In a 200th anniversary article for the New England Journal of Medicine, Salmaan Keshavjee of the Department of Global Health and Social Medicine at Harvard Medical School and Paul Farmer of Partners in Health “seek to elucidate the reasons for the anemic response to drug-resistant tuberculosis [TB] by examining the recent history of tuberculosis policy,” they write. The authors outline the history of TB drug development and how the disease became resistant to myriad drugs, and write that by the 1970s, “[t]uberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written. They continue, “In the United States, federal funding for tuberculosis research was cut; consequently, drug discovery, development of diagnostics, and vaccine research ground almost to a halt.”
Quality of Care
“Kenya has launched an investigation after researchers claimed HIV-positive women were being routinely sterilized without their consent in government hospitals,” the Guardian reports. The African Gender and Media Initiative issued a report “based on interviews with 40 women, suggest[ing] the practice was widespread and ongoing,” according to the newspaper. “The report also includes examples of coercive tactics used by medical staff to obtain consent — for instance, threatening to withhold antiretroviral medication or baby milk if the woman did not agree to the procedure,” the newspaper writes. “‘These allegations are very serious and the Kenya Medical Practitioners and Dentists Board is going to investigate them before appropriate action is taken,’ Shariff Shahnaz, the director of public health, told the Daily Nation newspaper,” the Guardian reports (Mojtehedzadeh, 9/4).
Approximately one-third of children under the age of five in southern Afghanistan, about one million, have acute malnutrition, “with a level of deprivation similar to that found in famine zones, a government survey has found, despite the hundreds of millions of dollars in foreign aid that has been poured into the region,” the Guardian reports. The U.N.-supported “Afghanistan Multiple Indicator Cluster Survey (MICS) found 29.5 percent of children are suffering from acute malnutrition there,” the newspaper states, noting that a level of more than 30 percent is one indicator of famine, as are death rates and families’ access to food.
“Despite pledges from governments across Eastern Europe and Central Asia to fight HIV/AIDS — one of the eight Millennium Development Goals — the region has the world’s fastest-growing HIV epidemic,” Inter Press Service reports in an article examining challenges to stemming the spread of the disease, particularly among injection drug users. “Punitive drug policies, discrimination and problems with access to medicines and important therapy are all driving an epidemic which is unlikely to be contained, world experts say, until governments in countries with the worst problems change key policies and approaches to the disease,” the news service writes. According to experts and activists, a lack of opiate-substitution therapy (OST) and needle-exchange programs, as well as discrimination against and “active persecution” of drug users who try to access therapy programs, contributes to the spread of HIV, IPS notes (Stracansky, 9/3).
“More than 4,000 delegates — including government officials, health experts, community leaders, scientists, indigenous populations, youth and people living with HIV — convened from 28-31 August in Sao Paulo, Brazil, for the 6th Latin American and Caribbean Forum on HIV/AIDS and Sexually Transmitted Infections (STIs),” UNAIDS reports in a feature story. “[T]he forum provided an opportunity to take stock of progress, challenges and lessons learned in HIV responses across the region,” according to UNAIDS, which adds, “Participants engaged on a range of issues, from AIDS financing and new HIV prevention technologies to strategies for closing treatment access gaps.” The article expands on several of these issues (8/31).
In a study published on Wednesday in the Lancet, researchers from the Centers for Disease Control and Prevention found that “[a]mong 1,278 patients who were resistant to two or more first-line tuberculosis drugs in Estonia, Latvia, Peru, Philippines, Russia, South Africa, South Korea and Thailand, 43.7 percent showed resistance to at least one second-line drug,” which “suggest[s] the deadly disease may become ‘virtually untreatable,'” according to the study, Bloomberg Businessweek reports (Kitamura/Narayan, 8/29). “In about a fifth of cases, they found resistance to at least one second-line injectable [versus oral] drug,” according to Reuters, which states “[t]his ranged from two percent in the Philippines to 47 percent in Latvia.” Overall, 6.7 percent of patients had extensively drug-resistant TB (XDR-TB), meaning patients are resistant to the first-line drugs isoniazid and rifampicin as well as drugs in the fluoroquinolone antibiotic class and a second-line injectable antibiotic, Reuters adds, noting “[r]ates in South Korea, at 15.2 percent, and Russia at 11.3 percent, were more than twice the WHO’s global estimate of 5.4 percent at that time” (Kelland, 8/30).
Though many pregnant women are aware that treatment could save their lives and the lives of their infants if they test HIV-positive during prenatal care, a new study and literature review have found that a “[f]ear of being stigmatized as an AIDS patient is still a major barrier to good medical care for pregnant young women in many countries,” the New York Times reports. The study, published last week in PLoS Medicine, was “based on a survey of 1,777 women in rural Nyanza Province in Kenya,” according to the newspaper, which adds, “Only 44 percent of mothers in the province delivered in clinics, and the study found that a major obstacle was that they feared HIV tests.” The study’s author, Janet Turan, a professor of public health at the University of Alabama at Birmingham, in July also published “a review of multiple studies in many countries” that documented multiple accounts of “stigmatizing behavior,” the newspaper notes (McNeil, 8/27).
“Counterfeit medications are a serious and sometimes deadly problem in developing countries,” but “two teams of U.S.-based scientists have developed quick tests can identify counterfeit drugs before they can cause harm,” VOA News reports. Toni Barstis, a chemist at Saint Mary’s College in Indiana, and a team of researchers “presented the new testing methods this week at the annual meeting of the American Chemical Society in Philadelphia,” the news service writes, noting, “Scientists hope their efforts can help prevent the thousands of deaths caused by fake medicines every year.”
Study Finds 'Inconclusive' Evidence To Support Use Of WHO-Backed Drug To Prevent Hemorrhage During Labor
According to a study published Monday in the Journal of the Royal Society of Medicine, “[t]he World Health Organization [WHO] should review its approval of a drug used to prevent life-threatening bleeding in women in childbirth because there is not enough evidence that it is effective,” Reuters reports. The study finds that “the evidence to support the use of misoprostol is ‘at best inconclusive,’ yet it is increasingly used in poorer countries to prevent postpartum hemorrhage (PPH),” the news service writes, noting “researchers analyzed 172 previous studies on the use of misoprostol during labor and found that only six had enough information to say whether or not the drug was effective in preventing PPH in rural and community settings in poor countries” (Kelland, 8/20).
“Ethiopia is preparing for a flood of medical doctors within ‘three to four years,’ an influx meant to save a public health system that has been losing doctors and specialists to internal and external migration,” IRIN reports. “‘We are now implementing strategies that intend to increase the current below-World Health Organization [WHO] standard number of medical doctors and retaining them in public hospitals,’ Tedros Adhanom, Ethiopia’s minister of health, told IRIN,” the news service writes. “‘We have now reached an enrollment rate of more than 3,100,’ [Adhanom] said,” adding, “The rate of enrollment in the country’s medical schools has increased tenfold from 2005, when it was below 300,” according to the news service.