Tuberculosis | EATG http://www.eatg.org European AIDS Treatment Group Thu, 16 Nov 2017 19:34:07 +0000 en-US hourly 1 https://wordpress.org/?v=4.8 Open letter to the Romanian MoH to focus on TB http://www.eatg.org/news/open-letter-to-the-romanian-moh-to-focus-on-tb/ Thu, 16 Nov 2017 19:34:07 +0000 http://www.eatg.org/?post_type=news&p=6776 The Romanian Health Observatory, supported by the Romanian Angel Appeal Foundation (RAA) under the Global Fund programme, has published “The Crisis of Anti-TB Medicines in Romania”, a comprehensive and evidence-based report and long-term sustainable solutions for the TB drugs situation in our country. The report is endorsed by the Romanian Stop TB Partnership.

The Report states that “Out of the 28 investigated TB medicines mentioned as essential or necessary for the treatment of Tuberculosis and drug-resistant tuberculosis by the World Health Organization or by the Methodological Guidelines for Implementing the National Program for the Prevention and Control of Tuberculosis in Romania, 15 essential drugs are reported to be unavailable or have disruptions in supply caused by existing legislative barriers in Romania. Other 3 drugs recommended in international guidelines, but considered to have alternatives, are missing from Romania.”

Despite the slight fall in TB incidence, Romania still has the highest number of new TB cases every year in the EU. It also is an upper-middle income country, which will make it ineligible for international donors in the near future.

Since 2007, full-course drug regiments for the treatment of MDR/XDR-TB have been procured by RAA through GDF mechanism, with funding from the Global Fund and Norway Grants. These drugs supported the NTP to provide adequate non-interrupted treatment to over 2,000 MDR/XDR TB patients. In addition, with the support of the Global Fund, a WHO Technical Assistance Mission was organized by RAA in 2016 to assess the situation and formulate recommendations for resolving the crisis. Until now, the Romanian State has made no significant progress in this regard.

We urge the Romanian Government to take immediate action in order to be able to procure the full regimens for both TB and MDR/XDR-TB patients, from domestic funds.

We have designed an open letter for the Romanian Prime Minister and the Minister of Health we want to send and publish this week. Please find attached the open letter, the Executive Summary and the full report, in English.

This letter has also been endorsed by EATG: TB Romania Open Letter_with signatures

]]> Join MSF and Stop TB Partnership in asking countries to #StepUpforTB http://www.eatg.org/news/join-msf-and-stop-tb-partnership-in-asking-countries-to-stepupfortb/ Sat, 11 Nov 2017 22:59:32 +0000 http://www.eatg.org/?post_type=news&p=6743 Join Médecins Sans Frontières (MSF) and the Stop TB Partnership in a call to action to #StepUpforTB by signing and sharing a petition by 14 November 2017. The petition will be delivered at the Global Ministerial Conference on Ending TB to be held on 16-17 November 2017 in Moscow, Russia. Sign the petition here!      

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World Antibiotic Awareness Week 13-19 November to draw attention to global AMR threat http://www.eatg.org/news/world-antibiotic-awareness-week-13-19-november-to-draw-attention-to-global-amr-threat/ Sat, 11 Nov 2017 22:45:10 +0000 http://www.eatg.org/?post_type=news&p=6764 World Antibiotic Awareness Week will take place next week from 13-19 November, shining a spotlight on the growing crisis of antimicrobial resistance (AMR). The first descriptions of infectious diseases becoming resistant to the antimicrobial treatments available were in 1948 and were for drugs used to treat tuberculosis (TB).

Although major gains have been made in medical R&D, the problem of drug-resistant TB (DR-TB) has only worsened. In 2016, there were an estimated 600,000 new cases of DR-TB. It is predicted that by 2050, DR-TB will lead to 2.5 million deaths annually, which would be a quarter of antimicrobial resistance (AMR) deaths.

“AMR is one of the most critical challenges the world faces. Strengthening the response to TB is a cornerstone in the fight against AMR.” said José Luis Castro, Executive Director of The Union.

World Antibiotic Awareness Week coincides with the World Health Organization’s (WHO) global political meeting of ministers in Moscow, Russia, on “Ending TB in the Sustainable Development Era: A Multisectoral Response”. The meeting aims to accelerate implementation of the WHO End TB Strategy, with immediate action addressing the DR-TB crisis, and will then inform the UN General Assembly High-Level Meeting (HLM) on TB in 2018.

The Russian Federation is one of the three countries in the world with the highest number of DR-TB cases, with those three countries (India, China and Russia) bearing more than half of the global burden. The incidence of DR-TB in Russia continues to increase, meaning it is crucial to the success of the international effort to end TB.

The WHO describes antibiotic resistance as one of the biggest threats to global health, food security, and development today. Earlier this year, the WHO’s Priority Pathogen Report, highlighted DR-TB as a priority for research and development in the battle against AMR. The report went on to highlight five key reasons why TB is a global priority for research and development.

Echoing this concern, the WHO Director General, Dr. Tedros, has said, “We cannot underestimate this crisis and we must do better to identify, track and manage these drug-resistant TB cases as part of our AMR efforts.”

Dr Paula I Fujiwara, Scientific Director of The Union said: “We need new and innovative approaches to research and development if we’re to solve the crisis of antimicrobial resistance. We look forward to working further with global leaders to accelerate progress against TB and AMR.”

As part of our work to combat this growing threat, The Union is working with partners on The Life Prize, a new way to unite researchers and incentivise new TB research and development funding.

Grania Brigden, Project Lead for The Life Prize said: “The Life Prize (formerly known as the 3P Project) aims to overcome the barriers to TB treatment development to ensure a healthy TB drug pipeline and ensuring that promising candidates are developed as combination regimens and are affordable and accessible to all those in need.”

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Fighting TB stigma: we need to apply lessons learnt from HIV activism http://www.eatg.org/news/fighting-tb-stigma-we-need-to-apply-lessons-learnt-from-hiv-activism/ Sat, 11 Nov 2017 21:10:58 +0000 http://www.eatg.org/?post_type=news&p=6745 BMJ Global Health published an article on TB stigma and how lessons learnt from HIV activism can be successfully applied to confront the TB-related stigma.

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TAG releases new report on TB research funding http://www.eatg.org/news/tag-releases-new-report-on-tb-research-funding/ Thu, 09 Nov 2017 20:27:37 +0000 http://www.eatg.org/?post_type=news&p=6738 Higher funding for TB research signals hope, but governments must dramatically increase spending to end TB.

Before the World Health Organization Global Ministerial Conference on Ending TB in the Sustainable Development Era, advocates call on all countries to increase support for TB research to reach global targets.

NEW YORK, NOVEMBER 8, 2017—Global funding for tuberculosis (TB) research reached a previously unreported high of $726 million in 2016, according to a report released today by Treatment Action Group (TAG) and the United Nations–hosted Stop TB Partnership. This represents a $100 million increase over 2015 levels and marks the first time annual funding for TB research and development (R&D) has exceeded $700 million since TAG began tracking spending in 2005. Although higher than in previous years, this amount remains woefully inadequate when judged against the innovation gaps holding back the response to TB, which is the world’s leading cause of death from a single infectious agent.

In October, the World Health Organization (WHO) announced that TB killed 1.7 million people in 2016 and caused 10.4 million new cases of TB disease. “WHO’s new TB burden estimates highlight the persistent lethality of the TB epidemic in the face of chronic underfunding and limited scientific progress,” said Mark Harrington, TAG executive director. “Exceeding $700 million in funding for TB R&D in 2016 is a hopeful sign, but with at least $2 billion needed annually, this must be the preliminary ascent, not the peak. We have to make up for decades of underinvestment and scientific neglect.” The Stop TB Partnership estimates that the world needs to spend $9 billion on TB R&D from 2016 to 2020 to stay on track with the global goal of ending TB by 2030.

TAG released the report, The Ascent Begins: Tuberculosis Research Funding Trends, 2005–2016, a week before ministers of health and high-ranking officials from over 90 countries will meet in Moscow at the first Global Ministerial Conference on Ending TB in the Sustainable Development Era, convened by the WHO and hosted by the government of the Russian Federation. The Ministerial Conference will culminate in a signed political declaration committing ministers of health and other agencies to work with each other and within their governments to end the TB epidemic by 2030, as called for by the United Nations Sustainable Development Goals (SDGs) and the WHO End TB Strategy. That strategy indicates that universal access to currently existing technologies will not be enough to reduce TB incidence and mortality to the desired near-elimination levels; instead, ending TB by 2030 will require introducing new tools to prevent, diagnose, and treat TB no later than 2025.

“Ministerial engagement on TB R&D is important, but unless we have heads of state committing to fill the TB research funding gap, we will go nowhere,” said Dr. Lucica Ditiu, executive director of the Stop TB Partnership. “We must raise the TB R&D topic on the political agenda, through our continuous advocacy, and the first-ever United Nations High-Level Meeting on Tuberculosis in 2018. And political commitments and discussions must translate into concrete actions. Governments must increase their spending on TB research to develop the innovations we need to end TB.”

The TAG/Stop TB Partnership report cautions that the spending increase observed in 2016 is mostly attributable to existing major donors such as the U.S. National Institutes of Health and the Bill & Melinda Gates Foundation, which together have contributed over half of all reported funding for TB research since 2005. Pharmaceutical industry expenditures on TB R&D declined for the fifth straight year.

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Download the report The Ascent Begins: Tuberculosis Research Funding Trends, 2005–2016

More information:

  1. Country-Specific TB Research Funding Targets
  2. WHO Global Ministerial Conference on Ending Tuberculosis
  3. G20 Leaders Declaration (para. 22 mentions TB R&D)
  4. BRICS Leaders Xiamen Declaration (para. 64 mentions TB R&D)

About TAG

Treatment Action Group is an independent, activist, and community-based research and policy think tank fighting for better treatment and prevention, a vaccine, and a cure for HIV, TB, and hepatitis C virus (HCV). TAG works to ensure that all people with HIV, TB, and HCV receive lifesaving treatment, care, and information. We are science-based treatment activists working to expand and accelerate vital research and effective community engagement with research and policy institutions.

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WHO compendium of TB guidelines and associated standards http://www.eatg.org/news/compendium-of-who-guidelines-and-associated-standards/ Thu, 09 Nov 2017 20:25:58 +0000 http://www.eatg.org/?post_type=news&p=6736 Compendium of WHO guidelines and associated standards: ensuring optimum delivery of the cascade of care for patients with tuberculosis

3 November 2017 | Geneva: The Global Tuberculosis Programme of the World Health Organization (WHO) has released the “Compendium of WHO guidelines and associated standards” to support the delivery of care for all persons affected by tuberculosis (TB).

The Compendium has been developed as a clear and concise instrument to facilitate the understanding and planning of delivery of high-quality care for everybody affected by TB. It incorporates all recent policy guidance from WHO; follows the care pathway of persons with signs or symptoms of TB in seeking diagnosis, treatment and care; and includes key algorithms and cross-cutting elements that are essential to a patient-centered approach in the cascade of TB care.

The Compendium is structured into 33 WHO standards and consolidates all current WHO TB policy recommendations into a single resource, with electronic links to the individual, comprehensive WHO policy guidelines.

Background

Ending the TB epidemic requires speedy adoption and implementation of the WHO End TB Strategy [1] to reach its the ambitious targets, within the framework of the United Nations Sustainable Development Goals. This in turn requires implementation and scale-up of the most modern standards for TB  prevention, diagnosis and treatment, supported by cross-cutting elements such as ethics and human rights and with significantly enhanced human and financial resources.

Beyond accelerated implementation of existing tools, an effective TB response must embrace innovation through the rapid uptake of new interventions such as diagnostics, medicines, and digital platforms to modernize care provision. Working with communities, civil society and any partners, governments need to assume full responsibility for ensuring access to person-centered, modern, high-quality TB services, regardless of whether care is sought from public, voluntary, private or corporate care providers. Securing comprehensive care along with essential support for each person with TB also calls for collaboration within and beyond the health sector.

“After decades of stagnation, finally new diagnostics, drugs and regimens have become available through intensified research efforts and increased field experiences,” said Dr Mario Raviglione, Director of the WHO Global TB Programme. “Implementing the standards of TB care outlined in this Compendium will ensure that these innovations rapidly translate into optimal care for all affected by TB.”

The Compendium will be updated annually, including in its digital format, to allow incorporation of new evidence emerging from the rapidly evolving TB diagnostic and treatment landscape.

[1] Implementing the End TB Strategy: the essentials (WHO/HTM/TB/2015.31). Geneva, World Health Organization. 2015. (http://www.who.int/tb/publications/2015/end_tb_essential.pdf; accessed 2 November 2017).

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Fact sheets on global health R&D http://www.eatg.org/news/fact-sheets-on-global-health-rd/ Thu, 09 Nov 2017 20:15:30 +0000 http://www.eatg.org/?post_type=news&p=6735 The Global Health Technologies Coalition (GHTC) released a six-part fact sheet series examining the contributions of the US government agencies to advancing global health R&D, including USAID, NIH, CDC, FDA, DoD, and BARDA.

The fact sheets can be downloaded here.

 

The Kaiser Family Foundation released an updated fact sheet explaining the US government’s role in addressing global TB, including the history of the US involvement and funding trends.

The fact sheet can be downloaded here.

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-32/ Wed, 08 Nov 2017 22:36:43 +0000 http://www.eatg.org/?post_type=news&p=6732 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 323 of the “Global Fund Observer.” The newsletter includes articles on various topics, including an announcement of a new fund to support the engagement of adolescent girls and young women in Global Fund-related and national processes; a commentary on the Global Fund and PEPFAR’s complementary approaches and collaborations; and a primer on transitioning from Global Fund support.

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UNAIDS: Living with HIV but dying from TB http://www.eatg.org/news/living-with-hiv-but-dying-from-tb/ Mon, 06 Nov 2017 22:50:15 +0000 http://www.eatg.org/?post_type=news&p=6692

Global progress to End TB not fast enough to reach global TB and HIV targets

03 November 2017 – Tuberculosis (TB) retains its undesirable status as the leading infectious cause of death globally. According to the latest WHO Global Tuberculosis Report 2017 launched this week, global progress in reducing new tuberculosis (TB) cases and deaths is insufficient to meet the global targets for TB and HIV, despite most deaths being preventable with early diagnosis and appropriate treatment of tuberculosis and HIV.

As part of global efforts to advance the response to TB is now being pushed higher up the global development agenda with hundreds of global leaders attending the first WHO Global Ministerial Conference on Ending TB in Moscow from 14-17 November and a dedicated United Nations General Assembly High-Level Meeting on TB in 2018.

“We have an unprecedented opportunity to shine the political spotlight on the inequalities that drive the epidemics of TB and HIV,” said Michel Sidibé, UNAIDS Executive Director, “The return on investment in TB and HIV is more than just dollars, it’s in voices heard, rights protected and lives saved.”

In 2016, the risk of developing TB disease among the 37 million people living with HIV was around 21 times higher than the risk in the rest of the world population. There were more than one million TB cases among people living with HIV—10% of all global TB cases in 2016. People living with HIV are much more likely to die from TB disease than HIV-negative people, and one in five (22%) TB deaths occurs among people living with HIV. In 2016, there were 374 000 TB deaths among people living with HIV, which represents almost 40% of all AIDS-related deaths.

TB disease and deaths can be avoided with TB preventive therapy but most people living with HIV who can benefit are not receiving it. In 2016, fewer than 1 million people newly enrolled in HIV care were started on TB preventive treatment. South Africa accounted for the largest share of the total (41%), followed by Mozambique, Zimbabwe and Malawi.

The global burden of drug-resistant tuberculosis continues to rise with an estimated 600,000 cases requiring treatment but only one in five were enrolled on treatment in 2016.

Global TB incidence is only falling at about 2% per year and 16% of TB cases die from the disease; by 2020, these figures need to improve to 4–5% per year and 10%, respectively, to reach the first (2020) milestones of the WHO End TB Strategy. Major gaps remain in global funding for TB prevention and treatment (US$2.3 billion) and TB research into new drugs, vaccines, and diagnostics (US$1.2 billion) for 2017.

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Report: TB medicine crisis in Romania http://www.eatg.org/news/report-tb-medicine-crisis-in-romania/ Thu, 02 Nov 2017 22:24:16 +0000 http://www.eatg.org/?post_type=news&p=6642

Authorities in Romania are unable to provide the full range of essential medicines needed for the treatment of TB, the Romanian Health Observatory said in its latest report, TB medicine crisis in Romania. While the contagious disease is designated a public health priority in the country, the root cause is “the existence of absurd and self-contradictory legislation and widespread government red tape” that blocks Romanian tuberculosis patients’ access to treatment, it said.

Missing meds: From 28 drugs considered necessary for treatment by the World Health Organization or Romania’s national prevention program, 15 are unavailable or have supply disruptions. One medicine not reimbursed for tuberculosis is reimbursed for HIV. “Practically, patients diagnosed with HIV and TB are more fortunate than patients who have only a diagnosis of tuberculosis,” the report observed. Meanwhile, the fact that only some drugs are available could increase prevalence of multidrug-resistant tuberculosis if patients end up taking an incomplete treatment. With more than 500 new cases of drug-resistant tuberculosis detected annually, Romania has the highest number of cases in the EU but one of the lowest rates of successful management.

At this point, international organizations are providing and co-financing the procurement of essential medicines needed for Romanian TB patients. The international funding will end in the first quarter of 2018. The patients will be left without access to the full course of treatment if the Romanian authorities will not be able to take over the procurement. Currently, the Government of Romania – an European Union member state – is not fulfilling its legal obligations towards TB patients.

A summary of the report in English can be downloaded here.

The full version of the report can be accessed here (in English) and here (in Romanian).

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Global TB Report 2017 http://www.eatg.org/news/global-tb-report-2017/ Tue, 31 Oct 2017 19:28:14 +0000 http://www.eatg.org/?post_type=news&p=6622 WHO report signals urgent need for greater political commitment to end TB; TB remains leading infectious killer.

30 October 2017 | GENEVA – Global efforts to combat tuberculosis (TB) have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37%, according to the Global TB Report 2017, released by WHO today.

Despite these achievements, the latest picture is grim. TB remains the top infectious killer in 2016. TB is also the main cause of deaths related to antimicrobial resistance and the leading killer of people with HIV. Progress in most countries is stalling and is not fast enough to reach global targets or close persistent gaps in TB care and prevention.

“While the world has committed to ending the TB epidemic by 2030, actions and investments don’t match the political rhetoric. We need a dynamic, global, multisectoral approach.” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “The good news is that we finally have two great opportunities to move forward: the first WHO Global Ministerial Conference to End TB in Moscow in 2017, followed by the first UN General Assembly High-Level Meeting on TB in 2018. These will build momentum, get different sectors engaged, and accelerate our efforts to make TB history.”

High global burden of disease and death in 2016

In 2016, there were an estimated 10.4 million new TB cases worldwide, 10% of which were people living with HIV. Seven countries accounted for 64% of the total burden, with India bearing the brunt, followed by Indonesia, China, Philippines, Pakistan, Nigeria and South Africa. An estimated 1.7 million people died from TB, including nearly 400 000 people who were co-infected with HIV. This is a drop by 4% compared to 2015.

Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. WHO estimates that there were 600 000 new cases with resistance to rifampicin – the most effective first-line drug, of which 490 000 had MDR-TB. Almost half of these cases were in India, China and the Russian Federation.

“The sheer numbers of deaths and suffering speak for themselves – we are not accelerating fast enough,” said Dr Mario Raviglione, Director of the WHO Global TB Programme. “Prompt action towards universal health coverage and social protection, as well as breakthroughs in research and innovations – will be critical to enable access to patient-centered care of the highest standards for all, especially the poorest, most disadvantaged people everywhere.”

Persistent gaps in care and financing

Tackling the epidemic requires action to close gaps in care and financing. It also requires progress in a particular subset of high TB burden countries (1).

  • Underreporting and underdiagnosis of TB cases continues to be a challenge, especially in countries with large unregulated private sectors and weak health systems. Of the estimated 10.4 million new cases, only 6.3 million were detected and officially notified in 2016, leaving a gap of 4.1 million. India, Indonesia and Nigeria accounted for almost half of this global gap.
  • Only one in five MDR-TB cases were started on treatment. India and China accounted for 39% of the global gap. Treatment success remains low, at 54% globally.
  • Of the almost half a million reported cases of HIV-associated TB, 15% were not on antiretroviral therapy (ART) as recommended by WHO. Most of the gaps related to HIV-associated TB were in the WHO African Region.
  • TB preventive treatment is expanding in two priority risk groups – people living with HIV and children under 5 years. However, most people eligible for TB preventive treatment are not accessing it.
  • For TB care and prevention, investments in low- and middle-income countries fall almost US$ 2.3 billion short of the US$ 9.2 billion needed in 2017. In addition, at least an extra US$ 1.2 billion per year is required to accelerate the development of new vaccines, diagnostics, and medicines.

“Shortfalls in TB funding are one of the main reasons why progress is not fast enough to be on track to reach the end TB targets,” said Dr Katherine Floyd, Coordinator of WHO’s Monitoring and Evaluation Unit at the Global TB Programme. “We have a double challenge. More domestic funding is needed in middle-income countries, and more international donor support is needed to support low-income countries”.

Political commitment and multisectoral action

Ending the TB epidemic requires action beyond the health sector to address the risk factors and determinants of the disease. For the first time the Global TB Report presents results from a new multisectoral monitoring framework that identifies linkages with the TB epidemic across seven Sustainable Development Goals (SDGs). Analysis of the latest status of the indicators for the 30 high TB burden countries show that most will be challenged to reach SDG targets.

In order to increase multisectoral action, plans to galvanize all sectors and secure attention at the highest levels have resulted in the WHO Global Ministerial Conference on Ending TB in the Sustainable Development Era, in Moscow, 16–17 November 2017. This will be followed by the very first UN General Assembly High-Level Meeting on TB in 2018, which will seek commitment from heads of state.

(1) The ten countries were: India, Indonesia, Nigeria, the Philippines, South Africa, Pakistan, Bangladesh, the Democratic Republic of the Congo, China and the United Republic of Tanzania.

Global TB Report 2017

Related links

 

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Twice-daily tenofovir alafenamide dose might overcome interaction with rifampicin http://www.eatg.org/news/twice-daily-tenofovir-alafenamide-dose-might-overcome-interaction-with-rifampicin/ Tue, 31 Oct 2017 14:26:37 +0000 http://www.eatg.org/?post_type=news&p=6609 Twice-daily tenofovir alafenamide (TAF) plus rifampicin provided similar exposures to once-daily TAF in pharmacokinetic study. This strategy might be a suitable option for people with HIV/TB coinfection.

The results were presented at the 16th European AIDS Conference (EACS 2017), held on 25-27 October 2017 in Milan, Italy.

Read the full report by Polly Clayden, HIV i-Base here.

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WHO to review its interim guidance on the use of delamanid in the treatment of MDR-TB http://www.eatg.org/news/who-to-review-its-interim-guidance-on-the-use-of-delamanid-in-the-treatment-of-mdr-tb/ Sat, 28 Oct 2017 09:00:39 +0000 http://www.eatg.org/?post_type=news&p=6601 WHO to review its interim guidance on the use of delamanid in the treatment of multidrug-resistant TB following the release of Phase III clinical trial results

The World Health Organization (WHO) has started preparations for a rapid review of its interim guidance on the use of delamanid in the treatment of patients with multidrug-resistant tuberculosis (MDR-TB). This follows the release of the phase III randomised control trial results by Otsuka Pharmaceutical at the 48th Union World Conference on Lung Health on 13 October.

Read the full announcement here.

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-31/ Wed, 25 Oct 2017 18:09:54 +0000 http://www.eatg.org/?post_type=news&p=6558 Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 322 of the “Global Fund Observer.”

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TB cases in the UK: 2000 to 2016 http://www.eatg.org/news/tb-cases-in-the-uk-2000-to-2016/ Wed, 25 Oct 2017 17:46:04 +0000 http://www.eatg.org/?post_type=news&p=6573 Official statistics annual reports from the UK enhanced tuberculosis surveillance systems.

To download Tuberculosis cases UK: 2000 to 2016, click here.

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Tuberculosis: The cornerstone of the AMR threat http://www.eatg.org/news/tuberculosis-the-cornerstone-of-the-amr-threat/ Thu, 19 Oct 2017 21:25:21 +0000 http://www.eatg.org/?post_type=news&p=6506 The TB Europe Coalition released a policy paper, Tuberculosis: The cornerstone of the AMR threat, providing a brief overview of what antimicrobial resistance (AMR) is. Furthermore, the paper looks in more detail at drug-resistant TB, and discusses why countries need to invest more in research and development of new drugs to tackle it.

To access the policy paper, click here.

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Good Participatory Practice Guidelines for TB Vaccine Research 2017 http://www.eatg.org/news/good-participatory-practice-guidelines-for-tb-vaccine-research-2017/ Thu, 19 Oct 2017 21:20:00 +0000 http://www.eatg.org/?post_type=news&p=6508 Aeras releases a document providing systematic guidance on how to effectively engage stakeholders throughout the entire life cycle of TB vaccine research.

GUADALAJARA, Mexico – Describing the value of working with funders, sponsors, industry partners, governments and community members during all stages of tuberculosis vaccine research and development, the Good Participatory Practice Guidelines for TB Vaccine Research released the first day of the 48th Union World Conference on Lung Health is the latest step in a movement to ensure those most affected by science inform its discoveries.

Inspired by the Denver Principles rallying cry of “Nothing about us without us,” the first good participatory practice guidelines for biomedical HIV prevention trials were developed in 2007 by UNAIDS and AVAC. Since then, guidelines have been published for HIV and TB drug trials, and for trials related to emerging infections.

The guidelines developed by Aeras, the product development partnership for TB vaccine development, address challenges unique to tuberculosis vaccine research including criteria and conditions for participation. Collaboration with community members in setting standards for vaccine trials will not only ensure that the resulting product will meet the needs and priorities of affected populations, authors said, but will increase research literacy, as well as buy-in for trials and an eventual vaccine, and will aid in product roll-out and research dissemination.

“The goal of a new TB vaccine can only be achieved if the needs and priorities of affected communities are addressed,” Anne Schley, one of the authors of the guidelines, said.

The release of the guidelines comes at an important time, authors noted, with 12 tuberculosis vaccine candidates currently in the pipeline, two of which are in large scale phase III trials in India and China.

The first participatory practice guidelines for HIV treatment and prevention trials followed the closure of  PrEP trials in Cambodia and Cameroon after activists protested that affected populations were not involved in the trial design and that in the resulting trial participants were not provided adequate counseling and medical care.

By Rabita Aziz

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TBVAC2020 review article now online http://www.eatg.org/news/tbvac2020-review-article-now-online/ Thu, 19 Oct 2017 21:18:52 +0000 http://www.eatg.org/?post_type=news&p=6507

TBVAC2020 (a European consortium of TB R&D partners led by TBVI and funded by the EC) gives an update on its progress towards the development of new, safe and affordable TB vaccines – essential to control the TB epidemic and combat AMR.

Highlights of results include:

  • Promising novel adjuvants, delivery systems, and live vaccine candidates are identified and evaluated for safety, immunogenicity, and protective efficacy
  • 4 novel cutting-edge technologies (to identify antigens and epitopes).
  • 51 tests comprised of 21 different vaccine candidates/approaches of safety, immunogenicity and/or efficacy have been completed or are on-going in the various models.
  • New TB Biomarkers have been discovered (of protection and TB risk) using innovative approaches including omics studies; to develop and improve key functional assays.

European leadership in TB vaccine R&D

The EC has played a key role in accelerating TB vaccine research. Sustained EC funding over the past years made it possible to establish a unique European network that is a leading player in global innovation in TB research. Over 50% of the global pipeline in TB vaccine candidates currently evaluated in clinical trials originate from this EC funded European network.

At the same time, the pipeline needs to be fed constantly with new innovative candidates since it is unlikely that one single vaccine could protect against all different forms of TB disease in all age groups. Thus, the concept of diversification gained increasing importance. TBVAC2020 intermediate results already shows it can contribute to the diversification of the global pipeline and that new TB vaccines are feasible.

About TBVAC2020

The Horizon2020 research project TBVAC2020 is a 4-year project launched in January 2015 and is coordinated and supported by the TuBerculosis Vaccine Initiative (TBVI). It aims at the discovery and development of novel tuberculosis (TB) vaccines from preclinical research projects to early clinical assessment.

As a key feature, TBVAC2020 strengthens the links between academia and industry through the services provided by TBVI organisation. It also ensures synergies in research and development and an effective and efficient use of resources, provided not only by EU, but as well 25% through other funders leading to a harmonized approach of TB vaccine R&D within the EU.

About TBVI

The TuBerculosis Vaccine Initiative (TBVI) is a non-profit foundation that facilitates the discovery and development of new, safe and effective TB vaccines that are accessible and affordable for all people.  As an Innovation Partnership, TBVI,integrates, translates and prioritises R&D efforts to discover and develop new TB vaccines and biomarkers for global use. TBVI provides essential services including technical support, knowledge management, resource mobilization and project management that support the R&D efforts of its consortium partners – 50 partners from academia, research institutes and private industry in the TB vaccine field.

Article details

The article provides an in-depth overview of activities and results of the TBVAC2020 project to date. The authors state that the progress that TBVAC2020 is making shows that new TB vaccines are feasible.
TBVAC2020: Advancing Tuberculosis Vaccines from Discovery to Clinical Development
Stefan H. E. Kaufmann, Hazel M. Dockrell, Nick Drager, Mei Mei Ho,Helen McShane, Olivier Neyrolles,Tom H. M. Ottenhoff7, Brij Patel, Danielle Roordink, François Spertini, Steffen Stenger, Jelle Thole, Frank A. W. Verreck, Ann Williams and TBVAC2020 Consortium
Front. Immunol., 04 October 2017
doi.org/10.3389/fimmu.2017.01203
Direct link: https://www.frontiersin.org/articles/10.3389/fimmu.2017.01203/full
Link to: EC factsheet Tuberculosis

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2017 Union World Conference on Lung Health http://www.eatg.org/news/2017-union-world-conference-on-lung-health/ Tue, 17 Oct 2017 18:19:13 +0000 http://www.eatg.org/?post_type=news&p=6477 The latest edition of the TB Online Weekly Newsletter provides coverage of the 48th Union World Conference on Lung Health held on 11-14 October 2017 in Guadalajara, Mexico.

To access the newsletter, click here.

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HIV: the benefits of prophylaxis of TB are confirmed http://www.eatg.org/news/hiv-the-benefits-of-prophylaxis-of-tb-are-confirmed/ Fri, 13 Oct 2017 17:23:46 +0000 http://www.eatg.org/?post_type=news&p=6456

Long-term follow-up in the ANRS TEMPRANO trial confirms that tuberculosis chemoprophylaxis in HIV-infected people is more than ever relevant in resource-limited countries. This prophylactic use of drugs reduces mortality, even among people taking antiretroviral treatment who have a high CD4+ T cell count. ANRS TEMPRANO was conducted by researchers of the Ivory Coast ANRS site, which comprises teams from Inserm (U1219, University of Bordeaux), the Infectious and Tropical Diseases Department of the Treichville University Hospital, and 8 other infection treatment centers in Abidjan. The results of this trial are published in the 9 October 2017 issue of The Lancet Global Health and should encourage countries where the burden of tuberculosis is heavy to apply the relevant WHO recommendations.

Tuberculosis is the leading cause of death among HIV-infected people in sub-Saharan Africa. In the 1990s, several studies showed that HIV-infected people who take the antibiotic isoniazid, for 6 to 12 months, are at lower risk of developing tuberculosis. On the basis of these studies, since 1993 the WHO has recommended that people living with HIV in countries where tuberculosis is rife should take isoniazid for 6 months. However, this recommendation has been little applied because it was deemed obsolete following the advent of antiretrovirals that restore immunity and hence lower the risk of tuberculosis. ANRS TEMPRANO has reassessed the benefits of isoniazid prophylaxis in the era of early antiretroviral treatment.

ANRS TEMPRANO was coordinated by Dr Xavier Anglaret and Professor Serge Eholie and conducted by researchers from the Ivory Coast ANRS site, which comprises teams from Inserm (U1219, University of Bordeaux), the Infectious and Tropical Diseases Department of the Treichville University Hospital, and 8 other HIV care centers in Abidjan. Sponsored and mainly funded by the ANRS, ANRS TEMPRANO, which was conducted between 2008 and 2015, showed that 6-month isoniazid prophylaxis for tuberculosis and early antiretroviral treatment both reduced the risk of severe morbidity in the first two years of follow-up. Published in The New England Journal of Medicine in 2015, these results greatly contributed to the formulation of WHO treatment recommendations. ANRS TEMPRANO participants were then followed up for an average of 4.5 years, and the findings are now published in the 9 October 2017 issue of The Lancet Global Health. This long-term follow-up shows that tuberculosis chemoprophylaxis reduces not only severe morbidity, but also mortality, and that this benefit, which is independent of and complementary to that of antiretroviral treatment, lasts at least 6 years after administration.

Professor François Dabis, the Director of the ANRS, notes that “We now have irrefutable evidence of the value of tuberculosis chemoprophylaxis in HIV-infected people in resource-limited countries in the era of antiretrovirals, even when these are initiated very early. The WHO recommendations should more than ever be applied.”

Sources:

Badje A, Moh R, Gabillard D, et al. Effect of isoniazid preventive therapy on risk of death in west African HIV-infected adults with high CD4 count: long-term follow up of the Temprano ANRS 12136 trial. Lancet Glob Health 2017; 5: e1080–89

Accompanying comment: Preventing tuberculosis in people with HIV—no more excuses. Lancet Glob Health 2017

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People still being denied improved treatment for multidrug-resistant TB http://www.eatg.org/news/people-still-being-denied-improved-treatment-for-multidrug-resistant-tb/ Fri, 13 Oct 2017 15:57:57 +0000 http://www.eatg.org/?post_type=news&p=6454 Médecins Sans Frontières urges governments to step up the use of newer TB drugs.

Guadalajara, Mexico, October 13, 2017—People with multidrug-resistant tuberculosis (MDR-TB) are still not receiving two newer TB drugs, bedaquiline and delamanid, which have been available for more than four years and have shown improved cure rates for the disease, deplored Médecins Sans Frontières (MSF) at the 48th Union World Conference on Lung Health in Guadalajara, Mexico, where the global TB community is meeting.

Bedaquiline and delamanid, which received marketing authorisation in 2012 and 2014, respectively, are the first new TB drugs developed in nearly 50 years. They represent a potential lifeline for people affected with the most resistant forms of TB, who face abysmal chances of being cured, yet MSF estimates that still less than 5 percent of people who could benefit from them in 2016 actually received them. MSF is concerned about the abysmally slow uptake of new drugs. Only 3,943 people received the two newer drugs in routine healthcare settings during the first half of 2017 – a meagre increase of 1,000 more people treated compared to the same period in 2016.

“Delamanid gave me a second chance at life and I wish that these tablets could be made available to the many people who are struggling with drug-resistant TB, because there are so many people who are vomiting from the standard treatment at the moment, or crying from the injection, or even losing their hearing and dropping out of school or work,” said Sinethemba Kuse, who had XDR-TB and was treated with delamanid in MSF’s project in Khayelitsha, South Africa.

Globally, 30% people with MDR-TB could benefit from the new drugs, according to estimates.* Yet, as of July 2017, only 10,164 people worldwide with DR-TB have received bedaquiline, and only 688 have received delamanid.

“Until five years ago, we had no treatment options and were forced to accept the risks of giving people a regimen containing DR-TB medicines that we knew had a slim chance of curing them; but what’s the excuse now for not using these drugs?” said Dr Isaac Chikwanha, HIV and TB Medical Advisor at MSF’s Access Campaign. “Today, it’s unacceptable to continue treating with the same old regimen of medicines and not providing better treatment, knowing very well that we could be giving people a much better chance to stay alive by using these newer drugs.”

Tuberculosis is the world’s deadliest infectious disease, killing 1.8 million people each year. Current standard treatment for DR-TB requires people to take nearly 15,000 pills over two years, causes severe and debilitating side effects, and cures just one in two people. The two promising newer drugs were brought to the market with great hope they would form the backbone of new and dramatically-improved treatment for DR-TB.

“Use of bedaquiline and delamanid is currently limited for several reasons, including the fact that some national TB programmes are too conservative,” said Dr Chikwanha. “The pathetic rollout of newer drugs is unjust for people who now have a chance at effective treatment.” The global TB community, governments and donors must collectively take urgent steps to increase access to these two newer, promising drugs in order to save the lives of people with DR-TB.”

MSF has been treating people with TB for 30 years. In 2016, MSF treated more than 20,000 people with TB, including 2,700 people with MDR-TB. As of June 2017, MSF, in partnership with national ministries of health, has started more than 1,500 patients in 14 countries on DR-TB regimens that include bedaquiline and/or delamanid.

* This estimate includes people who meet World Health Organization (WHO) criteria: people with extensively drug-resistant (XDR-) TB and people with MDR-TB who cannot tolerate treatment with other drugs. According to the conservative estimates of the DR-TB Scale Up Treatment Action Team (STAT), 30% of people with MDR-TB could benefit from the new drugs. Based on MSF’s field experience, this figure could go up to 70% in places where there is a high proportion of people with XDR-TB and with exposure to second-line drugs.

 

Issue brief: Four years and counting examines current opportunities to optimise MDR-TB treatment and to address the persistent access challenges that put treatment out of reach for people struggling to survive this deadly disease.  Available for download at: https://www.msfaccess.org/MDR-TB-issue-brief-2017

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Report shows growing HIV, TB and malaria crisis in Venezuela http://www.eatg.org/news/report-shows-growing-hiv-tb-and-malaria-crisis-in-venezuela/ Fri, 13 Oct 2017 15:35:53 +0000 http://www.eatg.org/?post_type=news&p=6453

Triple threat: Resurging epidemics, a broken health system, and a global indifference to Venezuela’s crisis

October 12, 2017, Toronto, CANADA and Caracas, VENEZUELA – Venezuela is in the middle of an unprecedented, state-made, complex humanitarian emergency with severe and widespread social consequences, including for people living with and affected by HIV, tuberculosis and malaria, ICASO and ACCSI said today in launching a new report. International inaction has set the stage for a rapidly worsening disaster in 2018.

“In May 2017, the Board of the Global Fund to Fight AIDS, TB and Malaria voted to support a regional response to the crisis,” said Mary Ann Torres, executive director of ICASO. “But this has not yet materialized.”

Venezuela’s government denies the crisis, and blocks publication of health data that would document the worsening disaster. In the absence of official health data, this report, Triple threat: Resurging epidemics, a broken health system, and global indifference to Venezuela’s crisis, draws on interviews with Venezuelan people living with HIV, doctors, advocates, academics and United Nations representatives to document the health emergency.

The government denial of the crisis, the country’s classification by the World Bank as Upper Middle Income, and the lack of official epidemiological data all made Venezuela ineligible for many forms of aid, including from the Global Fund. The Global Fund Board voted to provide aid to a regional response, but none has yet developed.

Despite the palpable suffering in Venezuela, the global community has yet to take decisive action. “The current health crisis in Venezuela is a symptom and a consequence of the failures of the global architecture which should be able to mount a response to any humanitarian crisis. The devastation we are facing is being perpetuated in part by the arbitrary rules and regulations that shape global health aid eligibility,” said Alberto Nieves, Executive Director of ACCSI. “The world will not achieve the sustainable development goals, if the global community continues to turn a blind eye to the public health catastrophe in Venezuela. We need decisive immediate global leadership to avert this crisis.”

About ICASO

ICASO is a Canadian organization that acts as a global policy voice on HIV issues that impact diverse communities around the world. Our advocacy work champions the leadership of civil society and key populations in the effort to end AIDS.  We do this through collaborative partnerships with people and organizations in all regions and various sectors, always with a view to serving and empowering communities.
www.icaso.org

About ACCSI

Acción Ciudadana contra el SIDA (ACCSI) (Citizens Action against AIDS) is a Venezuelan organization working to ensure effective and coordinated strategies to protect, promote and defend human rights of people living with HIV and other key and vulnerable populations.
www.accsi.org.ve


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Unitaid commits US $21.4 million to the WHO prequalification programme http://www.eatg.org/news/unitaid-commits-us-21-4-million-to-the-who-prequalification-programme/ Mon, 09 Oct 2017 21:55:57 +0000 http://www.eatg.org/?post_type=news&p=6430 Geneva – Unitaid is investing a further US$ 21.4 million in the World Health Organization’s (WHO) prequalification programme for medicines and diagnostics.

Unitaid has supported the prequalification programme for medicines since 2006 and for diagnostics since 2009. The decision, taken in July, to invest a further US$ 21.4 million increases the value of Unitaid’s total investment to date to over US$ 124 million. With around one third to be spent on diagnostics and two thirds on medicines, Unitaid’s support to WHO’s prequalification programme through to December 2018 will be used to cover activities related to HIV/TB/Malaria/HCV products specifically, with the following objectives:

  • 62 products will be assessed, and if meeting the necessary standards, will be made available for procurement by international agencies and national governments;
  • WHO will continue to monitor and maintain prequalified products through post market surveillance and/or requalification;
  • WHO will work with governments and national regulatory authorities in low- and middle-income countries to implement the ‘collaborative registration procedure’ for 50 , so patients can access them more quickly;
  • Patient safety and appropriate use of two new products will be ensured in at least six countries (e.g. bedaquiline, and dolutegravir for the treatment of multi-drug resistant TB and HIV/AIDS, respectively).

 

For more on WHO’s Prequalification programme:

Check out the WHO website

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-30/ Thu, 05 Oct 2017 21:30:49 +0000 http://www.eatg.org/?post_type=news&p=6387 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 321 of the “Global Fund Observer.” The newsletter contains numerous articles, including one on a transition readiness assessment report that suggests HIV-related civil society organizations in Panama may not “effectively survive the exit of the Global Fund,” and one on the potential implications of PEPFAR’s new strategy for the Global Fund.

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Georgia on the frontlines of tackling drug-resistant TB — a photo story http://www.eatg.org/news/georgia-on-the-frontlines-of-tackling-drug-resistant-tb%e2%80%8a-%e2%80%8aa-photo-story/ Fri, 29 Sep 2017 16:24:23 +0000 http://www.eatg.org/?post_type=news&p=6326

Georgia continues to struggle with tuberculosis (TB), today’s leading infectious disease killer, and its drug-resistant forms. The homeless, unemployed, migrants, prisoners, and people who excessively consume alcohol are among the most affected. But the good news is that the number of people suffering from drug-resistant TB has dropped over the past few years largely due to the arrival of new medicines. The first drugs to be developed in almost half a century — bedaquiline and delamanid — now offer the opportunity to treat multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) more quickly and effectively.

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National Academies presents 14 recommendations for US to improve global health http://www.eatg.org/news/national-academies-presents-14-recommendations-for-us-to-improve-global-health/ Thu, 21 Sep 2017 13:19:16 +0000 http://www.eatg.org/?post_type=news&p=6272

National Academies of Sciences, Engineering, and Medicine: Global Health and the Future Role of the United States

“Global Health and the Future Role of the United States, released in Spring 2017 by the National Academies of Sciences, Engineering, and Medicine, assesses U.S. investments in global health. Using the same rigor that the National Academies applied in advising U.S. policy for more than 150 years, a committee of experts from across the global health field reached consensus on why and how to continue America’s commitment to global health. The report culminates in 14 recommendations to guide action in improving the health of the world’s population…” (September 2017).

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The world is running out of antibiotics, WHO report confirms http://www.eatg.org/news/the-world-is-running-out-of-antibiotics-who-report-confirms/ Wed, 20 Sep 2017 21:40:04 +0000 http://www.eatg.org/?post_type=news&p=6257 20 September 2017 | Geneva A report, Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis, launched today by WHO shows a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.

Most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections identified by WHO as posing the greatest threat to health, including drug-resistant tuberculosis which kills around 250 000 people each year.

“Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine,” says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery.”

In addition to multidrug-resistant tuberculosis, WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – that are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only 8 are classed by WHO as innovative treatments that will add value to the current antibiotic treatment arsenal.

There is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

There are also very few oral antibiotics in the pipeline, yet these are essential formulations for treating infections outside hospitals or in resource-limited settings.

“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” says Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) set up the Global Antibiotic Research and Development Partnership (known as GARDP). On 4 September 2017, Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust pledged more than €56 million for this work.

“Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years,” says Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme. “If we are to end tuberculosis, more than US$ 800 million per year is urgently needed to fund research for new antituberculosis medicines”.

New treatments alone, however, will not be sufficient to combat the threat of antimicrobial resistance. WHO works with countries and partners to improve infection prevention and control and to foster appropriate use of existing and future antibiotics. WHO is also developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.

Note to editors

For more information, download the following reports:

The clinical pipeline analysis data can be explored in an interactive way through:

 

See also:

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-29/ Wed, 20 Sep 2017 19:25:57 +0000 http://www.eatg.org/?post_type=news&p=6262 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 320 of the “Global Fund Observer.” The newsletter includes articles on various topics, including country-level challenges related to the absorption of Global Fund money and the fund’s new results report.

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Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study http://www.eatg.org/news/diagnostic-accuracy-of-xpert-mtbrif-ultra-for-tuberculous-meningitis-in-hiv-infected-adults-a-prospective-cohort-study/ Sat, 16 Sep 2017 10:06:53 +0000 http://www.eatg.org/?post_type=news&p=6229 Summary

Background

WHO recommends Xpert MTB/RIF as initial diagnostic testing for tuberculous meningitis. However, diagnosis remains difficult, with Xpert sensitivity of about 50–70% and culture sensitivity of about 60%. We evaluated the diagnostic performance of the new Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis.

Methods

We prospectively obtained diagnostic cerebrospinal fluid (CSF) specimens during screening for a trial on the treatment of HIV-associated cryptococcal meningitis in Mbarara, Uganda. HIV-infected adults with suspected meningitis (eg, headache, nuchal rigidity, altered mental status) were screened consecutively at Mbarara Regional Referral Hospital. We centrifuged CSF, resuspended the pellet in 2 mL of CSF, and tested 0·5 mL with mycobacteria growth indicator tube culture, 1 mL with Xpert, and cryopreserved 0·5 mL, later tested with Xpert Ultra. We assessed diagnostic performance against uniform clinical case definition or a composite reference standard of any positive CSF tuberculous test.

Findings

From Feb 27, 2015, to Nov 7, 2016, we prospectively evaluated 129 HIV-infected adults with suspected meningitis for tuberculosis. 23 participants were classified as probable or definite tuberculous meningitis by uniform case definition, excluding Xpert Ultra results. Xpert Ultra sensitivity was 70% (95% CI 47–87; 16 of 23 cases) for probable or definite tuberculous meningitis compared with 43% (23–66; 10/23) for Xpert and 43% (23–66; 10/23) for culture. With composite standard, we detected tuberculous meningitis in 22 (17%) of 129 participants. Xpert Ultra had 95% sensitivity (95% CI 77–99; 21 of 22 cases) for tuberculous meningitis, which was higher than either Xpert (45% [24–68]; 10/22; p=0·0010) or culture (45% [24–68]; 10/22; p=0·0034). Of 21 participants positive by Xpert Ultra, 13 were positive by culture, Xpert, or both, and eight were only positive by Xpert Ultra. Of those eight, three were categorised as probable tuberculous meningitis, three as possible tuberculous meningitis, and two as not tuberculous meningitis. Testing 6 mL or more of CSF was associated with more frequent detection of tuberculosis than with less than 6 mL (26% vs 7%; p=0·014).

Interpretation

Xpert Ultra detected significantly more tuberculous meningitis than did either Xpert or culture. WHO now recommends the use of Xpert Ultra as the initial diagnostic test for suspected tuberculous meningitis.

Read the full study here.

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Global Fund Results Report 2017 http://www.eatg.org/news/global-fund-results-report-2017/ Wed, 13 Sep 2017 21:59:57 +0000 http://www.eatg.org/?post_type=news&p=6191 GENEVA, 13 September 2017 – Programs supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria have saved 22 million lives, according to a report released today. The report also shows significant increases in the number of people receiving treatment for HIV, diagnosis and treatment for TB and having an insecticide treated net to prevent malaria.

The Global Fund Results Report 2017, with cumulative results through the end of 2016, shows a decline of one-third in the number of people dying from AIDS, TB and malaria in the countries where the Global Fund invests.

“Investing in global health is a highly cost effective way to achieve greater security and stability, to protect communities worldwide from infectious disease and to halt emerging health threats,” said Marijke Wijnroks, Interim Executive Director of the Global Fund. “This report highlights outstanding achievements, and also how much more there is to do.”

Programs supported by the Global Fund, which are designed and implemented by local experts and communities affected by the diseases, provided 11 million people with antiretroviral therapy for HIV – more than half the total number of people on treatment worldwide.

Global Fund-supported programs have provided 17.4 million people with testing and treatment for TB, and 795 million mosquito nets to prevent malaria. As a result of prevention and control interventions in more than 100 countries, the Global Fund’s target of averting 140-180 million infections by the end of 2016 was met in 2015.

Since the peak of the crisis, the number of deaths caused by AIDS has declined by 48 percent in countries where the Global Fund invests, from 1.9 million in 2004 to 1 million in 2016. The mortality rate from TB declined 35 percent in countries supported by the Global Fund, and actual deaths declined 21 percent between 2000 and 2015 (excluding HIV-positive people).

As for malaria, which has seen a 50 percent decline in global deaths between 2000 and 2015, cases of malaria treated through Global Fund-supported programs rose 15 percent in the past year alone, to hit a cumulative total of 668 million by end 2016.

“These results show what we can achieve by sticking to our mission and values, but to end the epidemics and build healthier, more prosperous societies we must face the new challenges with courage, including improving the health of adolescent girls and young women and addressing the growing menace of antimicrobial resistance,” Dr. Wijnroks said.

Young people, in particular adolescent girls and young women, still face extraordinary levels of risk; in parts of Africa, young women aged 15-24 years are eight times more likely than their male peers to be living with HIV. To address the inequalities affecting women and girls, the Global Fund’s investments have increased significantly in the past seven years, with about 60 percent of the organization’s total investments now directed to women and girls, the report says.

More than one-third of Global Fund investments go toward building resilient and sustainable systems for health, which are critical to the fight against HIV, TB and malaria, improving the quality of health care overall, and enabling countries to respond to emerging regional and global health threats.

At the same time as investing to fight HIV, TB and malaria, the Global Fund is working with affected countries to increase their own contributions to creating sustainable domestic health programs. The Global Fund’s shared financing requirement stimulates domestic investment in health, which helps ensure the gains are sustainable and builds shared global responsibility for health. The report says to date countries have committed an additional US$6 billion to their health programs for 2015-2017 compared with spending in 2012-2014, representing a 41 percent increase in domestic financing for health.

With affected countries in the lead, the Global Fund partnership, which was set up in 2002, brings together governments, civil society, the private sector and people affected by the diseases to accelerate the end of the epidemics.

Full Report [ download in English | Français ]
Summary [ download in English | Français | 日本語 ]

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An Activist’s Guide to the TB LAM Test http://www.eatg.org/news/an-activists-guide-to-the-tb-lam-test/ Wed, 13 Sep 2017 21:45:27 +0000 http://www.eatg.org/?post_type=news&p=6181 As TB has risen to become the leading infectious killer of people living with HIV (PLHIV), diagnostic tests such as the TB LAM test are critically important to ensure diagnosis of TB quickly for this vulnerable population. LAM represents the only current point-of-care TB diagnostic test overall, that is specifically used for detecting TB in PLHIV with low CD4 counts, and is the only test that has a proven impact on reducing TB deaths in people with HIV.

An Activist’s Guide to the TB LAM Test provides important messaging and strategies to support in-country LAM advocacy and activism. Furthermore, this guide seeks to help advocates and activists ensure uptake of the test across a variety of key targets, including implementation by National AIDS and TB programmes, registration by regulatory authorities, to pressuring donors to push the use of LAM test among countries that are dually burdened by HIV and TB.

Download the guide here.

 

See also:

  • TB/HIV Activist Toolkit 2017 Update

 

The 2017 update to the TB/HIV Activist Toolkit modules, developed by Treatment Action Group, continues to build and provide fundamental information about TB in order to strengthen global advocacy and scientific literacy around TB and TB/HIV.

The toolkits cover important base knowledge on TB and TB/HIV, as well as strategies to support advocacy across diagnostics, treatments, and prevention for TB. The information is intended to help activists and others to develop community education materials and sessions on TB, and to inform their advocacy.

Download the toolkits here.

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Union statement: the need to ‘accelerate progress’ in the fight against TB is paramount http://www.eatg.org/news/union-statement-the-need-to-accelerate-progress-in-the-fight-against-tb-is-paramount/ Wed, 13 Sep 2017 21:28:31 +0000 http://www.eatg.org/?post_type=news&p=6200

Leaving no-one behind is fundamental to the Sustainable Development Goals (SDGs), formally adopted by the United Nations as core to international development.

Yesterday’s report in The Lancet (12/09/17) considers if the world is ready to deliver on aims such as universal healthcare (UHC) and finds that, at current rates of progress, fewer than five percent of countries are projected to reach 2030 targets for 11 indicators, including tuberculosis (TB).

A follow-up article in Le Monde (13/12/17) asserts that eliminating TB by 2030 is the world’s “impossible goal”.

These reports are important commentaries on our progress – progress that has been found wanting. If we are to eliminate TB by 2030, we can no longer rely on all the same solutions to problems that we have relied on to date. The stakes are too high.

The Union works in some of the world’s poorest communities where weak infrastructure, lack of investment and uneven quality in healthcare provision all impact negatively on achieving the SDGs and the aim to eliminate TB.

The Union has long advocated for advancement and investment at some fundamental levels to change this picture for good.

The first is the prioritisation of investment into research and development that will ensure more effective, cheaper, shorter TB treatments that are available to everyone, no matter their country of residence. The goal should be a treatment regimen that cures all forms of TB with treatment lasting a month or less.

The second is achieving universal access to high-quality, comprehensive TB care.

Dramatic progress has recently been made on developing shorter treatment regimens for multidrug-resistant TB (MDR-TB), thanks in part to The Union’s early research in Francophone Africa that resulted, last year, in the World Health Organization’s endorsement of a nine-month treatment regimen, compared to a previous 22- to 24-month standard.

But for this to be truly effective at reducing the incidence of MDR-TB, countries must move quickly to roll out the treatment, including providing better training and support for health workers and investing in complementary strategies that will help to strengthen healthcare services, such as mobile technologies and integrated services that provide support for associated illnesses, like diabetes, and for psychosocial support.

The aim to eliminate TB by 2030 is not an impossible one, but it is one that will challenge the world’s resources and the collective will to make good on its promise.

 

See also:

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Point-of-care CRP test may help detect TB in some people with HIV http://www.eatg.org/news/point-of-care-crp-test-may-help-detect-tb-in-some-people-with-hiv/ Mon, 11 Sep 2017 16:20:04 +0000 http://www.eatg.org/?post_type=news&p=6141 A point-of-care test for C-reactive protein (CRP) may detect tuberculosis in people with HIV and low CD4-cell counts who are starting antiretroviral therapy (ART), researchers suggest.

“Current tools to screen people living with HIV for active pulmonary TB are limited to symptom-based screening, which has an unacceptably high false-positive rate (up to 90%), and chest x-ray, which misses up to 20% of TB cases, has high infrastructure requirements and requires trained interpreters, both of which are not routinely available in most health care centers in TB-endemic areas,” Dr. Adithya Cattamanchi and Dr. Christina Yoon of the University of California, San Francisco, told Reuters Health.

“The high false-positive rate of the symptom screen is an important problem because it would require nearly all people with HIV without active TB to undergo costly and unnecessary confirmatory Xpert MTB/RIF testing while simultaneously denying eligible patients access to TB preventive therapy,” they explained in a joint email.

To investigate the utility of the point-of-care CRP test, Drs. Cattamanchi, Yoon and colleagues used it to screen 1,177 HIV-infected adults (median age, 33; 53% women; median CD4 count, 165 cells per microliter) for TB between July 2013 and December 2015. A total of 163 (14%) participants had culture-confirmed TB.

CRP concentrations were measured at baseline using blood obtained by fingerprick (concentrations of at least 10 mg/L defined a positive screen for TB). Sputum samples were collected for Xpert MTB/RIF confirmation and culture.

As reported in The Lancet Infectious Diseases, online August 25, the CRP test had 89% sensitivity and 72% specificity for culture-confirmed TB. Compared with WHO symptom-based screening, the CRP test had a lower sensitivity (89% CRP vs. 96% WHO) but much higher specificity (72% vs. 14%).

When Xpert MTB/RIF results were used as the reference standard, the sensitivity of the two screens were similar (94% CRP vs. 99% WHO).

The findings support CRP’s use as a TB screening test “for people living with HIV with CD4 count less than or equal to 350 cells per microliter who are initiating ART,” the authors conclude.

“For HIV clinics,” Drs. Cattamanchi and Yoon said, “our study suggests that replacing symptom-based TB screening with CRP-based screening would reduce the proportion of people with HIV requiring Xpert MTB/RIF confirmatory testing by more than half (60% absolute reduction) and increase the proportion of people with HIV immediately eligible for TB preventive therapy by more than fivefold.”

“In addition,” they noted, “for the vast majority of high-burden countries that use Xpert MTB/RIF as the confirmatory test, CRP-based TB screening can be expected to detect nearly all (94%) Xpert-positive TB cases – those cases that pose the greatest infectious risk to the community – while substantially reducing the costs of TB diagnosis.”

“Future studies should evaluate CRP-based TB screening in other outpatient HIV subgroups . . . and other outpatient populations targeted for systematic TB screening, such as household contacts of TB cases, miners, prisoners, etc.,” they conclude.

Dr. Annemieke Geluk of Leiden University Medical Center in the Netherlands, coauthor of a related editorial, told Reuters Health, “The strength of (the) study lies in prospectively demonstrating that fingerstick CRP reaches WHO criteria for sensitivity and specificity.”

However, “despite being highly sensitive for active TB, elevations of CRP are far from specific for TB as they are elevated also in many other diseases, so the interpretation of CRP results needs to be done with care, as other infections or health problems can affect these levels,” she said by email.

“Also, the immunology of TB is complicated, and TB comprises several stages of infection, which definitely can’t all be captured using one biomarker,” she observed.

“Future research in TB diagnostics should include more as well as other types of markers, such as transcriptomic markers, to develop a more specific point-of-care test for the most deadly infectious disease in the world,” she concluded.

Dr. Divya Reddy of Albert Einstein College of Medicine in New York City told Reuters Health, “The results are impressive and make a strong argument for the use of point-of-care CRP testing as a TB screening strategy in select HIV patients in resource-poor countries in Africa and Asia.”

“Although a formal cost-effective analysis hasn’t been done,” she said by email, “I suspect integration in public health programs will be easy and likely identify more TB cases at lower costs, thereby influencing the global TB epidemic.”

SOURCES: http://bit.ly/2xOlE0h and http://bit.ly/2eFFna3

Lancet Infect Dis 2017.

By Marilynn Larkin

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-28/ Wed, 06 Sep 2017 18:59:05 +0000 http://www.eatg.org/?post_type=news&p=6120 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 319 of the “Global Fund Observer.” The newsletter features articles on various topics, including funding absorption failures among some African countries and the process of selecting the Global Fund’s next executive director.

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WHO prequalifies key treatment for children with TB http://www.eatg.org/news/who-prequalifies-key-treatment-for-children-with-tb/ Tue, 05 Sep 2017 20:40:00 +0000 http://www.eatg.org/?post_type=news&p=6103

01 September 2017 – WHO has just prequalified a two-pills-in-one paediatric medicine that is critical for the continuation phase of the six-month treatment required to cure tuberculosis (TB). The medicine – rifampicin 75mg + isoniazid 50mg – is a fixed dose combination (FDC) tablet manufactured by Macleods Pharmaceuticals Limited. WHO medicines prequalification activities are partly funded by the Bill & Melinda Gates Foundation and by Unitaid.

WHO’s inclusion of the medicine in its Prequalification list means that the product has been found to meet international standards of quality, safety and efficacy. It is available for procurement through the Global Drug Facility, which supports TB medicines procurement for United Nations programmes, international procurement agencies as well as national procurement entities.

The listing of this product is very good news,” said Dr Mario Raviglione, Director of the Global TB Programme at WHO. “Lack of adequate child-friendly medicines to treat TB has been a huge problem for a long time. The fact that we now have the medicines and they meet WHO quality standards is expected to rapidly expand access to effective treatment for children all over the world.”

The prequalified double FDC is preceded, for the first few weeks of treatment, by another product – rifampicin 75mg + isoniazid 50mg + pyrazinamide 150mg. That product is currently under review by the Prequalification team. Both FDCs were included in the WHO Model List of Essential Medicines for children, in May 2017.

The child-friendly FDCs were developed in line with new WHO guidelines (Guidance for national tuberculosis programmes on the management of tuberculosis in children), which revised the medicine’s dosing to achieve appropriate therapeutic levels for children. They are water-dispersible tablets and have a pleasant taste. They offer the opportunity to simplify and improve treatment for children around the world and are therefore likely to enhance adherence and completion of treatment, as well as to prevent the development of drug resistance.

The child-friendly TB fixed-dose combinations have been developed with support from Unitaid through the STEP-TB project. The project was implemented by the Global Alliance for TB Drug Development (TB Alliance) in close collaboration with WHO.

 

See also:

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BCG jab may protect against TB for nearly twice as long as previously thought http://www.eatg.org/news/bcg-jab-may-protect-against-tb-for-nearly-twice-as-long-as-previously-thought/ Tue, 05 Sep 2017 20:19:04 +0000 http://www.eatg.org/?post_type=news&p=6102 Study shows vaccine guards against infection in adulthood when most transmission occurs

The world’s only licensed tuberculosis (TB) vaccine could offer protection against the disease for nearly twice as long as previously thought, according to new research published in the International Journal of Epidemiology.

Previously thought to be effective for 10-15 years, a new case-control study found that if given in early teenage years (12-13), the Bacillus Calmette-Guérin (BCG) vaccine protected over 50% of UK children against TB for at least 20 years, then waned. The research was led by the London School of Hygiene & Tropical Medicine and funded by the National Institute for Health Research. Although some studies in countries such as Brazil and Norway have indicated that BCG might be effective for longer than first thought, this study provides the most robust evidence to date.

With no new vaccine for TB imminently available, the researchers say their findings highlight the important role BCG is playing in preventing the spread of the disease, and provide an argument for uptake to be higher in areas where TB risk is high but vaccination coverage is low, such as parts of Central and Western Africa, East Asia and the Pacific – important new evidence for agencies like the World Health Organization (WHO) advising on vaccines. The results will also support countries where the routine BCG programme is at risk of being neglected to assess the cost-effectiveness of the vaccine, as well as the effectiveness of TB vaccines in development.

TB is a major, and preventable, cause of death and disease which mainly affects the lungs. Two to three billion of the world’s population are infected with Mycobacterium tuberculosis, 10% of whom progress to clinical disease. In 2015 there were an estimated 10.4 million new cases of TB and 1.8 million deaths globally.

In the UK, BCG vaccination was given mostly to schoolchildren until it was discontinued in 2005 as the risk of TB was low. It has continued to be recommended to babies and infants who are at higher risk. Although offered around the world, the length of the BCG vaccine’s protective effect is unclear, something this new research aimed to address.

The study was conducted among adults in the general population in England 10 to 30 years after they were offered the BCG vaccine at school. It compared 677 people (cases) who were diagnosed with TB, with 1,170 people without a previous history of the disease (controls). Adults in both groups were inspected for BCG vaccination scars and asked about their vaccination history by specially trained interviewers.  Overall, 75% of cases were vaccinated compared to 86% of controls.  These groups had been matched on year of birth and the researchers controlled for social and demographic variables including drug use, education and living region.

TB was less than half as likely to occur in vaccinated children compared with unvaccinated children 10 to 20 years later. The protective effect of BCG then declined after 20 years. The analysis took into account missing information in some people such as alcohol use and smoking, as well as the fact that individuals with TB were poorer, with a higher later risk of TB but less likely to have had BCG vaccination at school.

Lead author Dr Punam Mangtani, Associate Professor in Epidemiology at the London School of Hygiene & Tropical Medicine, said: “Tuberculosis kills nearly two million people every year, more than HIV/AIDS, but TB prevention methods have changed little in half a century. Progress in developing new TB vaccines is slow with BCG, developed in the 1920s, still the only option.”

“Previous studies have shown BCG can offer good protection against TB for up to 10-15 years following vaccination of secondary schoolchildren, but we do not know the duration of protection in different populations. Our study showed it offers moderate protection for longer than had been recognised. This could help countries who are moving towards being ‘low-risk’ areas assess the cost-effectiveness of BCG in the prevention of the disease, and also be a new yardstick against which new TB vaccines in development can be measured.”

BCG vaccine is given in infancy in 158 countries with an estimated 88% coverage overall.  Its protective effect can be lower closer to the equator where environmental non-tuberculous mycobacteria or TB infection are more common and, if they occur before vaccination, can mask or block its effect. Although the World Health Organization’s End TB strategy highlights the importance of continuing infant BCG vaccination in high prevalence settings, this study suggests it may have a bigger role to play.

Dr Mangtani said: “BCG given at school age may help in the control of TB, including reducing the risk of multidrug resistant disease, as those vaccinated around 13 years of age have been protected into adulthood when transmission of the infection was more likely. Health officials should consider recommending childhood BCG vaccination where TB risk is high and where infant vaccination has not been given. BCG is not perfect but until a new, more effective vaccine is approved and rolled-out, we should be maximising its potential. We should also be supporting the various agencies that make sure BCG is readily available globally.”

The authors acknowledge limitations of the study, including not being able to exclude subjects who had positive tuberculin skin test in the school vaccination programme who would have been ineligible for vaccination, and that subjects taking part are more likely to have been vaccinated than those not contactable or who had refused.

Publication

Punam Mangtani, Patrick Nguipdop-Djomo, Ruth H Keogh, Jonathan AC Sterne, Ibrahim Abubakar, Peter G Smith, Paul EM Fine, Emilia Vynnycky, John M Watson, David Elliman, Marc Lipman, Laura C Rodrigues. The duration of protection of school-aged BCG vaccination in England: a population –based 5 case–control study. International Journal of Epidemiology. DOI:10.1093/ije/dyx141

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Has the European Union met its targets for reducing TB fatalities? http://www.eatg.org/news/has-the-european-union-met-its-targets-for-reducing-tb-fatalities/ Tue, 29 Aug 2017 21:20:50 +0000 http://www.eatg.org/?post_type=news&p=6039

While tackling global health issues it is essential to measure the success of public health campaigns. In a study recently published in BMC Public Health, researchers report on the success of the European Union’s mission to reduce tuberculosis death rates across its countries. Here, we find out how they fared and look at the next steps for the future.

In September 2000, The United Nations (UN) defined ‘The Millennium Development Goals’ which outline targets to tackle extreme poverty in the world. This mission seeks to alleviate many global challenges – including poverty, hunger, disease, shelter limitations, equality, education and sustainability of the environment.

The European Union (EU) sought to address the extent of these problems by 2015. A key aim has been to see a reduction in the number of deaths caused by tuberculosis (TB). This infectious disease is a public health concern, as one third of the global population is thought to be infected with it.

In response to global health initiatives, the UN aimed to see a 50% reduction in death rates caused by TB by 2015, in comparison to figures from 1990. Marieke J. van der Werf, Sandro Bonfigli and Frantiska Hruba from the European Centre for Disease Prevention and Control, Granitsväg, in Stockholm investigated whether these milestones were actually reached, so that we can prepare for the next steps to further improve global health.

As shown in their recently published article in BMC Public Health, by obtaining data from the Eurostat database, the researchers analyzed cause of death statistics for populations belonging to all 28 countries of the EU. Looking at the time frame of 1999-2014, it appeared that TB death rates had decreased by 50%.

To add to this promising news, ‘the annual average percentage decline’, which shows how fast the fatality percentage declines from year to year, was a surprising 2.73%. This result was more than what was necessary for them to reach their target. This positive news shows that the EU has successfully reached its MDF goal of reducing TB fatalities in its member countries. Though, what hope do we have for the future?

Since 2016, a new goal has been constructed by the World Health Organization. They raise the bar to ambitious levels, using figures from 2015 for comparison against a target for a 35% reduction in tuberculosis fatality by 2020, and a 95% drop by 2035. The authors comment that this will cause heavy demand on governments and health care services.

Other parts of the world are setting such objectives too. The General Assembly of the United Nations set out a list of goals to cease various global health problems by 2030, including as the TB epidemic.

To reliably assess how the world copes with its public health initiatives, appropriate data collection and research will become increasingly important as we step into the public health challenges of the future.

By Clarissa Wright

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Update on safe, effective treatments for latent TB infection http://www.eatg.org/news/update-on-safe-effective-treatments-for-latent-tb-infection/ Tue, 29 Aug 2017 18:41:21 +0000 http://www.eatg.org/?post_type=news&p=6038

Isoniazid and rifampicin monotherapy and combination therapy regimens, as well as a weekly rifapentine plus isoniazid regimen, were found to be safe and effective for preventing tuberculosis (TB) reactivation among individuals with latent TB infection (LTBI). These findings from an update to a previous network meta-analysis of randomized controlled trials (RCTs) were published in the Annals of Internal Medicine.1

Preventing reactivation of TB among individuals with LTBI is a key component to achieving the World Health Organization’s (WHO’s) End TB Strategy and the United Nations’ Sustainable Development Goal of ending the global TB epidemic by 2030. There are numerous treatment regimens for LTBI, including regimens with lower pill burdens and of shorter duration. However, more evidence is needed regarding the efficacy of the more abbreviated regimens.1

The 2014 WHO guidelines for LTBI treatment, which provide recommendations for the least toxic and most effective regimens, are largely based on the findings from a prior network meta-analysis of RCTs.2-4 Recently, the European Centre for Disease Prevention and Control decided to develop new guidelines on LTBI treatment. As a result, an update to the 2014 network meta-analysis was needed.1

Dominik Zenner, MD, from the Tuberculosis Section of the Respiratory Diseases Department, Public Health England, and colleagues compared the safety and efficacy of LTBI preventative treatment regimens in an updated meta-analysis of RCTs that evaluated LTBI treatments.1

Only RCTs that reported prespecified outcomes of active TB prevention or hepatotoxicity were eligible for analysis. Of 61 RCTs that were included, 8 were new since the previous review. All 8 new studies recorded data on TB reactivation, 4 reported data on hepatotoxicity, and 6 were conducted only in participants with HIV.1

Monotherapy with isoniazid for 6 months (odds ratio [OR], 0.65; 95% credible interval [CrI], 0.50-0.83) or 12 to 72 months (OR, 0.50; CrI, 0.41-0.62) and monotherapy with rifampicin (OR, 0.41; CrI, 0.19-0.85) were found to be effective vs placebo.1

Several combination regimens were also effective when compared with placebo: rifampicin plus isoniazid regimens of 3 to 4 months (OR, 0.53; CrI, 0.36-0.78), rifampicin plus pyrazinamide regimens (OR, 0.53; CrI, 0.33-0.84), and rifampicin-isoniazid-pyrazinamide regimens (OR, 0.35; CrI, 0.19-0.61). Weekly rifapentine plus isoniazid regimens also demonstrated efficacy vs no treatment (OR, 0.36; CrI, 0.18-0.73).1

Pyrazinamide-containing regimens had higher hepatotoxicity than several isoniazid-containing regimens. Rifampicin monotherapy, rifampicin plus isoniazid, and rifapentine plus isoniazid generally had lower hepatotoxicity than isoniazid monotherapy.1

According to Dr Zenner, these study results confirm the safety and efficacy of isoniazid monotherapy for ≥6 months, rifampicin monotherapy for 3 to 4 months, and rifampicin plus isoniazid for 3 months for LTBI. These regimens are currently recommended by the WHO and the Centers for Disease Control and Prevention, he said.

Dr Zenner also noted that the updated meta-analysis demonstrated that a 12-dose regimen of rifapentine plus isoniazid, administered once weekly over the course of 3 months, is safe and effective. A short course of treatment with a low pill burden may help address the problem of patient adherence to treatment. “This is important for clinicians who have started using [this regimen], where it is available (for example in the USA, Sweden and Norway),” he said.

By Crystal Wong

References

  1. Zenner D, Beer N, Harris RJ, Lipman MC, Stagg HR, van der Werf MJ. Treatment of latent tuberculosis infection: an updated network meta-analysis [published August 1, 2017]. Ann Intern Med. doi: 10.7326/M17-0609
  2. Stagg HR, Zenner D, Harris RJ, Muñoz L, Lipman MC, Abubakar I. Treatment of latent tuberculosis infection: a network meta-analysis. Ann Intern Med. 2014;161:419-428.
  3. Getahun H, Matteelli A, Abubakar I, et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J. 2015;46:1563-1576.
  4. World Health Organization. Guidelines on the management of latent tuberculosis infection. Geneva: WHO Press; 2015.
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TAG’s Activist guides to TB diagnostics and treatment now available in Russian http://www.eatg.org/news/tags-activist-guides-to-tb-diagnostics-and-treatment-now-available-in-russian/ Mon, 28 Aug 2017 21:59:52 +0000 http://www.eatg.org/?post_type=news&p=6000 Treatment Action Group (TAG) in collaboration with the International Treatment Preparedness Coalition, Russia (ITPCru) released in Russian two of its publications:

1. An Activist’s Guide to Tuberculosis Drugs 2016
The Russian version is available here.

2. An Activist’s Guide to Tuberculosis Diagnostic Tools 2017
The Russian version is available here.

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Ukraine’s TB problem is ticking time bomb for Europe http://www.eatg.org/news/ukraines-tb-problem-is-ticking-time-bomb-for-europe/ Thu, 24 Aug 2017 21:59:25 +0000 http://www.eatg.org/?post_type=news&p=5976

Controlling the airborne disease takes on additional urgency this year as the country seeks to integrate into EU with a new visa-free regime.

ODESSA, Ukraine — In the Ukrainian tourist destination of Odessa, a port on the Black Sea, holidaymakers mingle with internally displaced people from the country’s war-torn east, local Roma, students, and economic migrants from Central Asia and the Caucasus, Africa and Asia.

Yet the air carries something less healthy than sea breezes: tuberculosis.

Odessa has the highest rate of TB in Ukraine, with 110 cases per 100,000 people in 2016, and rising fast. Closely linked with migration, instability and poverty, controlling this airborne disease takes on additional urgency this year as Ukraine seeks to integrate into Europe thanks to a new visa-free regime. Part of a migration corridor from Central Asia and the Caucasus to Russia and Western Europe, Ukraine has at least 5 million citizens working abroad, according to its foreign ministry: in Poland, Italy, Spain, Portugal, the Czech Republic, Russia and Germany. Another 1.5 million people have been internally displaced by the war in the east of the country.

“Ukraine should pay special attention to TB because it’s a very sensitive topic for Europe,” said Alexey Bobrik, the World Health Organization’s (WHO) technical officer for HIV, TB and viral hepatitis in Ukraine. “I’m talking about global security and transmission of TB through borders.”

Tuberculosis was largely wiped out in Western Europe in the early 20th century through treatment, improved health monitoring and awareness, and higher living standards. Since the Soviet Union collapsed the disease has returned with a vengeance in former Soviet states. Ukraine declared a TB epidemic in 1995.

Since then, the country has received huge amounts of international aid to tackle TB and its twin epidemic, HIV. But weak political will and chronic distrust of the country’s corrupt health system has held back progress. While overall TB rates are gradually falling, in places like Odessa they continue to rise. More worryingly, Ukraine is one of the leading countries in the world for multi-drug resistant (MDR) forms of TB, which do not respond to traditional treatment.

A quarter of newly diagnosed cases of TB in Ukraine in 2016 were MDR-TB, according to WHO. Cure rates for resistant forms are the lowest among all MDR-TB burden countries: 38 percent. In Odessa, where TB-HIV co-infection is rife, the overall TB cure rate last year was just 43 percent. “That basically shows you how effective the health system is here, which is a shame for a European country,” Bobrik said.

Unchanged system

Ukraine’s TB system has changed little since Soviet times. It’s based on in-patient treatment lasting months or even years in TB clinics and sanatoriums, often located in once-beautiful historical buildings that are in disrepair and unsuited to modern infectious disease control and patient needs.

“We can’t provide proper treatment conditions,” said Dr. Oksana Leonenko-Brodetskaya, who heads Odessa city’s TB clinic. It’s housed in a peeling pink classical building in the city center. “We’ve no individual isolated wards, and no phasing system of existing wards, and so cross-infection occurs.”

According to modern international standards, isolated in-patient treatment is not the answer to TB anyway — early and accurate diagnosis, early treatment and retention of patients on an ambulatory basis is. Most patients stop being infectious within days or weeks of starting treatment. In a country with no job or social security, and in a city like Odessa with a large migrant population, expecting patients to stay for months in poorly equipped hospitals is unrealistic, unnecessary and hugely expensive.

“Ukraine can’t afford it,” Bobrik said. “You can spend your funding on TB dispensaries and a lot of health workers who sit in these dispensaries and don’t go to patients. Or instead of that, you can create an out-patient model.”

Retaining out-patients requires a change of approach. More than 20 percent of newly diagnosed patients in Odessa in 2016 were migrants and non-residents of the city. Many — although far from all — are among the most disadvantaged members of society: the homeless, drug users, former prisoners. The stigma around TB is another reason patients try not to be associated with TB treatment centers.

“They all try to disappear,” Leonenko-Brodetskaya said of her patients, claiming many register with false addresses and fall off the grid as soon as they start to feel better.

Everyone concerned with TB in Odessa speaks about a taxi driver or a market trader still working with active TB and a fake health certificate, because they can’t afford to stop. The stories may be apocryphal but Maria Kochetova, who spent three months in a TB ward earlier this year, recalled patients there who stopped taking medication, checked out early or simply disappeared. Even among patients, there’s an instinct to blame other patients for spread of the disease.

Kochetova also recalled several patients dying of a disease which, if caught early enough, should be treatable. Kochetova’s doctors didn’t expect her to survive either. The 34-year-old called an ambulance only after weeks of what she told herself was flu. She’d never considered herself at risk from TB: She wasn’t homeless; she didn’t use drugs; she had a regular job as a cleaner.

Doctors told her it started with an earlier bout of pneumonia she’d left untreated because she couldn’t afford it.

“It’d cost money if I ended up in hospital,” she said. “I’m not the only one who does this; everyone keeps going until they fall down because they know hospital is so expensive.”

‘Free’ treatment

Ukrainian health care is theoretically free. In practice, patients pay for services and medication through an entrenched system of kickbacks to medical staff trying to supplement painfully low salaries. Kochetova was fortunate that once she did end up in hospital, her active TB was diagnosed within three days instead of three weeks, and TB treatment is genuinely free. But during those three days, she says she had to pay more than 1,000 Ukrainian hryvnia (€33) for various services — that’s two weeks’ wages for a junior medical worker.

“They fleece you for everything,” she said.

Non-hospitalized patients have to make daily trips to clinics to get medicines, which are supposed to be taken under observation to ensure patients complete treatment courses of up to two years for MDR-TB. Failure to complete courses leads not just to further illness but to more development of drug-resistant forms. The daily travel is onerous, especially for those with no income or fixed living place, or from rural areas.

Programs run by state clinics and nongovernment organizations in Odessa provide a solution: psycho-social support and incentives for patients to adhere to treatment by bringing medicines to their homes and providing other aid such as food parcels, bus tickets or mobile phone credit. Odessa city has also tried to incentivize medical staff. Under a pioneer bonus system to boost primary care diagnosis rates, family GPs receive 2,000 hryvnia (€66) for every fast, accurate TB diagnosis and referral. Last year, city authorities paid 200 bonuses from the 1,113 newly diagnosed cases.

In future, the city wants to keep TB treatment and monitoring within the ambulatory primary health care system, with bonuses for medical staff based on successful treatment outcomes.

These innovations are in line with overall Ukraine health reforms now in legislative limbo. These would change the old Soviet centralized model of funding institutions based on number of staff and hospital beds irrespective of numbers of patients and their needs, to patient-centered, results-based funding. Regions would have more autonomy to allocate funds to primary medicine, and to NGOs to provide services. The reforms should make most key health services genuinely free for patients.

Although backed by the EU and by international agencies that have largely underwritten Ukraine’s TB and HIV programming, parliament shelved the draft financing laws until the fall, and there is widespread opposition. In Odessa’s medical community, the reforms are surrounded by doubt and rumor, from fears they will cut jobs, to accusations that their real purpose is to sell off valuable real estate now used as clinics.

Examples from other post-Soviet and eastern bloc countries show that the transition to a new model is indeed painful, but can be achieved. With the Global Fund to Fight AIDS, TB and Malaria — Ukraine’s main health donor funding the majority of HIV and TB response — due to pull out of the region in 2020, Ukraine has little time left to find a domestic answer to its epidemics and its failing health system.

“For Eastern Europe it’s a particularly acute issue,” said Michel Kazatchkine, former director of the Global Fund. “Increasing epidemics, low coverage with treatment and prevention, no readiness and in some cases no willingness to pay for services for vulnerable people … nothing is ready.”

In his current role as U.N. special envoy for HIV/AIDS in Eastern Europe and Central Asia, Kazatchkine is lobbying for health reform in Ukraine to ease the transition once external funding stops.

“I would be less pessimistic than I was a year-and-a-half ago because I see changes. I’m seeing more political commitment,” he said. “AIDS and TB are on the agenda.”

By Lily Hyde

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Otsuka and Mylan announce license agreement to commercialize Deltyba™ for MDR-TB in high-burden countries http://www.eatg.org/news/otsuka-and-mylan-announce-license-agreement-to-commercialize-delamanid-deltyba-for-mdr-tb-in-high-burden-countries/ Thu, 24 Aug 2017 21:40:27 +0000 http://www.eatg.org/?post_type=news&p=5973

TOKYO, HERTFORDSHIRE, England and PITTSBURGH, Aug. 24, 2017 — Otsuka Pharmaceutical Co. Ltd. (Otsuka) and Mylan N.V. (NASDAQ, TASE: MYL) have entered into a license agreement between their respective subsidiaries, Otsuka Novel Products GmbH (ONPG) and Mylan Pharmaceuticals Private Limited (Mylan), to commercialize delamanid for the treatment of adults with pulmonary multidrug-resistant tuberculosis (MDR-TB) in low- and middle-income countries. Delamanid was discovered and developed, and is currently marketed by Otsuka under the brand name Deltyba™.

Under the terms of the agreement, Mylan has been granted an exclusive license by Otsuka to prioritize access to Deltyba™ in South Africa and India. Both countries are considered by the World Health Organization (WHO) as among the highest-burden countries for MDR-TB and TB/HIV co-infection, with over 150,000 estimated new cases of MDR-TB/rifampicin-resistant TB in 2015 alone.1 The Drug Controller General of India (DCGI) granted approval to Mylan to market Deltyba™ in India, and registration is under way in South Africa.

Mylan is anticipated to further exercise exclusive commercial rights and registration responsibilities in additional countries, including many other high MDR-TB burden countries where Otsuka does not have a commercial presence. The agreement announced today also allows both companies to enter into discussions and feasibility studies for a technology transfer plan, enabling Mylan to manufacture and distribute Deltyba™ for these markets in the future.

“Otsuka is a global leader in TB research and development and Mylan is a recognized leader in the provision of high-quality medicines for infectious diseases in many developing countries,” said Tatsuo Higuchi, president and representative director. “Given our respective experience in the field, our two companies are well positioned to work together in the fight against MDR-TB.”

Mylan President Rajiv Malik commented, “Mylan’s mission is to provide access to medicine to the world’s 7 billion people, including those in the developing world where the need for medicines like Deltyba™ are great and the challenges to reaching patients with high quality medicines are high. We are proud to partner with Otsuka to help deliver this important medicine in the highest-burden countries and provide more MDR-TB patients with access to treatment.”

Deltyba™ is one of two anti-tuberculosis medicines recently approved, after more than 40 years of treatment with the same agents. It is registered in the European Union, Japan, the Republic of Korea, Hong Kong, Turkey and India. Since regulatory approval, more than 4,000 treatment courses of Deltyba™ have been shipped for use in over 50 countries. Otsuka recently launched a novel, pre-approval access program in South Africa administered by the Department of Health and a similar rollout programme in India is ready to begin.

About Deltyba™

The efficacy of Deltyba™ was studied in a large, randomised, placebo-controlled phase 2 trial that included a 2-month treatment period and a 1-month follow-up of 481 MDR-TB patients (Trial 204), with 213 patients continuing to a 6-month open-label treatment trial (Trial 208), and concluding with a 24-month follow-up study of 421 out of the originally randomized 481 patients (Trial 116). Adding 100 mg Deltyba™ twice daily to a WHO-recommended OBR was associated with a statistically significant 53% increase (p=0.008) in the percentage of patients achieving SCC at 2 months (64/141, 45.4%) compared to those with placebo added (37/125, 29.6%).2 The reported mortality rate was lower in patients receiving Deltyba™ for at least 6 months (2/192 (1.0%) compared with those receiving Deltyba™ for 2 months or no Deltyba™  (19/229 (8.3%); p<0.001).3

Clinical trial results demonstrated that Deltyba™ is well tolerated with adverse events evenly distributed in the Deltyba™ and placebo treatment groups with the exception of QT prolongation. Electrocardiogram QT prolongation was reported in 9.9% (16/161) of patients receiving Deltyba™ as 100 mg twice daily compared to 3.8% (6/160) of patients receiving placebo plus OBR. This was not accompanied by any clinical symptoms such as syncope or arrhythmias.2
Publication of results of the phase 3 study to confirm the safety and efficacy of Deltyba™ is expected in 2018, and a paediatric investigational programme is underway.

About TB & MDR-TB

Tuberculosis (TB), an airborne infectious disease, is among the top causes of death in the world and is the leading infectious disease killer. Drug resistance poses a real challenge to fighting and treating TB. Globally in 2015, nearly half a million people developed MDR-TB, an infection resistant to at least isoniazid and rifampicin, the two most commonly used first-line TB drugs.1 Mycobacterial MDR strains with additional resistance to at least one fluoroquinolone drug and a second-line injectable agent are defined as extensively drug-resistant (XDR). Secondary or acquired resistance has its roots in inappropriate treatment.

Resistance to anti-tuberculosis drugs worsens the prognosis for a successful treatment outcome. The treatment of MDR-TB combines at least five drugs – active or presumed active against the resistant strain – for an extended period of up to 20 months or more depending on patient response. The anti-TB drug combinations are chosen depending on the patterns of resistance from drug susceptibility testing and tolerance.

TB is the leading killer of HIV-positive people: about 35% of HIV deaths were due to TB in 2015. That year, there were an estimated 1.2 million new cases of TB amongst people who were HIV-positive, 71% of whom were living in Africa.1

About Mylan

Mylan is a global pharmaceutical company committed to setting new standards in healthcare. Working together around the world to provide 7 billion people access to high quality medicine, we innovate to satisfy unmet needs; make reliability and service excellence a habit; do what’s right, not what’s easy; and impact the future through passionate global leadership. We offer a growing portfolio of more than 7,500 marketed products around the world, including antiretroviral therapies on which approximately 50% of people being treated for HIV/AIDS in the developing world depend. We market our products in more than 165 countries and territories. We are one of the world’s largest producers of active pharmaceutical ingredients. Every member of our more than 35,000-strong workforce is dedicated to creating better health for a better world, one person at a time. Learn more at Mylan.com.

This press release includes statements that constitute “forward-looking statements,” including with regard to Mylan further exercising exclusive commercial rights and registration responsibilities in additional countries, Mylan manufacturing and distributing Deltyba™ for other markets in the future and that a pre-approval access program in India is ready to begin.  These statements are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.  Because such statements inherently involve risks and uncertainties, actual future results may differ materially from those expressed or implied by such forward-looking statements.  Factors that could cause or contribute to such differences include, but are not limited to: any changes in or difficulties with Mylan’s or its partners’ ability to develop, manufacture, and commercialize products; any regulatory, legal, or other impediments to Mylan’s or its partners’ ability to bring products to market; Mylan’s and its partners’ ability to protect intellectual property and preserve intellectual property rights; the effect of any changes in Mylan’s or its partners’ customer and supplier relationships and customer purchasing patterns; other changes in third-party relationships; the impact of competition; changes in the economic and financial conditions of the businesses of Mylan or its partners; the scope, timing, and outcome of any ongoing legal proceedings and the impact of any such proceedings on Mylan’s or its partners’ business; actions and decisions of healthcare and pharmaceutical regulators, and changes in healthcare and pharmaceutical laws and regulations, in the United States and abroad; risks associated with international operations; other uncertainties and matters beyond the control of management; and the other risks detailed in Mylan’s filings with the Securities and Exchange Commission. Mylan undertakes no obligation to update these statements for revisions or changes after the date of this release.

About Otsuka

Otsuka Pharmaceutical Company, Ltd., a subsidiary of Otsuka Holdings Co., Ltd. headquartered in Tokyo, Japan, is a global healthcare company with the corporate philosophy: “Otsuka – people creating new products for better health worldwide.” Otsuka researches, develops, manufactures and markets innovative products, with a focus on pharmaceutical products to meet unmet medical needs and nutraceutical products for the maintenance of everyday health.

Otsuka Novel Products GmbH (ONPG), a subsidiary of Otsuka Pharmaceutical Company, Ltd., is dedicated to finding innovative solutions to fight the global pandemic of tuberculosis (TB). As the European marketing authorization holder for Deltyba, Otsuka Novel Products GmbH works in collaboration with other Otsuka Group companies, partners, non-governmental organisations and other stakeholders, to expand global access to Deltyba and fight multidrug-resistant TB.

References:

1 World Health Organization. Global tuberculosis report 2016. WHO/HTM/TB/2016.13.

2 Gler MT, et al. Delamanid for multidrug-resistant pulmonary tuberculosis. New England Journal of Medicine 2012; 366: 2151–2160.

3 Skripconoka V, et al. Delamanid improves outcomes and reduces mortality in multidrug-resistant tuberculosis. European Respiratory Journal 2013; 41: 1393–1400.

 

See also:

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-27/ Thu, 24 Aug 2017 18:01:44 +0000 http://www.eatg.org/?post_type=news&p=5978 Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 318 of the “Global Fund Observer.”

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Switzerland renews its commitment to fighting AIDS, TB and malaria http://www.eatg.org/news/switzerland-renews-its-commitment-to-fighting-aids-tb-and-malaria/ Wed, 23 Aug 2017 14:00:36 +0000 http://www.eatg.org/?post_type=news&p=5965 Bern, 23.08.2017 – The Federal Council has approved a budget of CHF 57 million for the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for the period from 2017 to 2019. As host country and one of the founding members, Switzerland has been an important partner for the Global Fund since it was created in 2002. Over the past 15 years, the Global Fund has helped save millions of lives and made great strides in combating these diseases. As ongoing pandemics, however, they still pose a major public health problem in middle and low-income countries. In sub-Saharan Africa, millions of deaths could still be avoided each year.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, launched after these three diseases were included in the Millennium Development Goals, has helped make significant progress in the fight against these diseases. Programmes supported by the Global Fund have saved 20 million lives and brought the number of deaths from HIV/AIDS, TB and malaria down by a third since 2002. Between 2012 and 2015 alone, such programmes averted 146 million new infections from these three diseases.

Despite the progress made, these pandemics still pose a major public health problem in middle and low-income countries, particularly in sub-Saharan Africa, where they represent a serious obstacle to economic and social development. In an effort to build momentum against these diseases and ultimately overcome them, they were included in the Sustainable Development Goals as a stand-alone goal (SDG 3): ‘ensure healthy lives and promote well-being for all at all ages’. Today the Global Fund is one of the main financing instruments in reaching this target.

The Global Fund’s new strategy for 2017 to 2022, Investing to end epidemics, is based on its vision of ending the epidemic nature of these three illnesses. Efforts in this direction are closely connected to efforts to eliminate extreme poverty, empower women and girls, enable greater access to education, combat climate change and encourage inclusive economic growth. The Global Fund strategy thus corresponds to the agenda of Switzerland’s foreign policy on health and, in particular, its targets in controlling infectious diseases, building stronger health systems and regarding International Geneva.

The Global Fund is a powerful and crucial partner in the fight against these three transmissible diseases, which together are responsible for the premature death of 2.6 million people each year, mainly women and children, and undermine development efforts in the worst-hit countries. The Global Fund has produced significant results and saved an impressive number of lives since being launched 15 years ago.

Following today’s decision, the Federal Council will allocate a contribution of CHF 57 million to the Global Fund for the 2017–20 period. This is a CHF 3 million decrease on the last replenishment period, in line with the budget adjustment announced by the Swiss Agency for Development and Cooperation.

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Deaths rates declined in South Africa due to HIV success – report http://www.eatg.org/news/deaths-rates-declined-in-south-africa-due-to-hiv-success-report/ Wed, 23 Aug 2017 13:45:29 +0000 http://www.eatg.org/?post_type=news&p=5959 Death rates have declined, largely due to successes in HIV, but a lot more needs to be done to defeat its “terrible twin”, tuberculosis (TB).

This is according to the 20th edition of the South African Health Review published by the Health Systems Trust (HST) on Wednesday.

The review, published annually, noted that life expectancy which rose from its lowest levels in the mid 2000s, has been maintained. In 2006, due to the explosion in new HIV infections and little access to treatment, life expectancy was 52 years but in 2015 it had risen to over 63 and remains stable. This increase was driven by a massively scaled-up antiretroviral programme: the largest in the world.

It noted that the prevention of mother-to-child transmission (PMTCT) of HIV, another big driver in helping people live longer, “is one of the success stories of the 21st century in South Africa”.

Before 2001 up to 30 percent of babies born to HIV positive mothers tested positive for the virus at six weeks of age. As of 2016 this has “plummeted” to around 1.4 percent supported by national policy, political will and scientific evidence.

Prevention of HIV

There have also been successes in prevention. Since 2010, an estimated 10 million HIV tests and half a million medical male circumcisions are done every year, while 750 million male and over 25 million female condoms are distributed.

Despite this, many gaps remain. Key populations, those at higher risk of HIV infection, “pose particular challenges in the South African context”, noted the review. These include sex workers, people who inject drugs, transgender people, prisoners and men who have sex with men.

According to the Joint United Programme on HIV/AIDS more than 20% of new infections in sub-Saharan Africa were in key populations and more targeted interventions are needed to reach these communities who are often stigmatised and struggle to access services at traditional health facilities.

Drug-resistant TB

The review also noted that more needs to be done to address drug-resistant TB (DR-TB) as it is “a significant threat to end TB efforts in South Africa”. It has implications for the fight against HIV as up to as many as 60 percent of TB patients are co-infected with HIV.

Although just under 20 000 patients were diagnosed with DR-TB in South Africa in 2015 the numbers continue to rise and there are concerns that a significant number of cases are undiagnosed.

While the country has recently expanded access to newer drugs for DR-TB the review noted that there are variations in available DR-TB services across different provinces. For example the national policy of decentralising DR-TB services, out of hospitals and into communities, has not been implemented evenly across provinces.

Challenges remain

“HIV has been a black cloud dominating the health landscape over the past 25 years,” note Professor Peter Barron and Ashnie Padarath in the review’s editorial.

They said that the most important success in reflect on is the response to HIV which has been “instrumental in improving the key health indicators relating to death rates, life expectancy, and maternal, child and infant mortality”.

“Nonetheless, it is also very clear that challenges remain and that much needs to be done to improve governance, leadership and accountability at strategic, district and facility level, as well as in terms of the overall planning and implementation of the health workforce.”

By Amy Green

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TB CAB’s proposed development pathway for regimens to treat XDR-TB http://www.eatg.org/news/tb-cabs-proposed-development-pathway-for-regimens-to-treat-xdr-tb/ Thu, 17 Aug 2017 21:59:32 +0000 http://www.eatg.org/?post_type=news&p=5905 One of the most critical scientific questions in TB today is the optimal combination of new and repurposed drugs for the treatment of extensively drug-resistant, pre- extensively drug-resistant, and hard-to-treat multidrug-resistant TB (XDR-TB, pre-XDR-TB, MDR-TB).

Тhe Global TB Community Advisory Board (TB CAB) has developed a position paper regarding the optimal design for future evaluation of regimens for the treatment of XDR-TB in order to influence the direction of discussions ongoing among stakeholders in the TB field.

The position paper can be downloaded here.

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Community response to the drug-resistant TB crisis in Europe http://www.eatg.org/news/community-response-to-the-drug-resistant-tb-crisis-in-europe/ Wed, 16 Aug 2017 21:13:25 +0000 http://www.eatg.org/?post_type=news&p=5895 On 12-15 May 2017, EATG, in collaboration with the Global TB Community Advisory Board (TB CAB), TBpeople (the Eastern European and Central Asian network of people with experience of TB) and Treatment Action Group (TAG), held a series of meetings in Brussels, Belgium discussing the situation of drug-resistant TB and its impact on the communities of people living with HIV in Europe.

A short video documentation of the meetings is available here.

A report from the meeting with the Belgian Senate on 15 May 2017 is available here.

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Communities and civil society strongly united in strategic advocacy for TB UN High Level Meeting towards ending TB http://www.eatg.org/news/communities-and-civil-society-strongly-united-in-strategic-advocacy-for-tb-un-high-level-meeting-towards-ending-tb/ Wed, 16 Aug 2017 19:31:46 +0000 http://www.eatg.org/?post_type=news&p=5893 11 August 2017 – As we embark on the road to the United Nations High Level Meeting (UNHLM) on TB, the Stop TB Partnership, in collaboration with APCASO and Treatment Action Group (TAG), hosted a global meeting from 29-30 July, where more than 60 community and civil society advocates from 32 countries strategized on advocacy priorities promoting community-led, people-centered, rights-based and gender transformative approaches to end TB.

Given the unprecedented momentum towards ending the global TB crisis, highlighted by commitments by the G20 Heads of State, BRICS Ministers of Health, Global Ministerial Conference and the historical opportunity of the September 2018 UNHLM on TB, communities and civil society will further continue to mobilize, pushing their governments towards TB programs that are people centered, ambitious and bold, to achieve the 90(90)90 targets of the Global Plan to End TB, and to hold their governments and all stakeholders accountable on their commitments.

Dr. Lucica Ditiu, Executive Director of Stop TB Partnership noted, “It is time to do two things. First, we must be bold and strong in our vision. Second, we must be united and positioned around and for people affected by TB. As a TB community, we must band together, capitalize on the once in a life-time opportunity with the HLM on TB, bring TB in the minds and hearts of Heads of States and Governments and be ready to work for all people with TB.”

The convening in Bangkok offered a unique opportunity for communities and civil society actors to come together to identify, document and transform the challenges and needs of the missing, marginalized and those affected by TB into advocacy imperatives and strategies.

Two overarching themes were emphasized: financial and political support enabling communities to be central in all aspects of the TB response, including decision making processes; and, secondly, adoption of community-centered, rights-based and gender-transformative approaches at all levels, including in framework-setting and decision-making platforms, like the UNHLM and the Global Ministerial Conference.

Together, advocates agreed on a set of six “thematic priorities for action” to inform their advocacy on ending TB that will be key for the discussions and deliberations around the UNHLM as well.

1. Responsive and comprehensive systems for health to end TB
2. Scaled up, people and community-centered, rights based, gender transformative responses to end TB
3. Accelerated research and development to end TB
4. Highest standards of accountability and transparency to end TB
5. Adequate and sustainable domestic funding to end TB
6. Equity and access to information, commodities and services, to end TB

RD Marte from APCASO emphasized that, “these six priorities can guide our advocacy agenda – as a TB community. These priorities can be adapted and framed to the requirements of the Global Ministerial Meeting, the UN HLM on TB and any future forums for engagement ensuring a strong and coordinated community voice that resonates at all levels of the TB response.”

“As civil society and communities we need to be focused and determined. Without us at the forefront of this fight, holding our governments to account on their commitments we will never end this insidious epidemic,” said Timur Abdullaev, TB Affected Community Representative, Stop TB Partnership Coordinating Board.

To harness the momentum, key next steps have been agreed by community and civil society advocates. Firstly, position statements on each of the six-thematic area will be composed, endorsed and leveraged by the TB community to systematically and strategically inform and engage in national, regional and global dialogues and forums.

Secondly, regional and global roadmaps outlining critical points of engagement are now in development.

Thirdly, to ensure the constant and continuous presence and effective engagement of communities and civil society in dialogues and spaces leading to and at the UNHLM on TB, a resourced community advisory panel that fully represents, engages and empowers the grass roots is critical and ought to come into effect as quickly as possible.

“As community activists now is the time to be furious, loud and demanding. To end TB we are, and have to continue to be, united and ready to fight,” stated Lynette Mabote from ARASA.

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Aktionsbündnis gegen AIDS warns about misleading use of data http://www.eatg.org/news/aktionsbundnis-gegen-aids-warns-about-misleading-use-of-data/ Tue, 15 Aug 2017 20:59:51 +0000 http://www.eatg.org/?post_type=news&p=5891 In this German article, contributed by EATG member Peter Wiessner, Aktionsbündnis gegen AIDS warns about the misuse and misinterpretation of epidemiological and statistical data by extremists and racist authors to shed bad light on immigrants and refugees. The current situation in tuberculosis poses a particular difficulty.

“The Robert Koch Institute (RKI) does what it always does. As per ordered, it is concerned with the recording of transmissible diseases, establishes trends and interprets those. As the state’s epidemiological institute in Germany, it is something like the counterpart of the American CDC (Center for Disease Control and Prevention). It is rather rare for the RKI to get into the headlines. What is done with the data collected is very likely to be beyond the direct influence of the institute, reason enough to exercise extreme caution. This article analyzes how RKI data are absorbed by right-wing and fascist media to spread racist propaganda against immigrants.”

Read the full original article on this link: http://www.aids-kampagne.de/aktuelles/2017-08-15-tuberkulose-und-rechte-propaganda-gegenueber-einwanderern

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EATG signed on TAG call for TB research for pregnant women http://www.eatg.org/news/eatg-signed-on-tag-call-for-tb-research-for-pregnant-women/ Tue, 15 Aug 2017 17:35:02 +0000 http://www.eatg.org/?post_type=news&p=5865 EATG signed a call initiated by Treatment Action Group (TAG, US) for support TB research for pregnant women that is addressed to the Task Force on Research Specific to Pregnant and Lactating Women (PRGLAC). This is a US body addressing gaps in knowledge and research on safe and effective therapies for pregnant women and lactating women. It will have repercussion out on the research community beyond the US.

For more information about the call, click here.

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Countries and donors should aim for new $90-$90-$90 target on HIV, hepatitis and TB drug prices, study shows http://www.eatg.org/news/countries-and-donors-should-aim-for-new-90-90-90-target-on-hiv-hepatitis-and-tb-drug-prices-study-shows/ Thu, 27 Jul 2017 21:57:24 +0000 http://www.eatg.org/?post_type=news&p=5805

HIV, hepatitis B and C and TB can each be treated for less than $90 a year where generic drugs can be made available, Dzintars Gotham of Imperial College, London, reported at the 9th International AIDS Society Conference on HIV Science in Paris.

To read the full article, click here.

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Input needed: TB Europe Coalition consultation on UN High Level Meeting on TB http://www.eatg.org/news/tb-europe-coalition-consultation-on-un-high-level-meeting-on-tb/ Wed, 26 Jul 2017 21:55:46 +0000 http://www.eatg.org/?post_type=news&p=5763

For many years progress against TB has been hampered by a chronic lack of political will and attention to tackle the world’s deadliest infectious killer. While this has been the case in the past, the upcoming two years provides a unique opportunity to turn the tide.

There are key opportunities to TB in the upcoming two years. The Global Ministerial Conference on TB in Moscow in November 2017, the Argentinian G20 (building off the success of TB inclusion in July), and the UN High Level Meeting on TB in 2018. Coordination of civil society and communities will be crucial in achieving ambitious and successful outcomes.

In order to shape the TB Europe Coalition’s position and ensure it is truly representative of the TB community, and in particular, the WHO Europe Region, the TB Europe Coalition has developed a survey.

You can find the link to the survey here: https://www.surveymonkey.co.uk/r/

The consultation will conclude on 9 August 2017. The TB Europe Coalition will collate all responses and formulate a WHO Europe regional wide position.

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Take action to prioritize TB research for pregnant women http://www.eatg.org/news/take-action-to-prioritize-tb-research-for-pregnant-women/ Wed, 26 Jul 2017 21:53:41 +0000 http://www.eatg.org/?post_type=news&p=5761 As the world’s leading infectious killer, tuberculosis (TB) affects pregnant women, and increases the likelihood of poor birth outcomes and death. Despite the urgent need for better TB prevention and treatment options, pregnant women remain woefully neglected by research initiatives. But we now have a chance to change the trajectory of research for pregnant women with TB, if you take action by August 14th.

On August 21-22, the newly-formed Taskforce on Research Specific to Pregnant and Lactating Women (PRGLAC) will meet for the first time. This taskforce will advise the Secretary of the U.S. Department of Health and Human Services (HHS) on ways the government can fill knowledge gaps for pregnant women.

Join Treatment Action Group (TAG) in an effort to help prioritize research for pregnant women with TB, by signing on to a community comment to PRGLAC on strategies the U.S. government can take to support research and researchers focused on meeting the needs of this vulnerable population. Strategies include the development of a TB medicine registry modeled after the Antiretroviral Pregnancy Registry (APR), and investigating ways to support the earlier inclusion of pregnant women in research.

Take action today:

  • Click here to read and sign-on, individually and/or organizationally, to the letter and comment to PRGLAC.
  • Click here to download an informational brief on how a TB medicines registry can benefit pregnant women with TB.
  • Learn more about research issues for pregnant women with TB in a recently published community perspective in CID: Community perspective on the inclusion of pregnant women in TB drug trials.

Sign-on deadline: Monday, August 14, 2017 5:00pm EST

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Brochure on people-centered TB care http://www.eatg.org/news/brochure-on-people-centered-tb-care/ Wed, 26 Jul 2017 21:34:42 +0000 http://www.eatg.org/?post_type=news&p=5759 A new brochure, Moving to people-centered care: Achieving better TB outcomes, published within the framework of the TB-REP project highlights the position of civil society on quality people-centered care for TB patients.

What could help civil society organizations to be effective in fighting the TB epidemic? With whom, in the first place, is it necessary to establish communication and interaction for an early achievement of results?

These and other important aspects of TB advocacy are covered, briefly and concisely, in the brochure.

The material was compiled by joint efforts of TB-REP partners and activists from among people affected by TB.

The brochure on people-centred care was issued in the framework of the 3rd EU Health programme thanks to the operating grant given to the TB Europe Coalition by the Consumers, Health, Agriculture and Food Executive Agency of the EU.

To download the brochure, click here.

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European researchers identify a mechanism of protection of the new TB vaccine MTBVAC http://www.eatg.org/news/european-researchers-identify-a-mechanism-of-protection-of-the-new-tb-vaccine-mtbvac/ Wed, 26 Jul 2017 13:32:50 +0000 http://www.eatg.org/?post_type=news&p=5758

Researchers at the University of Zaragoza (belonging to CIBERES) and the biopharmaceutical vaccine company Biofabri in Porrino, Spain in partnership with the TuBerculosis Vaccine Initiative (TBVI) are developing a new TB vaccine, MTBVAC. MTBVAC, a live attenuated M.tuberculosis vaccine, has been shown to provide improved protection as compared to BCG and the mechanism behind this greater efficacy has been hypothesized to be due to the ability of MTBVAC to present a wider collection of antigens of M. tuberculosis.

Recent studies show that:

  • The immune response to two dominant TB antigens present in MTBVAC but absent in BCG, is associated with the enhanced protection of MTBVAC as compared to BCG.
  • The discovery warrants further exploration of this immune response as a potential correlate of protection.

The findings uncover a first mechanism of the improved protection of MTBVAC as compared to BCG, and further exploration of this response as a potential biomarker of protection for MTBVAC is warranted.

To read the full press release, click here.

Publication: Nature Communications 8, Article number: 16085 (2017) doi:10.1038/ncomms16085

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Unitaid publishes its latest TB Diagnostic Technology Landscape http://www.eatg.org/news/unitaid-publishes-its-latest-tb-diagnostic-technology-landscape/ Mon, 24 Jul 2017 17:38:31 +0000 http://www.eatg.org/?post_type=news&p=5672 Tuberculosis (TB) continues to be a major public health threat despite being a curable disease. Latest figures from the World Health Organization (WHO), in 2015, indicate an estimated 10.4 million people had TB, and 1.8 million people died (1.4 million HIV negative and 400,000 HIV positive). Of further concern is that 480,000 cases of multidrug-resistant (MDR) TB* and a further 100,000 that were estimated to be rifampicin-resistant (RR) TB have occurred in the same period. Of those eligible for MDR TB treatment, only 125,000 people (20 per cent) were enrolled in treatment programmes.

Both the Sustainable Development Goals and the WHO End TB strategy aim to end TB. To achieve this global goal, the rapid and accurate diagnosis of both active TB disease and latent TB infection is critical for the timely initiation of treatment and, ultimately, control of the disease. Of the 10.4 million people who developed TB in 2015, 4.3 million cases were not diagnosed or notified and only one quarter of RR/MDR TB cases (132,000) were detected and reported. The underdiagnosis and underreporting of TB may be due to limited or delayed access to appropriate diagnosis and care, large private sectors not reporting cases, and the lack of access to appropriate diagnostic tools due to geographic and/or financial barriers.

The report published today (July 21) focuses on the status of current, emerging and potential technologies in TB diagnosis. Many countries still rely on tools such as sputum-smear microscopy but new diagnostics are slowly changing the TB diagnostics landscape. Since our last publication, the WHO has made policy guidance statements for five new or improved TB diagnostic products. Further changes are expected, with unmet needs identified and articulated in target product profiles, and a technology pipeline promising new products to address these needs. Several of these are currently undergoing evaluation in field studies. This edition of the Unitaid Tuberculosis Diagnostics Technology Landscape report is intended to complement earlier reports, and presents a comprehensive overview of TB diagnostic technologies that are commercially available or close to market.

*TB strains that are resistant to rifampin (RIF) and isoniazid (INH).

Read the full report: “Tuberculosis Diagnostics Technology Landscape report — Unitaid, July 2017.

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New Global Fund results show accelerated HIV treatment progress http://www.eatg.org/news/new-global-fund-results-show-accelerated-hiv-treatment-progress/ Thu, 20 Jul 2017 21:50:19 +0000 http://www.eatg.org/?post_type=news&p=5603 GENEVA, 20 July 2017 – Ahead of next week’s International AIDS Society Conference on HIV Science in Paris, France, the Global Fund to Fight AIDS, Tuberculosis and Malaria today announced new results that highlight accelerating progress in providing HIV prevention, treatment and care services.

The results show that 11 million people are receiving antiretroviral therapy for HIV through Global Fund-supported programs, an increase of 19 percent from a year before.

“Our partnership is achieving results on a scale that few of us thought was possible,” said Marijke Wijnroks, Interim Executive Director of the Global Fund. “But we need to do even more. The number of new infections is still too high and, as we continue to expand lifesaving HIV treatments we need a stronger focus on prevention, human rights and gender. Reaching key and vulnerable populations, youth, and adolescent girls and young women is absolutely essential.”

The results, based on data from the end of 2016, also show that programs supported by the Global Fund partnership provided 4.3 million pregnant women with antiretroviral medicines to prevent the transmission of HIV to their unborn children.

This incredible progress is due to the global partnership and commitment of governments, civil society groups, health workers and local and international organizations, along with support from major donors and organizations including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), UNAIDS and WHO.

Beyond the numbers, the Global Fund supports efforts to build resilient and sustainable systems for health, enabling partners to make advances in implementation of new treatments and approaches to serve people most at risk. Pre-exposure prophylaxis (PrEP), as part of comprehensive, (multisectoral) prevention programming is now available through Global Fund grants as an additional prevention choice for people at substantial risk of HIV infection. In collaboration with Unitaid and WHO, the Global Fund is supporting the expansion of HIV self-test kits – flexible options that help address the challenge of almost half of the people with HIV not knowing their status.

The new Global Fund results also show significant progress in the fight against tuberculosis and malaria from the end of 2015 to the end of 2016. The number of new smear-positive TB cases detected and treated increased from 15.1 to 17.4 million, an increase of 15 percent, and the number of people treated for multidrug-resistant TB (MDR-TB) increased by 40 percent, from 267,000 to 373,000.

Over the same period, the number of new insecticide-treated nets distributed to protect families from malaria increased by 21 percent from 659 million to 795 million. The number of malaria cases treated also increased by 15 percent, from 582 million to 668 million.

 

Downalod: Results Fact Sheet

Watch a short video here.

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Otsuka and R-Pharm announce licensing agreement to commercialize Deltyba™ in Russia and CIS countries http://www.eatg.org/news/otsuka-and-r-pharm-announce-licensing-agreement-to-commercialize-deltyba-in-russia-and-cis-countries/ Thu, 20 Jul 2017 10:55:22 +0000 http://www.eatg.org/?post_type=news&p=5589 Otsuka Pharmaceutical Co. Ltd. (Otsuka) and the Russian pharmaceutical company R-Pharm JSC (R-Pharm) have entered into a licensing agreement to manufacture and commercialize Deltyba™ (delamanid) for the treatment of adults with pulmonary multidrug-resistant tuberculosis (MDR-TB) in the Russian Federation and the Commonwealth of Independent States (CIS).

To read the full press release, click here.

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2017 TAG Pipeline Report http://www.eatg.org/news/2017-tag-pipeline-report/ Wed, 19 Jul 2017 21:50:57 +0000 http://www.eatg.org/?post_type=news&p=5565 TAG’s annual Pipeline Report: Promising new HIV, TB & HCV drugs and diagnostics

New York, NY, July 18, 2017 – Treatment Action Group (TAG) announces the launch of its annual research and development landscape analysis: The Pipeline Report: Drugs, Diagnostics, Vaccines, Preventive Technologies, Research Toward a Cure, and Immune-Based and Gene Therapies in Development.

Released in advance of the 9th IAS Conference on HIV Science convening next week in Paris, our 2017 report continues to demonstrate the significant yields of drugs and biologics research and the advancement of breakthrough technologies that aim to detect, prevent, treat or cure HIV, tuberculosis (TB) and hepatitis C virus (HCV).

This year’s Pipeline Report also acknowledges the critical challenges ahead, notably unstable political environments that threaten scientific progress and the translation of research into health and survival for people around the world.

“The tremendous gains of the past three decades and our ability to ensure that all those who can benefit receive the prevention, treatment, support, information, and care that they need are under threat by the retrenchment and austerity imposed by Western governments on their own people and the flatlining of investment in research and global HIV and TB prevention and treatment programs,” notes Mark Harrington, Executive Director of TAG, in the report’s executive summary.

Report authors note specific failures in implementing new tools and therapies across HIV, TB, and HCV. “Even the promise of existing breakthrough technologies such as the TB LAM test – the only true point-of-care diagnostic test with a proven mortality benefit for people living with HIV and TB with low CD4 counts suffers because of stagnant uptake and implementation by national TB programs” writes Erica Lessem, Director of TAG’s TB/HIV Project.

The development of direct acting antivirals (DAAs) associated with astonishing HCV cure rates is another monumental scientific achievement being overshadowed by prohibitive costs resulting in global access challenges. “In the United States, an exploding opioid epidemic threatens to increase incidence of HCV among young people – and yet we are still facing funding threats to substance abuse and treatment programs,” says Annette Gaudino, Co-director of the HCV Project at TAG. She adds, “this includes threats to payers, both public and private, if the Senate and Congress pass their health care bills, which really expropriate resources from the poor and sick to the rich, and keep breakthrough cures out of reach. Additionally, interest in continued R&D spending for more cures that could be lower cost options, is waning”

Emerging options for the prevention and treatment of HIV are also in grave danger of remaining out of reach for those who need them most, in large part due to payers being forced to reckon with drug pricing beyond what domestic and global markets can reasonably bear. “The HIV pipelines are robust with potentially safe and efficacious treatment and prevention candidates for those who need them most,” says Tim Horn, Deputy Executive Director of HIV and HCV Programs. “We’re finally seeing the development of regimens poised to reverse egregious pricing trends, but the challenges of affordable access aren’t for the pharmaceutical industry to solve alone.”

In the midst of our 25th Anniversary, TAG is alarmed that the progress we’ve made in ensuring robust pipelines for HIV, TB, and HCV faces unprecedented threats. We publish the Pipeline Report as an informational tool for activists who are working to ensure access to the best science and the scale up of affordable treatment and prevention options.

At TAG, we firmly believe we can end these three epidemics. That requires a commitment to research and the implementation of evidence-based tools to guarantee that people in need are able to access quality health care. With the 2017 Pipeline Report, we remain committed to the production and dissemination of research data and analysis to help shape evidence-based policy, to strengthen our own advocacy work, and to support our domestic and global partners in the fight.

If you are attending the IAS Conference on HIV Science meeting in Paris next week, visit us at booth No. 203 in the Palais des Congrès exhibition hall, where you can pick up a print copy of the 2017 Pipeline Report or a USB card containing several of our recent publications. Online (HTML) and downloadable (.pdf) Pipeline Report content can also be accessed via pipelinereport.org.

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-26/ Wed, 19 Jul 2017 14:55:23 +0000 http://www.eatg.org/?post_type=news&p=5567 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 316 of the “Global Fund Observer.” The newsletter features articles on various topics, including a piece on funding requests focused on adolescent girls and young women, as well as stories looking at programs in Malawi, Tanzania, and the Greater Mekong delta.

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3P Project enables radical change in R&D for TB treatment http://www.eatg.org/news/3p-project-enables-radical-change-in-rd-for-tb-treatment/ Sun, 16 Jul 2017 21:25:47 +0000 http://www.eatg.org/?post_type=news&p=5540 A new project that stimulates the development of affordable and effective drug regimens to treat tuberculosis (TB) is catching notice in policy circles.

The “3P Project” is based upon the three aims of the project, namely “pulling funding, pooling data and intellectual property and pushing funding” for the research and development of TB treatment, Grania Brigden, 3P Project Lead, told Intellectual Property Watch in a recent interview.

The 3P Project plans to distribute monetary prizes and grants for research and development of new treatment for TB, Brigden said. The intellectual property and the data resulting from the R&D will be pooled together and made available via licences, and the final costs of the medicines will be delinked from the costs of R&D, she said.

The underlying idea of the 3P Project originates from the Open Access Campaign of Médecins Sans Frontières (MSF – Doctors Without Borders), Brigden said.

The 3P Project is still in the development phase, according to Brigden. Nonprofit group International Union Against Tuberculosis and Lung Disease (Union) – with offices in various regions in the world – will host the secretariat of the 3P Project. There will be a close collaboration between the 3P Project, based in Geneva, and other organisations such as MSF and the Medicines Patent Pool (MPP) in order to avoid duplication of work, Brigden added.

The launch of the 3P Project is planned during the Global Ministerial Conference on TB from 16-17 November in Moscow. The event is especially relevant due to high number of TB cases in Russia.

Tuberculosis and R&D

Investment in research and development for TB – the world’s most deadly infectious disease – has been decreasing, even as the number of TB patients continues to increase, according to Brigden. It is not the science, but the lack of investment that prevents the development of a better treatment for TB, she said.

The market for TB treatment is failing, and the pipeline for new TB drugs is really weak, she said, adding that TB cannot be cured with one drug.

TB primarily occurs in the vulnerable groups of middle and low-middle income countries. Brazil, Russia, India and China – the BRIC countries – bear the highest burden of TB, but they do not invest as much in the R&D for TB treatment as countries with a lower burden, said Brigden. The 3P Project is talking with several governments about how the project could work for them, Brigden added.

There is a clear political will to do something about TB, Brigden said, adding that governments are starting to prioritise TB. And a clear link has been established between TB and antimicrobial resistance, she said. This changing landscape offers a unique environment for the launch of the 3P Project, said Brigden, who noted that the UN General Assembly High-Level Meeting on TB takes place in 2018.

The current treatment of drugs-resistant TB takes two years and entails painful daily injections for at least six months and a high number of tablets with several serious side-effects, according to Brigden.

TB is a global disease and it is in everyone’s interest to find a better treatment to cure, she said. The ultimate aim of the 3P Project is to find within 10 years a tuberculosis regimen that works “for everyone and everywhere” and cures TB patients in one month or less, Brigden said.

3P Project

The 3P Project offers a unique opportunity to move from a conceptual discussion on delinkage and failure in the market of TB treatment to an actual operationalisation, Brigden said.

The objective is to change the incentives for research for TB treatment by fostering partnerships, offering prizes and grants and pooling intellectual property and data together on a worldwide scale.

Pull funding

The monetary prizes granted by the 3P Project constitute rewards for the investment made by developers before phase 1 of the clinical trials, Brigden said. Different criteria will be established as conditions to receive a prize.

Developers will be required to transfer the IP and data related to TB to the pool after they win a prize, Brigden said. The drug compound and the related data will be made available by licence agreements governed by MPP, which has the necessary experience, Brigden said. The developer can continue to develop the TB drug and apply for grants after receiving the prize from 3P, she said. And the developers can keep the IP for all other purposes than TB.

The awarding of the prizes will not be linked to specific deadlines, but applications for prizes will always be possible, Brigden said. The aim of the 3P Project is to give two or three prizes a year, and there is an element of competition as no multiple prizes will be given for the same kinds of drug compounds, she said.

Data and IP Pooling

The pooling of data and IP aims at ensuring open collaborative research to ensure fair licensing for competitive production of the final products, according to the MSF website. Pooling of drug compounds is particularly important because TB cannot be cured by only one drug, Brigden said. The data from the clinical trials will be shared, irrespective of whether the outcome of the clinical trials was positive. Data sharing will facilitate the development of a better understanding of TB, she said.

Push Funding

Developers who get through the first phase of the clinical trials can apply for grants. Grants, the so-called pull mechanisms, provide upfront financing for developers for their R&D activities during the clinical trials. The grants allow developers to carry out the clinical trials without the need to invest their own money, Brigden said.

Brigden underlined that there will be no link between the market price of the medicine and the R&D costs. The profit percentage of the developer of the final drug will be defined in discussion between the developers and the 3P Project.

The aim is to establish “a real open” format for everyone to participate, according to Brigden. The grants and prizes will also be open to academic institutions and pharmaceutical companies.

The licence agreements will entail the obligation for the licensee who wants to have access to make the drugs available in highly affected countries such as Myanmar and Burkina Faso in order to gain access to the market in BRIC countries, Brigden said. This obligation ensures that the product becomes available “in the right way for everyone and everywhere,” she said.

By

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TB control, and the where and why of artificial intelligence http://www.eatg.org/news/tb-control-and-the-where-and-why-of-artificial-intelligence/ Sun, 16 Jul 2017 20:36:59 +0000 http://www.eatg.org/?post_type=news&p=5541

Abstract

Countries aiming to reduce their tuberculosis (TB) burden by 2035 to the levels envisaged by the World Health Organization End TB Strategy need to innovate, with approaches such as digital health (electronic and mobile health) in support of patient care, surveillance, programme management, training and communication. Alongside the large-scale roll-out required for such interventions to make a significant impact, products must stay abreast of advancing technology over time. The integration of artificial intelligence into new software promises to make processes more effective and efficient, endowing them with a potential hitherto unimaginable. Users can benefit from artificial intelligence-enabled pattern recognition software for tasks ranging from reading radiographs to adverse event monitoring, sifting through vast datasets to personalise a patient’s care plan or to customise training materials. Many experts forecast the imminent transformation of the delivery of healthcare services. We discuss how artificial intelligence and machine learning could revolutionise the management of TB.

 

To read the full publication in the European Respiratory Journal, click here.

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Cytokines predict TB recurrence in patients on ART http://www.eatg.org/news/cytokines-predict-tb-recurrence-in-patients-on-art/ Sat, 15 Jul 2017 14:16:14 +0000 http://www.eatg.org/?post_type=news&p=5517 Certain cytokines are predictors of the recurrence of tuberculosis in patients with HIV who are on ART, according to researchers.

Recognizing the cytokines as biomarkers can be valuable in diagnosing TB in HIV patients, they wrote in Clinical Infectious Diseases.

“There is an urgent need for the identification and validation of TB diagnostic markers in HIV-positive individuals, as this is the key for timely patient management and for the development of new therapeutics and vaccines,” researcher Aida Sivro, PhD, a postdoctoral research fellow with the Center for the AIDS Program of Research in South Africa (CAPRISA), and colleagues wrote.

The researchers enrolled a subset of participants in the CAPRISA 005 TB Recurrence Upon Treatment with HAART study, conducted at the CAPRISA eThekwini clinic in Durban, KwaZulu-Natal, South Africa. That study’s aim was to measure the incidence of recurring TB among 402 patients on highly active ART. The patients were screened for TB once every 3 months for 4 years.

The subset enrolled by Sivro and colleagues included 63 patients with recurring TB (cases) and 123 with no evidence of recurring TB (controls) during follow-up. Peripheral blood and plasma samples were collected from the patients.

In those samples, the researchers measured the levels of 21 cytokines that they said are important in immune response.

They found that significantly higher plasma levels of interleukin 6 (adjusted OR = 4.79; 95% CI, 1.66-13.81), interleukin 1 beta (aOR = 3.41; 95% CI, 1.26-9.24) and interleukin 1 receptor antagonist (aOR = 2.04; 95% CI, 1.04-3.98) were associated with an increased risk for recurrence of TB. Interferon beta was associated with a decreased risk for recurrence, they said (aOR = 0.27; 95% CI, 0.07-0.99).

The researchers stressed that there is “an urgent need” to identify diagnostic markers of TB in individuals with HIV to improve patient management and for the development of new drugs and vaccines.

“Because all HIV-infected individuals now qualify for ART, but ART does not completely ameliorate HIV-associated TB risk, the population for this study is important for defining TB risk factors,” they wrote.

Sivro A, et al. Clin Infect Dis. 2017;doi:10.1093/cid/cix357.

By Joe Green

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Tuberculosis makes the G20 Declaration http://www.eatg.org/news/tuberculosis-makes-the-g20-declaration/ Tue, 11 Jul 2017 21:33:23 +0000 http://www.eatg.org/?post_type=news&p=5465 The G20 Leaders’ Declaration carries an important section on antimicrobial resistance, and tuberculosis is identified as a priority for research and development.

On 7 & 8th July 2017, leaders of the G20 met in Hamburg, Germany, to address major global economic challenges and to contribute to prosperity and well-being.

Their Declaration, published on July 8, carries an important section on combatting antimicrobial resistance (AMR):

“AMR represents a growing threat to public health and economic growth. To tackle the spread of AMR in humans, animals and the environment, we aim to have implementation of our National Action Plans, based on a One-Health approach, well under way by the end of 2018.

We will promote the prudent use of antibiotics in all sectors and strive to restrict their use in veterinary medicine to therapeutic uses alone. Responsible and prudent use of antibiotics in food producing animals does not include the use for growth promotion in the absence of risk analysis. We underline that treatments should be available through prescription or the veterinary equivalent only. We will strengthen public awareness, infection prevention and control and improve the understanding of the issue of antimicrobials in the environment. 

We will promote access to affordable and quality antimicrobials, vaccines and diagnostics, including through efforts to preserve existing therapeutic options. We highlight the importance of fostering R&D, in particular for priority pathogens as identified by the WHO and tuberculosis.

We call for a new international R&D Collaboration Hub to maximise the impact of existing and new anti-microbial basic and clinical research initiatives as well as product development. We invite all interested countries and partners to join this new initiative. Concurrently, in collaboration with relevant experts including from the OECD and the WHO, we will further examine practical market incentive options.”

I am pleased to see this Declaration. It is timely and welcome, because AMR is a major health threat, and it is estimated that by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug-resistant infections.

Drug-resistant tuberculosis (DR-TB) is a perfect example of the threat posed by AMR. It is much smarter and cheaper to prevent DR-TB than treat it. And prevention of DR-TB requires better access to drug-resistance testing, high-quality treatment, access to new TB drugs, infection control, and increased political commitment with financing. Unfortunately, high TB burden countries are yet to seriously address these priority actions to tackle DR-TB. In many countries, only a quarter of MDR-TB patients are detected, and not even half of all patients with DR-TB are on second-line drug therapy.

A major reason behind poor TB control is the fact that TB is a low priority for many developing countries, and current TB budgets are insufficient to make progress in addressing DR-TB. Most National TB Programs in high burden countries are seriously under-funded, and, sadly, even emerging economies such as India are not spending enough on TB.

In this context, it may be more impactful for DR-TB control to be seen as one component of a comprehensive strategy to address AMR. While TB gets little attention, AMR is increasingly seen as a global health emergency and a security threat. Policy makers and donor agencies have prioritized AMR as a key issue for the global health security agenda, and the G20 declaration underscores this fact.

As I have argued previously, the door is wide open for the TB community to leverage this interest, and advocate for a well-funded, comprehensive AMR initiative that includes DR-TB as a key component. In fact, DR-TB could well be a pathfinder for successfully tackling AMR in low and middle income countries, and help make the case for greater investments. The TB community should therefore continue to advocate for including TB in the broader agenda to tackle AMR globally, and make sure DR-TB receives adequate funding and support.

The upcoming Global Ministerial Conference on TB in Moscow in November 2017, and the UN General Assembly High Level Meeting on TB in 2018 are exciting opportunities to push this agenda forward.

By Madhukar Pai

 

Further reading

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MSF TB report: Out of Step 2017 http://www.eatg.org/news/msf-tb-report-out-of-step-2017/ Thu, 06 Jul 2017 17:06:52 +0000 http://www.eatg.org/?post_type=news&p=5409 New MSF report shows slow progress in adopting and implementing key TB prevention, testing and treatment policies and practices.

NEW YORK/HAMBURG/GENEVA, JULY 5, 2017—Two days ahead of the G20 summit in Germany, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) and the Stop TB Partnership released a report that shows countries are lagging behind in tackling tuberculosis (TB), introducing the best diagnostic devices, and implementing globally-recommended policies. The third edition of the “Out of Step” report reviews TB policies and practices in 29[1] countries–which account for 82 percent of the global TB burden–and shows that countries can do much more to prevent, diagnose, and treat people affected by TB.

Although TB is preventable and treatable, it remains the world’s deadliest infectious disease, killing 1.8 million people in 2015 alone. During the same year, the majority (54 percent) of the 10.4 million people with TB lived in the countries represented at the G20 summit. Despite its deadly toll, most countries lag behind in implementing the new medicines and diagnostic tools available to tackle TB.

The G20 governments are major contributors to the global TB response, contributing more than $1.6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2016. These leaders must now mobilize their resources to get more people diagnosed, make effective treatments accessible to all people affected by TB, and reduce TB deaths.

“TB is an ancient killer, but we have the knowledge and the tools to tackle this disease; many countries are just not making use of these advances, and people are dying as a result,” said Lucica Ditiu, executive director of the Stop TB Partnership. “We’re calling on the G20 leaders to wake up and do something to stop the unnecessary deaths and the spread of TB, including drug-resistant TB.”

One of the major problems in the global TB response is that countries are not investing in tools to diagnose people in the first place. Only seven countries[2] in the report have made Xpert MTB/RIF—a rapid molecular test to diagnose TB and test for resistance to first-line TB drugs—widely available. This means that the majority of people in the 29 countries surveyed are still tested with a method that fails to detect many cases, or that requires a wait of up to several months to confirm the disease. This challenge explains why so many people remain undiagnosed and untreated; globally in 2015, based on the gap between estimated TB incidence and the actual number of cases reported, 4.3 million people with TB were never diagnosed.

“How are people supposed to get treated for TB when they’re not even getting diagnosed?” asked Dr. Isaac Chikwanha, HIV and TB medical advisor at MSF’s Access Campaign. “If countries don’t do more to make sure that people can be tested, it will be impossible to reduce preventable deaths from TB.”

For those who are diagnosed, some progress has been made to make newer, more effective treatment options and care available to ease the burden of living with TB.

For example, newer medicines for the treatment of DR-TB have demonstrated better outcomes than today’s regimens, which offer only a 28-percent cure rate for extremely drug-resistant (XDR) TB and a 52-percent cure rate for multidrug-resistant (MDR) TB. Seventy-nine percent of countries surveyed include the newer drug bedaquiline in their national guidelines, and 62 percent include delamanid in their guidelines. However, globally, only five percent of people who could have benefitted had access to these drugs in 2016.

Additionally, hospitalization for an extended period of time can limit the ability of a person to have a normal life and should be reserved only for the sickest DR-TB patients. The report found that 34 percent of the countries surveyed still require long-term hospitalization for treatment of DR-TB, which can fuel the spread of TB and increase rates of drug-resistance.

DR-TB treatment, which in some cases requires swallowing nearly 15,000 pills over up to a two-year period, can now be shortened to nine months. Shorter treatments help people to get back to a normal and productive life faster. However, only 13 of the countries[3] surveyed (45 percent) have made shorter treatments available.

“With TB, the clock is ticking rapidly, as every 18 seconds a person dies of TB. We have to change that,” said Sharonann Lynch, HIV and TB policy advisor at MSF’s Access Campaign. “The number of people diagnosed over the last four years has stalled, while the number of deaths has increased rather than decreased. Countries need to use new tools and step up the pace of their response.”

MSF and the Stop TB Partnership have launched a campaign called #StepUpforTB to urge governments to bring their TB policies and practices in-line with WHO recommendations (www.stepupfortb.org).

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Notes:

[1] Armenia, Afghanistan, Bangladesh, Belarus, Brazil, Cambodia, Central African Republic (CAR), China, Democratic Republic of Congo (DRC), Ethiopia, Georgia, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Mozambique, Myanmar, Nigeria, Pakistan, Papua New Guinea (PNG), Philippines, Russian Federation, South Africa, Swaziland, Tajikistan, Viet Nam, Ukraine and Zimbabwe.
[2] Armenia, Belarus, Brazil, Georgia, South Africa, Swaziland, and Zimbabwe.
[3] Afghanistan, Bangladesh, Cambodia, CAR, DRC, Kyrgyzstan, Myanmar, PNG, Philippines, Swaziland, Tajikistan, Viet Nam and Zimbabwe.

MSF is an independent international medical humanitarian organization that delivers medical care to people affected by armed conflicts, epidemics, natural disasters, and exclusion from health care. Founded in 1971, MSF has operations in over 60 countries today. MSF has been treating people with TB for 30 years. In 2016, MSF treated more than 20,000 people with TB, including 2,700 people with multi-drug-resistant TB (MDR-TB). The Stop TB Partnership and its 1,600 partners are a collective force that is transforming the fight against TB in more than 110 countries.

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Balti joins Zero TB Cities Initiative http://www.eatg.org/news/balti-joins-zero-tb-cities-initiative/ Thu, 06 Jul 2017 14:20:54 +0000 http://www.eatg.org/?post_type=news&p=5402 On June 29th, 2017, in Balti, Moldova, the Vice Mayor of Balti Igor Sheremet and Executive Director of the Stop TB Partnership Dr. Lucica Ditiu signed the ‘Declaration of Interest: Alignment with the Zero TB Initiative’. Balti becomes the second city in the region of Eastern Europe and Central Asia joining the initiative after Odesa joined it on May 30th, 2017.

‘Signing Zero TB Declaration is of great importance for the Balti municipality taking into account extremely high TB burden, and success of the TB response depends first of all on the efforts of all stakeholders. Here the role of local authorities is paramount both in terms of implementation of the municipal TB Program and in terms of support of civil society associations. I consider that signing this Declaration provides for the extended involvement of the local administration in the TB response and opens possibilities to engage international expertise. I would like to express my gratitude to all the parties who contributed to achieving this result,’ – pointed out Vice Mayor, Igor Sheremet.

Along with other Eastern European countries Republic of Moldova faces high burden of Tuberculosis. Although TB rates are gradually declining for the past decade, the situation is still challenging. According to WHO in 2015 Moldova had more than 4 000 new TB cases. About 32% of new TB patients are multidrug resistant and 9% of them have TB/HIV co-infection. The number of TB/HIV cases is continually growing and reached 13 per 100 000 in 2015.

TB burden in Balti is much higher comparing to the general country situation. In 2015, TB notification rate in Balti and in Moldova was 103.7 and 88.7 per 100 000 population accordingly. In 2015, Balti had 152 new TB cases. Every 3 days one person develops new TB disease and every fourth TB patient has HIV in Balti. TB mortality rates in Balti are about 45% higher than countrywide for past several years. TB/HIV incidence is also higher in Balti than in Moldova in general (25.3 vs. 13 per 100 000 in 2015) as well as TB/HIV mortality (11.3 vs. 4.5 per 100 000 in 2015).

The Declaration was initiated within the Fast Track TB/HIV responses for key populations in EECA cities project operating in five cities of EECA region. Operational research that will start in mid-2017 as a pKUS_5573art of the project will focus on strengthening linkages between TB and HIV programs to reduce HIV/TB mortality in the city of Balti.

‘I am pleased to see the increasing role of cities in EECA region in response to TB epidemic. I am very happy that Balti is joining the initiative today,’ stated Dr. Lucica Ditiu, Executive Director, Stop TB Partnership.

Sergey Filippovych, Director: Treatment, Procurement & Supply Management, Alliance for Public Health said: ‘Patient-centered approaches stipulate not only integrated medical care but also necessary social and psychological support. Such comprehensive support significantly increases the treatment success rates. Our experience shows that using these approaches increases treatment success rate in patients with multidrug-resistant tuberculosis to 86%. It is two times more than the average rate in EECA.’

Background information

The Zero TB Cities project, a collaborative initiative geared towards significant, accelerated reductions in tuberculosis mortality and prevalence in high-burden metropolitan areas. To date, Odesa, Ukraine; Chennai, India; Durban, South Africa; Karachi, Pakistan; Kisumu, Kenya; and Lima (Caraballyo), Peru have moved swiftly to design comprehensive programs, create new partnership models, and begin resource mobilization for this effort.

Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia is the Global Fund funded EECA regional project of Alliance for Public Health (Ukraine), AFEW International (The Netherlands), licit (Switzerland) and Stop TB Partnership under technical guidance of UNAIDS EECA office which is there to support city responses to HIV and TB in key populations in the five cities of EECA, including Balti. The project will be implemented throughout 2017-2019 and plans to develop efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in the project cities as well as increase the allocation of city funding to HIV/TB interventions for key populations.

The Stop TB Partnership is leading the way to a world without tuberculosis (TB), a disease that is curable but still kills three people every minute. Founded in 2001, the Partnership’s mission is to serve every person who is vulnerable to TB and ensure that high-quality diagnosis, treatment and care isavailable to all who need it. Together our 1 500 partners are a collective force that is transforming the fight against TB in more than 100 countries. They include international and technical organizations, government programs, research and funding agencies, foundations, NGOs, civil society and community groups and the private sector.

Alliance for Public Health is a leading non-governmental professional organization established in 2000 making a significant impact on the epidemics of HIV/AIDS, tuberculosis, viral hepatitis and other socially dangerous diseases in Ukraine and providing support on responses globally.

TB in Eastern Europe and Central Asia Project on Strengthening Health Systems for Effective TB and DR-TB Control funded by the Global Fund is there to decrease the burden of tuberculosis disease and halt the spread of drug resistance in target EECA countries through increasing political commitment and translating evidence into implementation of patient-centered TB models of care. The Principal Recipient of the Global Fund grant is PAS Center (Moldova). Alliance for Public Health is an implementing partner of the project on behalf of TB Europe Coalition, responsible for the civil society advocacy in support of the people-centered TB care in the region of Eastern Europe and Central Asia.

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Towards ending TB in Eastern Europe and Central Asia http://www.eatg.org/news/towards-ending-tb-in-eastern-europe-and-central-asia/ Thu, 06 Jul 2017 13:10:07 +0000 http://www.eatg.org/?post_type=news&p=5398 Use the best modelling available and work with all stakeholders for a patient-centered approach

30 June 2017 – Chisinau, Moldova – Two meetings held this week focused on addressing ending TB in high TB and DR-TB incident countries in the EECA region. A Regional Workshop on Application of Models in Assessing Cost and Impact of TB Programs in the EURO region held on 28-30 June was attended by 11 National TB Programme managers and their teams from Armenia, Azerbaijan, Belarus, Bulgaria, Georgia, Moldova, Romania, Kazakhstan, Tajikistan, Kyrgyzstan, Ukraine, world’s leading TB modelers, donors and partners. The workshop looked at innovative modelling and costing tools to achieve the targets of the End TB Strategy and Stop TB Partnership’s Global Plan to End TB 2016-2020. The tools will enable the 11 countries to develop robust National Strategic Plans addressing their burden, plan for future funding requests and advocacy at for increased national budgets. The meeting was organized by the Stop TB Partnership in collaboration with the Global Fund, WHO EURO and PAS (Center for Health Policies & Studies), Moldova.

A technical consultation of TB-REP partners in the 11 target countries from the EECA region followed from 30 June to 1 July, in order to discuss achievements so far and to launch the Blueprint: People-Centered Model of Care for EECA Countries – developed by the European Respiratory Society, London School of Economics and Political Science, London School of Hygiene and Tropical Medicine, PAS and the Stop TB Partnership. The meeting, which was organized by the Centre of Policy and Studies in partnership with the WHO Regional Office for Europe and the Ministry of Health of Moldova launched this Blueprint which includes policy options for an effective and efficient TB service delivery system that allows for a shift toward an outpatient care model with sustainable financing and aligned payment mechanisms.

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African Union adopts new strategic framework to end AIDS, TB and Malaria by 2030 http://www.eatg.org/news/african-union-adopts-new-strategic-framework-to-end-aids-tb-and-malaria-by-2030/ Thu, 06 Jul 2017 12:19:15 +0000 http://www.eatg.org/?post_type=news&p=5412 African Union endorses key initiatives to transform health systems and response to disease epidemics.

Addis Ababa, 5 July 2017- African Union Heads of State and Government on Monday adopted the AIDS Watch Africa Strategic Framework that will bolster the work of AIDS Watch Africa, the highest level continental vehicle for joint action, advocacy and accountability towards ending AIDS, TB and Malaria. During the meeting the leaders endorsed the Emergency Catch up Plan to accelerate the HIV response in West and Central Africa, a region that is lagging behind in its response. The meeting further endorsed the 2 million community health workers initiative that will build and create decent jobs while harnessing their capabilities in a seamless integrated health system.

‘We have a historic opportunity to end AIDS, TB and Malaria in this generation due to advancements in science, technology and improved delivery systems at the community level. Let us mobilise community workers, transform our health systems, build resilience and contribute to better health outcomes through increased investments in health,” said His Excellency Professor Alpha Condé, the President of Guinea and Chairperson of the African Union and AIDS Watch Africa.

Leading the way for evidence-based advocacy, data-driven accountability and resource mobilization efforts

The new AIDS Watch Africa strategy seeks to further mobilise and sustain high level leadership and commitment and galvanise all stakeholders and actors to form partnerships to end AIDS, TB and Malaria by 2030. Ending the three diseases is critical to the achievement of the bold aspirations of Agenda 2063 that seek to transform the continent’s development path. A key element of the strategy is to generate and disseminate strategic, culturally sensitive information to partners and others to ignite action at the international, regional, national and grassroots levels. The new strategy further seeks to strengthen accountability by Member States for measurable results and impact at the grass-root level.

The 15 year strategy will accelerate advocacy efforts to mobilise domestic and international resources to accelerate the implementation of commitments while increasing the efficiency of funding flows and spending. The framework will promote national level ownership among governments, the private sector and civil society.

Accelerating efforts to end the three diseases by 2030

While significant progress has been made in the HIV response, new infection rates remain high among young people especially young girls and women. Heads of State and Government committed to more concerted efforts and investments to address the unmet needs of young people and adolescents.

The meeting emphasised that the TB response continues to lag behind in terms of investments and response. Heads of State and Government committed to work on increasing coverage and access to services for detection and treatment of TB particularly for people living with HIV, children and mine workers.

The meeting further committed to sustain the gains made in the fight against malaria but raised concerns about the resurgence of malaria in particular in southern African countries that were reaching elimination stage. The meeting emphasised the importance of monitoring insecticide and antimalarial drug resistance and committed to invest in the development of new technologies and innovations to eliminate malaria.

About the African Union

The African Union spearheads Africa’s development and integration in close collaboration with African Union Member States, the Regional Economic Communities and African citizens. AU Vision: to accelerate progress towards an integrated, prosperous and inclusive Africa, at peace with itself, playing a dynamic role in the continental and global arena, effectively driven by an accountable, efficient and responsive Commission. Learn more at: http://www.au.int/en/

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European Parliament urges EU to give political response to HIV, Tuberculosis and Hepatitis http://www.eatg.org/news/european-parliament-urges-eu-to-give-political-response-to-hiv-tuberculosis-and-hepatitis/ Wed, 05 Jul 2017 21:59:48 +0000 http://www.eatg.org/?post_type=news&p=5377 The European Parliament strongly calls on the European Commission to step up its response to the HIV, TB and Hepatitis epidemics, developing a comprehensive and integrated policy framework to fight the 3 diseases, with a regional approach including countries in Eastern Europe and Central Asia. The response should take into account the massive drop in international assistance to the region, ensuring sustainable transition plans are in place and health programmes are scaled-up.

On July 5, the plenary of the European Parliament in Strasbourg adopted with a large majority and with a cross-party support a key resolution on the “EU’s response to HIV/AIDS, Tuberculosis and Viral Hepatitis”.

The resolution recognises the high burden of the three diseases in the EU and in neighbouring countries. In addition to being a health concern for European citizens and governments, these epidemics also represent a massive cost to the economy: it is estimated that multi-drug resistant tuberculosis alone  will be responsible for an additional 2.1 million deaths in the continent by 2050 at an economic cost of $1.1 trillion.

The European Parliament is making a strong wake-up call to the European Commission and EU member states: there is the urgent need to develop a comprehensive policy framework addressing the three diseases jointly, taking into account specific challenges faced within the EU and in neighbouring countries, where the burden of the epidemics is the greatest. Civil society organisations have been very vocal in the past years advocating for the adoption of such a policy framework, with a European joint response to HIV, TB and Hepatitis.

The resolution also underlines the importance for the EU to play a stronger political role in the dialogue with countries in Eastern Europe and Central Asia, ensuring plans for sustainable transition to domestic funding are in place so that programmes fighting HIV, TB and Hepatitis are sustained and scaled-up after the withdrawal of international donors’ support.

In addition, the resolution strongly reminds the importance of strengthening the work with communities and vulnerable groups, ensuring as well the participation of NGOs for the provision of services to affected populations.

These are issues that civil society and affected communities are frequently raising as key priorities for an effective response to the epidemics: the European Parliament is showing its willingness to hear citizens’ voices and concerns.

Finally, the Parliament underlines that an adequate level of spending and resource mobilisation will be needed if we are to meet SDG 3, ending the AIDS and TB epidemics. In this regard, the resolution makes a strong call to not only increase investments in research to develop new treatments, tools and people-centred approaches to fight the diseases, but to ensure these tools are available and affordable.

This resolution is an additional step the EU institutions are taking in raising their common response to the HIV, TB and Hepatitis epidemics. As the EU Action Plan on HIV came to an end in 2016, and no specific strategy was in place to fight TB and Hepatitis, the EU is increasingly understanding the key importance to tackle the three diseases with a common and joint approach. EU member states already agreed to do so last October, during an informal gathering of Health Ministers, when they showed support to the development of an integrated policy framework on HIV, TB and Hepatitis. Today, the European Parliament is making a strong call in the same direction. Now the Commission urgently needs to take action in response to these calls.

 

See also:

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Moscow TB meeting declaration gets a civil society makeover and is up for signers http://www.eatg.org/news/moscow-tb-meeting-declaration-gets-a-civil-society-makeover-and-is-up-for-signers/ Wed, 28 Jun 2017 21:59:00 +0000 http://www.eatg.org/?post_type=news&p=5305 Individuals and organizations interested in signing on to a civil society version of the Moscow Declaration that could serve as a blueprint for commitments and action toward ending the global impacts of tuberculosis over the next decade and a half have one more day to do so.

The Global Fund Advocates Network worked with members, partners, and representatives of affected populations to edit the “zero declaration” that the World Health Organization posted for feedback June 13. The document is intended to spell out agreed commitments on the part of officials from governments around the world to increase investments, adopt policies, and accelerate responses across sectors to meet international and WHO goals to reduce deaths, incidence, and harms from tuberculosis over the next fifteen years, and ending the global epidemic by 2035. It will be the centerpiece of the Nov. 16 – 17 Moscow WHO Global Ministerial Conference on ending TB, that, in turn will inform next year’s planned United Nations High Level Meeting on TB.

The civil society edit brings changes in style, tone and substance to the original, including asserting the impacts of politics, inequities and insufficient funding on the spread of the disease among the most vulnerable populations, and committing to adapting policies to ensure that tuberculosis care and prevention standards recommended by WHO are followed everywhere. The draft document can be accessed for signature here. The deadline for signatures is 5 pm. EST Thursday June 29.

By Antigone Barton

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New WHO report provides blueprint for delivering people-centred care for TB http://www.eatg.org/news/new-who-report-provides-blueprint-for-delivering-people-centred-care-for-tb/ Wed, 28 Jun 2017 21:55:04 +0000 http://www.eatg.org/?post_type=news&p=5310

WHO/Europe, in collaboration with partners, has developed a blueprint for a people-centred model of tuberculosis (TB) care that shifts care closer to people and communities. This entails moving towards ambulatory treatment and care, strengthening services involving primary care, and better integrating care across various providers, levels and settings within health systems.

The proposed model aims to transform the delivery of often-outdated TB services to enhance user-friendliness. It recommends that health and social care providers plan and develop care options in collaboration with the people who need and benefit from them. It also focuses on improving the financial arrangements that drive services, and creating a fit-for-purpose health workforce.

This first edition of the blueprint will help guide countries and partners to introduce and sustain effective and efficient services delivery for the prevention and care of TB.

Countries strengthen a primary-health-care approach to manage TB

At present, eastern European and central Asian countries are in the process of transitioning from hospital-based services for inpatients towards primary care services that increasingly assume important roles in the management, detection and prevention of TB and other communicable diseases.

To achieve a smooth transition, countries must overcome barriers including inefficient payment mechanisms for TB services, insufficient support of the health workforce, lack of capacity and uneven distribution of health workers, lack of modern health technologies, and poor access to quality medicines.

The blueprint provides tailored policy options to support countries in redesigning their existing models of care while putting people at the centre.

TB – a public health concern

TB, particularly multidrug- and extensively drug-resistant TB, is a significant public health concern in the WHO European Region. The Region includes 9 of the world’s 30 high-burden countries for multidrug-resistant TB. Latest surveillance data also indicate that in 2015, about 1 in 5 multidrug-resistant TB cases globally occurred in the Region.

In many countries, multidrug-resistant TB may be an indicator of partial health system failure. The disease can reflect outdated and excessive hospital-based care, delayed start of treatment, unnecessarily long hospital stays, challenges in accessing quality drugs, and insufficient patient support systems.


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WHO advises on the use of multidisease testing devices for TB, HIV and hepatitis http://www.eatg.org/news/who-advises-on-the-use-of-multidisease-testing-devices-for-tb-hiv-and-hepatitis/ Wed, 28 Jun 2017 21:50:25 +0000 http://www.eatg.org/?post_type=news&p=5309 Geneva, 26 June 2017 – The World Health Organization (WHO) released a new information note on “Considerations for adoption and use of multidisease testing devices in integrated laboratory networks”. The document, jointly prepared by the Global TB Programme and the Department of HIV and Global Hepatitis Programme, provides a strategic overview of key implementation considerations for diagnostic integration using testing devices for tuberculosis (TB), HIV and viral hepatitis.

TB is the top infectious killer worldwide, and the leading cause of death among people with HIV, resulting in 400 000 deaths annually. At the end of 2015, 10.4 million people fell ill with TB; 36.7 million people were living with HIV; 256 million people were living with chronic hepatitis B infection; and 71 million people were living with chronic hepatitis C infection. Coinfection with HIV, TB or hepatitis is common in many populations.

The percentage of people who know their infection status is limited. An estimated 60% of people with HIV have been diagnosed, and only 55% of TB patients had a documented HIV test result in 2015. Moreover, only 59% of the people who fell ill with TB in 2015 were detected and notified. For hepatitis, the situation is acute, with very low access to testing – only 9% of people with chronic hepatitis B infection, and 20% of people with chronic hepatitis C infection, knew their status in 2015.

New laboratory technologies are available or being developed to allow for testing of different conditions using a common platform for disease-specific tests. For instance, a single device can be used to diagnose TB and HIV infection, and quantitatively measure HIV and hepatitis C viral load. GeneXpert machines – initially procured by countries for the detection of TB and rifampicin resistance, following an initial WHO recommendation in December 2010 – were subsequently expanded for use in early infant diagnosis of HIV and viral load testing using relevant cartridges in the same GeneXpert device.

“With the power and adaptability of molecular technologies, we are in an era of great advancement for the rapid diagnosis of many diseases using single platforms,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme. “These platforms offer technical and financial efficiencies to countries in their disease control efforts, while expanding access to care and saving lives.”

“We encourage countries to use multidisease platforms for testing of HIV, TB and hepatitis as much as possible and feasible,” said Dr Gottfried Hirnschall, Director of WHO’s Department of HIV and Global Hepatitis Programme. “Multidisease devices can increase system efficiencies and improve access to testing for patients in need. Such devices can also help overcome specific challenges in diagnosis and treatment, such as HIV early infant diagnosis and viral load monitoring for both HIV and hepatitis.”

These devices bring new opportunities for collaboration and integration, which can provide significant system efficiencies and cost savings; increase patient access; and ultimately improve quality of care. WHO’s information note is primarily intended for use by national laboratory services and TB, HIV and hepatitis programme managers. It may also be of interest to managers of maternal, newborn and child health programmes, and sexual and reproductive health programmes; international and bilateral agencies; and organizations that provide financial and technical support to relevant national health programmes.

Download the document

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France to reimburse IGRAs to screen at-risk individuals for latent TB http://www.eatg.org/news/france-to-reimburse-igras-to-screen-at-risk-individuals-for-latent-tb/ Wed, 28 Jun 2017 21:45:48 +0000 http://www.eatg.org/?post_type=news&p=5308 The French decision to reimburse interferon-gamma release assays (IGRAs) for TB screening includes QuantiFERON-TB® Gold Plus (QFT-Plus®) and T-SPOT®.TB Test.

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-25/ Wed, 28 Jun 2017 08:19:45 +0000 http://www.eatg.org/?post_type=news&p=5307 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 315 of the “Global Fund Observer.” The newsletter features articles on various topics, including a piece discussing a new study showing the “Global Fund’s gender strategy contains a strong commitment to addressing gender inequalities, but there is a major gap between policy and practice,” and another on a new report from ICASO and EANNASO showing “the Global Fund’s current HIV prevention investments in Africa fall short of” UNAIDS’ benchmark of 26 percent of spending.

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-24/ Tue, 20 Jun 2017 20:35:03 +0000 http://www.eatg.org/?post_type=news&p=5199 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 314 of the “Global Fund Observer.” The newsletter features articles on various topics, including Kenya’s TB/HIV funding request to the Global Fund, which focuses on scaling up HIV prevention among key populations and prioritizes innovative TB case finding activities; Mozambique’s TB/HIV funding request to the Global Fund, which proposes scaling-up its key populations programs; and an Office of the Inspector General audit that concluded risk management processes at the Global Fund need improvement.

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Online consultation on the Zero Draft of the Global Ministerial Conference on TB Declaration http://www.eatg.org/news/online-consultation-on-the-zero-draft-of-the-global-ministerial-conference-on-tb-declaration/ Tue, 13 Jun 2017 18:16:46 +0000 http://www.eatg.org/?post_type=news&p=5166 Geneva, 13 June 2017 – The World Health Organization (WHO) is inviting feedback via an online consultation on the Zero Draft of the Declaration proposed for the First WHO Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: A Multisectoral Response, which will be held in Moscow on 16-17 November 2017. The consultation is open to the public – including Member States of the WHO, institutions, networks, civil society groups, individuals and relevant organizations with interest in TB and health issues. The online consultation will close on 30 June 2017.

This open global consultation will inform the improvement of the draft Declaration, and inputs collated will inform a WHO intergovernmental working group of the UN missions to finalize the declaration between June-September 2017. The final Declaration will be signed by Ministers of Health and other Ministers, at the Ministerial Conference, containing bold commitments by countries to accelerate action to end TB, face the urgent gaps in care, and meet the milestones towards the 2030 SDGs. The Declaration will inform the UN General Assembly High-Level Meeting on TB in 2018.

 

Download the Zero Draft Declaration here.

Please send your inputs by email to moscowTBdeclaration@who.int before 23:00 CET on 30 June 2017.

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IAS TB/HIV co-infection survey http://www.eatg.org/news/ias-tbhiv-co-infection-survey/ Tue, 13 Jun 2017 15:39:14 +0000 http://www.eatg.org/?post_type=news&p=5167

The International AIDS Society (IAS) is seeking input on how best it can engage in TB, using HIV co-infection as an entry point.

You are invited to fill out a short survey. It should take about 10 minutes to complete and all responses will be treated confidentially.

The survey will be open till 26 June 2017.

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WHO updates Essential Medicines List http://www.eatg.org/news/who-updates-essential-medicines-list/ Thu, 08 Jun 2017 21:50:17 +0000 http://www.eatg.org/?post_type=news&p=5105 WHO updates Essential Medicines List with new advice on use of antibiotics, and adds medicines for hepatitis C, HIV, tuberculosis and cancer

6 June 2017 | Geneva New advice on which antibiotics to use for common infections and which to preserve for the most serious circumstances is among the additions to the WHO Model List of Essential Medicines for 2017. Other additions include medicines for HIV, hepatitis C, tuberculosis and leukaemia.

The updated list adds 30 medicines for adults and 25 for children, and specifies new uses for 9 already-listed products, bringing the total to 433 drugs deemed essential for addressing the most important public health needs. The WHO Essential Medicines List (EML) is used by many countries to increase access to medicines and guide decisions about which products they ensure are available for their populations.

“Safe and effective medicines are an essential part of any health system,” said Dr Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. “Making sure all people can access the medicines they need, when and where they need them, is vital to countries’ progress towards universal health coverage.”

New advice: 3 categories of antibiotic

In the biggest revision of the antibiotics section in the EML’s 40-year history, WHO experts have grouped antibiotics into three categories – ACCESS, WATCH and RESERVE – with recommendations on when each category should be used. Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections.

The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of “last resort” antibiotics that are needed when all others fail. These changes support WHO’s Global action plan on antimicrobial resistance, which aims to fight the development of drug resistance by ensuring the best use of antibiotics.

WHO recommends that antibiotics in the ACCESS group be available at all times as treatments for a wide range of common infections. For example, it includes amoxicillin, a widely-used antibiotic to treat infections such as pneumonia.

The WATCH group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections. For example, the use of ciprofloxacin, used to treat cystitis (a type of urinary tract infection) and upper respiratory tract infections (such as bacterial sinusitis and bacterial bronchitis), should be dramatically reduced to avoid further development of resistance.

The third group, RESERVE, includes antibiotics such as colistin and some cephalosporins that should be considered last-resort options, and used only in the most severe circumstances when all other alternatives have failed, such as for life-threatening infections due to multidrug-resistant bacteria.

WHO experts have added 10 antibiotics to the list for adults, and 12 for children.

“The rise in antibiotic resistance stems from how we are using – and misusing – these medicines,” said Dr Suzanne Hill, Director of Essential Medicines and Health Products. “The new WHO list should help health system planners and prescribers ensure people who need antibiotics have access to them, and ensure they get the right one, so that the problem of resistance doesn’t get worse.”

Other additions

The updated EML also includes several new drugs, such as two oral cancer treatments, a new pill for hepatitis C that combines two medicines, a more effective treatment for HIV as well as an older drug that can be taken to prevent HIV infection in people at high risk, new paediatric formulations of medicines for tuberculosis, and pain relievers. These medicines are:

  • two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukaemia that has become resistant to standard treatment. In clinical trials, one in two patients taking these medicines achieved a complete and durable remission from the disease;
  • sofosbuvir + velpatasvir as the first combination therapy to treat all six types of hepatitis C (WHO is currently updating its treatment recommendations for hepatitis C);
  • dolutegravir for treatment of HIV infection, in response to the most recent evidence showing the medicine’s safety, efficacy, and high barrier to resistance;
  • pre-exposure prophylaxis (PrEP) with tenofovir alone, or in combination with emtricitabine or lamivudine, to prevent HIV infection;
  • delamanid for the treatment of children and adolescents with multidrug-resistant tuberculosis (MDR-TB) and clofazimine for children and adults with MDR-TB;
  • child-friendly fixed-dose combination formulations of isoniazid, rifampicin, ethambutol and pyrazinamide for treating paediatric tuberculosis; and
  • fentanyl skin patches and methadone for pain relief in cancer patients with the aim of increasing access to medicines for end-of-life care.

Note to Editors

The WHO Model List of Essential Medicines was launched in 1977, coinciding with the endorsement by governments at the World Health Assembly of “Health for all” as the guiding principle for WHO and countries’ health policies.

Many countries have adopted the concept of essential medicines and have developed lists of their own, using the EML as a guide. The EML is updated and revised every two years by the WHO Expert Committee on the Selection and Use of Essential Medicines.

The meeting of the 21st Expert Committee was held 27–31 March 2017 at WHO Headquarters. The Committee considered 92 applications for about 100 medicines and added 55 to the EML (30 to the general EML and 25 to the children’s EML).

 

Essential medicines

 

See also:

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News outlets examine HIV and TB responses in Ukraine http://www.eatg.org/news/news-outlets-examine-hiv-and-tb-responses-in-ukraine/ Wed, 07 Jun 2017 21:55:02 +0000 http://www.eatg.org/?post_type=news&p=5096 News outlets examine impacts of potential USAID cuts on Ukraine’s TB programs, NGOs’ efforts to address HIV epidemic in country amid Russian conflict

 

Devex: Ukraine’s fight against TB is at risk from USAID cuts

“A United States Agency for International Development-funded digital health program to help Ukraine manage its growing drug-resistant tuberculosis epidemic is a textbook example of effective foreign aid, according to health experts who worked on the project — but the country’s fight against the disease is now at risk from looming cuts to U.S. development aid. Ukraine has the second-highest TB burden in Europe, and one of the highest estimated numbers of multidrug-resistant TB, or MDR-TB, cases in the world…” (Edwards, 6/6).

 

VOA News: E. Ukraine conflict impacts war against HIV

“…On Wednesday and Thursday, United Nations Special Envoy for HIV and AIDS in Eastern Europe and Central Asia, professor Michel Kazatchkine, held a conference at Kyiv’s Alliance for Public Health and then visited some of the city’s harm-reduction organizations specializing in activities including needle exchanges, free medical testing, and condom distribution. … Despite the discouraging statistics, Kazatchkine said he sees progress in Ukraine thanks to the work of NGOs in partnership with the government. Unfortunately, a significant portion of Ukraine’s territory is under control of Russia and its proxies, and this has created serious obstacles for those trying to help fight the spread of HIV and AIDS…” (Kovpak, 6/2).

 

VOA News: Ukrainian NGO works to stop spread of HIV among sex workers

“During a recent visit to Kyiv, Michel Kazatchkine — the U.N. special envoy for HIV/AIDS in Eastern Europe and Central Asia — toured the Ukrainian capital’s various harm-reduction programs, aimed at stopping the spread of HIV. Among those was the nongovernmental organization Eney (Aeneas), which specializes in providing medical and legal assistance to female sex workers in Kyiv…” (Kovpak, 6/5).

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FIRS report: The Global Impact of Respiratory Disease http://www.eatg.org/news/firs-report-the-global-impact-of-respiratory-disease/ Mon, 05 Jun 2017 08:05:15 +0000 http://www.eatg.org/?post_type=news&p=5063

Forum of International Respiratory Societies releases “The Global Impact of Respiratory Disease”
Report outlines major causes of respiratory disease and mortality and lays out recommendations for global action

GENEVA, May 25, 2017 – The Forum of International Respiratory Societies (FIRS), an organisation comprised of the world’s leading international respiratory societies working together to improve lung health globally, today released “The Global Impact of Respiratory Disease.” The report lays out the tremendous impact that respiratory disease has on world health. Specific diseases addressed include COPD, asthma, acute lower respiratory tract infections, tuberculosis and lung cancer. It also provides several recommendations that global leaders can take to reduce the burden of respiratory disease and improve global health.

The report was released at A Call to Action for Lung Health, a World Health Assembly Side Event held in conjunction with the 70th World Health Assembly. The event included world leaders in respiratory heath, uniting in a call for action to improve lung health globally. An expert panel emphasised the global burden of lung disease, and outlined prevention strategies aligned with sustainable development priorities, including reduction of tobacco use, clean urban air, sustainable energy, climate change mitigation and reducing the spread of infection.

In addition to the Global Impact report, a global charter for lung health, calling for official recognition of a World Lung Day was launched during the event. The goal is to secure 100,000 signatures from healthcare professionals and organisations for subsequent consideration by the World Health Organization for global recognition. Learn more at www.FIRSnet.org.

“Prevention, control and cure of these diseases and promotion of respiratory health must be a top priority in global decision-making in the health sector,” said Dean Schraufnagel, MD, executive director of FIRS. “These goals are achievable, and the control, prevention and cure of respiratory diseases are among the most important cost effective health interventions available. Alleviating the burden of respiratory disease should be a leading strategy of the Sustainable Development Goals and a requirement for nations to achieve.”

Respiratory diseases impose an immense worldwide health burden. Five of these diseases are among most common causes of severe illness and death worldwide [1].

  • An estimated 65 million people have moderate to severe chronic obstructive pulmonary disease (COPD), from which about 3 million die each year, making it the third leading cause of death worldwide – and the numbers are increasing [2, 3].
  • Approximately 334 million people suffer from asthma [4], which is the most common chronic disease of childhood, affecting 14% of children globally. The prevalence of asthma in children is rising [5].
  • For decades, acute lower respiratory tract infections have been among the top three causes of death and disability among both children and adults. Although the burden is difficult to quantify, it is estimated that lower respiratory tract infection causes nearly 4 million deaths annually and is a leading cause of death among children under 5 years old [6]. Moreover, acute lower respiratory tract infections in children predispose for chronic respiratory diseases later in life. Respiratory tract infections caused by influenza kill between 250,000 and 500,000 people and cost between US $71 and $167 billion annually [7].
  • In 2015, 10.4 million people developed tuberculosis (TB) and 1.4 million people died from it [8].
  • The most common lethal neoplasm in the world is lung cancer, which kills 1.6 million people each year [9]; and the numbers are growing.

Recommendations

FIRS calls for these essential actions to reduce the burden of respiratory disease and improve global health:

  1. Increase public and policy makers’ awareness that respiratory health is essential to global health and that childhood respiratory disease may have long-term negative consequences on adult health by advocating at world health meetings and through publications and media postings.
  2. Reduce, and then eliminate, the use of all tobacco products through universal support of the Framework Convention on Tobacco Control 3. Adopt WHO standards, at a minimum, to reduce ambient, indoor, and occupational air pollution for all countries.
  3. Promote universal access to quality healthcare, including the availability of affordable, quality-assured, essential medicines and universal coverage for childhood and adult immunisations, including new conjugate vaccines by advocacy through WHO and government programmes.
  4. Improve early diagnosis of respiratory diseases through improving awareness and access to current procedures and the development of new tools through world health meetings and publications.
  5. Increase education and training of health professionals in respiratory disease worldwide though programmes of the FIRS societies, WHO and other governmental and non-governmental organisations.
  6. Standardise the monitoring of the prevalence, severity and management of respiratory diseases to enable development of well-informed national strategies though programmes of WHO and governmental and non-governmental organisations.
  7. Increase respiratory research to develop programmes, tools and strategies to better prevent and treat respiratory diseases though advocacy for governmental and nongovernmental research organisations.

“While respiratory disease has such a tremendous impact on the world’s population, it also is largely preventable, concluded Dr. Schraufnagel. “Investing the resources necessary to prevent and cure these diseases is a cost-effective investment that benefits the entire world. Public policy makers in the healthcare sector need to recognise the size of the problem and take concrete steps now to improve global lung health.”

References:

  1. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1459–1544.
  2. World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases. A comprehensive approach. Geneva, WHO, 2007. Available from: http://www.who.int/gard/publications/GARD_Manual/en/
  3. Burney PG, Patel J, Newson R, Minelli C, Naghavi M. Global and regional trends in COPD mortality, 1990-2010. Eur Respir J 2015; 45: 1239–1247. Available from: http://erj.ersjournals.com/content/45/5/1239
  4. Global Asthma Report. Auckland, Global Asthma Network, 2014. Available from: http://www.globalasthmareport.org/resources/Global_Asthma_Report_2014.pdf
  5. Pearce N, Ait-Khaled N, Beasley R, et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2007; 62: 758–766. http://thorax.bmj.com/content/62/9/758.long
  6. Pneumonia: The forgotten killer of children. Geneva, The United Nations Children’s Fund (UNICEF)/World Health Organization (WHO), 2006. Available from: http://www.who.int/maternal_child_adolescent/documents/9280640489/en/
  7. Influenza (seasonal) Factsheet. Geneva, World Health Organization, 2016. Available from: http://www.who.int/mediacentre/factsheets/fs211/en/
  8. Global Tuberculosis Report 2016. Geneva, World Health Organization, 2016. Available from: http://www.who.int/tb/publications/global_report/en/
  9. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer JClin 2015; 65: 87–108. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25651787

About the Forum of International Respiratory Societies (FIRS)

The Forum of International Respiratory Societies (FIRS) is an organisation comprised of the world’s leading international respiratory societies working together to improve lung health globally: American Thoracic SocietyAmerican College of Chest PhysiciansAsociación Latinoamericana De TóraxAsian Pacific Society of RespirologyEuropean Respiratory SocietyInternational Union Against Tuberculosis and Lung Disease, and the Pan African Thoracic Society. The goal of FIRS is to unify and enhance efforts to improve lung health through the combined work of its more than 70,000 members globally.

 

To download the report, click here.

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Médecins Sans Frontières TB field research in Tajikistan, Uzbekistan and Kyrgyzstan http://www.eatg.org/news/medecins-sans-frontieres-tb-field-research-in-tajikistan-uzbekistan-and-kyrgyzstan/ Mon, 05 Jun 2017 08:00:08 +0000 http://www.eatg.org/?post_type=news&p=5061 Childhood TB in Dushanbe, Tajikistan

Abstract

Children exposed to active TB, particularly within the household, have an increased risk of developing TB disease. In Tajikistan, a high-priority country for TB, the national policy is that all children <7 years who have been in contact with an active TB case should be screened and given isoniazid preventive therapy (IPT), if not contraindicated. Currently, little information is available on whether this policy is being followed. We aimed to identify the trends in paediatric TB, characteristics and treatment outcomes of paediatric TB, and coverage of contact tracing and IPT delivery in the country.

We undertook a retrospective cohort study of notified paediatric TB cases and household contacts in Dushanbe, Tajikistan from 2009 to 2013 to investigate trends in, and characteristics and outcomes of childhood TB cases, contact tracing and the proportion of eligible paediatric contacts who received IPT. During the study period, 380 paediatric TB cases were notified, of which 218 (57%) treatment records were available for analysis.

The majority of cases (N=138; 63%) were in the age group of 7–14 years. One hundred thirty-seven cases (63%) had extrapulmonary TB, of which 78 cases had hilar lymph node TB, 20 had peripheral lymph node TB, 19 had tuberculous pleurisy, 10 had bone TB, 8 had intestinal TB and 2 had TB meningitis. Successful treatment outcomes were registered in 94% of cases. Household contacts of 157 (72%) analysed paediatric TB cases were investigated; 61 households were identified with smear-positive pulmonary TB; 44 (76%) out of58 eligible children (<7 years) received IPT.

We found successful treatment outcomes, contact tracing and IPT coverage. However, strategies could be developed to further scale up active case finding and national protocols, including data linkages, to routinely monitor and evaluate the quality of contact tracing.

To download the full research paper, click here.

 

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Characteristics and treatment outcomes of new pulmonary TB patients with comorbidities in the Samarkand Region, Uzbekistan

Abstract

Despite good progress made in the fight against tuberculosis (TB), the disease remains a major public health threat worldwide. Comorbid diseases that increase the risk of developing active TB and have a negative impact on final treatment outcomes include HIV and diabetes mellitus. The effect of other conditions such as peptic ulcer and asthma/chronic obstructive pulmonary disease (together defined as COPD for this study) on TB is not clear. There is also little information in Uzbekistan about the interaction between these comorbidities and TB. This study was therefore carried out to assess the characteristics and treatment outcomes of TB patients with these specific comorbid conditions. This was a descriptive study of a cohort of patients with newly diagnosed pulmonary TB with specific comorbidities in the Samarkand region, Uzbekistan, from 2012 to 2013. There were 1260 patients with newly diagnosed TB, of whom 193 (15%) had comorbidities: diabetes (n = 116, 9%), HIV (n = 27, 2%), COPD (n = 29, 2%) or peptic ulcer (n = 22, 2%). Diabetes, COPD and peptic ulcer disease were mainly found in patients aged 55 years and above, while HIV coinfection was mainly found in patients aged 25–54 years. Clinical characteristics were fairly similar between those with and without comorbidities. Compared with those who had no comorbidities, patients with comorbidities had significantly reduced treatment success (78% versus 92%), a higher rate of death (9% versus 2%) and higher treatment failure (2% versus <1%). In conclusion, more attention needs to be paid to a systematic and timely approach to the screening and treatment of comorbidities in TB patients, to improve treatment outcomes and reduce mortality.

To download the full research paper, click here.

 

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Linkage between diagnosis and treatment of smear-positive pulmonary TB in urban and rural areas in Kyrgyzstan

Abstract

The performance of the tuberculosis (TB) programme should be judged on the basis of detected TB cases recorded in the laboratory register and not just those placed on treatment and recorded in the TB treatment register. We examined the performance of the TB programme in this regard in Kyrgyzstan in 2012.

This retrospective cohort study included all sputum smear-positive pulmonary TB cases registered in the TB laboratory register (584 persons). Data variables on geographical region, TB diagnosis, TB treatment and outcomes were sourced from various registers. We analysed (1) initial lost to follow-up (LTFU) between urban and rural areas; (2) time of starting treatment after diagnosis; (3) treatment outcomes of laboratory-registered and treatment-registered patients.

Of 584 patients diagnosed with new smear-positive pulmonary TB in two cities and eight rural districts, 59 (10%) were not traced in the patient TB treatment register and considered as initial LTFU. Rural areas had significantly higher initial LTFU (13%) compared with urban areas (8%). The mean time to initiating treatment among those who were entered in the TB register was 14 days (range 8–28 days). When all TB cases included in the laboratory register were used as the denominator, the overall treatment success rate reduced from 75% to 67% (a drop of 8%).

Reporting on TB programme outcomes without including initial LTFU tends to exaggerate TB programme performance. Concerted efforts are needed to limit initial LTFU and accelerate progress towards ending TB as a public health problem.

To download the full research paper, click here.

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End TB Progress Report endorsed at the World Health Assembly http://www.eatg.org/news/end-tb-progress-report-endorsed-at-the-world-health-assembly/ Sat, 03 Jun 2017 21:36:09 +0000 http://www.eatg.org/?post_type=news&p=5049 May 2017 | GENEVA – The World Health Assembly received with appreciation and endorsed a progress report on the End TB Strategy on 30 May. The Strategy was adopted by Member States in 2014 (resolution WHA67.1 (2014)).

This first progress report emphasized that actions and investments by countries were falling too short, and that renewed action and an acceleration of efforts was needed to reach the targets set within the End TB Strategy and the Sustainable Development Goals. The upcoming WHO Global Ministerial Conference on Ending TB in the Sustainable Development Era, which will be held in Moscow on 16-17 November 2017 and the UN General Assembly (UNGA) High-Level Meeting on TB planned for 2018 were flagged as key opportunities to drive high-level commitment and action by Ministers of Health, other Ministers, and Heads of State.

The report was commended by many countries including, Bahrain, Italy, Iraq, Japan, Malawi on behalf of the African region, Nigeria, Thailand, the Russian Federation, United Kingdom, Zimbabwe, United States of America (also on behalf of American Region), Suriname, Panama and  Australia, as well as partners – the Union and MSF. The WHO Secretariat was requested to report back at the 71st and 72nd World Health Assemblies on the outcomes of the WHO Ministerial Conference and the 2018 UNGA High-Level Meeting on TB, respectively.

“It is heartening to see the unanimous support from Member States to ramp up the fight against TB, as evidenced by the interventions made by Member States during the discussion on the End TB progress report”, said Dr Mario Raviglione, Director of the WHO Global TB Programme. “This is an early sign of commitment as we move forward to the momentous high-level events planned for 2017 and 2018”.

Access the progress report here

 

See also:

WHO Global TB Programme at the 70th World Health Assembly:

  • Ending TB featured prominently at the 70th World Health Assembly – click here to read about the events organized by the WHO Global TB Programme
  • Scaling up the use of digital technologies to support End TB Strategy implementation – joint WHO Global TB Programme and European Respiratory Society event

 

The Union at the 70th World Health Assembly

  • Click here to read about the The Union’s interventions at the World Health Assembly
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Odesa joins Zero TB Cities Initiative http://www.eatg.org/news/odesa-joins-zero-tb-cities-initiative/ Sat, 03 Jun 2017 21:30:13 +0000 http://www.eatg.org/?post_type=news&p=5054 On May 30th, 2017, in Odesa, Ukraine, the Mayor of Odesa Gennadiy Trukhanov signed the ‘Declaration of Interest to Alignment of Odesa city with the Zero TB Initiative’ with Stop TB Partnership. This makes Odesa the first city in Ukraine and entire region of Eastern Europe and Central Asia joining the initiative.

‘The Zero TB Initiative aims to drive us towards ending TB by focusing on local government participation to drive and maintain successes against TB. A combination of political will, knowledgeable health professionals, and mobilized communities are the recipe to end TB. I am pleased that Odesa is joining the initiative today,’ commented Dr Lucica Ditiu, Executive Director, Stop TB Partnership.

Tuberculosis remains the most common AIDS-related disease in Ukraine. Ukraine ranks 5th in the world on MDR-TB (hardest to treat forms) burden. In Ukraine the incidence of TB is 70.5 per 100 thousand population, which amounted to almost 30,000 cases in 2016. In Odesa in 2016, the incidence of TB was even higher at 110.1 which means 1,113 new infections detected.

A challenge is that Ukraine has one of the lowest treatment success rates in the EECA region: 72% among drug susceptible TB cases and 39% – among MDR-TB patients (while the WHO indicator is 85%). In Odesa, cure rates are very low, at the level of 43.2% in 2016 among smear positive patients (56.9% among new cases). The reasons of low treatment success rates are high level of HIV/TB co-infections, high level of treatment interruptions and existing health models that are not patient-focused.

‘Tuberculosis is one of the most dangerous infectious diseases of all the mankind. TB does not have borders and only through our joint efforts we can stop the spread of this disease. From its side, Odesa is ready to affront this plague of the XXI century. For this purpose, we use not only our own expertise in TB detection and treatment, but also the best practices of the developed European countries. We are also eager to share our knowledge with other participants of the Zero TB Cities Initiative,’ – pointed out Odesa mayor, Gennadiy Trukhanov.

Through participation in the Zero TB Cities Initiative, Odesa will have access to international TB expertise, training and exchange with the most successful TB responses as well as support in the development of its City TB Plan. Operational research that will start in 2017 as part of the Fast-Track HIV/TB Responses for Key Populations in EECA Cities Global Fund project will focus on improving treatment success rates through promotion of the ambulatory care models and motivation of primary healthcare personnel based on treatment outcomes.

Andriy Klepikov, Executive Director of the Alliance for Public Health said: ‘Alliance for Public Health demonstrates solutions which double TB cure rates in comparison with the standard approaches. The key to success is prioritized patient needs and management of individual cases and we will be further expanding this model’.

Baroness Alison Suttie, member of the House of Lords of UK Parliament who attended the signing ceremony said: ‘I think it is extremely important to encourage politicians to play a more active role in the fight against TB and I have been working with Ukrainian parliamentarians to promote this. It is impressive to see the mayors playing a growing role as well and I think this experience could be followed by other Ukrainian cities and other cities in the region”.

Background information

Alliance for Public Health is a leading non-governmental professional organization established in 2000 making a significant impact on the epidemics of HIV/AIDS, tuberculosis, viral hepatitis and other socially dangerous diseases in Ukraine and providing support on responses globally.

The Stop TB Partnership is leading the way to a world without tuberculosis (TB), a disease that is curable but still kills three people every minute. Founded in 2001, the Partnership’s mission is to serve every person who is vulnerable to TB and ensure that high-quality diagnosis, treatment and care is available to all who need it. Together our 1500 partners are a collective force that is transforming the fight against TB in more than 100 countries. They include international and technical organizations, government programs, research and funding agencies, foundations, NGOs, civil society and community groups and the private sector.

The Zero TB Cities project, a collaborative initiative geared towards significant, accelerated reductions in tuberculosis mortality and prevalence in high-burden metropolitan areas. To date, Chennai, India; Durban, South Africa; Karachi, Pakistan; Kisumu, Kenya; and Lima (Caraballyo), Peru have moved swiftly to design comprehensive programs, create new partnership models, and begin resource mobilization for this effort.

Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia is the Global Fund funded EECA regional project of Alliance for Public Health (Ukraine), AFEW International (The Netherlands), licit (Switzerland) and Stop TB Partnership under technical guidance of UNAIDS EECA office which is there to support city responses to HIV and TB in key populations in the five cities of EECA, including Odesa. The project will be implemented throughout 2017-2019 and plans to develop efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in the project cities as well as increase the allocation of city funding to HIV/TB interventions for key populations.

TB in Eastern Europe and Central Asia Project on Strengthening Health Systems for Effective TB and DR-TB Control funded by the Global Fund is there to decrease the burden of tuberculosis disease and halt the spread of drug resistance in target EECA countries through increasing political commitment and translating evidence into implementation of patient-centered TB models of care. The Principal Recipient of the Global Fund grant is PAS Center (Moldova). Alliance for Public Health is an implementing partner of the project on behalf of TB Europe Coalition, responsible for the civil society advocacy in support of the people-centered TB care in the region of Eastern Europe and Central Asia.

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ECDC: Systematic review on the diagnosis, treatment, care and prevention of TB in prison settings http://www.eatg.org/news/ecdc-systematic-review-on-the-diagnosis-treatment-care-and-prevention-of-tb-in-prison-settings-see-more-at-httpecdc-europa-euenpublications_layoutsformspublication_dispform-aspxlist4f5/ Sat, 03 Jun 2017 21:25:04 +0000 http://www.eatg.org/?post_type=news&p=5056 People in prisons have a higher prevalence of several communicable diseases than the general population.

ECDC released a report systematically reviewing data on the diagnosis, treatment, care and prevention of TB in prison settings, with a focus on the countries of the European Union and the European Economic Area.

To access the report, click here.

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Ukraine calls for all children affected with TB to receive the appropriate diagnosis, treatment, care and support http://www.eatg.org/news/ukraine-calls-for-all-children-affected-with-tb-to-receive-the-appropriate-diagnosis-treatment-care-and-support/ Sat, 03 Jun 2017 21:20:43 +0000 http://www.eatg.org/?post_type=news&p=5052 1st June, 2017, Ukraine – Today we celebrate International Children’s Day and it’s time to think of the one million children who are suffering with or are affected by TB and TB/HIV. Many children who live with parents, guardians and others who have confirmed TB do not receive preventive therapy. Many more thousands are sick with TB and do not have access to proper diagnosis or treatment, and 200,000 children’s lives are taken annually by TB – an unacceptable tragedy for a curable disease.

In many countries, children whose parents or guardians have TB are removed from their care and placed in orphanages or foster care. Their parents are often hospitalized for months and children pay the price of isolation policies that are not people-centered and do not consider the hardship on the families.

During a high-level mission in Kyiv in collaboration with Alliance for Public Health for the “Regional Cities Project,” the Stop TB Partnership discussed with Partners including the Ministry of Health, the National TB Program Manager, and the WHO Country Office, the achievements and challenges faced by country programmes in offering appropriate packages of care to all those affected by TB. The discussion evolved around the need for a paradigm shift in the TB work, ensuring that people affected by TB and especially children are at the core of all our interventions.

Ukraine National TB Program reports 100% coverage with preventive therapy of all child contacts of people who have confirmed TB. In spite of preventive therapy being a cost effective, proven intervention, globally, only 77 countries in 2015, reported coverage with preventive therapy in children contacts of bacteriologically positive people with TB – translated into 87,200 child household contacts out of 1.2 million (estimated to be eligible) receiving preventive TB therapy. Ukraine is among the few countries globally reporting 100% coverage.

Oksana Syvak, Deputy Ministry of Health of Ukraine on European Integration

“By introducing patient-oriented approaches in providing services to people affected by tuberculosis today we can significantly improve the quality of medical care. Also, it enables us to come closer in achieving ambitious goals of the global strategy towards ending TB epidemic in Ukraine.

However, today in Ukraine it is critical to implement approaches of public health. First of all, we have to protect people, especially children, from the possibility of getting sick from the vaccinated-driven infections, which includes tuberculosis. In addition, the Ministry of Health of Ukraine is currently engaged in complying to the approaches of detection and case management of TB in children with WHO recommendations, which will significantly improve the quality of medical care. ”

Nataliya Nizova, Director General of the Public Health Center of the Ministry of Health of Ukraine

“As of today, the treatment of TB in Ukraine is free and generally available. But we should not forget about effective means of prevention which can save thousands of lives.  I refer here to preventive therapy and BCG vaccination at birth in endemic countries. In Ukraine, TB morbidity in 2016, new cases and relapses, of children (0-14 years) is 8.8 per 100, 000 population (571 cases).

Only through the joint efforts of both on national and international levels, providing professional patient-oriented medical and social care and implementing effective preventive and information interventions we are able to overcome TB epidemic.”

Andriy Klepikov, Executive Director of Alliance for Public Health.

“Civil society should guard the interests of children and demand that governments and donors make investments in research to develop effective vaccines, diagnostic and treatment tools and child-friendly care. After all, it is the question of child’s rights protection.”

Lucica Ditiu, Executive Director of the Stop TB Partnership

“I hope the world will pay attention to the great steps forward that Ukraine is making towards ending TB: increased domestic financing for TB and HIV, bold public health reform, increasing partnership with civil society and declaring Odesa and Kyiv as fast track Zero HIV and TB cities, and a specific focus on all those vulnerable, including children with TB. I am glad we can support our colleagues and friends here as only by working together under the leadership of the Ukrainian government, can we hope to end TB in Ukraine before 2030.”

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We had to run our own trial for TB drugs – nobody else was doing it http://www.eatg.org/news/we-had-to-run-our-own-trial-for-tb-drugs-nobody-else-was-doing-it/ Sat, 03 Jun 2017 20:48:15 +0000 http://www.eatg.org/?post_type=news&p=5057 Tuberculosis kills more people than HIV, but medicines to treat the disease have barely improved in 50 years – it’s time for urgent and radical innovation.

Four years ago, Médecins Sans Frontières (MSF) made the decision to sponsor and run its own tuberculosis clinical trial. The aim was to find a new treatment regimen for drug-resistant tuberculosis (TB) that was radically better than what was currently available.

As an organisation that specialises in delivering short-term emergency healthcare, this was a bold and new direction to take. But it was a decision that came from our frustration, anger and impatience on behalf of the more than 20,000 people with TB that we treat every year. We felt compelled to search for improved treatments ourselves because too few pharmaceutical companies, organisations or universities were doing enough about it.

Every day 4,900 people die from TB, a infectious disease that affects the lungs and causes fever, coughing, and makes it difficult to breathe. It is one of the top 10 causes of death worldwide and now kills more people than HIV.

Yet the disease does not receive anywhere near the attention it deserves. Care, treatment and diagnostics remain woefully underfunded. Despite the fact that the number of new people being diagnosed with TB every year is decreasing, the overall number of people living with TB is at an all-time high as we fail to cure people already living with the disease.

An estimated two in every five people who fall sick with the disease are left undiagnosed and untreated. Medicines to treat TB have barely improved in 50 years.

The inadequate diagnostics and medicines mean that the complexity and severity of the disease is getting worse. TB needs to be treated with a range of different antibiotics but the same drugs have now been used for decades. The result is that an alarming number of strains of TB have become resistant to these antibiotics. Growing numbers of patients are being told that their six-month course of treatment hasn’t worked and they still have TB.

People diagnosed with drug-resistant TB face a grueling two years of treatment, during which time they must swallow more than 10,000 pills and have painful daily injections. The side effects are often incapacitating; they include constant nausea, joint pains, irreversible deafness and even psychosis. Many patients must spend prolonged periods in hospital, unable to earn a living and cut off from friends and family as well as all semblance of a normal life.

At the end of the two years, only half of these people will be told their treatment has been successful.

One key reason for the lack of investment in TB is that most people with the disease live in low- and middle-income countries, so there is little financial incentive for pharmaceutical companies to develop or research new drugs. It is also because drug companies make financial gains by patenting drugs. This patent restricts how the drug can be used. As a number of drugs are required to kill TB, it is difficult to trial new drugs together if they’ve been developed by different companies who have all put their own patent on their own drugs. As a result, the only two new drugs developed in the past 50 years remain out of reach of most patients. There is not sufficient evidence or research to recommend them for widespread use nor is there any evidence on how to use them as part of a novel regimen.

As an organisation of doctors, nurses and other medical staff we have been left feeling frustrated as thousands of our patients continue to suffer from these long, toxic and failing treatments. Finally we had had enough, so we decided to do something ourselves to find better treatment for our patients.

We wanted to run a trial that would put patients’ at its heart, with a focus on those people most in need of improved treatment, and where the outcome would have a real impact on people’s lives. We decided to trial a combination of drugs that only need to be taken for six months, with no daily painful injections, fewer pills, that hopefully has more bearable side effects and is potentially much more effective at curing all drug-resistant forms of TB.

After years of hard work, TB PRACTECAL started at the end of January 2017 in Uzbekistan. It is a full phase III clinical trial with four sites across Uzbekistan, Belarus and South Africa. The 630 participants will either take a combination of two new anti-TB drugs (bedaquiline and pretomanid) with three other existing drugs (linezolid, clofazimine and moxifloxacin), or be placed in the control group.

When the first patient took the first pill of the trial this felt like an exciting and important milestone. But the reality is we still have a long way to go.

A first set of trial results are expected within two years and final results within four. If successful, this combination of treatment could be recommended for widespread use by the World Health Organisation and rolled out in countries across the world.

But even if this trial is successful, while we hope it could have a real impact on the lives of some people with drug-resistant TB, it will be just a small step forward in the efforts to tackle this global epidemic.

For a start, we will need an ongoing “pipeline” of new drugs to replace the older ones as they become less effective. MSF has also initiated the 3P Project which aims to create a new, more collaborative approach to funding and developing TB drugs, as the current model is clearly not working.

Of course, MSF cannot solve the TB crisis alone. We also need better diagnostic tools that are also accessible to those who need them most. We need improved ways of developing individual drugs and quicker ways of combining them into regimens. We need combinations that are suitable for children, and all treatment needs to be affordable.

With thousands of people dying from TB each day, there needs to be a global response to this global crisis.

By Dr Bern-Thomas Nyang’wa

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UNHCR and Global Fund strengthen partnership to expand health services to refugees http://www.eatg.org/news/unhcr-and-global-fund-strengthen-partnership-to-expand-health-services-to-refugees/ Fri, 02 Jun 2017 21:52:38 +0000 http://www.eatg.org/?post_type=news&p=5019 GENEVA, 31 May 2017 – UNHCR, the UN Refugee Agency, and the Global Fund to Fight AIDS, Tuberculosis and Malaria today signed an agreement intended to improve health services for refugees and other displaced communities. This new agreement will strengthen UNHCR’s humanitarian response – focusing on public health and education as well as emergency care.

“Our focus remains on working together to provide specialized health care for refugees and communities hosting them,” said Filippo Grandi, the UN High Commissioner for Refugees. “Our partnership ensures refugees have access to treatments for HIV, tuberculosis and malaria.”

Both agencies are already working together in Rwanda, where UNHCR is implementing a grant of US$2.09 million from the Global Fund to address health needs for Burundian refugees.Further discussions are also underway to expand joint activities in the Middle East and East Africa.

“We need to better connect pieces of the humanitarian response within the larger development continuum,” said Mark Dybul, Executive Director of the Global Fund. “This framework promotes innovation and advancing efforts that make sense and that work.”

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Mark Dybul: Megatrends and maximizing impact http://www.eatg.org/news/mark-dybul-megatrends-and-maximizing-impact/ Fri, 02 Jun 2017 21:51:59 +0000 http://www.eatg.org/?post_type=news&p=5037 On 31 May, Mark Dybul completed a four-year term as Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The following is adapted from remarks he recently made to the Global Fund Board.

It is now 15 years since global health leaders came together to form the Global Fund partnership. We have made incredible progress toward the vision of a world free from the burden of HIV, tuberculosis and malaria, and investing in resilient and sustainable systems for health. The countries we serve have saved more than 20 million lives and reinvigorated communities and countries all over the world. More broadly, what seemed impossible 15 years ago has been achieved. We are at the tipping point of ending the HIV, tuberculosis and malaria epidemics.

But tipping points can go either way – success or failure. New and urgent challenges confront us. The last stages of a battle are often the toughest. Every inch of progress we make from here will be harder and costlier than the last. If we fail, the epidemics will rebound in aggressive, drug-resistant forms that we do not have the science or resources to control.

We need to address a real break point with young people. We can either have a demographic dividend, or we can have a demographic disaster. That’s true across the portfolio of development, but it’s especially true for HIV. In past years, the data have become very clear on the driver of the HIV epidemic in southern Africa: It’s adolescent girls and young women. We didn’t really understand the dynamics until a group called Caprisa showed, by tracing the virus genetically, how infections occur. We see it in a cycle of sexual relations, and we now know that 15-to-25 year-old adolescent girls and young women in some places in sub-Saharan Africa are 14 times more likely to be infected with HIV than boys and young men. They become vulnerable to infection by 25-to-35 year-old men.

Who are these people, as human beings? Why are they the most vulnerable, not just to HIV, but in general? What are the social and economic pressures that influence their behaviors and circumscribe their choices? The data show that we are flat out missing the young people most at risk. They are not even getting tested. If they do not seek testing, we can’t get them to services, and we will perpetuate the cycle. If we don’t start to reach these people, the cycle will become unbreakable. It’s breakable if we can understand who these people are, and cater prevention and treatment services to their needs.

We must find better and faster ways to engage young people about HIV. The choices are stark. If we stay the current course – with high infection rates and the current youth bulge in sub-Saharan Africa – we will have more HIV infections in 2030 than in the 2000s. If we invest vigorously and innovatively in responding to the challenges they face, we can end HIV as an epidemic for good. If we get it right, it can be a huge opportunity. If we don’t, it’s a massive cost.

The mobility of ideas and people is equally urgent. We live in an age of unprecedented connectivity, and we must do more to leverage the tools at our disposal to share ideas. In the development community, we’re not sharing ideas as quickly as we should be. As we develop mechanisms and tools, we need to create open source tools that can be shared on line. Ideas are moving so quickly. If we catch up, and share those ideas, we can do better in development. People are moving more than ever before. In 2015, there were 244 million people moving across borders, up by 71 million from 2000. Only 20 million of the 244 million, less than 10 percent, were refugees. Movement is about economic mobility. If we are to tackle the challenges that come from movement of people, we must broaden the issue beyond refugees.

To achieve global health security and end epidemics, we have to create models that reach people with prevention and treatment services wherever they go. The Maldives are an instructive example. They set up TB treatment programs for international workers, who account for 44 percent of professional workers and 76 percent of manual laborers. When these workers come into the country with TB, they receive comprehensive treatment, allowing them to be cured and to work. The alternative – turning away a person with TB at the border – risks losing that person to treatment entirely and potentially fueling the spread. Thailand provides its national health insurance to documented migrant workers and is trying to extend those services to undocumented workers. This is the future. How we take care of people who cross a border, from a health perspective, is something we must engage in, supporting countries to deliver such health care services.

If there is an infectious disease outbreak anywhere, all of us are threatened. When people move, we must reach them with good health services wherever they to choose go. The new threat of antimicrobial resistance can hit the world from many corners. Fighting malaria resistance in the Mekong or drug resistant TB anywhere in the world should be the responsibility of all of us. In today’s interconnected world, we cannot be safe if others are unsafe.

It’s a hugely exciting time, and a challenging time, in global health. If we do things the same way, we’ll do good work but we will never get where we need to go. To actually end the epidemics of HIV, tuberculosis and malaria, the Global Fund partnership needs to act, innovate and evolve as it has for the last 15 years. We can tackle these problems and we will succeed. The challenges might seem daunting, but we’ve achieved what was thought impossible 15 years ago, and we can do it again.

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-23/ Wed, 31 May 2017 21:50:56 +0000 http://www.eatg.org/?post_type=news&p=4991 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 313 of the “Global Fund Observer.” The newsletter features articles on various topics, including Zambia’s prioritization of front-line rural health workers in TB/HIV and malaria funding requests; differences between the Global Fund and other health financing mechanisms; and a new guide on how to manage community-based sub-recipients.

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Friends deeply concerned by proposed cuts to U.S. international assistance and the Global Fund http://www.eatg.org/news/friends-deeply-concerned-by-proposed-cuts-to-u-s-international-assistance-and-the-global-fund/ Thu, 25 May 2017 21:50:35 +0000 http://www.eatg.org/?post_type=news&p=4937 Washington, D.C., May 23, 2017 — Friends of the Global Fight Against AIDS, Tuberculosis and Malaria (Friends) expresses serious concerns about the Trump Administration’s proposed cuts of $225 million to the Global Fund under the FY 2018 budget plan shared today, and calls for Congress to honor the U.S. pledge to the Global Fund with an appropriation of $1.35 billion. Friends is also alarmed by the proposed 32 percent cut to U.S. foreign assistance, including cuts to other global health programs such as the President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI) and USAID’s TB program.

Global health investments benefit the U.S. by supporting economic growth and trade worldwide, protecting the U.S. from infectious disease threats which know no borders, and strengthening U.S. diplomatic relations – eliciting greater collaboration from partner nations on all issues.

“These proposed cuts to the Global Fund and the broader foreign assistance account, which currently comprises less than one percent of the U.S. federal budget, would be devastating to the health and safety of millions of people around the world, including U.S. citizens,” said Chris Collins, President of Friends. “U.S. investments in the Global Fund yield huge impact and leverage other donor contributions. The U.S. must not abandon its leadership on global health, squandering the opportunity to save lives and end epidemics.”

The Global Fund calculates that a cut of $225 million would translate to:

  • 299,250 fewer lives saved through Global Fund-supported programs
  • Loss of potential to prevent 4.28 million new HIV, tuberculosis (TB) and malaria infections
  • 240,750 fewer people put on antiretroviral therapy
  • 69,750 fewer women on treatment to prevent passing HIV to their babies
  • 344,250 fewer people on TB treatment and care
  • 9,675 fewer people on treatment for multidrug-resistant TB
  • Nearly 14 million fewer mosquito nets distributed to protect children and families from malaria
  • 2.7 million fewer households receiving indoor residual spraying to protect children and families from malaria
  • A lost opportunity to leverage $675 million in domestic investment toward fighting AIDS, TB and malaria
  • A lost opportunity to spur $4.95 billion in long-term economic gains

U.S. support to the Global Fund leverages additional investments from across the globe by requiring a two-thirds match from other donors worldwide. For every $1 the U.S. invests in the Global Fund, other countries and private sector partners must invest $2 more. This approach is working – in tandem with U.S. leadership, Japan increased its latest three-year pledge by 46 percent, the U.K. by 38 percent, Germany by 33 percent, and the European Union by 28 percent. In addition, every Global Fund grant contains an at least 15 percent co-financing requirement for domestic resources, enabling U.S. support to leverage increases in domestic financing, sustainability and shared responsibility for health programs by implementing countries. This has led to these countries committing an additional $6 billion in domestic financing to their health programs for the 2015-2017 period.

Republican and Democratic policymakers have agreed that, together, investments in public-private partnerships like the Global Fund and U.S. bilateral global health programs are among our greatest foreign policy successes.

“Thanks largely to American leadership through the Global Fund and U.S. programs, we have reached a tipping point in efforts to end the epidemics of AIDS, TB and malaria,” said Jonathan Klein, Board Chair of Friends and Co-founder and Chairman of Getty Images. “But if the U.S. does not continue steady support of these lifesaving efforts, we will live with the devastating impact of these diseases for many years to come. We implore our friends in Congress to act now to save lives.”

FRIENDS OF THE GLOBAL FIGHT AGAINST AIDS, TUBERCULOSIS AND MALARIA

Friends of the Global Fight Against AIDS, Tuberculosis and Malaria advocates for U.S. support of the Global Fund, and the goal to end the epidemics of AIDS, tuberculosis and malaria. For more information about Friends of the Global Fight, visit www.theglobalfight.org.

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Fighting multidrug-resistant TB in Georgia http://www.eatg.org/news/fighting-multidrug-resistant-tb-in-georgia/ Thu, 25 May 2017 10:54:26 +0000 http://www.eatg.org/?post_type=news&p=4935

Institute of Tropical Medicine Antwerp and others to assist the government of Georgia in developing a provider incentive payment scheme for TB.

Georgia is currently facing a problem of a high incidence of tuberculosis (TB) and relatively low treatment success rates. Many patients are not followed up properly which contributes to high levels of multidrug-resistant TB: 12 % of new patients are resistant to first line drugs. The health system underwent a number of dramatic reforms in 2003 and 2007, leading to a full-scale privatisation and deregulation of the health sector. Virtually all aspects of tuberculosis care and prevention are the responsibility of private-for-profit providers, for whom the long treatments that TB patients require are not necessarily a priority. Policymakers intend to use results-based financing (RBF) to stimulate the private actors to better engage with TB care.

Results4TB, a new 48-month research project carried out by teams from the Institute of Tropical Medicine Antwerp (Belgium), the Curatio International Foundation (Georgia), Queen Margaret University (UK) and the London School of Hygiene and Tropical Medicine (UK) will assist the government of Georgia in developing a provider incentive payment scheme for tuberculosis. It will generate evidence on its effects on adherence and treatment success rates and costs, and the conditions of success of the scheme.

“Tracing the introduction of a new policy presents a number of challenges in itself”, said professor Bruno Marchal, head of the research team at ITM, “but even more so when we need to find out how it works while it is being implemented. After all, this policy to motivate providers seems simple, but it intervenes in a complex health system. To assess whether it works and in which conditions, Results4TB brings together a unique skill set”. The project will produce methodological innovation regarding the use of realist evaluation alongside cost-effectiveness analysis and impact evaluation. Ariadna Nebot and professor Marchal from the Unit of Health Systems Organisation at ITM’s Department of Public Health will contribute to designing the theory-informed intervention and will guide its realist evaluation component.

In the framework of the project, policymakers, TB programme managers, providers, representatives of the Global Fund and other actors met with researchers in Telavi, Georgia in May to analyse the country’s approach to TB care. This initial engagement with key stakeholders will be followed by a second workshop in July to inform the design of the intervention, which will be piloted at the end of this year.

The Results4TB project (“Designing and evaluating provider results-based financing for tuberculosis care in Georgia: understanding costs, mechanisms of effect and impact”) is funded by the Department of International Development (DFID), the Economic and Social Research Council (ESRC), the Medical Research Council (MRC) and the Wellcome Trust.

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TAG condemns murderous White House-proposed 2018 budget cuts for health and research http://www.eatg.org/news/tag-condemns-murderous-white-house-proposed-2018-budget-cuts-for-health-and-research/ Wed, 24 May 2017 21:55:08 +0000 http://www.eatg.org/?post_type=news&p=4924 New York, NY, May 24, 2017 – The full disclosure of President Trump’s FY18 budget yesterday reaffirms the current administration’s intention of scaling-back critical progress in programs and research made in the fight against HIV/AIDS, TB, HCV, and other domestic and global health issues. Treatment Action Group (TAG), alongside many partner organizations, calls on all members of Congress to immediately ensure these proposed cuts are dead on arrival.

In presenting the budget earlier yesterday morning, Mick Mulvaney, Director of the White House Office of Management of Budget (OMB), contended that cuts and reductions made across agencies such as the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Science Foundation (NSF), and others were not to be deemed as “anti-science.” Yet the net effect of the full budget proposal on promising scientific research and programs undertaken and supported by these agencies tells a much different story.

“Another way of continuing to blatantly undercut the value of science is to defund science and programs that implement the fruits of our investments,” says Mark Harrington, Executive Director of TAG. “While the Trump administration continues to value massive tax cuts on the rich, the true costs will be the loss of health, lives, jobs, scientific breakthroughs and, the future of the human race.”

In addition to virtually destroying Medicaid and throwing millions out of health care through the American Health Care Act (AHCA), some of the deadliest and most dangerous of the President’s proposed budget cuts include:

Research and HIV:

  • A 20% ($8 billion annual) reduction to research at NIH;
  • The entire elimination of the Fogarty International Center, critical in training scientists in HIV and TB research from around the world to combat global health threats;
  • A 20% funding cut to CDC-funded HIV prevention programs;
  • $59 million in cuts to the Ryan White Program made through the elimination of Part F and Special Projects of National Significance (SPNS).
  • Elimination of the Secretary of Health and Human Services Minority HIV/AIDS Initiative (MAI)
  • Trimming $700 million from PEPFAR and $225 from the Global Fund to Fight AIDS, Tuberculosis and Malaria, The New York Times estimates these cuts will cost a million lives;
  • Eliminating funding for global health commitments to International AIDS Vaccine Initiative (IAVI) and advancing microbicides research.

Tuberculosis:

  • Reducing the CDC’s Division of TB Elimination (DTBE) budget by $12 million after years of success in contributing to declining TB rates domestically and promising research being done by the TB Trials Consortium (TBTC).
  • A $62.2 million slash to global TB programs at USAID, during a time where TB is currently the number one global infectious killer;
  • Eroding the budget of the Global TB Drug Facility (GDF), a critical lifeline to treatment access worldwide. 

Viral Hepatitis:

  • Stagnation of CDC hepatitis prevention efforts at $34 million, despite the recent tripling of new hepatitis C virus (HCV) cases linked with the explosively out-of-control opioid epidemic;
  • Continuing to limit the use of federal funding to purchase syringes, which prevent transmission of HIV and viral hepatitis and are a vital approach to ending these epidemics.

“Trump’s budget agenda continues to target research and programs that have proven to save lives, while bringing in substantial savings through prevention and expanding access to treatment,” said Tim Horn, Deputy Executive Director of HIV and HCV Programs. He added, “We cannot let this budget slide by or negotiate away decades of progress built by activists and researchers in our movement. The time to act is now.”

 

Additional information:

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MPP video: Working together for better treatment options http://www.eatg.org/news/mpp-video-working-together-for-better-treatment-options/ Wed, 24 May 2017 21:40:43 +0000 http://www.eatg.org/?post_type=news&p=4931 The Medicines Patent Pool (MPP) released a short film, in which MPP’s stakeholders from industry, government, civil society and patient groups discuss the foundation’s innovative business model, achievements and future plans to increase access to HIV, hepatitis C and TB treatment within the context of the UN Sustainable Development Goals.

To watch the video, click here.

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Population implications of the use of bedaquiline in people with XDR-TB: are fears of resistance justified? http://www.eatg.org/news/population-implications-of-the-use-of-bedaquiline-in-people-with-extensively-drug-resistant-tb-are-fears-of-resistance-justified/ Tue, 23 May 2017 19:20:35 +0000 http://www.eatg.org/?post_type=news&p=4885 Global rollout of the new antituberculosis drug bedaquiline has been slow, in part reflecting concerns about spread of bedaquiline resistance. Acquired resistance to bedaquiline is especially likely in patients with extensively drug-resistant tuberculosis (XDR-TB). However, the very high mortality rates of patients with XDR-TB not receiving bedaquiline, and promising cohort study results, suggest these patients also have greatest need for the drug.

In a Personal View published in The Lancet Infectious Diseases, Amber Kunkel, Jennifer Furin and Ted Cohen argue that resistance concerns should not forestall use of bedaquiline in patients with XDR-TB. Their position in favour of increased access to bedaquiline for these patients is based on three arguments. First, the use of drug combinations that include bedaquiline might prevent spread of XDR disease to others in the community. Second, until new combination regimens of novel drugs for XDR-TB become available, patients with XDR disease and their infected contacts will face equivalent outcomes if bedaquiline is either not provided because of policy, or not effective because of resistance. Finally, because resistance to bedaquiline and other antituberculosis drugs is caused by mutations within a single bacterial chromosome, use of bedaquiline in patients with XDR-TB will not substantially increase the risk of bedaquiline resistance in patients with drug-susceptible or multidrug-resistant (non‑XDR) tuberculosis strains.

 

Download the full Personal View here:

Population implications of the use of bedaquiline in people with extensively drug-resistant TB: are fears of resistance justified?

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Directly observed therapy for MDR-TB decreases mortality http://www.eatg.org/news/directly-observed-therapy-for-multidrug-resistant-tb-decreases-mortality/ Tue, 23 May 2017 12:11:02 +0000 http://www.eatg.org/?post_type=news&p=4883

ATS 2017, WASHINGTON, DC ─ Directly observed therapy (DOT) for multidrug-resistant tuberculosis (MDR-TB) was associated with a 77 percent decrease in mortality in the United States, compared to self-administered therapy from 1993 to 2013, according to new research presented at the ATS 2017 International Conference.

DOT is a strategy to ensure that people with TB adhere to a long and challenging drug regimen by having someone observe and record the taking of all medicines. MDR-TB is resistant to at least isoniazid and rifampin, two of the main therapeutic agents used to treat TB.

“Directly observed therapy is already recommended to treat all forms of TB, but it’s valuable to have this data on the effectiveness among patients with MDR-TB,” said Jorge Salinas, MD, lead study author and epidemic intelligence service officer in the Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination. “We wanted to assess whether the strategy influenced mortality in MDR-TB patients.”

The researchers analyzed data from 1993-2013 for 3,434 MDR TB patients, 709 of whom died during the follow-up period. The proportion of patients on DOT increased from 74 percent during 1993-2002 to 95 percent during 2002-2013.

Among MDR-TB patients in the study:

  • 34 percent were infected with HIV.
  • 18 percent had a previous diagnosis of TB disease.
  • 17 percent had an additional drug resistance.
  • 88 percent were born in either an Asian or Hispanic country.

The study adjusted mortality findings for these and other characteristics and found that across all demographic and clinical groups those who underwent DOT had significantly lower mortality.

“This protective effect may come from DOT alone or from other patient-centered measures, such as transportation assistance or food stamps given along with DOT by TB treatment facilities to improve treatment adherence,” Dr. Salinas said. “The findings reinforce that all patients with MDR-TB should receive DOT and other patient-centered measures to ensure patients complete their treatment.”

 

Abstract 5304

Factors Associated with Mortality Among Patients with Multidrug-Resistant Tuberculosis─United States, 1993-2013

Authors: J.L. Salinas, L.R. Armstrong, J.P. Cegielski, M.B. Haddad, B.J. Silk; Centers for Disease Control and Prevention – Atlanta, GA/US

Background: Multidrug-resistant tuberculosis (MDR-TB) is diagnosed when the patient’s Mycobacterium tuberculosis isolate is resistant to at least isoniazid and rifampin. Completing treatment reduces mortality and prevents TB recurrence and transmission to others. Although directly observed therapy (DOT) is standard care for ensuring treatment completion, some patients’ therapy is self-administered. In a large cohort of U.S. MDR-TB patients, we examined patient and clinical characteristics and treatment administration mode in association with mortality over time.

Methods: We analyzed surveillance data for MDR-TB patients treated in the United States during 1993–2013. We used Cox proportional hazards models to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) for the association of treatment administration mode (DOT versus self-administered therapy) with all-cause mortality during TB treatment, accounting for age (per 5-year increments), sex, race/ethnicity, HIV infection, previous TB disease, site of disease (i.e., pulmonary versus extrapulmonary), and additional drug resistance (i.e., resistance to at least one fluoroquinolone or a second-line injectable drug). Stratified models were also fit for origin (U.S.-born or foreign-born) and period of treatment (1993–2002 or 2003–2013).

Results: Among 3,434 MDR-TB patients, 709 (21%) died during TB treatment. Most patients were foreign-born of Asian (50%) or Hispanic (33%) race/ethnicity. Among those with available data, 710 (34%) had HIV infection reported, 606 (18%) had previous TB disease, and 577 (17%) had additional drug resistance. DOT increased from 74% during 1993–2002 to 95% during 2002–2013; all-cause mortality decreased from 31% to 11% during these periods. Older age (aHR: 1.15; 95% CI: 1.11–1.20) and reported HIV infection (aHR: 7.11; 95% CI: 5.46–9.24) were risk factors for all-cause mortality irrespective of patient’s origin or period of treatment. Receiving DOT (aHR: 0.23; 95% CI: 0.19–0.28) was protective in all stratified models.

Conclusions: In the United States, all-cause mortality during treatment has declined among patients with MDR-TB. DOT coverage has increased and remained protective over time against all-cause mortality, after adjusting for demographic and clinical characteristics known to be associated with mortality. A continued emphasis on maximizing DOT coverage can help reduce all-cause mortality.

 

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Readily available antibiotic could help to curb lung damage from TB http://www.eatg.org/news/readily-available-antibiotic-could-help-to-curb-lung-damage-from-tb/ Tue, 23 May 2017 12:09:22 +0000 http://www.eatg.org/?post_type=news&p=4904

Imperial scientists have found how a common antibiotic could help reduce lung destruction in people with Tuberculosis (TB).

TB is a leading cause of mortality worldwide, causing 1.8 million deaths in 2015 and infecting one in three people globally, with or without symptoms.

Left untreated, the disease can cause massive tissue damage in the lungs, leading to a contagious cough and eventual death.

People with HIV, whose immune systems are suppressed, are at increased risk of infection, as are those with diabetes, poor nutrition, and alcoholism.

Although effective, current antibiotics for TB take at least six months to clear the infection. They can also interact with anti-retroviral drugs used to treat HIV, causing a condition known as TB-IRIS which over-activates the immune system, causing further lung damage.

Now, a group of researchers from Imperial College London, University of Cape Town, London School of Hygiene and Tropical Medicine (LSHTM) and University of Southampton, led by Dr Naomi Walker from LSHTM and Imperial’s Department of Medicine, has found differences in immune responses between TB patients with and without HIV that could enable existing treatments to be used more effectively to treat TB.

They tested the phlegm, or sputum, of 210 patients in Cape Town, South Africa, for levels of enzymes called matrix metalloproteinases (MMPs), and found that the TB patients who were most infectious with worse lung damage tended to have the highest MMP levels, suggesting that MMP activity is linked to lung damage. HIV-infected TB patients, who tended to have milder lung damage and were less infectious, had lower MMP levels.

MMPs are known to digest collagen, a major structural protein in the body which helps to keep lung’s structure intact. However, a readily-available and relatively cheap antibiotic, called doxycycline, can inhibit the enzymes, which could help to reduce lung damage.

After creating a 3D model of TB infection that mimicked human lung infection in the laboratory, the authors then investigated whether they could prevent lung destruction by reducing MMP activity using doxycycline. They found in the laboratory model that doxycycline did indeed reduce the level of destruction in TB infected lung tissue.

The authors say that this means the now-probable link between MMP activity and lung destruction could potentially be targeted by doxycycline in humans, and lead to more treatment options for treating TB in the future.

Potential new treatments

Dr Walker said: “Our study paves the way for a clinical trial using doxycycline for TB. We have known for decades that, although TB patients with HIV do become very unwell, they don’t tend to suffer lung destruction as often as TB patients without HIV. From researching the mechanisms behind this, we now have a new potential drug target and a widely available, relatively cheap drug with which to take this forward.”

Dr Walker added: “Our findings may also help to diagnose those patients most at risk of lung damage for targeted treatment. However, although higher MMP levels and severe TB lung damage appear related at this stage, we have not proven that one causes the other. We also cannot say until it is tested on humans whether this will help to treat TB patients.”

“We are at an exciting stage in our research where we can put our findings to the test and hopefully help to reduce TB’s destructiveness in the future,” she said.

This research was funded by the Wellcome Trust.

Matrix Degradation in Human Immunodeficiency Virus Type 1–Associated Tuberculosis and Tuberculosis Immune Reconstitution Inflammatory Syndrome: A Prospective Observational Study” by Naomi F. Walker  Katalin A. Wilkinson  Graeme Meintjes  Liku B. Tezera  Rene Goliath Janique M. Peyper  Rebecca Tadokera  Charles Opondo  Anna K. Coussens  Robert J. Wilkinson Jon S. Friedland  Paul T. Elkington, published 5 May 2017 in Clinical Infectious Diseases.

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Time for action on antimicrobial resistance and TB http://www.eatg.org/news/time-for-action-on-antimicrobial-resistance-and-tb/ Mon, 22 May 2017 20:44:34 +0000 http://www.eatg.org/?post_type=news&p=4871 First G20 Ministers of Health Meeting in Berlin recognizes TB as a priority under antimicrobial resistance.

22 May 2017 – Geneva, Switzerland – The world is finally acknowledging the fact that TB claims the lives of 1.8 million people worldwide every year, and that 30% of all deaths related to antimicrobial resistance (AMR) are caused by drug-resistant TB globally. Ministers of health of the Group of Twenty (G20) member countries met for the first time in Berlin, Germany on 19 and 20 May to discuss a coordinated global response to global health challenges. The meeting paved the way for the adoption of an ambitious declaration on global health, that recognized TB and as a priority under AMR in paragraphs 23, 30 and 31. In paragraph 32, the Stop TB Partnership was recognized as an important partner, with the Declaration also welcoming the decision by Member States to hold a WHO Ministerial Meeting on TB in November 2017 and a UN High Level Meeting on TB in 2018.

Paragraph 32 reads: We recognise drug-resistant tuberculosis as an important threat and therefore commit to address tuberculosis within interventions for AMR. We acknowledge the need to develop and promote access to new drugs, diagnostics and vaccines to tackle drug-resistant tuberculosis consistent with the WHO End TB Strategy. We recognize the importance of other relevant initiatives and plans, such as the STOP TB Partnership. We welcome the decision by Member States to hold a United Nations High Level Meeting on Tuberculosis in 2018 and the WHO Ministerial Conference on Ending TB in the Sustainable Development Era to be held in Moscow in November 2017.

On Sunday 21 May, in line with the adoption of the Declaration and on the eve of the 70th World Health Assembly, the Stop TB Partnership and Unitaid organized a high-level event which focused on tackling AMR through innovation. Unitaid launched a new Call for Proposals with the aim of attracting smart ideas to accelerate access to innovative treatment regimens and diagnostics for tackling multidrug-resistant TB (MDR-TB). Existing treatments for MDR-TB are long, toxic, with often severe side effects, such as acute psychosis and deafness.

“Given the lingering threat of MDR-TB, we need to develop shorter, simpler, less toxic treatments to effectively tackle it. Unitaid is already investing US$ 60 million to speed up access to new drugs and test their efficacy in resource-limited settings.” said Lelio Marmora, Unitaid Executive Director.

Recently, the World Health Organization (WHO) recommended a shorter regimen for MDR-TB treatment, lasting 9 to 12 months, with 4 to 6 months of injectable drugs. Patients not eligible for the shorter regimen continue to require 18 to 24 months of treatment, including 8 months of injectable drugs. Currently, the range of treatment options fragments the market for drug-resistant TB, reducing the commercial incentive for innovation and development.

Under this Call, Unitaid aims to speed up the development and adoption of new treatment regimens for MDR-TB linked to simpler and faster TB testing, address market challenges and create the evidence needed to inform WHO guidelines.

“The current available medicines for MDR-TB are a challenge, in any ways you look at it: terrifying side effects including irreversible hearing loss and depression, huge costs – financial and human suffering and death. Therefore, none of us should spare any efforts to ensure that we have the shortest, most efficient and affordable treatment and to make it accessible to all. Drug-resistant TB must be fought with the right tools and we just don’t have them now. Pushing the research and development (R&D) TB agenda together with the AMR conversation gives me a lot of hope” said Dr Lucica Ditiu, Executive Director of the Stop TB Partnership.

The G20 Health Ministers underscored the need to “reinvigorate research and development in science and industry for antimicrobials” at their meeting in Berlin yesterday and highlighted the importance of investments made by Unitaid and other health partners in the fight against AMR.

Read the Unitaid Call for Proposals here.

 

See also:

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ITPCru poster: TB treatment http://www.eatg.org/news/itpcru-poster-tb-treatment/ Mon, 22 May 2017 20:20:37 +0000 http://www.eatg.org/?post_type=news&p=4858 ITPCru has developed a poster on TB treatment. It is based on the World Health Organization (WHO) guidelines 2010 with taking into account the April 2017 updates.

The poster contains 4 main blocks:

  1. general information about TB
  2. TB treatment recommendations
  3. HIV/TB co-infection and
  4. TB drugs

The poster has been developed for informational purposes to improve patients’ and TB activists’ literacy in regards to international standards of TB treatment.

The poster is available in English, Russian and Ukrainian languages:

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EATG Tuberculosis Team met Belgian Senate http://www.eatg.org/news/eatg-tuberculosis-team-met-belgian-senate/ Wed, 17 May 2017 21:59:36 +0000 http://www.eatg.org/?post_type=news&p=4779 IMG_20170515_104810_HDR

 

On May 15, EATG and TBpeople, EECA network of people with tuberculosis with support from the Stop TB Partnership, convened a meeting at the Belgian Senate to raise political awareness to the needs around the TB and TB/HIV epidemics. The meeting contributed to the discussion on patients’ perspectives on what should be done to end TB, including reaching targets in the Global Plan to End TB, World Health Organization End TB Strategy, and Sustainable Development Goals.


To build on the commitments made in the Parliamentarians’ Barcelona Declaration on TB, the meeting was attend by Senators Mr. Brotchi and Mr. Kanfaoui, members of the Parliament of the Brussels Capital Region, Ministry of Health, the Service of Infectious Diseases, and by our Belgian colleagues from the Damien Foundation and the Belgian Lung and Tuberculosis Association. 


Mr. Kanfaoui highlighted issues around the growing number of HIV/TB cases in Europe in recent years, and multi-drug resistant tuberculosis (MDR-TB) in Eastern Europe and Central Asia, and the need for joint actions. A working group will be established for further follow up of the meeting action points. The meeting will promote the need to further invest in clinical research and address issues related to (MDR-TB).


With priority focuses on the need for investment in R&D and partnership with community and civil society, EATG and TBCAB provided information of key challenges for patients in Western and Eastern Europe, and in Central Asia. The proposed solutions include the registration and use of new diagnostic tools and medicines, patient-centered care and access to social benefits and nutrition, and working with patients to establish recognized networks of people with TB.
Given the role the Belgian scientists of the Institute of Tropical Medicine in Antwerp played in moving towards ending TB, such as research on bedaquiline, the newest drug to treat MDR-TB, and doctors from the Belgian Damien Foundation, who, together with the Insitute and other partners, have worked towards introduction of short 9-month regimen, Belgium should continue playing a role for an increased commitment to look cross (EU) border and support initiatives that address the needs in neighboring countries to the EU.

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MSF open letter to G20 Health Ministers highlights 3 global health priority areas http://www.eatg.org/news/msf-open-letter-to-g20-health-ministers-highlights-3-global-health-priority-areas/ Wed, 17 May 2017 21:40:00 +0000 http://www.eatg.org/?post_type=news&p=4805 Médecins Sans Frontières: Open letter from MSF to the Meeting of the G20 Health Ministers

In an open letter to the health ministers of the G20, Joanne Liu, president of MSF International, writes, “Every day in our medical operations, Médecins Sans Frontières (MSF) faces numerous barriers to providing medical care and dignity to people in need. We therefore welcome the decision of the G20 to place ‘Global Health’ on its agenda. … We believe the G20 states should pay particular attention to three priority areas. … Attacks on medical facilities … Emergency preparedness and response … Antimicrobial resistance and drug-resistant tuberculosis”.

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Aidspan publishes new issue of ‘Global Fund Observer’ http://www.eatg.org/news/aidspan-publishes-new-issue-of-global-fund-observer-22/ Wed, 17 May 2017 20:02:03 +0000 http://www.eatg.org/?post_type=news&p=4803 Aidspan: Global Fund Observer

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, published Issue 312 of the “Global Fund Observer.” The newsletter features articles on various topics, including an article on an audit of the Global Fund’s in-country supply chain processes; an article on the launch of an e-learning portal for Russian-speaking civil society organizations responding to HIV and TB epidemics; and an announcement that the Global Fund and Pink Ribbon Red Ribbon will collaborate on programming to prevent cervical cancer.

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