“Government assurances that the scaling back of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in South Africa (SA) will be carefully managed to protect patients are welcome, but … [t]he reality is that the Department of Health is struggling to cope with severe medical staff shortages, financial resources that never seem to stretch far enough, inadequate infrastructure and maintenance programs, and administrative bottlenecks,” a Business Day editorial states. Though the reworking of PEPFAR funding will take place over five years “and does not entail the complete loss” of funding, “the shortfall will have to come from somewhere,” the editorial says, adding, “It will be tragic if, just as we are starting to see light at the end of the long, dark tunnel of the HIV/AIDS epidemic in SA, the gains of the past few years were to be reversed due to the loss of critical foreign funding and the government’s lack of capacity to plug the gap.”
Access to Health Services
“Abortions are just as safe when performed by trained nurse practitioners, midwives and physician assistants as when doctors do them, a new review of the evidence suggests,” Reuters reports. “Researchers analyzed five studies that compared first-trimester abortion complications and side effects based on who performed the procedures in close to 9,000 women — and typically found no differences,” the news service writes. The review is published in BJOG: An International Journal of Obstetrics and Gynaecology, according to the news service.
Brazil is expanding its national HIV/AIDS treatment program to include about 35,000 additional people, the Associated Press/Seattle Times reports. “Ronaldo Hallal of the [health] ministry’s Sexually Transmitted Disease Department said people with 500 or fewer CD4 cells per cubic millimeter will receive antiretroviral HIV treatment,” increasing the cutoff from 350 or less CD4 cells per cubic millimeter prior to the expansion, the news service writes. The Ministry of Health noted on its website that the expansion will require spending an additional 120 million reals, or $60,000, annually, according to the news service, which adds, “Hallal said Brazil already spends 1.2 billion reals ($600 million) each year in its free anti-AIDS program that is currently treating 223,000 people.” The AP notes Health Minister Alexandre Padilla said in a statement, “Brazil will be the only large country in the world to offer this kind of treatment that will reduce the risk of opportunistic infections like tuberculosis” (8/29).
“Many innovative solutions are being proposed to help tackle the spread of counterfeit drugs in developing countries,” GlobalVoices reports. The blog includes highlights from several news articles and blog posts on the topic, including a number of solutions used to identify such drugs. The blog also includes a link to a TEDxBoston talk by Ashifi Gogo, an entrepreneur from Ghana, in which he “explains how his solution works by combining cell phones, community, and the cooperation of governments and pharmaceutical companies” (Rakotomalala, 8/30).
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).
Noting that a “thin place” is “a place or situation that Celtic Mystics believed to be a coming together of heaven and earth,” Gary Darmstadt, head of the Bill & Melinda Gates Foundation’s Family Health Division, and Wendy Prosser, a research analyst with the Family Health Division, write in the foundation’s “Impatient Optimists” blog, “The London Summit on Family Planning was a ‘thin place’ for the global health community and for millions of women around the world who want to plan their families. It was transformational for so many reasons.” They continue, “The Summit brought family planning back into the mainstream of global health conversations, a place it hasn’t been in decades. And it put the focus of that conversation on women and what they want — voluntary access to contraceptives and the ability to plan their families and their futures” (8/29).
“In developing countries where access to health care during pregnancy can be scarce or grossly underused due to lack of education, financial costs, and proximity to health centers, women die unnecessarily from pregnancy and birth complications,” Jennifer James, founder of Mom Bloggers for Social Good, writes in this post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog. However, “[i]nternational agencies and developing country governments are working in partnership to reduce maternal death rates in order to meet the goal of reducing by 75 percent the number of women who die during pregnancy, childbirth, and immediately afterwards, in the most vulnerable countries,” she writes, and highlights three projects in sub-Saharan Africa that are working to save maternal lives (8/29).
Speaking Wednesday at a seminar titled “Campaign Against Counterfeit Medicines,” Mauritian Health and Quality of Life Minister Lormus Bundhoo “cautioned against the dangers posed by counterfeit drugs and their impact on human life” and “said that the authorities are determined to raise awareness on the dangers of the manufacture of and trade in counterfeit medicines, and the importance of combating counterfeit medicines in Mauritius,” PANA/Afriquejet reports. “The minister recalled that Mauritius had set up a National Pharmacovigilance Committee for drug surveillance and drug use in the public and private sectors since December 2011,” the news service writes, noting, “So far, there has been no evidence of counterfeit drugs in Mauritius, he stressed.” The news service provides some statistics about counterfeit drugs worldwide that were cited by Charges d’Affaires Troy Fitrell of the U.S. Embassy in Port-Louis, who also spoke at the event (8/29).
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).
In an opinion piece in the Guardian’s “Comment is Free” blog, Dean Baker, co-director of the Center for Economic and Policy Research, discusses potential policies contained within the “Trans-Pacific Partnership Agreement (TPP), a pact that the United States is negotiating with Australia, Canada, Japan and eight other countries in the Pacific region.” However, “[a]t this point, it’s not really possible to discuss the merits of the TPP since the governments are keeping the proposed text a secret from the public,” he says. Noting “[a] few items that have been leaked give us some insight as to the direction of this pact,” he discusses how the “pharmaceutical industry is … likely to be a big gainer” from the TPP if the pact includes “stronger and longer patent protection and also increased use of ‘data exclusivity.'”