Tag Archives: TB

South Africa: HIV/Aids Vaccine Research Hope

13 November 2013

South Africa is the only country in the world where a large AIDS vaccine trial is being planned, as the global scientific community struggles to find a way to eradicate HIV.

Announced at this week’s international AIDS Vaccine Conference in Barcelona, the South African trial will involve the only vaccine shown to have some effect on the virus when it was tested among 16,000 people in Thailand. Released in 2009, the Thai trial’s results showed that HIV infection rates were 31 percent lower in participants who had received the vaccine than those who had not.

“On the eve of some of the most important vaccine trials, I am proud of the critical role that the people of South Africa will play,” said Ntando Yalo from the Networking AIDS Community Of South Africa, speaking at conference opening.

But the trial’s researchers are cautious.

Glenda Gray is the South African trial’s lead researcher and executive director of the Perinatal HIV Research at the University of the Witwatersrand. She told conference delegates that trial would begin by testing the Thai vaccine on a small group of people to confirm the vaccine worked as well in South African populations as it did in Thai participants.

“It might not show the same efficacy as in Thailand,” Gray said. “For example, South African women are bigger, and have different (levels of) exposure to the virus.”

With a national HIV prevalence rate of about 17 percent, South Africans are likely to have had much more exposure to the HIV than people in Thailand, where just one percent of the population is HIV-positive. The modest protection offered by the Thai vaccine might be too weak for South Africa, Gray added.

If the vaccine is effective within this smaller group, researchers will modify it for use against the predominant strain of HIV found in South Africa. This modified vaccine would be tested on about 240 people and, if successful, move to a larger trial involving about 5,400 people.

Chasing a “Machiavellian” virus

But the virus, described as “Machiavellian” by scientist Dr Scott Hammer at the start of the conference, continues to evade almost all attempts to eradicate it.

Johnson & Johnson Head of Research Dr Jerry Sadoff said he had been involved in creating 11 vaccines, none of which had taken more than seven years to develop. HIV was the exception, he said.

“You can make a career out of the AIDS vaccine – I have been researching it for almost 30 years,” he joked.

Most vaccines train the body to recognise and kill viruses by injecting people with small, non-toxic “deactivated” parts of the virus.

The body learns to make antibodies to fight the deactivated virus, so that when it is faced with infection from the live, dangerous virus, it is able to recognise and fight it.

But HIV’s constant mutation once it is the body makes it a moving target that is hard to pin down.

About two percent of people infected with HIV are able to contain the virus so that they don’t get sick. Scientists have been studying these “elite controllers,” including sex workers in South Africa, for years but still don’t yet know how their immune systems manage to do this.

Unlocking how our immune systems can produce “broadly neutralising antibodies” to fight HIV is “one of the holy grails of vaccine design,” according to Hammer.

But as scientists struggle to unlock the secrets of our immune systems and HIV, AIDS Vaccine Conference organisers have decided to move away from narrow focus on vaccines.

About 13 years after the first AIDS Vaccine Conference was held, the Global HIV Vaccine Enterprise will open next year’s conference to a wider range of scientists working on HIV prevention methods, including antiretroviral (ARV)-based vaginal or rectal gels – or microbicides – as well as other forms of ARV-based prevention and medical male circumcision.

This much larger gathering of HIV prevention experts will convene in Cape Town next year.

Organisers also raised the issue of a therapeutic HIV vaccine for the first time. Unlike the vaccine being tested in South Africa, a therapeutic HIV vaccine would aim to treat HV infections, not prevent them. A small therapeutic HIV vaccine trial is currently underway in the United States.

[Courtesy AllArica News]

Africa: 7 Million on HIV/Aids Antiretroviral Treatment

23 May 2013:

The number of people in Africa receiving antiretroviral treatment increased from less than 1 million to 7.1 million over seven years, according to a United Nations report which documents the progress in the AIDS response in the world’s second largest continent.

“Africa has been relentless in its quest to turn the AIDS epidemic around,” said the Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS), Michel Sidibé.

Antiretroviral treatment increased from less than 1 million in 2005 to 7.1 million in 2012, with nearly 1 million added in the last year alone. AIDS-related deaths were also reduced by 32 per cent from 2005 to 2011.

The UNAIDS Update on Africa, which was released to coincide with the beginning of the African Union’s (AU) 21st summit in Addis Ababa, which began Sunday and runs through 27 May, attributes this success to strong leadership and shared responsibility in Africa and among the global community. It also urges sustained commitment to ensure Africa achieves zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“As we celebrate 50 years of African unity, let us also celebrate the achievements Africa has made in responding to HIV–and recommit to pushing forward so that future generations can grow up free from AIDS,” Mr. Sidibé said.

The report states that 16 countries–Botswana, Ghana, Gambia, Gabon, Mauritius, Mozambique, Namibia, Rwanda, São Tomé and Principe, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe–now ensure that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child.

Despite positive trends, Africa continues to be more affected by HIV than any other region of the world, and accounts for 69 per cent of people living with HIV globally. In 2011 there were still 1.8 million new HIV infections across the continent, and 1.2 million people died of AIDS-related illnesses.

In the report, entitled Update, Mr. Sidibé emphasizes that sustained attention to the AIDS response post-2015 will enhance progress on other global health priorities. He also identifies five lessons in the AIDS response that will improve the world’s approach to global health. These are: focusing on people, not diseases; leveraging the strength of culture and communities; building strong, accountable global heath institutions; mobilizing both domestic and international financial commitments; and elevating health as a force for social transformation.

“These strategies have been fundamental to Africa’s success at halting and reversing the AIDS epidemic and will support the next 50 years of better health, across borders and across diseases,” he said.

The report also stresses AU leadership is essential to reverse the epidemic. At this year’s Summit, AIDS Watch Africa, a platform for advocacy and accountability for the responses to AIDS, tuberculosis and malaria founded by African leaders in 2001, will review progress on health governance, financing, and access to quality medicines, among other areas, and measure whether national, regional, continental and global stakeholders have met their commitments.

The AU, UNAIDS and the New Partnership for Africa’s Development (NEPAD) will also launch the first accountability report on the AU-G8 partnership, focusing on progress towards ending AIDS, Tuberculosis and Malaria in Africa.

[Courtesy AllAfrica News]

Uganda: Paediatric Vaccine Crisis

KAMPALA, 20 May 2013  – Ugandan children are going unimmunized as the country grapples with persistent and widespread vaccine shortages, the result of insufficient funds and inefficient procurement and supply systems, officials say.

“We are getting reports and calls from all the districts about the stock-outs of all types of anti-immunization vaccines. They don’t have anti-TB [tuberculosis] vaccines, anti-tetanus, polio [vaccines]. The ministry is faced with inadequate funding for most of our programmes,” Asuman Lukwago, permanent secretary in the Ministry of Health, told IRIN.

“The current major problem on the vaccines is the distribution issue. We are working around the clock to have the problem solved and sorted out immediately.”

Most of the health centres across the country are facing critical shortages of vaccines to protect against tuberculosis, polio, tetanus, diphtheria, rotavirus and pneumonia, putting children at risk of largely preventable diseases.

Health officials now fear these frequent shortages could prevent mothers from bringing their children in for immunizations.

“You can’t [ask] mothers to move to health facilities three to four times and they don’t find vaccines. This practice discourages some of them to go back to the hospitals,” said Huda Oleru Abason, chairperson of the Parliamentary Forum on Immunization.

Procurement woes

In 2011, the government of Uganda shifted the procurement of vaccines and drugs from the Uganda National Expanded Programme on Immunization (UNEPI), under the Ministry of Health, to the National Medical Stores (NMS), an autonomous government corporation. The move was intended to inject efficiency into the country’s drug procurement system, but the drug shortages have continued.

Yet officials at NMS are blaming the shortages on late requisitions for vaccines by UNEPI. The procurement of drugs is the responsibility of NMS.

“Placing of orders is not the responsibility of NMS, it’s [the job of] UNEPI,” Dan Kimosho, a spokesperson at the NMS, told IRIN. “So if they don’t put request in time or under-quantified for the supplies, it’s not our problem. Our responsibility is to procure, store and deliver the requested vaccines. We can’t begin delivering vaccines to districts and health [facilities] if the orders have not been placed to us. We have the competency to deliver the requested drugs and vaccines.”

An estimated 48 percent of children under age five in Uganda are either unimmunized or under-immunized, meaning they do not complete their immunization schedules, according to the 2011 Uganda Demographic and Health Survey.

Uganda has recently experienced a decline in immunization levels, in part due to inadequate funding, health staff shortages and  [parents’]poor adherence to vaccination schedules.

In April 2013, the government launched a countrywide rotavirus and pneumococcal vaccination program targeting over 1.7 million children.

In an interview with IRIN, Director General of Health Services Ruth Achieng noted that, “Uganda is not doing very well in [its] immunization programme… We don’t want our children to die from preventable diseases. We need to act now. Otherwise, we shall get an outbreak of polio and tetanus.”

Uganda’s budget support for the Expanded Programme on Immunization, EPI, – which had been hailed for increased vaccination coverage between 2000-2007 – decreased by more than half in recent years, falling from 7.7 percent in the 2006-2007 financial year to 3.6 percent in 2009-2010.

Officials say the government has plans to revitalize the country’s immunization programs.
“We have worked out the revitalization plan, and if implemented well, we shall be able to change the low status of immunization in Uganda. The government has mobilized some funds and, with support from GAVI, everything is revisable. We are going to embark on [an] aggressive campaign to ensure there are no vaccine stock-outs in the country and ensure all the children are immunized,” the Ministry of Health’s Lukwago said.

There is also a legal push to improve immunization. An immunisation bill currently pending in parliament will make it illegal for parents and guardians to fail to have their children immunized. It also seeks to punish health officials who fail to offer immunization services to children.

[Courtesy of IRIN)

Kenya: Technology Revolutionizes TB Management

NAIROBI, 18 April 2013: The use of technology is revolutionizing the way Kenya manages tuberculosis (TB). Through a computer- and mobile-phone based programme called TIBU, health facilities are able to request TB drugs in real-time and manage TB patient data more effectively, health officials say. They also use the platform to carry out health education.

“One of the challenges we have had with TB treatment is people defaulting [on treatment], but this will reduce significantly because through TIBU we will be able to track down patient treatment progress,” Joseph Sitienei, head of the Division of Leprosy, TB and Lung Disease at Kenya’s National AIDS Control Programme, told IRIN.

“By being able to track a patient, the health workers can send them reminders on their mobile phones when they fail to appear for drug refills,” Sitienei added.

Information sharing

In Kenya, a dearth of information on TB among patients and poor management of patient data have always been a challenge.

“People at times default not because they want to but because they lack information, and health facilities do not share patient data and history. Now the government is beginning to appreciate the relevance of technology in managing diseases such as TB,” said Vincent Munada, a clinical officer at the Kenyatta National Hospital in Nairobi.

Sitienei noted that TIBU – which is Swahili for “treat” – has also helped health facilities better manage drug supplies.

“Initially, health facilities used to request for TB drugs manually, but with this new system, they can ask for the same and the request is relayed to the ministry headquarters immediately. That way, drugs are supplied on time,” he said.

Kenya is ranked at 15 on the UN World Health Organization (WHO) list of 22 countries with the highest TB burden in the world, and it has the fifth-highest TB burden in Africa.

The government says an estimated 250 district hospitals, out of the country’s 290, are using the programme, which was launched in November 2012.

The government is also using the technology to support multi-drug-resistant tuberculosis (MDR-TB) patients living far from medical facilities, sending money to patients via the Mpesa mobile phone money-transfer system  to cover transport costs.

Enormous potential

Mobile phone platforms like TIBU could have even wider life-saving potential.

A recent report by multinational firm PricewaterhouseCoopers noted that mobile phone applications such as short text messages could, over the next five years, help African countries save over one million of the estimated three million lives lost annually across the continent to HIV/AIDS, TB, malaria and pregnancy-related conditions.

“SMS reminders to check for stock levels at the health centres have shown promising results in reducing stock-outs of key combination therapy medications for malaria, TB and HIV. For HIV patients, simple weekly text reminders have consistently shown higher adherence amongst the patients,” said the report.

According to the report, Kenya alone could save some 61,200 lives over the next five years by embracing mobile-based health information management.

On TB, PricewaterhouseCoopers said: “TB is a largely curable disease, but requires six months of diligent adherence to the medication regime. mHealth [mobile health] could help control TB mortalities by ensuring treatment compliance through simple SMS reminders.”

The report noted that mobile phone-based care for patients could reduce emergency visits to health facilities by up to “10 percent.”

“You know, at certain times, a patient doesn’t even need to come to a facility. You simply share what you have with them over the phone. It saves patients time and relieves the health worker to attend to other pressing issues,” Kenyatta National Hospital’s Munada said.

A 2012 study in Kenya found that the use of mobile phones between patients and health workers improved antiretroviral therapy adherence among people living with HIV.

In one mobile health project, community health workers were able to track their patients’ conditions through the use of text messages.

[Courtesy of IRIN]

HEALTH: TB response failing children

 

The global fight against tuberculosis (TB) has failed children: most TB programmes under-diagnose, under-treat or completely leave children with TB out, despite the increase in paediatric TB, and rising numbers of children who are infected with drug-resistant forms of TB strains, according to new research.

A new report, released by Médecins Sans Frontières (MSF), found that 93 percent of children who are tested for TB using the most commonly used testing method, are deemed not to have the disease, despite later being confirmed to have it.

The study, presented at the Union World Conference on Lung Health in Kuala Lumpur, draws upon data collected over three years from over 2,000 children with TB in 13 MSF projects across six countries, including Myanmar and Zimbabwe.

Children co-infected with HIV and TB were at a greater risk of dying than children with TB, and while more than half the whole cohort had pulmonary TB, only 6.4 percent had tested positive for TB with the most commonly-used test (coughing up a sample of sputum to be checked under the microscope for bacteria).

A tricky diagnosis

But the report acknowledged that diagnosing TB in children is far more problematic. Most children, especially the youngest, cannot produce enough sputum for these tests. And even when they can, sputum-based tests do not detect paucibacillary or extrapulmonary TB that occurs more frequently in children.

“In an attempt to get adequate samples, health workers are forced to use invasive and painful measures, involving forcing vapour into their lungs to make them cough up sputum, or sucking out sputum from their stomach,” said Martina Casenghi, scientific advisor for MSF’s Access Campaign.

“The ideal test for children would be a test that does not rely on sputum… The ideal test would be something not requiring laboratory infrastructure [something like a urine pregnancy test] and that uses an easy to obtain sample such as urine, stool, finger prick blood test, etc. This ideal is not specific to children as it would help diagnose other difficult cases such as HIV co-infected or extrapulmonary TB,” Grania Brigden, TB adviser for MSF’s Access Campaign, told IRIN/PlusNews.

Although new diagnostic tools such as the GeneXpert test could mean much more rapid diagnosis of paediatric TB, it still has its limitations as it also relies on sputum samples, the report noted.

Nevertheless, “GeneXpert is a start, as it is an improvement from smear microscopy, especially if you use it on samples obtained from nasopharahgeal aspirate or induced sputum, and for that reason although it is not the perfect test we still feel that it has a role to play in improving diagnosis in children. It also can potentially aid in the diagnosis of drug-resistant TB in children,” Brigden added.

According to the report, one of the main barriers to developing a TB test that works in children has been the lack of a gold standard to assess performance of new diagnostic tools. “However, consensus on the methodological approaches to follow for evaluating new diagnostic tests in children has recently been reached… These new approaches should be implemented rapidly so that the rate of progress can be accelerated.”

Getting the dosage right

To make things worse, paediatric drug formulations and international treatment guidance for children remain inadequate, MSF found. In 2009, the World Health Organization (WHO) released revised dosage guidelines for TB in children, but the formulations available on the market today are still not tailored to deliver the new dosages.

“And a slow response on the part of WHO to release recommended drug strengths and the composition of new fixed-dose combination (FDC) drugs has meant that, despite two years having passed since new dosage guidelines were issued, no new FDC drugs for children have been developed to correspond to the new doses. Until that happens, treatment providers are struggling to provide children the new doses through complex interim dosing recommendations,” the report noted.

MSF urged WHO to provide clear guidance to drug manufacturers on needed fixed-dose combinations of first-line drugs to support implementation of the new WHO-recommended dosages.

TB affects nearly a million children globally every year, and up to 130,000 die annually from this preventable and curable disease.

Courtesy IRIN News

MYANMAR: “Urgent” need for HIV treatment

YANGON, 02 March 2012 (PlusNews) – Lack of access to anti-retroviral therapy (ARV) to treat HIV has left thousands of patients in Myanmar with deteriorating immunity and increased vulnerability to tuberculosis (TB), say health workers.

“The situation is dire,” said Peter Paul de Groote, head of Médecins Sans Frontières (MSF) in Myanmar. “The gap between the treatment that is needed and what is received is unacceptably high.”

ARV providers in Myanmar – of whom MSF is the largest – are concentrated in Yangon and Mandalay divisions, and Shan and Kachin states, which account for more than 60 percent of the country’s 133 ART distribution sites, according to UNAIDS Myanmar.

“The unfortunate case is that many people have to travel far to access treatment. This country has the potential to treat more people, save more lives and prevent transmission by expanding service provision,” Sung Gang, the UNAIDS Myanmar country coordinator, told IRIN from Yangon.

But according to MSF, funding is the biggest problem.

When donors did not deliver on pledges, the Global Fund to Fight HIV, Tuberculosis and Malaria cancelled its Round 11 fundingin late November.

While a Transitional Funding Mechanism has been established to provide emergency relief to current recipients, which will run out of money before 2014, it only covers essential services such as HIV treatment, care and prevention, leaving ARV providers unable to expand to other needed areas, notes MSF.

Scale-up interrupted

Funds from Round 11 were expected to treat 46,500 more patients in Myanmar, according to a recent MSF study.

Of the estimated 240,000 HIV-positive people, only 24 percent receive ARV therapy. Roughly 85,000 people need treatment but cannot access it, causing up to 20,000 preventable AIDS-related deaths annually, according to MSF.

“The Ministry of Health, MSF, and the hospitals all have the willingness and capacity to scale up. There are a lot of new donor pledges [going into Myanmar] but not for HIV,” MSF’s De Groote said.

Doctors are forced to prioritize treatment for patients in the most advanced stages of HIV/AIDS, despite proof that earlier treatment decreases transmission rates and improves health outcomes, according to the Inter-Agency Standing Committee’s(IASC) 2010 Guidelines for addressing HIV in humanitarian settings.

“Turning back patients is a difficult and impossible choice. We have to tell them, come back when you get sicker,” said Khin Nyein Chan, MSF’s deputy medical coordinator in Myanmar and a doctor at the NGO’s clinic in Yangon, one of four nationwide.

While the World Health Organization (WHO) recommends starting ARV medications when an HIV patient’s CD4 count, a specialized immune system cell measure, has dropped below 350 cells/mm3, doctors in Myanmar administer ARVs only to those with CD4 levels below 150 cells/mm3.

“They have to wait until severe life-threatening and opportunistic infections are in their bodies before we can treat them,” said Khin Nyein Chan.

TB threat

TB is one such opportunistic infection. An HIV-positive status can increase the chance of contracting TB by up to 37-fold, according to WHO.

In Myanmar, 300,000 people are infected with TB – 60,000 of whom are also HIV-positive – according to MSF.

The increased incidence of airborne TB among HIV patients not taking ARVs raises the likelihood that it will spread among the general population, said Maria Guavara, MSF’s medical coordinator.

“HIV/AIDS and TB are a lethal combination. Treatment of HIV drops the instance rate of TB.”

At Phoenix Association, a Yangon-based social support centre for HIV-positive people, patients seek solace from debt and disease.

One patient from Phyuu Township of Bago Division in the country’s south, Sai Hlaw Aung, 33, told IRIN in 2011 that battling HIV and TB had made him too weak to continue working as a bamboo cutter.

“Now I am not as strong as before. I have no idea how I could earn household income when I go back home,” said Sai Hlaw Aung.

The association allows out-of-town patients to sleep in the office while undergoing treatment in Yangon. Space is tight.

“Currently we need shelter to accommodate the people,” said Thiha Kyaing, head of the association told IRIN. Little has changed since.

“We don’t just want to bridge the treatment gap and walk away. We need sustainable programmes, and the sooner the better,” De Groote said. “If we don’t treat people now we will lose them,” he added.
[Courtesy of IRIN News]

KENYA: Workers Risk TB in Gold Mine

 

NYATIKE, 6 April 2011 (PlusNews) – Timothy Omuya spends most days chipping away at stones in search of gold and inhaling fine particles of dust without protective gear in western Kenya’s mines. It was not a huge surprise, therefore, when he tested positive for tuberculosis.
His local hospital put him on TB medication, but his long working hours meant he did not stick to the schedule.

“At times I fail to take them because I don’t go in good time to take new ones from the hospital when I finish the ones I have,” he told IRIN/PlusNews. “Here at the mines, we work both day and night, so the time you are supposed to go and take your medicine, you are deep down in the mine.”

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What Omuya did not realize was the risk to his family; his wife and youngest child are now both infected. His wife Peres says she and the child adhere to their medications strictly, but fears that if Omuya continues to miss doses of his medication, he may re-infect them.