BrightWorld

Dreams, Optimism, Wisdom

LIMA’S COMMUNITY-BASED XDR-TB TREATMENT TEACHES US September 26, 2008

Erle Frayne Argonza

From Lima beans to Lima community-based XDR-TB treatment, Lima got it! The exciting news about lessons that we can cull from Lima’s health teachings is that the components of the community-based approach are comprehensive and not just “let me inoculate you Patient so you won’t be vector to your household members and neighbors” sort of dinosaur treatment.

Below is the news about the special TB treatment that Lima shares to us all.

[28 August 2008, Quezon City, MetroManila. Thanks to SciDev database news.]

 

 

We can learn from XDR-TB treatment in Lima

Source: New England Journal of Medicine

11 August 2008 | EN | ES

A nurse prepares TB drugs in Peru

World Lung Foundation

A new report from Lima, Peru, offers hope for tackling extensively drug-resistant tuberculosis (XDR-TB) in the developing world, says Mario C. Raviglione in the New England Journal of Medicine.

The report shows that with “aggressive and appropriate” management, XDR-TB can be cured in most cases.

Raviglione highlights some of the factors that may have contributed to Peru’s success in treating the disease. All patients were given systematic drug-susceptibility tests and were treated with powerful second-line drugs, including a fluoroquinolone and an injectable drug. Where necessary, treatment regimens were reinforced with known effective drugs.

Strict community-based supervision was enforced, comprising psychological support, nutritional support and financial incentives. Additionally, intense bacteriological and clinical monitoring allowed for readjustments where necessary.

Raviglione believes that applying such an approach on a more global scale would help minimise, and effectively manage, drug resistance.

“In 2008, scaling up is indeed the major challenge faced by most complex health interventions worldwide … Effectiveness of a complex intervention depends on coordinated work among all forces.”

Link to full article in The New England Journal of Medicine

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CIRCUMCISION AS HIV PREVENTION September 12, 2008

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.”

 

MOST EFFECTIVE DRUGS FOR HIV/TB NOW OUT! September 8, 2008

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

 

 

EPIDEMIC CONTROL VIA EDUCATION: SRI LANKA’S KIDNEY DISEASE CASE September 4, 2008

Erle Frayne Argonza

 

Kidney diseases are potentially fatal, and I’d say this from out of experience. I suffered from nephritis at Age 8, and lucky was I to survive a two-year agony due to medication availability in my home town (it was almost a 4th World town then!). That ailment ruined my chance to do athletics in grade school, it made me shrink in esteem, and the weak kidney (aside from weak tonsils) contributed to my sickliness since then.

 

So it pays not only to understand the ailment, its diagnostics and medication. It pays all the more to know the preventive side of the ailment or any ailment for that matter. If the diagnostics side shows some shades of grey, then that could surely baffle the experts (medical scientists) and specialists, as a case proves in Sri Lanka.

 

Read the news below about Sri Lanka. The ‘good’ news about it is that the ailment has provided some nice research problems for the public health experts and pharmacologists.

 

[28 August 2008, Quezon City, MetroManila. Thanks to SciDev database news. This expert/analyst was former Silver Medal, National Powerlifting Class A Competitions, Middleweight Division, early 90s, Philippines. He is also a yogi & health buff.]

 

 

Sri Lanka kidney disease epidemic leaves doctors baffled

Chesmal Siriwardhana

12 August 2008 | EN | 中文

Almost all those affected are men from farming families

Flickr/World Bank

Doctors and researchers are puzzled by a sharp rise in chronic kidney disease among farming communities in the North Central province of Sri Lanka.

The number of cases has been steadily rising since the disease first came to light around eight years ago. Over 18,000 cases have now been reported, with cases in Eastern and Uva provinces as well as North Central.

In 2003, almost 200 hundred patients died from renal failure in the North Central province and the figure is increasing every year. Over half the population there is engaged in agriculture.

Almost all those affected are men from farming families without pre-existing conditions than can lead to renal disease, such as hypertension or diabetes.

The absence of clinical symptoms until the late stages of renal failure is also puzzling researchers and making early diagnosis difficult, leading to many deaths.

Local researchers have come up with several possible risk factors for the disease, including high groundwater fluoride content in some affected areas, leaching of heavy metals such as cadmium from agricultural chemicals into water sources, exposure to inorganic pesticides and fertilisers, and usage of aluminium vessels to store drinking water.

Several studies conducted by local researchers have found a strong link between high cadmium concentrations in water sources and high disease prevalence.

A team of medical experts from the WHO visited Sri Lanka to assess the situation in May this year. They recommended that non-affected agricultural regions be used as control areas in studies to find the disease’s cause, and preventative measures such as using clay pots to store water are used.

A long-term clinical study was also proposed by the WHO but has yet to be implemented, Rohana Dayaratne, a geneticist and physician attached to the National Hospital of Sri Lanka in Colombo, told SciDev.Net. 

He says local and international researchers should lead a combined effort to identify the causes and preventive measures, and that local researchers have a good knowledge about ground realities that should be combined with the financial and other resources of the international community.

The majority of the affected farming communities were settlers from different parts of the country, he says, meaning that there could be a genetic component to the disease.

The growing number of patients suffering from chronic renal disease is becoming a heavy burden on the health sector, as the treatments — dialysis and organ transplants — are costly procedures.

Efforts are underway to educate the public about risk factors, maximise early diagnosis with weekly clinics and field visits to vulnerable areas, and introduce preventive measures.

 

DRUG-RESISTANT TB NEARS END WITH POWERFUL NEW TOOL August 31, 2008

DRUG-RESISTANT TB NEARS END WITH POWERFUL NEW TOOL

Erle Frayne Argonza

 

In the domain of field epidemiology comes a very brightening news about a powerful new tool that can diagnose drug-resistant tuberculosis or TB.

 

TB had ravaged many countries for centuries, and was only curbed for a while after the 2nd world war. But flawed policies and practices led to the near-catastrophic return of TB to near-pandemic levels.

 

The news about the powerful new tool is contained below.

 

Happy reading!

 

[12 August 2008, Quezon City, MetroManila. Thanks to SciDev database news.]

 

 

 

Powerful new tool to diagnose drug-resistant TB

Sharon Davis

2 July 2008 | EN

Mycobacterium tuberculosis

Flickr/AJC1

[DURBAN] Clinical trials of a new molecular technique have found it to be effective at quickly identifying multidrug-resistant tuberculosis (MDR-TB) in resource-poor settings.

As a result, the WHO has endorsed the use of the test in all countries with MDR-TB.

South Africa’s National Health Laboratory Service and Medical Research Council (MRC), and the Foundation for Innovative Diagnostics (FIND) collaborated to test 30,000 patients suspected to have MDR-TB in South Africa between 2007 and 2008. They used both the rapid test and conventional testing.

They announced the results at the opening of the 2008 South African Tuberculosis conference in Durban this week (1 July).

The test uses polymerase chain reaction (PCR) technology to amplify Mycobacterium tuberculosis DNA and look for genetic mutations that cause resistance to drugs.

It is the first of its kind to be used against TB and the first new tool for TB in 50 years, says Martie van der Walt, acting director of the TB Epidemiology and Intervention Research Unit at the MRC.

The new TB test yielded results on 92 per cent of all samples compared with about three-quarters (77.5 per cent) of samples tested by conventional methods. It takes between eight hours and two days to get a result, compared to six to eight weeks for conventional testing.

Patients who receive appropriate drugs sooner minimise their risk of acquiring additional drug resistance, van der Walt told SciDev.Net. Earlier diagnosis also cuts the chance of infecting others.

Seventeen countries will receive the tests over the next four years through the WHO Stop TB Partnership’s Global Drug Facility. FIND and the WHO’s Global Laboratory Initiative will help countries build the capacity — such as laboratory equipment and trained staff — to carry out tests based on PCR techniques.

Mario Raviglione, director of the Stop TB Partnership said in a teleconference this week (30 June) that laboratories in Lesotho, where MDR-TB rates are among the highest in the world, would be ready to use the test within three months.

Laboratory technicians in Ethiopia have been trained, and facilities upgraded, and rapid testing is expected to begin by the end of 2008. Technicians in the Democratic Republic of Congo, the Ivory Coast, Kenya, Nigeria and Uganda have also been trained and are using the test on a smaller scale.

The new tests will be phased in from 2009–2011 in Bangladesh, Indonesia Myanmar and Vietnam.

Developed by Hain LifeScience in Germany, and Innogenetics in Belgium, the test has previously been used on a limited scale by researchers and private laboratories in resource-rich countries, said Richard O’Brien, head of product evaluation and demonstration at FIND.

At US$5 per patient, the test halves diagnosis costs — excluding associated infrastructure and laboratory capacity costs necessary for molecular testing. Using the tests will still be cheaper than treating a larger epidemic, according to O’Brien.

The success has rekindled commercial and research interest in creating a test tailored for extremely drug-resistant TB. A prototype should be available later in 2008. 

 

COMMUNITY-DIRECTED HEALTH CARE August 22, 2008

Erle Frayne Argonza

Who says that community-based health care systems won’t work? In the Philippines this has been an on-going effort, with the University of the Philippines leading. Couples of communities were adopted by the U.P. Manila in other regions precisely to study the effects of intervention via community organization.

Below is a news caption about a study that shows the effectiveness of community-based health care. Community-based health care has already been revolutionizing access to health care by many poor folks in the south.

Enjoy your read!

[02 August 2008, Quezon City, MetroManila. Thanks to SciDev database news.]

Community-directed healthcare ‘effective’, finds study

Abiose Adelaja

23 June 2008 | EN

In the strategy, family members help deliver drugs and administer treatment, instead of patients visiting a clinic

Flickr/CharlesFred

Community-administered healthcare is effective in combating a range of illnesses including river blindness and malaria as well as micronutrient deficiencies, according to a study of over two million people in three African countries.

The researchers say restrictive health department policies on who can administer medications should be altered so that other illnesses can be tackled in a similar fashion.

Community-directed drug intervention (CDI) has proved successful in delivering the drug Ivermectin to treat river blindness, also known as onchocerciasis. In the strategy, family members help deliver drugs and administer treatment, instead of patients visiting a clinic.

The study looked at the effectiveness of CDI in strategies to fight river blindness, later pairing it with treatments against malaria, tuberculosis and micronutrient deficiencies, in Cameroon, Nigeria and Uganda. Community dispensing of drugs, vitamin A supplements and insecticide-treated mosquito nets was compared with conventional delivery strategies over three years.

Researchers found that the number of feverish children receiving the right antimalarial treatment doubled, exceeding the 60 per cent target set by the Roll Back Malaria campaign. The use of insecticide-treated bednets also doubled.

Vitamin A supplementation coverage was also significantly higher in districts using CDI compared with those that did not. But community-directed interventions for tuberculosis proved only as effective as treatment from clinics.

Samuel Wanji, a researcher at the University of Buéa who conducted the southwest Cameroon part of the study, says the African Programme for Onchocerciasis Control — linked to the WHO and with 19 health ministers on the board — has given the go-ahead to extend the use of CDI for river blindness in countries that have lower, but still significant, levels of the disease.

The expanded programme will investigate whether CDI works as well in places where disease infection is less intense, and is scheduled to begin before the end of the year. Dispensing of other medications will be added as the programme progresses.

“The study’s approach is very useful for increasing access to health and will reduce the burden on health facilities,” says Hans Remme of the WHO Special Programme for Research and Training in Tropical Disease.

But a shortage of drugs and other materials remains a drawback, according to a WHO report of the study.

 

Link to WHO CDI report

 

MALARIA CROSS-BORDER RESEARCH IN LATIN AMERICA August 9, 2008

Erle Frayne Argonza

Cross-border malaria research is a new thing in health services and epidemiology. The conduct of this requires first of all an established people-to-people relationship in order to prosper, this relationship being the base for an expert-to-expert and state-to-state relationships.

Incidentally, cross-border relations are increasing in the South, a pattern that is observed likewise among Latin American states. Cross-border research in malaria is a representative instance of the multiplying cross-border relations, the good news being that it is even rewarded among certain countries, as reported in the news below.

Enjoy your read.

[26 July 2008, Quezon City, MetroManila. Thanks to SciDev database news.]

Cross-border malaria research rewarded in Africa

Bibi-Aisha Wadvalla, Esther Tola and Christina Scott

12 June 2008 | EN

The money will go into further research, including final-stage trials of a malaria vaccine for children

Flickr/aheavens

Four African institutions carrying out malaria research have won an international cooperation award from the Prince of Asturias charitable foundation in Spain for their joint efforts.

The award, announced last month (28 May) and worth €50,000 (around US$77,000), went to Ghana’s Kintampo Health Research Centre, Mali’s Malaria Research and Training Centre, Mozambique’s Manhica Centre of Health Research and the Ifakara Health Research and Development Centre in Tanzania. They are scheduled to receive their awards in October this year.

The centres carry out biomedical research, vaccine trials, demography research and local training of personnel.

Ogobara Doumbo, director of the Mali centre, told SciDev.Net the award would help expand successful strategies such as insect-repellent mosquito nets and occasional (intermittent) preventative drug treatment for children and pregnant women.

About 80 researchers have been working on clinical trials of malaria vaccines at four sites in Mali since 2003, including molecular biologist Abdoulaye Djimdé, who developed simple techniques to monitor drug resistant malaria parasites from a drop of blood on filter paper.

Doumbo says they are now working on candidate vaccines targeting the early phase in the parasite’s life cycle in the human bloodstream.

The money will be ploughed straight back into further research, says John Aponte, head of the statistics unit at the Barcelona Hospital Clinic and a member of the team at the Manhiça Centre of Health Research.

Aponte said final-stage (phase three) trials of the RTS,S malaria vaccine for children under five years should begin in late 2008 or early 2009 at 11 centres in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania. 

Commentators say that the awards are a sign of Africa being at the forefront of solving African health problems.

“Mozambique and Africa are starting to lead the path toward solving their own health problems, and to deliver useful solutions to the rest of the world,” Graça Machel, president of nongovernmental organisation the Community Development Foundation in Maputo, who has worked with the Manhiça Centre for 12 years, said in a press statement.

”The work of the recipients reflects their respective commitment to cooperation across national and institutional boundaries — the type of cooperation that will be needed to effectively combat malaria at the global level,” said Christian Loucq, director of the PATH Malaria Vaccine Initiative, in a press statement.