By Carole Leach-Lemens
Engaging lay counsellors to provide a combination package of evidence-based interventions in Nyanza, Kenya and addressing partner disclosure, as well as pre-treatment education about the benefits of antiretroviral therapy (ART) for maternal and child health in Malawi’s Option B+ programme, improved retention in care and reduced loss to follow-up of mothers with HIV and their infants, studies presented last week at the Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston show.
Poor retention in care of mothers with HIV and their infants across the prevention of mother-to-child transmission (PMTCT)/paediatric care continuum continues to undermine what is otherwise a remarkable success. If retention is not adequately addressed, programme success and maternal and infant health are threatened. In resource-poor settings, studies have shown 17% of pregnant women with HIV initiated on ART do not return after their first antenatal care visit; one third of women with HIV who give birth in a clinic are lost to follow-up three months after delivery.
By Bob Roehr
01 March 2016
A new understanding of the role gut microbiota plays in HIV disease is beginning to emerge, suggesting potential new strategies to manage the infection
HIV is a disease of the gut, a concept that’s easy to lose sight of with all the attention paid to sexual transmission and blood measurements of the virus and the CD4+ T cells it infects and kills. But the bottom line is that about two thirds of all T cells reside in the lymphoid tissue of the gut, where the virus spreads after exposure, even before it shows up in blood. Blood, however, has been the focus of research and care because it is easy to sample and broadly represents what is going on throughout the entire body.
The gut is a lot harder to access, which is why much of it remains a crudely delineated terrain that can only be examined with blunt and invasive tools. But a better understanding of the gut environment will be necessary to achieve the next level of advances in comprehending the disease and fashioning better interventions, researchers said last Wednesday at the annual Conference on Retroviruses and Opportunistic Infections in Boston. “Why do we care about the microbiome?” asked Nichole Klatt, a University of Washington (U.W.) pathobiologist, whose lab focuses on mucosal immunology. Klatt, who organized and chaired the conference session, answered her own rhetorical question, summarizing that HIV infection decreases the number and diversity of beneficial bacteria and increases those that have negative effects on the gut.
NEW DELHI – The Global Fund to Fight AIDS, Tuberculosis and Malaria praised India’s leadership and vision for launching an ambitious national framework to eliminate malaria by 2030, and called the country’s significant progress against the disease an example in global health
With the support of many partners, India has seen a dramatic decline in malaria rates and malaria deaths. Through combined interventions that include rapid diagnostic tests, artemisinin-based combination therapy, long-lasting insecticidal nets and indoor residual spraying, India is projected to achieve a fall in case incidence of 50-75 percent between 2000 and 2015
“India is showing others that with commitment, partnership and innovative strategies we can eliminate malaria,” Mark Dybul, Executive Director of the Global Fund, said during the presentation of the National Framework for Malaria Elimination in India 2016-2030 and the Operational Guidelines for Malaria Elimination in India. “This framework is a hugely important step that gets us closer towards that goal.
J.P. Nadda, Minister of Health and Family Welfare of India, stressed his country’s engagement to eliminate the disease.
“I can only assure you that the Government of India fully stands committed to the malaria elimination program, with the support of all stakeholders,” said Nadda.
During a two-day meeting that brought together the Government of India, WHO, academics and the Indian and global public health sector, partners discussed strategies and implementation of the framework, innovation and research, health system strengthening, and shared experiences for malaria elimination.
Under the framework, India aims to eliminate malaria (zero indigenous cases) throughout the entire country by 2030, and maintain malaria-free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria. Elimination will be undertaken in a phased manner, with states with low incidence rates first, followed by the high-incidence ones.
The framework is in line with the Asia Pacific Leaders’ Malaria Alliance Malaria Elimination Roadmap for 2030.
India’s commitment to regional malaria elimination is timely. Emerging drug resistance in the Greater Mekong region is threatening the progress made toward elimination. Resistance to artemisinin – the most commonly used drug worldwide against malaria – has been detected in Myanmar, Thailand, Viet Nam, Laos and Cambodia.
Prior to the integration of Ausaid and DFAT in November 2014, I had been on the periphery of aid policy issues for some 35 years.
Like many on the periphery, I had strong views.
I was a sceptic about the historical record of development assistance.
Indeed I had some sympathy for the view that aid was, for the most part, an area of policy failure paved with the best of intentions.
These days I do not have the luxury of armchair pontification.
The more I have been involved in aid policy as head of the Department responsible for its delivery, the more nuance has crept into my views.
The balance sheet today looks less stark.
The policy challenges are genuinely complex.
It is still my view that the most important ingredients of economic success for poor countries are good policies and good leadership.
No aid program can compensate for their absence.
But well thought through aid programs certainly can contribute to their presence.
Today I want to focus on three things.
First, I want to address three conceptual issues which are central to our aid program.
I want to address the link between private sector led economic growth and poverty reduction.
I want to explore the links between security and development.
And I want to say something about the anatomy of that difficult task of state-building.
Second, I want to talk about how we are addressing these concepts in the very different contexts of Asia, the Pacific and globally.
Finally, I want to say something about innovation and why we want it to have a more prominent place in our aid policy thinking.
Economic growth, the nature of that growth and poverty reduction
Let me start by exploring the links between private sector-led economic growth and poverty alleviation.
This is important because too often the debate about growth and poverty reduction turns into an either/or choice between poverty and growth.
This is a false dichotomy.
Generating growth in developing countries is always a balancing act between supporting overall economic development and supporting the poor to participate in that development.
That’s why in Australia’s aid program there continues to be considerable investment in human and social development, in social protection, in women’s empowerment and in disability inclusive development.
The empirical evidence on the centrality of economic development as a driver for poverty reduction is clear.
China is the obvious example.
More comprehensively, a 2013 World Bank analysis of growth and income changes across 118 countries over four decades shows that incomes of the bottom two quintiles in the population grew at about the same rate as the average annual incomes.
The report found that economic growth lifts people out of poverty and leads to shared prosperity on average.
It also helps to explain how the rapid growth in the developing world in recent decades has led to such dramatic poverty reduction.
What is also becoming clearer is that poverty in a country acts as a handbrake on growth.
In an American Economic Review article from a few years ago, Georgetown University Professor of Economics Martin Ravallion, found that poorer countries experience lower rates of economic growth.
In other words: poor countries grow slower.
Part of the solution comes with an emerging middle class.
A larger middle class makes growth more poverty-reducing – the handicaps faced by poor countries in their efforts to become less poor are very difficult to overcome.
Part of the population is caught in a poverty trap and doesn’t have the basic capabilities to respond to the opportunities that economic growth presents.
Finally, there is growing acceptance that countries with less inequality experience faster and more durable growth.
There is a clear consensus that sustainable job growth can only be delivered by a larger private sector.
There is also an emerging consensus on the importance of focusing on women’s empowerment and supporting women’s engagement in the economy and society.
It generates more growth — and growth that is more poverty reducing and more sustainable.
Recent McKinsey analysis suggests that if every country were to advance gender equality as well as its best performing neighbour, global GDP would increase by around $12 trillion or 11 percent over the next decade.
Indeed, the very first line of the McKinsey report sets out exactly what’s at stake:
‘Gender inequality is not only a pressing moral and social issue but also a critical economic challenge. If women – who account for half the world’s population – do not achieve their full economic potential, the global economy will suffer.’
Importantly, supporting economic development involves much more than development assistance alone.
The Howard Government decision in 2003 to remove tariffs and quotas from imports from Least Developed Countries has seen imports from those countries grow at an average rate of 16 percent per year over the past decade.
In 2015, Australia’s two-way merchandise trade with countries with which Australia has an ongoing bilateral development partnership was valued at about $33 billion – more than ten times the value of the development assistance.
The Government’s economic diplomacy agenda recognises that the deployment of our foreign policy, trade and development instruments in an integrated manner delivers a better overall result.
Aid-for-trade investments without focusing on stronger market access make little sense.
Abd Al Gader could barely walk when he arrived at a refugee camp in Jordan fleeing the war in Syria. After receiving treatment for TB, the 12-year-old is strong enough to play football and attend one of the camp’s schools.
Abd Al Gader, a 12-year-old with big, dark eyes, could barely walk when he arrived at the Zaatari refugee camp in the Jordanian desert after escaping the war in Syria. Suffering from tuberculosis and having run out of medicine, Abd Al Gader fled with his family from their farm east of Damascus with the few belongings they could carry and embarked on a dangerous journey towards safety.
Abd Al Gader’s cough worsened as the family trekked for days, sleeping in the open during cold, February nights and enduring shelling and thieves, before finally reaching the border. “We lost our crops and our house was destroyed,” said the boy’s father, Awash. “I feared for his life. That is when I decided we had to leave.”
In Zaatari, the family settled into a tentAbd Al Gader resumed his TB treatment at the camp’s clinic. Today, cured of the disease, he is strong enough to play football with his friends in a dusty pitch and to attend one of the camp’s schools.
In cooperation with local and international partners, the Global Fund is supporting the provision of essential TB prevention, diagnosis and treatment services to Syrian refugees in Lebanon and Jordan. The assistance comes from the Global Fund’s Emergency Fund, a special initiative to provide quick, flexible access to funds to respond to HIV, TB and malaria in acute emergency situations.
Tuberculosis, a highly infectious disease spread from person to person through the air, can move quickly in close quarters like a crowded refugee camp. Stopping TB is necessary, not only to protect refugees immediately at risk, and also to free up critical resources within refugee settings to treat basic illnesses, which are chronic in emergency situations like the Syria crisis. Since the outbreak of the conflict, more than 4 million Syrians have sought shelter in neighboring countries, mostly in overcrowded camps like Zaatari and in informal settlements with no or limited access to health services. Infectious diseases such as TB are increasing the burden on already overstretched public health systems.
“To defeat these diseases we must follow the people wherever they are, regardless of their status, circumstance, or ethnic and religious background,” said Mark Dybul, Executive Director of the Global Fund. “Partnerships like this give us the flexibility to respond quickly and better serve the people in need.”
Global Fund grants in the region are funding interventions that include TB diagnostics and treatment, screening of refugees upon arrival, strengthening referral services, training of health workers and raising awareness of the disease. The International Organization for Migration is implementing the programs in collaboration with WHO and the National Tuberculosis Programs of Jordan and Lebanon.
Since the program started, there have been more than 400 confirmed cases of TB in Jordan and Lebanon and four cases of multidrug-resistant TB in Jordan (according to 2014 data, the latest available), and the success rate of TB treatment among Syrian refugees is 90 percent. The Global Fund is extending emergency interventions in Lebanon and Jordan, and providing funding for TB services for Syrian refugees in Iraq.
The Zaatari camp now houses 79,000 refugees. Like most refugees, Abd Al Gader’s family first moved into tents, later replaced by prefabricated shelters. The father has built a kitchen and bathrooms, but dreams of returning to Syria one day. Abd Al Gader’s cough is now gone, but needs to pause to catch his breath when he plays football. When asked what he wants to do when he grows up, his eyes light up: “I want to be a football player for Barcelona FC.” He pauses, then adds: “Or maybe an architect and rebuild Syria.”