University of California San Francisco – News Center
By Jeff Sheehy
(left) A Kenyan farmer stands in a field of irrigated crops made possible by intervention program Shamba Maisha. Photo by Rachel Steinfeld
(right) A group of Kenyan farmers standing with co-primary investigator Craig R. Cohen (right) and co-investigator Rachel L. Steinfeld (center)
A multifaceted farming intervention can reduce food insecurity while improving HIV outcomes in patients in Kenya, according to a randomized, controlled trial led by researchers at UC San Francisco.
The study found that participants in the intervention arm, who received agricultural and financial support, were able to increase the quantity and quality of food consumed. At the same time, their CD4 T-cell counts increased and their rate of viral suppression increased by about one half. In contrast, both the CD4 cell counts and the rate of suppression fell for those in the control arm.
“While this was a pilot study, these results prove the concept that improving food insecurity and alleviating poverty can affect HIV clinical outcomes,” said the trial’s co-primary investigator, Sheri D. Weiser, MD, MPH, UCSF associate professor of medicine at the UCSF Division of HIV, Infectious Diseases and Global Medicine at San Francisco General Hospital.
In sub-Saharan Africa, where 24.7 million people are living with HIV (71 percent of all people living with HIV), 240 million people are food insecure. Food insecurity increases the risk of becoming infected with HIV and food insecure people with HIV are less able to take anti-HIV therapies and make clinic visits, and have poorer nutritional status. Together, those issues make treating and preventing HIV more difficult, leading to sicker patients and more deaths. In turn, once someone is infected with HIV, food insecurity gets worse due to loss of economic activity and productivity, loss of social support due to HIV stigma and the costs of medical care.
“HIV/AIDS and food insecurity are intertwined in a vicious cycle, with each increasing vulnerability to and exacerbating the severity of the other,” Weiser said. “We have the biomedical tools to treat and prevent HIV, but we need interventions like this that combine healthcare with development, and address food insecurity, poverty and disempowerment if we are to achieve the UNAIDS goal of ending the HIV/AIDS epidemic by 2030.”
The trial, conducted over one year at two Family AIDS Care & Education Services (FACES) health facilities in the Nyanza region in Kenya, enrolled 72 participants at one facility for the intervention group and 68 at the other facility for the control group. Participants were HIV positive individuals between 18 and 49 years old on anti-HIV therapy and all had access to surface water for irrigation and land.
The intervention, titled Shamba Maisha, Swahili for “Farm Life,” had three components. Microfinance loans were provided by and managed by Adok Timo, a Kenyan microfinance organization, with support from the two collaborating partners in FACES: UCSF and the Kenyan Medical Research Institute. These loans were used to purchase farming implements and supplies along with manual irrigation pumps designed by KickStart, a non-profit organization that develops and markets new technologies that are used to establish new small businesses.
“The pumps make it possible for farmers to irrigate year round, which reduced dependence on seasonal rainfalls. Producing food year round enables farmers to move from subsistence farming to commercial farming and also allows them to capture higher crop prices during the dry season,” said the trial’s co-primary investigator, Craig R. Cohen, MD, MPH, UCSF professor in the Bixby Center for Global Reproductive Health in the department of obstetrics, gynecology and reproductive sciences.
The third element was agricultural and financial management training. Agricultural training included practical demonstrations on sustainable farming techniques, use of the water pump, planting, soil and water conservation, and integrated disease and pest management. Financial training focused on record keeping, along with savings and investments.
“Shamba Maisha is the first trial to link agriculture with HIV outcomes,” Cohen said. “The intervention is unique in that it is sustainable, transformative and empowering. If you were to take away our involvement tomorrow, the knowledge and materials to continue the livelihood intervention would still exist in the community.”
Labor Senator Jenny McAllister speaks at the LIFE Programme in Ho Chi Minh City, Vietnam for an LGBTI meeting and cultural performance. The LIFE Programme is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria and is dedicated to reducing new HIV infections within the community through peer support programs, counseling, education and condom distribution.
Globally, the Global Fund has helped put an additional 1.5 million on treatment for HIV, a 22% increase since 2014, bringing the total to 8.1 million people. A total of 5,100,000,000+ condoms have been distributed throughout the world.
by Bianca Auping-Kamps –Senior Fund Portfolio Manager, the Global Fund
In remote parts of Papua New Guinea, focusing HIV prevention on those most at risk of the virus is not straightforward. I was confronted with this in Port Moresby recently as I discussed the condom use of sex workers with some of the Global Fund’s implementing partners.
What happens, for example, when someone is trading sex for transport? While they may not identify as a sex worker, they are nonetheless potentially exposed to HIV. Reaching people like this is an absolute necessity.
Challenges like this informed a new grant we formalised in Papua New Guinea today. While Papua New Guinea has made good progress in reducing its HIV epidemic, only a grassroots, community-led approach will make fresh inroads against the disease.
That’s why the new grant focusses on behaviour. It looks at how people at risk of HIV act in the real world, but also the attitudes of those who need to support them, such as medical and criminal justice workers. In Papua New Guinea, gender based violence and stigma against men who have sex with men and transgender people is still very real. So the solutions need to be grounded and realistic.
For example, peer leaders in the transgender community will be trained to distribute condoms among their friends and colleagues and point them towards medical services, when necessary. Since these peer leaders will work with specific clinics, trust will deepen. At the same time, health workers will be trained to be more sensitive and receptive to groups such as men who have sex with men. In a more trusting, open environment, people are more likely to discuss their behaviour and address risk.
Today’s grant agreement is a good encapsulation of the Global Fund Partnership. Partners such as the Australian and US Government have worked with people affected by HIV as well as Papua New Guinea churches, health officials and private sector partners such as Oil Search Health Foundation to create this program. No one has all the answers but by working together in partnership we can have a genuine impact.
Global Fund News Flash
Viral load testing is the best way to know if a child is HIV positive. It’s also a powerful tool to determine if HIV drugs are working. The problem is that until now, the tests were often prohibitively expensive and contract terms varied.
New agreements struck between the Global Fund and seven diagnostic manufacturers aim to change that. After a year of in-depth negotiation and intense study of the market, the Global Fund sourcing team believes it’s found a route to affordable and stable prices, better contracting, and hopefully, expanded testing.
The manufacturers have agreed to provide the test components at a stable and competitive all-inclusive price as low as US$15 per test, which includes the cost of testing equipment. Today, tests can cost as much as US$85.
A more competitive price is welcome, but Christopher Game, the Global Fund Procurement head, explained that it’s not the only benefit of the agreement.
“What we were really after was transparency and reliability,” Game said. “So yes, the price reduction is great, because it will free up money to do more testing. But just as importantly, we now have transparency around the various components of that price, such as transport and machine maintenance.”
The machines required for the tests don’t come cheap, selling for around US$150,000. By stabilizing the other elements required to test, Game and his team expect to see an expansion in the number of tests done.
The agreement should deliver net savings of at least US$30 million over three years to the Global Fund, and potentially much more. Seven manufacturers have been through a technical and commercial evaluation before being added to the panel of suppliers. The framework agreements last at least three years. Other public health funders and agencies will also be able to enter into agreements based on the benchmark prices and contracting negotiated.
GENEVA, 18 May 2015—On HIV Vaccine Awareness Day, UNAIDS is calling for a renewed global commitment to finding an effective HIV vaccine.
“A vaccine would be a major step towards ending the AIDS epidemic,” said UNAIDS Executive Director Michel Sidibé. “There have been encouraging recent scientific advances that give us hope for the future development of an HIV vaccine.”
UNAIDS is committed to leaving nobody behind in the HIV response. A major advantage of vaccines is that they promote equity and can be used effectively in all communities and settings, including those where many other health services can be harder to deliver.
Studies show that an HIV vaccine is possible. The RV144 vaccine trial in 2009 lowered the rate of HIV infection by 31%. There is much hope that ongoing research will build on this trial and deliver results. Newer vaccine candidates, as well as neutralizing antibodies, are also being studied.
Vaccines have eradicated smallpox, and polio is close to eradication. Vaccines have also effectively controlled diphtheria, pertussis, tetanus, mumps, measles and rubella, among other infectious diseases.
However, in 2013, HIV vaccine research and development saw the largest decline in investment since 2008. In order to transform promising concepts into an effective and accessible vaccine increased and sustained funding will be critical.
Global Health News
Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.