nets and intermittent prophylaxis to prevent malaria; detection and treatment of syphilis; folic acid supplementation; and management of diabetes in pregnancy.

Stillbirths have largely been neglected in policy prioritizing for a variety of reasons. “There was little in terms of verified data for stillbirths and even less for its categories – whether intrapartum [during childbirth] or antepartum [before childbirth] – and risk factors, and little confidence that interventions could make a difference,” said Bhutta.

The Lancet series hopes to change this perception by re-framing stillbirths so that they are not seen as an unexplained event that occurs in the womb, but as something that is potentially preventable if appropriate care is given during pregnancy and birth. Bhutta suggested in his paper that cheaper solutions, such as improving antenatal care, preventing malaria, detecting and treating syphilis, be adopted immediately, while more expensive interventions, such as training health workers, and procuring equipment for emergency births, could be built up gradually.

Other interventions would require improved long-term funding allocations, including addressing hypertension, diabetes, post-term pregnancy (which lasts longer than usual) and monitoring foetal growth problems. Providing skilled attendants at birth would reduce intrapartum stillbirths by about 23 percent, said Dr Joy Lawn, of NGO Save the Children, making it the most effective single intervention. Almost half the women in low- and middle-income countries give birth at home, without any skilled assistance. Voucher schemes or conditional cash transfers could be used to encourage women to have their babies in a facility, since in settings where the highest infant mortality occurs, only half of all births take place in facilities.

In high-income countries, where most women receive fairly good quality care while giving birth, the proportion of stillbirths is less than 10 percent of all births. Sub-Saharan Africa, which has a scarcity of skilled birth attendants, has been making swifter progress than Asia in encouraging women to give birth in a facility.

“One year ago, the international community became acutely nervous about the lack of progress on reducing maternal mortality,” Lawn said. A year later, maternal mortality in sub-Saharan Africa had fallen by 2.6 percent. “This marks significant progress… For stillbirths, a lot of the focus in high-income countries has been because parents have called for it. Setting a global policy goal is one good way of getting it on the agenda.” One-third of African countries could meet the Millennium Development Goal to reduce childhood mortality (Goal Four) and to improve maternal health (Goal Five), which would also reduce stillbirths. Some investments in reducing maternal mortality are already having a positive effect on the number of stillbirths, but these results are not given due significance. “Governments could argue for more investment if they counted stillbirths in the work they’re already doing,” Lawn told IRIN. Saving mothers’ lives costs $23,000 per death averted, but if stillbirths and neonatal deaths are included, the figure drops to $2,700 per life saved. “Our single message is, ‘Care at birth may be more expensive, but it gives you the biggest bang for your same buck if you count it properly’.”

[Courtesy of IRIN]

BURUNDI: Women risk HIV rather than starvation

Desperate and displaced, some Burundian women will do anything, including have unprotected sex for money, to escape the dreadful living conditions in the Bujumbura suburb of Sabe, where more than 480 families of internally displaced persons (IDPs) have lived for several years.

Burundi has more than 100,000 IDPs as a result of several years of political turmoil; most of the families in Sabe are returnees from neighbouring countries.

“I know cases of parents whose daughters go into town or elsewhere every night to look for money from men who offer big money [for sex],” Ferdianne Bukuru, vice-president of the Sabe IDP site, told IRIN/PlusNews. “Young girls are attracted by wealthy men and are drawn into prostitution as IDPs have no means to survive.”

For many of these girls and women, the fear of HIV is dwarfed by the immediate need for money to buy food and other necessities.

“Do not talk of AIDS… I don’t fear [it]; I would rather get food and die in the future instead of dying hungry today,” said 18-year-old Jacqueline*. “I have been at this site since 1993; nobody has come to help me to improve my life and especially go back to school.”

Madeleine*, 32, feels the same way. “When I came across a man who feeds me and clothes me, I must accept, for food,” she said. “Who can refuse a large sum of money when she is in poverty like this?”

Madeleine said NGOs fighting HIV/AIDS visited the site occasionally, but not enough to have an impact on people’s behaviour. Condom use – perceived to be less profitable than unprotected sex – is not as consistent as it should be.

“Condoms do not allow us to have enough money; if a man offers his money, he insists on intercourse without a condom,” said one 17-year-old student.

Women who do not turn to sex work often wind up becoming second or third wives to the few men in the site who are able to support more than one wife.

“I already understand what HIV is, but I don’t think my force is enough to stand against it,” said Nzeyimana*, a mother of two girls. “These men may have more than three women – as they brandish [currency] notes, no one can resist.”

he few organizations working to prevent HIV/AIDS say their work is hampered by poor funding.

“For a long time we had collaborators at this site and its surrounding areas in the fight against AIDS in IDPs sites, but now things have changed. We had targeted IDPs sites in Bujumbura and elsewhere, but we are forced not to work at these sites due to limited resources and logistics,” said Basilisse Ndayisaba, coordinator of the Society of Women Against AIDS-Burundi, one of the largest HIV NGOs in the country. “These IDPs no longer have the advice or training of our staff.”

Ndayisaba said her organization last worked in Sabe in May 2010.

Burundi has an adult HIV prevalence of 3.3 percent; the country’s fight against HIV has been hit with delays in Global Fund grants holding up activities and most recently, the World Bank’s withdrawal of its HIV funding.
[Courtesy of IRIN PlusNews]
*Only one name provided to protect the source’s identity

World Malaria Day 2011

World Malaria Day 2011 is a time for examining the progress we have made towards malaria control and elimination and to renew efforts towards achieving the target of zero malaria deaths by 2015.

Malaria is particularly devastating in Africa, where it is a leading killer of children. In fact, there are 10 new cases of malaria every second. Every 45 seconds, a child in Africa dies from a malaria infection.

Malaria does not only kill, it can have long term consequences. Severe malaria often leads to brain damage, holding back a child’s mental development resulting in lifelong impacts.

Yet Malaria is a preventable and curable disease and can be treated effectively with existing drugs and treatment is most effective if administered within 24 hours of the onset of fever.

It costs less than £4 to deliver a long-lasting insecticide treated bednets. The lives of 3 million children by 2015 if every child at risk of malaria sleeps under a net.

Malaria is a disease caused by the blood parasite Plasmodium, which is transmitted by mosquitoes. Malaria, from the Medieval Italian words mala aria or “bad air,” causes 200 million illnesses per year and kills nearly one million people – mostly children under the age of five.

Forty percent of the world’s population lives in malaria endemic countries, and its treatment consumes nearly 40 percent of these countries’ public health resources. In addition to the burden on local healthcare systems, malaria illness and death costs Africa approximately £7 billion per year in lost productivity.

However there have been notable successes, especially in Africa. In five years, following rapid improvements in control efforts, deaths from malaria fell by nearly 70% in Rwanda and 62% in Ethiopia. In Zanzibar, in east Africa, overall deaths from malaria have fallen 90% since 2003.

These success stories should give us hope. While eliminating malaria completely will always be the ultimate goal, there is no reason why anyone should die from it. Every life lost is needless. With common resolve and a united front malaria can be beaten.

References:
RBM http://www.rollbackmalaria.org/keyfacts.html
D
IFID http://ht.ly/4EYuU

MYANMAR: Malarial drug resistance “hotspots” identified

Health experts had barely finished one project to contain anti-malarial drug resistance along the Thai-Cambodia border when their attention was drawn to Myanmar, where early warning signs suggest a waning influence of the anti-malarial drug Artemisinin.
Malaria is a leading cause of morbidity and mortality in Myanmar and a leading cause of deaths in children under five, says the UN World Health Organization (WHO).

Resistance to the previous standard treatment for malaria, chloroquine, was first reported in the 1950s along the Thai-Cambodia border. By the 1980s it had spread to sub-Saharan Africa, which has the world’s highest rate of malaria mortality.

Evidence of resistance emerged from Southeast Asia once again in 2007, this time to Artemisinin, one component of the combination therapies used worldwide to control malaria. Donors, starting with the Bill & Melinda Gates Foundation, pumped US$22 million into the border from 2009.

Charles Delacollette, coordinator of the Bangkok-based Mekong Malaria Programme with WHO, said while those huge multi-country efforts have worked to bring down reports of malaria infections, “what we are seeing along the Thai-Myanmar border seems equally serious … to what we had at the Thai-Cambodian one”.

Read More Here: 

HIV/AIDS: Drug Trial Disappoints

A three-country study has been halted after daily doses of the antiretroviral (ARV) Truvada, used as a pre-exposure prophylaxis (PrEP), failed to prevent HIV infection in the women participating.

Family Health International (FHI) will begin closing FEM-PrEP trial sites in Tanzania, Uganda and South Africa after early results showed no difference in the rate of HIV infection among women taking the ARV and those taking the placebo.

Pre-exposure prophylaxis would involve giving a daily dose of a single ARV drug to people who were HIV-negative but at high risk.

The results were both surprising and disappointing after several PrEP success stories, but researchers would start analysing the data and blood samples to pinpoint why the drug did not work, said Dr Timothy Mastro, FHI Vice President of Health and Development.

The results might be due to missed doses among patients, or an initial indication of Truvada’s ineffectiveness as an HIV prevention strategy for women when taken orally.

“There are a number of … [reasons] for why the study may not have been successful. We used the same product as the iPrEX [Pre-Exposure Prophylaxis Initiative] study [a previous project] but … in that study, the primary mode of HIV transmission was receptive anal intercourse,” Mastro told IRIN/PlusNews.

The iPrEX study showed that a daily dose of Truvada reduced the risk of HIV infection among men who have sex with men(MSM), a high-risk group, by about 44 percent. Mastro said the United States Centres for Disease Control was drafting guidelines for the use of Truvada by MSM.

“Our study population [this time] was mainly at risk for HIV through vaginal intercourse, and there are substantial transmission dynamics. Drugs taken orally are distributed [in the body] in quite a different way than those taken topically,” he said.

In July 2010, a study by the Centre for the AIDS Programme of Research in South Africa (CAPRISA) released the first positive results from a microbicide trial when it found that found that a vaginal gel containing the ARV, tenofovir, a component of Truvada, was 54 percent effective in preventing HIV infection in women who consistently applied it before sex.

“The concentration of drugs in the rectal tissue is very different to that in vaginal tissues, so that could have been a factor [in the FEM-PrEP trial],” Mastro noted.

Although the FEM-PrEP study, in which 1,950 women took part, might not have shown positive results, Mastro said it could inform the work of researchers in similar ongoing trials, such as the VOICE microbicide study.

“It will be very important to fully analyse the data so we understand the findings and can compare our results with those from ongoing studies. In the scientific process we learn something from every step,” he commented.

FHI researchers will be evaluating blood samples taken from the roughly 60 women who became HIV-positive during the study to check for the presence of drug-resistant HIV strains, some of which can develop when patients adhere poorly to an ARV drug regimen.

Scientists will also be seeking an answer as to why the women who took Truvada had a higher pregnancy rate than their peers on the placebo, despite reportedly taking birth control medication. Mastro said this might also be due to poor adherence to oral contraception, or Truvada might have interacted with the birth control drugs to weaken their contraceptive effects.

“The iPrEX study demonstrated the safety and efficacy of the use of Truvada [by MSM] for HIV prevention, and that remains valid,” he told IRIN/PlusNews. “At this time, we simply don’t know the safety or the efficacy for women.”
[Courtesy of IRIN]

Stillbirths “absent from global health agenda”

The annual number of stillbirths around the world is more than double the number of people who die from HIV-related causes, according to a new report that says this widely overlooked epidemic could be dramatically mitigated with better antenatal care.

Some 2.64 million foetuses die after the 28th week of pregnancy, most of them in low- and middle-income countries, according the report published by The Lancet.

While the number of stillbirths globally has fallen from an estimated three million in 1995, the decline lags behind progress in reducing deaths in children under the age of five. The series authors say the lack of recognition of the issue at a global health level means not enough is being done to prevent more babies from dying.

“Parental groups must join with professional organizations to bring a unified message to UN agencies regarding the need to include stillbirths in global health policy.”

The authors report that grieving mothers are often disenfranchised from their communities; stillbirths can also affect future parenting and lead to divorce. In many countries, bereavement counselling is not widely available for families dealing with depression after a stillbirth.

“Behind the statistics are individual stories of families devastated by the loss of their precious child,” Janet Scott, research manager at Sands, a British stillbirths and neonatal death charity, said in The Lancet. “A baby who dies before he or she is born is no less loved and cherished, the grief and pain for the parents no less agonizing and enduring, and the guilt at not being able to protect that child no less intense.”

According to the UN World Health Organization, the five main causes of stillbirth are childbirth complications, maternal infections in pregnancy, maternal disorders such as hypertension and diabetes, foetal growth restriction and congenital abnormalities.

t Madiany Hospital in Rarieda District in western Kenya’s Nyanza Province, doctors and midwives deal with stillbirths on a daily basis; health workers are overwhelmed by expectant mothers from the entire district, even though the number of women who seek antenatal care is a mere fraction of what it should be.

“We are just one hospital serving a whole district with a huge population. To reduce cases of irregular antenatal visits among pregnant mothers – one of the biggest contributing factors to stillbirths – we need to build the capacity of lower level health centres to provide antenatal care,” Sylvia Warom, in charge of the hospital’s maternity ward, told IRIN.

“Many women come to the hospital when they realize they are pregnant and you never see them again until they are ready to deliver; it is unfortunate because many come to deliver already dead children,” she added.

In rural Nyanza, health centres are few and far between, and many women lose their babies on the long journey from home to the hospital, while others lose babies by choosing to deliver at home. More than half of all Kenyan women deliver their babies without the benefit of skilled medical professionals.

According to The Lancet series, an estimated 1.2 million of all stillbirths happen during labour and delivery, highlighting the need to increase the number of women delivering babies with skilled birth attendants present.

Better healthcare, better data

“In Uganda only 42 percent of women receive skilled attended delivery,” said Robina Biteyi, national coordinator of the Uganda chapter of The White Ribbon Alliance, an international maternal health NGO. “It is estimated that 15 percent of all pregnancies are likely to develop life-threatening complications and will need emergency obstetric care but in Uganda, only 24 percent have access to it.”

The authors of The Lancet series noted that measures to reduce stillbirths often overlapped with those to reduce maternal and child deaths. Some recommended interventions include: skilled care at birth and emergency obstetric care taking priority in settings with the highest burden and the weakest health systems; provision of basic information and service access to health-care users and ensuring health-care providers have skills, knowledge, and resources.

Other measures include the provision of folic acid supplements, supplying insecticide-treated nets in malaria-endemic areas and routine syphilis screening during antenatal visits.

“We need to improve access to family planning; there is an unmet need for family planning of 41 percent in Uganda,” said Biteyi. “There is also an urgent need to increase the number of health workers and improve their services of employment and ensure retention; currently Uganda is short of 2,000 midwives,” said Biteyi.

The authors further noted that there was a dearth of information on the subject of stillbirths, and to effectively tackle the problem it would be necessary to develop mechanisms to monitor stillbirths and better understand their causes.

“To prioritize stillbirth prevention, health professionals need data on rates, causes, and preventive opportunities, as well as global leadership,” they said.

[Courtesy IRIN]