Nifty infographic of the day: the ripple effects of Ebola

Monday, November 17, 2014

For better or worse, Ebola is becoming old news. Aside from the initial case in Dallas that was transmitted to two nurses, there have been no more cases here in the U.S., and panicked predictions of a massive outbreak causing mayhem and catastrophe never materialized (much like public health experts said they would not - funny how that works).

The outbreak in West Africa is ongoing and continues to be a tragedy on a massive scale that is losing public interest. Numerous articles by countless experts and pundits have discussed lost opportunities and the weaknesses in the healthcare systems that the outbreak has laid bare. Now, the MPH@GW blog has kindly provided aninfographic on the outbreak and its collateral damage. They asked me to share it on the IH Blog and told me that I could post it here, too (being the opportunist that I am).


New(ish) report from OCHA on humanitarianism and cyber-warfare

Thursday, November 13, 2014

I set this report aside when I saw it posted on Twitter last month but have not had a chance to read it until now. OCHA has released an "occasional policy paper" (I guess that absolves them from the obligation of publishing one on a schedule?) discussing and providing guidelines for the use, collection, and exchange of information related to humanitarian operations, and the relationship of this information management to security and cyber-warfare threats. As an epidemiologist with experience in both knowledge management and disease surveillance, the report was particularly interesting to me. It is not too long and is pretty interesting stuff.
In 2013, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) examined emerging issues relating to information and communications, particularly the spread of cell phones and connectivity, advanced data analytics and other tools. Humanitarianism in the Network Age, the first UN report to identify information as a basic need in humanitarian response, sketched a vision of a future in which affected people produce and share information in real time with each other and with humanitarian responders, disasters are better anticipated through sophisticated monitoring systems, and accurate data and analysis clear the fog of war.

However, the “Network Age” also comes with risks and challenges. A humanitarian crisis can create a justification for waiving concerns about how information is collected and used, even as cyber-warfare, digital crime and government surveillance rises, particularly in unstable contexts.

To deal with these challenges, Humanitarianism in the Network Age recommended that the humanitarian sector develop robust ethical guidelines for the use of information. It specifically called for “do no harm” standards that clearly address liability, privacy and security. This report looks in more depth at these issues and makes recommendations to ensure that emerging technology is used responsibly.
Here is a screen capture of the key messages:

According to North Korea, North Korea is the second(!)-happiest country on Earth

Wednesday, November 12, 2014

This gem actually popped up on my Facebook news feed via my husband, who is currently in a global policy studies Master's program. Though this is (slightly) old news, I still felt like it was worth sharing: apparently, DPRK's Chosun Central Television ranked the Hermit Kingdom second in a "happiness" index, second only to China, its big brother:
[A] new global happiness index released by North Korea's Chosun Central Television awarded China 100 out of 100 possible points. If the "Gross National Happiness" survey is to be believed, isolated dictatorships are the key to overall well-being, with North Korea reportedly coming in second with 98 points, followed by Cuba, Iran and Venezuela. ...the lowest marks are said to have gone to South Korea, which scored just 18 points to come in at 152, while the United States...fared even worse at 203 with a measly three points...
Here is the actual chart, which should probably be submitted to /r/dataisugly (but I digress).

This from the country that insists that the "human rights" of its citizens consist of freedom from Western imperialism. Delightful.

Catching up: TB research round-up

Wednesday, November 5, 2014

Similar to yesterdaBy's round-up of HIV-focused studies, this is a collection of recently-published studies on TB.

A major global health item this week was a study examining the rising incidence of diabetes in the developing world and its link to TB:
Diabetes rates are rising everywhere; a part of an overall increase in non-communicable diseases. As the world gets better, more people suffer lifestyle diseases. These include diabetes and heart disease, and other ailments that go along with a population that is living longer, like cancer.

The non-communicable diseases burden in low-income countries is expected to increase to 69 percent by 2020, from 47 percent in 1990. That is cause for concern by itself. Some 384 million people have diabetes and it will reach nearly 600 million cases by 2035. The diseases often associated with unhealthy diets, is particularly burdensome in low- and middle-income countries, where more than 80 percent of the 3.4 million annual diabetes deaths occur.

Toss in the potential for increased risk of TB and things get worse. The risk of contracting active TB is up to three times higher for people who have diabetes, also making them carriers of a contagious and potentially deadly infection.

Immediate action is needed to fend off a “looming co-epidemic,” according to a report released by The Union and the World Diabetes Foundation.

A new anti-TB drug, bedaquiline, has shown promise in treating MDR-TB and XDR-TB:
The study population comprised 35 people who were provided with compassionate access to the drug between 2011 and 2013. After six months of therapy, 97% of study participants with culture-positive pulmonary TB at baseline had achieved culture conversion.
...
Bedaquiline is a new antibiotic with activity against drug-resistant strains of TB. It was approved by the Food and Drug Administration (FDA) in the United States and the European Medicines Agency after it demonstrated efficacy in clinical studies.
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The authors note that the efficacy was better than that observed in clinical trials.

Sputum-smear conversion occurred in 48% and 69% of participants at three and six months, respectively.

The median time to culture conversion was 85 days.

An analysis published in Lancet Infectious Diseases showed that increased expenditure on social protection programs (e.g., sickness, disability and unemployment benefits, old age pensions, housing support) is associated with improved TB control:
With this new policy in mind, an international team of investigators looked at the relationship between social protection expenditure and TB control between 1995 and 2012 in the 21 countries that are now members of the EU.
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Overall, the authors found a strong relationship between increased per-person expenditure on social protection and lower TB incidence (p = 0.003) and mortality (p = 0.01) rates.

Cross-national analysis controlling for GDP and expenditure on public health showed that each $100 increase per person in social protection expenditure was associated with a fall per 100,000 population in the number of TB notifications (-1.53%, p = 0.01), TB incidence rates (-1.70%, p = 0.02), non-HIV-related TB mortality rates (-2.74%, p = 0.01) and all-cause TB mortality rates (-3.08, p = 0.01).

“Our findings add to the empirical evidence that investing in social protection is justified, not just because it is fair and protects the most vulnerable populations, but also because it contributes to measures to reduce the global burden of tuberculosis,” write the authors. “Social protection programmes are likely to provide a vital component of a robust tuberculosis prevention strategy, especially for vulnerable groups.”

Namibian Supreme Court holds government liable for forcibly sterilizing HIV-positive women

On Monday, Namibia's Supreme Court ruled in favor of three HIV-positive women who had been sterilized without their consent after giving birth.
Chief Justice Peter Shivute ruled that the doctors should not have sterilised the women and ordered consideration of damages for the victims, who each claimed one million rand (about $90,000).

The director of the Namibian Women's Health Network, Jennifer Gatsi Mallet, applauded the decision, saying the cases were only the tip of the iceberg.

"We have documented dozens of cases of other HIV-positive women who have been forcibly sterilised. The government needs to take active steps to ensure all women subjected to this unlawful practice get redress," she said.

Mallet said the decision proves that "public hospitals in Namibia have been coercively sterilising HIV-positive women without their consent."

The Southern Africa Litigation Centre, which backed the women in their legal challenge, said the decision had far-reaching consequences for HIV-positive women throughout Africa who have been forcibly sterilised.

"This decision sends a clear message that governments throughout Africa must take concrete actions to end this practice," said deputy director Priti Patel.
The ruling itself was hailed as a human rights victory; however, the fact that this is still happening is beyond appalling. Shamefully, forced sterilization of HIV-positive women is not uncommon - just last month, the Inter-American Commission on Human Rights took up a similar case by a Chilean woman.

Catching up: HIV research round-up

Tuesday, November 4, 2014

I am finally emerging from a monstrous load of urgent freelance work, which is why the blog was silent last week. I was finally able to catch up on global health news last week, so I thought I would post groups of similar studies today and tomorrow. Today's round-up will be HIV-related; tomorrow will feature tuberculosis.

I will kick off with results released yesterday: a study conducted in Uganda and presented at the HIV Drug Therapy Glasgow conference found that the ART efavirenz reduces levels of levenorgestrel, which is used in hormonal implants common in developing countries:
Hormonal contraceptive implants are highly reliable forms of contraception, and have been shown to prevent conception for at least five years with a pregnancy rate of less than 1%. As a form of contraception, implants compare favourably in convenience and reliability to the male condom, and do not require regular clinic visits in order to maintain the contraceptive method.

The disadvantage of progesterone-based hormonal contraceptive implants for women living with HIV lies in the interaction between levenorgestrel and antiretroviral drugs which induce CYP3A4 metabolism. Both efavirenz and nevirapine have been shown to reduce levonorgestrel levels, but the impact has been unclear.

However, a retrospective cohort analysis of unwanted pregnancies among 570 women living with HIV using the Jadelle contraceptive implant in Swaziland, published earlier this year, showed that the only factor associated with unwanted pregnancy was efavirenz treatment.
...
After adjusting for body weight, levenorgestrel levels in the nevirapine group were 32 to 39% higher than those in the control group during the follow-up period, levenorgestrel levels in the efavirenz group were 40 to 54% lower than those in the control group, and in three cases fell below the minimum recommended concentration for contraceptive efficacy.
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The research group concluded that the levonorgestrel implant should be used with nevirapine-based antiretroviral therapy.

A meta-analysis published in AIDS asserts that prevalence of transmitted drug-resistant HIV has doubled in low- and middle-income countries in recent years:
An international team of investigators wanted to establish a better understanding of global trends in rates in transmitted resistance and variations according to world region and risk group.

They therefore conducted a meta-analysis, analysing the results of 212 studies conducted between 1999 and 2013 that reported on rates of transmitted drug resistance.

The authors examined trends in industrialised and low- and middle-income countries. They also compared rates between the main HIV risk groups: men who have sex with men (MSM); people who inject drugs (PWID); and heterosexuals.

Overall, North America was the world region with the highest burden of transmitted drug resistance, which was present in 14% of MSM, 9% of PWID and 11% of heterosexuals.

Western Europe was the next-worst affected region, with transmitted resistance present in 11% of MSM, 6% of PWID and 7% of heterosexuals.

There was also a notable epidemic of transmitted resistance in South America, where prevalence in the key populations were 8% for MSM, 14% in PWID and 8% in heterosexuals.

High rates of transmitted resistance were observed among MSM in Oceania (Australia 16%), Eastern Europe/Central Asia (10%) and East Asia (8%).

A study in AIDS and Behavior by researchers from Brown University School of Public Health examines the male-to-male sex trade as a driver of HIV infection in Mexico, specifically focusing on condom use in MSM in Mexico city:
In his research, including detailed interviews and testing with hundreds of male sex workers on the city's streets and in its clinics, his team estimates that the prevalence of the virus among them could be as high as 40 percent. Because of inconsistent condom use and high degrees of infection among many sex workers, about 8 percent of their customers and other partners become infected each year. Infection can spread further from there.

But out of such seemingly bleak knowledge, Galárraga said, there is also hope. In a new study in AIDS and Behavior, Galárraga, lead author João Filipe G. Monteiro, and colleagues project that a 10-percent increase in condom use by HIV-positive male sex workers would reduce an 8 percent annual infection rate among their partners to 5.2 percent. Meanwhile, increasing the number of HIV-positive sex workers on antiretroviral medications by 50 percent would slash the infection rate among clients to 4.4 percent. More aggressive interventions could cut the rates further.

"There is universal access to HIV treatment in Mexico, so if this is implemented, especially among these key populations, it can really make a dent in the concentrated epidemic that Mexico has," Galárraga said.

NYU researchers examine the link between HIV, drug use, and tourism in the Caribbean, specifically in the Dominican Republic:
Insufficient attention has been paid to the intersection of drugs and tourism as contributing factors for the region's elevated HIV/AIDS risk. Caribbean studies have almost exclusively focused on drug transportation. Seldom acknowledged are the roles which drugs play in tourism areas which may be fueling the Caribbean HIV/AIDS epidemic.

Now a new study, "Illicit drug use and HIV risk in the Dominican Republic: Tourism areas create drug use opportunities," published in Global Public Health addresses this gap by conducting in-depth interviews with 30 drug users in Sosúa, a major sex tourism destination of the DR. The study's results suggest three themes: (1) local demand shifts drug routes to tourism areas, (2) drugs shape local economies and (3) drug use facilitates HIV risk behaviors in tourism areas.

The results of a study published in PLoS One detail how an intervention in South Africa reduced mother-to-child transmission of HIV:
The incidence of HIV infection in South Africa tops that of any nation in the world, with some 6 million of the country's nearly 50 million residents infected. Sadly, young women—and particularly young pregnant women—suffer some of the highest rates of HIV infection. More than one-fourth of pregnant South African women are infected with the virus; in some communities, the infection rates are even higher.

But those infection rates might be reduced—and the overall health of children improved—through community-based peer counseling programs...The study found that having specially trained lay community mothers from the Mentor Mother Programme make regular home visits to pregnant women, and later to those mothers and their infants, led to significantly better health outcomes 18 months later in both the mothers and their children.
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Among other outcomes, the study found that Mentor Mother home visits led to a 50 percent improvement by mothers in completing tasks designed to prevent mother-to-child transmission of the HIV virus, compared to mothers in the control group of the study who did not receive home visits, just clinic-based pre- and postnatal care.