Zimbabwe could save up to US$3 billion in treatment of HIV and Aids and downstream costs if the country can scale up its Voluntary Medical Male Circumcision (VMMC), a health official has said.
Report by Christopher Mahove
Ministry of Health and Child Welfare, HIV and Aids and TB Specialist, Owen Mugurungi, said if the VMMC was to make an impact in the country, there was need for a rapid scaling up of the programme among the 15 to 49 age groups to above the 80% mark, which translated to 1,9 million men.
“If we do that, we will be able to reduce the rate of HIV infection from the current 130 000 new infections to less than 50 000 per year by 2020,” said Mugurungi.
“What it means is we would have also prevented close to 750 000 new HIV infections throughout the country and we would have invested around between US$100-US$120 million, but in terms of treatment and downstream costs, we will probably save US$2,9 billion.
“So you can see from an investment perspective, of saying where should we put our money, this is one of the high return areas in which we should be able to put our money.”
He said at community level, there were also even more benefits for partners of circumcised men and others, as it contributed to more than 75% prevention of HIV and Aids transmission to spouses.
Circumcision, Mugurungi said was also crucial in the elimination of the human papiloma virus, which affected the male organ and was the major cause of cervical cancer in women.
“This is because we know that if we circumcise all men, 60% of them are more likely to have reduced risk and if they have reduced risk, they are also less likely to transmit the disease, so that cascades to situations where even at community level, there is higher or better prevention,” he said.
Mugurungi said although the male circumcision programme had started on a slow note in 2009 in terms of uptake, the trend was slowly improving, with high hopes that the country would be able to reach its target.
“….but we are happy that in 2010, we circumcised the whole year, about 15 000, and already this year, 2013, during this previous campaign, which just happened during the holiday, we have circumcised more than 15 000.
“We are happy that we have achieved in less than six weeks what we achieved in 12 months. If that is anything to go by, we are happy to say that at least people are beginning to take it up and we will be able to circumcise more,” Mugurungi noted.
He said there was need for extensive educational campaigns to take the correct message to the people.
There are also other benefits that have for a long time been associated with circumcision, among them the prevention of genital ulcerations and general personal hygiene.
Mugurungi said studies done in South Africa, Kenya and Uganda had shown evidence that HIV infection rate among circumcised males was 60% lower than in those who were not.
Before the introduction of the male circumcision programme only a handful of private health institutions were offering the service and mostly for reasons other than as an HIV intervention measure.
In Africa, the vulnerability of women and girls to HIV remains high, with women constituting 59% of people living with HIV.
19 May 2013
By Samuel Mungadze
A NATIONAL Strategic Plan for HIV, tuberculous (TB) and sexually transmitted infections has been adopted on Friday, during South African National Aids Council (Sanac) meeting in Secunda, Mpumalanga, which was chaired by Deputy President Kgalema Motlanthe.
The National Strategic Plan has a target to have 3-million people on antiretroviral (ARV) treatment by 2015. South Africa currently has 1.9-million people on treatment.
The plan also aims to eliminate the transmission of HIV infection from mother to child by 2015 and to reduce AIDS-related maternal deaths. The country has in the recent past seen significant changes in the rate of mother-to-child HIV transmission.
Between 2008 and 2012, the rate of mother-to-child HIV transmission dropped from 8% to 2.7%. There was a leap in the percentage of HIV-infected women receiving ARV therapy between 2011 and 2012, from 87.3 % to 99%.
Similarly, 99 % of all infants born to HIV-infected women receive prophylactic ARV medication to reduce the risk of early mother-to-child HIV transmission in the first six weeks.
In this plan “Sanac aims to reduce TB incidence and mortality caused by TB in people living with HIV by 50 % in 2015″, read the statement from the council.
Sanac also approved plans to launch an HIV prevention programme aimed at sex workers. Details of the project were, however, not released with the council saying it would do so closer to the launch.
The National Strategic Plan is one of the many plans the government is implementing. Early, this month, Health Minister Aaron Motsoaledi announced the introduction of fixed-drug combination ARV therapy.
Patients living with both HIV and TB, have started being treated on the new therapy.
Fixed-drug combination therapy is a combination of three crucial antiretroviral medications in one tablet, taken only once a day.
This eliminates the need for patients to take three or more pills at various intervals per day.
19 April 2013
From the Business Day Live
By Daniel Wasonga
Non-communicable diseases (NCDs) are not passed from person to person, and include those such as cancer, diabetes and hypertension. They may be of long duration and slow in progression, or in some instances, result in rapid death. NCDs are categorized mostly by their non-infectious causes and not their duration. Like all diseases that develop slowly and worsen over a long period of time, NCDs require chronic care management.
Expectant mothers, especially those beyond the first 42 days, are uniquely vulnerable to NCDs and require proper maternal care at home or in healthcare facilities. Exposure of these women to any disease is detrimental to their health and that of their unborn babies. Chronic diseases increase the health risks of expectant mothers and without adequate care, maternal mortality will rise beyond the current undesirable levels, especially in the developing economies.
NCDs disproportionately affect the low and middle income countries, where 80% (29 million) of deaths related to these diseases occur. Women in general already bear the burdens of NCDs, which are compounded by myths and misconceptions. Social and cultural taboos often prohibit women from opening up about issues such as family planning and unwanted pregnancies, which impairs the few efforts being made at improving these conditions. Furthermore, the constant “blame game” has not really helped in bringing stakeholders together in finding solutions for the specific issue of maternal mortality related to NCDs.
The cost of treatment is high. For expectant mothers who are the sole breadwinners in their households, getting proper care for NCDs may be difficult. This is especially the case in Africa, where cancer, cardiovascular disease, chronic respiratory disease and diabetes are leading causes of death in women. Worldwide, these diseases kill 18 million women yearly.
The impact of these diseases on society as a whole is enormous – maternal mortality goes beyond its consequences on individuals. The loss of women who are at their prime would leave an economic and social gap in society. Ignoring this aspect of the link between maternal mortality and NCDs is a mistake our decision makers and policy formulators should not make.
The overwhelming emphasis on reproductive and maternal health has pushed the special focus on NCDs to the periphery, an approach that is not effective. Maternal mortality remains the least achieved of the Millennium Development Goals (MDGs) and multi-faceted solutions promise better returns. A comprehensive approach to women’s health that goes beyond the maternal focus is essential and much more sensible. The current interventions are too rigid and limited to the MDGs with little or no focus on post-MDG initiatives.
Although some achievements have been made in Africa on reversing maternal mortality, the progress has been limited and unequally distributed within and among countries. The upcoming Conference of African Ministers of Health should focus on compounding the gains made within countries and ensuring there is no disconnect between government and initiatives taken at the grassroots level. In the push towards achieving the MDGs, Africa needs renewed commitments from the governments and feasible, effective monitoring and evaluation mechanisms. Best interventions should also be shared between countries to underline the collective efforts in eradicating maternal mortality.
23 April 2013
Health Minister Aaron Motsoaledi has described the launch of the new triple combination antiretrovirals as a revolution.
Johannesburg — The Minister of Health, Dr Aaron Motsoaledi says the roll-out of the Fixed Dose Combination (ARV) during the 2013/14 financial year as announced last year is on track.
The Minister will formally launch the programme on the 8th of April 2013 at Phedisong 4 Clinic – Ga-Rankuwa, north of Pretoria.
“We will be starting with newly diagnosed HIV positive persons eligible for treatment, HIV positive pregnant women and breast-feeding mothers” said Motsoaledi.
Other Patients currently on ARV’s will be switched to the Fixed Dose Combination after clinical assessment by their health care providers.
There are about 1.9 million patients on ARV treatment in South Africa.
5 April 2013
By South African Departmment of Health
People living with MDR-TB and their healthcare providers call for urgent action
Download the manifesto: TB manifesto (PDF)
Read the ‘Test me, treat me’ manifesto and see who signed it at: msfaccess.org/TBmanifesto
“We have been waiting for half a century for new drugs that are effective against tuberculosis. Must we wait another fifty years to seize this historic opportunity to improve and roll out treatment for drug-resistant TB?” said Dr Erkin Chinasylova, TB doctor for MSF in Swaziland. “Getting better treatment is beyond urgent, but we are not seeing anything like the level of prioritisation required to make this a reality.”
MSF projects are seeing unprecedented numbers of people with MDR-TB around the world, with drug resistance found not only among patients who have previously failed TB treatment but also in patients newly diagnosed with TB – a clear sign that MDR-TB is being transmitted in its own right in the communities in which we work.
Left untreated, the infectious disease is lethal, but treatment today puts people through two years of excruciating side effects, including psychosis, deafness and constant nausea, with painful daily injections for up to eight months. Barely half of people get cured.
After close to five decades of insufficient research and development into TB, two new drugs – bedaquiline and delamanid – have recently been or are about to be approved.
Research is urgently needed to determine the best way to use these new drugs so that treatment can be made shorter and more effective, and rolled out to treat the growing number of people with MDR-TB. People on MDR-TB treatment and their caregivers from around the world outline these and other demands in the Test me, treat me manifesto, and urge others to join their call for urgent action.
“It’s 2013 and I’m beginning a fourth year of living with TB, when I should be in my fourth year at university,” said Phumeza Tisile, a 22-year-old woman who receives treatment for extensively drug-resistant TB from MSF in Khayelitsha, South Africa, and is one of the signatories of the manifesto. “I’ve swallowed around 20,000 pills and received over 200 daily painful injections since I started treatment in June 2010, and the drugs have left me deaf. I wish I could take just two tablets a day for a month or so and be cured.”
The number of people receiving MDR-TB treatment globally remains shockingly low, at less than one in five. Greater political and financial support from the international community is needed to address this gap.
“Right when TB should be the global priority, the trend we’re seeing is that it is being deprioritised. This is unacceptable,” said Dr Manica Balasegaram, executive director of MSF’s Access Campaign.
The Global Fund provides about 90 per cent of international support for TB, but it has recently reduced the share going to the disease. Ahead of a key replenishment meeting later this year, donors must ensure the Fund is adequately financed so that countries have the support they need to strengthen the MDR-TB response.
With better treatment on the way, affected countries should scale up efforts to diagnose and treat MDR-TB today, so that robust programmes are in place once the new drugs are introduced.
See MSF infographics on TB – length of treatment, side effects, access to treatment etc – at msfaccess.org/TBmanifesto
Drug-resistant forms of TB are a neglected global health crisis: the World Health Organization estimates there were 630,000 cases of MDR-TB in 2011. MSF started providing treatment to people with MDR-TB in 2001. In 2011, MSF provided treatment to 1,300 people with MDR-TB in 21 countries.
By Doctors Without Borders
19 March 2013
JOHANNESBURG, 6 March 2013 (IRIN) – The HIV/AIDS epidemic arrived in sub-Saharan Africa after decades of neglect had left healthcare systems dangerously weak, barely able to cope with the onslaught of patients. Then the money started pouring in – funding for HIV programmes rose from 5.5 percent of health aid in 1998 to nearly half of it almost 10 years later.
But the jury is still out on whether the large sums of AIDS funding have made healthcare systems more resilient, whether ” the capacity gains conferred over the past decade will be durable as donors pull out [and whether] previous, pre-aid boom fragilities in service delivery and volatility in public spending would be reduced in the post-donor period,” noted Amanda Glassman, director of global health policy and research at the Washington-based Center for Global Development.
Some have argued that the AIDS epidemic has helped generate an overall increase in health funding and mobilized an international push for more equitable healthcare access. But others maintain that the billions of donor dollars spent fighting HIV/AIDS in the last decade have done little to strengthen fragile national health systems.
In the initial, emergency phase of the epidemic, donors bypassed weak areas of national health systems to set up structures that would yield faster results. On the ground, this meant modern HIV/AIDS clinics, fully staffed and equipped, offering free services in one corner of a public hospital, while the rest of the hospital limped along with inadequate infrastructure, high user fees and staff shortages.
“It was appropriate and inevitable at the time. We had to react the way we did. Now, we need to be responsive to the current situation and what we learned,” said Alan Whiteside, executive director of the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal.
It is difficult to assess whether donor funding has increased resilience, but gains in health status and HIV/AIDS service coverage – such as the number of eligible people receiving antiretrovirals (ARV) and the number of pregnant women receiving services to prevent mother-to-child transmission of the virus – suggest that health-system capacity has been strengthened, Glassman told IRIN.
Even with its health sector crippled by tuberculosis (TB) and HIV epidemics, South Africa’s antiretroviral programme is now the biggest in the world – over 1.7 million HIV-positive people are treated by the government. And in this year’s budget speech, Finance Minister Pravin Gordhan announced plans to put an additional 500,000 people on treatment each year.
“The [treatment programme] has added staff and resources to the base of the health system, brought in a whole lot of technical assistance from the outside, and, in an intangible way, it has raised hope amongst [healthcare] providers,” said Helen Schneider of the School of the Public Health at the University of the Western Cape.
“The [treatment programme] has added staff and resources to the base of the health system … and, in an intangible way, it has raised hope amongst [healthcare] providers” HIV treatment programmes have created new regiments of healthcare workers, including lay counsellors and patients with good ARV adherence who assist with adherence counselling through clinics and community outreach. The community outreach approach has been extended to home-based care for patients with extensively drug-resistant TB. In addition, to deal with the scarcity of doctors, nurses have been certified to initiate HIV treatment and to expand access to HIV treatment.
Community health has been positively affected. A recent study conducted in South Africa’s KwaZulu-Natal Province – one of the regions hardest hit by the HIV epidemic – found that increased access to ARV therapy has raised adult life expectancy by more than 11 years since 2004. The observed increase in life expectancy was one of the most rapid in the history of public health, noted the authors of the study, released in the February edition of the journal Science.
But major challenges remain – particularly for countries that are over-reliant on international funding and that still don’t spend enough of their domestic budgets on health.
The real test
As AIDS becomes a chronic and manageable condition, donors are turning their attention to strengthening health systems. The Global Fund to Fight AIDS, TB and Malaria has acknowledged that weak health systems have limited the performance potential of its projects. The US President’s Emergency Plan for AIDS Relief (PEPFAR) is looking at a “deeper integration of HIV services into existing national programs and systems”.
And the real test to measure the resilience of health systems is yet to come. “We won’t really know if that strengthening can be sustained until donors phase out,” Glassman told IRIN.
Savvy recipient countries that have used donor funds earmarked for specific diseases to build their health systems will fare better. Rwanda, for example, used its Global Fund and PEPFAR monies to fund insurance coverage for the poor, including benefits related to HIV, TB and malaria.
“Governments that allowed all the donor spending off-budget on AIDS will have a major problem building resilience, and the transition arrangements [for when donors pull out] in those settings are still vague,” Glassman warned.
By Kanya Ndaki
6 March 2013
Durban – Staff at McCord Hospital in KwaZulu-Natal have received notices informing them that it would close in March, the Sunday Times reported.
This comes after the provincial health department said it would no longer provide the hospital with an annual subsidy.
In the notice, the hospital’s chief executive, Kevin Smith, says: “McCord has not received notification of an intention to renew this funding. As a result of the loss of this grant funding, McCord loses its licence to operate as a state-aided hospital and cannot afford to continue operating.”
McCord is one of KwaZulu-Natal’s largest hospitals, consisting of 140 beds and 400 staff. It also runs the country’s biggest HIV care and treatment programme.
The hospital is scheduled to stop all healthcare services on 31 March, according to the report.
Patients will be referred to other state-funded hospitals in the city of Durban.
The province’s Health MEC Sibongiseni Dhlomo declined to comment on the matter.
20 January 2013
JOHANNESBURG, 15 January 2013 (PlusNews) – The only HIV vaccine trial to achieve moderate success took place four years ago, yet it continues to reveal new information about the virus and renew hopes for a future vaccine.
In 2009, researchers released the findings of a six-year HIV vaccine study carried out in Thailand known as RV144. Conducted among 16,000 HIV-negative men and women, the trial found that HIV infection rates were 31 percent lower among participants who received the vaccine than in those who had not.
It was an encouraging protection rate, but short of the minimum 50 percent prevention rate required to slow the epidemic, which afflicts an estimated 34 million people worldwide, according to researchers at Duke University in the US.
Now, researchers say they have a better understanding of why the vaccine might have worked – and possible new targets for future vaccines.
Released in a recent edition of the journal Immunity, the study found that the vaccine prompted an immune response from four different antibodies.
Researchers from Duke University, the US Military HIV Research Programme and the Thailand Ministry of Public Health used data collected from three of the trial’s participants to determine that these antibodies worked on an important site on the surface of HIV-infected cells. These antibodies essentially marked infected cells for death by natural killer cells, part of the body’s immune response.
The research could change the way future HIV vaccines are designed.
According to study co-author and Duke Human Vaccine Institute director Barton Haynes, the findings show the importance of often ignored “variable” sites on the surface of infected cells for vaccine research. Traditionally, most researchers have shied away from pinning their hopes on such sites because they differ across strains of HIV, he told IRIN/PlusNews.
He cautions, however, that researchers cannot say for certain this kind of immune response was the reason behind the Thai trial’s limited success.
This study follows similar results from South African research that may have identified yet another novel vaccine target. The South African research looked at broadly neutralizing antibodies that target and bond with specific sugars, blocking the virus from infecting healthy cells. According to Haynes, an ideal HIV vaccine candidate would be able to induce both types of immune responses.
HUMAN rights lawyers representing a group of HIV-positive Zimbabweans incarcerated in Botswana are set to file papers in the Gaborone High Court later this month to force the state to provide anti-retroviral treatment to foreign inmates.
The Botswana Network on Ethics, Law and HIV/Aids (Bonela), which advocates for the rights of people living with the disease, says the Zimbabwean detainees have gone without this essential medication for years because imprisoned foreigners are not allowed access to HIV treatment.
In the class action representing four men and a woman, Bonela wants the court to order the Botswana government to provide the life-saving drugs to all foreign prisoners.
One of the prisoners, George Vingaso, was extradited from South Africa’s North West province and convicted of car theft in Botswana where he is now serving a 10-year sentence at Gaborone Central Prison.
Vingaso tested positive after being arrested in South Africa where he was put on ARV therapy, but the treatment stopped after his extradition and subsequent imprisonment in Botswana.
Without drugs, Vingaso’s CD4 count dropped and his health is said to have deteriorated rapidly.
Doctors who first examined him in Botswana in 2010 discovered he had developed boils, swollen legs and breathing problems. Bonela then filed a court application requesting government to comply with a previous court order to supply Vingaso with ARVs, but that was ignored.
Human rights lawyers said government’s inaction was risky as Vingaso’s low CD4 count exposed him to deadly opportunistic infections such as tuberculosis, a common disease in overcrowded and poorly sanitised Botswana prisons such as Gaborone Central Prison.
Bonela executive director Uyapo Ndadi said the prisoners’ state of health was serious with Vingaso’s condition being the worst.
“All of them are sick and their situation is dire,” said Ndadi in a telephone interview. “Their CD4 counts are low and this makes them vulnerable, but they are not yet sick. The other prisoner (Vingaso) has a very low CD4 count and he has been struggling with the illness for about three years now,” he said.
Ndadi said Vingaso was not receiving ARVs, despite a 2008 court ruling by the Village Magistrates Court ordering the government of Botswana to provide the necessary treatment. “The government has ignored the order,” said Ndadi.
In 2010, Vingaso’s court application requesting the ministry of health to provide ARVs was successful, but the ministry refused to comply claiming it is too expensive to provide free ARVs for foreign prisoners.
Botswana’s locally manufactured ARVs are provided free only to Batswana; foreign nationals have to pay for them.
A month-long supply of drugs retails for P180 (about US$22,90), slightly cheaper than in Zimbabwe where ARVs cost US$30.
Bonela argues that denying anyone ARVs constitutes inhuman treatment and discrimination under Sections 7 and 15 (3) of Botswana’s Constitution, and intends to present medical evidence to show how going without ARVs has affected terminally ill prisoners.
“We have spent about a year compiling affidavits and obtaining medical tests,” Ndadi said. “We are preparing to file our papers and if there is a material dispute then the matter will go to trial,” he said.
Ndadi said he was hopeful of Bonela’s chances of success this time.
According to defence and security expert, Martin Rupiya of the Pretoria-based Institute for Security Studies, many African governments have responded to the HIV pandemic in prisons like “ostriches with their heads buried in the sand”. Speaking at an AU conference in South Africa in November last year, Rupiya said African governments had failed to effectively curb the HIV scourge.
He said ignoring infected foreign prisoners was risky as foreigners sometimes carry different or more complex strains of the HIV virus which can undermine a government’s efforts to fight the disease.
“The hosting of foreign nationals sometimes brings different strains of the viruses that effectively challenge national programmes and existing drug protocols,” Rupiya said.
“The result is the creation of a constituency within communities that remains excluded and therefore immune from the various public health campaigns, including the most recent ARV treatment and increased access campaigns,” he said.
Challenging the right to access ARV treatment and protesting poor prison conditions appear to be a growing trend in southern Africa.
Beyond Botswana and a historic victory in 2006 by South African Aids activists, courts in Zambia and Zimbabwe are due to hear cases of imprisoned HIV patients claiming denial of ARVs constitutes an infringement of the right to health.
By Tendai Marima
11 January 2012
HARARE, 11 January 2013 (PlusNews) – Chronic shortages of generic and antiretroviral drugs, stock-outs, high medication costs, and long distances to clinics are some of the hurdles people face in their quest to access essential medicines in Zimbabwe.
At any given time, public health facilities in much of Zimbabwe have in stock only half of a core set of critical medicines, according to findings from civil society groups working to improve access to medicines in Southern Africa.
Zimbabwe is still recuperating from a drastic decline in health services caused by sub-optimal investments in healthcare and an unprecedented economic crisis in 2008, during which the local currency crashed.
To make matters worse, over 80 percent of the country’s drugs are externally funded.
A poorly resourced local pharmaceutical industry can barely provide the country with its essential medicine requirements, and government-backed institutions, such as the National Pharmaceutical Company of Zimbabwe (NatPharm), which is mandated with securing drugs and healthcare products on behalf of state institutions, are struggling to survive.
“NatPharm is government funded, and we are supposed to procure medicines for onward supply to health institutions, but this is not happening because our shareholder, the government, has not been able to fund us lately,” NatPharm director Charles Mwaramba told IRIN/PlusNews. “We just woke up one day in 2009, and we did not have any money for operations.”
Since then, government has not been able to pay NatPharm. In the 2013 national budget, NatPharm did not even get an allocation, and has been forced to make ends meet by storing medicines for NGOs and other clients for a fee.
Itai Rusike, the executive director of the Community Working Group on Health, a network of civil society organizations, warns that depending on donors to supply the country with medication is “unsustainable.”
“The health sector is severely crippled by all sorts of problems, not least of them poor government funding and skewed priorities. Where is our voice as civil society when NatPharm is not being funded? We need a strong voice in the health sector because health is a fundamental human right. We must not be cowed into silence, fearing authority will come down us,” Rusike said.
A regional problem
But Zimbabwe’s ailing pharmaceutical sector is not alone.
Recent surveys conducted by the Southern Africa Regional Programme on Access to Medicines and Diagnostics (SARPAM) in the Southern African Development Community (SADC) region have found evidence of market failures resulting in uncompetitive drug pricing and unstable availability of medicines, which compromise the health and well-being of people living in the region.
Civil society groups are hoping the roll-out of the Tendai – an acronym for Tracking Essential National Medicines and Diagnostics Access Initiative -project will monitor the availability of medications at healthcare facilities and gradually bring about some improvement. Under the initiative, community health workers from a network of civil society partners use mobile phones to collect data on the availability of medicines at points of access in participating countries, which include South Africa, the Democratic Republic of Congo and Zimbabwe.
SARPAM coordinates the data collection using customized open-source survey software. The software allows monitors to capture many types of instantly accessible data, including digital surveys, voice recordings and photos that provide insight into real issues at the community level. The data can be shared immediately with social networks and mailing lists.
“SADC is an epicentre of illnesses, yet policymakers and governments are still not prioritizing medicines,” said Daniel Molekele, the SARPAM civil society coordinator.
Although Tendai is still in its infancy, data generated in the pilot stages have been helpful in identifying problems, monitoring interventions, building awareness and adding to the dialogue around access to medicine, Molekele added.