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Erle Frayne Argonza
Who says that male circumcision does not have any positive health value at all, that it is more of an esthetic practice than a medical one?
In the Philippines, ‘libreng tuli’ (free circumcision) is among the health services offered by NGOs and social service groups to community members. As President of the KAKAMMPI in 89-93, I led the conduct of this free service for the adolescent boys of Anakbayan in Paco district, (Old) Manila, and in Tondo district, (Old) Manila. Not only were the surgical operations simple and well accepted, they also somehow ensured my group’s relevance among urban poor residents of the beneficiary communities.
But there is the lingering question raised about the true health value of circumcision. With a recent development in HIV research, it seems that the issue is coming to a close finally. Circumcision could very well be very cost effective a way to prevent HIV, and Africa itself could save as much as billions of dollars of prospective medications via male circumcision.
See the exciting news below.
[28 August 2008, Quezon City, MetroManila. Thanks to SciDev database news… The Kakammpi is a national organization of dependents of overseas workers, largely concerned with advocacy and community organizing. As its president, I was involved in the drafting of a proposed law for migrants that was passed later, as the Omnibus Law for Overseas Workers.]
Circumcision for HIV prevention ‘cost effective’
Mohammed Yahia
11 August 2008 | EN | 中文
Photoshare
[MEXICO CITY] In addition to decreasing the transmission of HIV, circumcision is cost effective and can reduce the risk of human papillomavirus (HPV) infection, researchers have announced.
Researchers presented a mathematical model at the International AIDS Conference in Mexico City last week (6 August) that showed that male circumcision programmes are economically feasible in Sub-Saharan Africa.
While they may cost more than US$900 million dollars to initiate, the budget for antiretroviral therapies would be cut considerably with the reduction in new infections.
“Calculations suggest that, over a 20-year period, two billion dollars would be saved,” said Bertran Auvert, professor of public health at France’s national biomedical institute INSERM.
Auvert also announced that HPV infection can be cut by around 40 per cent in men, as well as circumcision reducing HIV infections by 60 per cent.
“Circumcision could therefore be an indirect way of limiting the risk of genital cancers caused by HPV in women,” said Auvert.
According to Alvaro Bermejo, executive director of the International HIV/AIDS Alliance, studies in South Africa show a high level of acceptance of male circumcision. “We’ve seen high uptake and there are lengthy waiting lists right now,” he said.
But expansion of the practice in Africa has proved slow. “If it were a traditional biomedical product, like a pill, I think we would see roll-out much more quickly,” said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition. “But you are dealing with a deeply cultural and social issue.”
For example, the elders of the Luo tribe, a large community in Kenya, have refused to endorse male circumcision as it is against their culture and they are not convinced it will decrease the rate of new infections.
And in Indonesia, Christians have been reluctant to get circumcised because the practice is associated with the coming of age for young Muslim boys, explained Karen Houston Smith, deputy director of Family Health International, Indonesia. “They feel this casts some doubt on the validity of their Christianity.”
Bermejo stressed that dialogue and information will be essential for any global strategies to roll out male circumcision.
And the messages need to be clear. “We need to be sure we are not putting women at risk. We need to be sure that men who do get circumcised don’t think that they can now stop using condoms” said Warren.
“But that doesn’t mean we should not be scaling up in a strategic and smart fashion that is addressing all of these other factors.”
Erle Frayne Argonza
Tuberculosis could be a way to contract HIV, and cases encountered in the field are replete with this route to the dreaded disease.
From Cape Town comes a welcome news about a wonder drug that is most effective for treating patients who become sick of HIV precisely thru the TB way.
The good news is contained below.
[28 August 2008, Quezon City, MetroManila]
Scientists reveal ‘most effective’ drug for HIV/TB patients
Carol Campbell
15 August 2008 | EN | 中文
Efavirenz capsules
Flickr/MikeBlyth
[CAPE TOWN] The antiretroviral drug efavirenz has been recommended for tuberculosis patients who then contract HIV.
Researchers compared the effectiveness of the antiretroviral drugs efavirenz and nevirapine in 4,000 South African HIV patients. Some already had tuberculosis (TB) and were taking rifampicin.
Nevirapine — the cheaper of the two drugs — was found to be less effective in patients with existing TB, with higher HIV loads in their blood than those on efavirenz.
HIV-infected patients who were already on antiretroviral drugs when they subsequently developed TB were unaffected, highlighting the complexity of treating concurrent HIV and TB infections.
Researchers from the Western Cape provincial health department, Médecins Sans Frontières and the University of Cape Town (UCT) published their findings in the Journal of the American Medical Association (6 August).
Study leader Andrew Boulle warns that the research is not a rejection of nevirapine, which is popular in the developing world because of its low cost, simplicity of use and its safety for pregnant HIV-infected women.
“Four out of five of our patients in the study continued to do well on nevirapine,” said Boulle, a public health specialist from the School of Public Health and Family Medicine at UCT.
The long-standing anti-TB drug rifampicin slows down the liver’s ability to process nevirapine, making the anti-HIV drug less effective and causing an increase in virus levels.
Efavirenz is only slightly affected by rifampicin, said Katherine Hildebrand, another UCT researcher. But it costs twice the price of nevirapine. “We need to get the price of efavirenz down in places with high HIV/TB co-infection,” she told SciDev.Net.
The research also disproves earlier assumptions that people with both TB and HIV may need increased doses of efavirenz. Researchers found that efavirenz in normal doses was ideal for HIV patients regardless of whether they had TB or not.
“Efavirenz should be used unless there are compelling reasons not to use it. Unfortunately many developing countries do not have access to efavirenz which is more expensive,” said Gary Maartens from UCT medical school’s clinical pharmacology division. Botswana and South Africa both use efavirenz extensively.
Link to abstract in Journal of the American Medical Association
Erle Frayne Argonza
The Millenium Development Goal has been seriously reflected upon and guiding the actions of member states of the UN since its release earlier this decade. The target of halving poverty by 2015 is a tall order, as the key result areas for intervention are legion.
The countries of Africa are surely working their way in a most cooperative manner across the continent, via their regional/continental formations such as the African Union. From the continent comes the news about planning to draw a common framework for health research, and the challenge to put them into action.
Enjoy your read!
[06 August 2008, Quezon City, MetroManila]
Time to turn words into deeds on health research
27 June 2008 | EN
An Ethiopian doctor conducting research
WHO/TDR/Crump
African ministers have committed themselves to a set of actions to boost health research in their countries. Now they must implement them.
There is much encouragement to be gained from the commitment to health research demonstrated by Africa’s health and science ministers at a meeting in Algeria this week (23–26 June). At the meeting, ministers from 17 African countries announced a collective commitment to ensuring a higher priority for health research at both a national and regional level, and across the continent.
Improving health in the developing world is one of the key Millennium Development Goals (MDGs). These include, for example, reducing the mortality rate among children under five by two-thirds and maternal mortality by three-quarters, and making a significant impact on malaria and other tropical diseases. None of these targets will be achieved without extensive research into new methods of diagnosis and treatment.
The Algiers meeting was organised as a preparatory meeting for the Global Ministerial Forum on Research for Health that takes place in Bamako, Mali, in November 2008.
Its key outcome was the ‘Algiers Declaration’, a commendable list of 22 actions that ministers agreed to implement before the end of 2009, and intended to ensure that the potential contribution of health research to achieving the MDGs is delivered.
The actions include increasing funding for health research and research capacity-building by African governments, and boosting mechanisms for scientific and ethical oversight of all such activity. The ministers also agreed to “support the translation of research results into policy and action by creating appropriate mechanisms and structures, including promoting networks of researchers, decision-makers and policymakers for evidence-based public health action”.
Communication challenges
Provided these commitments are met, Africa’s health will receive a significant boost. But it became clear from the discussions in Algiers that there are several key issues that must be tackled urgently if this is to happen.
One is the need for better information about the health priorities of the continent — and a clearer idea within African countries themselves about how these priorities can best be addressed through research.
Donor agencies from the developed world — who provide much of the funding for such research — are frequently criticised by African stakeholders for seeking to impose an agenda that reflects the donor’s own priorities. But many of these agencies insist that they would be delighted to engage in a more informed, two-way dialogue on what their research priorities should be.
This means that African nations need to develop their own capacity for setting research priorities. Two essential components of this are adequate information about current research efforts and the development of professional skills among both research administrators and government officials — part of a broader need to develop a robust research infrastructure.
Another necessity is the development of stronger networks to ensure that African researchers and politicians — including particular ministers — communicate with each other more effectively. Far too often, gaps remain between scientists’ understanding of what is needed for health research to be put into practice, and the willingness of decision-makers to implement the steps that make this possible.
Ethical considerations
An additional need is to boost national capacities to address the ethical dimensions of health research — particularly at a time when the activities of researchers from the developed world, including those carrying out large-scale clinical trials for pharmaceutical companies, are under closer scrutiny.
A survey of capacity to conduct ethical reviews in 634 research institutes in 43 countries was presented at the Algiers meeting by a WHO team. They found that half of those who have a “high research activity” don’t have written policies requiring researchers to obtain informed consent from trial participants.
There is still much debate to be had about how the situation can be improved. Nevertheless, it is clear that health research in Africa needs to be conducted in a more ethical manner than in the past. And building the capacity to achieve this must form an integral part of future plans.
Closer collaboration
A third priority to emerge from the meeting was the need to encourage more research collaboration. The final declaration calls for promotion of equitable cooperation, technology transfer and collaboration, emphasising that this requires both North–South and South–South dimensions.
But it became clear at the meeting that delegates — mostly African ministers and researchers — had a greater interest in the second of those. They were more interested in how African countries could transfer knowledge between themselves than in receiving knowledge from Northern institutions, a sentiment echoed by Elias Zerhouni, the director of the US National Institutes of Health.
Finally there was general acceptance among the Algiers delegates that none of these aims could be achieved without adequate funding.
Participants broadly agreed that not only should African countries seek to boost their spending on research and development to at least one per cent of their gross domestic product — a target endorsed by last year’s African Union summit — but that at least ten per cent of research spending should be dedicated to health research.
But, as science ministers are already aware, there is a large step between putting forward a wish list and ensuring that those who control the purse strings are prepared to listen and act. The Algiers Declaration has provided a framework within which action can occur. What is now required is the political commitment within individual African countries to turn those words into deeds.
David Dickson, Director, SciDev.Net
Erle Frayne Argonza
Magandang hapon! Good afternoon!
From Africa comes a heartwarming news about boosting their respective capacities for clinical trials. The shot in the arm will be through grant funds provided by the European and Developing Countries Clinical Trials Partnership (EDCPT). Entry points for project engagements will be certain specific diseases.
Enjoy your read.
[24 July 2008, Quezon City, MetroManila. Thanks to the SciDev database news.]
Clinical trials in Africa receive funding boost
Naomi Antony
6 June 2008 | EN | 中文
A malaria clinical trial investigator
WHO/TDR/Crump
The European and Developing Countries Clinical Trials Partnership (EDCTP) announced this week (3 June) that it will inject over €80 million (around US$124 million) into African medical research.
Half of this sum has already been approved and will go towards malaria research and the development of tuberculosis (TB) vaccines. The remainder, expected later this year, has been earmarked for HIV and TB treatment and for the provision of vaccines and microbicides.
The combined sum will be the largest approved by the EDCTP since it was established in 2003, and should reinforce the European Union’s partnership with Sub-Saharan Africa.
The EDCTP links 14 member states of the European Union, as well as Norway and Switzerland, to countries in Sub-Saharan Africa, largely by providing resources for joint clinical trials, capacity building and networking activities.
In particular, EDCTP funds projects to create and develop capacity for ethical review of clinical trials and to improve regulatory frameworks for drug approval.
Charles Mgone, executive director of EDCTP, told SciDev.Net that the new funding will go to help all these activities, with the “lion’s share” being given over to clinical trials.
“Quite often when there is North–South collaboration, the ideas come from the North, the money comes from the North, even the principal investigators come from the North,” says Mgone.
“These [EDCTP-funded] projects empower Africans, enabling them to take ownership over the projects and do the work. Looking at the 27 projects we have approved, around 24 of them have African principal investigators working in Africa.”
Victor Mwapasa from the Malawi College of Medicine is one such example. He and his colleagues are looking at whether antimalarial drugs, specifically artemisinin-based combinations, are safe to use in two particular groups — those who are HIV positive and children aged under six months.
“Most studies looking at the safe use of antimalarials have tended to omit very young children, those who weigh less than five kilograms or are under six months old,” Mwapasa told SciDev.Net. “But this is a high-risk malaria group.”
Mwapasa says he is excited to be part of such a large collaboration with African and European researchers.
His team’s research will also be carried out in Mozambique and Zambia. “We rarely do research together, despite sharing the same problems,” he adds.
Erle Frayne Argonza
In the lands of the Semites comes brightening news about medical imaging. This news is particularly great for poorer families of developing economies, who can do their own information gathering and monitoring of health-related problems right in their palm.
Happy reading.
[20 July 2008, Quezon City, MetroManila. Culled via SciDev news.]
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Researchers devise ‘mobile’ medical imaging system
Wagdy Sawahel
16 May 2008 | EN | 中文
The new system transfers medical images via mobile phones
Flickr/johnmuk
Researchers have developed a new system enabling medical images to be transferred via mobile phones, which could make imaging technology cheaper and more accessible to poor countries.
According to the WHO, three quarters of the world’s population does not have access to medical imaging and more than half of available medical equipment in developing countries is not used due to maintenance problems and lack of trained personnel.
To address this, Boris Rubinsky at the Hebrew University of Jerusalem, Israel, and colleagues separated the components required in a medical imaging system.
A simple device ― one measuring electrical impulses for example ― collects data from the patient in the field. This is transmitted via the mobile phone to a central site where the data is processed, an image produced and sent back to the field, again via the mobile phone.
Using the system, the researchers successfully produced a clear image of a simulated breast cancer tumour.
“The wide availability of cellular phones has suggested that imaging devices do not have to be all in one physical place and that their components can be spread around the world and connected through cellular phones, rather than connected physically with electrical wires,” Rubinsky told SciDev.Net.
“The physicians can use their own cellphones to plug into [the data collection device] and send the raw data, in the form of a text message or email, to a geographically distant central facility — that can serve thousands of users — and within seconds sends back the processed image the way you would send a picture to your cellphone,” he says.
“This system is economical as the cost of [the data collection device] near the patient site is not a major part of the cost of the entire system, making it less expensive and easier to maintain,” he adds.
Rubinsky hopes they can develop a more advanced prototype for the detection of breast cancer within a year.
Morad Ahmed Morad, a professor of medicine at Tanta University, Egypt, says the device is an “ideal example of turning information and communication technology into solutions making a real health impact on lives of poor people in developing countries”.
The study was published in PLoS ONE last month (30 April).
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