These neglected tropical diseases include:

• lymphatic filariasis
• blinding trachoma
• sleeping sickness
• leprosy
• soil-transmitted helminthes
• schistosomiasis
• river blindness
• Chagas disease
• visceral leishmaniasis
• guinea worm

Check out the related webcast and infographic

For example, JHPIEGO is working to protect women and girls with strategies like HPV vaccination and improved screening.

Researchers at the University of Pennsylvania, lead by Dr. Carrie Kovarik, are using innovative techniques like mobile phone based telemedicine to improve screening for cervical cancer in resource-challenged countries.

The Global Initiative against HPV and Cervical Cancer also has several programs to fight against cervical cancer including education, strengthening HPV vaccination programs and improving screening and treatment programs for cervical cancer.

What other innovative programs are you aware of to fight this deadly disease? What approaches do you think will be most successful at eradicating cervical cancer globally?

World AIDS Day is a time to renew our commitment to the 34 million people living with HIV/AIDS worldwide and the recent developments revolving around HIV, including several scientific breakthroughs in HIV prevention research and Secretary Clinton’s recent remarks declaring that it is possible to reach an AIDS-free generation, make this an especially exciting time to reflect on the epidemic.

According to Dr. Bertozzi, the strategy of the Bill & Melinda Gates Foundation includes both decreasing new infections and improving quality of life of those currently infected. A large focus of this strategy is on the delivery of current strategies in large part through the Global Fund as well as smaller national programs.

Despite the proven effectiveness of existing prevention approaches, there are limitations. For example, many women are not in a position to insist that their partners wear condoms and daily adherence to prophylactic treatments is difficult. The development of a vaccine and other new prevention options is critical for successfully fighting the epidemic, especially in developing countries. The largest investment in newer technologies is currently in trying to develop a HIV vaccine. As such, a focus is on the success of the RV144 HIV vaccine trial, which recently showed encouraging results in Thailand and advancing that to the next generation of the vaccine with hopes of increased efficacy.

They are also investing heavily on products that can be used by individuals to protect themselves either topically in the vagina or systemically. While daily use of vaginal microbicides has shown mixed results, many reasons may contribute to this, especially lack of adherence which is a common problem with daily use products. To address these challenges, they are working on products which are less dependent on adherence such as a vaginal ring which slowly releases the antiretroviral compound dapivirine and can be left in for up to a month.

Another strategy is systemic daily antiretroviral prophylaxis which has also had mixed results and faces problems with adherence, but looks promising. They are focusing on injectables which can be injected every 1 to 3 months, decreasing the need for adherance. The Gates Foundation is currently supporting clinical trials to evaluate the effectiveness of Pre-exposure prophylaxis (PrEP) such as this for HIV prevention.

Images from the Bill & Melinda Gates Foundation

Additional efforts are on enhancing the delivery of male circumcision and scaling up these programs with fewer resources. Despite three clinical trials demonstrating the protective benefit of the procedure, donors and countries have been slow to invest in voluntary male circumcision for HIV prevention. The foundation is investing in advocacy efforts to encourage more rapid scale-up of male circumcision for HIV prevention and funding research on new technologies and methods for performing male circumcision safely and less expensively. This strategy is so cost effective that it costs more money to NOT implement such programs due to the future treatment savings.

The Gates Foundation is also working towards improving the delivery and effectiveness of current programs. With decreasing funding in a faltering global economy, scale up of treatment has continued at the same pace by improving efficiency of programs. Fortunately this has been happening in HIV treatment. Continuing efforts to reduce the cost of drugs, design and implement more efficient delivery systems and further task shifting and sharing among health providers is needed without compromising care and can even lead to improved quality of care.

Bill Gates and Rotarians make the “This Close” gesture on the steps of the U.S. Capitol in Washington, D.C. on World Polio Day, October 24, 2011, to promote Rotary’s End Polio Now campaign and show how close the world community is to eradicating the scourge of polio

Learn more about World Polio Day and global efforts to eradicate this disease which has been decreased thus far by 99% thanks to efforts including vaccination campaigns.

“Africa is pursuing ambitious targets against malaria and having timely, trusted data is critical to reaching our goals,” said Joy Phumaphi, Executive Secretary of ALMA. “Armed with this information, African leaders and partners can make policy decisions and demand action that will help countries rapidly improve their efforts against malaria.”

World Hepatitis Day

The Kaiser Family Foundation recently completed a survey of 2,583 American adults ages 18 and older to analyze public opinion about HIV/AIDS.

According to the survey:

• There is a decreasing sense of national urgency and visibility of HIV/AIDS.
• African Americans, particularly young men, expressed higher levels of concern about HIV than Caucasians.
• After almost a decade of decline, an increased number of Americans reported that they were personally  “very concerned” about becoming infected.
• More than 50% of Americans support increased funding for HIV/AIDS, with  fewer than one in ten reporting that they feel that the federal government spends too much on HIV/AIDS.

A webcast is also available about the survey findings.

Another resource to track the HIV epidemic is AIDSVu, which was created by researchers at the Rollins School of Public Health at Emory University. This site shows the number of individuals living with HIV, HIV testing sites and National Institutes of Health-funded HIV prevention and vaccine trial sites throughout the US.

Two studies from the Johns Hopkins Bloomberg School of Public Health were recently published in Health Affairs‘ June issue on Strategies for the Decade of Vaccines. The studies examined the impact of expanding immunization against pneumococcal pneumonia; Haemophilus influenzae type b (Hib);  bacterial meningitis; diphtheria; pertussis; tetanus; measles; rotavirus and malaria to cover 90% of children in 72 countries. They found that increasing vaccine development and delivery over the next 10 years in these 72 countries could prevent 6.4 million children from dying with an economic savings of $231 billion in the value of statistical lives saved and over $151 billion saved through reduced treatment costs and increased productivity. The issue brief audiocasts offer more insight into these and other contents of the June issue.

From the Bill and Melinda Gates Foundation website

While this looks promising, another study from the GAVI Alliance suggests that developing nations will be challenged to pay for expanded vaccine delivery without substantial outside support. In order to procure the projected benefits of increased immunization efforts, creative vaccine financing strategies will be needed. One such effort comes from the Bill & Melinda Gates Foundation’s commitment over the current decade–the Decade of Vaccines–to promote childhood immunization in the developing world.

US News and World Report interviewed Sherman about his book and about What Disease Mean in the Modern World. A related article from Nursing Degree.net’s blog entitled 10 Diseases That Totally Changed the World similarly discusses the ways in which diseases have impacted the course of history.

Field workers in Macha Zambia capture mosquitoes with traps.

Image from JHSPH website

According to the study’s senior author George Dimopoulos, PhD, “We’ve previously shown that the mosquito’s midgut bacteria can activate its immune system and thereby indirectly limit the development of the malaria parasite. In this study we show that certain bacteria can directly block the malaria parasite’s development through the production of free radicals that are detrimental to Plasmodium in the mosquito gut.”

This finding suggests that mosquitoes of the same species and strain sometimes have different resistance to the Plasmodium parasite. Scientists hope that this discovery could lead to new methods to reduce the spread of malaria, for example, by exposing mosquitoes in the wild to this bacterium.

For more on malaria and recent developments in the fight against this global killer, check out our recent blog posting on World Malaria Day.

Johns Hopkins Bloomberg School of Public Health offers several resources for reflecting on the global impact of malaria.

• A debate on eradication of malaria

• The life cycle of malaria

• Nobel laureate Peter Agre’s reflections on achievements and priorities in the struggle to conquer malaria
• Malaria Research News
• The Quest to Develop New Antimalarials
• Malaria History

During a recent Duke Global Health Institute talk as part of Global Health Week 2011, Ugandan physician and HIV/AIDS pioneer Peter Mugyenyi gave a talk on the unresolved AIDS crisis in Africa. In his talk, Mugyenyi reiterated that, although progress has been made in the fight against HIV/AIDS, the epidemic is far from over. He emphasized that the implementation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have played large roles in saving the lives of millions around the globe. For example, Mugyenyi directs the Joint Clinical Research Center in Kampala, which receives funding from these organizations to bring life-saving antiretroviral therapy to hundreds of thousands of Ugandans. In the following video of Mugyenyi’s talk at Duke, he shares his thoughts on the role of universities in the fight against HIV/AIDS and his hopes and concerns for the future.

Peter Mugyenyi: The Unresolved AIDS Crisis in Africa

• Bill Gates
• David Oshinsky Pulitzer-Prize-winning author of “Polio: An American Story“
• Helen Rees of the WHO’s Strategic Advisory Group of Experts on Immunization
• Ciro de Quadros, Executive Vice President of the Sabin Vaccine Institute

amongst a panel of experts on the fight to eradicate polio and the role and potential of vaccines. Tune in Monday, January 31st at 9:30am Eastern Standard Time at www.gatesfoundation.org to view this discussion on ways to protect populations across the globe from life-threatening diseases such as polio as experts delve into the immense progress that has been made, via such efforts as childhood immunizations, to reduce polio by 99% and attempt to eradicate the second transmittable but preventable disease in history.

This webcast coincides with the release of the Bill Gates’ third Annual Letter, in which he identifies polio eradication as one of the major priorities for the Gates Foundation. Further inspiring this quest at eradication, the Annual Letter will be launched the day after Franklin Delano Roosevelt’s birthday at the Roosevelt House, the location where this inspirational figure taught himself to crawl as a grown man struck by paralytic polio.

The event will also be available ‘On Demand’ following the webcast.

The 2010 UNAIDS report highlights updated information regarding the epidemic, including the growing number of people practicing safe sex, and gaining access to antiretrovirals in many parts of the world. Offering hope that progress is being made to quell the epidemic, UNAIDS reports that at least 56 countries have either stablized or achieved significant declines in rates of new HIV infections, with new HIV infections declining almost 20% in the last five years. At the same time that rates of new infections are declining overall worldwide, the number of new infections are increasing in areas like Eastern Europe and Central Asia, in large part due to injection drug use.

Highlights of the UNAIDS 2010 Report on the Global AIDS Epidemic

This global discussion series began this past May with a debate entitled “Test and Treat: Can We Treat Our Way Out of the HIV Epidemic?” which looked at testing and treating strategies with a focus on their role in Africa.

In June, a debate on “Behavior Change in HIV Prevention” took place looking at dynamics involved in behavior change approaches and their past ineffectiveness.

Check out these past debates and the ones still to come including theis week’s August 26th debate on “Discordant Couples and HIV Transmission” and continue to follow this debate series for future conversations.

Selected sessions are webcast live each day with past sessions also available for viewing. Find the complete guide-to-coverage as well as the webcasts already available for viewing including the Opening Session, Monday’s plenary with former President Bill Clinton, and Tuesday’s session on the study which found Microbicides containing HIV drugs lower the infection risk in women.

Today’s schedule includes:

The WHO is calling for earlier treatment of those infected with the HIV virus, suggesting that if people are treated before their immune systems become weakened by the virus, HIV-related mortality can be reduced by 20% between 2010 and 2015. In addition, early therapy also has a benefit in preventing transmission of the virus. These new guidelines expand the number of people eligible for antiretroviral therapy from around 10 million to about 15 million people. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that the cost needed for HIV treatment in 2010 will be about US$ 9 billion.

Figure 1.

For the first time in the 15 year-long search for an HIV prevention method that women can control, a vaginal microbicide gel called Viread has been shown to decrease the risk of HIV infection by as much as 54%.  Even though the microbicide does not prevent transmission in every woman who uses it, this is the first promising tool that women are able to use without the cooperation of the male partner.  This is an important consideration most of the new HIV infections in women living in Africa were acquired through forced sex with infected men who refuse to wear condoms. Women and girls represent 60 percent of the 22 million people infected with HIV living in Africa.

The gel was developed by Conrad, a nonprofit organization based in Arlington, Virginia, and funded by the U.S. and South African governments under royalty-free license from Foster City, California-based Gilead, the world’s biggest maker of AIDS medicines. The Bill Gates Foundation also helped fund the trial.

In the clinical trial, coordinated by scientists at the Centre for the AIDS Program Research in South Africa (CAPRISA), the use of the microbicide was compared to a placebo in a group totaling 889 women located in either the urban setting of Durban or the  rural setting of Pietermaritzburg in the KwaZulu-Natal province of South Africa.

The main active ingredient of Viread was a 1% vaginal gel formulation of the nucleotide reverse transcriptase inhibitor tenofivir. The pill form of tenofivir is already used in combination with other antiretroviral agents for the treatment of HIV and works  by slowing HIV’s spread through a patient’s body.  The secret to tenofovir’s success as a topical agent may be that it absorbs into the vaginal wall and into the cells targeted by HIV. Other gels have had to be sufficiently spread around and present in the vagina during intercourse in order to work.

Participants of the clinical trial were instructed to apply the gel 12 hours before and up to 12 hours after intercourse. Participants were told that the gel was experimental and were also counseled to use condoms or another means of HIV prevention. According to the trial results, when compared with the placebo group, women in the tenofovir group showed 39 percent fewer HIV infections. Within the tenofovir group, women who used the gel more than 80 percent of the time had 54 percent fewer infections than women who used the placebo gel .  For women who did not use the gel regulalrly ( less than 80 percent of the time) there was a 28 percent reduction.

Some theories as to why the gel did not perform better:

The net impact seen in the study reflects the combined effect of many variables, only one of them the action of tenofovir, which penetrates into the vaginal tissue, protecting the cells that HIV targets for infection. Other variables include the prevalence of HIV infection in the male population; the number of sexual partners a woman had; the amount of AIDS virus (“viral load”) in an infected man’s semen; concurrent use of condoms; and, most important, the consistency with which a woman used the gel.

For that reason, the researchers said, it’s impossible to say how much protection this microbicide might afford any woman.

“We can only approximate it,” said Salim Abdool Karim of the University of KwaZulu-Natal in Durban, South Africa, who helped lead the study. “What you see is a mixture of the efficacy of the product mixed with the ability to use the product. It is fundamentally dependent on human behavior.”

Other scientists speculated that some women who became infected despite using the tenofovir gel might have been exposed to men with very high HIV load (which occurs soon after infection).

“My most likely explanation is that you have to go up on the dose,” said Anthony S. Fauci, who heads the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. “You may have maxed out on 1 percent,” he said, meaning a more concentrated gel might produce greater protection.

Over the past 15 years, six other microbicides were tested in 11 clinical trials, with none showing a protective effect.  Previous gels relied on drugs that weren’t specifically designed to target HIV.

Another important finding in the trial was that the gel prevented the transmission of genital herpes (caused by the herpes simplex virus-HSV) by 51%.  A genital herpes infection increases the susceptibility to HIV infection because the HSV virus can cause open lesions to form.

If further development and testing continues to be successful, more potent formulations combined with marketing that makes the product more appealing to women could lead to increased prevention of HIV transmission.

A product could be ready as early as 2013 if the results are confirmed by a second study known as Voice that is enrolling patients.

Gilead, which donated the active ingredient in the gel, won’t participate in the commercialization of the product in developing nations. They are unsure of whether or not will market the gel in the U.S. and Europe. Conrad gave the rights to manufacture the gel to the government of South Africa to get the product to women in the country most affected by the disease as quickly as possible.

The findings of the study were described at the 18th International AIDS Conference in Vienna, Austria and the research article was published in Science magazine.

For More Info:

1. Sciencenews
2. Businessweek
3. WashingtonPost

Source: Wikipedia

This is the first in a series of posts for the American Public Health Association’s National Public Health Week.

Most of us associate biodiversity with images of tropical rain forests and coral reefs. While these ecological hot-spots are an important source of medications and global ecosystem services, biodiversity also plays a key role in neighborhoods across the US through regulating the spread of diseases such as Lyme disease. But how is that possible, you might ask, and what can you do about it?

Lyme disease  affects hundreds of thousands of people across the US, with a greater concentration in the northeast. Recent decades have seen an explosion of urban sprawl across the northeast leading to decreased species diversity along with people living in close proximity to fragmented habitats.  But how are these related?

The connection is explained succinctly in Sustaining Life: How Human Health Depends on Biodiversity:

“The Blacklegged Tick (Ixodes scapularis) is the vector of Lyme disease, as well as of several other pathogens in the eastern U.S., and the primary reservoir for Lyme disease in this region is a common rodent, the White-Footed Mouse (Peromyscus leucopus)…Mice live in many different habitats, from pristine old-growth forest to degraded woodlots, garden sheds, and even kitchens. Several studies have demonstrated that populations of White-Footed Mice become very concentrated in small forest fragments, probably due to the absence of other vertebrate species that prey upon, or compete with them (forest fragmentation…affects predators over prey disproportionately). As a consequence, tick populations in small forest fragments have many White-Footed Mice, but few other mammalian hosts on which to feed, resulting in a high proportion of the ticks being infected and able to infect people. In contrast, in more extensively forested areas, the combination of fewer White-Footed Mice and more abundant, alternative, reservoir-incompetent hosts (an incompetent reservoir for Lyme does not pass on the Lyme bacteria to ticks that bite them, or does so poorly) results in a lower proportion of the tick population being infected.”

This phenomenon is known as the Dilution Effect: As species richness declines there is a subsequent decrease in the “dilution” of host-species making Lyme disease easier to spread. As the authors note, the dilution effect is not unique to Lyme, the same mechanism also operates in Hantavirus and West Nile Virus and possibly many others. As sprawl-based development patterns spread to more areas of the planet, we can only expect to see an increase in the number of dilution effect diseases unleashed upon populations worldwide.

So how can you increase biodiversity in your community and thereby help protect the health of your family and neighbors?

Get involved with your local conservation commission and bring these dangers to their attention. Find ways to support local parks and nature preserves. Also, if you have a yard or garden, try to plant local species that help support wildlife.  Most importantly: Education! If you are in college or school, talk to your professors about integrating awareness of biodiversity into curriculum.  Thanks to the UN and various donors, Sustaining Life is available at a very affordable price and can serve as a great textbook without placing a great financial burden on students. In addition, local schools can serve as great sources of biodiversity through gardens and planting of local species on grounds. Often these locals are less expensive to maintain, requiring less water and fertilizer.

These are just some ideas…we’d love to hear from GP readers with their experiences and success stories.

But long time advocacy is finally paying off as the WSJ reports that World Bank and the Indian government are set to spend $4 billion to “to ensure that by 2020 no untreated municipal sewage or industrial runoff enters the 1,560-mile river.”.  The methods proposed also have the benefit of being less carbon and electricity intensive than traditional wastewater treatment plants – key aspects for a country with chronic brownouts in a warming world.  In order to reach their goal, the government and partners will need to engage the most neglected slums which, if done right,  has the potential to create environmental justice at the same time as cleaning the river.

Of course, governments have a tendency of announcing lofty environmental goals which are then forgotten in the next election cycle. The Ganges also had a previous cleanup effort that failed to reach its goals, partly because of lacking public participation. Hopefully things will be different this time, but GP would love to hear from anyone with on the ground insight.

In the face of this expanding pool of people in need, US government funding seems to be staying stable. For example, at the same time that the Obama administration has announced plans to expand HIV treatment to at least 4 million by 2013, they have also signaled no increases in funding budgets through fiscal 2011. Defending the administrations commitment to fight the global pandemic, Eric Goosby, the President’s AIDS czar, stated that “our commitment to universal coverage hasn’t wavered.”

For more on the global fight on AIDS and particularly the fight in Uganda, check out the Wall Street Journal’s January 30th article and slideshow.

More details on the study can be found in the January 5, 2010 issue of Annals of Internal Medicine.