With incentives to find new antibiotics signed into U.S. law last month, “multiple players are vying for the lead in the [multi-drug resistant tuberculosis (MDR-TB)] drug development niche,” Nature Medicine reports. “The fifth reauthorization of the U.S. Prescription Drug User Fee Act (PDUFA), signed into law on 9 July, includes a subsection called the Generating Antibiotic Incentives Now (GAIN) Act that aims to spur development of antibiotics for drug-resistant bacteria, including MDR-TB,” the news service writes, noting, “Drug makers that ask for approval of medicines to treat these pathogens will receive priority review, as well as five additional years of market exclusivity and fast-track status.” Currently, MDR-TB treatment “involves a bevy of regular tuberculosis medicines that, in many cases, must be administered for as long as two years or more … [and] don’t always work,” Nature Medicine states, adding, “The hope is that new medicines will shorten treatment times and improve cure rates.” The article discusses several medicines that are in different phases of research (Willyard, 8/6).
Noting “the total clinic-level cost of providing a year’s worth of antiretroviral drugs … ha[s] dropped” in some countries, Charles Kenny, a fellow at the Center for Global Development and the New America Foundation, discusses “disagreement over the effectiveness of the global AIDS response” in this Bloomberg Businessweek opinion piece. Kenny highlights a debate that took place last week on the sidelines of the XIX International AIDS Conference (AIDS 2012) that “focused on the question: should we use resources for antiretrovirals at a cost (including overhead) of perhaps $350 per patient per life year saved if we could use those resources to provide a course of drugs to cure victims of tuberculosis at a cost of $5 to $50 per life year, or of extending childhood immunizations at the cost of $2 to $20 per life year?” He writes, “Simply, millions of people are dying unnecessarily, for lack of $350 a year or less. It may be those who don’t get AIDS treatment, or those that don’t get other treatments because the available money is being used to buy antiretrovirals.” He continues, “If anything could open treasury accounts in the rich world to provide a larger flow of resources to global health, perhaps it is to get policymakers in those countries to think through these gut wrenching decisions that limited funding (and lack of funding flexibility) forces doctors and ministers and activists alike to make every day” (7/27).
NPR continues its coverage of issues being discussed at the XIX International AIDS Conference (AIDS 2012) with several stories on its health blog and radio programs. On Thursday, “Tell Me More” host Michel Martin spoke with Teguest Guerma, the first woman director general of the African Medical and Research Fund (AMREF) about how African nations are responding to the HIV/AIDS epidemic and how they are working “to find the solutions ourselves, with the support of the international community,” Guerma said, according to the program’s transcript (7/26). On “All Things Considered,” correspondent Jason Beaubien reports on how South Africa’s Kwa-Zulu Natal province is responding to high rates of HIV and tuberculosis (7/26). NPR’s “Shots” blog reports on Alexandra Volgina, who won a Red Ribbon Award for her efforts to raise awareness about drug shortages in Russia and prompting the Ministry of Health to respond (Doucleff, 7/26).
In this Politico opinion piece, Desmond Tutu, archbishop emeritus of Cape Town, South Africa, and Gerry Elsdon, a South African businesswoman and television host — both tuberculosis (TB) survivors — write that one priority at the XIX International AIDS Conference (AIDS 2012) in Washington, D.C., this week “should be spearheading a joint global effort against HIV and tuberculosis.” They write, “The rationale for a joint effort is clear,” adding, “Where HIV and TB are most common, the epidemics have merged, or are in the process of merging, into a single co-epidemic,” and “[t]hose whose immune systems are weakened by HIV are at extreme risk of dying from TB.” They conclude, “Thanks to a series of recent scientific breakthroughs, this week’s conference is the first in 30 years that has activists seriously contemplating the end of AIDS. Yet to see a real end to AIDS, we must put an end to TB. So let’s combine our efforts to reach these two goals” (7/24).
“Results from a groundbreaking trial of three drugs given in combination — one of them completely new and one not yet licensed for this use — killed more than 99 percent of patients’ [tuberculosis (TB)] bacteria after two weeks of treatment,” and the combination “appears to be equally effective on drug-resistant TB,” the Guardian reports (Boseley, 7/23). The combination “comprises a candidate TB drug called PA-824, the antibiotic moxifloxacin not yet approved for TB therapy, and an existing TB drug, pyrazinamide,” Agence France-Presse writes, noting the combination is called PaMZ (7/23). “Because the combination doesn’t contain isoniazid or rifampicin, the two main medicines used against TB, it also may provide a much-needed weapon against strains that fail to succumb to those drugs and are spreading, the researchers wrote,” Bloomberg Businessweek reports (Bennett, 7/23). The Phase II study, which was presented on Monday at the International AIDS Conference in Washington and published in the Lancet, “needs to be confirmed in larger and longer trials,” according to Reuters (Steenhuysen, 7/23).
With Africa’s “emerging position in the global order, … [a]stute African leaders are striving to ensure that this realignment delivers a new paradigm of partnership for sustainable health development — a partnership that is led by Africa, for Africans, through African-sourced solutions,” UNAIDS Executive Director Michel Sidibe writes in a Huffington Post “Impact Blog” opinion piece. The African Union is taking steps “to reduce the continent’s dependence on foreign solutions and foreign ‘aid’ while adopting and scaling up development solutions that have been proven to work in different African countries, and finding better and more sustainable approaches to financing them,” he states. “It makes a lot of sense to apply such an approach to addressing three killer diseases: AIDS, tuberculosis (TB) and malaria,” he continues, adding that “the overreliance of Africa’s AIDS response on foreign investments, foreign drugs and foreign solutions must be addressed.”
Jennifer Furin, an infectious diseases physician and medical anthropologist who specializes in the management of tuberculosis (TB) and HIV in resource-poor settings, writes in a post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog that “when it comes to the great advancements made in global HIV and TB care, children are being left behind.” She continues, “All children with HIV and TB deserve access to diagnosis and treatment, and the death of even a single child from either one of these diseases signifies a global failure. … It is time to require that pediatric formulations of TB and HIV medications be developed.” She notes that StopTB.org will host a talk show on July 22 featuring women and young people who have been affected by TB and HIV (7/17).
GlobalPost’s “Global Pulse” blog interviews Mario Raviglione, the director of the WHO’s Stop TB Department since 2003, “about the progress and frustrations with detection and treatment of tuberculosis [TB].” Among other topics, Raviglione discusses “progress in addressing HIV-TB co-infection,” the emergence of extensively drug-resistant TB (XDR-TB), and research in diagnostics, such as the GeneXpert machine, which gives a “very quick” diagnosis of MDR-TB, according to the blog (Donnelly, 7/12).
PEPFAR “is recommending improvements to efforts to detect [tuberculosis (TB)] in settings offering health services to pregnant women, women with HIV, newborns, and children,” the Center for Global Health Policy’s “Science Speaks” blog reports. The blog outlines the recommendations of the PMTCT/Pediatric HIV Technical Working Group, which said the decision to produce guidelines for integrating TB screening into maternal and child HIV programs was based on “[r]ecent studies [that] have shown that HIV-infected pregnant women are at increased risk of transmitting both TB and HIV to their infants” (Barton, 7/11).
The widespread incidence of drug-resistant tuberculosis (TB) “calls for a new approach to TB in the developing world,” a Bloomberg editorial states. A “breakthrough test,” called Xpert MTB/RIF, “makes mass screening [for drug-resistant TB] feasible,” according to the editorial, which notes the test, developed by “California-based Cephied Inc. in collaboration with the non-profit Foundation for Innovative Diagnostics with funding from the Bill & Melinda Gates Foundation,” detects resistance to the TB drug rifampicin, provides results in two hours, and can be used without advanced laboratory facilities.