KFF Daily Global Health Policy Report

In The News

Research Presented At IAS 2013 Gives Scientists Hope For 'Functional Cure'

“Two HIV-positive patients in the United States who underwent bone marrow transplants for cancer have stopped antiretroviral therapy and still show no detectable sign of the HIV virus, researchers said Wednesday” at the 7th International AIDS Society Conference on Pathogenesis, Treatment, and Prevention (IAS 2013) in Kuala Lumpur, Malaysia, the Associated Press reports (Ng, 7/3). “One patient is HIV-free nearly three years later, and the other more than four years later,” NBC News notes (Fox, 7/3). “The patients have been off antiretroviral therapy for just 15 and eight weeks respectively, which researchers said means it’s far too soon to say they’ve been cured of HIV, the virus that causes AIDS,” according to the Wall Street Journal. “But even with that caveat, the patients are among a small group of cases helping to fuel optimism among many AIDS researchers and activists that a cure for the lethal disease, once considered out of reach, is now achievable,” the newspaper writes (Winslow, 7/3). “Data on the same two patients was presented a year ago at [the IAS 2012] conference in Washington, D.C., by the same researchers, Timothy Henrich and Daniel Kuritzkes” of Brigham and Women’s Hospital in Boston, Forbes notes, adding, “But at the time the patients had not stopped taking their AIDS medicines” (Herper, 7/3). “‘While stem-cell transplantation is not a viable option for people with HIV on a broad scale because of its costs and complexity, these new cases could lead us to new approaches to treating, and ultimately even eradicating, HIV,’ Kevin Robert Frost, the chief executive officer of amfAR, The Foundation for AIDS Research, which funded the study, said in a statement,” Bloomberg Businessweek reports (Bennett, 7/3).

“The patients’ success echoes that of Timothy Ray Brown, the famous ‘Berlin patient,’ who has shown no signs of resurgent virus in the five years since he got a bone-marrow transplant from a donor with a rare mutation conferring resistance to HIV,” the New York Times reports (McNeil, 7/3). However, Henrich and Kuritzkes “caution that it is still too early to know whether or not the Boston patients have been cured,” Nature notes (Hayden, 7/3). “Long-term follow up of at least one year will be required to understand the full impact of a bone marrow transplant on HIV persistence,” Henrich said, according to The Guardian (Boseley, 7/3). “In two other studies presented at [IAS 2013], French researchers said patients who began treatment as soon as possible after diagnosis had the best chance of shrinking the viral reservoir and reviving their immune system,” Agence France-Presse reports, noting other researchers gave an update on the case of the “Mississippi baby,” “an HIV-positive infant in Mississippi who was put on a course of antiretroviral drugs within a few days of birth [and who] had remained free of the virus 15 months after treatment was stopped.” The research “strengthens the motivation for pursuing the once-unthinkable goal of eradicating HIV or repressing it without daily drugs — a condition referred to as a ‘functional cure’ or ‘functional remission,'” AFP writes (7/3).

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New York Times Profiles Bush's Work In Africa

The New York Times profiles former President George W. Bush’s work in Africa, writing, “While [he] is remembered at home for war, terrorism and national security, in Africa he is seen as a lifesaver who as president helped arrest a deadly epidemic and promoted development of impoverished lands. Now out of office, he has devoted his post-presidency in part to continuing to aid the world’s poorest continent.” Since leaving office, Bush “has quietly returned to Africa three times, renovating health clinics and expanding screening and treatment programs to fight cervical cancer,” the newspaper notes and describes his work with the Millennium Challenge Corporation and PEPFAR. “Africa and global health have become a Bush family affair,” the newspaper writes, noting the global health-related activities of former First Lady Laura Bush and daughters Jenna and Barbara. The New York Times also discusses Bush’s meeting with President Obama in Tanzania during Obama’s recent three-country tour of the continent (Baker, 7/2).

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African Leaders Pledge To Reprioritize Agriculture In National Policies At Food Security Meeting

At the conclusion of a meeting at the African Union in Addis Ababa, “African leaders pledged on Monday to reprioritize agriculture in their national policies and increase state spending to end hunger across the continent by 2025,” The Guardian reports, noting ministers “committed to working with the private sector, farmers’ groups, civil society and academia to increase productivity, while also addressing the underlying causes of malnutrition.” The newspaper writes, “Ministers promised to accelerate efforts to meet the targets of the Comprehensive Africa Agriculture Development Programme (CAADP), which emerged from the Maputo agreement in 2003” and “committed African governments to spend 10 percent of national budgets on agriculture and increase productivity by six percent.” According to The Guardian, “Leaders also pledged to give women access to more land and credit — 70 percent of Africa’s agriculture workforce is female — and make the sector more attractive to young people by increasing the use of technology.” The newspaper adds, “The final declaration did not set out any concrete targets or cash commitments, and it will therefore fall to delegates at next year’s agriculture-focused A.U. summit to put flesh on the bones” (Ford, 7/2). In related news, Inter Press Service interviews José Graziano da Silva, director-general of the U.N.’s Food and Agriculture Organization (FAO), about efforts to end hunger on the continent (Newsome, 7/2).

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Despite Gains, Child Mortality Not Declining At Pace To Meet MDGs, U.N. Progress Report Says

“The number of children who die before their fifth birthday dropped by 700,000 children between 2010 and 2011, which is not enough to put the world on track meet the United Nation’s goal to cut under-five deaths by two-thirds before 2015, according to a U.N. progress report published Monday,” GlobalPost’s “Pulse” blog reports. “Progress toward the Millennium Development Goal [MDG] to reduce child mortality has accelerated since the U.N. established the target in 2000, according to the report,” the blog writes, and highlights some of the findings. “In all regions of the world, fewer children are dying. But wealthier regions are progressing faster,” “Pulse” notes, writing, “The most progress has been made among children between the ages of one and five, [David Oot, associate vice president of health and nutrition for Save the Children,] said, because interventions for many deadly diseases, like measles and polio, are logistically simpler to address.” In addition, “[w]hile overall child mortality rates have dropped 2.5 percent per year since 1990, infant death rates have declined by just 1.8 percent,” the blog states. “With relatively simple interventions, Oot said it is possible to make significant progress toward the U.N.’s goal before the December 2015 deadline,” according to “Pulse” (Stuart, 7/2).

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Ethiopia, Botswana, Dominican Republic See Biggest Food Security Gains, Global Food Security Index Says

“Ethiopia, Botswana and the Dominican Republic made the largest gains in food security in the past year, according to … this year’s Global Food Security Index, published by the Economist Intelligence Unit,” VOA News reports. “Increases in income and food availability in developing countries drove the largest improvements in this year’s” report, the news service writes, noting, “Botswana ranked number 43 out of 107 countries studied. But most of sub-Saharan Africa scored low. Even with this year’s gains, Ethiopia is number 90.” VOA continues, “Democratic reform and political stability were linked to improvements in food security in Burma and Sri Lanka, while conflict pushed Mali, Yemen and Syria down the index,” adding, “The index comprises 27 measures of food affordability, availability and quality” (7/2).

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U.K. Should Do More To Demonstrate Cost-Effectiveness Of Malaria Interventions, Report Says

“The U.K. has funded 25 million mosquito nets since 2010, but the National Audit Office [NAO] said usage among target groups, such as children, was disappointing,” BBC News reports. “The U.K. spent £252 million [$384 million] in 2011-12 on counter-prevention measures in 18 countries, 16 of them in Africa,” the news service writes, noting the NAO “said the countries had been ‘well-chosen’ but questioned the effectiveness of some of the spending” (7/2). “While [the Department for International Development’s (DfID)] programs use proven interventions such as bednets, which compare favorably with global benchmarks for cost-effectiveness, the department has further to go to demonstrate that it has fully secured value for money, [the NAO] said,” according to The Guardian. “In its report, the NAO said DfID needs to leverage more developing country resources while obtaining the best value from its own bilateral programs and from the support it channels through multilateral organizations,” the newspaper writes, adding, “The U.K. needs to do more to encourage poor countries to strengthen their own health systems so that aid for malaria has a more lasting impact, [the] government watchdog said” (Tran, 7/2). “Mortality rates from malaria in Africa have dropped by a third in the past decade but the NAO warned this progress was at risk of stalling and there could be ‘a rapid resurgence of the disease,'” according to BBC (7/2). “Despite recent progress, malaria infects about 219 million people each year, killing an estimated 655,000,” The Guardian notes (7/2).

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Doctors Face Challenges In Treating Drug-Resistant TB Among Children

NPR’s “Shots” blog and “All Things Considered” on Tuesday reported on the challenges of treating children with tuberculosis (TB), particularly drug-resistant TB, a “growing epidemic.” TB drugs are not designed for children, which “means they aren’t packaged in smaller doses, and may not even have been tested for child-specific effectiveness or side effects,” the blog notes, quoting Christoph Hoehn, the acting country director for Médecins Sans Frontières in Tajikistan, who with colleagues has “been running a pilot project in Tajikistan since 2011 to treat children with drug-resistant TB.” The blog profiles the doctors’ efforts and the stories of several young TB patients (Beaubien, 7/2).

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New York Times Examines Efforts To Trace MERS Virus Origin

The New York Times reports on researchers’ efforts to trace the origin of the coronavirus causing Middle East respiratory syndrome (MERS). “The virus, first detected [in Saudi Arabia] last year, is known to have infected at least 77 people, killing 40 of them, in eight countries,” the newspaper writes, adding, “As the case count climbs, critical questions about MERS remain unanswered. Scientists do not know where it came from, where the virus exists in nature, why it has appeared now, how people are being exposed to it, or whether it is becoming more contagious and could erupt into a much larger outbreak, as SARS did.” According to the newspaper, “The disease almost certainly originated with one or more people contracting the virus from animals — probably bats — but scientists do not know how many times that kind of spillover to humans has occurred, or how likely it is to keep happening.” The newspaper details the emergence of the virus, quoting a number of emerging diseases experts, and discusses efforts to catch and test bats in Saudi towns near where cases of MERS were reported. “The team has also tested camels, goats, sheep and cats, which might act as intermediate hosts, picking up the virus from bats and then infecting people,” the newspaper notes (Grady, 7/1).

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Editorials and Opinions

South Africa's HIV Epidemic Near 'Tipping Point' Thanks To Efforts Of Government, PEPFAR, Global Fund

“On Sunday, I had the honor of joining President Barack Obama, Archbishop Desmond Tutu, and leaders of several local non-governmental organizations at the Desmond Tutu HIV Foundation (DTHF) Kethuphila Youth Center in Cape Town, South Africa,” Ambassador Eric Goosby, head of the U.S. State Department’s Office of Global Health Diplomacy and the U.S. global AIDS coordinator, writes in the Huffington Post’s “Impact” blog. Goosby provides an overview of the meeting, noting President Obama spoke “about the strong partnership that has been built during his administration between our two countries in tackling” the HIV/AIDS epidemic. “I was also fortunate to visit the Hout Bay Clinic in Western Cape Province, where I announced an additional $10 million in PEPFAR funding to support South Africa’s ongoing efforts to expand voluntary medical male circumcision (VMMC) for HIV prevention,” Goosby continues. He discusses PEPFAR’s contributions to South Africa’s VMMC for HIV prevention program to date and writes, “As a result of our combined efforts, and with additional support from the Global Fund to Fight AIDS, Tuberculosis and Malaria and other partners, South Africa is now near the critical programmatic tipping point in its epidemic — the point at which the number of new annual adult HIV infections falls below the annual increase in adults on [antiretroviral treatment (ART)].” He continues, “Increasingly, South Africa is on the path to achieving an AIDS-free generation” (7/2).

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Education, Family Planning Critical To Future of Women, Girls

“As first ladies from around the world, including Michelle Obama, gather in Tanzania on Tuesday to talk about women’s empowerment, it’s crucial that both education and contraception are addressed,” Suzanne Ehlers, president and CEO of Population Action International, and Halima Shariff, director of Advance Family Planning Tanzania, write in GlobalPost’s “Pulse” blog. “There’s been a lot of focus on girls’ education, and for good reason: we know that educating girls not only empowers them, but raises lifetime incomes for them, their families, and their countries,” they note, adding, “But it’s harder, and less likely, for more girls to stay in school if comprehensive sexuality education and access to contraceptives are not available.” They continue, “Reversing these trends is key to ensuring that the next generation of women has a different future from that of their mothers,” citing a recent World Bank report that “stressed that increased access to family planning and reproductive health services form the linchpin to lifting women and families out of poverty, providing healthier lives and better outcomes for children in developing nations.” They discuss the relationship between education and family planning in Tanzania and conclude, “Contraceptives help people plan their lives and achieve their goals. Period. Let’s endeavor to give all girls not only the power, but the tools, that first ladies are lucky enough to have. The tools that we were both privileged enough to have. The tools that each of them deserve” (7/2).

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From the Global Health Policy Community

Blog Examines Report On HIV Prevention Research Released At IAS Conference

“With the United States funding 70 percent of the world’s research and development of biomedical answers to HIV prevention, progress that has yielded the potential for immediate advances against the global epidemic is in danger of stalling, with lasting consequences, according to a report [.pdf] released at the International AIDS Society [IAS] conference in Kuala Lumpur this week,” the Center for Global Health Policy’s “Science Speaks” blog reports. “‘From Research to Reality, Investing in HIV Prevention Research in a Challenging Landscape’ examines investments, outcomes and next steps in HIV vaccine and microbicide research, antiretroviral treatment as prevention, pre-exposure prophylactic use of antiretroviral drugs, medical circumcision, as well as other biomedical prevention approaches,” the blog notes, and details some of the report’s findings. “The report, which includes graphics illustrating not only current funding sources, but research involvement through trial participation, concludes the potential of more productive partnerships exists,” the blog states (Barton, 7/2).

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Recognizing Efforts Of Humanitarian Workers To Save Lives In Syria

“Along with widespread destruction and violence in Syria, health facilities are being destroyed, and medical staff are being targeted. And yet doctors, nurses, and medical staff — tireless heroes in this conflict — have been quietly working at USAID-funded health facilities across Syria since February 2012,” Rebecca Gustafson of USAID’s Syria Response Management Team writes in the agency’s “IMPACTblog.” “To date, USAID-supported medical teams have performed over 85,000 surgeries, treated hundreds of thousands of patients, and saved countless lives,” she continues, adding, “USAID medical programs in Syria provide medical supplies and equipment, pay doctors’ salaries, and train additional first responders and medical staff. Every day, U.S. humanitarian aid saves lives in Syria” (7/2).

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Examining Global Burden Of Disease 2010 Estimates

In a PLOS Medicine essay, researchers from Sweden, South Africa, Denmark, the U.K., Jamaica, Ghana and Vietnam “present a range of reflections on the Global Burden of Disease 2010 estimates, highlighting their strengths as well as challenges for potential users,” the summary states. “The Institute for Health Metrics and Evaluation (IHME) and its partners recently completed what is probably the largest ever exercise undertaken in epidemiological modeling, the Global Burden of Disease 2010 (GBD-2010) estimates,” the authors write, adding, “However, it is important to realize that ‘estimates are estimates, and not measurements’; they may perform better in some respects than others.” They conclude, “While GBD-2010 is undoubtedly a massive achievement for global health, our discussion above also reveals continuing concerns. … Planners and policymakers, in particular, need to come to an understanding of how much reliance they should reasonably place on these estimates, especially in data-sparse countries” (Byass et al., 7/2).

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Essay Examines Efforts To Combat Substandard, Counterfeit Medicine In Rwanda

In an essay in PLOS Medicine, Agnes Binagwaho of the Ministry of Health of Rwanda and colleagues examine the issue of substandard and falsified medicines, highlighting successful efforts to combat the issue in Rwanda. “Substandard and falsified medicines are major global health challenges that cause unnecessary morbidity and mortality around the world and threaten to undermine recent progress against infectious diseases by facilitating the emergence of drug resistance,” the authors write in a summary. “In a recent study, Rwanda had the lowest prevalence of poor quality tuberculosis drugs among African countries in the sample,” the authors note, concluding, “Drawing on our experiences in Rwanda scaling up pharmacovigilance for malaria and tuberculosis, we call for a global treaty and leadership by the [WHO] to address manufacturing and trade in substandard and falsified medicines” (7/2).

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