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India’s Search For TB Drug Feaured In BBC Health Check

How will Obama’s health reforms change the health of America? Why counting the dead and finding out why people die improves public helath. And India’s search for a TB drug.

Click here for mp3 stream.

Singapore To Improve Detection And Treatment Of Tuberculosis

Gov Monitor

Partnership could lead to improved detection and treatment of the highly infectious disease that affects millions worldwide.

An investment of S$3 million is being pumped into tuberculosis (TB) research by A*STAR's Singapore Immunology Network (SIgN), bioindustrial group Institut Mérieux and its in vitro diagnostics company bioMérieux.

The project, which involves setting up a joint laboratory in Biopolis, Singapore aims to investigate and identify novel biomarkers that could allow early identification of individuals at risk of TB disease development and disease reactivation. This could lead to better diagnosis and treatment for the highly contagious disease.

At the shared lab, researchers from SIgN and bioMérieux will study the immune cells in the blood of infected individuals without active TB, and compare them with those in individuals with active TB, as well as non-infected healthy controls.

Any change in gene expression and behaviour of the immune cells will then be analysed to identify biomarkers associated with TB infection and/or TB re-activation.

This information would be especially pertinent to clinicians and researchers as current tests cannot reliably detect if the individual is at risk of developing the disease.

In addition, the identification of predictive biomarkers will also help clinicians accurately assess patients' responses to TB treatment and deal appropriately with those who have developed drug resistance to Mycobacterium tuberculosis, the bacterium responsible for causing TB.

This will lead to early and accurate assessment of the effectiveness of treatment in TB patients.

One of the lead researchers involved in the collaboration is Prof Paola Castagnoli, Scientific Director of SIgN. Said Prof Castagnoli, "The risk of developing active TB is higher in persons with weak immune systems, especially in those infected with HIV, and young children under the age of five. There is an urgent need to understand and find new ways to eradicate the disease - through prediction, early detection and effective treatment - and this timely collaboration seeks to accomplish exactly that." Prof Castagnoli was part of a team of scientists that published findings on the way dendritic cells and macrophages cope with Mycobacterium tuberculosis in 2008.

The co-investigator on the project, Professor Christian Brechot, who is also the Vice President of Institut Mérieux in charge of scientific and medical affairs, said, "We are very pleased with this partnership between Institut Merieux, bioMérieux and SIgN. It reflects the strategy of Institut Mérieux and its companies to establish long-term partnerships with internationally recognised research institutions, in particular in Singapore. The joint laboratory will focus its activities on tuberculosis, as part of Institut Mérieux's research programs, as well as on oncology. We look forward to the success of this important agreement."

Prof Philippe Kourilsky, Chairman of SIgN, said, "Infectious disease is an area that cannot be tackled alone - Singapore has identified infectious diseases as one of its flagship areas of focus for its research efforts and is working closely with its regional and global partners; SIgN already has some meaningful partnerships with several industry players including Cytos and Vivalis. We are excited at this opportunity to partner Institut Mérieux and bioMérieux, which we hope will accelerate the process of discovery and find something of direct impact to the treatment and management of tuberculosis. This collaboration will reinforce SIgN's position as a premier immunology research centre that focuses on addressing the pressing diseases facing Singapore and the region."

TB cases down in India

Sify News

The incidence of tuberculosis (TB) is showing a declining trend as a result of the Revised National TB Control Programme (RNTCP), parliament was told Friday.

'The estimated incidences of all cases per lakh population has come down from 184 per lakh population in 2001 to 168 per lakh in 2007,' Minister of State for Health Dinesh Trivedi said in a written reply to the Lok Sabha.

Over 12,700 microscopy centres and over four lakh treatment centres have been set up across the country under the RNTCP, based on WHO recommendations.

'Since its inception, nearly 12 million TB patients have been put on treatment by RNTCP resulting in saving more than two million additional lives,' Trivedi said.

A detection rate of 70 percent and treatment success rate of 85 percent has been achieved in line with the targets of TB control, he said.

NGOs and private practitioners and other medical associations have also been involved in the programme. The minister also said that guidelines on air-borne infection control has also been developed to promote preventive measures.

Fears over TB treatment funding cuts in London

BBC News

The van, called Find and Treat, contains an X-ray machine which can detect signs of tuberculosis.

The homeless are the most at risk group so the van visits hostels across the city, but the Department of Health has said funding will end in December.

Al Story, who runs Find and Treat, said he was trying to find new funding.

He said: "It remains unclear where the money is going to come from to continue our good work.

"It is serving an extremely vulnerable population and there will be a gap in tuberculosis control in London."

'Vulnerable population'

NHS London has also refused to guarantee funds.

During a day BBC London spent with the van, the team scanned 50 people for signs of the potentially deadly lung disease.

One of those scanned had signs of the infection.

An NHS London spokesman said: "Tuberculosis is a serious issue in London and it is important we have the right services in place.

"We are currently discussing the future of Find and Treat and this includes working to thoroughly evaluate how successful the programme has been so far."

Early ARVs enhance survival in HIV-TB

healthdev.net

Currently, a gap of up to 8 weeks between commencement of TB treatment and initiation of HAART is advised, to reduce the risks of immune reconstitution inflammatory syndrome (IRIS) and adverse drug interactions. The findings of the CAMELIA (Cambodian early vs late introduction of antiretrovirals) were presented at AIDS 2010 on 22 July by Dr Francis Xavier Blanc, Bicetre Hopital, France.

CAMELIA researchers recruited 661 people with TB and HIV into the randomised trial, across five sites in Cambodia. All of the participants had newly diagnosed acid-fast bacillus smear positive TB. Their CD4 counts were below 200 cells/mm3 (on average 25 cells/mm3). Both pulmonary and extrapulmonary TB cases were included; some participants had both forms of TB.

The trial population was divided equally into two groups. One group received early HAART, just two weeks after initiation of TB treatment. The other group received HAART 8 weeks after the start of TB treatment, in accordance with normal guidelines. There is moderate evidence to suggest that starting TB treatment before antiretrovirals (ARVs) is always better in terms of adverse events and tolerability, so TB treatment was begun before HAART in both groups. MDR-TB rates were low, at 1-2% in both groups.

After 50 weeks, 146 participants were known to have died, 59 in the early arm and 90 in the late arm. This demonstrated that survival was significantly enhanced in the early arm (p= 0.002). At week 50, median CD4 cell gain was 114, and nearly all the participants had an undetectable viral load. Calculations of survival gave a 3-year survival probability of 82% if ARVs are given early, two weeks after TB treament starts, and 70.2% if they are given late, at 8 weeks (p =0.002).

Participants were at higher risk if they had MDR TB, combined pulmonary and extrapulmonary infection, and low (<16) BMI at baseline, regardless of when ARVs were given. IRIS was significantly more frequent in the early arm (p<0.0001), but symptoms were manageable. Only 12 (1.8%) patients were lost to follow-up.

The CAMELIA study has shown that initiation of HAART at 2 weeks, rather than 8 weeks, after the onset of TB treatment significantly improves survival in severely immunosuppressed HIV-infected adults, despite the increased incidence of IRIS. The findings could have significant implications for TB-HIV treatment programs globally.

"We calculated that if this early ART was applied in all HIV-TB cases, it would result in about 50,000 lives saved" said Dr Blanc.

Dr Blanc also noted that all the patients in the CAMELIA study were highly immunocompromised, and it is unclear whether the best timing of ARVs would be different in people with HIV-TB with higher CD4 counts.

No MOSOTOS, it’s time for action on TB and HIV

RESULTS UK

This week, RESULTS and the rest of the Action Project team have been calling for an end to MOSOTOS (More of the Same Old Talk, Opinions and Speeches) at the International AIDS Conference in Vienna.

Despite numerous declarations, pledges and promises, international agencies such as the World Bank, Pepfar, UNAIDS and WHO have failed to ensure that all people living with HIV (PLWHA) have access to TB screening and prevention. We are calling for an end to MOSOTOS and for global leaders to start living up to their promises.

One in four deaths among PLWHA is caused by tuberculosis. Despite being the leading infectious killer of PLWHA, the percentage of people with HIV who are regularly screened for TB has increased from 0.6 percent to only 4.1 percent in 2004.

The MOSOTOS campaign has been spreading around the AIDS Conference and has now been adopted by other civil society groups who share our frustration with endless commitments that are not translated into improved health outcomes for the world's poorest and most marginalised people.

Our alternative conference newsletter has proved to be popular with participants, as has our MOSOTOS mascot. Although it has been delivered in a light-hearted way, our message is very serious: just talking about scaling up TB-HIV services without action or sufficient resources is unacceptable.

At a press conference yesterday, we launched our TB-HIV report card which highlights the screening scandal. Panelists agreed we need to start calling the failure to screen PLWHA for TB what it is: ‘malpractice' and a denial of human rights. Dr Anthony Harries from the International Union Against TB and Lung Disease explained just how straightforward TB screening is. Screening for TB simply involves regularly asking an HIV-positive patient if they are displaying any of the following four symptoms: a persistent cough, fever, night sweats and loss of weight. If the answer is no then they probably don't have TB, but could be started on preventative therapy which is useful to reduce the high risk of contacting TB in HIV-positive patients. If some of the symptoms are present then the patient should be tested for TB and be given appropriate treatment and care.

Early diagnosis and treatment of TB can result in many needless deaths being prevented. Thabile Dlamini, Deputy General Secretary of the Treatment Action Campaign (TAC), spoke at the press conference about how she had been misdiagnosed for TB many times herself. Similarly her brother was started on TB treatment late following numerous misdiagnoses. After a few weeks on TB treatment his health did not improve and he was later diagnosed with multi-drug resistant TB. His diagnosis was too late. Thabile informed us that she had buried her brother just days before travelling to Vienna for the AIDS Conference.

As this tragic story illustrates, the failure of policymakers to turn words into actions has irreversible consequences for families and communities around the world. To stop people with HIV dying from TB, all HIV/AIDS programmes must screen for TB and implement the "3 Is" - intensified case finding, infection control and isoniazid preventative therapy.

Additionally, affected countries, donors and technical agencies must act to ensure universal access to quality TB-HIV care by 2015 - moving in coordination with the goal of universal access to antiretroviral therapy. This, of course, all requires extra resources. A key opportunity for donors to replace MOSOTOS with action will be to commit $20 billion at the Global Fund replenishment meeting in October.

Vienna 2010:TB screening - more talk, no action

http://healthdev.net

Health advocates are outraged by MOSOTOS (More Of the Same Talk Opinions and Speeches) with little implementation of the same.

This week the world is converging in Vienna Austria for the 18th International AIDS conference. More pledges, promises and declarations will be made to add to others that have been made previously without any or very minimal implementation if any.

One failed promise is that of TB screening among people Living with HIV. (PLWHAs). To date globally, only 4.1% of PLWHAs are screened for TB despite the infection being the leading killer of PLWHAs. It is worse in Africa which is at 3%. Almost 25% of PLWHAs eventually die from TB because they are not tested for it and therefore not properly treated.

According to WHO 2009 Global Tuberculosis Control report, a total of 1.4 million HIV positive people attending HIV care services were screened for TB. This is only 4.1% of the total 33.3 million estimated PLHAs.

For two decades, the HIV/AIDS community has known that TB and HIV/AIDS are intimately linked, particularly in sub Saharan Africa where HIV has caused TB incidences to triple since 1990. Yet after so many promises, declarations and calls to action HIV programs are still failing to identify the most likely infection to kill those accessing HIV services.

‘I have had HIV for almost 20 years and the only time I ever came close to dying was with TB.’ Said Lucy Chesire a renowned TB HIV advocate from Kenya. It took seven months in a hospital bed before the doctors could think of screening me for TB. I am not sick from TB anymore but I am sick, tired and fed up that screening is not being provided to 96% of HIV positive people.

Unlike Lucy who was lucky to survive, many patients today are dying of TB without ever knowing they suffered from TB. ‘WHO recommends every person with HIV/AIDS to be screened of TB’. Said Emily Wright, Project Director for Advocacy to Control TB Internationally (Action). ‘So the fact that only 4.1% of HIV positive people around the world are screened for TB is simply rampant unmitigated malpractice’. Concluded Emily a TB advocate.

Country level programs are not the only actors that are failing on this issue. The leading sources of International HIV/AIDs funding the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS TB and Malaria (GFATM) and the World Bank do not routinely monitor the number of PLHAs being screened for TB in HIV/AIDS programs they support.

‘None of the three biggest AIDS donors are reporting the proportion of PLHAs being screened for TB’. Said Wainwright. It is essential that these donors ramp up HIV testing to TB patients further operationalize stated commitments to collaborative TB HIV services and significantly increase resources to address the same.

To stop PLHAs dying of TB, programs must screen all PLHAs accessing care for TB and make the�three Is ( Intensified Case Finding, Infection Control, and Isoniazid Preventive Therapy ) central to HIV/AIDS services and universally available.

Affected countries donors and technical agencies must act to ensure universal access to quality TB- HIV care by year 2015- moving in coordination with the goal of Universal access to ART. Likewise heads of state and ministers of health endemic countries must take the lead in committing to a goal of universal access by 2015 on TB –HIV care.

‘The time for MOSOTOS is over. It is time to take action!’ Concluded Lucy Chesire also calling for integration of TB and HIV services. ‘TB and HIV services should be accessed from one point, from one nurse, from one facility on one day. Stop dividing the patient and wasting their time seeking services instead of being economic productive in their own ways ’ said Lucy.

Health watchdogs sound alarm over TB/HIV deaths

Associated Free Press

Two global health agencies joined forces on Thursday in a campaign aimed at averting 200,000 deaths each year by co-infection from tuberculosis and the AIDS virus.

"Every three minutes a person living with HIV has his or her life cut off prematurely by TB," said Jorge Sampaio, UN Secretary General Ban Ki-moon's special envoy on stopping tuberculosis.

"This is completely unacceptable. TB is a preventable and curable disease."

Sampaio presided over a signing of a memorandum of understanding on the sidelines of the 18th International AIDS Conference, gathering the UN agency UNAIDS and Stop TB, a public-private health partnership.

They pledged to work towards halving the mortality from TB/HIV in 2015 compared to a base line of 2004, a year in which 400,000 people died.

"We are talking about a massive human tragedy," the executive secretary of Stop TB, Marcos Espinal, told AFP. "African countries in particular have been devastated by co-infection."

Espinal estimated that several billion dollars each year would be needed to reach the 2015 objective, but much of this could come from smarter use of existing resources.

"There is a package of activities that if properly implemented by countries will work," he said.

Several dozen activists demonstrated before the event, pounding drums and holding up a black coffin symbolising the death toll from co-infection by the two microbes.

In the middle of the past decade, researchers uncovered the dismaying consequence from these two overlapping pandemics: people who were co-infected were often placed on the fast track to death.

TB is a lung disease that is caused by a germ, Mycobacterium tuberculosis. Around two billion people around the world are infected by the bacteria, but the vast majority never fall sick. A far smaller number -- nine million a year -- develop symptoms of the disease.

However, the risk doubles when an individual is infected by HIV, which weakens the immune system, allowing the germ to run riot.

Without TB treatment, which costs around 25 dollars a person, 90 percent of co-infected people die within two or three months. Of the two million deaths that occur from HIV infection each year, around one in four is linked to TB.

Alasdair Reid, HIV/TB advisor at UNAIDS, said co-infections could to a large degree be tackled through simple measures and under existing guidelines.

Investment in health clinics and labs should focus on facilities that can diagnose and treat both infections at the same time. Careworkers should be trained to ask a patient with HIV whether he has been coughing recently, to see whether antibiotics should be initiated.

Separately, French and US researchers reported good results from a Cambodian trial into boosting survival chances for people who were badly infected with HIV and newly diagnosed with TB.

The standard approach is to begin TB treatment and then wait eight weeks before administering antiretrovirals, which repress HIV.

The reason for the delay is a condition called immune reconstitution inflammatory syndrome, in which the immune system essentially goes haywire and makes the infection far worse, sometimes lethally.

But the survival chances are better if the antiretrovirals are started only two weeks after beginning the TB treatment, the study found.

Researchers enrolled 661 adult volunteers at five sites in Cambodia.

Fifty-nine out of 332 patients who started antiretrovirals two weeks after beginning TB treatment died, compared to 90 out of 329 counterparts who started anti-HIV drugs after eight weeks.

Living With AIDS, Dying of TB

One in four deaths among people living with HIV/AIDS (PLHA) results from tuberculosis (TB). Despite being the leading infectious killer of PLHA, the percentage of PLHA that are regularly screened for TB has increased from 0.6 percent to only 4.1 percent since 2004.

Health advocates are outraged that patients are not being dually tested for both diseases.

"I have had HIV for almost 20 years, and the only time I've ever come close to dying was with TB," said Lucy Chesire, a renowned TB-HIV advocate from Kenya. "I am not sick from TB anymore, but I am sick, tired and fed up that TB screening is not being provided to 96 percent of HIV-positive people."

For two decades, the HIV/AIDS community has known that TB and HIV/AIDS are intimately linked, particularly in sub-Saharan Africa where HIV/AIDS has caused TB incidence to triple since 1990. Yet, after years of promises, declarations, and calls to action, HIV programs are still failing to identify the most likely infection to kill those accessing HIV services. According to the WHO 2009 Global Tuberculosis Control report, the most recent data show a total of 1.4 million HIV-positive people attending HIV care services were screened for TB. This is only 4.1 percent of the total 33.3 million estimated PLHA.

"WHO's policy is that every person with HIV/AIDS should be regularly screened for TB," said Emily Wainwright, Project Director for ACTION. "So the fact that only 4.1 percent of HIV-positive people around the world are screened for TB is simply rampant, unmitigated malpractice."

Country-level HIV/AIDS programs are not the only actors failing on this issue. The leading sources of international HIV/AIDS funding - the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank - do not routinely monitor how many PLHA are being screened for TB in HIV/AIDS programs they support.

"None of the three biggest AIDS donors are reporting the proportion of PLHA being screened for TB," said Wainwright. "It is essential that these donors ramp up HIV testing for TB patients, further operationalize stated commitments to collaborative TB-HIV services, and significantly increase resources for TB-HIV services."

To stop people living with HIV from dying of TB, HIV/AIDS programs must screen all PLHA accessing HIV/AIDS care for TB and make the "3 Is" - intensified case finding, infection control, and isoniazid preventative therapy - central to HIV/AIDS services and universally available.

Additionally, affected countries, donors, and technical agencies must act to ensure universal access to quality TB-HIV care by the year 2015 - moving in coordination with the goal of universal access to ART. Likewise, heads of state and ministers of health in endemic countries must take the lead by committing to a goal of universal access by 2015 on TB-HIV care.

Dr. Anthony Harries, Senior Advisor to the International Union Against TB and Lung Disease, highlighted an additional challenge in limiting the suffering caused by the dual epidemics. According to Harries, TB-HIV co-infection is likely the leading cause of death of health workers in sub-Saharan Africa.

"All around Africa immuno-compromised patients and health workers are being crowded in the same cramped clinics with people who likely have TB and even drug-resistant TB. Then we refuse to screen them for TB," said Dr. Harries. "This is wrong, this is deadly, and this must stop immediately."          

# # #

About ACTION

ACTION (Advocacy to Control Tuberculosis Internationally) is an international partnership of civil society advocates working to mobilize resources to treat and prevent the spread of tuberculosis (TB), a global disease that kills one person every 20 seconds.

ACTION's mission is to build support for increased resources for effective TB control, especially among key policymakers and other opinion leads in both high TB burden countries and donor countries. With effective policy advocacy and greater political will, rapid progress can be made against the global TB epidemic

For more information, contact: Blair Hinderliter,

+1 202 230 2188;/ 0650 310 1638, bhinderliter@results.org

The World Bank Must Invest In Aid More Wisely

http://www.guardian.co.uk/commentisfree/2010/jun/11/world-bank-invest-aid-more-wisely

On Wednesday, the UK government announced that multilateral development agencies such as the World Bank will need to show results in order to continue receiving UK taxpayer support. Andrew Mitchell, the UK secretary of state for international development, has stated his aim to direct funds to agencies with "a proven track record of delivering results."

This makes sense. The international aid community can't continue to pour money into programs without knowing if they're working.

The global economic meltdown has hit the developing world particularly hard. With trade declining, poor nations have witnessed a drying up of financial resources. Their already fragile infrastructure is now even more unstable, and many citizens are losing access to basic necessities like medical care.

The human toll is expected to be enormous. The World Bank estimates that around 400,000 more children will die this year in poor countries because of the downturn.

In response, the Bank has ramped up aid efforts, tripling its healthcare investments from $1bn to $3bn (£2bn) this year.

This investment is definitely needed. But the Bank and governments that help fund it have to ensure this money is spent wisely and leads to better health for the world's poor. This requires improving or eliminating those parts of the Bank's health portfolio that aren't working before donors put more money into them.

One top target for reform? SWAps short for "sector-wide approach" aid programs.

Instead of funding a development project with a very specific focus, like tuberculosis (TB) or malaria, SWAps channel donor funds to broad health initiatives in a developing country. For instance, instead of financing the delivery of HIV medicines or bed nets in Ghana, SWAps money is provided to the government to spend toward broader goals like "improving the public health sector" and a number of health services.

Worldwide, between 1998 and 2007, the World Bank and other international donors increased funding for SWAps from $2m to $937m annually. During that time, SWAps have become one of the most popular aid instruments used in Africa for health services.

In principle, the SWAps approach makes good sense. Donors work together closely with each other and aid-receiving governments to fund national plans for improving health. In practice, however, too often this approach is not working out as planned.

In fact, a 2009 study from the World Bank's Independent Evaluation Group examined 11 major healthcare SWAps projects in Ghana, Malawi, Uganda, and several other countries. Only four were determined to be successful. And in those cases, the improvements in health outcomes for the local population were generally modest at best.

The Bank report also concluded that most SWAps tried to do too many things, instead of focusing on effectively addressing the priority problems that cause the most illness, disability and death of poor people in poor countries.

In addition, evidence - including the Bank's own - says that the Bank and its aid partners have done a very poor job of collecting evidence to even know if SWAps are working. They have also failed to make information public in ways that could enhance program implementation. Only one SWAps has been evaluated independently. This is contrary to good practice and good sense.

Consider TB, the disease that causes the most deaths among HIV-infected Africans. Roughly 9.4m new cases of TB were reported in 2008, the most recent year of data, as well as 1.8m TB-related deaths.

Action (Advocacy to Control Tuberculosis Internationally), an international partnership of advocates supported by the Bill & Melinda Gates Foundation that works to increase TB aid and improve its effectiveness, recently reviewed Swaps in 15 African countries. Only three aimed to both find and cure more cases of TB. Most of the rest only partially tracked the disease. Three didn't track TB at all.

Indeed, the Bank's report and others have noted that international agencies too often seem more interested in the process of establishing and administrating a SWAp than its actual results. A working paper from the World Bank evaluated SWAps in half a dozen developing countries concluded that "strong emphasis" is put on "process tasks ... distract[ing] attention from health sector performance".

Fixing SWAps requires development authorities to shift their priorities. These programmes need to focus obsessively on the achievement of better health for poor people. They need to be reviewed at least once every two years by an independent group to determine if they're on track to meet pre-established health metrics. The results of these analyses should be publicly available. The Bank and its donor partners also need to link their financing more closely with performance. SWAps that aren't meeting expectations should be restructured or defunded.

The ultimate goal, of course, is to ensure money is spent wisely and actually leads to better health for the poor in Africa.

A New Report Slams the World Bank’s Support of Health Systems for Insufficient Focus on Result

http://blogs.cgdev.org/

The Washington-based NGO ACTION has just released a report on the effectiveness of the World Bank's preeminent instrument for strengthening health sectors in poor countries: the Sector Wide Approach or SWAp. Through a SWAp the World Bank and other donors collectively provide broad financial support to a country's health sector, in order to foster country ownership and to coordinate all the many parts of the health sector toward improving the population's health status.

This is one of the best reports on the mysterious workings of World Bank aid modalities that I've ever seen. Perhaps I'm not the best judge, since I already know what a SWAp is, but to me the report seems to clearly lay out the reasons the Bank got into the SWAp business and then shows the deficiencies with the way SWAps currently work. Congratulations to the author Richard Skolnik and his colleagues for making a seemingly boring and impenetrable topic come alive. They also demonstrate that an evaluation can be quite persuasive in the absence of a randomized controlled trial or other equally rigorous statistical analysis.
The authors cite CGD's new report on "cash-on-delivery" (COD) aid in a passage urging that SWAps move increasingly toward results-based financing. They go beyond CGD's work in stressing that a results-based focus would improve the internal accountability within donor agencies, as well as between donors and their constituencies and within the recipient countries. Here's a quote I like a lot:

"After many years of paying insufficient attention to results, management within these institutions must provide stronger incentives for staff to focus on achieving results. ... If the achievement of key indicators for TB control were a trigger for the disbursement of financing, then it is likely that both countries and their development partners would pay more attention to realizing these results than they do now. (Pp. 22-23)"

Some will argue that it's not fair to ask that interventions designed to strengthen health systems demonstrate an immediate improvement in health status. I disagree. Assuming that the typical developing country health system in need of a SWAp is less than fully functional, reorganization and system strengthening should improve some of the more narrowly-targeted, front-line programs in the short-term, and positively contribute to health status within the 3 to 5 year framework of a development project. Indeed, knowing that they will be held accountable for improvements in various measures of health status (not just for changes in procedural indicators), donor and recipient country staff will design the SWAp to assure that it focuses first on improving population health in the easiest ways, while simultaneously making changes to the system that will only bear fruit in the outer years of the project. If neither the donor staff nor the recipient government is willing to be held accountable for health improvements during the project's time-frame, that is not an argument for turning one's back on results, but rather for lengthening the duration of the project to 8 or even ten years, if necessary.

I have two qualms about this report, one of form and the other of content. On form, my one regret is that the authors were unable to come up with any charts or statistics to show how little attention to results currently occurs in SWAps. I wish there were a few charts one could lift to cite this analysis. Lifting a pithy quote into a PPT is just not very satisfying, at least for me.

My other point of contention is that the authors seem unaware of the tension between their own purpose, which is to assure more attention to tuberculosis in African health sectors, and the challenge of adding results measurement to a SWAp, which has the broader purpose of improving overall health status. They allude to a list of indicators one might develop for the SWAps, against which donors would provide payments. But coming up with such indicators and more importantly the dollar amount of the reward attached to a unit improvement in each, is no trivial task. In the absence of a market mechanism in which the suppliers and consumers arrive at prices which are mutually acceptable, the World Bank and its donor partners would have to negotiate such rewards.

The alternative to long lists of indicators is the purist version of the COD approach, which would use only one indicator for the SWAp, a measure of the population's overall health status, as measured for example by an age-adjusted mortality rate. Such an approach would depend on all the implementers, on both the donor and recipient sides, to figure out to what degree vertical programs like TB should be "ring-fenced" for protection and to what degree they should be integrated into horizontal systems, all with the ultimate objective of improving overall health status. Such an approach might result in less expenditure on TB interventions than TB enthusiasts like the authors of this report would prefer. I hope that they and other disease-specific interest groups would be willing to agree on a single measure and then let the chips fall where they may.

World Bank Misses the Boat on Tuberculosis in Africa

http://globalpoverty.change.org/

What happens when you pour billions of dollars in funding into an idealistic-sounding (if dubiously implemented) program for 13 years, but fail to invest evaluating it?

Well, sooner or later, a group like ACTION (Advocacy to Control Tuberculosis Internationally) comes along and calls you out on it. That's exactly what's happening today, with the release of a new report examining how the World Bank and its partners have failed to improve health through their use of sector-wide approaches.

Also known as SWAps, the sector-wide approach sounds pretty terrific on paper. Every bullet point of the strategy is equipped to please: unlike narrowly targeted projects, SWAps aim to broadly support government and the creation of a holistic, cross-sector strategy, with an emphasis on partnerships and the goal of promoting dialogue and coordination. In fact, that's exactly why SWAps emerged in the 1990s - as a way to counter-balance critiques that conventional projects sidelined governments and went too far in imposing donor priorities.

Unfortunately when it comes to health, says ACTION, such a set of seemingly noble aims has gone badly wrong. Their findings suggest that SWAps are characterized by a "general lack of attention to results," and an incredibly poor ability to monitor or evaluate any of the health programs they support.

If you aren't already familiar with ACTION, they're the authors of what's now become an increasingly gloomy trilogy of reports documenting the world's failure on tuberculosis. In 2006, they published a report documenting how less than 1% of the World Bank's health lending in Africa supported efforts to fight TB (Enduring Neglect: The World Bank's Inadequate Response to Africa's TB Emergency). In 2008, they authored Living With HIV, Dying of TB, a report chronicling the failure of the World Bank's lead multi-country HIV/AIDS program in Africa to tackle tuberculosis, despite the fact that (as Andrew's previously written here) the two are often linked.

Like its predecessors, the findings of this study (Aid WIthout Impact, backed by the Bill & Melinda Gates Foundation) are similarly grim. Though the World Bank has previously funded tuberculosis-specific programs in countries like India and China, the agency has chosen to rely on the broad SWAps model for Africa - and that choice, the report (which covers 2001 to 2008) suggests, has been fatal. "It was difficult," ACTION notes, "to find evidence that SWAps were enabling improvements in health outcomes."

Their recommendation? Try focusing on "better health outcomes," rather than seeing SWAPs as "an end in themselves."

Most people ACTION interviewed said they liked the SWAps approach and thought it was important - but were hard-pressed to avoid admitting that so far, it hasn't exactly translated into improved results for the sick. And after over a decade of funding, as the report makes clear, goodwill unattached to real results are hardly enough. Especially in a time of donor pullback, the message is obvious: quit putting funds into programs that don't work.

The World Bank’s “horizontal” approach to health falls horizontal?

http://aidwatchers.com/

The history of foreign aid for global health has seen a cycling back and forth between two alternative approaches. The "vertical" approach focuses on fighting one disease at a time, and in Africa has been very effective in targeting smallpox, Guinea worm, measles, and river blindness, to name a few examples. After large initial successes though, diminishing returns to vertical programs set in. The "horizontal" approach instead invests sector-wide to make health systems work to administer prevention and treatment for all diseases. (For more on the history and pros and cons of these approaches, see Can the West Save Africa, pp 57-60).

Since the late 1990s, the Bank and other donors have shifted resources to back the idea that "it's the health system, stupid." (According to the Institute for Health Metrics and Evaluation, health sector support shot up from $2 million in 1998 to $937 million in 2007, and surpassed specific funding for TB and malaria for the first time in 2006.)

Strangely enough, whether this resource shift has actually improved health has never really been tested.

A new report funded by the Bill and Melinda Gates Foundation found that sector-wide approaches (aka SWAps-the development industry never misses the chance to make a silly acronym) "are not yet being implemented in a way that has led to improvements in health outcomes in effective, efficient, measurable, or sustainable ways." In other words... SWAps don't work.

Written by Richard Skolnik, Paul Jensen and Robert Johnson of ACTION (Advocacy to Control TB Internationally), the report looks especially at whether the Bank's sector-wide programs are associated with success in TB detection and treatment, and concludes with a number of alarming or surprising findings. (We don't know if the authors have a predisposition towards the vertical approach given their affiliation with advocacy on one disease, but they do seem to ask the right questions.)

First, the authors find little evidence of the impact of SWAps on health outcomes, and what little there is, is mixed at best. The World Bank's own evaluation picks up on a "general lack of attention to results," "insufficient attention to ensuring that SWAps are technically sound," "a general failure to monitor country expenditures," and "very weak monitoring and evaluation of the health programs that SWAps are supporting." In the history of SWAps, there has been only one rigorous, independent evaluation, in Tanzania.

Second, only three of the 15 Bank SWAp projects in sub-Saharan Africa from 2001-2008 even included indicators for detection of TB cases and successful treatment of TB. And in only one country (Tanzania), a SWAp "might" be linked to an actual health outcome: higher rates of TB treatment success.

Third, the aid workers and health experts interviewed for the evaluation said that SWAps focus on the process of coordinating aid delivery, which has become an end in itself, obscuring the need to actually increase successful treatment and decrease deaths. NONE of them questioned the need to work through SWAps BUT they almost all agreed there is "little evidence" that SWAps are associated with improved health outcomes.

This suggests to us that it's not only about correctly choosing the right mix of horizontal and vertical but whether ANY approach will work unless it has feedback and accountability. Is this why SWAps were a good idea in theory but a disaster in practice?

What to do? The authors have some suggestions, which are a little hard to believe aren't already being done as a matter of course: Create incentives to focus on results not the process, drastically increase transparency of project information and evaluation, and do independent program evaluation.

Come to think of it, the donors' behavior reminds us of Aid Watch's analogy from Monday. Here, the Bank sends truckloads of money down the same SWAps road, ignoring increasingly obvious and urgent signs that the Bank should change course. But still it hurtles along, unfazed by even its own evaluators shouting from the side of the road that what it's doing isn't working.

Health Ministry adjusts TB control strategy for Thailand

http://www.mcot.net/cfcustom/cache_page/75565.html

Thailand's Public Health Ministry has improved both its strategy as well as its medications to fight against Tuberculosis (TB) as the country remains listed among 22 countries with problems in containing the disease, Permanent Secretary for Public Health Paichit Varachit said today.

Among 120,000 TB infections in Thailand, 44,000 -- nearly one third -- are new patients.

Some 2,800 new cases or 1.7 per cent were diagnosed as being TB multidrug-resistant while an estimated 13,000 TB-infected people die from this contagious disease each year, Dr Paichit said.

The permanent secretary explained that a major difficulty in controlling TB in Thailand is the spread of HIV virus as 16 per cent of HIV-positive persons also contracted tuberculosis.

Only 83 per cent of Thailand's TB patients, meanwhile, can complete the six-month course of anti-TB medications and fully recover, lower than the World Health Organization (WHO) standard at 85 per cent at minimum.

As more TB-positive migrant workers flood into Thailand, Dr Paichit said that it is increasingly difficult for health staff to control the disease.

Responding to TB-related problems, the public health ministry cooperated with local administration organisations, hospitals and the Tuberculosis Chest Diseases and Critical Care to better the TB control programme in the country, aiming to increase more full-scale treatment and cure for the patients.

The ministry will apply multi-TB pills to cure patients -- both children and adults -- to reduce the problem of incomplete intake of several medicines.

Dr Paichit added that the WHO also provided free anti-TB liquid formula , worth Bt3 million (nearly US$91,000) for Thailand, to cure infected children. (MCOT online news)

Aeras Pioneering Use of Mobile Technology to Conduct Clinical Trials in Emerging Economies

http://www.prnewswire.com/news-releases/pioneering-use-of-mobile-technology-to-conduct-clinical-trials-in-emerging-economies-979

Last week, at the fourth annual Clinical Trials in Emerging Economies conference, Margaret Ann Snowden, Director of Biostatistics and Data Management at Aeras Global TB Vaccine Foundation, and Daragh Ryan of Cmed Technology, presented a case study of the application of the latest in clinical data technology to a large Phase II clinical trial in South Africa. The presentation provided an update on how effective technology can be in promoting the development of affordable vaccine regimens for the prevention of tuberculosis (TB) worldwide.

In July 2009, Aeras enrolled the first subjects in a Phase II double-blind, randomized clinical trial of a TB vaccine candidate in infants in Worcester, South Africa. In this study, Aeras is using Cmed's Timaeus clinical data management platform to electronically capture data from three clinical sites in South Africa, while managing and analyzing the data from its headquarters in Rockville, Maryland USA in near real time. The Timaeus self-contained appliance technology allows clinicians and study coordinators in South Africa to capture data and perform edit checks on clinical data immediately; per study metrics to date, edit checks take an average of 0.376 seconds to run, and page turn rate has averaged 0.119 seconds. Timaeus then communicates all captured data to Aeras' US headquarters using consumer-standard, off-the-shelf mobile data cards, enabling staff at Aeras to review or report upon clinical data upon transmission.

"Aeras is an agile organization. We want the ability to make real-time, metric-based decisions on a weekly - and even daily - basis, as needed, and to position ourselves to be submission-ready on the back end," said Snowden.

When asked about the sites' experience with Timaeus over the past year, Snowden indicated that Aeras had received very positive feedback to date. In total, only 12 user calls have been placed to Cmed Technology's help desk. To prevent staff downtime, Timaeus will continue to work in the event no mobile signal is present, similar to industry-leading mobile devices. Clinicians and monitors can continue to work without interruption. When the mobile signal is restored, Timaeus automatically re-connects and communicates all data (with a full audit trail) without any user action.  

As Aeras expands its global vaccine development, Cmed Technology will continue its partnership with Aeras for ongoing advancement in the areas of trial configuration, monitoring, data management and reporting.

World Bank gives Africa $11.5b financial support in 2010

http://www.ghanabusinessnews.com/2010/07/04/world-bank-gives-africa-11-5b-financial-support-in-2010/

The World Bank has committed a total of $11.5 billion to Africa in the fiscal year 2010. That is from July 1, 2009 to June 30, 2010

The Bretton Woods Institution said the Bank committed the funds to help the continent recover rapidly from the financial crisis that hit the world in 2008.

The Bank, according to the release, supported 113 projects, with $4.3 billion in commitments from the International Bank for Reconstruction and Development (IBRD), and $7.2 billion in commitments from the International Development Association (IDA).

The World Bank Group said it committed more than $72 billion assistance for developing countries in fiscal year 2010 as the world faces a fragile and uneven recovery.

In fiscal year 2010, the Bank Group supported an estimated 875 projects to promote economic growth, overcome poverty, and promote private enterprise, with record commitments in education, health, nutrition, population, and infrastructure providing much-needed investments in crisis-hit economies, it said.

The Bank indicated that this assistance was provided in loans, grants, equity investments and guarantees to help countries and private businesses contending with significantly diminished private capital flows in the wake of the global downturn.

According to the Bank, private flows are forecast to recover only modestly from $454 billion in 2009 to $771 billion by 2012, still far below the $1.2 trillion in 2007.  Overall, the financing gap of developing countries is projected to be $210 billion in 2010, declining to $180 billion in 2011 down from an estimated $352 billion in 2009.

Commitments from the World Bank Group to sub-Saharan African countries, which the Bank considers its top priority, rose to $13.85 billion in fiscal year 2010, up 28 percent from $9.9 billion in fiscal year 2009. This included $7.2 billion from the IDA, or 49 percent of total IDA commitments; $4.3 billion from the IBRD; a record $2 billion from the International Finance Corporation (IFC); and $345 million in Multilateral Investment Guarantee Agency (MIGA) guarantees for projects in the region.

IBRD and IDA disbursements in sub-Saharan African countries stood at $6 billion in fiscal year 2010.

Journalists participate in TB awareness program

http://thehindu.com/news/article503095.ece

Journalists from across India who were awarded fellowships by the REACH Lilly MDR-TB Partnership Media Programme to study issues related to tuberculosis (TB) participated in a two-day orientation programme here on Monday and Tuesday.

The group discussed the science of TB, the structure of the Revised National Tuberculosis Control Programme (RNTCP) in India, and the challenges in the management of TB, including multi-drug-resistant tuberculosis (MDR-TB), TB-HIV co-infection, the role of private practitioners and stigma.

In addition, the journalists participated in skill-building sessions led by Jaya Shreedhar, technical health adviser, Internews Network, in learning to use data and statistics for health reporting and identifying common challenges in reporting on public health.

‘Keep the issue alive'

Interacting with the group, V. Kumaraswami, director (in-charge), Tuberculosis Research Centre (TRC), urged journalists to find creative ways to keep the issue of TB alive in the media.

M.S. Jawahar, deputy director, TRC, pointed out that TB was one of the greatest serial killers in history and continues to be as big a problem today.

Padma Priyadarshini, senior research officer, TRC, spoke of the difficulties in diagnosing and controlling HIV-TB co-infection. Ramya Ananthakrishnan, medical director, REACH, highlighted the need to study the socio-economic factors that have a tremendous impact on TB, including poverty and nutrition.

The participants also visited the District TB Centre.

Global Fund Exec Director Michel K & Indonesian Pres. Meet to Discuss Incresed Heatlh Investments

http://www.theglobalfund.org/en/pressreleases/?pr=pr_100623

The Executive Director of the Global Fund Professor Michel Kazatchkine met with Indonesian President Susilo Bambang Yodhoyono today to congratulate him for progress in fighting AIDS, TB and malaria and to request Indonesia's support for efforts with the Global Fund's donor countries to increase funding for the three diseases worldwide.

"Indonesia is a major voice in the G-20 and its support will be very important in 2010, a critical year for global health," says Professor Kazatchkine. "This year the Global Fund's donors will decide if we get the resources that would allow us to reach the health-related Millennium Development Goals. We have made huge progress in recent years and could make history. But this progress is fragile and AIDS, tuberculosis and malaria will gain force again unless we continue scaling up our interventions." He added: "Indonesia has made rapid progress in fighting these diseases and can play an important role in ensuring that our progress is not reversed."

Indonesia, as a G-20 member country, is providing a strong voice for the need to continue scaling up health investments. UN Secretary General Ban-Ki-moon will chair a crucial meeting in New York on October 5 this year where donor countries will pledge resources to the Global Fund for the period 2011-13.

The Global Fund and Indonesia also signed today new grant agreements amounting to over US$ 55 million to scale up the government and civil society's response to HIV in all 33 of the country's provinces. The new grants will be implemented by the Ministry of Health, National AIDS Commission and Nahdlatul Ulama, the largest Muslim faith-based organisation in the country.

Since its inception in 2002, the Global Fund has committed over US$ 630 million to fight the three diseases in Indonesia. It accounts for sixty five percent of total resources in the country to fight TB and malaria and forty five percent of resources to fight HIV.

New Report Finds Significant Investments in Broad Sector-Wide Approaches Are Not Producing Intended

http://www.action.org

Washington DC - A new report released today shows that the World Bank and other development agencies have invested billions of dollars over the last decade in an approach to health that is not achieving intended outcomes. The new report "Aid Without Impact" found little evidence that sector-wide approaches (SWAps) have been associated with improved health outcomes in low-income countries in sub-Saharan Africa. Specifically, the report examined the use of SWAps for improving health, with particular attention to their impact on TB. The report was released by ACTION (Advocacy to Control TB Internationally), a project funded by the Bill & Melinda Gates Foundation.

"Given the global economic crisis, now more than ever we must ensure that aid is good value for money and delivers planned results," said Richard Skolnik, former manager of the World Bank's health, nutrition, and population programs in South Asia and one of the authors of the report. "Unfortunately, this report shows that important support from the World Bank and its partner agencies for health in Africa is not improving the health of the poorest Africans as planned."

The release of this report coincides with an upcoming replenishment meeting where the World Bank will plan for how to best secure billions of dollars in new funding from donors. "The World Bank is fundraising this year from the perspective that its aid is needed now more than ever," said Paul Jensen, policy analyst for ACTION and an author of the report. "As donor governments provide financing for the Bank, they must demand that support for Africa deliver better health for the poorest people. Our report shows that donors may get a bigger bang for their buck elsewhere, unless substantial changes are made to the SWAps approach.  In fact, the findings of our report are similar to those of a recent evaluation from the World Bank's own Internal Evaluation Group. The issue now is whether or not the development community will act on these findings and improve the effectiveness of its assistance."

Sector-wide approaches, or SWAps, emerged in the late 1990s in response to certain limitations that were observed in project-based approaches to health. Project-based approaches were narrow in scope and strengthened a distinct part of a country's health program or an area of institutional capacity such as financing the construction of hospitals or the procurement of drugs. However, these were criticized for denying recipient governments ownership, lacking sustainability and fragmenting sector development. In the SWAp model, donors provide support to a recipient government for broad-based improvements in the country's healthcare system. It intends to coordinate donor financing, allow recipient governments to plan investments, and holistically develop the health sector. 

As the world's second leading infectious killer after HIV/AIDS, tuberculosis (TB) remains an exceptional public health threat. With the severity of HIV/AIDS in Africa and TB's increasing resilience to the standard drugs, TB has resurfaced as an urgent global problem requiring effective control. In 2008 there were 9.4 million new TB cases and 1.8 million deaths, 44% of them in Africa. The majority of those with TB in sub-Saharan Africa go undiagnosed, with over 88% of multidrug resistant TB cases unidentified in 2008. While World Bank control efforts in Asia have been implemented through large-scale TB-specific investments, the Bank has pursued a different strategy in Africa - SWAps. 

While the report acknowledged the importance of a SWAp approach to development assistance for health in low-income countries in sub-Saharan Africa, it emphasized that in most countries, SWAps are not being implemented effectively, efficiently, sustainably, or in measurable terms.  Similarly, the World Bank's own Independent Evaluation Group found that "only 4 of the 11 completed projects supported by SWAps had satisfactory outcomes in achieving their relevant program objectives."

The ACTION report identified specific flaws in the approach the World Bank and its partners are taking, including a general lack of attention to results, failure to monitor and ensure country expenditures focus on high priority investments, and weak monitoring and evaluation of health programs that SWAps are supporting. Additionally, the report suggested that the World Bank and its development partners did not pay sufficient attention to improving the control of TB from 2001 to 2008 in their health sector development projects.  These programs in countries with many cases of TB rarely included targets for both finding and curing more people of TB (only 20%). In addition, only a limited impact on curing TB could be associated with SWAps.

The report notes that in order for the World Bank and its partners to develop effective assistance programs for health with better outcomes, they need to recognize the failure of SWAps to meet their aims. They also need to ensure that these programs are independently evaluated, that the results of the evaluations are made public, and that they link their funding to the achievement of results.  They also need to ensure that such programs focus on the health problems that take the greatest number of lives, set reasonable targets for gains in those areas, and more carefully monitor and evaluate their efforts.

Aid Without Impact was developed by ACTION (Advocacy to Control Tuberculosis Internationally), which is an international partnership of advocates supported by the Bill & Melinda Gates Foundation that works to mobilize resources to treat and prevent the spread of TB worldwide.

Parliamentary caucus on TB and HIV in Canada

Some 200 advocates, parliamentarians, community leaders and stakeholders came together in Ottawa on Parliament Hill last Monday to participate in the inaugural launch of the caucus, whose creation was initiated by MP Dr Ruby Dhalla. The caucus is co-chaired by Dhalla and MPs Lois Brown from the Conservative Party, Johanne Deschamps from the Bloc Québécois, and Megan Leslie from the New Democratic Party. Their goal is to raise awareness about HIV/AIDS and TB in Canada's parliament and to create a forum within parliament for the exchange of ideas to help support and increase access to care and treatment for those living with HIV/AIDS and TB.

"It was refreshing to see so many parliamentarians and senators in attendance last night who put partisanship aside and united in their support for fighting these global health challenges of HIV/AIDS and TB. The creation of the HAT caucus is a tribute to the survivors, volunteers and advocates who have worked tirelessly to develop solutions and raise awareness. Change for the better can be achieved through our collective and collaborative efforts," Dhalla said.

The HAT Caucus was launched with internationally renowned guest speaker Stephen Lewis, former UN Special Envoy for HIV/AIDS in Africa. "The emergence of the HAT Caucus is a significant development on the Canadian political scene," Lewis said.

Dr James Orbinski, founder of Dignitas International and former President of Doctors Without Borders, also was a speaker. "The HAT Caucus has emerged because Canadian Parliamentarians recognize that HIV/AIDS and TB are critical global health challenges that must be addressed, regardless of political affiliation. My hope is that through a greater awareness of the challenges faced, our government can take informed, practical and equitable action for the benefit of the global community," Dr Orbinski said.

Via (Stop TB Partnership)

Global Fund provides new grant for Indonesia to fight HIV

Indonesia and the Global Fund on Wednesday signed new grant agreements amounting to over 55 million U.S. dollars to scale up government and civil society's response to HIV. The new grants will be implemented by the Ministry of Health, the National AIDS Commission and Nahdlatul Ulama, the largest Muslim religious organization in the country.

The Executive Director of the Global Fund Professor Michel Kazatchkine said that he is pleased with Indonesia's achievement in combating HIV/AIDS, tuberculosis and malaria.

Since its inception in 2002, the Global Fund has committed over 630 million U.S. dollars to fight HIV/AIDS, tuberculosis and malaria in Indonesia.

The organization accounts for 65 percent of total resources in the country to fight against tuberculosis and malaria, and 45 percent of resources to fight against HIV/AIDS.

The Global Fund has become the dominant financier of programs to fight against the three diseases with approved funding of 19.4 billion U.S. dollars for more than 600 programs in 145 countries.    

Via (People's Daily Online)

Incidence of Malaria jumps when Amazon forests are cut

a team of scientists from the University of Wisconsin-Madison, writing in the current ( June 16, 2010 ) online issue of the CDC journal Emerging Infectious Diseases, presents the most enumerated case to date linking increased incidence of malaria to land-use practices in the Amazon.

The report, which combines detailed information on the incidence of malaria in 54 Brazilian health districts and high-resolution satellite imagery of the extent of logging in the Amazon forest, shows that clearing tropical forest landscapes boosts the incidence of malaria by nearly 50 percent.

"It appears that deforestation is one of the initial ecological factors that can trigger a malaria epidemic," says Sarah Olson, the lead author of the new report and a postdoctoral fellow at the Nelson Institute, Center for Sustainability and the Global Environment.

The clearing of tropical forests, say Olson and senior author Jonathan Patz of the University of Wisconsin School of Medicine and Public Health, creates conditions that favor malaria's primary carrier in the Amazon, the mosquito Anopheles darlingi, which transmits the malaria parasite if it draws its blood meals from infected humans.

"The deforested landscape, with more open spaces and partially sunlit pools of water, appears to provide ideal habitat for this mosquito," Olson says, noting that Anopheles darlingi has been shown to displace other types of mosquitoes that prefer forest and that are far less prone to transmit malaria.

"This study of human malaria cases complements our previous work that focused more on the abundance of the malaria-carrying mosquito," Patz adds. "In those studies from the Peruvian Amazon, we showed a correlation between this mosquito's larvae and aquatic breeding sites in disturbed habitats following land clearance."

The new Wisconsin study focused on 54 Brazilian health districts in a corner of the Brazilian Amazon near Peru and where detailed health and population data were collected in 2006 by Brazilian researchers. Combined with high-resolution satellite data of changes in land cover, the health data reveals the large human-health impact of relatively small changes to the forest landscape.

"A 4 percent change in forest cover was associated with a 48 percent increase in malaria incidence in these 54 health districts," notes Olson. "The health data used in the study is of the highest quality and spatial resolution. Unlike previous studies, our data allowed us to zoom in on areas where people are being exposed to malaria and to exclude areas where they are not being exposed."

The health districts reflected in the Wisconsin study are typical of many of the thousands of such districts spread across Brazil and its Amazon region. Since 2001, the Brazilian Ministry of Health has similarly monitored and treated malaria in more than 7,000 districts. Deforestation in the districts, says Olson, is occurring as it typically does in Amazonia, and occurs mostly near rivers, the backbone of the region's transportation system, and spreads outward.

The new work, argues Patz, an authority on environmental change and human health, shows how deforestation and land clearing contribute to malaria's dynamic at the frontier of settlement. "In 2006, the county that encompasses these health districts was in the top five of all Brazilian counties with malaria," Patz says. "Even after we adjusted for human populations, access to health care and other factors, malaria hot spots paralleled locations with the most destruction of rainforests."

The message from the study, say Olson and Patz, is that tropical forest conservation may benefit human health more than we realized.

"Land-management practices show promise as useful interventions to reduce malaria risk factors," says Olson.

Patz and Olson believe the new work provides a template that could be used to spatially track environmental risk factors and the incidence of malaria, which infected an estimated 500,000 Brazilians annually across the Amazon basin from 1997 to 2006. "The technology is there. The health data is there. Health officers with cell phones could gather data for the whole Amazon region," Olson says.

The National Aeronautics and Space Administration funded the new study.

Via (Media-Newswire.com)

Global Fund defends Rwanda spending

Rwanda is the biggest recipient of Global Fund financing for HIV/Aids, Malaria and TB compared to all its regional partners with up to a billion dollars projected to be spent, according to data compiled by a Global Fund monitoring group. A combination of government and other recipients are estimated to get some $923,877,060 in different grants for the three diseases. The money was approved between 2002 and 2009 but with some grants for the next three years as most grants are ongoing. 

From this amount, some $331,480,350 has already been disbursed, according to Aidspan, a non-profit agency which monitors Global Fund resources.

The group says a computation of the 12 rounds of funding combining malaria, HIV and TB suggests that implementation of the grants is eight months behind schedule.

Burundi alone has only managed to tap less than 20 percent of what Rwanda will be receiving. Uganda, Kenya and Tanzania are all getting less compared to their small partner Rwanda.

For the Global Fund itself, money coming to Rwanda is dollars well spent.

Data compiled by Aidspan also indicates the five East African Community (EAC) countries put together are getting the biggest share of Global Fund money - even when the region is not the worst affected by the three targeted diseases.

East Africa alone has been allocated $4.76 billion - followed by West and Central Africa with $3.13 billion. The Southern Africa region which is said to be worst affected by HIV/Aids and TB globally comes in third Global Fund allocation.

The Arab and Muslim areas of North Africa and the Middle East will be getting just $1.05 billion.

Global Fund spokeswoman Marcela Rojo defended the large allocations to Rwanda and East Africa saying grants are requested by the countries themselves. 

She said the Fund "does not implement programs directly, relying instead on a broad network of partnerships with other development organizations on the ground to supply local knowledge and technical assistance where required."

"It is this country-ownership model that also makes the Global Fund successful as countries implement programs according to their national strategies and their needs," said Rojo. 

"Therefore, regarding your question as to why East Africa receives more funding, you should know that the Global Fund is a demand-driven model and therefore responds to requests from countries (it does not assign amounts by region)," she wrote in email exchanges with RNA from Geneva.

"The same applies for Rwanda: if Rwanda sends proposals to the Global Fund that are technically sound and our Technical Review Panel (a panel of 40 experts) approves them, then Rwanda receives funds according to the proposal they submit."

The Global Fund official said the same policy applies to other countries.

There have not been any serious reported cases of fraud or corruption regarding Global Fund money but the Auditor General says in the 2008 report that there had been some cases recorded.

In Kirehe district (eastern Rwanda), the jailed ex-mayor even managed to put himself on the Global Fund payroll as a nurse, according to the Auditor General.

Via (RNA News)

Over 300 patients in limbo when government’s supply of multi-drug resistant meds runs out

These are patients who are battling to survive with the highly infectious strain of TB.

Most of them are using second-line drugs which are the last line of combinations that could be used. They are supposed to be on treatment fulltime, taking a combination of injections and tablets everyday for a period exceeding 18 months.

The country is struggling to get adequate supplies of capreomycin, an important drug.

It is taken as an injection.

Themba Dlamini, Director of the TB Centre in Manzini, has confirmed that there is a shortage of the drug capreomycin.

Dlamini said the centre ran short of the drug for a couple of days when patients who had come for the injection were turned back.

However, he said on Thursday the centre received a supply of the drug from Doctors Without Borders, which lent them a few drugs to keep the centre going.

The patients fear for their lives.

They are scared that they could develop resistance to this second line drugs and have nowhere to run to now since the second line is the last line in MDR treatment.

They are all praying that their body accepts the drugs when they are re-administered to them.

*Zodwa Dlamini (43) is frail and very sickly.

She has been fighting the dreaded combination of TB and HIV in her body since 2005 and has suffered several relapses of TB due to an inconsistent supply of drugs.

She is now using the last line of drugs, the same she had to live without for at least two weeks after the Manzini TB centre suffered a drug outage recently. Her strain is deadly and highly infectious and if she does not get drugs immediately, she might die. The people she lives with are also at huge risk.

They could be infected with a strain of TB that is not easy to treat.

Even though she suffers from a highly resistant TB strain, she roams the streets of Manzini, probably infecting other people.

At home she lives with four minor children, who are exposed every day to the worst strain of the TB that she is infected with.

She said nurses had tried to test these children for TB but she declined to give them permission.

"My fear is that it would torture me to death to know that I have infected my children," she explained. Ideally, patients like her, according to medical experts are supposed to be hospitalised in isolated areas but due to weaknesses in the country's health institutions she stays at home.

She now fears for her life and that of the four children she lives with in Mbekelweni.

She says if she dies, she wants the world to know that government played a role in her death.

She said, "I religiously took my medication only to be let down by the outage."

She is clear of the consequences associated with stopping TB treatment without finishing the whole course. "The relapses I have suffered since 2005 are a results of the inconsistent supply of the drugs by government."

Zodwa believes that had she had a consistent supply of drugs, she would be TB free by now.

Via (Swaziland Times)

72% HIV/AIDS sufferers in Malaysia are Muslims

More than 70 percent of the 87,710 HIV/AIDS sufferers in the country are Muslims, Malaysian AIDS Council vice-president Datuk Zaman Khan said today.

Therefore, he said, the celebration for this year's World AIDS Day would emphasise efforts to enhance the participation of and awareness on AIDS among Muslims.

He said what was more worrying a report by the United Nations General Assembly Special Session (UNGASS)on AIDS which stated that nine Malaysians were infected with the disease everyday.

Also of concern was the spread of the disease among women, from 9.5 percent in 2000 to 20 percent last year, he said when speaking at a function to commemorate World AIDS Day here last night.

He said that in 2000 the main cause of women being infected with HIV/AIDS was drug addiction, but lately, it had been attributed to heterosexual sex (30 percent).

This happened because of lack of concern and cooperation from the society to protect women from the disease, he added.

On HIV/AIDS sufferers in Terengganu, he said, a total of 315 new cases were reported last year.

Kelantan recorded the highest number of HIV/AIDS cases at 596, followed by Pahang (431) and Selangor (378), he added.

Via (Bintulu.org)

Kenya to launch TB fund

The Head of TB division at the Ministry of Public Health, Dr Joseph Sitienei said on Friday that the fund to be known as Stop TB partnership would boost the grants Kenya gets from the Global fund and ensure the funds collected were used prudently.

"This will be an open forum and it will be architected in the same way as it is in the global level where we have the Stop TB partnership in Geneva housed by the World Health Organisation. So this will be a local mirror image of what is happening globally," Dr Sitienei said.

Speaking during a visit at the Kenyatta National Hospital by Friends Africa, a Pan African non-governmental organisation, Capital Group Chairman Chris Kirubi pledged Sh1 million towards the fund and urged the private sector to support the initiative.

"This is in the spirit of encouraging Global fund to come on board to support the effort," Mr Kirubi said.

"The challenges we have are many and we should not let the poor people suffer," he added.

Friends Africa Chairperson Aigboje Aig-Imoukhuede said although the Global fund had made tremendous progress towards financing Africa, there was need for the private sector to also join in.

"It is one thing to enable access to finance but it is much greater to enable access to life, access to good health care and the private sector has to appreciate that it is in our own self interest to also support financially the activities that are taking place to save our employees, to save our brothers and sisters," he said.

The Deputy Executive Director of the Global Fund to fight HIV/AIDS, TB and Malaria Dr Debrework Zewdie said it was necessary for countries to try and source internal funding for the three diseases.

"You cannot sustain control of these diseases by depending on outside governments all the time," she said.

Statistics indicate that tuberculosis kills 1.2 million people every year globally. In Kenya, 110,000 cases of TB are recorded annually.

Currently there are over 500 cases of Multi drug resistant TB, which is a more serious type of TB that is resistant to drugs.

Dr Sitienei said a patient suffering from extensively drug resistant TB (X-DR TB), which is an advanced form of MDR-TB died on Thursday after nine months of treatment.

"This was the only case of XDR TB in East and Central Africa and we had already spent over Sh2million treating her," he said.

Via (CapitalFM)

Key to fighting malaria found in yellow fever vaccine

Researchers at Rockefeller University may have found a way to fend off malaria by using a yellow fever vaccine, according to a newswire.rockefeller.edu report.

Researchers were able to genetically alter the yellow fever vaccine to prime the immune system, which fends off the mosquito borne parasites that cause malaria. It was discovered that the modified yellow fever vaccine, along with a booster, gave mice immunity to malaria.

In the 1960s, scientists discovered that one form of the malaria parasite, the sporozoite, can wake up the immune system and help to protect against future infection. The only way to gather sporozoites, however, is to pluck them one-by-one from the salivary glands of irradiated, malaria-ridden mosquitoes. To provide immunity, the attenuated parasites must then be injected in high doses - or delivered by the bites of hundreds of mosquitoes - a labor intensive approach not feasible for large-scale use.

Charles M. Rice, head of the Laboratory of Virology and Infectious Disease at Rockefeller University, said he knew there had to be another way to get the benefits of sporozoite immunization. With that in mind, Rice and his team began looking at a yellow fever strain used in the yellow fever vaccine, known as YF17D, which has been used to successfully vaccinate more than 400 million people since 1937.

Researchers inserted the sequence of a malaria gene into the YF17D vaccine and found that the gene could produce its protein in cultured cells. The protein they chose, called CSP, covers the surface of the malaria sporozoite and is thought to be the main reason that this form of the parasite stimulates the immune system so effectively, Rice said.

"These results are exciting because they show the YF17D-CSP vaccine can prime the immune response against a malaria parasite,"lead author Cristina Stoyanov told newswire.rockefeller.edu. "Although the utility of this approach for human immunization is not yet clear, the team hopes that further studies in other animal models might eventually lead to an effective vaccine."

Via (Vaccine News Daily)

Michael Kazatchkine Discusses the Successes and Needs of the Global Fund

Science Speaks

Dr. Michael Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, spoke to a group of global health advocates yesterday at a roundtable discussion hosted by the Council on Foreign Relations, as a part of their Future of U.S. Development Assistance for HIV/AIDS roundtable series. Kazatchkine discussed the unprecedented progress achieved in the last ten years by developing countries in their fights against HIV/AIDS, TB, and malaria, thanks in part to funding provided by the Global Fund. He also spoke of the need for donor nations to not only sustain their contributions but increase them in order to achieve Millennium Development Goal (MDG) number 6, which relates to combating HIV/AIDS, tuberculosis and malaria.

At current funding levels, we are nowhere near achieving the HIV/AIDS treatment goals set out in MDG number 6, which call for universal access to treatment for all those who need it. Without a substantial increase in investments, this goal is unattainable. There are 2.8 million people receiving HIV treatment through Global Fund supported programs today. Kazatchkine discussed the importance of providing treatment as a prevention intervention, and emphasized the need to scale-up treatment services. Thanks to the scale-up of treatment to date, mortality rates have greatly decreased. For example, mortality rates in Addis Ababa have been reduced by 60 percent.

Efforts to combat HIV/AIDS have resulted in 930,000 HIV-positive pregnant women receiving a complete course of ARV prophylaxis to reduce mother-to-child transmission. Also, 120 million HIV counseling and testing sessions have been conducted and 4.9 million basic care and support services have been provided to AIDS orphans and vulnerable children. In addition, 2.3 billion condoms have been distributed.

Kazatchkine highlighted progress on tuberculosis and the Global fund's contribution to advancing that goal. The MDG goal is to have a TB incidence rate of 124 per 100,000 by 2016. Currently the rate of incidence is 164 per 100,000. Seven million persons have access to TB diagnostic services and treatment through Global Fund-supported programs, a 30 percent increase from mid-2009.

The Global Fund currently provides roughly 20 percent of international resources to fight AIDS, 63 percent of international funding to fight tuberculosis and 60 percent of funding to fight malaria.

According to Kazatzchine, "If donors provide sufficient resources, by 2015 we could virtually eliminate transmission of HIV from mother to child, dramatically reduce deaths from AIDS, prevent many new HIV infections, and achieve significant declines in TB prevalence and mortality."

Kazatchkine described the achievements as fragile. An increase in contributions is critical to sustain and to facilitate additional progress in fighting these three infections. On October 5th donors will pledge their contributions for the next three years, which could greatly influence the outcome of the MDG 6 goal by 2015. Kazatchkine explained that a total pledge of $17 billion for the next three years is needed to continue to make progress. Donors contributed $10 billion during the last replenishment period in 2007.
The United States, as the largest contributor the Global Fund, provides 28 percent of funding. Kazatchkine explained that every dollar received from the U.S. leverages $2 from other donors. The U.S. must increase its contributions in October in order to achieve the attainable goals of eliminating malaria, and greatly reducing the prevalence of HIV/AIDS and tuberculosis within the next few years. It is notable that the Administration requested fewer resources for the Global Fund in its fiscal year 2011 budget that Congress had appropriated the year before.

Cross-country Laboratory Network to Raise East Africa’s Defenses Against Disease

web.worldbank.org

In health facilities across Eastern Africa, it is not unusual to wait long hours to be seen by a doctor or nurse, to receive urgently needed medications, or to retrieve laboratory results. In fact, wait times for laboratory results can run into several weeks-lost time as patients struggle with conditions as serious as multi drug resistant tuberculosis; lost time as infectious diseases spread undetected across national borders.

The World Bank's recently approved US$63.66 million East Africa Public Health Laboratory Networking Project aims to establish an urgently needed network of high-quality public health laboratories. The laboratories will improve access to diagnostic services among vulnerable populations living in the cross-border areas of Kenya, Tanzania, Uganda, and Rwanda.

"The East Africa Public Health Laboratory Networking Project effectively addresses both a key weakness in health systems and a critical gap in the continental response to TB," said Richard Scobey, Acting Director of Regional Integration in the World Bank's Africa Region. "It represents our strong commitment to expanding access to services to vulnerable groups and highlights the innovative use of ICTs to improve public health in Africa."

The laboratories in this regional network will serve as surveillance sites to monitor hot spots for disease transmission and will make optimal use of internet and mobile communications to improve public health. In addition, they will support the roll-out of new diagnostic technologies for drug resistance monitoring and for more efficient TB diagnosis.

The capacity to communicate outbreak-related information across national borders in real time is more important than ever before, as East Africa moves towards a common market that will allow greater labor mobility with an increased threat of disease transmission across countries.

For TB-HIV co-infected patients or those afflicted with drug resistant strains of TB, it is a struggle to obtain an accurate and timely diagnosis in a stigma-free environment.

Labs: A Critical Pillar in Health Systems

Laboratories are the weakest link in the region's public health defenses, seriously hindering each country's ability to confirm and respond in a coordinated manner to disease outbreaks. The laboratory networking project aims to address the common challenges facing the four countries: dilapidated infrastructure built decades ago; inadequate supply and quality of human resources which are the backbone of quality diagnostics; and manual information systems which are not effective for decision making.

"By creating a safe and productive environment and by improving the career prospects of laboratory personnel through a strong mentorship program coupled with a certificate award, we hope to restore trust in the laboratory by both clinicians and patients," noted Dr. Willis Akhwale, Head of the Department of Disease Prevention and Control in Kenya's Ministry of Public Health. "As we jointly scale up disease control efforts, we will focus on the evidence base for decision making which is becoming critical."

Well functioning laboratory networks are critical for diagnosing pathogens and dealing effectively with disease outbreaks such as cholera, meningitis, and Rift Valley Fever.

"Tuberculosis control programs have been pioneers in promoting tiered networks of laboratories, hence can serve as an entry point for broader systems strengthening," said Dr. Mario Raviglione, Director of the World Health Organization's (WHO) Stop TB Program.

The project will adopt the WHO's step-wise laboratory accreditation process, which promotes practical and affordable quality management systems aimed at enhancing accountability and sustainability.

"The Bank-supported East Africa Public Health Laboratory Network offers a monumental opportunity to contribute to global efforts and end the neglect of this critical pillar in health systems", said Dr. John Nkengasong, acting Associate Director for Laboratory Science at the Center for Global Health at the United States Centers for Disease Control.

Centers of Excellence

Each country participating in the East Africa Public Health Laboratory Networking Project will become a center of excellence for a key aspect of the project. Rwanda will take the lead on ICT and performance-based financing. Kenya will serve as a center for integrated disease surveillance and response, and for operational research. Uganda will take the lead on laboratory networking and accreditation, and Tanzania will develop high-quality training programs.

"Taking a regional leadership role has an empowering effect," noted Dr. Alex Opio,Assistant Commissioner of Health Services at the Ministry of Health in Uganda. "This is a tremendous opportunity to contribute to the new East African Community."

Dr. Deo M. Mtasiwa, Chief Medical Officer, Ministry of Health and Social Welfare of Tanzania echoed this view. "Tanzania is committed to serve as a regional hub for training and to make optimal use of our state-of-the-art National Health Laboratory Quality Assurance and Training Centre,"he said.

Partnerships

Several partners have contributed actively to the design and development of the project, including the U.S. Centers for Disease Control, the World Health Organization, the United States Agency for International Development, and the International Union against Tuberculosis and Lung Disease.

Through partnerships, parallel grant financing for specialized TB diagnostics has been secured from the International Drug Purchase Facility (UNITAID) through the EXPAND-TB Project which is a collaborative effort of WHO/Global Laboratory Initiative, the Foundation for Innovative New Diagnostics and the Global Drug Facility.

The project will help implement the strategic disease control priorities of regional institutions such as the East African Community and the East, Central, and Southern Africa Health Community (ECSA-HC). ECSA-HC will play a critical convening and coordinating role at the regional level.

"We appreciate the World Bank's effort to coordinate closely with other partners," said Dr. Agnes Binagwaho, Permanent Secretary of Rwanda's Ministry of Health, "this is very much in the spirit of synchronizing efforts and maximizing impact on the ground."

For further information please contact: Miriam Schneidman, Lead Health Specialist, (mschneidman@worldbank.org)

Global fund reports 2.8 million people with HIV treated by mid-year

blog.taragana.com

Around 2.8 million people with HIV across the globe have received life-saving antiretroviral (ARV) treatment by mid-year, a 22 percent increase from the like period last year, according to a report released Wednesday.

The Global Fund, which released its report in Geneva, is a unique global public-private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria.

The Global Fund supported tuberculosis programmes have so far provided seven million people with effective TB drugs treatment.

"This is a 30 percent increase from mid-2009. Tuberculosis remains the leading cause of death among people infected with HIV. The World Health Organization estimating that one in four TB deaths worldwide is HIV-related," said an official statement.

The Global Fund also reported progress in the fight against malaria, with a cumulative total of 122 million insecticide-treated bed nets delivered through its funded programmes to families at risk of contracting the disease.

With more than $10 billion disbursed to more than 500 grants so far, the Global Fund currently provides around one-fifth of international resources to fight AIDS, as well as 63 percent of international funding to fight tuberculosis and 60 percent of international funding to fight malaria.

"As a result, 5.7 million lives have been saved. In less than a decade, the Global Fund has gone from an idea to a highly efficient tool to turn donor resources into lives saved," said Michel Kazatchkine, executive director of the Global Fund.

Additional results showed that a total of 2.3 billion condoms have been distributed while 930,000 HIV-positive pregnant women have received a complete course of ARV prophylaxis to reduce mother-to-child transmission.

Besides, 120 million HIV counselling and testing sessions have been conducted and 4.9 million basic care and support services have been provided to AIDS orphans and vulnerable children since the Global Fund started financing grants in 2003.

The results reported combine data from individual programs supported by the Global Fund in 144 countries.

In October 2010, UN Secretary-General Ban Ki-moon will chair a meeting of the Global Fund's donors where they will pledge resources for the period 2011-13.

"The Global Fund assesses that it will need between $17 billion and $20 billion to respond to demand from developing countries for resources to fight the three diseases during the coming three years," he said.

Senegal tackles malaria with song contest

A fisherman, a hairdresser and a radio DJ seated in a swish villa in Dakar have one thing in common: the desire to win Senegal's hottest music competition while boosting awareness about malaria.

Several people sit strumming guitars while a television blares in the background on the top floor of a house where the final contestants in an American-Idol like song contest have been living for the past week.

While star power is certainly up for grabs in the finals Wednesday night, the search for Senegal's next big artist is all about teaching people how to stave off the mosquito-borne disease which kills a million people annually.

The contest is linked to the star-studded name of Youssou Ndour, often dubbed Africa's most famous singer. He recently recorded a malaria anthem with other well-known local artists.

His brother and producer Bouba Ndour sees it this way: "If I could sell every line of every Youssou Ndour song in every village in Senegal - I can sell the malaria message."

From some 1,000 demo tapes sent in by contestant hopefuls, numbers have been whittled down to nine finalists in concerts held around the country.

Contestants also had to write tests on malaria knowledge and spend time with healthworkers in villages to proceed to the next round.

Among the finalists is Jack Diabone, 28-year-old radio DJ from Tambacounda in eastern Senegal who himself had malaria just a few weeks ago but "luckily I caught it early."

"I said to myself, why not take part and use my voice to transmit the message."

Ibrahima Diouf, 33, from Kaolack, east of the capital says he gets great satisfaction from taking his knowledge back to his village.

"I learned new things about malaria I didn't know."

According to New York-based NGO Malaria No More which works in Senegal, an African child dies every 30 seconds from the disease which is easily preventable and treatable.

Annual economic loss in Africa due to malaria is estimated to be 12 billion US dollars.

Ndour's malaria anthem tells the story of a young man who gets malaria and misses out on life, and how he should have used a mosquito net.

Appealing to local culture is one tactic to reach global malaria targets to have all Africans covered with prevention and treatment tools by the end of this year, and eliminate malaria mortality by 2015.

"We are taking the power of comedy and music and culture to tell the story of malaria control," Malaria No More managing director Kate Campana told AFP.

A popular Senegalese comedian dresses up like a mosquito in one of Ndour's music videos and its hugely popular traditional wrestlers, whose matches draw tens of thousands, have all signed up to spread the message.

For Bouba Ndour big names are the "only way to attract the public."

"We made sure while the people were there (at the concerts) that the right message is delivered and while they went to a great concert ... they were really prepared to face malaria and change behaviour."

Screened on television and ending with a bang on Wednesday night, the show is like American Idol, but with a humanitarian twist.

Bouba - who is also president of the judging panel - says of the contestants: "It's two extremities. To be honest you will see an artist sing and you will almost laugh. Some of it was terrible you have to admit it, and some of it was very good."

The winner gets to perform to a 20,000-strong crowd in Bercy, Paris with Youssou Ndour in coming weeks as well as an album. While the winner will be a malaria ambassador, so will those contestants heading back to their villages.

Via (Orange Uganda)

Secretary-General Addresses Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria

Thank you, Mr. [John] Tedstrom, for your kind introduction. I am delighted to be here.

And thank you all. Thank you for your work with the Global Fund to scale up access to anti-malarial drugs, for fighting the stigma of HIV in the workplace, for your part in launching the MassiveGood initiative.

I have just come from the Women Deliver meeting where we have unveiled a Draft Joint Action Plan to help Governments deliver on the promise of health for women and children. This promise has been neglected for too long. It is time for a decisive change in pace. Here it is [holds up Joint Action Plan]: our plan to accelerate progress on women's and children's health, to help us meet the Millennium Development Goals by the target date of 2015. I ask you to read the plan and decide what you will do to contribute.

The United Nations appreciates your energy and commitment. Partnership is in our common interest - in building a better world, and in building a better workforce.

Just look at what partnerships have meant for our fight against HIV, tuberculosis and malaria. New HIV infections have decreased by 17 per cent since 2001. Our work on TB has saved an estimated 6 million lives. We have financed more than 90 per cent of the bed nets we need to fight malaria.

These successes are attributed to partnerships among all actors. The theme of your conference, "Work Smarter", highlights our opportunity to now take these partnerships to the next level. We need to work smarter by utilizing our networks to reach more people - by acknowledging our comparative strengths. By eliminating duplication and promoting efficiency. Working smarter means saving more lives. And we need to save many more lives.

Huge gaps remain: For every two people who start anti-HIV treatment, there are five new HIV infections. Four thousand five hundred people die from TB every day. Every day! And every 45 seconds, a child dies of malaria. Unless we dramatically accelerate our efforts, our efforts to meet the Millennium Development Goal will be at risk.

I am convening a Millennium Development Goals summit of global leaders in New York in September. I will ask Governments to come up with a practical and results-oriented plan, with concrete steps and timelines. My most important message is that we can meet the goals by 2015 - with the right commitment and the right policies.

Three points will be crucial moving forward. First, we must be steadfast. Last week, I visited an AIDS clinic in Uganda, where the remarkable Dr. Peter Mugyenyi has pioneered treatment for HIV/AIDS patients. Partly due to his efforts, Uganda was the first country in sub-Saharan Africa to register a drop in adult national HIV prevalence. The number of people on treatment has doubled in the past two years.

Just as important: Dr. Mugyenyi told me that treatment for HIV/AIDS had major benefits for all patients. Deaths in children who were not affected by HIV/AIDS also dropped by 83 per cent.

It was a timely reminder that treatment for HIV/AIDS helps us to address all our health and development challenges. The Millennium Development Goals are indivisible. Our work for one can only help to advance our work for all the Goals. Funding for the AIDS response, including through a successful replenishment of the Global Fund, must be sustained.

Second: contributions and responsibilities must be clearly defined. The business community must bring top quality expertise, technology and management skills. Governments and multilateral organizations must ensure that the best programmes are prioritized and sustained. Civil society must help make sure that policies and programmes reach the most distant, isolated communities. The next generation of public-private partnerships will be based on the priorities of developing countries. National ownership is the only route to ensure sustainability.

Third, we must produce concrete results. That means building capacity, delivering services more efficiently, changing attitudes and policies, and eliminating stigma and discrimination. We know that partnerships help to make CEOs and public servants better leaders. Partnerships can also improve public perception of brands and programmes. But the main point of our partnership is to improve the health of families, communities and countries. We must stay focused on creating the highest possible value: saving lives.

The United Nations continues to confront the world's crises head on, relying on strong partnerships with Governments, businesses, multilateral organizations and civil society. We have a proud and growing record of achievement working with the private sector. The United Nations Global Compact has become the world's largest corporate citizenship initiative. It has promoted partnerships between the United Nations and the business community in 135 countries.

I hope many of you will attend the Global Compact's tenth anniversary summit in New York in two weeks' time. It will be a timely opportunity to share some of the new and innovative approaches that will be generated here today and tomorrow.

I wish you a very successful conference. And I look forward to even deeper partnerships between the United Nations and the private sector.

Via (7th Space)

Experts say cross-border barriers to TB treatment should be addressed urgently in Europe

European countries need to take steps to ensure continuity of care for people with TB if they move between countries as migrants or travelers. At the Wolfheze expert meeting last week in The Hague, Europe's TB experts called for a more concerted effort across borders to provide quality TB diagnosis, care and treatment follow-up to those infected and affected.

European countries face an array of challenges in cross-border TB control, they stressed. In addition to lack of continuity of care for TB patients when they transfer to another country, these include insufficient clarity in coverage of treatment costs and lack of data on health providers in the country of destination.

Wolfheze Workshops, a think-tank movement of European TB experts, was initiated by KNCV Tuberculosis Foundation and its partners in 1990. Every one to two years a growing number of clinicians, researchers and TB program managers from all (53) member states of WHO European region convene for the Wolfheze Workshops. The Wolfheze movement was established as a forum to discuss the latest developments and scientific insights in the field of TB control and to reach consensus on modern TB control policies, guidelines and standards in the WHO European region.

On the initiative of KNCV Tuberculosis Foundation a working group was established at this 20-year jubilee edition of Wolfheze Workshops. Also involving the European Centre for Disease Prevention and Control (ECDC), World Health Organization and country representatives, the working group will define the minimum standards of TB care across the borders to ensure patients' rights and public health interests.

Via (Stoptb.org)

Real Salt Lake Joins the Fight Against Malaria

Malaria kills roughly a million people worldwide, and nearly 90 percent of those deaths occur in Africa. Real Salt Lake's Robbie Russell was nearly one of those statistics.

Living in Ghana when he was 7, Russell was bitten by a mosquito and contracted malaria.

"Malaria, it hits you all at once really hard and you either make it or you don't," he said.

One of the heroes of last year's MLS Cup, Russell still has nightmares based on the hallucinations he had during his fever stages of malaria. He remembers being pretty sick for about two and a half days before his fever started to break.

His experience with malaria is a big reason Russell is so willing to help raise awareness for the deadly virus.

On Thursday, Russell and eight teammates teamed up with the United Nation Foundation's "Nothing But Nets" campaign at the Washington Monument to raise awareness about malaria. RSL co-owner Dave Checketts, coach Jason Kreis and assistant Miles Joseph were also on hand.

"Credit to the team and the guys that they're willing to come out here," Russell said.

With the World Cup starting next week in South Africa, Nothing But Nets and MLS W.O.R.K.S. - the league's community outreach initiative - are working together to capitalize on the global exposure to fight malaria.

RSL got involved by holding a soccer clinic with D.C.-area children to educate them about the preventable and treatable disease.

Before area youth soccer teams broke off into drills with various RSL players,Danielle Garrahan of Nothing But Nets explained to roughly 50 kids how malaria kills nearly a million children every year.

"The thing that really hurts-it's children that suffer the most," Russell said. "It's not the adults. The adults have better immune systems-they can fight it off. It's the kids-they're little, they're not always in the best places, they're sleeping in very poor conditions and they get bit. A kid just cannot deal with it."

Russell was lucky-his family enjoyed good living conditions when he contracted malaria. He had clean water and proper medical attention, unlike hundreds of thousands.

Nothing But Nets is spearheading an inexpensive way to stop the spread of malaria. The foundation raises money to provide insecticide-treated bed nets to those in need. A bed net can protect a family of four for three to five years and costs only $10 to produce, deliver and educate its recipient on the proper use.

Since its creation, Nothing But Nets has raised $30 million to send three million nets to Africa.

"It's just a simple, easy way to save a life. It's really important it gets out there," Russell said. He and teammate Jean Alexandre are the official Nothing But Nets spokesmen for RSL.

Other RSL players who participated Thursday by either helping the kids in some soccer drills or interacting with them while drawing pictures were Kyle Beckerman, Chris Wingert, Chris Schuler, Raushawn McKenzie, Collen Warner, Luis Gil and Nelson Gonzalez.

Via (Deseret News)

TB Trial Splits HIV Community in South Africa

One of South Africa's most eminent HIV scientists has been accused of causing "preventable deaths" during a clinical trial he conducted on people co-infected with HIV and TB.

Reaction to the trial, published this year in the New England Journal of Medicine, has split the South African HIV/AIDS community with a number of HIV clinicians criticising the study design.

But Professor Salim Abdool Karim, Pro Vice-Chancellor at the University of KwaZulu-Natal, says that it is easy to judge his trial with the benefit of hindsight.

"But when the trial was designed, there were no clear guidelines about whether TB and HIV could be treated together, mainly because of concerns about how patients would tolerate the drugs, how the drugs would interact and concerns about 'Immune Reconstitution Syndrome [a resurgence of latent infections]," said Abdool Karim.

Between 2005 and 2008, Abdool Karim and colleagues conducted a trial on 642 patients on TB treatment to establish when they should start antiretroviral treatment.

The trial, "Starting ARV therapy at three points in TB therapy" (SAPiT), divided patients into three groups. The first two groups started ARVs while on TB treatment, while the third group only started ARVs once they had completed their six-month TB treatment.

Twenty seven people (12.7 percent) died in the "sequential arm" where ARVs were delayed until after TB treatment was finished. This was double the deaths in the other two groups (5.8 percent) which integrated TB treatment and ARVs.

But initially more deaths took place in the integrated arm of the trial. Most of the deaths in the sequential arm only happened after six to ten months when all patients had already finished their TB treatment. In other words, the benefit of combining TB treatment and ARVs took some months to emerge.

Bio-ethicists Sean Philpott and Udo Schuklenk described the trial as "deeply flawed" and estimated that there had been around 10 "preventable deaths" in the trial on the website of the Hastings Centre bioethics forum.

"The failure of this research ethics committee to recognise the clinical, ethical, and legal deficiencies in this study is shameful and, we hope, will be investigated by the relevant South African authorities," charges Philpott, associate professor of bioethics at Union Graduate College in the US and Schuklenk, Research Chair in Bioethics at Queens University in Canada.

A number of HIV clinicians have also criticised the trial. Their key concern is that the patients in the "sequential arm" had low CD4 counts (average 140) yet their ARV treatment was delayed for six to nine months, despite ARVs being recommended for people with CD4 counts below 200.

Dr Francois Venter, head of the Southern African HIV Clinicians Society, acknowledged that it was an "awkward situation, as I have great respect for the researchers involved".

But Venter said that the study design was "bad" and that the researchers could have got similar results if they had recruited a bigger group of patients with CD4 counts above 200.

"There are a number of questions that need to be answered to clear the air," said Venter. "Were there senior HIV clinicians looking after the patients? Why was there such a long delay in patients in the sequential arm getting ARVs? Why did the KwaZulu-Natal ethics board approve the study?

"This week, Dr Douglas Wilson, head of clinical services at Edendale Hospital, and Dr Graeme Meintjes from the University of Cape Town criticised the trial in a letter to the New England Journal of Medicine.

"The criticisms of SAPiT are unjustified, in my view, and represent a retroactive application of the very knowledge that the study generated," said Dr Richard Chaisson, a world renowned TB expert, Professor of Medicine and International Health Director of the Johns Hopkins University Centre for Tuberculosis Research in Baltimore.

"The SAPiT trial has provided extraordinarily important data that will ultimately save thousands of lives. When the study was designed and conducted, there was no reliable information on the timing of antiretroviral therapy in patients with HIV and TB," added Chaisson.

"At that time, the major concerns of clinicians were immune reconstitution syndrome (IRIS), drug interactions and additive drug toxicities. As a result of these concerns, almost no patients with HIV/TB were receiving antiretroviral therapy, not only in South Africa, but in the US and Europe.

"In our clinics here in Baltimore, almost all clinicians opted to wait until TB therapy was completed before starting ART to avoid complications. Most clinicians believed that a delay in starting treatment was not detrimental. In fact, a mantra of the time was 'ART is never an emergency, but TB therapy is'. The SAPiT study clearly showed that earlier initiation of ART was safe and lifesaving, and that IRIS was not the serious problem that most clinicians had anticipated it would be. "

Professor Scott Hammer, head of Columbia University's Division of Infectious Diseases, said the trial was "ethically designed and executed and has contributed truly important data to the HIV-tuberculosis co-infection field".

"The South African National Department of Health guidelines at the time of the study recommended initiating antiretroviral therapy in patients with CD4 counts of less than 200 cells per cubic millimetre after they have completed two months of tuberculosis treatment," said Wilson and Meintjes.

"The SAPiT study did not offer the standard of care to patients in the sequential-therapy group, resulting in advanced immuno-suppression that remained untreated for up to nine months and higher mortality."

In response, Abdool Karim said: "The World Health Organisation guidelines, which were the basis of the 2004 South African guidelines, categorically state that recommendations on the initiation of antiretroviral therapy in tuberculosis are 'provisional' and 'pending ongoing studies', since the 'optimal time to initiate [antiretroviral agents] in patients with [tuberculosis] is not known'."

Doctors overseeing those on the trial could put them on ARVs at any time if they showed signs that they needed it, and this happened in seven percent of cases.

International TB experts have also defended the trial.UNAIDS adviser Dr Catherine Hankins said it was "justifiable to run the sequential arm in the manner that it was done at that time for several reasons".

"First, it was common practice at the time in most TB programmes to defer treatment until at least the intensive phase was over, if not to the end of TB treatment," said Hankins.

"Second, the HIV status of many TB patients was not known because many TB programmes were not even offering HIV testing to their patients, despite recommendations from WHO and UNAIDS in 2004. Third, WHO needed unequivocal evidence to make clear recommendations about starting all people with TB on antiretroviral drugs as soon as possible - and the SAPIT study has now provided exactly that. - Health-e News Service.

Via (AllAfrica.Com)

100 Cases of Malaria Diagnosed in Seven Days

According to a note from the local "Abel dos Santos" hospital, another 36 cases of trauma, acute respiratory diseases (25), dermatitis (21), and 20 of acute diarrhoea, were also diagonosed.

In the same period, 21 cases of injuries were also recorded, plus 19 cases of typhoid, 18 of sexually transmitted diseases (STDs), dental caries (16), gastritis (16), high blood pressure (13), haemorrhoid (07) and tuberculosis (03) out of a total of 315 patients, against 292 of the previous period.


The "Abel dos Santos" hospital has the capacity to admit 20 patients.

Via (Angola Press)

BURKINA FASO Testing indoor spray for malaria prevention

Health teams are spraying homes with insecticide in the high-risk southwest, in Burkina Faso's first trial of the method to combat malaria. In 2009 the disease struck more than 20,000 people and killed 110 in the targeted district, according to the Health Ministry.

Funded by the US Agency for International Development (USAID), the project is expected to cover 25,000 households in the district of Diébougou - using the insecticide bendiocarb - for one season at a cost of US$1.4 million.

Indoor spraying should take place before the rainy season each year and cover most homes in endemic areas, but health workers say given the cost it is not yet clear when Burkina would be able to apply the method annually across the country.

"For now only endemic areas can receive [indoor spraying] because of its cost," Patrice Combary, head of the national programme against malaria, told IRIN.

USAID plans to treat Diébougou again next year, along with another district yet to be designated, according to Adama Koné, head of the indoor residual spraying project in Burkina.

The World Health Organization (WHO) says indoor spraying is most effective when 80 percent of households in targeted areas are treated. WHO says the method, using DDT or other effective insecticides, should be included in national malaria control strategies where the proper conditions exist. "There must be sufficient capacity to deliver the intervention effectively, prevent unauthorized and un-recommended use of public health pesticides and manage insecticide resistance," WHO's Africa office says in a 2007 paper.

Indoor spraying is seen as reinforcing existing measures - insecticide-treated bed nets and appropriate drugs for patients with probable or confirmed malaria.

The government plans by end-June to distribute eight million treated bed nets - one net for every two people.

Burkina registered some four million cases of malaria in 2009, according to the Health Ministry. In 2008 malaria struck 247 million people worldwide, killing one million, WHO says; most of the deaths were children in Africa. In Africa every 45 seconds a child dies of the disease.

Via (IRINnews)

Mining Driving TB Epidemic in Sub-Saharan Africa

Some of the main driving factors of sub-Saharan Africa's growing tuberculosis epidemic can be found deep underground in its gold, diamond and precious mineral mines. A new Oxford University-led study warns of the health risks faced by miners and their families.

The study says Africa's mining industry "may be implicated" in as many as 760,000 new cases of TB every year.

Lead author, Oxford researcher Dr. David Stuckler, says, "It's well known that miners have the highest risk of tuberculosis of any occupational group in the world, especially in sub-Saharan Africa. But the striking finding of our study was that not just miners are at risk. But through a system of circular migration, these risks are spread to their families, communities and entire countries."

Dust, crowding, HIV

"In gold mines, such as those in South Africa, there are high levels of silica. This is known to create risks over the long-term of silicosis, which damages the lungs and puts miners and workers at risk of contracting or activating tuberculosis," says Stuckler.

The miners' poor living conditions also make them more vulnerable to TB.

"Miners travel long distances and seasonally, living in barracks and hostels at the mines. Often these are cramped and poorly ventilated quarters sometimes referred to by researchers as prison-like in their size and scope. This creates conditions that are conducive for spreading an airborne disease rapidly," he says.

And then there's HIV/AIDS, the spread of which is now linked to TB. Stuckler says the study shows that African countries with the greatest intensity of mining activity also have the greatest rates of tuberculosis and HIV.

Stuckler says, "Due to the transitory nature of the work, miners are often away from their families for extended periods. This can lead to risky sexual activity. Sexworkers locate often alongside mines and peripheral mining communities and in a setting where HIV prevalence is very high. In some cases as many as 2 out of 5 people are infected."

Early treatment not enough

Many mining companies have health clinics that can diagnose miners with TB and start treatment. However, the study says that doesn't go far enough to stop the spread of the disease.

"When that miner travels home," he says, "often the medicines and medical records of the miner do not. So when the miner reaches Swaziland or Lesotho, a doctor recognizes signs of tuberculosis. He or she is often working blind, not knowing what medicines the miner has or hasn't taken. In this case, there's potential for treatment disruptions, medical mismanagement that can breed drug resistant strains. Those drug resistant strains threaten us all."

The Oxford researcher adds, "One study in Lesotho found that 1 out of 4 cases of extensively drug resistant tuberculosis - this is a strain of the disease that's virtually resistant to our main tuberculosis drugs - one quarter of those cases was occurring in miners, ex-miners and their families. We're seeing strong evidence that through migration a disease becomes an epidemic."

The study of sub-Saharan African mining and TB was a joint effort by researchers at Oxford and Brown Universities, the University of California at San Francisco and the London School of Hygiene and tropical Medicine. It recommends that mining companies and governments work together to ensure "transparent, accountable standards" of cross border care. The study also calls for early screening of miners.

"A policy of simply dismissing miners from work when they show signs of tuberculosis will not work and creates a broad set of costs and risks to entire societies," he says.

The study says over the past 20 years, there's been a doubling of the yearly annual incidence of TB. It now infects about 350 out of every 100,000 people in sub-Saharan Africa. That's despite the spending of tens of billions of (US) dollars on TB-related programs.

The study was published in the American Journal of Public Health.

Via (voanews)

Product(RED) Generates Landmark $150 Million for the Global Fund

The Global Fund's largest private sector contributor (PRODUCT)REDTM, has passed a funding milestone of US$ 150 million to support Global Fund HIV and AIDS programs in Rwanda, Lesotho, Swaziland, Ghana, Zambia and South Africa. (PRODUCT)RED is today one of the largest consumer-based private sector initiatives to raise money for an international humanitarian cause.

Developed and launched in 2006 by rock musician Bono and Bobby Shriver, then chairman of DATA, (PRODUCT)RED brings together some of the world's leading companies as partners in a joint commitment to channel up to 50% of profits from (Red) products to the Global Fund to assist in the fight against HIV and AIDS. Partners include American Express, Apple, Bugaboo, Converse, Gap, Emporio Armani, FLOWE(RED), Hallmark, Dell, Nike, Penguin and Starbucks.

Through its partnership with (RED), the Global Fund is able to direct increased resources to individuals and communities affected by HIV and AIDS in Africa. One hundred percent of the money earned for the Global Fund through (RED) is invested in Global Fund-financed grants and no overhead is charged ensuring that all funds raised have the greatest impact possible.

"We chose to work for the Global Fund because it is the world's largest and most effective financer of the fight against HIV and AIDS,' said Susan Smith Ellis, CEO (RED). ‘The Global Fund's country-led, performance-based model puts the countries themselves in charge of designing solutions appropriate for them and making them work locally. This is incredibly important to us,' she added.

In Rwanda for example, (RED) money has already provided antiretroviral therapy (ART) to more than 27,000 people living with HIV and reached over 34,000 HIV positive pregnant women with preventative ART to reduce the risk of mother-to-child transmission of the virus. Similarly in Lesotho, (RED) money has provided more than 45,000 people living with HIV with lifesaving ART and reached more than 16,000 HIV positive pregnant women with preventive ART to reduce mother-to-child transmission of the virus.

"(RED) money has impacted millions of people living with HIV and AIDS in Africa, saving lives and bringing hope to those living with the disease," said Professor Michel Kazatchkine, Executive Director of the Global Fund. "(RED) is a great example of what can be achieved through effective public-private partnerships - the concept has been an enormous success, engaging the private sector in raising awareness and a sustainable flow of funds to help reduce the devastating impact of the pandemic."

Funds channeled by donors and partners through the Global Fund are making a dramatic difference to global health and have saved an estimated 4.9 million lives to date from AIDS, tuberculosis and malaria. However, progress is fragile and even a small reduction in funding at this stage can reverse gains made over the past years.

Via (The Global Fund)

Global Fund gives 20 mil for HIV, TB

UGANDA has received $20m (about sh40b) from the Global Fund to fight HIV and malaria. the Uganda AIDS Commission (UAC) boss, Dr. Kihumuro Apuuli, said an announcement was made to that effect early last week.

The money will be used to purchase drugs (ARVs), test kits and other health-related equipment. The recipients are ministries, districts and civil society.

The money for the civil society organisations will be channelled through The AIDS Support Organisation (TASO).
last August, Uganda received $24m for HIV, and got over $27m from for tuberculosis treatment last month.

Kihumuro added that the Swedish government recently committed $1.3m towards the fight against the pandemic over the next four years.

A grant agreement, paving way for the disbursement of the funds, was signed between Ugandan and Swedish officials.

Kihumuro was last week addressing the Uganda Network of Aids Service Organisations (UNASO) 8th annual general meeting at Imperial Royale Hotel in Kampala. He asked the organisations not to misuse the money.

UNASO chairman John Mugisha said they were concerned about some provisions in the proposed HIV Prevention and Control Bill.

"Whereas we welcome legislation on HIV and AIDS, we note with concern that some of the provisions in the bill will undermine the progress we have registered over the last years," he said.

Citing local governments, Mugisha said they had noted a decline in the local leaders' commitment towards fighting HIV/AIDS.

Via (New Vision)

Business delivers in the fight against TB, HIV/Aids

President Bush's successful PEPFAR program regarded private sector engagement as critical to its success. And Obama administration efforts like the Global Health Initiative are taking this one step further, explicitly engaging business and tapping private sector assets and expertise to improve the efficiency, effectiveness and sustainability of government programs to fight HIV/AIDS, TB and malaria.

Eight companies will receive GBC's Awards for Excellence in Business Action at a rare gathering of international leaders, joining corporations, governments and international agencies around a common objective, including the Secretary-General of the United Nations, the heads of the WHO, UNAIDS, PEPFAR and the Global Fund, U.S. Secretary for Health and Human Services Kathleen Sebelius, top CEOs, recording star and activist Annie Lennox and PSI Board member Ashley Judd. Former U.S.
Secretary of State Condoleezza Rice also will be honored for her commitment and leadership in the creation of the U.S. President's Emergency Plan for AIDS Relief, the President's Malaria Initiative and the Millennium Challenge Corporation.

The standard-setting programs by the NBA, sanofi-aventis, Eli Lilly & Company, Newmont Ghana Gold Limited, Boehringer Ingelheim Pharmaceuticals, Inc. and NetsforLife, a partnership among The Coca-Cola Africa Foundation, ExxonMobil and Standard Chartered Bank, are part of a broader global movement in which governments, international organizations, civil society and companies are aligning strategies and actions on the frontlines of the fight.

"Governments and non-profits can't do it alone. The private sector needs to step up now to avert tragedy, and use what we know about how to join the forces of business with governments and non-profits to make the health of people sustainable over the long term," said GBC President and CEO John Tedstrom. "Coalition members - and these exemplary companies in particular - have done so much that has built momentum in the fight against HIV/AIDS, TB and malaria, for people and communities around the world. We need more companies to do the same."

"Fighting global diseases requires innovation, commitment and collaboration. It takes more than one scientist, one government or one company to tackle the health challenges people are facing today.

Business, government and civil society must pool their resources, expertise and reach to positively impact global health," said Muhtar Kent, Chairman and CEO of The Coca-Cola Company and co-chairman of the Coalition's Board of Directors. "We salute these private sector leaders who are joining together to improve health and foster economic development around the world."

After many years of working on the periphery, business is now playing a pivotal role in the fight. This major shift has been gaining momentum over the past five to seven years, as governments, international organizations, non-profits and the private sector join forces to align strategies and actions in global health.

Via (PR Inside)

More resources needed to tackle TB in Kenya

Click here for a PDF of the article

Fight Malaria Fashionably

Today, London-based designer Markus Lupfer unveiled his limited-edition Malaria No More ‘net dress' for the UK online fashion store ASOS.

The elegant, ready-to-wear party piece embodies Lupfer's talent for artfully recreating everyday classics. It is fitted to the knee in midnight blue jersey underlay, topped with black tulle netting that forms an oversized shoulder bow to promote the use of mosquito nets in the fight against malaria.

"I was inspired by Malaria No More UK's mission and the simplicity of the project," said Lupfer. "As a fabric, netting is strong and surprisingly versatile and I am pleased to see the net finish works on this piece, a somewhat experimental take on a little black dress!"

All proceeds from the dress will support Malaria No More UK's efforts to combat the disease in sub Saharan Africa. This is ASOS's second product for Malaria No More UK, following the success of Stephen Webster's limited edition Mosquito ring in autumn 2009, which sold out in record time and was worn by Victoria Beckham.

Sadly, the net dress is only on sale in the UK-which means those of us in the US will need to wait for this amazing design to catch on Stateside!

Via (Malaria No More)

Tuberculosis expert to head US charity’s African lab

William Bishai, a tuberculosis specialist, was today named as the director of the first Howard Hughes Medical Institute (HHMI) research laboratory outside the United States. HHMI will invest US$70 million over ten years in the KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH) being built in Durban, South Africa. Bishai will take up the post in September.

As part of a partnership with the University of KwaZulu-Natal in South Africa, the research institute will study HIV and tuberculosis, and the interaction between the two diseases. Tuberculosis is a major cause of death for people living with HIV and AIDS. Construction of the building is scheduled to start in September, and it is due to open in 2012. The institute is expected to house 110 staff, including nearly 50 researchers.

Bishai, a US citizen who expects to move to Durban in 2011, is at present the co-director of the Johns Hopkins Center for Tuberculosis Research in Baltimore, Maryland. Here he speaks to Nature about his plans for K-RITH.

What are the advantages of an institute like this being located in South Africa rather than in the United States or Europe?

The rates of tuberculosis are falling in North America and Europe. Here in Baltimore we've reached incredibly low rates - well under 50 cases a year. But worldwide, it is setting all-time record highs. K-RITH is a tremendous opportunity to conduct research in a place where the disease under study is abundant.HHMI chose South Africa because it has a high burden of HIV and tuberculosis. The existing educational and research systems in South Africa will also allow the science to be built from the ground up. That's really different from where you just do the translational research in the high-disease-burden setting but locate the basic science elsewhere. KwaZulu-Natal was also the epicentre an outbreak of extensively drug-resistant tuberculosis (XDR-TB) that was reported in The Lancet1 in 2006. The outbreak in Tugela Ferry, about three hours' drive north of Durban, was a real killer. That observation was, I think, a strong stimulus to locate K-RITH there.

Why do you think you were chosen for this job?

The pathogenesis of tuberculosis has been a career-long focus of mine. I have also participated in translational research, particularly in antibiotic regimen development. Furthermore, I still see patients at a clinic in the Johns Hopkins infectious-diseases division. Perhaps those skills were what the committee were looking for.

What research will K-RITH do?The tuberculosis field is drastically lagging behind the HIV field in terms of standard tools such as diagnostics and 'biomarkers' [biological molecules, usually proteins, used to track the progress of diseases] needed to implement better therapies. Because biomarkers are required to determine whether new drugs are working, the lack of these basic tools is making clinical trials for tuberculosis drugs and vaccines enormously expensive. Improving this 'toolbox' is a tremendous mandate for K-RITH.

We also need better drugs, and wouldn't it be great if we could prevent tuberculosis with a vaccine? The same goes for HIV. Clinical HIV research is going very well in KwaZulu-Natal, and some seminal papers on HIV plus tuberculosis have come from those cohorts. We're eager to expand those clinical cohorts to individuals that are suffering from tuberculosis only. That would enable us to become a site for tuberculosis vaccine trials.

Only a few years ago, the country had a president who doubted that HIV caused AIDS, and a health minister who promoted beetroot and other vegetables as treatment options. Has the current South African government's more open stance on HIV made it easier to conduct HIV and tuberculosis research?

We're incredibly excited about the positive turn of events in the government of South Africa. I think that signals that it is eager to tackle the problems.

In five years' time, what will the institute have accomplished?

I think our success at the five-year mark will be a completed K-RITH building populated by world-class scientists who have strong links to the clinical resources in KwaZulu-Natal. If those three things can be accomplished, I am confident that there will be improved diagnostics and biomarkers. But the real goal is to establish a long-term structure that will connect basic science to the clinical problems that are abundant in South Africa.

Via (Nature News)

Development Aid in Five Easy Steps

Every country, rich and poor, should ensure universal coverage of primary health care, including safe childbirth, nutrition, vaccines, malaria control, and clinical services. Each year, nearly nine million children die of conditions that could be prevented or treated, and nearly 400,000 women die because of complications during pregnancy.

Almost all of these deaths are in the world's poorest countries. Ending these deaths would not only reduce suffering, but would also unleash economic prosperity in impoverished and unstable societies.

The greatest barrier to doing so is that the poorest countries can't afford universal primary health care, even though the cost per person is very low. Using immunizations, modern medicines, state-of-the-art diagnostics, mobile phones, and other new technologies, universal primary health care is now highly effective and very inexpensive, costing around $54 per person per year in the poorest countries.

Yet, because of their very low incomes, the poorest countries can afford only around $14 per person from their national budgets. Financial help from abroad is needed to cover roughly $40 per person per year. With approximately one billion impoverished people still lacking primary health care, the total sum needed is around $40 billion per year. Foreign donors - including the United States, the European Union, and Japan - are currently contributing around one-third of that, roughly $14 billion per year.

The remaining annual financial gap is therefore about $26 billion. With that money, the lives of many millions of mothers and children would be saved each year.

This is not a lot of money for the rich countries, but they fail to come up with it. The most obvious gap is in the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a global initiative to help the poorest countries fight these killer diseases. The Global Fund is desperately short of money, yet the Obama administration and other governments are not responding to the financial need.

The rich countries could easily come up with the money. First, the US could end its expensive and failed war in Afghanistan, which is costing around $100 billion per year. If the US gave a tiny fraction of that $100 billion in development aid for Afghanistan, it would be far more successful in achieving peace and stability in that war-ravaged country.

For example, the US could give $25 billion in development aid each year and another $25 billion for global health, and still save $50 billion each year to reduce the US budget deficit. Afghanistan, and hence the US, would be far safer, the world would be far healthier, and the US economy would benefit enormously.

A second approach would be to tax the big international banks, which are earning excessive profits on their speculative trading. Even after Wall Street nearly wrecked the world economy, the US government coddled and protected it, enabling its return to huge profits - perhaps $50 billion - last year.

The bankers again paid themselves huge bonuses - more than $20 billion for 2009. This money should have gone to the world's poorest people rather than to the bankers, who certainly did not earn it.

It is time for an international tax on bank profits - perhaps implemented as a levy on international financial transactions - which would raise tens of billions of dollars each year. In pressing the case for such a tax, the developing countries should not accept the meager excuses offered by the US and other countries in order to protect their bankers.

A third approach would be to obtain increased contributions from the world's richest people. Several of them, including Bill Gates, George Soros, Warren Buffett, and Jeffrey Skoll, are already mega-philanthropists, committing huge sums for the world's good. Yet other billionaires have yet to make comparable donations.

According to the most recent Forbes list, there are 1,011 billionaires in the world, with a combined net worth of $3.5 trillion dollars. This means that if each billionaire would contribute 0.7% of their net worth, the total sum would be $25 billion per year. Just imagine, 1,000 people could ensure primary health care for one billion impoverished people.

A fourth approach should be to look to a company like Exxon-Mobil, which earns billions of dollars each year in Africa but, according to one of the company's online reports, spent only around $5 million per year on malaria control programs in Africa from 2000 to 2007. Exxon-Mobil could and should be funding much more of the continent's urgently needed primary health services, either out of royalties paid by the company or out of corporate philanthropic donations.

Fifth, new donor countries, such as Brazil, China, India, and Korea, have the vision, energy, economic dynamism, and diplomatic interest to expand their donor support in the poorest countries, as well as in the poorest parts of their own countries. If the US and Europe are too neglectful to do their part, the emerging economies can and will pick up part of the slack. Fortunately, these new donors are becoming trusted partners in Africa.

The rich world says that it lacks the money to do more, but what it lacks is imagination, not resources. The US should divert its wasteful military spending to new health financing. The world should implement a global bank tax. The billionaires should step up their philanthropy. The oil companies should pay more. New donor countries like China can fill the financing gap left by the traditional donor countries.

The money is there. The needs are urgent. The challenge is one of morality and vision.

UNAIDS and the Global Fund meet with Chair of the African Union

Directors of UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria commended President Bingu wa Mutharika on Malawi's progress in the AIDS response and his leadership as Chairperson of the African Union on AIDS, health, food security and development.

"President Mutharika's vision for the African Union is essential to a sustainable response to AIDS and the Millennium Development Goals," said Mr. Michel Sidibé, Executive Director of UNAIDS.

"As Chair of the African Union, President Mutharika can showcase Malawi's achievements in health," said Prof. Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "President Mutharika can be a strong voice for Africa as the international community focuses on achieving health-related and other Millennium Development Goals."

During their meeting with the President, the Executive Directors emphasized the pivotal role of African voices in advocating for strong leadership in the response to HIV and health. The Executive Directors also emphasized the link between sustaining progress in the AIDS response and ensuring a fully funded Global Fund.

Mr Sidibé and Prof. Kazatchkine also expressed their concern over the recent conviction of Steven Monjeza and Tiwonge Chimbalanga, two men in Malawi who were sentenced to 14 years in prison with hard labour for "indecent practices between males" and "unnatural offenses." They discussed with President Mutharika the health, societal, cultural and human rights ramifications of this case, which has attracted international attention.

"Criminalizing sexual behaviour drives people who engage in same-sex relations underground and hampers HIV-related programmes aimed at addressing their needs," said Prof. Kazatchkine.

"Evidence from several countries in Africa shows a significant number of new HIV infections occurring among sex workers, people who use drugs and men who have sex with men. Opening a societal dialogue on these sensitive and critical issues is the only way to guarantee access to health services and restore dignity to all," said Mr Sidibé.

President Mutharika expressed his appreciation to Mr Sidibé and Prof. Kazatchkine for raising these issues. He said that he is confident the cultural, religious and legal dimensions of the debate generated around this case will lead to a positive outcome. He also recognized the importance of good health and development and proposed to serve as a strong advocate for the replenishment of the Global Fund, and work towards an HIV-free generation in Africa.

GSK Teams Up with Online Communities to Invent New Treatments for Malaria

GlaxoSmithKline (GSK) has decided to team up with well known public domain data providers, European Bioinformatics Institute (EMBL-EBI), the U.S. National Library of Medicine (NLM) and the U.S.-based informatics service provider Collaborative Drug Discovery (CDD). Their aim is to make available important scientific information of over 13,500 compounds that eventually contributes to the invention of new malaria treatments.

Thus, for the first time in history, a pharmaceutical company has contributed the structures of a large number of compounds. It was achieved through the partnership between the web hosts and their expert research tools which the researchers will get for free of cost. Researchers usually host this on websites which includes top quality scientific data about the molecules from GSK's own compound library. These molecules have exhibited potency against the very dangerous malaria parasite, P. falciparum.

Patrick Vallanc who is the head of drug discovery at GSK said, "We are delighted that EMBL-EBI, NLM and CDD have joined us in this worthwhile endeavor to apply the principles of open source to drug discovery for malaria. Defeating this disease will require many scientific minds working together. We hope researchers from across the world will now use this information to drive further studies, and that other groups from pharmaceutical industry to academia will add their information to this on-line resource."

John Overington who is the leader of the EMBL-EBI's ChEMBL team said, "We're proud to be able to add value to the GSK data by incorporating it into ChEMBL and linking it with a vast array of information that could help researchers to find new treatments for malaria."
Steve Bryant who is the head of NLM's PubChem said, "By making these data available through public resources such as PubChem, GSK is greatly facilitating the research process."

Barry A. Bunin who is the CEO of Collaborative Drug Discovery said, "In decades of medical breakthroughs from Big Pharmas, this is the first time a group is openly sharing all the chemical and biological data - not just the few hits."

This kind of data is a stepping stone to develop new medicines. Scientists can conduct more extensive research on these compounds to discover new drugs by analyzing the
structure of the compound and information about where they influence the malaria parasite.

Air travellers with TB triple since 2006

Authorities are discovering a growing number of tuberculosis patients who have travelled by air while contagious, several of them potentially exposing other passengers to the most worrisome, drug-resistant strains of the disease, public-health alerts suggest.

Reports of infectious air passengers more than tripled to 65 last year from 18 in 2006, prompting extensive attempts to warn travellers who might have been contaminated, Public Health Agency of Canada scientists say.

The agency notified 2,472 passengers who sat close to the TB patients on their flights between 2006 and 2008, though some airlines refused to divulge their passenger manifests, according to a just-published article.

Outside experts say the danger of contracting tuberculosis from someone on a plane is low, but called the statistical trend disquieting all the same.

"It is a concern whenever you have someone flying who has open TB," said Dr. David Haldane, a microbiologist at Dalhousie University. "It's certainly not desirable.... The more people you have flying, the more risk you have."

Although the agency does not routinely follow up with passengers, it has yet to hear from local officials about any who tested positive, said Dr. Edward Ellis, the organization's head of tuberculosis control. Still, he said it is important to track down contacts, especially when some risk contracting drug-resistant disease.

"I'd be much more concerned if the attitude was 'Well, the risk is very low, so we're not going to follow up at all,' " Dr. Ellis said. "If I'm a passenger and I'm sitting next to an infectious TB case, I know eventually I'm going to be contacted, and they're going to check me."

The increased numbers are likely a result of rising levels of air travel and more awareness of the question on the part of public-health units, he said.

The issue of infectious tuberculosis patients spending hours in the enclosed space of an airliner alongside hundreds of other people grabbed the world's attention in 2007 when word got out that American Andrew Speaker had flown to Europe and back, with a stop in Canada, despite having multi-drug-resistant TB.

Tuberculosis is an airborne disease, meaning tiny particles remain suspended in the air for hours, said Dr. Wendy Wobeser, an infectious-disease specialist at Queen's University.

Planes filter their cabin air, however, so the particles do not linger for long, and the greatest chance of being infected by a TB patient is on long flights, for those sitting within a couple of rows, she said. None of the people who sat close to Mr. Speaker tested positive. Most people who do get the infection can be cured with antibiotics.

Still, federal guidelines say that no one should board a plane -- or frequent other crowded, public places -- if they suffer from infectious tuberculosis.

The Public Health Agency of Canada received reports from local or international officials of 104 such patients taking flights into or out of Canada between 2006 and 2008, said its paper in the journal Travel Medicine and Infectious Disease. There were another 65 last year. Officials filed reports after diagnosing patients with tuberculosis and determining they likely flew while contagious.Nine had strains resistant to one or more antibiotics, including four who had multi-drug-resistant versions of the bacteria. Most were born outside Canada.

The agency identified 110 flights that fell under Canadian jurisdiction, then started the detective work. Although compliance has improved lately, airlines earlier ignored requests to turn over passenger manifests in five cases.

Even for the flights where patient manifests were released, actual contact information was not always available, so the agency used Canadian passport records and border-entry cards to fill in some of the blanks.

Affecting primarily the lungs, with such symptoms as chest pain and bloody coughing, tuberculosis still causes millions of deaths a year around the world. TB was a major killer in Canada, too, until the 1950s, when it started to disappear rapidly. It has levelled off in recent years to about 1,600 additional, active cases yearly, with new pockets among some recent immigrants and aboriginal people.

Given the relatively low risk posed by TB air passengers, the value of the federal program to track and investigate them is not absolutely clear, said Dr. Wobeser, who noted that some local tuberculosis programs, on the other hand, are quite under-funded.

"It is a costly intervention," she said of the agency's efforts. "I'd have to look at the actual yield to come to a conclusion about its effectiveness, its cost effectiveness."

Via (The Nat'l Post)

Donor commitments to the Global Fund to Fight AIDS, Tuberculosis and Malaria Fund Come Up For Review

Achieving targets to eliminate mother-to-child transmission of HIV and tuberculosis rates hang in the balance as donor commitments to the Global Fund to Fight AIDS, Tuberculosis and Malaria Fund come up for review.
For the past seven years, the Geneva-based Global Fund has made some of the largest contributions to health aid in history, said the Fund's executive director,Michel Kazatchkine.

International donors will meet in October 2010 to decide whether, and how much money, they will give the international financing organization. Kazatchkine said progress so far had put the world on track to reaching important health milestones by 2015, but reaching these goals would depend on renewed funding.

"The next replenishment will be absolutely key to where the world will be in 2015. If we continue to scale up we should be able to reach or surpass some of the health-related Millennium Development Goals (MDGs), such as containing the spread of multidrug-resistant TB (MDR-TB), and virtually eliminating mother-to-child transmission by 2015," Kazatchkine told IRIN/PlusNews.UNAIDS executive director Michel Sidibe agreed. "Without a fully-funded Global Fund, our shared dreams of universal access to HIV prevention, treatment, care and support could become our worst nightmare, putting the lives of millions currently on treatment in jeopardy."

The October replenishment meeting comes at a time when donors like the United States and the UK Department for International Development (DFID) have backed away from increasing their HIV funding commitments. The US President's Emergency Plan for AIDS Relief (PEPFAR) contributes one-third of all Global Fund monies.

A new 126-page report, "The Global Fund 2010: Innovation and Impact", released this week, details progress made by Fund-suported programmes, including increased access to antiretrovirals (ARVs), improved TB cure rates, and reduced levels of AIDS-related mortality and new HIV infections.

According to the report, 2.5 million people have received ARV treatment since 2002 through the Fund, which provides half of all ARVs dispensed in developing countries; the Fund also accounts for two-thirds of TB funding worldwide.

In sub-Saharan Africa, the organization is the single largest multilateral funding mechanism in the health sector, and its support has meant that countries like Namibia, Rwanda and Zambia are likely to reach their MDG targets for universal ARV access.

The Fund recently awarded South Africa about US$43 million as part of its Round 9 of grants. South African Health Minister Dr Aaron Motsoaledi said the country relied heavily on partners like the Global Fund to provide treatment to the 920,000 people enrolled in the country's public-sector ARV programme.Kazatchkine said he hoped donors would renew or increase their commitments, come October, and that developed nations would realize that the economic downturn plaguing their domestic constituencies had often been felt much harder in countries with a high disease burden and export-driven economies.

Sisonke Msimang, executive director of the Open Society Initiative for Southern Africa, told guests at the report launch that international donors needed to bear in mind that funding HIV also meant funding broader goals, such as strong civil societies, improved health systems, and better health outcomes.

The report noted that the introduction of HIV services in Rwanda was followed by an increase in the uptake of primary health care services.

Sidibe said highlighting the wider benefits of funding could be the way to secure donor money for HIV in future. "The Global Fund has helped us to change completely the architecture of aid - it has changed completely the governance system of aid; it has created an alternative service delivery approach that has expanded government's capacity to deliver."

"We need to leverage resources to push broad health objectives, and this means integrating, bringing in the links between reproductive health, maternal and child health," he told IRIN/PlusNews. "We need to take HIV/AIDS out of isolation."

Via (All Humanity TV)

Purdue researchers to use grant to fight malaria

Purdue University researchers hoping to fight drug-resistant strains of malaria will get a $100,000 funding boost to help their efforts.

The grant from the Bill & Melinda Gates Foundation could help fight malaria, which of course can often be fatal without the necessary treatment.

Purdue chemistry professors Christine Hrycyna and Jean Chmielewski hope to create a way to revive once-successful malaria drugs so that they can fight drug-resistant strains of the disease.

Via (Chicago Tribune)

Associate Professor of Medicine at Harvard Medical School discusses the need to scale up HIV testing

In this video interview, Dr. Rochelle Walensky, an associate professor of medicine at Harvard Medical School and an expert in epidemiology and outcomes research, discusses the need to scale up HIV testing and link those who test positive to appropriate care. She also talks about a new avenue to reach men who may be infected with the virus.

Dr. Walensky spoke at an event in Washington last week, "Changing Course: Stemming the Deadly Twin Epidemics of HIV and Tuberculosis," where more than 100 HIV and TB scientists, policymakers, and advocates have come together to discuss the future of US global health policy and potential new scientific breakthroughs in the battles against HIV and TB.

You can find out more about Dr. Walensky's presentation here and get more info about the event here.

Via (Science Speaks)

Are Supercomputers the Answer to the Worlds Malaria Crisis?

Supercomputers, once the privilege of a select few universities and government laboratories, have become redefined in recent years so as to make them more accessible to smaller research labs as well. This includes a team from Intellectual Ventures in Bellevue, Wash., that is taking advantage of the speed and power of a supercomputer brought online over the past year to create complex simulations they hope will reveal solutions to complex problems, including the spread of malaria.

Intellectual Ventures' supercomputer is a work in progress that is shared by two different teams of researchers within the organization-one studying malaria (pdf) and the other, called TerraPower, studying nuclear reactor technology. The malaria project got off the ground in 2007, after the Bill and Melinda Gates Foundation called upon Intellectual Ventures to develop new technologies to fight malaria. This spawned the idea of using computer models to simulate the spread of the disease worldwide.

The supercomputer consists of 138 Dell blade servers running multiple processing units (or cores) on each server, for a total of 1,104 cores. Intellectual Ventures generally devotes 1,024 of those cores to TerraPower and the rest to its malaria research. The researchers chose Microsoft Windows as its operating system (Linux is also commonly used in supercomputing clusters) because the system administrators at their facility are familiar with Microsoft software. It did not hurt that Microsoft co-founder Bill Gates is investing in both the TerraPower and malaria projects, and that Intellectual Ventures itself was formed by former Microsoft executives Nathan Myhrvold and Edward Jung.

The supercomputer, which has five terabytes of memory and 30 terabytes of storage, supplies the brute power to crunch numbers, but this would mean little without the software to instruct the computer. The software pulls biological data on the behavior and reproductive rates of the Plasmodium parasites and the mosquitoes that carry them, as well as information on infection patterns and immune responses among humans. Other data include where people live and how they travel, environmental factors (temperature, rainfall and elevation) that are important to malaria transmission, and the locations of different species of mosquitoes. The software uses this data from a variety of sources-including the World Health Organization, Malaria Atlas Project, universities and NASA-to create models of how malaria outbreaks play out.

Before the supercomputer became available last year, the malaria project researchers used an eight-core computer to establish the basics of their research. They needed to expand their computing power, however, to more accurately model the disease over larger geographic areas. "A larger cluster means you can simulate larger areas in the same amount of time," says Philip Eckhoff, a research scientist at Intellectual Ventures. The team uses the Monte Carlo approach to create its malaria simulations, relying on information from repeated trials to build results. As such, access to more cores allows the researchers to run more trials faster and reach their target number of trials sooner.

Via (The Scientific American)

The Global Fund to Fight AIDS, Tuberculosis and Malaria launches Round 10

On the 20th of May, the Global Fund launched its Round 10 Call for Proposals. The deadline for submissions is the 20th of August 2010. As has been previously mentioned, the round is being launched in the context of a resource-constrained environment and with the Global Fund's 2011-2013 replenishment process soon to be underway.

Community Systems Strengthening
This Round is of of vital importance to Civil Society and community organisations; it includes the newly approved Community Systems Strengthening (CSS) framework, developed after a wide consultation faciltated by ICASO, UNAIDS and the International HIV/AIDS Alliance. Community Systems are community-led structures and mechanisms used by communities through which community members and community based organisations and groups interact, coordinate and deliver their responses to the challenges and needs affecting their communities. Although a large number of countries, particularly in Latin America and the Caribbean, have already included CSS interventions within previous Global Fund proposals, the new CSS framework contains a range of areas of service provision, indicators and targets which will facilitate the development of national and regional proposals for Round 10. The full CSS framework is available here: http://bit.ly/CSSFramework

New Funding Stream for Most At Risk Populations - Round 10 only
The Board of the Global Fund has approved a new funding stream (the total pot is limited to US$200million over 5 years) for Most At Risk Populations in countries with concentrated epidemics. This was a significant decision for middle-income countries in light of the newly approved prioritisation model for proposals recommended by the Technical Review Panel in the traditional funding stream; the model prioritises low income countries. Proposals submitted through the new funding stream will not compete for funding with proposals from low-income countries with generalised epidemics. A Fact Sheet on the New MARP Funding Stream is available here: http://bit.ly/FactSheetMARPFundingStream

Round 10 Guidelines and Forms
The Round 10 Guidelines and Forms have been amended to include CSS, and policies on Gender, and Sexual Orientation and Gender Identity. All relevant documentation for Round 10 is available on the Global Fund Website: http://www.theglobalfund.org/en/applynow/

Archivel Farma Claims it Can Help The Lancet’s Call to Tackle TB

The Lancet this week issued a call to arms to fight tuberculosis which it says has become a neglected disease. Yet, it points out, in reality there is more tuberculosis today than at any other time in history with 2 million deaths in the past year alone and 9 million new infections. It cites the emergence of drug-resistant strains and the confluence of the HIV epidemic, which makes people more susceptible to TB, as being responsible for turning TB into a global public health crisis. Archivel Farma has a novel theory about TB that opens up new ways of tackling it.

The current view is that TB lies dormant within people, which is known as Latent TB Infection (LTBI). However, Professor Cardona, the company's Chief Scientific Officer, and Head of the Experimental Tuberculosis Unit of the Research Institut Germans Trias i Pujol, believes that this is not the case as it does not explain why it currently takes a nine month course of antibiotics to eliminate a dormant infection. His Dynamic Hypothesis is that TB is constantly re-infecting the patient and swapping from a non-replicating to replicating form - a strategy evolved over hundreds of thousands of years to ensure that it is very hard to get rid of. As the antibiotics are only effective on the replicating version, the Dynamic Hypothesis explains why it takes nine months of antibiotics as this is the time it takes for all the non-replicating bacteria to slowly change to replicating and be eliminated.

He is testing his Dynamic Hypothesis by taking high resolution Tomography scans of patients with LTBI. Under the current Dormant Hypothesis, the lesions in the lungs caused by LTBI should remain static in size and location. According to the Dynamic Hypothesis, the lesions will change in size with some disappearing and others appearing in new locations and the initial results are showing just that.
The Dynamic Hypothesis provides the company with a unique way of treating LTBI by using a combination of antibiotics drugs for a month to eliminate the active TB along with two injections of the company's new therapeutic vaccine called RUTI® which tackles the dormant form.

Luis Ruiz-Avila, Archivel's CEO, explains, "TB is either tackled by drugs companies or by vaccine companies. We are the only company that is using both to cut the treatment time down from nine months to just one. This provides a tremendous opportunity to tackle the very serious problem of TB as, for the first time, there is now a cost effective means to tackling the reservoir of TB that is present in one third of the world's population. A long and expensive nine month treatment is always going to have problems especially in poorer countries where it is mainly prevalent and where the chances of reinfection are very high. Our new regime of a short course of tablets and two injections will be much easier for people to understand and comply with so the problems of not completing the nine month course and resulting drug resistance are eliminated and reinfection can be reduced due to the immunity provided by the vaccine."

The RUTI vaccine is produced from Mycobacterium tuberculosis, the strain that actually produces TB. Uniquely, the company cultures the bacteria under conditions that mean that most of the bacteria turn into the hard to treat non-replicating form. This means that resulting vaccine stimulates the body to target this form in particular. The company is hopefully that it will also confer long term immunity to LTBI, which will be the subject of future trials. Meantime, the Phase I trial has been successful completed and the Phase II clinical trial of Archivel's combination treatment for LTBI will be starting shortly in South Africa and includes patients with HIV who are particularly susceptible to developing active TB as their HIV-compromised immune systems are less able to win the battle with the re-infecting TB.

Via (PRWeb.com)

Anti-malaria efforts focus on pregnant women and children

Health authorities are successfully battling malaria in remote eastern Indonesia by linking efforts to fight the mosquito-borne disease to maternal and child healthcare.

"Pregnant women and children are especially vulnerable to malaria, and modern malaria diagnosis and prevention can be delivered via existing maternal health and immunisation services in a symbiotic way," said William Hawley, a malaria expert with the UN Children's Fund (UNICEF).

Nurses and midwives help the malaria programme with diagnosis, treatment and bed net distribution, Hawley said. Furthermore, because people want bed nets, more women use antenatal care and bring their children to be immunised.

"The malaria programme, the antenatal care programme, and the expanded programme on immunisation all benefit, but most important - women and kids benefit," Hawley said.

Malaria was once the top health problem in South Halmahera District - 400 islets inhabited by 200,000 people in North Maluku Province, health officials say.

Swamps, poor sanitation, poverty and low levels of immunisation left the population - pregnant women and children in particular - vulnerable to health problems.

By integrating prevention, diagnosis and treatment with antenatal care and child immunisation, the number of malaria deaths in South Halmahera plummeted from 226 in 2003 to four in 2008, and the incidence of malaria dropped by 50 percent, according to the district health office.

Hawley said neighbouring districts in the Maluku Islands are trying to replicate South Halmahera's success, and similar anti-malaria efforts are under way in several other districts in Indonesia. 

Free treatment 

The head of South Halmahera District, Muhammad Kasuba, stepped up the anti-malaria programme three years ago. 

"We have to scrub out this disease altogether, so we can start developing our infrastructure," said Kasuba, who has provided his district with universal healthcare since 2007 to ensure the community receives free malaria treatment as well as other basic health services. 

Residents were also taught to prevent mosquito breeding by turning over boats filled with water and digging channels from the sea to lagoons to keep them too salty for mosquitoes, while children learned how to differentiate between malaria mosquitoes and other types. 

Authorities also set up the South Halmahera Malaria Centre as a hub for training and coordination. 

About half of Indonesians - 158 million of the country's 230 million people - are at risk of malaria infection, according to the University of Oxford's Malaria Atlas Project (MAP) and the Ministry of Health. 

In 2008, there were 411,979 malaria cases confirmed by lab tests, though an additional 863,213 were tallied as probable cases, according to the World Health Organization (WHO). It reported that 2.15 million insecticide-treated bed nets were distributed between 2004 and 2008, enough to cover six million people living at high risk of malaria. 

Elsewhere in Indonesia, local health authorities, supported by WHO and Care International, implemented anti-malaria efforts after the devastating tsunami in Aceh in December 2004. 

The island district of Sabang, off the coast of Banda Aceh, had a 4.3 percent malaria prevalence in 2005. That dropped to less than 1 percent prevalence rate in 2009, said Hawley. 

TB Alliance Trumpets New, Improved Drugs at World Health Assembly

Like polio and leprosy, developed countries have long since tamed tuberculosis. But even now, other parts of the world continue to struggle against the disease, with nearly all (98 percent) of TB's 1.7 million worldwide deaths occurring in developing countries. TB's high comorbidity with HIV infections has recently added another level of urgency to efforts to find a faster, less expensive cure.

And for the first time in over 40 years, promising new drug candidates have appeared on the R&D scene. The candidates are designed to be effective not only against not regular TB, but also against multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of the disease, as well as those co-occurring with HIV. The drugs are expected to reduce treatment time to two months, as opposed to the current (40-year-old) six-month regimen for regular infections. Current courses for MDR are even longer, and just 1 percent of patients get the proper treatment.

But activist organization Treatment Action Group puts a $2 billion per year price tag on the R&D needed to bring these drugs through the pipeline, and current funding is well below that-75 percent below, according to Médicins Sans Frontières.

New vaccines, drugs, and diagnostics could reduce TB's global infection rate by 71 percent by 2050. That may seem a long way away, but according to TB Alliance communications manager Joanna Breitstein, that's the best case scenario. The current rate of reduction for the disease is just 1 percent per year, and without advances in technology and drugs for MDR TB, the rate is likely to stay the same. That's even grimmer news when you take into account population growth: reduction becomes negligible.

On the plus side, there was a general increase of almost 100 percent in public financing of health worldwide, according to an April article in The Lancet. The exception? Sub-Saharan Africa, where government spending actually decreased. The region has an extraordinarily high infection rate, partially due to the high incidence of HIV/AIDS in the population.

New study finds 125 million pregnancies globally at risk from malaria every year

A new study has estimated that roughly 125 million pregnancies are at risk from malaria every year. Until now, estimates were only available for endemic countries in Africa.

The study was conducted by the Malaria in Pregnancy Consortium. The Malaria in Pregnancy Consortium was established in 2007 at the Liverpool School of Tropical Medicine to improve the control of malaria in pregnancy.

From the article, ‘Consortium leader Professor Feiko ter Kuile from LSTM explained: "Until now, it was impossible to estimate the number of pregnancies at risk of malaria for endemic areas outside Africa. For the study, we estimated the sizes of populations at risk of malaria and used data from various sources to calculate the annual number of pregnancies in each country. We then multiplied the number of pregnancies by the fraction of the population living within the spatial limits of malaria transmission in that country. We calculated that in 2007, 125.2 million pregnancies occurred in areas with P.falciparum and/or P.vivax transmission."

Experts Say Decades Of UN Efforts To Fight Tuberculosis Have Flopped And New Strategies Required

With more than 9 million people infected last year, including 2 million deaths, officials say there is more tuberculosis now than at any other time in history. In a special tuberculosis edition of the British medical journal Lancet published on Wednesday, experts said past failures prove new strategies are required.

For years, the World Health Organization and partners have fought TB largely with a program where health workers watch patients take their drugs - even though the agency acknowledged in a 2008 report that this treatment program didn't significantly curb TB spread.

Experts said TB isn't only a medical problem, but is intertwined with poverty, as it spreads widely among people living in overcrowded, dirty places. They said TB programs need to go beyond health and include other sectors like housing, education and transportation.

Some officials questioned whether continued U.N. programs could even combat TB. "The main priority for TB control is improved living conditions and economic growth, which is outside the control of the U.N.," said Philip Stevens, a health policy expert at International Policy Network, a London-based think tank. "TB cannot be tackled in isolation."

Stevens said the global health community also needs to be more vigilant about the drugs they buy for TB programs. According to a 2007 report from the Global Fund to fight AIDS, Tuberculosis and Malaria, half of the drugs the fund bought for poor countries didn't comply with their own drug quality standards.

Dr. Mario Raviglione, head of WHO's TB department, said the recent fall in TB was "very minor" and that the agency was trying to understand how better to fight the epidemic.

Still, WHO said their basic TB programs cured more than 36 million people between 1995 and 2008, and saved up to 6 million from dying of the potentially fatal lung disease.

But the recent spread of drug-resistant TB illustrates there have been major shortcomings. Drug-resistant TB emerges when patients don't finish their pills or take substandard drugs - like many of those bought by the Global Fund.

One of the public health community's biggest failings in fighting drug-resistant TB is the lack of basic data. In a WHO report published in March, the agency said it didn't know whether the global outbreak of drug-resistant strains are getting bigger or smaller.

"It is surprising how much data we're lacking," said Pamela Das, executive editor at Lancet, who co-authored an accompanying commentary in the journal. "There are so many gaps that we don't really know what's going on."

One of the Lancet papers called for the disease to be eliminated by 2050, while another said WHO guidelines on treating people infected with both TB and AIDS were not based on good evidence and needed to be revised.

Das said WHO and partners should be proud of drop in TB cases, but that the agency has failed to achieve its mandate and those gains could soon be reversed. She doubted the disease could be wiped out by 2050 unless current strategies addressed the poverty underlying much of TB.

Global Fund Launches “Born Free HIV” Campaign

"It is heartbreaking that over 400,000 babies are born with HIV every year even though we have the medical means and the expertise to prevent this," says Carla Bruni-Sarkozy, The Global Fund's Ambassador for Protecting Women and Children against AIDS. "I hope the BORN HIV FREE campaign will inspire millions of people to support The Global Fund so we can finally put an end to this terrible injustice."

Carla Bruni-Sarkozy's support for the BORN HIV FREE campaign follows a call in 2009 from UNAIDS head Michel Sidibé to virtually eliminate mother-to-child transmission by 2015. HIV-positive mothers can pass on HIV to their babies during pregnancy, child labor, delivery or by breast-feeding. The risk of transmission can be significantly reduced if they get access to prevention and
treatment services.

"We can win this battle against AIDS if we get the funding we require," says Professor Michel Kazatchkine, Executive Director of The Global Fund. "This campaign is intended to encourage people to sign up in support of The Global Fund and to show their leaders that there is strong public support to continue and increase funding for its mission."

The campaign was conceived by French musician and producer Julien Civange at the request of Carla Bruni-Sarkozy, and co-produced with The Global Fund. Designed to work across various social and traditional media platforms, the campaign brings together several major companies who have joined up as official partners in support of The Global Fund: Google, JC Decaux, Jean-Paul Gaultier,
MSN, Orange, Tiffany & Co. and YouTube which will be a major platform for the campaign.

"YouTube is proud to be a main platform for this creative and innovative campaign." says Chad Hurley, YouTube CEO and co-founder. "This campaign will show governments that their citizens endorse this effort and by supporting the Global Fund and its ambassador Carla Bruni-Sarkozy we want to encourage fellow YouTube visitors to visit the Born HIV Free YouTube channel, watch and
share its videos and sign up in support."

The campaign will operate in several languages with the vivid and imaginative short animation films aiming to expand public awareness that an HIV-free generation is now truly possible within five years if governments continue funding the fight against HIV and AIDS. Nearly 100 media organizations are supporting the campaign.

The campaign films were produced by Oscar-winning creative team H5, as well as by Les Bonzoms for Paris Passion, with music by Amy Winehouse, TWA/MAP and NEXUS Productions. The films focus on the promise of life fulfilled for children who are protected from HIV. Actor and director Vincent Perez has directed a special video with Carla Bruni-Sarkozy to promote the campaign on
YouTube. The animations will be distributed through various social and mass media platforms. They are supplemented with a film by the award-winning Swedish animator Jonas Odell showcasing the tremendous advances made in the fight against the three diseases since the inception of The Global Fund in 2002.

The BORN HIV FREE web site was designed and developed by red design, and the YouTube Channel was developed by type3. The campaign logo uses two ribbons to embody the overarching theme: a small red ribbon, to represent a child, enveloped by a larger grey ribbon, representing the love and care of a mother. Tiffany & Co. has created a collector's item brooch of this logo and Jean-
Paul Gaultier is producing a collector's item tee-shirt.

Since its establishment in 2002, The Global Fund has approved proposals totaling US$ 19.4 billion making it the main contributor to the health-related Millennium Development Goals. If current progress rates are maintained, it is possible to ensure that virtually no children anywhere in the world are born with HIV by 2015.

A majority of The Global Fund's resources come from donor governments. This year countries will pledge funding for the next three years (2011-2013) to fight the three diseases. On 5 October 2010, UN Secretary-General Ban Ki-moon will chair a meeting of donor countries in New York.
The BORN HIV FREE campaign will run until the key meeting in New York in order to mobilize public support for these decisions which will determine whether the battle to virtually eliminate mother to child transmission of the virus will be won or lost.

www.bornhivfree.org

Watch the videos on: www.youtube.com/bornhivfree

The Lancet Releases Special Issue on TB

May 2010.The Lancet released a special issue on tuberculosis, which includes a series of papers and comments highlighting the need for new tools, the threat posed by drug-resistant strains, results of current control efforts, and other issues about TB worldwide. The series also includes comments about how to scale-up an integrated TB and HIV response, the burden of the disease in women and children, and how migration patterns within and between countries contribute to the spread of TB.

You can view the PDFs here

Experts estimate Myanmar needs upwards of $20 mil U.S. to fight Malaria

"Some key challenges are insufficient funding available for malaria prevention and control activities, and [the] emergence of drug-resistant malaria," Kunii said.

Evidence of tolerance to Artemisinin - the most effective drug used to treat malaria - has been found in the southeast, along the border with Thailand, and in southern Mon State.

"It is very important to react aggressively to this threat," said Frank Smithuis, the former director of Médecins sans Frontières in Myanmar and now head of Medical Action Myanmar.

"In Cambodia, where resistance to Artemisinin was first detected, an enormous effort is being made to contain the spread of resistance. This is all financed by the first-world countries," he said.

"Surely there is no reason whatsoever not to give similar support to control malaria in Myanmar. It is urgent for the first world to increase humanitarian and development aid to control malaria in Myanmar."

There are also significant access restrictions and logistical challenges, especially during and after the rainy season, when local malaria transmission is most intense, one aid worker from an international NGO said, on condition of anonymity.

"It would be good to increase the number of facilities to diagnose and treat malaria. In addition, it is essential to make effective malaria treatment affordable for everybody," Smithuis said.

He said estimates of annual malaria cases range from 4.2 million to 8.5 million. The official reported number of deaths is about 9,000 a year, but he said the actual figure is likely much higher.

According to Myanmar's National Malaria Control Programme, 76 percent of the country's estimated 50 million inhabitants live in malaria-prone areas.

Populations most vulnerable to malaria are migrant workers and marginalized ethnic groups, experts say.

Malaria, a vector-borne disease, affects 300 million people in 90 countries around the world, and kills one million people annually - 90 percent of them in Africa, and 9 percent in Southeast Asia, say health experts.

Symptoms include fever, headache and vomiting, and usually appear 10-15 days after the mosquito bite. Left untreated, malaria can become life-threatening.

Via (IRIN News)

British Government Urged to Reveal TB Plans

"We look forward to working with a new Defra team which we trust will move farming back up the political agenda," said RABDF chairman, David Cotton.

"The Conservatives and Liberal Democrats made a very clear commitment prior to the election to introduce a comprehensive package of measures to control TB, including a science based targeted control in hotspot areas.

"The two parties now have the opportunity to nail their true colours to the mast and show they are prepared to influence and drive change to current TB policy within government.

"We urge that discussions are initiated immediately in order to prevent any further spread of this insidious disease and stem the massive tax payer spend on needless culling of reactors which last year cost tax payers £90m for 40,000 head.".

He also called for an overhaul of the previous government's Responsibility and Cost Sharing proposals.

"While we have already supported the principles of responsibility and cost sharing and continue to believe that they can have the potential to deliver improved animal health within the national livestock population, we would however urge government to ‘slow down' the policy decision making on the proposed Animal Health Bill," he said.

He said the industry wanted to see detailed evidence of how the proposed Animal Health Organisation (AHO) could operate ‘without impacting on the industry's wallet any further than through implementing bio-security and taking other proactive measures that already take place'.

Via (The Farmers Guardian)

False positives in TB diagnosis lead to real negatives for HIV patients

"Among HIV-infected persons with suspected TB, falsely diagnosing persons with TB by rapid testing was associated with increased mortality when compared with the group of patients who received the correct diagnosis," said study lead author Robert Blount, M.D., clinical fellow in pulmonary and critical care medicine at UCSF's School of Medicine.

The results of the study will be presented at the ATS 2010 International Conference in New Orleans, with co-authors Laurence Huang, Lucian Davis, Adithya Cattamanchi, Saskia den Boon, William Worodria and Moses Joloba also in attendance

"Tuberculosis remains a common cause of pulmonary disease worldwide," Dr. Blount said. "HIV-infected patients are particularly susceptible to TB. Diagnosis can be a challenge, because the standard test-- sputum culture -- p although sensitive and specific, often takes several weeks to yield results."

Physicians and researchers have long understood that missing a positive diagnosis of tuberculosis in patients who actually have the disease can result in poor outcomes and an increase in mortality rates. But the link between mortality and false positives -- diagnosing someone with tuberculosis who does not have the disease -- has been less widely understood.

In this study, Dr. Blount and his colleagues evaluated the outcomes of 600 HIV-infected patients who were treated at Mulago Hospital in Kampala, Uganda, including patients who were incorrectly diagnosed with tuberculosis following rapid testing.

"Studies tend to emphasize the negative impact of missing the diagnosis of TB," Dr. Blount noted. "Our study shows that falsely diagnosing patients with TB who do not actually have TB is also associated with negative outcomes."

Dr. Blount said the poorer outcomes are likely due to the fact that patients who are misdiagnosed are treated erroneously for tuberculosis while the actual underlying condition remains untreated. Because physicians believe tuberculosis is the culprit, any search for the real underlying disease is delayed, as is proper treatment, he said.

Dr. Blount said the study's results serve to caution physicians to continue monitoring patients who have been diagnosed with tuberculosis to ensure the treatment is working, and to reassess the diagnosis if patients are not improving.

"These results remind us as clinicians that diagnostic tests are not 100 percent accurate, and that falsely diagnosing patients with a disease who do not actually have that disease can lead to negative outcomes," he said. "We must continue to re-evaluate a patient's clinical progress. If he or she is not responding as predicted to treatment for a diagnosed disease, we must entertain alternative diagnoses."

Dr. Blount also noted the results indicate a need for further refinement of rapid diagnostic tests for tuberculosis.

"These rapid tests, however, are not always as sensitive or specific for determining if a person has TB," he said. "Further research should be focused on the development of more sensitive and specific TB diagnostic tests and the clinical impact of these new tests. Ideally, these tests should be affordable enough to be used in low-income countries, where the burden of tuberculosis is high."

Via (Science Blog)

Nathan Wolfe Director of Global Viral Forecasting traces origins of Malaria

transcript below...

Question: How did you discover the origins of malaria?

Nathan Wolfe: Malaria has a huge impact on the human population. It affects people throughout the tropical world. This is a devastating disease and while there are treatments to it, diagnosis is difficult, there is an adequate means for diagnosis and treatment is not universally available, so people are dying, it's impacting livelihoods throughout the world, this is one of our most important public health crises of our time, really, is malaria.

NIH Makes A Statement On National HIV Vaccine Awareness Day

"More people today have access to life-saving antiretroviral therapy for HIV/AIDS than ever before. Yet for every person who begins treatment for HIV infection, two to three others become newly infected. Treatment alone will not curtail the HIV/AIDS pandemic. To control and ultimately end this pandemic, we need a powerful array of proven HIV prevention tools that are widely accessible to all who would benefit from them.

Vaccines historically have been the most effective means to prevent and even eradicate infectious diseases. They safely and cost-effectively prevent illness, disability and death. We at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have been working for more than two decades with our colleagues worldwide to develop an HIV vaccine, and this research continues to rank among our top priorities.

National HIV Vaccine Awareness Day marks an opportunity to reflect on our progress, renew our commitment to finding an HIV vaccine, and personally thank the scientists, community educators, health care workers, and especially the many study volunteers who have dedicated their time and energy to this important endeavor. Only with the continued commitment of volunteers may we more effectively confront the global scourge of HIV/AIDS and pursue the goal of an HIV vaccine.

We have witnessed significant progress in HIV vaccine research during the past year. Notably, a major clinical trial in Thailand gave us the first indication that an experimental vaccine can protect some humans against HIV infection. With the participation of more than 16,000 volunteers, investigators found the vaccine to be 31 percent effective at preventing HIV infection. Although this level of protection is modest, it gives us hope that a safe and effective HIV vaccine is possible. The priority now is to try to understand how the vaccine induced protection against HIV infection in some individuals, and to build on those results.

The Thai trial demonstrated the power of large-scale clinical trials to advance HIV vaccine development and to answer fundamental scientific questions. Such trials are possible only through strategic partnerships among federal collaborators, nongovernmental organizations and the private sector. NIAID continues to pursue focused clinical HIV vaccine research through such partnerships.

At the same time, we are bolstering our commitment to the basic laboratory research that provides a foundation for future vaccine development. In the past year, scientists at NIAID and elsewhere discovered several new antibodies able to neutralize diverse HIV strains that circulate worldwide. These antibodies disable HIV by latching onto vulnerable sites on the virus. Some of these sites previously were unknown, so their discovery widens the field of targets that a vaccine could exploit. Current and future studies will determine whether scientists can develop HIV vaccines based on protein replicas of these targets, and whether the immune response to these vaccines might protect people from HIV infection. Many other studies also are under way to explore basic questions about HIV and its interaction with the immune system.

As we recognize recent progress in HIV vaccine research and hope for continued advances, we must remember that a vaccine alone will not end the HIV/AIDS pandemic. If an HIV vaccine is developed, it will need to be used in concert with multiple other scientifically proven HIV prevention tools. NIAID continues to support research into an array of investigational HIV prevention methods, including pre-exposure prophylaxis with antiretroviral drugs, microbicides, and expanded HIV testing and treatment with linkage to care.

Via (center for vaccine ethics and policy)

Shrinking the malaria map

A group of researchers have revealed1 a tool which they say has the potential to stamp out malaria from areas on the verge of eliminating the disease. As more malaria-fighting tools and funds become available, the possibility of eliminating the disease from some areas may be within reach, according to a special report2 published today in Science.

The tool, published in the June edition of Journal of Infectious Diseases, can be used to predict hotspots of malaria transmission using the results of a pin-prick blood test to assess antibody levels in people passing through local health facilities.

Over the past decade, the funding made available for malaria control to countries where the disease is endemic has soared, according to the Science report. In 2009, the total stood at almost US$1500 million, up from less than US$100 million in 2000.

This has led to gains in the control of the disease. More people have access to anti-mosquito bednets as well as newer, more effective antimalarial drugs, and indoor insecticide-spraying has increased. In Africa, disease-control campaigns have been most successful in small countries. In Rwanda, the rapid roll out of these interventions in 2007 reduced the incidence of malaria by more than 50% in children under five years of age.

But many of the larger African countries continue to shoulder a heavy burden from the mosquito-borne disease. A quarter of all malaria cases recorded in Africa occur in Nigeria, and the ongoing conflict in the Democratic Republic of Congo has made the country "one of the most difficult countries anywhere to fight malaria", say the authors.

The first steps on the path to malaria eradication could be taken by stopping the transmission of the disease in specific geographical regions where it is already largely under control, according to the report.

The recent reductions in malaria incidence have stirred debate on how best to allocate funds to control the disease in the future. Some experts believe that public health authorities should channel money into programmes designed to stamp out malaria once and for all in areas where control strategies have reduced incidence successfully - thereby "shrinking the malaria map". Others say that money is better spent in trying to reduce the burden in areas that remain badly affected by the disease.

Brian Greenwood, from the London School of Hygiene and Tropical Medicine in the UK, believes it is reasonable to attempt both strategies - so long as the balance is right.

"It's silly not to think about elimination," he explains. "If South Africa and China want to eliminate malaria then they should be encouraged." Disease control funds should be allotted with a 90-95% focus on areas hardest hit by the disease, and the remaining 5-10% earmarked for elimination programmes in areas where the burden is lower, he suggests.

But in terms of research funding, Greenwood believes the scales should be tipped a little more in favour of elimination. Much of the malaria-control research currently underway will not produce real-world applications for five to 10 years, he points out. "By that point, more countries may be at the point [near elimination] when they can consider using them."

Greenwood is part of the research group that this month published details of a tool aimed at elimination. The team believe that it could be used to put an end to malaria transmission in countries where the disease has been brought under control.

Working in a sub-district of Tanzania's Korogwe region, they mapped malaria-transmission hotspots - areas where the incidence of the disease among 1200 infants was high. Using three different measures of malaria risk, and with the help of spatial statistics, they determined which one of the measures was most successful at predicting the high-incidence "clusters".

One of the risk measures was based on information about the antibody levels against the malaria parasite in 1630 local people who came to one of four district health centres about a medical problem of any kind. The second measure was based on a measure of infection with the parasite in these patients. The third measure of risk was an environmental variable: the distribution of mosquito vectors in the region. This was based on various data sources, including the number of mosquitoes collected in the homes of 600 children enrolled in another study.

Statistical tests revealed the presence of antibody markers was the best predictor of the actual incidence of the disease. "Serological markers of exposure to malaria showed a tight correlation with malaria incidence and predicted transmission hot spots with high precision," write the authors.

"This [approach to identifying transmission hotspots] could work in countries approaching elimination," says Greenwood. Focusing control activities in these areas could help stop the transmission of the malaria parasite, he adds.

Health authorities in 20-30 countries have now said elimination of the disease could be a realistic aim. These include the southern African nations of Namibia, Botswana and Zanzibar, some Middle Eastern countries, island nations, as well as China and Mexico, according to Greenwood.

Via (Emerging Health Threats Forum)

New Technique May Quickly Distinguish between Active and Latent TB

"Current blood tests for tuberculosis are reasonably good at distinguishing between uninfected and infected persons, but cannot tell the whether an infected person has active, and possibly infectious, tuberculosis or has latent infection," said senior author Jason Stout, M.D., M.H.S., assistant professor of medicine at Duke University Medical Center. "Generally a culture is required to tell the difference between latent infection and active tuberculosis, but a culture usually requires weeks to deliver a result. A rapid test that could tell the difference between latent and active tuberculosis would be a major step forward."
The findings will be reported at the ATS 2010 International Conference in New Orleans.
"This pilot study explored whether using patterns in the immune response to tuberculosis could be helpful in improving rapid diagnosis of the disease," Dr. Stout said.

Dr. Stout and colleagues collected whole blood samples from 71 people belonging to one of three groups: those with active tuberculosis, those with latent tuberculosis infection, and those who were not infected with tuberculosis. After exposing the samples to pieces of the tuberculosis bacteria to stimulate an immune response, researchers measured the levels of 25 specific proteins, called cytokines, to determine the presence of a pattern that could allow them to differentiate among the three groups.
"We found that a pattern of two cytokines, called MCP-1 and IL-15, was reasonably good at differentiating between persons sick with TB and persons infected but not sick," Stout said. "In addition, a third cytokine, called IP-10, looked promising in distinguishing between uninfected persons and infected individuals."
Stout said that while previous studies identified all three cytokines as possible individual predictors of tuberculosis infection, the usefulness of the combination of MCP-1 and IL-15 was unexpected.
"These findings could lead to earlier diagnosis of active tuberculosis, which could be beneficial for both the sick person and others around her or him who might be spared from infection," Dr. Stout noted. "There is also the potential for avoiding unnecessary and potentially toxic medications in persons who are not sick with tuberculosis."

Although the initial results were promising, Dr. Stout noted the sampling for this pilot study was limited, and added that further research would be needed to determine if the results could be replicated in a larger population, "ideally a group of persons suspected of having tuberculosis."
"Future studies may also help researchers determine whether examining additional cytokines would improve on the accuracy of our results," he added.

Via (Newswise.com)

Mexico going green in the fight against Malaria

For over half a century, the battle against malaria has been waged with powerful anti-malarial drugs and potent mosquito-killing insecticides, weapons born from the wonders of synthetic chemistry. In recent years, however, fed up with the financial and ecological drawbacks of chemical warfare, malarious communities from China to Tanzania to Mexico have been forging a new way to fight the scourge, one that draws inspiration from the lessons of ecology more than chemistry. Rather than attempt to destroy mosquitoes and parasites outright, these new methods call for subtle manipulations of human habitats and the draining of local water bodies - from puddles to irrigation canals - where malarial mosquitoes hatch.

The most striking example comes from Mexico, which has completely abandoned its previously lavish use of DDT in malaria control for insecticide-free methods and has seen malaria cases plummet. Like many countries, Mexico for decades relied upon insecticides to fight the disease, by spraying mosquito-killing chemicals on the interior walls of homes where blood-feeding mosquitoes rest, among other methods. Between 1957 and 1999, taming Mexico's malaria required 70,000 tons of DDT.

New, environmentally-sensitive methods, such as clearing vegetation along waterways and around homes, were introduced in Oaxaca, the country's most malarious region, in 1998. By 2002, malaria cases had fallen from more than 17,500 to just 254, and Mexico incorporated the new methods In Oaxaca, officials recruited volunteers to remove algae and trash from rivers and streams.into its national anti-malaria program. By 2000, Mexico had completely phased out use of DDT in malaria control; by 2002, it had phased out all other insecticides in malaria control as well, while simultaneously keeping malaria in check. No deaths from malaria were reported in Mexico in 2008, the most recent year of data available from the World Health Organization.

Similarly, in Sichuan, China, new, non-chemical methods involving the manipulation of water flow in irrigation canals have led to the near cessation of malaria, with malaria rates plummeting from 4 per 10,000 in 1993, to less than 1 per 10,000 by 2004. In several counties of the province, no malaria cases were reported at all between 2001 and 2004. Similar non-chemical gains against the disease have been achieved in Dar es Salaam, Tanzania, as well.

Malaria currently infects 300 million people a year and kills nearly one million, and though the incidence of malaria is decreasing in some countries, it still rages in many others.

The new, greener methods of control rely upon insights into the exacting set of local environmental conditions that malaria transmission requires. While it is commonly considered a disease of poverty, malaria is just as much a disease of the environment. In part, that's because both malaria parasites and the mosquitoes that carry them thrive in warm, humid conditions.

But it is also because malaria-carrying mosquitoes, all of which hail from the genus Anopheles, don't generally venture far from where they hatch, and each species tends to lay its eggs in a specific kind of water body. Some prefer shady, flowing waters; others require sunlit puddles. Some can tolerate brackish water, while others must have clear water. That means that if people's exposure to the habitats of local malarial mosquitoes can be reduced, they will get fewer bites, and thus less malaria.

Malaria transmission is also critically dependent on the life span of the mosquito. The malaria parasite won't become infective inside the insect until it completes a 7-12 day cycle of development. That means that anything that decreases mosquito longevity - a dearth of useful places to hide from predators, say, or excessively dry conditions - can also effectively squelch malaria.

In Oaxaca, Mexico, malariologists found that the local malaria vector, Anopheles pseudopunctipennis, hatches from the still, algae-choked waters on the edges of streams, rarely flying more than 2 kilometers from its birthplace. And so, starting in 1999, they recruited volunteers in malarious communities to remove green algae and trash from the rivers and streams near their settlements.

"As a gift," says Jorge Mendez, former chief of Mexico's anti-malaria agency in the Ministry of Health, "we gave house paint to the local residents, to motivate community participation." The density of AnophelesChemical methods cannot provide the long-lasting sustainability of environmental methods.larvae dropped by 90 percent within three years. Mexican health officials made life more dangerous for the surviving insects, too, by clearing the vegetation around domiciles, where Anopheles mosquitoes hid from both predators and the desiccating sunshine. They also provided prophylactic anti-malarial drugs. The program ultimately cost 75 percent less than the insecticide-reliant one it replaced.

In Sichuan, China, Anopheles hyrcanus prefers the standing water found in rice paddies, traditionally kept permanently flooded. A water-saving "wet/dry" irrigation scheme introduced in 1994 called for periodically drying out the rice fields. "The Chinese have fine-tuned this to an art," says Princeton University malariologist Burton Singer. The result was the destruction of Anopheles' larval habitats, a four-fold reduction in malaria, and increased harvests to boot.

In Dar es Salaam, Tanzania, Anopheles gambiae lays its eggs in trash-blocked sewer drains, and so community workers there began a program of clearing drains and spreading the microbial insecticide Bacillus thuringiensis into sewers. "This was the lowest-hanging fruit of them all," says Gerry Killeen of the Ifakara Health Institute in Tanzania, "the most basic and undramatic environmental management." It led to a 30 percent drop in A. gambiae's transmission of malaria.

Other techniques, useful in areas where destroying or minimizing mosquito habitats is untenable, can be as simple as making sure people close the eaves of their houses. More capital-intensive methods include leveling roads to avoid the formation of puddles, and installing running water and sanitation systems so that homes are less likely to be near stagnant water.

These nuanced - but decidedly low-tech - programs recall an earlier, pre-chemical era, when malaria control workers made similar gains against the disease by tinkering with the local environment, mostly because they had few other options. In the copper mines of Zambia during the 1930s, for example, malariologists significantly reduced malaria by clearing vegetation, removing obstructions from local waterways, and draining flooded areas. In Panama, during the building of the canal in the early 1900s, anti-malaria workers drained swamps and coated puddles with a thin skin of larvae-suffocating oil, part of a multi-pronged anti-malaria strategy that enabled the canal to be built. Similar measures helped eradicate malaria in the U.S. South.

Environmental management methods fell into disuse after World War II, with the development of a string of synthetic insecticides and drugs, led by DDT and chloroquine. Powerful and highly effective, modern insecticides and anti-malarial drugs can kill malaria mosquitoes and parasites quickly and cheaply, wherever they are used, regardless of local conditions. They can be implemented in even the most remote locales, with minimal infrastructure.

Managing the local ecosystem to minimize malaria vectors, in contrast, requires concerted effort from local communities, and expertise not just from health officials, but from ecologists, farmers, and engineers as well. It In sub-Saharan Africa, financing for the war on malaria increased tenfold between 1998 and 2008.is labor-intensive. Ditches must be dug, drains cleared, vegetation removed. And what might be the perfect salve in one place could be the worst possible thing to do in another. "The details of what you need depend on the local ecological conditions," says Singer. "You can't mastermind it with a master plan." And while insecticide-spraying campaigns, drug distribution, and the doling out of insecticide-treated bednets can bring malaria mortality down rapidly, reaping the benefits of environmental tinkering takes years.

And so today, while the preferred chemicals have changed - instead of DDT and chloroquine common in the postwar era, the chemicals of choice are now primarily pyrethroid insecticides, impregnated in bednets, and anti-malarial drugs based on artemisinin, an extract from the sweet wormwood tree - the emphasis on chemical control has not.

The current war against malaria in sub-Saharan Africa, for which financing from governments and NGOs increased tenfold between 1998 and 2008, calls for 730 million bednets doused with insecticides, 172 million homes sprayed annually with insecticides, 228 million drug treatments for malaria patients, and 25 million preventive drug treatments for pregnant women, to be blanketed across Africa's malarial heartland, as the inter-agency Roll Back Malaria Partnership has outlined. Today, 11 countries are conducting formal campaigns to eradicate the disease, and malaria declines in the wake of chemical-based anti-malaria campaigns have been reported in Equatorial Guinea, Zanzibar, Sao Tome and Principe, Rwanda, and Ethiopia.

And yet, as dramatically effective and universally applicable chemical methods may be, they cannot provide the long-lasting sustainability of environmental management methods. None of the chemical methods of malaria control last longer than a handful of years. Insecticide-treated bednets must be replaced or re-treated every three to four years. Drugs must be continually administered. Interior walls must be re-sprayed with insecticide every six to 12 months.

With sustained funding and political commitment, insecticidal and pharmaceutical treatments for malaria could, in theory, go on indefinitely. The trouble is that in the meantime, the malaria parasite and the mosquitoes that carry it become increasingly adept at resisting the‘Our enthusiastic programs are again going to founder in the swamp of biological resistance.'chemical onslaught. Plasmodium parasites that could circumvent the killing action of artemisinin drugs have already emerged in parts of Southeast Asia. By 2007, artemisinin drugs were failing in up to 30 percent of malaria cases in parts of Thailand and Cambodia, and by 2009, those drug-resistant parasites had spread deeper into southern Cambodia. Experts worry that it is only a matter of time before these drug-resistant malarias spread into the malarial heartland in sub-Saharan Africa.

Similarly, malaria-carrying mosquitoes that can resist the pyrethroid insecticides commonly used to treat bednets were first reported in 1993, and have since turned up across sub-Saharan Africa. In a 2005 study in Cameroon, just as many kids using treated nets came down with malaria infections as those using untreated ones.

While DDT is still used in indoor spray campaigns against malaria, resistance to the chemical - and related insecticides - is widespread.

"Our enthusiastic programs are again going to founder in the swamp of biological resistance," warned malariologist William Jobin, on the scientific website MalariaWorld in April.

Finally, as the chemical war against malaria intensifies, so, too, do fears of toxicity. While the volume of DDT and other insecticides used in spray campaigns against malarial mosquitoes is miniscule compared to agricultural use, environmentalists and farmers worry that the increasing availability of DDT for malaria control could result in surreptitious diversion onto farms. Concerns simmer, too, about the understudied problem of disposal of the insecticide-treated bednets.

The environmental management programs in Mexico, China, and Tanzania all arose in the wake of just such concerns. Mexico's program, for example, was implemented after a 1996 agreement with the United States and Canada to phase out all uses of DDT. The irrigation program in Sichuan, China was implemented after the cost of running a 1986-1993 program of insecticide-treated bednet distribution became unmanageable. In Dar es Salam, the local malaria vectors had adapted to the widespread presence of bednets by biting outdoors instead.

The benefits of environmental management techniques - their longer-term sustainability, ability to harness community participation, and lower overall costs - may tip the balance in their favor in other fronts in the war on malaria, too. Health officials from Ecuador and Nicaragua, for example, have been flocking to Mexico to learn about their malaria program, Mendez says.

Many experts hope these techniques - still limited to just a handful of countries - will become more widespread, not to replace chemical methods entirely, but as complementary alternatives that will reduce the use of insecticides and drugs.

Via (E360/Yale)

Disabling Crucial Structure in TB Bacterium may Assist New Drug Design

In a study, scientists from the U.S. Department of Energy's (DOE) Brookhaven National Laboratory, Stony Brook University (SBU), and Weill Cornell Medical College describe new features of how this structure, known as a proteasome, is put together and how it works. The details could assist researchers working to develop anti-TB drugs. "Mycobacterium tuberculosis, the bacterium that causes TB, infects one person in three worldwide, so finding new ways to battle this pathogen is a major public health priority - particularly in developing nations where active TB infections are endemic," said study co-author Huilin Li. Earlier studies revealed important structural details of the Mycobacterium tuberculosis proteasome, a piece of cellular machinery that carves up unwanted or damaged proteins, allowing the bacterium to evade a key defense of the human immune system.

The researchers have even identified small molecules that might be incorporated into drugs to inhibit the proteasome. "The primary aim of this new study was to look at how the proteasome, comprised of 28 proteins, is constructed," said Li. The scientists used Brookhaven Lab's National Synchrotron Light Source (NSLS) - a source of intense x-ray, ultraviolet, and infrared light - and a cryo-electron microscope to take molecular-level snapshots of the proteasome at various stages of assembly.

The studies revealed important intermediate steps and changes in the shapes of the components making up the completed structure. The snapshots also reveal how one component in particular can inhibit the assembly process. "Such detailed understanding of the assembly process might suggest novel approaches for developing anti-TB drugs by preventing the maturation of the proteasome. This would be an alternative to the traditional approach of inhibiting the activity of the mature proteasome," said Li.

The researchers were also curious to find out how the Mycobacterium tuberculosis proteasome keeps the entrance to the protein-cleaving chamber shut. "The fully constructed proteasome is literally a death chamber for cellular proteins, so the passage to the chamber has to be safely closed, and open only when necessary," explained Li.

Higher-level organisms, such as humans or yeast, also have gate-closed proteasomes to degrade unwanted proteins. In these cases, the gate closure mechanism is known and straightforward-each of the seven end proteins is different, and they can assume different conformations, or shapes, to open and close the gate. But in bacterial proteasomes, the seven end proteins are identical. "The question has been how the same protein sequence takes on the necessarily different conformations in order to seal the central pore," said Li. Images taken by the scientists using x-ray beams at the NSLS reveal an asymmetric and tightly closed gate structure at the seven-fold symmetrical entrance. The scientists also snapped additional images showing that the gate structure retains some flexibility. "This flexibility may be key to opening the gate to allow entry to proteins that need to be degraded. Figuring out how to reduce the flexibility, and thus keep the gate permanently shut, could be yet another strategy in developing proteasome-targeting anti-TB drugs," said Li. The new approaches are particularly attractive because the differences in assembly and gating mechanisms between human and TB proteasomes are more significant than the differences in the enzyme active sites that have been primary targets for drug development.

Thus, drugs designed to inactivate these aspects of the TB proteasome would be less likely to also inhibit proteasomes in human cells. The study appeared online in EMBO J, the journal of the European Molecular Biology Organization.

Via (MedIndia)

Crucell and NIH Announce Start of Malaria Vaccine Trial in Burkina Faso

Dutch biopharmaceutical company Crucell N.V. today announced the start of a Phase I clinical study in Burkina Faso of its AdVac®-based malaria vaccine vector. Crucell is developing its malaria vaccine vector in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), the Centre National de Recherche et de Formation sur le Paludisme (CNRFP) in Burkina Faso, and the Noguchi Memorial Institute for Medical Research at the University of Ghana. The study is a randomized, controlled, double-blinded, dosage- escalation clinical trial evaluating the immunogenicity and safety of the recombinant malaria vaccine vector Ad35-CS in malaria semi-immune, healthy adult volunteers living in Burkina Faso. This is the first study evaluating the safety and immunogenicity of this AdVac®-based malaria vaccine vector candidate in a population residing in a malaria endemic area. "We are very pleased that the collaboration with NIH enables us to enter into this new trial," said Dr. Jerald Sadoff, Crucell's Chief Medical Officer at Crucell. "Using Crucell's technologies, we are on a joint mission to develop a vaccine against malaria, one of the top three killers in the world, causing close to a million deaths every year, mostly amongst children." The study is funded by NIAID/NIH and conducted by Burkinabè researchers at the CNRFP, lead by the director of the CNRFP Dr. Sodiomon B. Sirima, MD, PhD. "The innovative approach in designing this malaria vaccine vector gives us confidence that it could open a new, promising era in the quest for an effective malaria vaccine, which would save the lives of millions of our children." said Dr. Sirima. A Phase I clinical study recently completed in the United States demonstrated that the Ad35-CS vector has an acceptable safety and immunogenicity profile in malaria naïve, healthy adult volunteers. About AdVac® technology AdVac® technology is a vaccine technology developed by Crucell and is considered to play an important role in the fight against emerging and reemerging infectious diseases, and in biodefense. The technology supports the practice of inserting genetic material from the disease-causing virus or parasite into a have hicle' called a vector, which then delivers the immunogenic material directly to the immune system. Most vectors are based on an adenovirus, such as the virus that causes the common cold. The AdVac® technology is specifically designed to manage the problem of preexisting immunity in humans against the most commonly used recombinant vaccine vector, adenovirus serotype 5 (Ad5), without compromising large- scale production capabilities or the immunogenic properties of Ad5. AdVac® technology is based on adenoviruses that do not regularly occur in the human population, such as Ad26 and Ad35. In contrast to Ad26 and Ad35 antibodies, antibodies to Ad5 are widespread among people of all ages and are known to lower the immune response to Ad5-based vaccines, thereby impairing the efficacy of these vaccines. All vaccine candidates based on AdVac® are produced using Crucell's PER.C6® production technology. About PER.C6® technology Crucell's PER.C6® technology is a cell line developed for the large-scale manufacture of biopharmaceutical products including vaccines. The production scale potential of the PER.C6® cell line has been demonstrated in an unprecedented successful bioreactor run of 20,000 liters. Compared to conventional production technologies, the strengths of the PER.C6® technology lie in its excellent safety profile, scalability and productivity under serum-free culture conditions. These characteristics, combined with its ability to support the growth of both human and animal viruses, make PER.C6® technology the biopharmaceutical production technology of choice for Crucell's current and potential pharmaceutical and biotechnology partners. About Crucell's malaria vaccine Crucell is developing a recombinant malaria vaccine, Ad35-CS, based on the company's AdVac® technology and PER.C6® manufacturing platform. The vaccine candidate is made by inserting the gene for the CSP from the P. falciparum malaria parasite into adenoviral vectors, which act as a have hicle' for vaccination delivery. This prime vaccine candidate is currently being tested in a phase I study in partnership with the National Institute of Allergy and Infectious Diseases (NIAID). About Crucell Crucell N.V. (NYSE Euronext, NASDAQ: CRXL; Swiss Exchange: CRX) is a global biopharmaceutical company focused on research development, production and marketing of vaccines, proteins and antibodies that prevent and/or treat infectious diseases. In 2009 alone, Crucell distributed more than 115 million vaccine doses in more than 100 countries around the world, with the fast majority of doses going to developing countries. Crucell is one of the major suppliers of vaccines to UNICEF and the developing world. Crucell was the first manufacturer to launch a fully-liquid pentavalent vaccine called Quinvaxem®. Quinvaxem® protects against five important childhood diseases and over 130 million doses have been sold since its launch in 2006 in more than 50 GAVI countries. Through Quinvaxem® and its innovation, Crucell has become a major partner in protecting children in developing countries. Crucell's core portfolio also includes a vaccine against hepatitis B and a virosome-adjuvanted vaccine against influenza. Crucell also markets travel vaccines, such as an oral anti-typhoid vaccine, an oral cholera vaccine and the only aluminum-free hepatitis A vaccine on the market. The Company has a broad development pipeline, with several product candidates based on its unique PER.C6® production technology. The Company licenses its PER.C6® technology and other technologies to the biopharmaceutical industry. Important partners and licensees include Johnson & Johnson, DSM Biologics, sanofi-aventis, Novartis, Wyeth, GSK, CSL and Merck & Co. Crucell is headquartered in Leiden, the Netherlands, with subsidiaries in Argentina, China, Italy, Korea, Spain, Sweden, Switzerland, UK and the USA. The Company employs over 1200 people. For more information, please visit www.crucell.com. Forward-looking statements This press release contains forward-looking statements that involve inherent risks and uncertainties. We have identified certain important factors that may cause actual results to differ materially from those contained in such forward-looking statements. For information relating to these factors please refer to our Form 20-F, as filed with the US Securities and Exchange Commission on April 7, 2010, in the section entitled 'Risk Factors'. The Company prepares its financial statements under International Financial Reporting Standards (IFRS).

Global Fund Oks $4 Million For Fiji TB Program

Minister for Health Dr Neil Sharma said the grant will contribute to upgrading laboratory systems in the main divisional facilities, supporting the national TB program and strengthening the health information systems.

"A significant aspect of the project is the overseeing of the treatment of around 650 TB patients over the past five years and the screening and distribution of TB prophylaxis to more than 750 children in contact with infectious patients," said Sharma.

He said the ministry being the principal recipient will work with the sub-recipients including the Fiji Red Cross Society, the Fiji Nursing Association and the Fiji School of Medicine and nursing programs under the College of Medicine, the Nursing and Health Sciences of the Fiji National University, the National TB program, the National Reference Laboratory, the Fiji Pharmaceutical and Biomedical Service Centre and The Health Information Unit.

The programme will be carried out over the next 27months.

The Global Fund is a multi-billion-dollar international financing mechanism intended to help advance the fight against diseases such as TB, AIDS and malaria.

AIDS War Is Falling Apart In Uganda

On the grounds of Uganda's biggest AIDS clinic, Dinavance Kamukama sits under a tree and weeps.

Her disease is probably quite advanced: her kidneys are failing and she is so weak she can barely walk. Leaving her young daughter with family, she rode a bus four hours to the hospital where her cousin Allen Bamurekye, born infected, both works and gets the drugs that keep her alive. But there are no drugs for Ms. Kamukama. As is happening in other clinics in Kampala, all new patients go on a waiting list. A slot opens when a patient dies."So many people are being supported by America," Ms. Kamukama, 28, says mournfully. "Can they not help me as well?" The answer increasingly is no. Uganda is the first and most obvious example of how the war on global AIDS is falling apart. The last decade has been what some doctors call a "golden window" for treatment. Drugs that once cost $12,000 a year fell to less than $100, and the world was willing to pay.

In Uganda, where fewer than 10,000 were on drugs a decade ago, nearly 200,000 now are, largely as a result of American generosity. But the golden window is closing. Uganda is the first country where major clinics routinely turn people away, but it will not be the last. In Kenya next door, grants to keep 200,000 on drugs will expire soon. An American-run program in Mozambique has been told to stop opening clinics. There have been drug shortages in Nigeria and Swaziland. Tanzania and Botswana are trimming treatment slots, according to a report by the medical charity Doctors Without Borders. The collapse was set off by the global recession's effect on donors, and by a growing sense that more lives would be saved by fighting other, cheaper diseases. Even as the number of people infected by AIDS grows by a million a year, money for treatment has stopped growing.

Other forces made failure almost inevitable. Science has produced no magic bullet - no cure, no vaccine, no widely accepted female condom. Every proposal for controlling the epidemic with current tools - like circumcising every man in the third world, giving a daily prophylactic pill to everyone contemplating sex or testing billions of people and treating all the estimated 33 million who would test positive - is wildly impractical. And, most devastating of all, old-fashioned prevention has flopped. Too few people, particularly in Africa, are using the "ABC" approach pioneered here in Uganda: abstain, be faithful, use condoms. For every 100 people put on treatment, 250 are newly infected, according to the United Nations' AIDS-fighting agency, Unaids. That makes prospects for the future grim. Worldwide, even though two million people with the disease die each year, the total keeps growing because nearly three million adults and children become infected.

Even now, the fight is falling short. Of the 33 million people infected, 14 million are immuno-compromised enough to need drugs now, under the latest World Health Organization guidelines. (W.H.O. guidelines are conservative; if all 33 million were Americans, most clinicians would treat them at once.) Instead, despite a superhuman effort by donors, fewer than four million are on treatment. Just to meet the minimal W.H.O. guidelines, donations would have to treble instead of going flat. Uganda is a microcosm of that: 500,000 need treatment, 200,000 are getting it, but each year, an additional 110,000 are infected. "You cannot mop the floor when the tap is still running on it," said Dr. David Kihumuro Apuuli, director-general of the Uganda AIDS Commission.

Some battles will still be won. Middle-income countries with limited epidemics, like India, Brazil and Russia, can probably treat all their patients without outside help. China almost certainly can. South Africa might; it has a raging epidemic but is rich by African standards. But for most of Africa and scattered other countries like Haiti, Guyana and Cambodia, it seems inevitable that the 1990s will return: walking skeletons in the villages, stacks of bodies in morgues, mountains of newly turned earth in cemeteries. As he tours world capitals seeking donations, Dr. Michel D. Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said he had become "hugely frustrated." "The consistent answer I hear is: ‘We love you, we hear you, we acknowledge the fund's good results, but our budget is tight, our budget is cut, it's the economic crisis.' " No commander in the global fight openly concedes that the war is over, but all admit to deep pessimism. "I don't see the cavalry riding to the rescue," said Dr. Anthony S. Fauci, an AIDS researcher who leads one of the National Institutes of Health. "I'm worried we'll be in a ‘Kampala situation' in other countries soon," said Ambassador Eric Goosby, the Obama administration's new global AIDS coordinator. "What I see is making me very scared," agreed Michel Sidibé, executive director of Unaids. Without a change of heart among donors, Mr. Sidibé said, "the whole hope I've had for the last 10 years will disappear."

Donors give about $10 billion a year, while controlling the epidemic would cost $27 billion a year, he estimated. His predecessor, Dr. Peter Piot, said he had seen optimism soar and then fade. Hopes rose from 2001 to 2003 when cheap generic antiretroviral drugs became available, Secretary General Kofi Annan of the United Nations formed the Global Fund and President George W. Bush initiated the President's Emergency Plan for AIDS Relief, or Pepfar. "Then, we were at a tipping point in the right direction," Dr. Piot said. "Now I'm afraid we're at a tipping point in the wrong direction." (read more)

As the Need Grows, the Money for AIDS Runs Far Short

United Nations raises awareness of malaria in Africa

According to the United Nations Foundation Nothing But Nets, one child dies of malaria every 30 seconds but since 2001 the Measles Initiative has distributed millions of bed nets to children in Africa in order to prevent the disease.
The UN campaign was created in 2006 and has cooperated with numerous partners and thousands of supporters, including UNICEF, the World Health Organization, the United Methodist Church and many others.

Two years later, the campaign joined the Office of the UN High Commissioner for Refugees (UNHCR) to expand the program and send more preventive bed nets to refugees in Africa. By the end of 2009, Nothing But Nets had sent more than one million nets to the African continent. On World Malaria Day, thousands of people around the globe participated in The Sleep Out to End Malaria. The initiative, which took place in various locations across the United States, Zimbabwe, South Korea and others, would help end malaria deaths by 2015. Volunteers are now organizing an autumn Sleep Out to End Malaria on a large number of university campuses.

On Sunday, the UN Nothing But Nets campaign made a Buzz Tour bus stop in downtown Toronto at the Yonge-Dundas Square and provided information to bystanders on the crucial health issue in Africa and the organization. The bus was converted from a school bus and is fuelled on waste vegetable oil and outfitted with solar panels. Volunteers urged people to contribute $10 to join the "global fight against malaria." The money would send a preventive bed net to Africa. So far, more than 3.1 million bed nets have been sent.

300 Cases of TB Diagnosed in Cunene Province

About 306 new cases of tuberculosis were detected in the southern Cunene Province, by the local health authorities, in the first quarter of the current year. According to the head of Cunene's public health department, João Perdo, in comparison to the previous three months there was an increase of 101 cases. According to João Pedro, the increase of TB cases is due to the poor diet of many citizens and excessive use of alcohol. via (Angola Press)

Canada to fund “point of care” diagnostics

Read the press release below

Grand Challenges Canada Launches its First Grand Challenge, Point-of-Care Diagnostics, with the Goal of Saving Lives through Innovation.

TORONTO, May 3 /CNW/ - The Honourable Jim Flaherty, Minister of Finance for Canada, today announced the launch of Grand Challenges Canada, an innovative initiative that will help redefine Canada's role in the developing world by bringing together Canadian scientists, developing world scientific researchers, and the private sector to solve some of the most persistent health challenges facing poor countries.

Grand Challenges Canada's mission is to identify global Grand Challenges, fund researchers and organizations to address them, and support the implementation and commercialization of the solutions that emerge.

The Government of Canada is committing $225 million over five years to the Development Innovation Fund, announced in the 2008 Budget, to support the best minds in the world in a collaborative search for solutions to global health challenges.

Grand Challenges Canada was created to implement the realization of this goal working with the International Development Research Centre (IDRC), a Crown Corporation and the Canadian Institutes of Health Research (CIHR), a Government of Canada Agency.

Grand Challenges Canada is an independent not-for-profit organization governed by its own Board and guided by a Scientific Advisory Board, whose members are some of the world's most distinguished medical scientists from both the developed and developing world. Grand Challenges Canada is hosted at the McLaughlin-Rotman Centre for Global Health.

A Grand Challenge is a specific critical barrier that, if removed, would help solve an important health problem in the developing world with a high likelihood of global impact through widespread implementation. Grand Challenges Canada will identify, fund and support a total of five Grand Challenges in global health.

"Grand Challenges Canada will lead the way in making a better, safer and healthier world", said Minister Flaherty. "It is an ambitious new Canadian organization aimed at supporting global partnerships to solve the developing worlds most difficult and pressing health challenges."

"The Bill & Melinda Gates Foundation is supportive of the mission of Grand Challenges Canada and pleased to work together on the Grand Challenge of Point-of-Care diagnostics," said Dr. Carol Dahl, Director of Staff for the Global Health Program of the Bill & Melinda Gates Foundation.

The purpose of this challenge is to improve the diagnosis of diseases afflicting millions in the developing world by bringing diagnostic tools to the patient's bedside.

"Innovation saves lives," said Dr. Peter A. Singer, Chief Executive Officer of Grand Challenges Canada and Director of the McLaughlin-Rotman Centre for Global Health, University Health Network and University of Toronto. "Diagnosis is the prelude to effective treatment. Bringing diagnostic tools to the patient's bedside is better, faster, and cheaper than sending a sample to a laboratory 100 km away."

Diagnostic improvements could save more than 100,000 lives annually from malaria-related deaths alone and could reduce more than 365 million unnecessary treatments, which can lead to wasted resources and drug resistance.

Said Mr. Joseph L. Rotman, one of Canada's most philanthropic business leaders and Chairman of Grand Challenges Canada, "once these innovative solutions are created, it is up to a collaboration of business, academia, government and philanthropy to invest in and develop these advances and make them available and affordable to all who need them. It's gratifying to see that the Canadian Government has the far-sighted vision to support this extraordinary venture which will make such a difference in the world and to Canada's role in international development."

About Grand Challenges Canada Grand Challenges Canada is a unique and independent not-for-profit organization dedicated to improving the health and well-being of people in developing countries by integrating scientific, technological, business and social innovation. Grand Challenges Canada works with the International Development Research Centre (IDRC) and the Canadian Institutes of Health Research (CIHR) and other global health foundations and organizations to find sustainable long-term solutions to the most pressing health challenges. Grand Challenges Canada is hosted at the McLaughlin-Rotman Centre for Global Health. Grand Challenges Canada

World tuberculosis day : Innovate to eliminate TB!

World tuberculosis day : Innovate to eliminate TB

Description: 

Despite impressive gains on Tuberculosis (TB), it's take the live of nearly 2 millions people each year. On the European continent the spread of drug-resistant forms of TB represent a serious threath. New and innovative approaches, including a quick test for TB, more effective drugs and vaccine, are needed urgently. Learn about recent progress and actions needed from speakers Dr Jorge Sampaio, UN special envoy to stop TB; Mr John Bowis, former MEP; Mr Philippe Douste-Blazy, UNITAID chair executive board; Mr Tido von Schoen-Angerer, Executive director of the access to essential medicines campaign, Medecins Sans Frontières; Mr Peter Gondrie, Director of KNCV Tuberculosis Foundation; Mr Dima Sherembey, All-Ukrainian network of PLWH.

Time to walk the TB/HIV talk

Guardian (UK)

World TB Day 2009 Media Call Transcript

ACTION, 24 March 2009

Operator:  Good day and welcome to the World TB Day media call.  This call is being recorded.   At this time, I would like to turn the call over to Joanne Carter; please go ahead.   Joanne Carter:  Thanks very much, operator and thanks to everyone for taking the time to join us today on this important call on World TB Day and thanks for your patience.  We’re starting a few minutes late. Today’s call is jointly sponsored by the ACTION Project, which is a global TB advocacy project and by the Infectious Diseases Center for Global Health Policy and Advocacy.   My name is Joanne Carter and I’m the executive director of RESULTS Educational Fund in Washington, D.C. and we’re the secretariat for the ACTION project and I’ll be moderating this call.   On today’s call, several experts and activists will be discussing two important reports that were just released today.  First, the World Health Organization’s annual TB control report which has important new data showing that the number of people co-infected with HIV/AIDS and TB is essentially double last year’s estimate.  And a report issued by the ACTION project called “Living with HIV, Dying of TB,” which shows that major HIV/AIDS donors are doing far too little to address the shocking gap of TB-HIV integrated services.   Just to give you a sense of how severe that gap is, the WHO also estimates that only 2 percent of all people living with HIV are being screened for TB.  This is also double last year’s estimate.  But rather than being good news and an indicator of how far we’ve come, I’d argue that this is a measure of how far we still have to go to tackle this co-epidemic.   One logistical note before we begin, due to a previous speaking engagement at the Stop TB Partners Forum in Brazil, our first speaker, Dr. Dick Chiassen will need to leave our call earlier, so he won’t be able to stay through the whole call.  So just to accommodate any questions the media may have for him, we’re going to have Dick speak first, take a few brief questions, then go back to the rest of our speakers and additional questions.   So just to start, Dick Chiassen is the director of Johns Hopkins Center for Tuberculosis Research.  And he’s also director of the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE).  And he’s also a member of the International Disease Society of America’s Global Infectious Disease Scientific Advisory Committee.   So Dick, thanks for joining us from Rio.  And please, go ahead to give us just some opening perspective especially on the WHO’s report released today.   Dick Chiassen:  So good afternoon everybody and thank you.  I’m speaking to you on a cell phone on a table top in a room that now does have power.  And the conference here in Brazil, the Stop TB Partnership meeting is hopelessly behind schedule, so I’m not as crushed for time as originally thought.  But I do want to take a few moments to talk about the new report from the World Health Organization on the burden of HIV-related TB.   It’s been clear for a number of years now that the impact of the HIV epidemic on tuberculosis has been staggering.  And if you look at the burden of TB in Africa in particular there has been more than a tripling of TB rates in Africa over the last 15 or so years as the HIV epidemic has grown there.  HIV is the most important risk factor for tuberculosis in the world.  It increases the risk of TB dramatically in people who are co-infected.  Those of us who have been working on the ground in Africa have seen this extraordinary burden clinically but the surveillance mechanisms that the World Health Organization relies on have not adequately captured just how important HIV related TB is in Africa until the last year. Due to some improvements in surveillance methodologies in Africa, we have new data showing that the prevalence of HIV related TB is essentially twice as high as previously thought by the mechanisms used by the WHO to estimate the TB burden.  And importantly, the number of deaths related to tuberculosis and HIV are double what they were previously thought to be.   So due to this improved surveillance we now have very good and certainly much better than before data showing the incredible impact of the HIV epidemic on tuberculosis and particularly the impact on tuberculosis-related deaths in the world.  And in this new report showing the increased burden of HIV related TB showing that while HIV is associated with about 15 percent of the global burden of tuberculosis much higher than that in Africa, but globally it accounts for 15 percent of tuberculosis in the world.  It accounts for a quarter of the deaths from tuberculosis.  And tuberculosis is the most common cause of death in people with HIV.  If we look at the African continent, AIDS is the leading cause of death in Africa for all causes and people dying in Africa with AIDS are dying of tuberculosis.   So all of this underscores the importance of HIV-related TB and the importance of trying to combat it.  And I’ll just briefly say that there are three strategies that need to be pursued to control HIV-related TB and they involve finding the TB that is there, treating it, once it’s found and then preventing TB in people who don’t have it.   In terms of finding TB, the diagnostic tests that are available in most of Africa are hopelessly antiquated and incredibly insensitive.  And so finding new technology to more quickly and reliably diagnose TB is a very important strategy.  There’s a very high prevalence of undiagnosed tuberculosis in people with HIV in Africa.   In terms of treating tuberculosis we have good treatment for tuberculosis currently but it’s more than 50 years old and we need to have better treatment.  Treatment that will cure tuberculosis more quickly, that will cure multidrug-resistant tuberculosis which is increasingly common including in people with HIV in Africa and that will be faced to administer with antiretroviral drugs.  We have the paradox now of people surviving their HIV because of antiretroviral drugs, then dying of tuberculosis because of inadequate treatment.   And then finally, with prevention of tuberculosis we have very good effective inexpensive preventive therapy for tuberculosis but it’s not being used.  The World Health Organization report estimates that fewer than 2 percent of HIV infected patients around the world who should be getting TB preventive therapy are actually receiving it.  It’s really disgraceful.   And then controlling the spread of tuberculosis in HIV clinics, controlling the spread of tuberculosis in hospitals and in the community is another important strategy.  And all of that leads us to the need to invest more in tuberculosis control.  Currently major global donors who are supporting HIV efforts such as PEPFAR and the Global Fund are not supporting HIV-related TB interventions to the extent that is required.  And I’ll end with that.   Joanne Carter:  Thanks very much, Dick.  Just to get a sense of your time, should we go ahead and take some questions from journalists now because you will need to step out? Dick Chiassen:  Well, that would be fine by me.  That would be great.   Joanne Carter:  OK.  Why don’t we go ahead, then, operator.  Can you just tell folks how they can go ahead and ask some questions? Operator:  Of course, thank you.  Today’s question-and-answer session will be conducted electronically.  If you would like to ask a question, you may do so by pressing the star key followed by the digit 1 on your touch-tone phone.  We will proceed in the order that you signal and take as many questions as time permits.  If you’re joining us on a speakerphone, please make sure your mute function is off to allow your signal to reach our equipment.  Again, that is star 1 if you have a question.   And we will take our first question from David Brown with the Washington Post.   David Brown:  Yes, hi.  Thanks.  Dr. Chiassen, can you say how – what the life expectancy is for an HIV patient with a given stage of disease, given CD-4 count, let’s say, with and without tuberculosis so we have some sense of how life – how longevity is shortened by co-infection with TB? Dick Chiassen:  Well, the – I guess the key issue is when the tuberculosis develops.  People with HIV are increasingly susceptible to TB the more immuno-compromised they become as their CD-4 counts fall.  But we know that the risk of tuberculosis essentially doubles the second someone is infected with HIV.  So HIV immediately confers an increased risk of TB and then it keeps growing as their CD-4 count falls.   Once tuberculosis occurs, once someone becomes sick with TB, which can occur at any time during the course of HIV infection, then without treatment the likelihood of death is essentially 100 percent within 6 months.  With treatment, we can cure TB as long as it’s not drug-resistant TB.  The problem in Africa is that far too many people who have TB aren’t being diagnosed and they’re not being treated and so they die and they die quickly.  So I can’t answer your question with a round number for any given CD-4 count.  What I can tell you is that the risk of TB is high with HIV and it gets higher and higher the more immuno-compromised the patient becomes.  And once it occurs it’s uniformly fatal without treatments in very few months.   David Brown:  OK.  Thanks.   Operator:  And as a reminder, it is star 1 if you would like to ask a question.  And at this time, there are no other questions.   Joanne Carter:  Thanks very much, operator.  And I would say Dr. Chiassen, if you can stick around, that would be great.  I understand if you need to leave.  Let’s then move on to our next speaker.  And next we’re going to hear from Paul Jensen who is the Global Research Coordinator for RESULTS Education Fund and the TB Action Project who will give us a summary of the findings of the report that Action released today Living with HIV, Dying of TB, A Critique of the Response of Global AIDS Donors to the Co-Epidemic.  And Paul oversaw the development of this report.  So Paul, please go ahead.   Paul Jensen:  Thanks, Joanne.  So I’ll start by briefly describing the context in which we conducted the research and then I’ll describe what we analyzed and what we found.   So first, the context, starting in the last 1980s research began showing that TB and HIV interacted in a deadly way at the level of the patients.  And then throughout the 1990s it became evident that at the population level, HIV was driving a resurgence of the TB epidemic especially in sub-Saharan Africa.   In 2002, WHO issued recommendations calling for an integrated response to TB and HIV.  These were revised in 2004.  And since then they’ve provided clear guidance on how to integrate the response to TB and HIV.  And they made it clear that an HIV program that does not include TB interventions where the disease burden demands it is not properly conceived.   And that meanwhile, over the years, the number of high profile people like Nelson Mandela and Archbishop Desmond Tutu have made public pronouncements that at times at HIV/AIDS international conferences urging that TB be addressed in people living with HIV.   And then, lastly, the WHO has provided TB-HIV costs estimates or funding that’s needed annually to reduce TB deaths among people with HIV by 80 perecnt by 2015.  And that figure totals $19 billion over the next 7 years which includes ARVs.  But when you look at just what’s required for TB-HIV intervention specifically $615 million was needed in 2009.  But it’s important to keep in mind that these calculations were done before these new surveillance data came out so they’re likely to undershoot the actual costs by a considerable measure, but these are the cost estimates that we have to go on. So all of this is to say that the newest data coming out today while they’re alarming, they shouldn’t cause any epiphanies among those administering AIDS programs.  And with that as a context, and doing this research we asked a pretty simple question, to what extent has the world’s largest supporters of global AIDS efforts addressed TB, given TB is the disease most likely to kill people being served by these programs.  And how is this reflected in policy and funding and programming?  And in the sets of activities or outputs that they monitor and evaluate in order to measure their effectiveness on the ground? And we focus on four institutions, the President’s Emergency Plan for AIDS Relief in the U.S.; the World Bank’s Africa Multi Country AIDS Program; the Global Fund to Fight AIDS, TB and Malaria; and the Support for HIV that’s provided by the U.K. government’s Department for International Development.  And we chose these donors because they provide substantial resources that in many ways that are key to driving the global AIDS agenda.  Then lastly all of them are formally, rather, declared a commitment to integrate their HIV/AIDS programming with that for TB.   So with that I’ll take you through some of the key findings that are fleshed out in more detail within the report, but in broad strokes, we found the following.  Resources are insufficient.  It’s actually impossible to even say what the four institutions collectively are providing because some don’t even disaggregate their funding data for TB-HIV.  But where we could measure resource levels, however, we found that they were modest.   In terms of policies, they vary considerably from clear and ambitious to incoherent or sometimes non-existent.  Within individual AIDS programs or projects TB-HIV activities when they do occur are typically small in scale and narrow in scope.  And monitoring and evaluation of activities when it does occur is sporadic and often voluntary and does has not allowed any of the institutions to tally program by program or country by country what it’s doing for TB-HIV and to what outcome in any sort of comprehensive way.   So now I’ll briefly go through the institutions individually and I’ll touch on key findings.  First, PEPFAR, the U.S. global AIDS initiative.  It provided $18 billion for HIV/AIDS over the last 5 years concentrated mostly in 15 focus countries, 12 of which are in sub-Saharan Africa.  And PEPFAR has pretty clear and ambitious TB-HIV policies.  In fact, TB-HIV is categorized as a quote “priority program area” and individual country teams are urged to scale up TB-HIV activities.   What we found though is that funding and programming are both insufficient when you consider the disease burden.  Any initiatives and its own stated goal which aims to ensure that all people with HIV are screened for TB.  And that all TB patients are provided HIV counseling and testing.  And PEPFAR itself describes the scale-up of TB-HIV activities as slow.  They also identified broad gaps.   And we analyzed PEPFAR’s country operational plans they are broad planning documents for 12 of the focus countries that are in sub-Saharan Africa.  And just to clarify these are broad planning documents and they don’t get into the nitty gritty of every activity but they’re the most detailed accounts of programming that PEPFAR makes available publicly.  And in the absence of more concrete data they provided a pretty decent proxy for what they’re doing on the ground.   And the plans list out projects in their project components.  And so we just went through and we counted how many project components included at least one TB-HIV activity.  And because they’re broad documents we didn’t try to analyze the scope or type of the individual projects, just if they included at least one TB-HIV activity.  And we found that over the past 5 years the number and percent of these project components increased from 4 percent in 2004 to 23 percent in 2008.  And this suggests progress but modest progress with less than a quarter of project components planning to address TB-HIV in any way.   And next, the World Bank’s Africa Multi Country AIDS program or the Africa MAP.  And this was launched in 2000 and has committed since then over $1.6 billion to support HIV/AIDS programs in Africa.  TB-HIV efforts within that program are largely incoherent and poorly tracked.  There’s no TB-HIV policy strategy or monitoring and evaluation framework in place to guide TB-HIV activities.   In 2007, the Bank issued a new agenda for action for HIV/AIDS in the Africa region which we were consulted on while it was being developed.  And it includes a statement of commitment to integrate HIV/AIDS and TB efforts.  But the MAP doesn’t actually have a strategy for doing this.  And while MAP resources can be used for TB-HIV it’s impossible to tell from the public documents how much funding, if any, is provided on a project by project basis because the budget information doesn’t disaggregate funding of TB – for TB-HIV, rather.   The MAP also does not require its projects to monitor and evaluate TB-HIV activities or even activities to address opportunistic infections generally.  And for this reason, it’s impossible to tell the extent the effectiveness of TB-HIV activities that it’s contributing towards.  And this isn’t to say that they’re not doing anything.  We analyzed the project documents for MAP in seven countries with high burdens of TB and HIV/AIDS.   And in the early phases of these projects going back to 2000 we found that only three of the seven, Ethiopia, Burundi and Rwanda included any planned TB-HIV activities.  And five of those have since moved on in to their second phase and of those five, only two of them -- Ethiopia and Kenya -- include any plans for TB-HIV activities.  So again it’s impossible to determine the level of resources being provided in these cases.  And none of the projects address TB-HIV in a more comprehensive way in their second phase, than they did in their first phase.  And this is in spite of the fact that new international guidance provided by WHO and the bank’s new agenda for action were issued in the meantime.   And they are also two internal evaluations of the MAP project and the reports include almost no references to TB-HIV.  So with the information that they make public it’s pretty hard to assess what they’re doing, let alone to what outcome.   And then lastly the Global Fund to Fight AIDS, Tuberculosis and Malaria which was established in 2002 and has approved over $15.1 billion in grant funding since then, it’s the largest external funding of TB programs. It provides roughly a quarter of international support for HIV/AIDS.  Being largely country-driven the Global Fund relies heavily on grantees and agencies providing them technical assistance.  So include TB-HIV activities in both their grants, in their TB grants and in their AIDS grants.  So to a large extent they’re country-driven and then informed by technical guidance.   The guidance coming from the Global Fund secretariat however, sends grantees a pretty weak signal that they need to include TB-HIV.  On the grant application forum that grantees submit to the fund, in fact, the only guidance that recommends TB-HIV activity is included as a footnote.   So we analyzed grant proposals for nine countries in sub-Saharan Africa that together accounted for more than half of all TB-HIV cases in 2006.  And we found that of these nine only $6.8 million was budgeted for TB-HIV in 2008.  And in some cases, proposals planned to carry out activities but then didn’t include any sort of budget line to fund them.   Recently, however, the Global Fund’s board adopted a new policy on TB HIV that calls for projects entering their second phase to include robust and measurable activities in TB-HIV and this showed serious commitment and if implemented properly could address this problem head on.   So I’ll end there with our main findings and I’ll end with just a question that was raised in our research and that’s you know while HIV programs have been rapidly expanding and expanding access to treatment and testing and it’s pretty clear that they haven’t taken the steps needed to address TB-HIV including the infection control measures that are needed to prevent it from spreading in clinical settings, the question arises as to the extent to which these settings where people with weak immune systems are congregating to receive treatment for HIV are actually facilitating the spread of TB which is airborne among people who are immuno-compromised and something that I think Dick touched on and I’ll end with that.   Joanne Carter:  Thanks very much, Paul.  Now, I’d like to ask Dr. Carol Dukes Hamilton to make some remarks on these issues.  Carol is co-chair of the Infectious Diseases Center for Global Health Policy and Advocacy and also a professor of medicine at Duke University.  And Dr. Hamilton has also served as the North Carolina TB Control Medical Director so thanks for being with us and please go ahead.   Carol Hamilton:  Thank you, Joanne and thank you all for joining the call.  Most of what I have to say has already been said in some form, but just to remind you that TB is a contagious lung disease that has been well known and recognized since the 19^th Century, this is not a new disease. And since the 1960s, we’ve had drugs available to cure nearly every case of TB, if the drugs are properly taken.  But now, in 2009 instead of declaring this disease conquered, you’ll be reporting that there were even more cases in 2007 than in 2006, 9.3 million new cases, up from 8.3 million cases in 2000 and 6.6 million in 1990.  And furthermore, the drugs used to treat TB, which have been around since the late 1950s, are getting relatively weaker and weaker against a bacteria that’s basically figuring out how to evade the TB drugs.  So our focus is really on TB-HIV and should be. Another aspect of this that just bears some reminding, 4 years ago colleagues in Tugela Ferry, South Africa made a really alarming discovery.  An extensively drug-resistant strain of TB, so called XDR-TB, unbeknownst to anyone had widely circulated in their rural community in South Africa.  XDR-TB is nearly untreatable with our current arsenal of TB drugs.  XDR-TB had found its way into the TB-HIV co-infected population there in Tugela Ferry and 52 of the 53 people identified with XDR-TB and HIV/AIDS died within 2 weeks of their diagnosis.  They had just started their lifesaving HIV medications, but as has been mentioned before, they died of TB before the HIV drugs could really take effect. So those of us who work in this field are really not shocked to see the estimates of TB-HIV deaths rise as Dr. Chiassen said, the currently used TB diagnostics do not pick up TB very well, especially when used in populations that have HIV infection, and this is a really important area that needs further resources. So add to the diagnostics problem the fact that these drug-resistant TB bacteria are uniquely able to exploit the weakest individuals and the weakest healthcare systems where it can flourish and spread and you’ll see why we’re quite alarmed at the foothold this potentially untreatable form of TB is gaining in China, India, the former Soviet Union and South Africa. So, in addition to the devastation that TB causes among people with HIV/AIDS, its powerful enough to kill even the most able-bodied.  Nearly 1.3 million deaths from TB are among HIV negative men, women and children.  So furthermore, TB can pass easily between people with and without HIV infections, so in countries where TB and HIV/AIDS are prevalent and co-exist it is really an escalating situation and that’s exactly what we’re seeing in sub-Saharan Africa. So, what do we need?  We need U.S. leadership, specifically as already – as Paul and others have discussed, we need TB – we need leadership around the HIV-TB programmatic funding as well as TB research.  We need programs to be able to do the kind of research, public health evaluations, et cetera to really understand what we’re doing in the clinics, and as has been mentioned, a really important issue is the lack of serious attention to infection control, meaning we need to put in place strategies to prevent TB from spreading in that population. The second and final issue I’ll mention has to do with research and TB.  We need increases in NIH budgets to specifically address, for example, TB vaccine development and improving TB diagnostics, and the CDC’s division of TB elimination which funds clinical trials will (try) testing new TB drugs and treatment strategies.  So I’ll end there and be happy to take questions when you’re ready. Joanne Carter:  Thanks so much, Dr. Hamilton. And now lastly, but far from least, we’re really thrilled to have Kenyan TB-HIV patient-activist, healthcare worker, and really, global leader on TB and HIV advocacy Lucy Chesire with us to give us a perspective on the – really, on the ground impact of this latest data and this co-epidemic.  Lucy, please go ahead. Lucy Chesire:  OK, hello.  I guess basically what we’re seeing is that when you look at TB-HIV, its actually a major co-infection within the African continent, and TB has actually been recognized as the leading killer of people living with HIV.  And one thing that we have come to see from experience of implementing TB-HIV collaborative activities is that this has been a missed opportunity for years, but thanks to the funding that we are now seeing though global fund and even PEPFAR, whereby it has made it much, much easier for persons living with HIV to get access to TB treatment.   But I know we still have a challenge when it comes to the issue of diagnosing and screening people living with HIV, but now when you look at the co-infection rates, it actually ranges from 60 percent to about 80 percent in areas where co-infection is much, much higher.  And I guess my motivation on this comes from the aspects whereby I survived TB-HIV co-infection and TB also created the door for me to be able to access and to reach vital therapy and out of that, getting to see the difference that it made in my own life means that this is one thing that we need to work together so that we continue mobilizing resources through the Global Fund, though PEPFAR so that countries are better placed to continuing offering the services so that patients can actually benefit. Looking at the screening of all TB patients for HIV, we are getting amazing results whereby over 80 percent based on the Kenyan experience of TB patients have had access to HIV testing, 60 percent have been confirmed to be HIV positive and currently being referred for treatment and one of the things that we are actually working on is to make sure that at the end of the day, all persons living with HIV are actually screened for TB. Now, when you look at the global statistics, it’s pretty a shame because only 2 percent of persons living with HIV are actually being screened for TB and I guess we need to put more effort when we are looking at the collaborative effort so that we put in measures to be able to address infection control, to be able to intensify case finding among persons living with HIV so that if someone is smear positive they can be able to get access to TB screening and get started on treatment because we know the cost effectiveness of insuring that these services are actually there.  And then most importantly is the issue of infection control whereby measures need to be put in place so that at the end of the day persons are not getting TB within the healthcare facilities where they’re actually accessing their antiretroviral therapy. But I just want to say that investing in TB-HIV and insuring that adequate resources are mobilized, both from the North and the South would actually make a difference in insuring that we get all the patients who need the treatment to be on it at the appropriate time. Joanne Carter:  Thanks, thanks, Lucy, thanks very much.  Operator, we’ll now open it up for questions again.  So if you can just give a quick reminder on how folks can ask questions. Operator:  Thank you.  If you would like to ask a question today, it is star 1 on your touchtone phone.  And once again, that is star 1.  And we will go first to Jon Cohen with Science magazine. Jon Cohen:  Hi, if Dr. Chiassen is still there, this might be most appropriate for him.  Do you know – can you explain why the numbers doubled for co-infection?  What the actual surveillance techniques were that led to the doubling? Male:  Dr. Chiassen – excuse me, he’s left the room.  He had to go to another session. Jon Cohen:  He did leave. Male:  But I’ve got his aides, Claudia’s mobile number here, so we can get that to you so you can connect with him a bit later. Jon Cohen:  Or if anyone else can answer …  Lucy Chesire :  Let me just answer that, if you allow me.  I think when you’re looking at the numbers that doubled, what we are basically seeing is that it became much more accessible for TB patients to be able to accept what we call diagnostic testing and counseling within the healthcare facility which was being rolled out in most of the TB clinics and this has resulted in many patients, getting the testing onsite, despite in the past where by we were losing out on a lot of referrals cases when a patient had to be referred to the voluntary counseling and testing site.  So when the services became readily available, at the TB clinic, it made a big difference and many more patients were able to get to know their HIV status and many of them were actually enrolled on pre-ART care. Paul Jensen:  And then I would just add to that – this is Paul, that in a general sense its maybe because of improved data collection and better participation from countries reporting what they’re collecting, but we can put you in touch with WHO to get a more precise answer. Operator:  And we’ll take our next question from Benjamin Case with Interpress Service. Benjamin Case:  Hi, this question is for Dr. Hamilton.  Just curious, what have been the funding patterns for TB related research and prevention in the U.S. in the past few years and what can we anticipate from the new administration during the economic crisis. Carol Hamilton:  Yes, that’s a very good question and the funding in particular to the CDC, which is where the programs out in the states get their money, has been going down.  Its been going down from 5 to 10 percent and programs have had to cut back on training and education, opening new clinics, et cetera.  So the money has been going down from the CDC for programs. In addition, for TB research, and many people don’t really recognize that the CDC’s TB elimination group is actually the one that is slated to perform any TB clinical trials kind of work, which is different than you know usually we think of the NIH as doing clinical trials work, which they do for HIV/AIDS for example and cancer drugs.  But the CDC does that, performs that function for TB drugs and the TB trials consortium for example and the TB epidemiologic consortium which do important work in the U.S., their budgets have also slowly declined over the last 5 to 7 years. And – did that answer your question? Benjamin Case:  Yes, yes it does.  Thank you. Operator:  And we will take our next question from Brenda Wilson with National Public Radio. Brenda Wilson:  Thank you.  I just want to be clear, when the World Health Organization says that 33 percent of the 9.3 million people who are infected with HIV are co-infected, and only 2 percent of HIV positive people have been screened, is there another estimate or how realistic is that then.  Or am I misunderstanding something? Male:  We’re having trouble hearing on this end in Brazil. Brenda Wilson:  OK, I’ll try asking – I’ll try speaking up louder.  If I understood correctly, WHO says 33 percent of the people with tuberculosis are also infected with HIV and you’re saying that 2 percent of the people with HIV have been screened, so does that 33 percent – is that an estimate which takes into consideration more than the 2 percent who have been screened? Carol Hamilton:  This is Carol Hamilton; let me try to address that.  I think the way you should look at that is out there in the community when we have – in the world when you have somebody who comes in and you recognize that they have tuberculosis, the recommendation is that every patient with TB should be screened for HIV because there’s such a tight connection between the two. But worldwide, the number that really – the number of TB patients that are screened for HIV is only 2 percent.  OK?   Now, of those who are screened, TB patients who are screened for HIV, 33 percent are found to have HIV infections.  Do others agree that that’s the way those numbers go? Male:  Hi, this is … Lucy Chesire:  No, I don’t agree.  I think it’s the other way around where we are saying that 2 percent of persons living with HIV are actually being screened for TB.  And the data from WHO shows that 37 percent of TB patients are actually getting involved on anti retroviral therapy.  But when it goes to the number of patients who are actually being screened, – the number of TB patients being screened for HIV, the numbers vary from – one country to the other.  But on average it’s about 40 to 60 percent globally. Paul Jensen:  Hi, this is Paul, just to hopefully clarify a little bit.  Brenda, that 33 percent refers to the number of people with HIV who have TB infection.  And there are two stages, you could say; one is the latent infection of TB and then the progression of that to actual infectious disease.  And so that one third, that 33 percent refers to the number of people with HIV worldwide estimated will also have a latent TB infection. The 2 percent refers to people who have actually been physically screened and reported to have been screened, and that’s 2 percent of people with HIV who have been reported to be screened for TB disease, not TB infection but TB disease. Brenda Wilson:  OK, thank you. Operator:  And as a reminder if you would like to ask a question today, it is star 1 on your touchtone phone.  And we will take a follow up question from David Brown from the Washington Post. David Brown:  Yes, thanks.  Is the screening for TB a chest x-ray?  Because presumably it’s not a skin test and are there any other screens for – or is it a sputum test or what is it? Paul Jensen:  Yes, it – it would – the screening would entail a sputum test, typically.  And then, from there, a chest x-ray.  It’s also important to keep in mind, it’s a little bit difficult in people with HIV to screen using the sputum test because they often don’t actually produce bacteria in the sputum itself.  A lot of times the TB has disseminated past the lungs and is in another part of the body that doesn’t produce sputum.  But that would be the standard test, the sputum smear test followed by a chest x-ray. Joanne Carter:  And … David Brown:  OK, well– can I just follow up?  The implication when you all say that only 2 percent of people with HIV are being screened for TB is that you know this is an outrage and screening can be done easily and it actually tells you something.  So can you – can you sort of expand on that?  Can it be done easily?  And is it a good way of diagnosing TB?  It sounds like it’s hard to do and it gives you a misleading answer lots of times. Joanne Carter:  I don’t know, Dr. Hamilton, if you want to take that … Carol Hamilton:  Sure. Joanne Carter:  Or we can make some comments here as well. Carol Hamilton:  Sure, I think you raise a really good point.  It is difficult because these diagnostic tests that we have are so insensitive, so you’re raising a very good point.  Nevertheless, if you are able to see the bacteria under the microscope, that does indicate a higher level of infectivity.  So it is helpful.  But even better would be if we had better diagnostics deployed out in these clinics.   So that in fact, you could do sputum and not only just the test where you look under the microscope, but also for culture you know that would be ideal, because we know we have a couple – at least two different studies that have been done in the last year that show that even in patients who have fairly subtle symptoms, HIV patients who have fairly subtle, if no, symptoms, if you actually take their sputum and culture it anywhere from 10 to 25 percent in these high burden countries will be culture-positive for TB.  So we need better diagnostics. Joanne Carter:  And this is Joanne Carter, and I think the only thing that I would add is that I think your questions a really good one and it absolutely points to the need for better diagnostics, especially point of care kind of diagnostics, but that because there is you know the sputum microscopy that is available and even ways to improve that because there is actually a clinical algorithm for diagnosing this, it is more to say that the – it’s not an excuse for inaction.   So we need better diagnostics, but we actually need to sort of maximize the use of the existing tools that we have, which can certainly you know save the majority of lives of people and that that’s – I think part of the outrage is that we’ve known this for a long time and this isn’t happening and you know frankly the resources and the urgency around having the diagnostics you know in the pipeline and ready to be out in the field are also not happening, but just that we can’t use it as an excuse for inaction. David Brown:  Can I ask one more follow up? Joanne Carter:  Of course. David Brown:  If someone is PPD positive and has latent you know TB, latent infection with TB and then they become infected with HIV, do 100 percent of them go on to develop active TB? Carol Hamilton:  If you’re assuming that this HIV infected person or population never gets HIV drugs, never gets antiretrovirals.  The estimate is that 10 percent of that group, their likelihood of going from latent TB infection to disease is 10 percent annually.  So in theory, if they have and lived with HIV for 10 years, the answer would be yes.  In fact, what happens, hopefully is that they get – there’s an intervention with antiretrovirals, but if not, then it is – you know I don’t know that anyone can say it’s 100 percent, but you know if you do the math, 10 percent per year it’s very high. David Brown:  OK, and but if they get anti retroviral treatment and no TB treatment they still go on to die of TB, isn’t that what Dr. Chiassen was saying? Carol Hamilton:  Well, if you start – if they have only latent TB infection and they’ve not progressed on to active disease and they get started on anti retrovirals, their CD4 counts go up and you’ve gotten them before they progress to disease, then no, not necessarily.  So we still would like to give those people preventive therapy, but a the CD4 count goes higher and higher, then they kind of move out of that extremely high risk phase, if you see what I mean.  If they stayed down in that low CD4 count area then they are at extremely high risk.  With anti retrovirals their risk becomes somewhat lower, but it is true that we try to give them isoniazid and preventive therapy to – even while we’re giving them anti retrovirals. David Brown:  OK, thanks. Joanne Carter:  And it is worth noting – back to the point Dr. Hamilton made earlier about the case in Tugela Ferry, that you know again, I think the thing that was very worrisome to folks was the spread of that XDR-TB, but the fact that it actually happened in part and was initiated in part in an antiretroviral support group.  So it was folks that actually were on ARVs so to that point of it certainly doesn’t – it reduces risk but it certainly doesn’t eliminate it. David Brown:  OK, thanks. Operator:  Follow up question from Benjamin Case with Inter Press Service. Benjamin Case:  Hi, again.  Sorry, this is just following up first of all on my previous question, I neglected to press a little further about what we can expect from the new administration now, or what we can predict from the new administration about TB funding for the CDC or if there’s any basis on which to make that determination right now. Joanne Carter:  I don’t know, Dr. Hamilton, if you have a better sense.  I don’t think – I mean I think we’re all awaiting to see the details on this.  I mean, I think its – I think we’re hopeful that there would be increased investments and there certainly ought to be and worried about whether you know they would be – any of these would be a consequence of the – of some of the budget cuts that are going to need to happen. Carol Hamilton:  What – and what I do know is that in the recent stimulus package that was announced, the CDC is getting very little money and the money they’re getting, none of it is going to the TB program at all.  In terms of the NIH budget, the NIH budget has gone up significantly and there’s not – there’s not too much in there that is too much – specifically addresses TB research issues, but there is some.  So that’s why I know thus far.  Now … Joanne Carter:  Yes, sorry, go ahead. Carol Hamilton:  I was just going to say, the second issue has to do with PEPFAR funding and a big issue is concern about whether or not the administration is going to continue to not only – to fund PEPFAR at an increasing level, which is what’s needed to both support people already on anti retrovirals as well as expand program as needed.  So you guys can probably respond more to that. Joanne Carter:  No I th

Global Fund Media Call Transcript

RESULTS USA, 29 January 2009

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