In recognition of World AIDS Day on December 1, the Atlantic features a collection of new and previous stories related to HIV/AIDS, titled “AIDS Around the World: Prevention, Treatment and Beyond.” The section, sponsored by Chevron, features a story on HIV in China, an outlook on HIV treatment, and a GIF showing annual adult HIV prevalence worldwide (11/30).
BBC News examines “a worrying drop in the effectiveness of the artemisinin-based drugs” against malaria along the Cambodian-Thai border, and how clinics are attempting to combat the trend by offering monetary incentives to patients to complete treatment regimens. “Thanks to the efforts of health workers … , and the widespread availability of treatment, malaria still only kills a handful of people in Thailand each year,” according to the BBC. “The focus now is on trying to monitor and contain artemisinin drug resistance into a few hotspots, prolonging the drug’s effective lifespan globally until alternative treatments are available,” the news service writes, adding, “Africa’s hopes of maintaining its progress rests firmly on South East Asia’s efforts.” Fatoumata Nafo-Traore, executive director of Roll Back Malaria and the former health minister of Mali, said if drug-resistant malaria reached Africa, it would be a “massive crisis” because there is not an alternative drug to the usually highly effective artemisinin-based drugs, according to BBC (Fisher, 11/22).
“More than one-quarter of people diagnosed with tuberculosis [TB] at a clinic in India’s largest city of 18 million have a strain that doesn’t respond to the main treatment against the disease, according to preliminary data from a new diagnostic being tested,” the Wall Street Journal reports. The newspaper obtained “preliminary and not peer reviewed” data from TB clinics in Mumbai, and Puneet Dewan with the Bill & Melinda Gates Foundation TB program in India “said the WHO and Indian authorities are taking the data seriously because it appears to confirm other studies in recent years of similarly high rates of multi-drug-resistance, in which patients don’t respond to the two most powerful TB medicines.” According to the newspaper, “The WHO and India currently estimate India has about 100,000 of the 650,000 people in the world with multi-drug-resistance” (Anand/McKay, 11/23).
“This week delegates from about 100 member countries of the World Health Organization are meeting in Buenos Aires with the aim of strengthening defenses against substandard and fraudulent medicines,” Amir Attaran of the University of Ottawa and Roger Bate, a resident scholar at the American Enterprise Institute, write in a New York Times opinion piece. “The meeting is extremely important, but to make progress a number of hurdles will have to be overcome,” they say, noting a paper recently published in the BMJ outlines such challenges. “In Buenos Aires, the delegates first need to agree which medicines are good and which are bad,” the authors say, adding, “[C]ountries need to agree that protecting intellectual property and public health are two different things.” Unless countries define the “difference between honest drug companies that sell accidentally substandard medicines, and organized criminals who sell a deliberately falsified … drug,” then “criminals will continue to slip through loopholes and honest companies, pharmacists and doctors will find themselves prosecuted unjustly,” they write.
According to a new report (.pdf) released by Medecins Sans Frontieres (MSF) at the Union World Conference on Lung Health in Kuala Lumpur, many tuberculosis (TB) programs “under-diagnose, under-treat or completely leave children with TB out, despite the increase in pediatric TB, and rising numbers of children who are infected with drug-resistant forms of TB strains,” PlusNews reports. The report, based on “data collected over three years from over 2,000 children with TB in 13 MSF projects across six countries,” found that diagnosis of children using the most commonly used TB test is inaccurate and pediatric TB drug formulations and treatment guidelines are inadequate, the news service notes. MSF called for the development of new TB tests that do not require sputum samples or laboratory infrastructure and “urged WHO to provide clear guidance to drug manufacturers on needed fixed-dose combinations of first-line drugs to support implementation of the new WHO-recommended dosages,” PlusNews writes (11/16).
The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria on Thursday announced it will “integrate” the Affordable Medicines Facility-malaria (AMFm), implemented in 2010 as a pilot program to provide low-cost artemisinin-based combination therapies (ACTs) in poor and rural areas, “into its existing core system of providing grants to countries to purchase drugs, bed nets and other malaria-control measures,” Nature News Blog reports (Butler, 11/15). “During a transition period in 2013, the lessons learned from the operations and resourcing of Phase 1 of the AMFm, such as manufacturer negotiations and the co-payment mechanism, will be integrated into core Global Fund processes,” a Global Fund press release states.
The Affordable Medicines Facility-malaria began as a pilot program in 2010 to “provide a ‘co-payment’ to the manufacturers of [artemisinin-based combination therapies (ACTs)], thereby allowing commercial wholesalers and private or government health services to purchase the drugs at a fraction of the already low negotiated price,” Kenneth Arrow, a Nobel laureate in economic sciences in 1972 and an emeritus professor of economics at Stanford University, writes in a New York Times opinion piece. The program subsidized ACTs — a newer, more effective malaria treatment — to “sell [them] as cheaply as [less-effective] chloroquine in Africa’s private pharmacies and shops, where half of all patients first seek treatment for malaria-like fevers,” he states. “Strikingly, it has worked,” Arrow writes, noting a recent independent review of the program published in the Lancet.
“Growing resistance to a key anti-malarial drug derived from a shrub used in traditional Chinese medicine is threatening to roll back gains made in combating the disease,” according to experts attending a U.N.-sponsored malaria conference that concluded on Friday in Sydney, Australia, the U.N. News Centre reports. Malaria “therapies based on artemisinin — an extract from the sweet wormwood bush used for centuries in Chinese medicine as a fever cure — were” formulated in combination with other antimalarials to form artemisinin-based combination therapies (ACTs) that the WHO thought would be effective for years, but resistance to the ACTs has begun to appear in some areas, the news service notes. “Specifically, [the Roll Back Malaria Partnership] noted, artemisinin resistance has been detected in Cambodia, Myanmar, Thailand and Vietnam,” the news service writes (11/2). Agence France-Presse examines efforts to fight drug-resistant malaria on the Thai-Myanmar border (Rook, 11/4).
IRIN examines the controversy surrounding the Affordable Medicines Facility-malaria (AMFm), writing, “The argument over the way it operates has reignited ahead of a board meeting of the [Global Fund to Fight AIDS, Tuberculosis and Malaria] on 14-15 November, which is due to assess the success of the project and its reliance on private sector providers.” The news service reports on an evaluation of AMFm published recently in the Lancet and another paper by Oxfam criticizing the facility. The Global Fund Board, which administers AMFm, “is meeting in nine days to decide whether AMF has worked as was intended, and whether it should be continued, scaled up, or abandoned altogether,” IRIN writes (11/5).
“More than 200 health experts have gathered in Sydney for a three-day conference to bolster political commitment to tackle the spread of malaria,” IRIN reports (10/31). “‘Malaria 2012: Saving Lives in the Pacific’ is being co-hosted by [Australian] Foreign Minister Bob Carr and United Nations Special Envoy for Malaria Ray Chambers,” according to an AusAID press release, which adds, “The conference, which is being convened by AusAID, begins on Wednesday with two days of technical and policy discussion, culminating on Friday 2 November with a ministerial action meeting” (10/30). “‘There were 30 million [malaria] cases and 42,000 deaths reported in Asia [in 2010] so we aim to achieve greater regional collaboration and coordinated efforts from this conference,’ Fatoumata Nafo-Traore, executive director of Roll Back Malaria Partnership, told IRIN,” the news service notes (10/31).