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HIV Drug Implemented in Kenya
In 2017, there were approximately 36.9 million people living with HIV/AIDS worldwide. Additionally, 6.1 million of those with HIV were located in western and central Africa. Kenya, a country in eastern Africa, had approximately 1.5 million people living with HIV/AIDs in 2017. That same year, an HIV drug implemented in Kenya started to successfully combat this deadly immune system virus. Unitaid and the Kenyan government simultaneously introduced it to the country.

Dolutegravir and Antiretroviral Therapy

The new HIV/AIDS drug, Dolutegravir or DTG, received approval in 2014 and is the most recent and effective antiretroviral drug used in the treatment against HIV/AIDs. DTG has been the drug of choice in high-income countries for its antiresistance properties, few side effects and easy one pill a day treatment. In 2015, the World Health Organization recommended this drug replace other first-line regimens for adults and adolescents. Recently this drug was not available in low-income countries, like Kenya, because of its high cost.

In 2018, only 62 percent of people with HIV/AIDs had access to antiretroviral therapy, which was an increase from the previous year. This corresponds to the 23.3 million people who were able to receive treatment, however, approximately 14.6 million people could not access treatment. In Kenya, 75 percent of adults with HIV/AIDs received treatment in 2018, which increased from 2016, when only 64 percent of people received treatment. One reason for the increase in HIV/AIDs testing is the partnerships between the government of Kenya and Unitaid that began in 2017 which introduced the generic brand of DTG.

Now, the generic brand of this life-saving drug has been available to people in Kenya since early 2018. This new HIV drug implemented in Kenya has the potential to make life-saving drugs more accessible to those who would normally not be able to afford it. In 2017, a number of nonprofits including the Bill & Melinda Gates Foundation, Unitaid, USAID, PEPFAR and others agreed to a pricing agreement to help make the drug more affordable in developing countries. This pricing agreement would allow public sector purchases at $75 per person, per year.

Side Effects of Other Drugs

Before the introduction of DTG, the first-line drug in Kenya was Efavirenz, an antiretroviral medication with side effects for some users including nausea, dizziness, rash and headaches. When the pricing agreement first emerged, the Kenyan Ministry of Health decided that the first round of DTG it distributed would go to 27,000 people who suffered the negative side effects from efavirenz. Then, the Ministry of Health assigned various other health clinics to receive the drug until it could become available to the entire country.

The number of new HIV/AIDs diagnoses in Kenya has halved over the last decade to approximately 80,000 people a year. The new HIV drug implemented in Kenya will only help decrease the number of people suffering from HIV/AIDs. Comprehensive sex education, HIV/AIDs testing centers and the continuation of drug pricing agreements will help alleviate the prevalence of HIV in developing countries, like Kenya.

Hayley Jellison
Photo: Flickr

UNAIDS: Efforts to End HIV/AIDS in East and Southern Africa
UNAIDS is the international movement working to end the HIV/AIDS epidemic worldwide by 2030, which aligns with the U.N.’s Sustainable Development Goals. Its fight against HIV/AIDS in East and Southern Africa has seen encouraging results.

In 2016, UNAIDS created the 90-90-90 targets for 2020, aiming to have 90 percent of all people with HIV know they are HIV positive, 90 percent of those who know their status receive antiretroviral therapy (ART) consistently and 90 percent of those receiving treatment show viral suppression (having no symptoms of HIV/AIDS).

HIV/AIDS in East and Southern Africa a Main Target of UNAIDS

East and Southern Africa is the region of the world most impacted by HIV/AIDS. UNAIDS estimates that 19.4 million people in that region have HIV/AIDS. However, since the creation of the 90-90-90 targets and the subsequent implementation of more rigorous prevention and treatment programs, tremendous progress has been made towards curbing the transmission of and deaths from HIV/AIDS.

These statistics show how East and Southern Africa are faring in each of the 90-90-90 categories:

  1. Knowing Status
    According to a UNAIDS Special Analysis from 2017, in 2016, 14.7 million of an estimated 19.4 million people with HIV/AIDS in East and Southern Africa knew their status. That is 76 percent, up from 72 percent the previous year.
  2. Receiving Antiretroviral Therapy
    Seven million people with HIV/AIDS in East and Southern Africa are on ART. This means that 60 percent of all people with HIV (up from 53 percent in 2015)—or 79 percent of those who know their status—are receiving treatment.
  3. Showing Viral Suppression
    Seven million people on ART in this region show suppressed viral loads. Thus, 50 percent of people with HIV in East and Southern Africa (up from 45 percent in 2015)—which is equivalent to 83 percent of those receiving ART—show viral suppression.

Both the infection rate and death rate from HIV/AIDS are improving. Infection rates peaked between 1995 and 1998, when UNAIDS estimates that 1.7 million people in East and Southern Africa were newly infected each year. The decline began in 1990 and has continued. In 2016, UNAIDS estimated that 790,000 people contracted HIV/AIDS, down from 850,000 a year before.

Deaths from HIV/AIDS in East and Southern Africa peaked about a decade later than infection rates did, with approximately one million people dying annually between 2004 and 2006. In 2010, 720,000 people died from HIV/AIDS. By 2016, that number had dropped by nearly 50 percent to 420,000 deaths. As UNAIDS notes, it is extraordinary to see a death rate cut nearly in half in just six years.

Much of this recent success must be attributed to the work of UNAIDS, which is working to make testing and treatment of HIV/AIDS available to everyone. Its programs specifically target young women, pregnant mothers-to-be and males who, because of the stigma around HIV/AIDS, are often the least likely to receive proper treatment.

Multi-Pronged Efforts Reach Most Vulnerable Populations

Efforts aimed at young females including getting comprehensive sex education into all primary and secondary schools in East and Southern Africa, encouraging girls to stay in school (and away from dangerous sex work), and providing easily accessible female and reproductive healthcare.

UNAIDS is also helping to equip maternity clinics with what they need to ensure that all pregnant women will be aware of their HIV status and are able to get the care they need to have a healthy pregnancy.

Along with working to end the stigma around HIV/AIDS and providing accessible places to receive testing and treatment, UNAIDS aims to distribute 30 male condoms to every man living in the region each year. It also offers voluntary male circumcision programs, which can help prevent female to male HIV transmission.

East and Southern Africa may be the region most affected by HIV/AIDS, but UNAIDS is doing tremendous work towards achieving its 90-90-90 goals by 2020 and its goal of ending the HIV/AIDS epidemic by 2030. Continuing to spread awareness about HIV/AIDS and making testing and treatment increasingly available will ensure that these successes continue.

– Abigail Dunn
Photo: Flickr

Treating HIV in Saint PetersburgIf Saint Petersburg were the same today as it was ten years ago, it would be known as one of the top five cities in the Russian Federation affected by the HIV virus. However, it is now the fourteenth most affected city. Treating HIV has been a top priority for the city, and as a result it has been able to get the epidemic under control. Saint Petersburg is the first city in the Russian Federation to achieve a steady decline in HIV infections, and fewer people are becoming infected with the virus throughout the city.

Last year, about 1,750 people were newly diagnosed with HIV in Saint Petersburg alone, a number that was even higher in the years before. In total, 42,000 people in the city were living with HIV. The city was able to get 80 percent of the people affected access to services at the Center for AIDS Prevention and Control.

The Center for AIDS Prevention and Control provides antiretroviral therapy (medicine that directly treats HIV), useful information and specialized medical care as well as prevention medicines for both pre-exposure and post-exposure.

Affected citizens in Saint Petersburg can also visit the city AIDS center, where they are able to get new syringes, sterile equipment and other preventative tools such as condoms. Saint Petersburg has also partnered with community organizations that have contributed to treating HIV by testing women for HIV, giving out free condoms and talking to consultants. Unfortunately, Saint Petersburg is one of the only cities in the Russian Federation that provides affected citizens with such a wide range of prevention and treatment.

An important factor in reducing the number of people affected by HIV was the availability of quick HIV testing. That way, someone who is affected can know immediately to begin taking antiretroviral therapy to both treat the disease and prevent any new infections.

The government has been supporting an outdoor advertising campaign teaching residents about HIV prevention services and public service announcements. The advertising has three main messages regarding HIV: the importance of testing, the availability of treatment and the elimination of stigma and discrimination against people with HIV.

Saint Petersburg is a good example of a city that was greatly affected by the HIV epidemic, but through a variety of preventative and treatment measures was able to take control of the epidemic and achieve a drastic shift in the number of people diagnosed.

– Chloe Turner

Photo: Flickr

HIV/AIDS in Angola
On Aug. 5, the United Nations Development Programme (UNDP) and the Global Fund announced a $30 million grant to prevent the spread of HIV/AIDS in Angola, as well as improve coverage of therapy and treatment.

In 2014, there were 300,000 people in Angola living with HIV and 26 percent of adults received antiretroviral treatment coverage. The grant for HIV/AIDS seeks to solve challenges like the elimination of mother-to-child transmission, adherence to antiretroviral treatment and prevention for young people.

The grant for HIV/AIDS in Angola will also increase coverage in several areas like antiretroviral therapy, testing and counseling and the promise of long-term treatment. Antiretroviral therapy recently proved itself to be an effective way to suppress the HIV Virus and prevent the disease from progression and transmission to more people.

This course of treatment is particularly effective at reducing death and infections when performed in a regimen.

The grant also seeks to include key populations into its strategy for HIV/AIDS in Angola. The grant has a strong focus on sex and reproductive health education and rights including HIV for adolescents, youth and girls. According to the WHO, the strategy is to increase the amount of “HIV-positive pregnant women on antiretroviral therapy.”

The national strategic plan for key populations in Angola also includes “sex workers and men who have sex with men.” The grant includes funds for a legal environment assessment and will propose steps for strengthening the human rights environment to create a more effective HIV response. According to the UNDP, training is provided for “health workers, prison workers and police to reduce stigma and discrimination” towards these key populations.

The grant for HIV/AIDS in Angola will run from July 2016 to June 2018 with a focus on preventing future spread of the disease within the country and lowering the numbers of people living with HIV/AIDS.

Taameen Mohammad

Photo: UNDP

HIV in MozambiqueDoctors Without Borders (DWB) is an international organization that works to improve global health conditions. One of their current missions is fighting HIV in the sub-Saharan African nation of Mozambique.

In Mozambique, one in ten adults is estimated to be HIV positive. DWB is focusing its efforts on increasing treatment and reducing the spread of the disease for sex workers and truck drivers — two demographics that are particularly at risk for infection. Their highway corridor project is estimated to reach and positively impact 3,800 sex workers and 4,500 truck drivers.

In the port city of Beira, cargo trucks are continuously moving through docks, loading and unloading cargo. The cargo is then transported to many areas of central and southern Africa. This highway corridor used for cargo transportation is also at risk for spreading HIV.

DWB offers weekly HIV testing and counseling for truck drivers along the highway as far as the border of Malawi. Additionally, the organization is responsible for distributing free condoms at truck stops.

The organization has also implemented several strategies for sex workers, who are ten times more likely to be HIV positive than the general population.

Most strategies fighting HIV in Mozambique focus on educating these workers and increasing access to HIV prevention and treatment. Another important tactic includes distributing free condoms to women who engage in sex work.

DWB also encourages sex workers to get tested for HIV and even provides on the spot testing in Beira.

If a woman’s test result is negative, she is offered the option to join a program called PrEp, which stands for pre-exposure prophylaxis. In this program, patients receive an anti-AIDS drug that aims to block the virus in women who face a high risk of infection. Although PrEP is relatively new for fighting HIV in Mozambique, it has been shown to significantly reduce one’s chance of infection.

If tests results come back positive, women are referred to a clinic for further treatment. They also have a chance to talk with DWB’s “peer educators,” who are current or former sex workers employed by DWB to speak publicly about HIV prevention and treatment. Women feel comfortable talking to them because they do not make them feel ashamed of their work and all information discussed is kept confidential.

Hearing HIV discussed in public settings greatly reduces the shame and discrimination that is often associated with the disease. In 2010, Mozambique experienced a 58 percent increase in the number of people receiving antiretroviral treatment for HIV. This does not reflect an increase in the number of people infected, but rather an increase in willingness to be tested and receive treatment.

To increase access to treatment, DWB employs people to speak publicly about their own experiences in order to reduce shame surrounding the issue, which is a key step in fighting HIV in Mozambique. The organization also offers a training program for nurses that will allow them to be able to prescribe antiretroviral treatments for patients. Not only does this increase access to treatment, but it also creates jobs and more self-sufficient communities.

Both sex works and truckers in Mozambique often engage in unsafe sex practices that make them vulnerable to HIV infection and transmission during their travels. Through the numerous initiatives mentioned above, DWB is working to improve the quality of life for these two groups as well as for all HIV patients.

Nathaniel Siegel

Photo: Reliefweb

Viral Diagnostic Technology
In today’s world, there are about 35 million people living with HIV. New HIV treatments are in near-constant development, but monitoring their effectiveness is almost as important as the treatment itself. By keeping track of what is working (and what is not), new and more effective HIV treatments can be developed, and regimens can be individualized to see what is working the best for each patient.

Viral load tests (tests that measure the concentration of the HIV virus in the blood) are done to monitor treatment. If there are over 1000 copies of the virus per mL of blood, then doctors will adjust the patient’s HIV treatment. Unfortunately, in the current method of viral load testing, results can take weeks to come back to doctors, making it difficult for them to make decisions about adjusting care. Not only that, but they can be expensive and hard to administer in a clinical setting.

Kathyrn Kundrod and Jay Fraser, undergraduate students at Lehigh University, were part of a team that developed a microfluidic device to measure viral load. Their project is called Viral Diagnostic Technology. With this innovation, only a small sample volume of blood would be needed for testing, and it could be done more quickly and efficiently. If the entire system comes to fruition, the test could be done on-site with doctor and patient.

As Kundrod says, their device is “more portable, easier to operate, and less expensive than other approaches currently in use or in development.” In fact, the estimated price tag for each unit of this Viral Diagnostic Technology is about $2.38.

The science behind the development has to do with how the HIV is being looked for.
In a nutshell (and for those who aren’t engineers), the device would run an electrical current cyclically between two electrodes, through the porous membrane of the microfluidic device. If there is a high concentration of HIV in the bloodstream, antibodies (specifically, anti-gp120) built into the device will capture it, basically building little antibody walls around the virus. These little walls keep the electrical current from making it to the second electrode, thereby reducing peak current values.

In an even smaller nutshell, if there is a certain amount of HIV in the bloodstream, the “peak current values” of the Viral Diagnostic Technology device will be lower, and the doctor will know to adjust HIV treatment. If there is no HIV (or below a certain amount of HIV), peak current values will be higher and the doctor will know to continue treatment in the same way.

The innovative design, created by five students at LeHigh, earned first place at the National Institute of Health’s Design by Biomedical Undergraduate Teams (DEBUT) challenge. It will therefore receive $20,000 to advance the development of their project.

The group, which is now known as Cyclic Solutions, hopes to have their design for Viral Diagnostic Technology procured by an organization such as UNITAID or the World Health Organization (WHO). With over 15 million people globally currently receiving HIV treatment, a device that can measure its effects in low-resource settings could save millions of lives.

Emily Dieckman

Sources: Lehigh University, News Medical, NIH 1, NIH 2
Photo: Flickr

aids epidemic
Recent statistics released in a new report by UNAIDS show that the number of new HIV/AIDS cases have been decreasing steadily. This new data shows that for every 10 percent increase in treatment coverage, there is a one percent decline in new infections among those living with HIV. However, the report also noted that far more international effort was needed because this current pace is insufficient to completely end the AIDS epidemic.

In 2013, 2.1 million new HIV/AIDS cases were recorded, down from 3.4 million new cases in 2001. 2013 also saw an additional 2.3 million people gain access to the life-saving antiretroviral therapy (ART), which is a drug that substantially suppresses many of the symptoms of AIDS and increases life spans. This means that a grand total of 13 million people have previously had or currently have access to ART. AIDS-related deaths have fallen by one-fifth in the past three years.

The most headline-grabbing piece from the report came from Michael Sidibé, Executive Director of UNAIDS, who said, “If we accelerate all HIV scale-up by 2020, we will be on track to end the epidemic by 2030.”

However it is important to know that while there has been significant improvement, considerable work still needs to be done. Sidibé went on to say that if we don’t continue to scale up efforts, then we would “[add] a decade, if not more” to the 2030 goal.

Only 15 countries account for more than 75 percent of the 2.1 million new HIV infections in 2013. In Sub-Saharan Africa the countries of Nigeria, South Africa and Uganda account for 48 percent of all new HIV infections in the region. Fewer than four in 10 people currently with HIV lack the ART necessary to survive. HIV prevalence is estimated to be 12 times higher in sex workers, 19 times higher among gay men, 28 times higher in drug injectors and up to 49 times higher among transgender women. Sub-Saharan adolescent girls and young women account for one in four new HIV infections.

While there are a tremendous amount of fascinating statistics on the matter, it’s important to not get lost in them. This new report from UNAIDS shows that progress is being made, but an even stronger effort is needed in order to end the AIDS epidemic in a timely fashion and save millions more lives.

Andre Gobbo

Sources: BBC, UNAIDS 1, UNAIDS 2
Photo: New America Media

HIV_Care_in_Rwanda
In a country where just 20 years ago, genocide claimed nearly one million lives, the Rwandan government has revamped HIV treatment for the poor by reforming the standards of successful care.

In Sub-Saharan Africa, there are now over 7.5 million people receiving antiretroviral therapy, 150 times as many as a decade ago. Medications have become easier to manage and overall, more effective, forcing some patients to take no more than one pill each day. Also, HIV testing has become much more widely available and the virus is being detected at an earlier stage before the circumstances are too dire.

In Rwanda, many HIV patients are taking their medications as directed, medication which suppresses the virus in their bodies to the point where it is essentially non-detectable. Success here is achieved when the HIV positive individual can earn a living, support their family and care for their community no differently than uninfected individuals. Furthermore, patients who would have previously been hospitalized with severe complications of HIV are now receiving regular preventive care.

The steps forward being taken in this small country are undeniable. Compared with 54 percent of medical patients worldwide, 91 percent of Rwandan patients who require HIV medications have access to life-saving treatment. Even more encouraging, 98 percent of women undergo HIV testing during their prenatal visits. In a country with only one doctor for every 17,000 people, nurses and community health workers have been trained to provide HIV services that were before, only available from physicians. Aggressive media campaigns by the government and other international organizations remind and encourage the public to “Know Your Status” while targeted outreach programs concurrently focus on the high-risk groups.

Rwanda is one of the first sub-Saharan countries to nearly eradicate the transmission of HIV from mothers to their newborns. Due to this, the number of new HIV cases has been cut in half during the last decade, and perhaps soon, it will fulfill the dream of accomplishing an “AIDS free generation.”

– Sonia Aviv

Sources: The Atlantic, The World Bank, BWH Global Health
Photo: AIDS Health