PSI’s “Healthy Lives” blog reviews a recent Science magazine article written by James Shelton of USAID’s Bureau of Global Health in which he raises concerns about the use of antiretroviral drugs (ARVs) as a prevention strategy. The blog notes he especially expresses concerns over drug adherence and resistance. “Dr. Shelton does not entirely dismiss the usefulness of ARVs, but seeks to look a bit more critically at how effective they are as a prevention tool,” the blog states, noting that Shelton’s article concludes, “ARVs are no ‘magic bullet.’ But ARVs’ best potential is to contribute to the existing combination arsenal, which, well applied, can have a major impact in stemming the global HIV pandemic” (1/6).
Treatment and Prevention Strategies
“In public comments [.pdf] submitted this week, a group of 14 leading HIV/AIDS and health organizations stated their support for Food and Drug Administration (FDA) approval of emtricitabine/tenofovir disoproxil fumarate [TDF/FTC] … as pre-exposure prophylaxis (PrEP) to prevent HIV infection in adult men and women,” a press release from AVAC: Global Advocacy for HIV Prevention states. “Modeling studies have shown that widespread access to PrEP could reduce new HIV infections, and thus the scale of the global HIV epidemic, substantially around the world,” the press release says, adding, “The FDA’s decision on TDF/FTC as PrEP could help pave the way for global health funders and developing countries to step up their planning for implementation” (5/1).
“The world is falling behind in its pledge to reduce HIV/AIDS infections and improve treatment, especially in sub-Saharan Africa, according to a U.N. report [.pdf] released Monday” by U.N. Secretary-General Ban Ki-moon, the Associated Press reports. The report to the U.N. General Assembly “said that ‘critical challenges remain’ if the world is to make good on promises made at a U.N.-sponsored meeting on HIV/AIDS in June 2011,” the AP writes (Alt Powell, 4/30). “Among the targets set by the international community at the June 2011 high-level meeting are the elimination of new HIV/AIDS infections in children, cutting sexually transmitted infections by 50 percent, and delivering antiretroviral therapy to 15 million people,” Xinhua/China Daily notes (5/1).
Trade officials met last week at the U.N. World Intellectual Property Organization “to make progress on a proposal that would allow poor countries to provide inexpensive generic versions of lifesaving medications, rather than rely a single version of the same drugs under expensive patent monopolies,” but the U.S. “remained steadfast in rejecting proposals aimed at lowering the prices of existing medicines in poor countries,” the Huffington Post reports (Carter, 5/29). At the 18th session of the Standing Committee on the Law of Patents (SCP), delegates considered two proposals, according to Intellectual Property Watch. The news service notes that a South African proposal (.pdf), submitted on behalf of the African Group and the Development Agenda Group (DAG), would have assisted developing nations adapt their patent schemes “to make full use of the flexibilities available in the international patent system in the interest of public health,” and a U.S. proposal (.pdf) “warned against any weakening of patent protection as a solution to the lack of availability of medicine in developing countries” because, “the delegate said, less patent rights would be detrimental to innovation” (Saez, 5/25).
The PBS NewsHour on Friday featured an interview of Anthony Fauci, director of the NIH National Institute of Allergy and Infectious Diseases (NIAID), by Senior Correspondent Ray Suarez, in which they discussed an FDA panel’s recommendation that the antiretroviral Truvada be approved for pre-exposure prophylaxis (PrEP) to prevent HIV among healthy people at risk of contracting the virus. If approved, Truvada “can be potentially very effective” as a prevention modality among specific populations at high risk of contracting HIV, Fauci said, according to the interview. Fauci also discussed the medication’s cost and concerns about adherence to the drug regimen, PBS notes (Suarez, 5/11).
Study Shows Prevalence Of Drug-Resistant HIV Strains In Uganda Rising, Among Highest In Sub-Saharan Africa
“The prevalence of drug-resistant HIV strains in Uganda has risen from 8.6 percent to 12 percent in the last five years, one of the highest rates in sub-Saharan Africa, according to a recent study,” PlusNews reports. “The PharmAccess African Studies to Evaluate Resistance (PASER) monitoring cohort study report for 2008-2012” — “which was based on results from the capital, Kampala, the western town of Fort Portal, and the eastern town of Mbale” — “found that the prevalence of transmitted drug resistance among people who have never taken life-prolonging antiretroviral (ARV) medication was substantially higher in Uganda” than in Kenya, Nigeria, South Africa, Zambia, and Zimbabwe, the news service writes.
Medecins Sans Frontieres (MSF), the largest provider of antiretroviral treatment (ART) in Burma, also known as Myanmar, are calling for the gap between the need for and access to ART in the country to be closed, the Guardian reports. Approximately 240,000 people live with HIV in Burma, and doctors say half are in need of “urgent” ART, but national data estimates less than 30,000 were receiving ART in 2010, the newspaper writes, adding, “In a country where nearly 33 percent of people live below the poverty line, thousands of Burmese are unlikely ever to be able to afford ART, which, according to [MSF], cost $30 a month.”
Estimated 740,000 Deaths In Africa Averted Between 2004-2008 In Association With PEPFAR, Study Shows
“The lives of more than 740,000 people in nine African countries were saved between 2004 and 2008 by the U.S. President’s Emergency Plan for AIDS Relief [PEPFAR],” according to a study conducted by Stanford University School of Medicine researchers and published in the Journal of the American Medical Association (JAMA) on Wednesday, HealthDay News reports (3/15). “The study is the first to show a decline in all-cause mortality related to the program,” a Stanford press release notes, adding, “To measure the impact of the program, [Eran Bendavid, assistant professor of medicine at Stanford,] and his colleagues analyzed health and survival information for more than 1.5 million adults in 27 African countries, including nine countries where PEPFAR has focused its efforts” (Richter, 5/10). According to the study, “an estimated total of 740,914 all-cause adult deaths were averted between 2004 and 2008 in association with PEPFAR,” and “[i]n comparison, PEPFAR was associated with an estimated 631,338 HIV-specific deaths averted during the same period,” a JAMA press release states, noting that “all-cause adult mortality declined more in African countries in which … PEPFAR operated more intensively” (5/15).
AIDS activists in Uganda are worried about a proposed reduction in the country’s health budget, as Parliament begins “a months-long budgeting process for the … next fiscal year,” VOA News reports. “AIDS activists have expressed concern that Uganda’s proposed budget for the next fiscal year includes a six percent cut in health funding to $307.5 million,” which “is less than 10 percent of the country’s overall budget,” the news service writes. Joshua Wamboga of The AIDS Support Organization said a lack of financial commitment from the government could undermine efforts to fight HIV/AIDS in the country, VOA notes, adding, “Government officials said the cut to the health budget reflects construction projects in that sector that have been completed and no longer require funding.” According to VOA, “The budget is months away from being finalized and activists hope there is still time to increase funds” (Green, 5/15).
Maternal Deaths Drop By Nearly Half Worldwide Over 20 Years; Greater Progress Still Needed, U.N. Reports
“The number of women dying of pregnancy- and childbirth-related complications has almost halved in 20 years, according to new estimates released [on Wednesday] by the United Nations, which stressed that greater progress is still needed in significantly reducing maternal deaths,” the U.N. News Centre reports (5/16). “The report, ‘Trends in Maternal Mortality: 1990 to 2010,’ shows that from 1990 to 2010, the annual number of maternal deaths dropped from more than 543,000 to 287,000 — a decline of 47 percent,” a UNFPA press release states (5/16). However, “[w]hile substantial progress has been achieved in almost all regions, many countries, particularly in sub-Saharan Africa, will fail to reach the Millennium Development Goal (MDG) target of reducing maternal death by 75 percent through 2015,” Inter Press Service writes (Deen, 5/16). “Countries in Eastern Asia have made [the] most progress on improving the health of expectant and new mothers, said the report,” Agence France-Presse adds (5/16).