New test to detect HIV in babies boosts hope of meeting UN targets

This was originally published on Global Health TV on October 25, 2016.

When Saquina, a 38-year-old single mother living in Nacala Porto, Mozambique, learned she was HIV positive while pregnant, she thought her life was over. Instead, she decided to accept her HIV status and follow the advice of the nurse who counseled her.

She did not miss any visits to the health center. She took the pills that helped prevent transmission of the virus to her unborn child. She participated in support groups with other HIV-positive mothers. When her son Frenchou was born, she gave him medication every day and breastfed him exclusively for six months.

When he was two years old, Frenchou was tested for HIV and found negative — another of many recent successes in the prevention of mother-to-child transmission (PMTCT), according to the Elizabeth Glaser Pediatric AIDS Foundation.

Between 2009 and 2015, there was a 60% decline in new HIV infections in children in the 21 priority countries, according to a UNAIDS report released in June. Seven of those countries reduced infections by more than 70%. A total of 1.2 million new infections among children were averted in these countries.

But if you thought thought that all is now well with PMTCT, and that we can move on to other HIV challenges, you would be mistaken. While a 60% drop is certainly encouraging, it is significantly below the 90% target set by the World Health Organization (WHO). UNAIDS has set a goal of eliminating all new HIV infections among children by 2020 while ensuring that 1.6 million children have access to HIV treatment by 2018.

A long, hard road to reversing the stagnation of family planning in Nigeria

DKT Bee Lydia, a community health worker, gives Iya Lekan a Sayana Press injectable contraceptive at her house. She has five children and does not want any more, at least for now.

This was originally published on Global Health TV on September 27, 2016.

LAGOS, Nigeria — Lydia, a community health worker for DKT Nigeria, steps carefully as she navigates the grimy streets of Makoko, one of the worst slums of Lagos. She is trying to avoid mud or something worse. The sanitation is abysmal. But Lydia is on a mission — to bring contraception to some of the most disadvantaged women in Nigeria.

This day, she calls on Iya Lekan. Although neither Iya, 36 years old, or her husband have regular work or specific sources of income, they have five children to look after.

“I don’t know how many times I have given birth,” she says in Yoruba, the local language here. “I’m tired.”

Iya told Lydia she was ready to start practicing family planning. Lydia presented various options, and Iya chose a three-month injectable called Sayana Press. Lydia immediately gave her the injection in her upper thigh.

Some people think Sayana Press could be a game-changer. It’s a new version of the well-known Depo-Provera injectable contraceptive, but contains 30% less of the active ingredient and can be administered by lesser-skilled health workers. The United Kingdom has already approved it for self-injection.

Last month, I spent an afternoon with Lydia, a member of the DKT Bees, a group of community health workers (CHWs) who focus on family planning in some of the grittiest parts of Lagos. DKT calls their CHWs “bees” because they are like the hard-working insects that go from flower to flower spreading pollen. But instead of pollen, DKT Bees go house to house counseling, educating and dispensing contraceptives.

The road to greater contraceptive use in Nigeria has not been smooth. It’s shocking that the percentage of married women using modern contraception in Nigeria is only 9.8 percent (Nigeria Demographic & Health Survey 2013). That figure is lower than all countries in West Africa except Gambia, Guinea and Mauritania, according to the 2016 World Population Data Sheet, and has has hardly changed in the last ten years. Nigeria has a population of 187 million, making it the seventh largest country on earth. If current trends continue, it will be tied for third, with the United States, in 2050.

Already a contraceptive success story in West Africa, Ghana seeks to do better

DKT Ghana midwife advising on family planning at a community gathering in Mpraeso, in the Eastern region of Ghana.

This was originally published in the Huffington Post on September 26, 2016.

ACCRA, Ghana — Although West and Central Africa is an underachieving region in terms of family planning compared to the rest of the continent, Ghana is the family planning star within that region: It has a higher rate of contraceptive use than all the other 24 countries except the island nations of Cape Verde, and São Tomé and Príncipe. 

However, Ghana - with 29 percent of married women using modern contraception, is still much lower than Eastern Africa (37 percent) and Southern Africa (59 percent), according to the 2016 World Population Data Sheet. The fertility rate has barely changed since 1998 and more than 1 in 3 pregnancies are unplanned.

Last month, I visited Ghana to see how the country is faring in terms of of its commitment to family planning. Until recently, Ghana had one of the fastest growing economies on the continent. That fact and the peaceful transfer of power in 2008 were recognized by President Barack Obama in 2009 when he made Ghana the first stop of his first visit to Africa as president. Recently, however, the economy has stagnated.

World Contraception Day on Sept. 26 provides a good opportunity to reflect on the current situation in Ghana and how matters can be improved to enable every Ghanaian woman who wants contraception to have access. The government has set an ambitious goal of reaching 50 percent of married women with modern contraception methods by 2020.

The next great pandemic: What will it look like and where will it come from?

This was originally published on Global Health TV on August 23, 2016.

A few years ago, in a survey by epidemiologist Larry Brilliant, 90 percent of epidemiologists said that a pandemic that will sicken 1 billion, kill up to 165 million and trigger a global recession that could cost up to $3 billion would come in the next two generations. Currently, we’re living through three pandemics — HIV, Zika and cholera. What will the next pandemic look like and where will it come from?

Those are some of the questions science journalist Sonia Shah attempted to answer in an event marking the centennial of the Johns Hopkins University’s Bloomberg School of Public Health and in her book “Pandemic: Tracking Contagions from Cholera to Ebola and Beyond,” published earlier this year. The book should be required reading for anyone interested in the future of global health.

Shah spent six years trying to figure out how microbes turn into pandemic-causing pathogens. She looked at the history of pandemics, particularly cholera because it’s one of our most efficient pandemic-causing pathogens. She went to places where new pathogens are emerging to try to figure out what are the political and social drivers that push these microbes into human populations.

UN needs to look beyond patents for improving access to medicines

This was originally published on Devex on August 4, 2016.

The lack of access to medicine has become a regular feature of the health landscape in many developing countries. In the West African country where I’ve been spending time lately, stockouts of essential medicines happen regularly, not only in the public sector (where you might expect it) but also in projects well-funded by donors (where you might not).

The World Health Organization estimates that availability of selected generic medicines was only 38 percent and 46 percent in the public sector in low- and middle-income countries, respectively, and a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief.

Earlier this year, U.N. Secretary-General Ban Ki-moon appointed a High-Level Panel on Access to Medicines to assess this problem and come up with some solutions. Specifically, the purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”

But leaks from the panel’s highly secretive proceedings suggest that the secretary-general told the panel to focus on intellectual property and patents to the exclusion of other issues that hamper access to medicine — weak health systems, questionable government policies, a lack of health workers and a lack of resources.

Controversy brewing over the greatest barriers to access to medicine

A worker selects medicine from the MEDS (Mission for Essential Drugs and Supplies) warehouse in Nairobi. MEDS is jointly owned by the Kenya Conference of Catholic Bishops and the Christian Health Association of Kenya. Photo: Bedad Mwengi

This was originally published on Global Health TV on July 16, 2016.

In comments last week at the International AIDS Conference in Durban, South Africa, UN Secretary General Ban Ki-moon said four things deserved credit for getting the AIDS pandemic under control — people living with HIV, biomedical companies, generic medicines and international finance.

But despite his gratitude to biomedical companies and generic medicines, the secretary-general is overseeing a process that threatens to undermine those companies' ability to improve access to medicine in developing countries.

The World Health Organization says an estimated 2 billion people (27% of the world’s population of 7.5 billion) lack access to essential medicine, most of them in Africa and Asia, but a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief treatment.

To address this staggering problem, the Secretary-General set up a High-Level Panel on Access to Medicines earlier this year. The purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”

Sounds like a great and noble idea, right? But some expert commentators say the panel is on track to do more harm than good because of its terms of reference.

Kenya starts to shift focus to chronic diseases while not relenting in HIV fight

A patient at a rural health camp in Mwae County, Kenya has his blood pressure checked as part of a full physical exam. If he needs hypertension treatment, he will get it as part of the cost of the camp. Photo: Bedad Mwangi

This was originally published on Global Health TV on June 28, 2016.

For some time, huge disparities between global health spending and the global disease burden have raised concerns that this funding was not being allocated based on the evidence. That is, money was not always going where the disease burden was greatest.

The Institute for Health Metrics and Evaluation (IHME) has pointed out that the disparities are most extreme in HIV/AIDS on the high end and non-communicable diseases (NCDs) on the low end.

As the toll from communicable diseases like AIDS and malaria decline and people live long enough to get NCDs, we need to invest more in fighting NCDs (also called “chronic diseases”) and reduce these glaring disparities between global health spending and disease burden. Countries like Botswana, Eritrea, Kenya Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zambia — all countries that increased their treatment coverage by more than 25% between 2010 and 2015, according to UNAIDS — now have to pivot to NCDs without taking their eyes off of HIV.

Kenya is an excellent case in point.