Global HIV infections on the rise, says Study

An international team of researchers analysed the findings from the Global Burden of Disease 2015 study and found that despite a steady decline in HIV and AIDS-related deaths between 2005 and 2015, the global rate of new infections had dropped by a mere 0.7 per cent per year in the same period.

The study published in The Lancet HIV and its findings were announced at the ongoing AIDS 2016 conference in Durban, South Africa.

Lead author of the study,  Dr Haidong Wang, from the Institute for Health Metrics and Evaluation at the University of Washington, said: “The findings of the Global Burden of Disease Study 2015 on HIV reveal challenges that the global health community faces in the effort to end AIDS by 2030, among other global goals.” 

Wang said the increase in incidence in some countries, both in­ terms of rate and number of new infections, is one of the most significant findings of the study especially given the fast decline in new infections globally between 1997 and 2005 and the tremendous amount efforts and resources global community has committed to in the past decade.

He said the increase in new infections could be due to factors at the nation level, such as “lower than optimum viral load suppression, exaggerated ART coverage and a potential increase in risky sexual behaviour in the presence of ART treatment”, but further analysis would be needed to differentiate between specific countries.

The researchers found that the slow decline of new HIV infections worldwide of 0.7 per cent per year between 2005 and 2015, compared to the annual 2.7 per cent between 1997 and 2005, meant new infections at stagnated at around 2.5 million per year.

While some progress is being made in getting life-saving treatment to people with HIV, the sheer numbers of people getting HIV and dying are devastating.

The number of people living with HIV steadily increased from 27.96 million in 2000 to 38.8 million in 2015, and infection rates increased in 74 countries, mostly in sub-Saharan Africa and south and south-east Asia.

Based on these numbers, most countries would fail to achieve the UNAIDS 90-90-90 target – by 2020, 90 per cent of people living with HIV will know their status, 90 per cent of all people diagnosed with HIV will be on antiretroviral therapy (ART), and 90 per cent of people on ART will have viral suppression.

The researchers also found that annual deaths from HIV/AIDS declined from a peak of 1.8 million in 2005 to 1.2 million in 2015, which they say is partly due to the increased availability of ART. The proportion of people living with HIV that were on ART had greatly increased from 6.4 per cent to 38.6 per cent in men and 3.3 per cent to 42.4 per cent in women.

“While some progress is being made in getting life-saving treatment to people with HIV, the sheer numbers of people getting HIV and dying are devastating.”

Eliminating Neglected Tropical Diseases: A new initiative to finish what we started

Dr. Matshidiso Moeti

By Matshidiso Moeti

When I was a child living in apartheid South Africa, I saw first-hand the pain and suffering experienced by the patients my parents cared for at their medical clinic. Patients came in and out, looking for treatment to their ailments and afflictions. I learned how constant illness and discomfort was an everyday reality for so many of our neighbours.

Now a physician myself, I know that daily sickness and pain is also a reality for a billion people around the world who are affected by neglected tropical diseases (NTDs). NTDs are a group of preventable and treatable diseases that place a constant and heavy burden on the poorest, most marginalized and most isolated communities around the world. Together they cause more than 150,000 deaths every year worldwide, yet even that number vastly understates their impact.

By and large, NTDs are not killer diseases. Instead, over years and decades, they sap people’s strength, destroy their quality of life and eat away their savings. For many people who suffer from them, chronic fatigue, bad vision and persistent discomfort seem to be routine parts of life.

Luckily, treating and preventing many NTDs is medically simple, and the vast majority of the drugs needed to do so are generously donated by pharmaceutical companies – 1.5 billion treatments were donated globally in 2015 alone. But delivering those drugs is harder than it sounds. We need better information on where people are infected or at risk, infrastructure to distribute medicine to remote areas and a system to track progress.

An effort of such scale demands substantial funding and technical capacity, posing a major challenge for many African countries. Designing effective programmes is just half the battle; effective collaboration and sustainable funding for these programmes are crucial ingredients for success.

Over the past few years, we’ve seen increased momentum in the fight against these debilitating diseases. In 2012, a coalition of representatives from various sectors endorsed the London Declaration on Neglected Tropical Diseases, an ambitious plan to control, eliminate or eradicate 10 neglected diseases. In 2014, two dozen African countries pledged to strengthen their commitment to NTDs under the Addis Ababa Commitment on NTDs. And in 2015, the Sustainable Development Goals made clear that tackling NTDs was essential to helping communities break free of poverty.

That’s why the World Health Organization – together with a coalition of multinational organizations – is launching the Expanded Special Project for Elimination of Neglected Tropical Diseases, or ESPEN. ESPEN has a broader mandate than its predecessor, the African Programme for Onchocerciasis (APOC), which closed in December 2015. APOC focused on one disease; ESPEN focuses on five – onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminths and trachoma – that can be controlled and eliminated through mass drug administration, the simple and cheap administration of medicine to all people living in high-risk areas.

To succeed in helping these millions of people, the fight against NTDs must be led by affected countries themselves. Much of that work is already taking place through national NTD programs in partnership with public and private organizations. To help make these programs effective and sustainable, ESPEN will support countries each step of the way: it will support them as they map the burden of these diseases, deliver treatments accurately and efficiently, monitor progress and secure certification when they successfully eliminate diseases from within their borders.

ESPEN will also help countries work better together and work better with their partners. ESPEN will support countries to strengthen their strategic leadership role in convening and coordinating partners support, a must-have for a successful delivery of interventions and progress towards elimination. It will create an online portal so countries can access and share information, and help the range of organizations working on NTDs to coordinate with one another and streamline their efforts. It will also advise governments on how to raise money for NTD efforts, and the best targets for spending it.

This project is building on an existing global and pan-African movement to combat NTDs. APOC helped countries make enormous strides against onchocerciasis (river blindness), achieving a significant reduction in the number of people affected by this debilitating disease.

ESPEN is an essential component of a broader health agenda, and the in-country systems established with its support will outlive NTDs. The recent tragic Ebola outbreak revealed the need for a stronger WHO, and I have initiated a Transformation Agenda for the WHO Secretariat in the African Region to ensure that the Organization evolves to provide quality support to countries to improve and transform their health systems in a manner that is sustainable and accelerates the pace of health development in sub-Saharan Africa.

ESPEN and the elimination of NTDs are both integral components of this Agenda. Arming countries with structures to track disease and deliver services to the most remote corners of society builds stronger health systems. These systems form the basis of the infrastructure needed to respond to emergencies and ensure universal access to the entire menu of primary healthcare services – from childhood immunizations to reproductive healthcare.

The tools and knowledge needed to alleviate the neglected suffering of millions of people are in our hands. I hope countries across Africa and partners will join with ESPEN to treat those afflicted by NTDs, eliminate the devastating diseases of poverty that prey on forgotten communities, and build stronger health systems that deliver for everyone.

Dr Matshidiso Moeti is the World Health Organization’s Regional Director for Africa.

Rapid Results Initiative debuts in Nigeria

The Rapid Result Initiative programme designed to quickly and visibly impact on the health of most Nigerians particularly the most vulnerable and poor, has been introduced by the Federal government.

At the launch to kick start the operationalization of the programme tagged “Better Health for all”, the Minister of Health, Prof. Isaac Adewole, said the programme is expected to achieve results within 100 days.

He said the Rapid Result Initiative would be deployed in seven major areas that would conform with local and international health priorities.

Under the programme, 110 Primary Health Centres would be revamped within 100 days, one in each Senatorial district including a facility in Fuka Local Government in Niger State.

“During my unscheduled visit to Fuka, I noticed there was no functional PHC to offer basic health care and I promised that Federal Government will provide a functional facility, today as we speak the Fuka PHC is ready for commissioning”.

Adewole also said the Ministry would inaugurate Mutual Health Associations at community level to improve access to affordable and qualitative health care.

“Mutual Health Associations are either privately or publicly incorporated body registered by the National Health Insurance Scheme solely to access health care service through health care facilities accredited by the scheme”, he explained.

The Initiative would help treat 200,000 Severely Acute Malnourished children in the North East of the country, while 10,000 surgeries, including hernia, cleft lip, and palate repairs, myomectomy, hysterectomy, Vesico-vaginal Fistula (VVF) amongst others in 46 Federal tertiary institutions.

Other aspects of the initiative include operationalizing the Nigeria Centre for Disease Control, NCDC, which entails having at least one laboratory in each geopolitical region including the Federal Capital Territory.

The designated hospitals as laboratories were University of Port Harcourt Teaching Hospital, Aminu Kano Teaching Hospital, Kano; University Of Maiduguri Teaching Hospital, Borno State, University of Enugu Teaching Hospital, Enugu State; Lagos University Teaching Hospital, Jos University Teaching Hospital and Asokoro/ Gwagwalada Specialist Hospital FCT.

Through partnership with Novo Nordisk, the Ministry plans to screen about 500,000 Nigerians for diabetes free of charge while and they would be appropriately referred to facilities that would cater for their needs if that warranted.

On transparency and accountability, Adewole said the Media and Publicity component of the Initiative would be on ground to engender trust and accountability through media campaigns and close monitoring of the programme to ensure that quality services were provided to the people as promised.

HIV elimination and lessons from Cuba

Born HIV free. PHOTO: Courtesy UNAIDS

IN 2014, Cuba officially became the first country in the world to eliminate the transmission of HIV and syphilis from mother to child. That country has gone down in history as the first in the world to be validated by the World Health Organization, WHO, for the elimination of mother-to-child transmission of HIV and syphilis.

Margaret Chan, Director General for the World Health Organisation, WHO, described the feat as one of the greatest public health achievements possible.

“This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation” Chan noted.

Cuba’s success story broke the jinx of elimination of mother to child transmissions. It emphasized the importance of intervention and assistance of a regional organisation in reducing transmission and providing access to anti-retroviral drugs.

This achievement provides inspiration for other countries to advance towards elimination of mother-to-child transmissible disorders.

This set the stage for other countries to eliminate mother-to-child transmission of HIV and syphilis. Next in line were Belarus, Armenia and the Republic of Moldova. In Asia, Thailand set the pace. The success for these countries is also a celebration for children and families all over the world. These countries are validated proof that it is possible to realize the right of all children to be born HIV-free.

HIV can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth and breastfeeding. Mother-to-child transmission accounts for over 90 percent of new HIV infections among children.

Elimination of mother-to-child transmission (eMTCT) programmes provides antiretroviral treatment to HIV-positive pregnant women to stop their infants from acquiring the virus. Without treatment, the likelihood of HIV passing from mother-to-child is 15 – 45 percent.

However, antiretroviral treatment and other effective PMTCT interventions can reduce this risk to below 5 percent. But elimination drops it to zero. So what can other countries in particular learn from Cuba?

Nigeria, which has the 2^nd highest rate of HIV/AIDS in Africa and the world, needs to take heed. First, it is fact that Cuba’s success did not occur by chance, but as a deliberate and orchestrated resolve.

Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed the key to success, even against daunting challenges.

For those that know better, the main driver in Cuba’s successful elimination of mother-to-child HIV transmission was a combined effort of political will and a resolute populace to stop the progression of transmission.

Everyone knows Cuba’s health system is a model for the provision of access to health care delivery, research and development. Cuba’s health system is based on preventive medicine, rather than curative.

Nigeria can and should adopt the same level of success with its own health care system, because this could significantly lead to the expected decrease mother to child transmission in the region.

Within Cuba, there were three major drivers that broke the infection chain for transmission. First was provision of additional HIV and syphilis testing for pregnant women and their partners. 

Next was the offering of Caesarean deliveries instead of natural deliveries, and, third, provision of suitable breast milk substitutes.

It is accepted that treatment for prevention of mother-to-child-transmission is not 100 percent effective, and elimination of transmission is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.

What to be done is simple. Now, Nigeria must work harder to ensure early access to prenatal care, HIV and syphilis testing for both pregnant women and their partners. Treatment for women who test positive and their babies must be assured. Caesarean deliveries and substitution of breastfeeding must not be wanting. 

These services are provided as part of an equitable, accessible and universal health system in which maternal and child health programmes are integrated with programmes for HIV and sexually transmitted infections.

Nigeria must ensure early universal access to free services for antenatal care, HIV and syphilis testing for pregnant women and their partners. It must also provide treatment for women who test positive, and let there be early diagnosis in infants and community engagement.

Ensuring that no baby is born with HIV is an essential step towards achieving an AIDS-free generation. But in Nigeria, far too few pregnant women and their infants have access to this preventive treatment.

Pregnant women must be tested for HIV. PMTCT programmes must be scaled up to include all mothers and babies who need them – no matter how impoverished or geographically isolated they may be. And where prevention of mother-to-child HIV transmission is accessible, it must be delivered consistently and with the most effective drugs available.

Cuba ensured early access to prenatal care, HIV and syphilis testing for pregnant women and their partners.  It also mandated treatment for women who test positive and their babies, Caesarean deliveries and substitution of breastfeeding. The services are provided as part of an equitable, accessible and universal health system in which maternal and child health programmes are integrated with HIV/AIDS and sexually transmitted infections. All these Nigeria must replicate.

The lessons are clear. An equitable, accessible, universal health system in which maternal and child health programmes are integrated with programmes for HIV and sexually transmitted infections are uncontestable.

Nigerians expect that these achievements will inspire their country to seek validation that they have ended mother-to-child transmission of HIV and syphilis. 

It is only by ensuring truly universal access to HIV and syphilis prevention, treatment and care for all, while respecting individual rights, that the HIV and syphilis epidemics in children will be truly eliminated once and for all.

Melinda Gates announces US$80m commitment to close gender data gap

Melinda Gates

Co-Chair of the Bill and Melinda Gates Foundation, Melinda Gates, on Tuesday announced a three-year, $80 million commitment to close the gender data gap and accelerate progress for women and girls around the world.

Making the announcement at the three-day Women Deliver conference in Copenhagen, Denmark, Melinda said the funding will help fill critical gender data gaps; improve the accuracy and reliability of data collection; equip decision makers with better evidence; and support civil society’s efforts to hold leaders accountable for their commitments.

She said the money would help gather more reliable data about women’s lives, such as time spent on unpaid work or farming, which is needed to inform policy and programs and accelerate progress for women and girls.

“It’s great that women and girls are at the heart of the Sustainable Development Goals. But right now there is insufficient data to build a baseline for nearly 80 percent of SDG 5 indicators.

“If advocacy for women and girls is about giving voice to the voiceless – gathering and analyzing data is about making the invisible visible.”

Also at the Conference, a new discussion paper, entitled: “Delivering the power of parity: Toward a more gender-equal Society”, finds that achieving the economic potential of women and making progress toward the United Nations’ Sustainable Development Goals, SDGs, will require $1.5 trillion-$2 trillion in annual spending on essential services in 2025, while the potential economic gains could be six to eight times this outlay.

“Narrowing the gender gap can unleash massive growth,” noted Vivian Hunt, Managing partner of McKinsey's United Kingdom and Ireland offices.

 “But in order to realize the $12 trillion opportunity that comes from advancing gender equality in the world of work, we have to tackle gender gaps in society more broadly. Our new analysis finds that the economic benefits of narrowing gender gaps far outweigh the additional social spending required." 

In her contribution, CEO of Women Deliver, Katja Iversen, said “Investing in gender equality – and in girls’ and women’s health – is investing in human progress. A woman multiplies investments made in her future by creating a better life for herself and her family, community and society. The announcements today show the ripple effect that these investments have for society and the world.”

Buhari urges West, Central Africa to mobilise youth for agric development

Nigerian President, Muhammadu Buhari, has urged West and Central African countries to mobilise youth for agric development to generate employment, food production and wealth creation.

Buhari, who made the call in Abuja, at the opening of the 9th regional implementation forum for International Fund Agricultural Development, IFAD, supported projects in West and Central Africa, said population rise in Africa could only be sustained by young people in the sector.

Buhari who was represented by the Minister of Agriculture and Rural Development, Audu Ogbeh, said measures to curb rural-urban migration and rural development have to be on mobilising and engaging young people in the agric sector by providing the needed technology and provision of basic infrastructure in the rural areas.

 Ogbeh said a study undertaken by the Brooklyn Institution in 2012 underscored that at the continental level, Africa’s estimated population of 1.2 billion would double by 2050, with the attendant fact that about 70 percent of the population would be constituted by those within the age bracket of 30 years or less.

“Arising from this development is that the youth issues need to be addressed in both the rural and urban sectors to enable us avoid future problems. One of the ways to address this urgent concern is to accord priority attention to the transformation of agricultural production in the rural areas, with the youth population as agent of change and transformation, “ he stated.

During the forum, themed: ”Investing in Rural Youth, How do we Plant Seeds for the Future?”, IFAD President, Kanayo Nwanze, in his keynote said governments of West and Central Africa should heavily invest focus on young farmers to curb the unprecedented rise of youth restiveness and social vices.

Lamenting that over the past three decades, agricultural productivity has stagnated or declined, he said the development was not good for the continent or for young women and men and women.

“It is time to reverse decades of neglect of African agriculture. It must be reversed because when you abandon agriculture you abandon your nation’s ability to feed itself.”

Nwanze said  to meet  demand, young people need to be the farmers and food processors of tomorrow, not just to feed themselves and their villages, but to grow the food to feed African cities.

“But without investment in infrastructure, in economic activities and employment opportunities, there is an equally big risk that Africa’s demographic dividend will be squandered.

“If we want young people to stay and work in rural areas, there needs to be considerable investment in infrastructure. These include investment in processing plants, electricity, warehouses, roads and ports,” Nwanze stated.

TB: Nigeria ranks among countries with highest burden

On this year’s World Tuberculosis Day, the World Health Organisation ranks Nigeria one of the countries with the highest burden of Tuberculosis even as  TB deaths dropped 47 percent between 1990 and 2015. 

Tuberculosis is still a major public health problem in Nigeria, with the country ranking high among the high TB burden countries which collectively bear 80% of the global burden of TB that infects about half a million Nigerians every year, and kills 170,000. 

The number of TB cases notified in the country has increased over the last decade although more than 500,000 TB cases have been successfully treated free of charge over the same period and the burden in Nigeria is further compounded by the ongoing HIV/AIDS epidemic and the emergence of multi-drug resistant tuberculosis (MDR-TB).

The Global Fund to fight AIDS, Tuberculosis and Malaria, disbursed a total of US$165,108,596 to TB control and prevention in Nigeria that recorded a total of 310,000 smear positive TB cases in 2015. 

In a statement to mark the World Tuberculosis Day, themed "Unite To End TB", the WHO calls on countries and partners to unite to end the scourge of TB as a target  in the Sustainable Development Goals by 2030.

The world health body notes that although there has been significant progress in the fight against TB, with 43 million lives saved since 2000, the battle is only half-won as over 4000 people lose their lives each day to TB.

Regretting that many communities most burdened by tuberculosis are the poor, vulnerable and marginalized, WHO says ending TB will only be achieved with greater collaboration within and across governments, and with partners from civil society, communities, researchers, the private sector and development agencies.

Further, WHO says there still formidable challenges despite the advances, adding that, fragile health systems, human resource and financial constraints, and the serious co-epidemics with HIV, diabetes, and tobacco use are still threatening the eradication processes.

“Multi-drug resistant TB, MDR-TB, is another critical challenge. Urgent and effective action to address antimicrobial resistance is key to ending TB by 2030. So are increased investments, as the global tuberculosis response remains underfunded for both implementation and research.”

According to WHO, in 2014, 9.6 million people fell ill with TB and 1.5 million died from the disease, including 380 000 among people living with HIV.

Lucica Ditiu, Executive Director for the Stop TB Partnership, said there are new strategies and a global commitment to end TB.

Ditiu says if the world really wants to end TB, “we need a paradigm shift, a change in the way we fight TB at every level, in every community, in every health facility, in every country. 

"This means changing the way we think of TB, adjusting our packages, policies and guidelines and putting people at the centre of our interventions, so we reach all the people that need them.”