Video: Step up the Pace for Women: Jordan Jarvis

Jordan Jarvis of the Young Professionals Chronic Disease Network (@NCDAction), speaks about why we need to step up the pace for women, HIV & AIDS, and noncommunicable diseases (NCDs). (Watch video.)

Join us Monday, July 21, 18:30-20:30, in plenary room 3.

Related

Women, HIV & AIDS, and NCDs: A Call to Action for Low- and Middle-Income Countries. (Not in Melbourne? Join the conversation online with hashtag #womenHIVNCDs.)

 

Video: Step Up the Pace for Women: Bob Chapman

Bob Chapman of the American Cancer Society talks about why we must step up the pace for women living with HIV and chronic diseases. (Watch video.)

Join us Monday, July 21, 18:30-20:30, in plenary room 3.

Related

Women, HIV & AIDS, and NCDs: A Call to Action for Low- and Middle-Income Countries. (Not in Melbourne? Join the conversation online with hashtag #womenHIVNCDs.)

 

 

Monday: Booth and Poster Presentations on PMTCT, Option B+, OVC; Satellite on Women, HIV, and NCDs

Poster Exhibition: Orphans and Vulnerable Children (OVC)

{Photo credit: Jessica Charles/MSH, Nigeria.}

CUBS Nigeria. {Photo credit: Jessica Charles/MSH, Nigeria.}

From 12:30 to 14:30 on Monday, July 21, meet MSH colleagues working with orphans and vulnerable children (OVC) in Nigeria and Lesoto.

At MOPE367, meet Megh Jagriti, senior technical advisor, Building Local Capacity (BLC) for Delivery of HIV Services in Southern Africa. His poster is called: “Evidence based OVC programming – optimizing resources and ensuring impact in Lesotho.”

At MOPE413, hear more about, “Using organizational capacity building to ensure the sustainability of community-based interventions for orphans and vulnerable children: lessons from the CUBS project in Nigeria.” (This poster by Obialunamma (“Oby”) Onoh will be presented today by an MSH colleague.)

Booth 312

Join us all day, Monday, July 21, in the exhibition centre at booth #312 for information and conversation on prevention of mother-to-child transmission (PMTCT) of HIV, including Malawi’s Option B+. (Learn more about Option B+ for PMTCT)

18:30 – Satellite Session on Women, HIV, and NCDs

Also on Monday: Join us for a special satellite session on women, HIV & AIDS, and non-communicable diseases (NCDs) at 18:30 in plenary room 3. Join the conversation on Twitter with hashtag #womenHIVNCDs.

[ MONDAY, JULY 21 | 18:30-20:30 in Plenary Room 3.]

Women, HIV/AIDS, and Non-Communicable Diseases

MONDAY, JULY 21 | 18:30-20:30 in Plenary Room 3

Co-sponsored by MSH, The American Cancer Society, and Medtronic.

Join us to examine and discuss addressing HIV co-morbidities in AIDS and non-AIDS related events; the role of health systems in integrating non-communicable disease (NCD) care into HIV care models; lessons that can be leveraged and applied beyond 2015; and how primary health care models can be adapted in this context of an emerging global burden of chronic NCDs while ensuring sustainability, cost-effectiveness, and efficiency in lower and middle-income countries.

Refreshments will be served.

 

 

Southern Africa Development Community to Host Monday Satellite 7 AM

Stephen Sianga [second from right], Director of the Southern African Development Community (SADC) and SADC representatives at Booth #330 at AIDS 2014. — in Melbourne, Australia.

Stephen Sianga [second from right], Director of the Southern African Development Community (SADC) and SADC representatives at Booth #330 at AIDS 2014. {Photo credit: Johanna Theunissen/MSH.}

Facebook gallery: AIDS2014: SADC

Rise and shine, AIDS 2014 delegates! Join the Southern Africa Development Community (SADC) on Monday, July 21, at 7:00 am in room 103 for a satellite session called “One SADC, One Vision, One Way: Walking the Talk.”

The SADC region is the epicenter of the global HIV epidemic. To date, 10 projects  financed by the HIV and AIDS Fund have been completed. The projects have, among things, increased capacity to address HIV prevention, scaled up PMTCT, and addressed access issues for key populations in SADC Member States. The knowledge generated from the projects will inform the region in developing evidence based policies/interventions and future strategies in the post 2015.

Panelists include representatives from Zambia, Zimbabwe, and Malawi. (Read complete session details.)

  • From policy to practice: SADC Member States making a difference. – D. Magure, Zimbabwe
  • Tangible results from domestically financed projects: Remembering young people, the future of tomorrow – “Needs, Challenges and Opportunities for Adolescents living with HIV in Southern Africa” – D. Cataldo, Malawi
  • Tangible results from domestically financed projects: Reaching communities – “Communicating HIV prevention: Empowering local communities to drive the HIV response in the SADC Region” – M. Chingona, Zambia
  • Working in unison: Together for greater impact . – M. Manganite, Zambia

Join the conversation in room 103!

SADC satellite session "Walking the talk" on Monday, July 21, 7:00 am, in room 103.

SADC satellite session “Walking the talk” on Monday, July 21, 7:00 am, in room 103. {Photo credit: Rachel Hassinger/MSH.}

Mourning

We send our heartfelt condolences to the families of everyone lost on MH17, including our HIV & AIDS colleagues en route to Melbourne.

The International AIDS Society released this statement today (Friday, July 18):

The International AIDS Society (IAS) today expresses its sincere sadness at receiving news that a number of colleagues and friends en route to attend the 20th International AIDS Conference taking place in Melbourne, Australia, were on board the Malaysian Airlines MH17 flight that has crashed over Ukraine earlier today.

At this incredibly sad and sensitive time the IAS stands with our international family and sends condolences to the loved ones of those who have been lost to this tragedy.

 

 

Stepping Up the Pace on Pediatric HIV & AIDS: “Treatment is Prevention”

This post also appears in the MSH Global Health Impact Blog.

On the eve of the 20th International AIDS Conference (AIDS 2014), Rachel Hassinger, editor of MSH’s Global Health Impact Blog, spoke with Dr. Scott Kellerman, global technical lead on HIV & AIDS, to discuss his latest research on prevention of mother-to-child transmission (PMTCT) of HIV and pediatric HIV & AIDS. Kellerman and colleagues will be attending AIDS 2014, July 20-25, in Melbourne, Australia. (Read more about the conference.)

RH: What is the state of HIV & AIDS globally?

[Scott Kellerman]
SK: We are at the threshold of a sea change. In the beginning, our HIV prevention tool box was sparse. We could offer extended counseling and condoms, and impart information, but not much else. Behavioral change was the cornerstone of tackling the epidemic. It worked sometimes, but, not consistently.

Now biomedical advances are propelling treatment as prevention—even what I call “treatment IS prevention”.

Where we used to see mothers unable to access treatment and die, now, more often than not, we see mothers, even in remote communities, survive. We also see infants of HIV-positive women born HIV-free.

RH: That’s inspiring—a decade or two ago, that wasn’t the case.

SK: Yes, overall, our global response to HIV & AIDS is maturing and recent advances are extremely exciting—but not fast enough. We still fall far short of our treatment and, by extension, our prevention goals.

As I think about previous AIDS conferences, I recall a palpable tension between the “prevention” camps who were advocating for more prevention funding and the “treatment” camps who saw the future of control of the epidemic in more treatment funding.  Cries of “you can’t treat your way out of this epidemic!” rang out in conference halls. Perhaps the most striking thing about the maturation of our response is that our community is coming to the conclusion that treatment IS prevention.

Take PMTCT and Option B+.

Option B+ is an approach to preventing mother-to-child transmission [MTCT] that offers all HIV-infected pregnant and breastfeeding women antiretroviral therapy [ART] for life, regardless of CD4 count.

PMTCT has long been “treatment is prevention.” By treating the mother during pregnancy and breastfeeding with ART, we are preventing her infant from acquiring the virus from her. That much isn’t new—both Options A and B use treatment of the mother to prevent mother-to-child transmission.

Option B+, developed in 2011, takes this a step further. The government of Malawi, with technical support from MSH—including my colleague, Dr. Erik Schouten—developed Option B+ out of necessity. Fertility rates are high in Malawi, and CD4 testing capabilities are minimal—and slow, at best. By offering treatment for life to an HIV-positive pregnant or breastfeeding woman regardless of CD4 count, it has raised the standard for other countries to follow.

We now see many countries in Africa and elsewhere adopting this strategy.

Option B+ also says: the country understands that the woman’s life is critical for the well-being of the children and commits to treating the mother for her HIV infection, as well as providing prophylaxis for the infant. It really raises the emphasis on the health of women as key to the health of the family, the community, and the nation. It’s the right thing to do.

RH: At the AIDS 2012 conference two years ago, Option B+ was the talk of the conference! What’s happening now?

SK: Global support for Option B+ is building—but only recently. The WHO [World Health Organization] included B+ in the 2013 treatment guidelines.

RH: So, how close are we to reaching an AIDS-free generation?

SK: Honestly, I feel that we are close to an AIDS-free generation—it is within our human reach—if the international community addresses the epidemic together from every angle, and thinks outside the box.

The end is in sight for eliminating maternal to child transmission [MTCT] and pediatric HIV.  But even if we reach this lofty goal, how will we know?

RH: That’s what you and colleagues are testing now, correct?

SK: Exactly. There’s several promising approaches to measure the effectiveness of PMTCT—and Option B+, in particular—that MSH and colleagues are pursuing. In one study, published in PLOS ONE last month, we show the potential for routine testing at immunization clinics to monitor mother-to-child transmission (MTCT) of HIV in Malawi.

The study also shows the potential of regular data collection as a surveillance tool to assess changes in effectiveness of prevention of MTCT (PMTCT) as Option B+ is scaled-up across the country.

RH: Is this a new method for monitoring transmission?

SK: Yes, it is. We [MSH and colleagues] derived population-based estimates of the HIV vertical transmission rate (VTR) by testing a sample of infants less than 3 months old at their first immunization visit at 53 randomly chosen clinics in four Malawian districts. Comparing the population-based estimate of VTR to the results of subsequent evaluations of the national program will allow Malawi to assess trends in the effectiveness of the national PMTCT program, and by extension, the effectiveness of Option  B+.

The approach can be expanded to track programming effectiveness for young infants over time in Malawi, and in other countries adopting Option B+. You can read more about the study in the press release or directly in PLOS ONE where it’s downloadable for free.

We’re also partnering with the CDC [US Centers for Disease Control and Prevention] on a four-year research evaluation to determine HIV-free child survival following Malawi’s initiation of Option B+. The study will follow 37,000 Malawian mother-infant pairs and measure the rates of mother-to-child transmission in HIV-exposed infants at 4 to 12 weeks, 12 months, and 24 months of age, and HIV-free survival at 6 to 12 weeks, 12 months, and 24 months of age. In addition to supporting this research evaluation of Option B+, we support district-level health systems strengthening and country efforts to provide HIV testing, counseling, and treatment to the prison population.

We’re supporting the Governments of Ethiopia and Uganda to scale-up their roll-out of Option B+, too. In Ethiopia, for example, we’ve supported implementation of Option B+ in 276 health centers.

RH: So, we’re supporting progress on implementation and research of Option B+ for PMTCT.

SK: Yes, but reaching an AIDS-free generation is not just about PMTCT.

Even with an absolutely perfect PMTCT system—that identifies and treats every infected mother presenting for antenatal care—there are many women who never make it into antenatal care, are never seen by a health worker during their pregnancy, and never get a chance to be tested or understand how to protect their children from being born with HIV.

The AIDS Journal featured a series of papers on pediatric HIV, written by an amazing array of researchers and thinkers. In the set of articles, we show, among other things, that the infrastructure and health systems that are responsible for caring for kids are really suffering. It comes down to health systems strengthening, not only for adults but also for pediatric care systems—which are separate from those for adults, and are often much less resourced. I guest edited the supplement last fall—and its downloadable for free.

Until now, the primary response to pediatric HIV has been to further strengthen PMTCT programming, which is a critical intervention, and one that is close to my heart. But a lot of kids are missed by PMTCT.

There’s no PMTCT without antenatal care and HIV testing. There’s no PMTCT without stronger health systems.

RH: Can you give an example?

SK: Our HIV work is part of our whole systems approach in many countries. In Ethiopia, for example, about 790,000 Ethiopians are living with HIV. Through one of our projects [ENHAT-CS], we’re supporting the government’s efforts to scale-up comprehensive HIV & AIDS services at health centers and integrate them with other health services, such as maternal, newborn, and child health. ENHAT-CS supports mother support groups in over 80 health centers. HIV-positive women—“mother mentors”—lead the groups. Data show a beneficial effect of mother mentors and mother support groups on uptake of and adherence to HIV care and support and reduced vertical transmission rates among HIV-positive women. And four of the mother mentors in Ethiopia received international recognition for their life-saving work.

Through the SIAPS program, [Systems for Improved Access to Pharmaceuticals and Services Program], we’re partnering with the Ethiopian Government to improve information systems at hundreds of ART clinic pharmacies to improve HIV patient care and adherence to treatment.

We’ve actually been working in partnership with Ethiopia saving lives for 10 years.

Watch video

RH: The state of global funding is shifting. Since the creation of PEPFAR [the US President’s Emergency Plan for AIDS Relief], the US and global communities have concentrated a lot of money into reducing the HIV & AIDS epidemic, more than for any other area of global health. This year, newly appointed Ambassador Deborah Birx, MD, US Global AIDS Coordinator, reiterated this shift, noting that PEPFAR’s congressional mandate calls for half of funds to go directly to treatment.

If there is a continued push toward treatment, what happens to the other parts of the whole? 

SK: We’ve built an incredible system around fighting AIDS: structures of concentric programming circles with HIV prevention and treatment programs aimed at the individual in the middle, but with considerable resources directed at the myriad societal structures that often inhibit people in need of basic care and treatment.

With flat lined or diminishing resources, there’s a renewed focus on increasing the efficiency and getting back to basics—putting pills into people’s mouths, focusing on key populations: men who have sex with men, sex workers, IV-drug users; and eliminating pediatric HIV. It is time that we shift our thinking from a vertical siloes approach, to a cross-cutting, diagonal whole.  When it comes down to it, HIV is an infectious disease and we know how to treat it. We can’t keep funding everything.

The question is: How do we increase the efficiency of the AIDS response? And how can we leverage these structures to improve other health areas—the whole person?

We can integrate HIV & AIDS services with other health services—like maternal and child health, tuberculosis, and family planning. Instead of building three separate clinics–a reproductive health clinic next to a tuberculosis (TB) clinic next to an HIV & AIDS clinic–build a clinic that provides quality, integrated services for all of these essential needs. Train community drug shop owners, so that a person living with HIV in a rural community, can pick up pills safely. We’re not the only ones who are doing this well. Many of my colleagues in other organizations are working hard to integrate services and increase efficiencies, too. We can work together to leverage these systems to provide services for multiple health areas, MNCH, TB, family planning, and chronic diseases.

The cost of AIDS medicines has decreased, and coverage for treatment is the norm in many low- and middle-income countries. And, we still have more to do to ensure access for the poor and most vulnerable. Programs like the Malawi prison effort, and the Ethiopian religious leaders and mother mentors are helping to ensure that more and more, people are testing voluntarily for HIV, and getting treatment. But stigma and discrimination are still major issues.

RH: What about HIV & UHC?

SK: We’ll be talking a lot with partners and colleague about universal health coverage (UHC) in the post-2015 development framework at the AIDS 2014 conference. There’s a breakfast on Tuesday [July 22] on building UHC on lessons learned from the AIDS response. You can learn more about the UHC breakfast, and other MSH AIDS2014 events.

RH: What else will you and colleagues be talking about at AIDS 2014?

SK: We’re co-sponsoring three evening sessions [6:30 pm] on Monday, Wednesday, and Thursday. On Monday [July 21], the conversation will focus on women, HIV & AIDS, and non-communicable diseases; on Wednesday [July 23], supply chain for HIV & AIDS medicines and commodities; and on Thursday [July 24], HIV & TB.

And, before the conference begins, I’ll be speaking at an event about PMTCT and pediatric HIV—and on the importance of research and development for stepping up the pace. Our data systems are still primarily designed to count the number of things done, not measure progress toward goals.

We need more research on pediatric HIV, like the article in PLOS ONE outlining a design to measure population-based vertical transmission rates; the AIDS journal supplement focused on PMTCT and pediatric HIV; and the ongoing CDC-supported evaluation to measure the efficacy of Option B+.

As we get closer to our goals of eliminating mother-to-child transmission, these studies could help numerous sub-Saharan Africa countries measure progress toward keeping infants HIV-free.

Follow Scott Kellerman and MSH colleagues throughout AIDS 2014

 

AIDS 2014: High-level Speakers Announced, Mark Your Calendars

This post also appears in the MSH Global Health Impact Blog.

Guess who’s coming to the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia, July 20-25?

President Bill Clinton, 42nd President of the US and founder of the Clinton Foundation; activist Sir Bob Geldof; Michel Sidibé, Executive Director of UNAIDS; and Ambassador Deborah Birx, US Global AIDS Coordinator of US President’s Emergency Plan for AIDS Relief (PEPFAR), are among confirmed high-level speakers.

MSH is coordinating three satellite events with partners, presenting numerous posters, hosting a booth (#312) at the exhibition hall, and providing live blog coverage of the conference. And, MSH President & CEO, Dr. Jonathan D. Quick, will introduce the Hon. Michael Kirby for the Jonathan Mann Memorial Lecture during the Opening Plenary Session. Be sure to add these MSH events as your build your online itinerary with the program-at-a-glance.

Subscribe to our email list and we’ll send more details closer to the conference about how you can connect with us at AIDS 2014.

Visit the MSH conference blog for updates in realtime. (We’ll be tweeting @MSHHealthImpact with hashtag #AIDS2014.)

Ian Lathrop contributed to this content.

Related

New Study by MSH Published by PLoS One Evaluates Impact of Option B+ for PMTCT in Malawi through Immunization Clinic-Based Surveillance

Watch video: 10 Years of Partnership to Save Lives in Ethiopia

More about our work on HIV & AIDS

Join us at AIDS 2014!

Join us at the 20th International AIDS Conference in Melbourne, Australia! From July 20-25, MSH and our partners will participate in plenaries, satellite sessions, poster presentations, and exhibition hall events. At this year’s conference, MSH is coordinating and participating in three satellite events.

 

WOMEN, HIV/AIDS, AND NON-COMMUNICABLE DISEASES

MONDAY, JULY 21 | 18:30-20:30 in Plenary Room 3

Refreshments will be served. Co-sponsored by MSH, The American Cancer Society, and Medtronic, this session will examine what we know about addressing HIV-comorbidities in both AIDS and Non-AIDS related events; the role of health systems in integrating NCD care into HIV care models; determine which lessons could be leveraged and applied beyond 2015 in the context of an emerging global burden of chronic NCDs; and to discuss how primary health care models can be adapted in this context while ensuring sustainability, cost-effectiveness, and efficiency in lower and middle-income countries.

GLOBAL HEALTH TRANSFORMATION: BUILDING UHC ON THE LESSONS OF THE AIDS RESPONSE

TUESDAY, JULY 22 | 07:00-08:30 in Room 104

Breakfast will be served  The HIV/AIDS response transformed the world’s understanding of what’s possible in health and what’s necessary to achieve change. Today, prominent stakeholders in global health, including many low- and middle-income countries, are adopting universal health coverage (UHC) as a new health sector priority. For UHC to succeed as a transformative global health movement, the UHC movement must employ lessons from the HIV/AIDS response in improving access, safeguarding rights, and benefiting vulnerable and marginalized populations. Please join Management Sciences for Health and the International HIV/AIDS Alliance for an interactive panel discussion on what the UHC movement can learn from the HIV/AIDS response. Features keynote from the Hon. Michael Kirby and distinguished speakers from MSH, International HIV/AIDS Alliance, World Bank and more!

THE ROLE OF THE PRIVATE SECTOR IN STEPPING UP THE PACE OF SUPPLY FOR HIV/AIDS COMMODITIES

WEDNESDAY, JULY 23 | 18:30-20:30 in Plenary Room 111-112

Co-moderated by Gordon Comstock, Sr. Principal Technical Advisor, Supply Chain Management Systems Projec The global community is well on its way to reaching the agreed target of 15 million people on treatment by 2015. At the same time, many are challenging the traditional roles of central medical stores and ministries of health in procuring, storing, and distributing public health commodities. Organized by the Partnership for Supply Chain Management, of which MSH is a part, this satellite will explore the increasing role that local, regional, and international companies are playing in the delivery of medicines, test kits, laboratory supplies, and other health commodities and helping meet the global target of 15 million on treatment by 2015.

LEARNING THE LESSONS FROM HIV FOR IMPROVED TB CONTROL AND BEYOND

THURSDAY, JULY 24 | 18:30-20:30 in Room 101

Keynote speech: “How HIV Successes Have Improved South Africa’s Health Care” – Dr. Yogan Pillay, Deputy Director General, National Department of Health, South Africa

Join MSH’s Bada Pharasi, South Africa Country Representative, and many others for a networking and drinks reception to launch Strengthening Health Systems.