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Date: Sun, 18 Jul 1999 23:28:08 -0500
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Subject: Africa: Health Updates
Africa: Health Updates
Date distributed (ymd): 990718
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+
Summary Contents:
This posting contains three recent press releases from the
World Health Organization Regional Office for Africa, one on
the HIV/AIDS emergency, and two on malaria. It also contains
a press release on a new Uganda-U.S. study identifying an
inexpensive drug for preventing mother-to-child HIV
transmission.
+++++++++++++++++end profile++++++++++++++++++++++++++++++
New Links on Africa's Health
Africa Policy Strategic Action Issue Area
http://www.africapolicy.org/action/health.htm
Starting point for web links on Africa's health, HIV/AIDS,
malaria, reproductive health, and more.
Fairness & Accuracy in Reporting
on the debate over affordable AIDS drugs for African countries
http://www.fair.org/activism/aids-africa.htm
Calls for protest against ABC report grossly biased in favor
of U.S. drug companies' campaign to stop South Africa from
producing affordable generic versions of AIDS drugs.
************************************************************
World Health Organization Regional Office for Africa
For further information:
Contact:
WHO Regional Office for Africa (Temporary Office in Harare),
Division of External Coordination and Programme Promotion
E-mail: [log in to unmask];
Web: http://www.whoafr.org (site still in development)
Tel: 263-4-703580/ 705043/ 706951 Ext. 3141
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Press Release: WHO/AFRO/PR/1999/024
African Countries Urged to Declare
HIV/AIDS a National Emergency
24 June 1999
Harare - African Heads of State and Government have been
urged to declare HIV/AIDS "a national emergency"and to support
the declaration by allocating appropriate resources to combat
the epidemic.
"I hereby call on our Heads of State and Government to declare
HIV/AIDS a national emergency or a national disaster. And for
the sake of the future of our children and of our continent,
I plead that this be done immediately, without further delay,"
Dr. Samba said at a press interview in Harare.
"If our leaders publicly acknowledge that we have this problem
on our hands, people's attention will be even more focussed on
the problem and international assistance will be more
forthcoming to help us tame the epidemic. HIV/AIDS is already
wiping out whole populations in parts of the continent," he
said.
Dr. Samba noted that Africa which has only 10% of the world's
resources, carries 90% of the global disease burden and
accounts for close to 70% of people living with AIDS, 83% of
AIDS deaths and 95% of the global AIDS orphans.
"Indeed HIV/AIDS has become a development issue," Dr. Samba
argued, pointing out that the disease is killing off the most
productive portion of the workforce in Africa, and reducing
life expectancy by up to 20 years, from 65 years about ten
years ago to about 40 years now.
Among the consequences of the spread of HIV/AIDS in Africa are
a weakening productive base, a growing orphan population,
further strains on already under-staffed and under-funded
health services, and the loss of gains made in the health
sector in the continent over the last three decades.
Dr. Samba said factors accounting for this grim situation
include the wide practice of unprotected sex, high incidence
of sexually transmitted diseases and poor access to care and
information.
He reiterated his earlier warning that "prevention is an
effective insurance against HIV/AIDS."
According to WHO's 1998 World Health Report, AIDS is now the
number one killer in Africa, and the fourth leading cause of
death worldwide.
The Report, issued in May, says that AIDS caused 1,830,000
deaths in Africa in 1998 alone. This is twice as many deaths
as is caused by malaria which has now been relegated to the
number two position on the continent's roaster of deadly
diseases.
----------------------------------------------------------
Press Release: WHO/AFRO/PR/1999/030
WHO Will Succeed in Malaria Control - Dr. Samba
30 June 1999
The World Health Organization (WHO) Regional Director for
Africa, Dr. Ebrahim M. Samba, has expressed optimism that WHO
and its partners will succeed in their current effort to
substantially reduce the human death toll and economic losses
to Africa due to malaria.
Speaking Wednesday at the opening of a two-day meeting on the
Roll Back Malaria (RBM) partnership in Harare, Dr. Samba
listed four factors which, he said, will guarantee the success
of the RBM project, especially in Africa.
These are vastly improved knowledge of the disease itself, the
availability of "infinitely better tools" for malaria control,
genuine involvement of Africans in control efforts, and
commitment by Africa's political leadership to the Roll Back
Malaria project.
Unlike previous anti-malaria efforts, RBM is an all-embracing
initiative which seeks to mobilize and coordinate a global
coalition including leaders from malaria-endemic countries,
the WHO itself, UN agencies, NGOs, scientific communities and
public and private sector organizations.
The RBM partnership, which is unique in international health,
is led by WHO with its medical expertise, and draws from the
special expertise of participating agencies and organizations,
thus pooling resources to eliminate costly overlaps.
Dr. Samba stressed that the success of the RBM movement, and
the partnership which drives it, will depend on the
commitment, interest and strategic actions of national
governments.
This in turn is dependent on the full support of WHO, and of
concerned development partners, working in synergy to support
national strategies that will yield the greatest possible
benefits for people whose lives are affected by malaria.
Dr. Samba was also optimistic that by the end of the RBM
project, health systems in African countries will have been
sufficiently strengthened to tackle other health challenges.
In his remarks, the Manager of the Roll Back Malaria project,
Dr. David Nabarro, called on the meeting to identify clear
directions for the future. "We stand ready to serve and we
look up to you to guide us on the way forward," he said.
Among other things, the two-day meeting is reviewing the
implementation of RBM in Africa and how the partnership is
working to support the project. It is also expected to agree
ways through which national authorities can effectively
coordinate actions and partners at the country level to roll
back malaria.
WHO experts say almost all the 550 million people south of the
Sahara are at risk from malaria which kills more than one
million Africans yearly. Economic losses attributable to the
disease were estimated at $2 billion in 1998, and projected to
reach $3 billion by 2000.
-----------------------------------------------------------
Press Release: WHO/AFRO/PR/1999/032
Roll Back Malaria to Cost $2 Billion over 10 Years
6 July 1999
It will cost $2 billion to implement the World Health
Organization's Roll Back Malaria (RBM) project over the next
10 years, according to a report on the second meeting of the
RBM partnership which ended in Harare at the weekend.
The report, released on Tuesday, says that "there is an
absolute shortage of funds for health in Africa," and calls on
funding institutions to be more flexible in accommodating
"cross-cutting initiatives" in the global fight against
malaria.
It stresses the need for both short-term and longer-term
mobilization strategies, and for governments and donors to
jointly develop flexible and transparent funding mechanisms
and reporting systems. The report adds that for the RBM
partnership to produce sustainable results, adequate funding
levels must be maintained, increased accountability and
transparency should be the norm, while capacity-building
should be continuous.
It also calls for the integration of malaria control
activities with ongoing health sector development programmes
and suggests that RBM could well serve as a lens to view and
promote progress in health sector development in Africa.
On the progress made in rolling back malaria in Africa, the
report says activities so far undertaken include: the
development of a draft strategy and work plan; the development
of advocacy materials and a framework for monitoring progress;
the development of modalities for initiating RBM at the
country level, and the development of communication linkages
between global and regional partners.
According to the report, activities slated for implementation
over the next two years include: the development of a
framework for country-level implementation of RBM;
identification of country needs and provision of appropriate
resources for the intensification of priority health actions,
and the institution of functional partnerships at the national
and local levels in malaria-endemic countries.
Others are the establishment of effective mechanmisms for the
involvement of community-level organizations in the RBM
movement, and the incorporation of private sector bodies
including the media, NGOs, professional associations and
research groups in national and global partnerships.
The RBM partnership is a broad network of national
governments, international and bilateral organizations, NGOs,
the private sector and others contributing resources and
skills to reduce the malaria burden across the globe. It was
launched in New York in October 1998 by WHO, UNICEF, UNDP and
the World Bank, and formally established in Geneva two months
later.
************************************************************
Effective drug regimen for preventing transmission of HIV
Family Health International
July 15, 1999
For more information: NIAID (National Institute of Allergy and
Infectious Disease), a component of the National Institutes of
Health (NIH). NIAID conducts and supports research to prevent,
diagnose and treat illnesses such as HIV disease and other
sexually transmitted diseases, tuberculosis, malaria, asthma
and allergies.
Press releases, fact sheets and other materials are available
on the NIAID Web site (http://www.niaid.nih.gov).
Telephone contact:
Office of Communications And Public Liaison (301) 402-1663
Durham, NC - Researchers Identify a Simple, Affordable Drug
Regimen That is Highly Effective in Preventing HIV Infection
in Infants of Mothers with the Disease.
A joint Uganda-U.S. study has found a highly effective and
safe drug regimen for preventing transmission of HIV from an
infected mother to her newborn that is more affordable and
practical than any other examined to date. Interim results
from the study, sponsored by the National Institute of Allergy
and Infectious Diseases (NIAID), demonstrate that a single
oral dose of the antiretroviral drug nevirapine (NVP) given to
an HIV-infected woman in labor and another to her baby within
three days of birth reduces the transmission rate by half
compared to a similar short course of AZT. If implemented
widely in developing countries, this intervention potentially
could prevent some 300,000 to 400,000 newborns per year from
beginning life infected with HIV.
"This extraordinary finding is the most recent in our efforts
to bring an end to AIDS, not only in the United States but in
countries around the world," says Health and Human Services
Secretary Donna E. Shalala. "American scientists along with
our international partners are committed to developing
treatments that not only work, but that are also feasible in
other health care settings. These results achieve both those
goals."
"This study represents the most promising advance to date
toward the goal of finding strategies that can be used
worldwide to prevent the spread of HIV from infected mothers
to their infants," says NIAID Director Anthony S. Fauci, M.D.
NIAID is a component of the National Institutes of Health.
In an announcement from Kampala this morning, Ugandan
officials hailed the finding. "This research provides real
hope that we may be able to protect many of Africa's next
generation from the ravages of AIDS," says Crispus Kiyonga,
M.B.Ch.B., Uganda's Minister of Health. "We commend the
collaborative effort of our country's scientists, led by
Professor Francis Mmiro from Makerere University Faculty of
Medicine, and their U.S. colleagues, led by Dr. Brooks Jackson
from The Johns Hopkins University School of Medicine." Finding
affordable interventions for developing countries is key to
curtailing the global AIDS epidemic. In parts of the
hardest-hit area, sub-Saharan Africa, up to 30 percent of
pregnant women are infected with HIV, and 25 to 35 percent of
their infants will be born infected. The UNAIDS estimates that
approximately 1,800 HIV-infected babies are born every day in
developing countries.
Unfortunately, the standard AZT regimen used to prevent
perinatal HIV transmission in the United States is too
expensive and impractical for widespread use in developing
countries where many women may not receive prenatal care.
Based on average U.S. wholesale costs, the cost of the drug
used in the nevirapine regimen in the current study is
approximately 200 times cheaper than the long-course AZT used
in the United States, and almost 70 times cheaper than a short
course of AZT given to the mother during the last month of
pregnancy - a regimen tested in Thailand by the Centers for
Disease Control and Prevention and reported effective in 1998.
The Uganda study investigators, part of the NIAID-supported
HIV Prevention Trials Network (HIVNET), opened the trial two
years ago at Mulago Hospital, affiliated with Makerere
University, in Kampala, Uganda. They completed enrollment last
April. All women entered into the study were in their ninth
month of pregnancy. None had taken antiretroviral drugs while
pregnant.
The study, known as HIVNET 012, compared the safety and
efficacy of two different short-course regimens of antiviral
drugs administered late in pregnancy. The women were assigned
at random to receive either a 200-mg dose of oral nevirapine
at the onset of labor, followed by a 2-mg/kg oral dose given
to their babies within three days of birth; or a 600-mg dose
of AZT at the onset of labor, and 300-mg doses every three
hours thereafter during labor. The infants born to mothers in
the AZT group received 4 mg/kg given twice daily for the first
week of life. Both drugs appeared to be safe and
well-tolerated.
Study design, data collection and analysis was provided by a
team of researchers led by Dr. Thomas Fleming, a
biostatistican at the Fred Hutchinson Cancer Research Center
and the University of Washington School of Public Health and
Community medicine in Seattle.
For the interim analysis, the study team looked at data from
618 mothers (308 receiving AZT and 310 receiving nevirapine)
and their infants.
Nevirapine was markedly more effective. At 14 to 16 weeks of
age, 13.1 percent of infants who received nevirapine were
infected with HIV, compared with 25.1 percent of those in the
AZT group.
"In this study, the short-course nevirapine regimen resulted
in a 47 percent reduction in mother-to-infant HIV transmission
compared with a short course of AZT. The implications of this
study for developing countries, where 95 percent of the AIDS
epidemic is occurring, are profound," says Brooks Jackson,
M.D., the lead U.S. investigator on the trial.
Long-term follow-up of both the mothers and their babies
remains a high priority to assess any late drug toxicities as
well as long-term survival. The mothers and their children
will continue to be actively followed until the babies are 18
months old. This period is critical to establish the efficacy
of the intervention because even if a baby is born HIV-free,
he or she may acquire the virus during breastfeeding. The data
analyzed so far cover only the first three months of the
newborn's life. Ugandan and U.S. investigators will soon
launch a follow-up study to evaluate the efficacy of
nevirapine administered to the mother during labor and to the
newborns for a longer period of time.
Breastfeeding is practiced widely in developing countries.
Most studies indicate that the rate of HIV transmission via
breastfeeding is highest in the first few months of life. No
intervention has yet been shown to prevent HIV transmission
through breast milk other than not breastfeeding.
The single-dose nevirapine regimen to mother and infant
substantially lowers the cost barrier that has kept many
countries from adopting drug strategies that prevent perinatal
HIV transmission. Still, access to other health care services
required to implement this regimen, such as counseling and
voluntary HIV testing, are beyond available resources of many
developing countries. But if further research upholds
nevirapine's good safety record, the investigators say that
potentially all pregnant women who live in areas of high HIV
prevalence could receive the drug during labor, even in the
absence of an established HIV diagnosis.
In the United States and other industrialized countries, many
HIV-infected pregnant women already take combination drug
regimens that include AZT. A study now being conducted in the
United States and Europe is evaluating if adding nevirapine to
standard treatment regimens will have any extra benefit in
preventing perinatal HIV transmission in these countries. For
pregnant women who do not know their HIV status until they
begin labor, the nevirapine regimen provides a last-minute
prevention option.
Nevirapine, developed by Boehringer Ingelheim Pharmaceuticals,
is a non-nucleoside reverse transcriptase inhibitor, and is in
a different class of antiviral drugs than AZT but works
against the same HIV target enzyme that is critical for the
virus to infect new cells. It can be easily stored at room
temperature. Besides being inexpensive and potent, nevirapine
is rapidly absorbed and transferred across the placenta to the
infant, and it breaks down slowly. For these reasons, it was
thought that even a single dose to the mother and infant might
provide enough protection to the baby during the time of
exposure to HIV at birth. In March 1996, nevirapine was
licensed in the United States for treatment of HIV infection
in adults. AZT, made by Glaxo Wellcome, was first approved in
the United States to treat AIDS in 1987. In August 1994, AZT
received an additional indication for use in preventing
perinatal HIV transmission.
************************************************************
This material is being reposted for wider distribution by the
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