PrEP for teenagers – what doctors say

A study suggests most physicians would be willing to prescribe PrEP to teens, but the doctors themselves need to be educated on its use. Pre-exposure prophylaxis (PrEP), a daily antiretroviral pill, can lower the risk of getting HIV from sex by up to 90%, according to the U.S. Center for Disease Control and Prevention.

Reuters reports on a study that surveyed 162 U.S. doctors who worked with adolescents and young adults. While 93% of the clinicians had heard of PrEP, only 35% had prescribed it.

In the survey, more than half of the respondents said they had only treated a few teens and young adults with HIV. Just 15% of the clinicians reported treating many HIV-positive youth.

The results suggest that some providers may still need to be educated about PrEP and made aware that it’s now approved for use in teens, said Matthew Beymer, a researcher at the University of California, Los Angeles, David Geffen School of Medicine, and at the Los Angeles LGBT Center.

“I think the take-home message is that PrEP works well whether you are an adolescent (and over 77 pounds) or an adult provided you take your medication every day,” Beymer, who wasn’t involved in the study, said.  “Teens should consider taking PrEP if they either have an indication for PrEP or feel that taking PrEP would reduce their concerns about contracting HIV.”

June 26, 2018


New Drug Helps Patients Beat Drug Resistant TB

News from the 5th South African Tuberculosis Conference in Durban is that a new drug could change the fate of people with extensively drug-resistant TB (XDR-TB).

Health-e News reports that the death rate for XDR-TB patients fell to 27% after the introduction of the blockbuster anti-TB drug bedaquiline. Before the introduction of this drug, about half of XDR-TB patients would die.

“DR-TB comes in two forms. Multi-drug resistant TB (MDR-TB) is resistant to two of the most common anti-TB drugs and XDR-TB is resistant to four – leaving very few drugs available. DR-TB treatment has traditionally equated to taking a cocktail of old and toxic drugs for about two years. The side-effects of this treatment are often debilitating, for example deafness, but even if patients take all their pills religiously they have a very slim chance of being cured.

In 2013, South Africa made “a bold and innovative move” to introduce a brand-new drug into the TB programme, according to Dr Francesca Conradie, a DR-TB expert from the Southern African HIV Clinicians Society.

It was bold, she said, because bedaquiline’s manufacturer Janssen Pharmaceuticals had not completed the usually-required years of rigorous safety and efficacy testing. Early trials had shown promising results but health experts had safety concerns.

But because, with so few effective drugs available, patients were dying, the Department of Health made the decision to introduce it to a small number of patients as part of a compassionate access programme. In 2014, access was rapidly scaled up and now two thirds of people receiving bedaquiline are in South Africa.

“The reason other countries with DR-TB epidemics haven’t introduced bedaquiline in the same way we have simply comes down to a lack of political commitment,” said Conradie. “The South African government has put their money where mouth is and the result is we have much fewer people dying of DR-TB.”

 

June 18, 2018


Recent article published in the New York Times:

"It Saves Lives. It Can Save Money. So Why Aren't We Spending More on Public Health?"

Funding for health campaigns is surprisingly low when you consider they’re often so valuable that they pay for themselves.

Not only have many public health interventions in the United States been hugely successful, but they’ve also saved more money than they’ve cost.

And yet Americans spend relatively little money in that domain and far more on medical care that returns less value for its costs. Instead of continually complaining about how much is being spent on health care with little to show for it, maybe we should direct more of that money to public health.

Think of it this way: Americans can expect to live into their late 70s, on average, in large part because of public health investments. From 1900 to 1999, life expectancy at birth increased from 47 years to 77 years. Although much of that was because of significant improvement in the care of babies and children, experts believe that 25 of the 30 years gained can be attributed to public health advances.

Read the full article here: https://www.nytimes.com/2018/05/28/upshot/it-saves-lives-it-can-save-money-so-why-arent-we-spending-more-on-public-health.html

 

june 5, 2018


South Sudan’s quiet victims of war: With HIV, without help

South Sudan’s five-year civil war is quietly creating another kind of victim: those prevented from getting life-saving antiretroviral medicine. Experts say the number of affected people could be in the hundreds of thousands, reports AP News.

Currently just 13 percent of the estimated 200,000 South Sudanese living with HIV are being treated, according to UNAIDS. That compares to 42 percent of people in neighbouring Congo, another impoverished country that has long faced instability. Although South Sudan’s 2.7 percent HIV prevalence isn’t notably high for sub-Saharan Africa when compared to countries like Swaziland, whose prevalence is at 27 percent according to UNAIDS, concerns are rising that the civil war has made accurate tracking of the disease impossible. Local aid groups think the country’s HIV prevalence is likely higher, citing a recent increase in people testing positive due to widespread transactional sex by women trying to support themselves and families and mass rape by armed men, especially in the capital, Juba.

At the same time, the conflict has sent millions fleeing while sexual violence rises as a weapon of war, according to human rights groups.

“The army are the ones raping. They’re the ones with the guns,” said Evelyn Letio, director of the National Empowerment of Positive Women United, a local group supporting women with HIV. Both sides in the civil war have been accused of abuses including rape.

28-year old Juba resident, Marlene Freet, says the worsening economy caused by the civil war makes it hard to find the food she needs to take with her HIV medication.

Sometimes she eats only once a day, she says.

May 29, 2018


Rapid response to Ebola outbreak

There are concerns that the latest Ebola outbreak in the Democratic Republic of Congo may not fizzle out as has happened with the other most recent outbreaks there. This time the outbreak is near the Congo River, a transport route to Kinshasa. Officials are worried this could lead to a rapid and more widespread outbreak of the disease. In response, the DRC and U.N. agencies have begun deploying rapid response teams to prevent the spread of Ebola.

Devex reports that early funding pledges have also been announced in response to the outbreak of Ebola.

The United Kingdom government pledged 1 million British pounds ($1.36 million) on Thursday through the Joint Initiative on Epidemic Preparedness, with the Wellcome Trust committing a further 2 million pounds to support rapid response to the outbreak. The funds will be made available to the DRC government and WHO for research to support the operational response, according to a statement from the Wellcome Trust.

WHO released $1 million from its Contingency Fund for Emergencies to support response over the next three months, with the goal of preventing the disease from spreading to surrounding areas.

may 15, 2018


Two bug killers better than one

Mosquito nets infused with two pesticides work much better against malaria than those with only one, reports the British Medical Journal (BMJ). The nets, investigated in a recent study reduce prevalence in children by 44 percent.

As a result of the findings, published in The Lancet last month, the World Health Organization has used them in areas where mosquitoes have developed resistance to the first-line insecticide. The new nets contain pyrethroids, a class of chemicals used in nets for over a decade, along with the newer compound, piperonyl butoxide, which blocks mosquitoes’ ability to break down pyrethroids. (It is sometimes called a “pesticide synergist.”)

“It is hard to find new insecticides suitable for nets, because they must kill or repel mosquitoes and yet be safe for the babies and youngsters who sleep under them. The insecticides also must be able to stand up to washing and intense sunlight”, reports the BMJ.

may 7 2018


Health care for all

As the World Health Organization (WHO) is working to accelerate universal health care (UHC), The Economist writes that this idea of health care for all is affordable.

“A country need not wait to be rich before it can have comprehensive, if rudimentary, treatment. Health care is a labour-intensive industry, and community health workers, paid relatively little compared with doctors and nurses, can make a big difference in poor countries. There is also already a lot of spending on health in poor countries, but it is often inefficient. In India and Nigeria, for example, more than 60% of health spending is through out-of-pocket payments. More services could be provided if that money—and the risk of falling ill—were pooled.”

Chile and Costa Rica spend about an eighth of what America does per person on health and have similar life expectancies. Thailand spends $220 per person a year on health, and yet has outcomes nearly as good as in the OECD. Its rate of deaths related to pregnancy, for example, is just over half that of African-American mothers. Rwanda has introduced ultrabasic health insurance for more than 90% of its people; infant mortality has fallen from 120 per 1,000 live births in 2000 to under 30 last year.

Research led by Dean Jamison, a health economist, has identified over 200 effective interventions, including immunisations and neglected procedures such as basic surgery. In total, these would cost poor countries about an extra $1 per week per person and cut the number of premature deaths there by more than a quarter. Around half that funding would go to primary health centres, not city hospitals, which today receive more than their fair share of the money.”

“So long as half the world goes without essential treatment, the fruits of centuries of medical science will be wasted”, writes the Economist. Universal basic health care can help realise its promise.

april 30, 2018


A place where sex workers can be safe

Senegal is the only place in Africa where sex workers are regulated by the state. Identification cards confirm the women as sex workers and give them access to some free health care, condoms and education initiatives.  The Economist asks why this small west African state is so different.

The Senegalese system has its roots in the country’s colonial legacy. French legislation that regulated prostitution in order to prevent the spread of sexually transmitted diseases was kept on the books after independence in 1960, when many other Francophone countries dropped it. In the 1980s Senegal responded to the HIV epidemic sweeping across the continent by establishing a range of policies to counter the threat, and to target vulnerable populations. One measure involved revamping the regulation of sex work, which under the French had required sex workers to register with the authorities. The system was reinforced after the HIV epidemic and the authorities tried to get as many women as possible to sign up.  

Today, the law enshrines a woman’s right to work in the sex trade if she is over 21. Health check-ups are mandatory and in fact a woman can have her sex worker identity card declared invalid if she does not go for regular check-ups.

In most other African states, sex work is criminalized, which leads to higher HIV infection rates, because women are reluctant to visit health care facilities.

april 23, 2018

 

 


Factfulness: Why Things Are Better Than You Think 

He challenged the doom-and-gloomers in global health by challenging preconceptions and misconceptions. Now, a year after his death, a book by Hans and Ola Rosling and Anna Rosling Rönnlund, gives us ten reasons why we’re wrong about the world. In the book, Factfulness: Ten Reasons We're Wrong About the World--and Why Things Are Better Than You Think, the authors ask why so many people — including Nobel laureates and medical researchers — get the numbers so wrong on pressing issues such as poverty, pandemics and climate change. The book isolates the ten instincts that lead to what Rosling calls the “overdramatic worldview”: that pervasive, generally pessimistic global perspective that often cancels out significant progress made in the face of vast challenges.

Rosling also covers five risks that we “should worry about”: global pandemic, financial collapse, a new world war, climate change and the extreme poverty that still afflicts 700 million people. 

The book ends with a plea for a factual world view. Rosling was optimistic that this outlook will spread, because it is a useful navigational tool in a complex world, and a genuine antidote to negativity and hopelessness.

(This is a shortened version of an article, Swansong of Hans Rosling, data visionary, by Jim O’Neill published in Nature).

April 11, 2018


Beer promotion and health - not a good mix

The Global Fund is pulling out of a partnership with beer company Heineken – just weeks after the controversial deal was made.

Many working in public health had been highly critical of the partnership, entered into by the new executive director of the Global Fund to Fight AIDS, TB and Malaria, Peter Sands. Alcohol abuse is closely associated with health and behavioral risks.

For weeks, The Global Fund defended the decision. In a short statement the Global Fund says Heineken is being cut off because of ‘the company’s use of female beer promoters in ways that expose them to sexual exploitation and health risks’…”.

april 3, 2018