Warning signals from the volatile world of influenza viruses

The current global influenza situation is characterized by a number of trends that must be closely monitored. These include: an increase in the variety of animal influenza viruses co-circulating and exchanging genetic material, giving rise to novel strains; continuing cases of human H7N9 infections in China; and a recent spurt of human H5N1 cases in Egypt. Changes in the H3N2 seasonal influenza viruses, which have affected the protection conferred by the current vaccine, are also of particular concern.
Viruses in wild and domestic birds

The diversity and geographical distribution of influenza viruses currently circulating in wild and domestic birds are unprecedented since the advent of modern tools for virus detection and characterization. The world needs to be concerned.

Viruses of the H5 and H7 subtypes are of greatest concern, as they can rapidly mutate from a form that causes mild symptoms in birds to one that causes severe illness and death in poultry populations, resulting in devastating outbreaks and enormous losses to the poultry industry and to the livelihoods of farmers.

Since the start of 2014, the Organisation for Animal Health, or OIE, has been notified of 41 H5 and H7 outbreaks in birds involving 7 different viruses in 20 countries in Africa, the Americas, Asia, Australia, Europe, and the Middle East. Several are novel viruses that have emerged and spread in wild birds or poultry only in the past few years.

Some of the outbreaks notified to OIE have involved wild birds only. Such notifications are indicative of the heightened surveillance and improved laboratory detection that have followed the massive outbreaks of highly pathogenic H5N1 avian influenza that began in Asia in late 2003.

Detection of highly pathogenic avian influenza viruses in wild birds signals the need for a close watch over poultry farms. Migratory waterfowl, immune to the disease, are known to spread avian viruses to new areas by quickly crossing continents along the routes of several flyways. These migratory waterfowl subsequently mix with local wild birds and poultry that then become infected.
H7N9: no change in the epidemiology of human infections

The world’s first three human cases of infection with the H7N9 avian influenza viruses were reported by China on 31 March 2013. Investigations by Chinese authorities determined that the earliest likely cases had symptom onset in mid-February. That event also marked the first time that this H7N9 subtype had been detected in humans, poultry or any other animals.

To date, 602 human H7N9 cases and 227 deaths have been reported, the vast majority in mainland China. This total includes 4 cases reported by the Taipei Centers for Disease Control and 13 cases reported by the Centre for Health Protection, Hong Kong SAR, China. Malaysia reported one case in a Chinese traveller in 2014, and Canada reported two mild cases in travellers returning from China in January 2015.

The epidemiological pattern seen during 2013 showed a sharp spike in cases in March and April followed by only two cases reported during the summer. The official closing of live poultry markets in several provinces in April may have contributed to this decline. A second wave of infections began more slowly in October.

A similar pattern of seasonality was seen during 2014, but with a higher and earlier spike in January and more cases reported during the spring compared with 2013. Again, cases virtually ceased over the summer, then gradually increased in November. Cases increased in January 2015, but not as sharply as seen during the same month in 2014.

Like H5N1, the H7N9 virus causes serious illness in humans. But unlike H5N1, H7N9 does not cause illness or deaths in birds. The absence of signs of disease in infected birds omits the warning signal calling for heightened surveillance for human cases. Consequently, the detection of human cases has triggered a search for the virus in birds.

As observed, a substantial proportion of human cases have reported direct exposure to live poultry or contaminated environments, including live poultry markets. In addition, careful studies have shown that exposure to live poultry and poultry markets are risk factors for H7N9 infection.

All evidence indicates that the H7N9 virus does not spread easily from one person to another, though it may transmit from poultry to humans more readily than H5N1.

In a few small clusters of human cases, the possibility of limited human-to-human transmission cannot be excluded. However, all possible transmission chains have been short, with no evidence of spread into the wider community.

Approximately 36% of reported human cases have been fatal. It is not yet known whether significant numbers of asymptomatic or mild cases also are occurring without being detected. The existence of asymptomatic and mild cases would lower the percentage of people who died from this infection.
H5 viruses: currently the most obvious threat to health

The highly pathogenic H5N1 avian influenza virus, which has been causing poultry outbreaks in Asia almost continuously since 2003 and is now endemic in several countries, remains the animal influenza virus of greatest concern for human health. From end-2003 through January 2015, 777 laboratory-confirmed human cases of H5N1 virus infection have been reported to WHO from 16 countries. Of these cases, 428 (55.1%) have been fatal.

Over the past two years, H5N1 has been joined by newly detected H5N2, H5N3, H5N6, and H5N8 strains, all of which are currently circulating in different parts of the world. In China, H5N1, H5N2, H5N6, and H5N8 are currently co-circulating in birds together with H7N9 and H9N2.

The H9N2 virus has been an important addition to this mix, as it served as the “donor” of internal genes for the H5N1 and H7N9 viruses. Over the past four months, two human infections with H9N2 occurred in China. Both infections were mild and the patients fully recovered.

Virologists interpret the recent proliferation of emerging viruses as a sign that co-circulating influenza viruses are rapidly exchanging genetic material to form novel strains. Viruses of the H5 subtype have shown a strong ability to contribute to these so-called “reassortment” events.

The genomes of influenza viruses are neatly segmented into eight separate genes that can be shuffled like playing cards when a bird or mammal is co-infected with different viruses. With 18 HA (haemagluttinin) and 11 NA (neuraminidase) subtypes known, influenza viruses can constantly reinvent themselves in a dazzling array of possible combinations. This appears to be happening now at an accelerated pace.

For example, H5N2 viruses recently detected in poultry in Canada and in wild birds in the US are genetically different from H5N1 viruses circulating in Asia. These viruses have a mix of genes from a Eurasian H5N8 virus, likely introduced into the Pacific Flyway in late 2014, along with genes from North American influenza viruses.

Little is known about the potential of these novel viruses to infect humans, but some isolated human infections have been detected. For example, the highly pathogenic H5N6 virus, a novel reassortant, was first detected at a poultry market in China in March 2014. The Lao People’s Democratic Republic reported its first outbreak in poultry, also in March, followed by Viet Nam in April. Genetic studies showed that the H5N6 virus resulted through exchange of genes from H5N1 viruses and H6N6 viruses that had been widely circulating in ducks.

China detected the world’s first human infection with H5N6, which was fatal, in April 2014, followed by a second severe human infection in December 2014. On 9 February 2015, a third human H5N6 infection, which was fatal, was reported.

The emergence of so many novel viruses has created a diverse virus gene pool made especially volatile by the propensity of H5 and H9N2 viruses to exchange genes with other viruses. The consequences for animal and human health are unpredictable yet potentially ominous.
H5N1 infections in Egypt

The sudden increase in the number of H5N1 human infections in Egypt that began in November 2014 and continued during January and February 2015 awakened concern. From the start of November to 23 February, Egypt reported 108 human cases and 35 deaths. The number of cases over this period is larger than yearly totals reported by any country since human H5N1 virus infections re-emerged in late 2003.

According to FAO, a total of 76 outbreaks of highly pathogenic H5N1 avian influenza were detected in 20 of Egypt’s 27 governorates between 18 January and 7 February 2015. Of these outbreaks, the majority – 66 – occurred in household poultry.

Although all influenza viruses evolve over time, preliminary laboratory investigation has not detected major genetic changes in the viruses isolated from patients or animals compared to previously circulating isolates that would help to explain the sudden increase in human cases.

Health and agricultural officials in Egypt have extensive experience with this disease. In their view, more widespread circulation of H5N1 in poultry during this time, combined with the large number of households that keep small flocks with poor understanding of the associated health risks, is the most likely explanation for this spurt in new cases.

This observation, in turn, signals an urgent need for agricultural investigations to identify, and reduce, the source of this heavy viral contamination. A second motivation is the very real risk that poultry trade, whether legal or illegal, will introduce the virus to new countries. The detection of cases with moderate illness suggests that surveillance on the human side is reasonably good.

On 10 February, Egyptian authorities notified WHO of a case of H9N2 infection in a three-year-old boy. The illness was mild and the boy was discharged from hospital fully recovered. However, the fact that H9N2 is co-circulating with H5N1 is cause for concern.
Reduced vaccine protection against seasonal influenza

Experts convened by WHO decide on the composition of seasonal influenza vaccines for the northern hemisphere in February of each year. Doing so gives manufacturers sufficient time to have doses of vaccines ready before the start of the flu season, usually in October or November.

Since February 2014, the genetic make-up and antigenic properties of the H3N2 virus, the predominant seasonal virus circulating in North America and Europe, changed significantly. This change allowed most of the viruses circulating in the flu season to elude protection provided by the vaccine which was designed for an older virus with distinctly different characteristics.

As a result, interim estimates of the effectiveness of the current seasonal vaccine in reducing the risk of medical visits associated with influenza infection – in all age groups – was only 23% in the US. This is lower protection than usual but is not unexpected for seasons when there is a significant rapid change in the properties of circulating viruses. Seasons where there is a significant reduction in seasonal vaccine protection due to the rapid and unpredictable evolution of influenza A viruses are relatively rare with only four seasons during the past 25 years.

Since the 2004–2005 influenza season, US researchers have produced annual estimates of vaccine effectiveness. Estimated vaccine effectiveness in the US has ranged from 10% to 60%, with effectiveness in most years being 40-60%. This calls for better vaccines.
The state of global preparedness for an influenza pandemic

On many levels, the world is better prepared for an influenza pandemic than ever before.

The level of alert is high, supported by elevated virological surveillance in both human and animal populations. For example, during 2014, the 142 laboratories in 112 countries in the WHO Global Influenza Surveillance and Response System tested more than 1.9 million clinical specimens. By keeping a close watch over the volatile world of influenza viruses, these laboratories operate as a sensitive early warning system for the detection of viruses with pandemic potential.

More national laboratories are now equipped, staffed, and trained to conduct early detection, isolation, and characterization of viruses. Drawing on support from laboratories in the WHO System, WHO offers all interested laboratories – anywhere in the world – free diagnostic reagents and test kits for seasonal viruses and for viruses of the H5 and H7 subtypes.

During the 2009 H1N1 pandemic, WHO and its collaborating laboratories were able to start shipping diagnostic reagent kits in 7 days after the declaration of a public health emergency of international concern. The mechanisms worked out for accomplishing this rapid response will be another asset when the next pandemic inevitably begins.

Countries that have experienced human cases of avian influenza know the disease well and have mechanisms in place to detect cases quickly, track the likely source of infection, and monitor close contacts for symptoms and any evidence of human-to-human transmission.

WHO, through its Global Influenza Surveillance and Response System network, is closely monitoring the emergence and evolution of influenza viruses with pandemic potential, assessing associated risks, and developing candidate vaccine viruses for pandemic preparedness purposes.

Ways are being found to shorten the time between the emergence of a pandemic virus and the availability of safe and effective vaccines. Advances in synthetic vaccine technology mean that candidate vaccine viruses can be produced in about two weeks following detection of a virus with pandemic potential.

Fast-track procedures for regulatory approval have been developed. In Europe, advance studies using “mock-up” vaccines can greatly expedite regulatory approval. These studies use an influenza strain that has not circulated recently in human populations to mimic the novelty of a pandemic virus.

Strengthened surveillance, advances in vaccine production technology, and regulatory preparedness can possibly shorten the time lapse between the detection of a pandemic virus and the availability of vaccines to 3–4 months. With WHO support, more low- and middle-income countries now have facilities for manufacturing vaccines. According to a recent estimate, the maximum annual global manufacturing capacity has risen to 1.5 billion doses of seasonal influenza vaccines and the potential of 6.2 billion doses in the event of a pandemic.

Safety and immunogenicity data on pandemic vaccines are now substantial. These data draw on more than 130 clinical trials of H5 vaccines and vaccines combining protection against H5 with protection against seasonal influenza.

More antiviral medicines, including peramivir and laninamivir as well as oseltamivir and zanamivir, are now available to treat influenza and reduce the duration and severity of infection.

The WHO Pandemic Influenza Preparedness framework, which came into effect in May 2011, provides mechanisms for ensuring that the information and benefits that accrue from sharing influenza viruses and biological materials are fairly distributed, as expressed through increased access of developing countries to vaccines and other medical products needed during a pandemic. The framework includes provisions for manufacturers to share a fixed proportion of their pandemic vaccines with WHO as these vaccines roll off the production line.

In the final analysis, as was shown during the 2009 H1N1 pandemic, the overall response of health systems, especially in the developing world, will have a major impact on how well available vaccines and other medical interventions can be provided to protect populations during the next pandemic.

Critical capacities needed include adequate storage and delivery channels, an ability to quickly extend services to large numbers of people in all age groups, a well-developed laboratory system, and sufficient numbers of staff and hospital beds. Experience in conducting mass public education campaigns, supported by public confidence in the health system, is another key asset. However, these capacities are lacking in a large number of developing countries.
Warning: be prepared for surprises

Though the world is better prepared for the next pandemic than ever before, it remains highly vulnerable, especially to a pandemic that causes severe disease. Nothing about influenza is predictable, including where the next pandemic might emerge and which virus might be responsible. The world was fortunate that the 2009 pandemic was relatively mild, but such good fortune is no precedent.

WHO and its collaborating laboratories continue to help countries strengthen their alert, surveillance, and response capacities. A quality assurance program has been conducted by WHO since 2007 to maintain global influenza virus laboratory detection capacity, with panels of testing materials being provided free-of-charge to countries once or twice a year. To further capacity building in countries, particularly developing countries, nearly $17 million was provided in 2014 through the Pandemic Influenza Preparedness framework.

Virological research, which has done so much to aid the detection and understanding of novel viruses, assess their pandemic risks, and track their international spread, needs to continue at an accelerated pace.

More R&D is needed to develop better vaccines and shorten the production time. During a severe pandemic, many lives will be lost in the 3 to 4 months needed to produce vaccines.

An influenza pandemic is the most global of infectious disease events currently known. It is in every country’s best interests to prepare for this threat with equally global solidarity.

Culled from http://www.who.int/influenza/publications/warningsignals201502/en/

President Goodluck Ebele Jonathan signs HIV Anti-Discrimination ACT 2014

The President of the Federal Republic of Nigeria, H.E Dr. Goodluck Ebele Jonathan GCFR, has signed the HIV and AIDS Anti-Discrimination ACT 2014, a reflection of Nigeria’s commitment to stopping all forms of stigmatization and discrimination targeted at people living with HIV/ AIDS.

This historical legislation makes provisions for the prevention of HIV-related discrimination and provides for access to healthcare and other services. It also provides for protection of the human rights and dignity of people living with HIV and those affected by AIDS in Nigeria.

The new law is a notable milestone in the fight to end discrimination as well as a source of renewed hope that all acts of discrimination against people living with HIV such as recruitment and termination of employment, denial of access to services including healthcare, education, association and other social services will be quickly reduced and ultimately ended.

Reacting to this news, the Network of People Living with HIV in Nigeria (NEPWHAN) also expressed its joy in the legislation. The National Secretary of the body Mr. Victor Omosehin said “This is a New Year gift from Mr. President to the 3.5 million Nigerians living with HIV. We appreciate this unprecedented development as it is the beginning of the end to stigma and discrimination in Nigeria”

The law is the latest addition to Nigeria’s commitment to end the AIDS epidemic by 2030. During the past four years alone, close to four million pregnant women were tested for HIV and now know their status, while 8.2 million adults in the general population were tested. By 2013, the number of HIV infections had declined by 35% and Nigeria is pursuing efforts to stop new infections altogether. The number of sites providing services to prevent mother-to-child transmission of HIV increased from 675 in 2010 to 5,622 in 2013.

The Government of Nigeria remains fully committed to improving the health of Nigerians and getting to zero new HIV infections, zero AIDS related deaths and zero discrimination. Ultimately, Nigeria will be able to end the AIDS epidemic by 2030.

U.S. Budget Proposal Supports Global Health

President Barack Obama’s budget request for 2016, which includes US$1.1 billion for the Global Fund, provides firm support for strengthening health systems all over the world.

This year’s budget request delivers on President Obama’s 2013 pledge to provide $1 million for every $2 million invested in the Global Fund, and leaves room for increased contributions that can save lives as the Global Fund raises additional donor and domestic funds for improving health.

The U.S. is the leading contributor to the Global Fund, providing approximately one-third of the Global Fund’s resources since it was established in 2002. The U.S. hosted the successful launch of the Global Fund’s Fourth Replenishment in 2013.

The strong partnership between the Global Fund and the U.S., including the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI), has achieved dramatic advances toward defeating HIV, tuberculosis and malaria.

culled from www.globalfund.org

Activist Strategies for Increasing Access to HCV Treatment in Low- and Middle-Income Countries

written by Karyn Kaplan

Liver disease from hepatitis C virus (HCV) is one of the leading causes of death around the world. At least 185 million people have been infected and almost 500,000 people die from it each year. The hope for eradicating HCV has recently gained new momentum: effective treatments reaching a 100 percent cure rate in clinical trials are now available. But unaffordable drug prices and expensive diagnostic tools are keeping HCV cures from the majority of people who need them—those living in low- and middle- income countries (LMICs).

There are many significant barriers to HCV eradication: the lack of accurate epidemiological data, which are necessary for development of policies, programs, and resource allocation; the criminalization of people who inject drugs and the banning of harm reduction programs, which perpetuate ongoing HCV infection; and the absence of global and national political will (with few exceptions) to address the epidemic.

But AIDS activists have developed and implemented successful strategies to overcome similar challenges in addressing the HIV epidemic. From Johannesburg to New York, Río de Janeiro to Bangkok, activist-driven policies have helped more than 10 million people gain access to HIV treatment. Antiretroviral therapy (ART) has saved 4.2 million lives in LMICs—despite the belief among policy makers and world leaders that doing so would be impossible.

While HCV and HIV differ in significant ways (for example, HCV can be cured with short-course treatment, while HIV treatment is lifelong), lessons learned from three decades of AIDS activism are useful for the growing HCV activist movement.

Activist Strategies for Increasing Access to HCV Treatment in Low- and Middle-Income Countries presents a number of key strategies through real-world case studies and shows how strategies used to combat the AIDS epidemic can be—and have been—adapted to increase HCV treatment access.

These strategies are introduced in three sections:

Section One: Laying the Groundwork through Community Organizing

Strategy 1: Framing HCV Treatment and Prevention as Basic Human Rights, Particularly for Injection Drug Users
Strategy 2: Organizing People Living with HCV for Community Education and Mobilization
Strategy 3: Forming Alliances with Local, Regional, and Global Organizations to Influence Policy
Strategy 4: Demanding Global HCV Policies and Funding Streams

Section Two: Overcoming the Cost Barriers to HCV Treatment Access

Strategy 5: Negotiating Lower Prices with Drug Companies
Strategy 6: Challenging Intellectual Property Barriers through Patent Oppositions
Strategy 7: Overriding Patent Barriers through Compulsory Licenses and Parallel Importation

Section Three: Collaborating with Researchers to Build Your Case for HCV Treatment Access

Strategy 8: Using Mathematical Modeling to Predict Cost-Effectiveness and Public Health Benefits of HCV Treatment
Strategy 9: Advocating for Policies and Programs Based on Evidence Provided by Operational Research

Officials flesh out ‘Getting to Zero’ HIV plan

Public health officials, health care providers, and community advocates provided more details and raised more questions about the city’s “Getting to Zero” plan for eliminating new HIV infections at a recent Board of Supervisors Budget and Finance Committee hearing.

Attendees emphasized that funding for the new initiative should not come at the expense of existing HIV services.

Gay supervisors Scott Wiener and David Campos, both of whom have been active in efforts to expand access to pre-exposure prophylaxis, or PrEP, attended the January 21 hearing in lieu of regular committee members Eric Mar and John Avalos.

“We know that if we’re able to get people tested regularly so that they know their status, if when people do become positive they’re immediately connected with treatment, [and] if we are able to keep people consistently on treatment so they’re healthy and have a suppressed viral load, that will reduce new infections,” said Wiener, who publicly disclosed last fall that he is taking PrEP. “If we can get it right here in San Francisco, it will spread to other the parts of the country and other parts of the world.”

As previously reported, the Getting to Zero plan aims to make San Francisco the first city to eliminate HIV infections through a combination of PrEP, prompt antiretroviral therapy, and efforts to retain people with HIV in care and treatment. The name reflects UNAIDS’ triple goal of zero new infections, zero AIDS deaths, and zero stigma for people living with HIV.

The coalition, which has grown to more than three-dozen members, includes representatives from the Board of Supervisors and the mayor’s office, the Department of Public Health, UCSF, the San Francisco AIDS Foundation, Project Inform, other local AIDS service organizations, Kaiser Permanente, private HIV care providers, and community advocates.

Good progress to date

San Francisco was an epicenter of the early AIDS epidemic and has consistently been a leader in providing new models of care and treatment.

The city has seen a steady decline in new HIV infections, reaching 359 in 2013. The number has fallen in all demographic groups except for young people age 25 to 29, and there have been no HIV infections among newborn babies since 2006, noted steering committee member Neil Giuliano, SFAF CEO. The number of deaths attributable to HIV has fallen to 182, and there has been an increase in the number of people living with HIV as they survive longer, now nearing 16,000.

Looking at the cascade of care, San Francisco already does better than the U.S. as a whole. In 2012, 94 percent of people with HIV in San Francisco had been tested and knew their status, compared with 82 percent nationwide. While 72 percent of people diagnosed with HIV in the city were linked to care and 63 percent started treatment and achieved viral suppression, the corresponding nationwide figures were 66 percent and 25 percent, respectively.

Three-part program

The first prong of the three-part Getting to Zero plan involves expanding access to PrEP. Gilead Sciences’ Truvada (tenofovir plus emtricitabine) taken once daily has been shown to reduce the risk of HIV infection by more than 90 percent.

“I want to emphasize that PrEP is really a game changer,” said Susan Buchbinder, director of Bridge HIV at DPH. “We have been in the same place for HIV prevention for the last 30 years [and] have not had any other real new tools to prevent infections.”

The latest estimates suggested that fewer than 1,000 people in San Francisco are receiving PrEP – including more than 500 at Kaiser Permanente alone – though a recent surge in interest has likely increased this number. According to PrEP researcher Robert Grant from the Gladstone Institutes, as many as 6,000 city residents could potentially benefit from PrEP.

But cost is a barrier for many people, with a price tag of approximately $1,200 per month. Last fall the Board of Supervisors passed legislation, introduced by Campos, that allocates approximately $300,000 to hire “navigators” to help people obtain PrEP through existing channels such as private insurance, Medi-Cal, or Gilead’s patient assistance programs.

Noting that the Getting to Zero plan relies heavily on PrEP, Campos suggested that $300,000 “is a drop in the bucket” and “may not necessarily reflect the level of commitment that is needed.”

The second prong is rapid antiretroviral therapy as soon as people find out they are infected. In 2010 San Francisco was the first city to recommend that all people diagnosed with HIV should start treatment regardless of CD4 T-cell count, but this is now reflected in national treatment guidelines.

“During the early phases of HIV when patients appear to be asymptomatic, levels of virus in the blood are causing inflammation and affecting their organs,” explained Diane Havlir, chief of the division of HIV/AIDS at San Francisco General Hospital. “Now we know that at all stages of HIV disease the virus is more toxic than medications, therefore we should be starting treatment immediately.”

Havlir added that there is a “two-for-one benefit” of early therapy because people who start treatment and achieve undetectable viral load dramatically reduce their risk of transmitting HIV – by 96 percent in one major study.

Under San Francisco’s RAPID ART program, people who are diagnosed with HIV are “offer[ed] treatment on the spot,” Havlir said, referring to quick access to antiretroviral therapy. Getting to Zero seeks to expand this initiative from SFGH and DPH clinics to all providers citywide.

The third prong involves retention in care, for example when someone loses their job, their housing, or their health insurance.

“For many diseases, having a short interruption in therapy isn’t devastating,” Havlir said. “That is not the case for HIV. When people [stop] taking HIV therapy the virus levels immediately surge and it’s very unhealthy for the patient and also puts the community at risk for transmission.”

Campos emphasized the existing disparities in access to PrEP and HIV treatment and the many factors that affect outcomes, including lack of housing. Mental health issues and substance use are also barriers facing many people living with, or at risk for, HIV.

“There are still many disparities in certain communities including the African-American community, the Latino community, and the transgender community,” he said. “You can’t talk about serving those living with HIV without talking about the other issues that impact their lives.”

Campos suggested that the Getting to Zero coalition “doesn’t really reflect the diversity of San Francisco,” and emphasized the importance of people from the most heavily affected communities having a place at the table.

Need for more funding

DPH chief financial officer Greg Wagner explained that over the past five years San Francisco has seen more than $14.6 million in cuts to state and federal HIV funding, with more expected for the coming year. In fiscal year 2014-2015 the city will spend about $36 million for HIV health services, about $15 million for prevention, and about $5 million for epidemiology and research.

The Getting to Zero effort will require additional funding over and above the current HIV budget, although the exact amount has not yet been determined.

“Getting to Zero’s first year initiatives are costed out at a bit over $2 million,” steering committee member Jeff Sheehy told the Bay Area Reporter. “[The coalition] is hoping the city can cover roughly half and is actively seeking funding from foundations, private industry, and other sources for the remainder. We want this to be a public-private initiative.”

Several speakers emphasized that funding for the Getting to Zero initiative must not replace existing HIV services and programs.

“Our future success in getting to zero is going to be built on the existing foundation of HIV services that we want to make sure does remain intact,” said Stephanie Goss from the Asian and Pacific Islander Wellness Center. “We have to ensure we don’t leave the most vulnerable and hardest to reach communities behind.”

written by Liz Highleyman

liz@hivandhepatitis.com

Global Fund’s next five-year strategic Review: 2017-2021

The Global Fund’s next five-year strategy, for 2017-2021, will be our roadmap in a rapidly changing health and development landscape. The new strategy will include thorough engagement and deep consultation with a diverse group of stakeholders, partners and experts from a range of backgrounds and disciplines. Working on the strategy starts with asking some big questions: What kind of Global Fund will we need in 15 years? What is the role of the Global Fund in that world? What ideas should be central in the next strategy? How should the Global Fund adjust to maximize impact and better serve the people in the countries? A key input into the new strategy will be a review of the implementation of our current strategy, 2012-2016, conducted by an independent evaluation advisory group.

The Strategic Review 2015 will provide invaluable input, both for the new strategy and for the next Replenishment, in addition to enhancing the implementation of the current strategy, and will help the Global Fund strengthen and sustain its gains in the future. The Strategic Review has two main objectives. One is to review the progress in strategy implementation to date of the 2012-2016 Strategy. The second is to assess impact against the three diseases over the past 10 to 14 years.

The Technical Evaluation and Reference Group, an independent group of experts that reports to the Global Fund and known as TERG, met earlier this month in Geneva to formalize an evaluation methodology. For the first main objective, experts will place 27 individual evaluation questions, developed in a consultative process, to assess progress on the strategy’s five strategic objectives. Such questions will include: To what extent have investments focused on the highest-impact countries, interventions and populations? What progress has been made in addressing human rights standards – including non-discrimination, gender equality, and accountability in grant management? To what extent have actual domestic resource contributions increased through the introduction of the new funding model? Also, case studies will be used to collect more in-depth and qualitative information.

The case studies will include 16 desk reviews of available data and documents, and in some cases selected telephone interviews with Country Coordinating Mechanisms, Principal Recipients and civil society organizations, as well as face-to face interviews in four countries. The list of the 16 countries will be finalized soon. For the second main objective, experts will review impact plausibility assessments in selected countries. They will also primarily be using existing data and in-country assessments. Preliminary findings and initial recommendations of the Strategic Review will be ready in May and a draft of the Strategic Review report will be ready by July. The Global Fund Board will receive the full report in November.

Closing the Gap on Children

Tremendous progress has been made over the last decade in expanding access to antiretroviral therapy for adults, but efforts to reach children and adolescents living with HIV have not moved as fast. Worldwide, more than 3 million children are living with HIV, 90 percent in sub-Saharan Africa. Only a quarter of children living with HIV has access to antiretroviral therapy, and in some countries coverage for children is half the coverage for adults. Evidence shows that without it, 50 percent of children living with HIV may die before their second birthday and 80 percent before their fifth birthday.

Martin Auton, who leads sourcing of HIV Products at the Global Fund, said the pediatric ARV market has traditionally been small and fragmented. Specific challenges of producing ARVs for children, including the fact that individual country demand is often lower than production batch sizes, and non-availability of more child-friendly drug combinations, have long been obstacles.

This gap is unacceptable, many partners agree. Working together, national governments, external donors, international agencies, non-profit product developers and the private sector are mobilizing actions and high-profile initiatives to accelerate children’s access to HIV treatment. In late 2014, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) announced the Accelerating Children’s HIV/AIDS Treatment Initiative, to double the number of children receiving antiretroviral treatment in sub-Saharan Africa.

The Global Fund, one the largest funders of pediatric ARV globally along with PEPFAR, is building on this momentum. Last December, the Global Fund chaired a Pediatric ARV Procurement Working Group to define priorities for a coordinated approach to the procurement of paediatric ARVs. The working group brings together partners and stakeholders including the Ethiopia Pharmaceuticals Fund and Supply Agency, Kenya Medical Supply Agency, the Organization of Eastern Caribbean States, Partnership for Supply Chain Management, the Clinton Health Access Initiative, the Pan-American Health Organisation, Supply Chain Management Systems, PEPFAR, UNICEF and UNITAID. The group is intensifying efforts to improve the supply and to promote the use of the best formulations.

WHO and other partners convened coordinated events to provide inputs into future WHO guidance on ARV regimens and dosage forms for children. Deliberations also included alignment with the UNITAID funded Paediatric HIV Treatment Initiative (PHTI) with the objective to develop new combination products that do not currently exist. Auton said global initiatives by many partners aimed at developing effective and easy-to-take medicines and at making them widely available are closing the gap. “Ending pediatric AIDS needs shared responsibility.”

culled from www.globalfund.org

Friends Africa Wins $100,000 ONE Africa Award

The ONE Campaign on Sunday 30 November, unveiled Nigeria’s Friends Africa as the winner of the $100,000 ONE Africa Award, 2014. The award was presented to Friends Africa representative, Didier Kindambu, by ONE Africa Executive Director, Dr. Sipho S. Moyo during the Big Brother Africa Hotshots live eviction show in Johannesburg.

Joining Dr Moyo on stage to announce the winner and present the award was former Miss Universe and UN Goodwill Ambassador for Youth and HIV/AIDS, Mpule Kwelagobe and African pop star Fally Ipupa. The ceremony was hosted by Big Brother Africa’s I.K. Osakioduwa.

Each year, The ONE Campaign awards the prize of $100,000 which is underwritten by an endowment from The Howard G. Buffet Foundation to recognize and reward the exceptional work of an African organization that works toward the achievement of one or more of the Millennium Development Goals. The award is in its seventh year running.

Friends Africa is Africa’s leading health advocacy organizations that work with governments, the private sector, the international community and community-based organizations on mobilizing political and financial support for the fight against HIV/AIDS, TB and Malaria.

Dr. Sipho Moyo said: “This year, over 120 impressive organizations from 22 countries applied for the ONE Award. I wish to congratulate Friends Africa for the outstanding work they do and for this well-deserved recognition. Through partnerships, innovation and proactivity, they continue to make an excellent contribution to the fight against preventable diseases in Nigeria and in Africa”. She added: “It is indeed befitting that this award came on the eve of World AIDS Day. According to ONE’s World AIDS Day report, released today, 38% of people living with HIV and 36% of deaths in Sub-Saharan Africa are from Nigeria and South Africa alone. This makes the work of Friends Africa even more important, and we hope that this award will empower them to step up their fight towards an HIV/AIDS-free Africa”.

CEO and Founder of Friends Africa, Dr Akudo Anyanwu Ikemba, said: “On behalf of the entire team and board of Friends Africa, we are delighted and humbled to finally receive this award. This is the third time we have qualified as a finalist and we are thankful to the ONE Africa team for recognizing our efforts and that of our numerous partners on ensuring a HIV-free African continent. We are indeed inspired to do more”.

Human Rights, Women and Children and Sexual Minorities Dominate Discussion At ICASA 2013

Analysis: ICASA 2013 addressed issues that align with the Global Fund’s funding priorities

“Now More Than Ever: Targeting Zero,” was the theme of the 7-11 December International Conference on AIDS and STIs in Africa (ICASA 2013), urging activists and policymakers not to lose sight of the goal of an AIDS-free generation.

Zambia’s first lady Christine Kaseba-Sata offered a keynote address that exhorted special attention be paid to women and young people in the fight against HIV/AIDS in the continent: two key population groups suffering from disproportionate rates of HIV infection.

“Africa must commit itself to ending practices that promote gender violence against women and girls if the goal of ending the AIDS scourge on the continent is to be achieved,” Dr Kaseba-Sata said. The availability of contraception supported by targeted outreach to adolescents and young people to explain the importance of safe sexual activity will be critical to the fight against AIDS; the continent cannot afford to ignore that young people are sexually active, she said, and must do more to protect them than condemn them for sexual behaviours.

Dr Kaseba-Sata called for an integration of sexual and reproductive health education into schools around Africa, allowing youths to make informed, rather than risky, decisions.

Other speakers acknowledged the silence that most often accompanies discussions of men who have sex with men and sexual minorities in Africa. Ignoring these populations, which also have disproportionately high infection rates for HIV, comes at a peril for countries and risks undermining the real and legitimate progress being made to beat back the scourge. Entrenched hostility to sexual minorities that is cloaked in legislation, religion or traditional values must be overcome with dialogue, compassion and understanding, delegates were repeatedly told.

Among the most intimate of the opening remarks were those from Cyriaque Ako, a health activist in francophone West Africa including his native Cote d’Ivoire, who talked about the hostile prejudice he was confronted with on a near daily basis.

Gay men in Africa “need to resist in order to exist”, he said. Decriminalization of gay sex in the 38 countries in Africa where harsh penalties, including fines and jail time, are still meted out for homosexual behaviour, is one of the first and best ways to fight the spread of HIV on the continent. Decriminalization will also break the silence that prevents effective outreach to men who have sex with men, rendering many condom and safe sex promotion campaigns ineffective.

The Global Fund has outlined its priorities for funding in sub-Saharan Africa that make clear the importance of outreach to this key population, a position reiterated at ICASA by Mark Dybul, the Secretariat’s executive director, at a workshop organized by the Women4GF lobby group.

“We are committed to ensuring that Global Fund money is used for programmes that focus on human rights in the fight against the three diseases. We believe that the rights of sexual minorities should be respected, as key populations hold the key to the effective fight against the pandemic,” Dybul said.

Read the original story, with tables and illustrations where appropriate.

Stigmatisation Kills More Than HIV/Aids

Cameroon’s government through the Ministry of Public Health has launched a ruthless battle against stigmatisation, which is believed to be more detrimental than the actual effects of the AIDS pandemic on the human body.

It would be noted that the fight against HIV/AIDS has grown beyond prevention and transmission. Though both approaches are still relevant, the major bone of contention is how to accept and live with the virus, as well as being accepted and let to live without any strings attached to one’s personality. Such is the dilemma faced by the main character, Damascus Sondia in Blasius Ngome’s “J’ai le SIDA” the French version of his novel “I Have AIDS”.

Due to a reckless sexual life, Sonia undergoes a hectic mental trauma when advised by his ophthalmologist to do an HIV/AIDS screening. Asked to return for his results after two days, the 48-hour delay was longer than two years. Time during which Sondia reviewed his life, though the only thing he could see was death.

He even intended to write his will, dig up his own grave, chose his funeral attire, select the funeral songs and prepare everything as though he was there. It was equally a time when he sought God more than ever before in his life, believing the day of reckoning with his maker was at hand.

In the 206-page novel, the author through the lead character’s mind reveals the devastating effects of the pandemic with characters like Cornelius Kwedi who organises an “Operation AIDS for all” in distributing the pandemic, while others had committed suicide. Due to ignorance and the fear of stigmatisation, none in effect actually dies of AIDS itself. When Sondia’s medical test revealed negative, he resolved to contribute immensely in the fight again the killer disease, though his was a narrow escape.

 
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