IHSJ Reader, July 22, 2011

IHSJ Reader     July 2011     Issue 5          

Note: Triple asterisk (***) indicates subscription-only sources.

HAITI

As Cholera Surges in Haiti, Aid Withers Away (Richard Knox, NPR, July 15, 2011)
As the rainy season carries on, cholera continues to plague Haiti . The Haitian Ministry of Health reports that cases more than tripled between April and June, with high concentrations in rural communities. It appears that support and programs for cholera prevention and treatment have not kept pace with the expansion of the epidemic. For more information about the underlying causes of cholera in Haiti and how it can be stopped, visit: http://act.pih.org/choleraupdate and read Louise Ivers’ blog post describing the critical situation in the Central Plateau and Lower Artibonite at: http://www.pih.org/news/entry/with-choleras-return-dr.-ivers-reflects-on-9-month-effort.  

Haiti After the Earthquake (Paul Farmer, Public Affairs, July 12, 2011)
Paul Farmer's latest book provides an intimate account of events following the catastrophic January 12, 2010 earthquake in Haiti. Paul’s first-person narrative of the “acute-on-chronic” disaster reveals how Haiti’s vulnerability is rooted in a history of structural violence: foreign invasion, neoliberal economic policy, illegitimate debt, adverse social conditions, ecological degradation, and an underfunded public sector. He highlights the influx of support for Haiti from the international community while offering a pointed critique of the lack of support for the Government of Haiti and providing solutions for improving aid to Haiti within a broader vision of reconstruction and renewal. Paul’s reflections on Haiti’s past, present and future are followed by 11 moving essays from clinicians, humanitarians and those personally affected by the quake.

MENTAL HEALTH

Grand Challenges in Global Mental Health (Nature, July 7, 2011)
Results from a study conducted by the US National Institute of Mental Health calls for increased investments across all countries in preventing and treating mental, neurological, and substance abuse (MNS) disorders and sets 25 grand challenges to improving mental health. The global burden of MNS disorders is disproportionately felt in low and middle-income countries where the weak health systems often lack the capacity to provide care. Partners In Health works in low-resource settings to integrate mental health care and psychosocial support into comprehensive health services.

HEALTH SYSTEMS STRENGTHENING/FINANCING

In Sierra Leone, Heartening Progress for Pregnant Women (Adam Nossiter, New York Times, July 17, 2011)
On April 27, 2010, Sierra Leone eliminated health user fees (facility-based or co-payments) for pregnant women, new mothers, and children under five years old. The results, according to DFID senior health economist Robert Yates, have been “nothing short of spectacular”. The increased health service utilization--including a 214% increase in children receiving care at health facilities--has already resulted in significant reductions in maternal mortality and malaria-induced fatalities.  Though financing gaps remain for the health system, Sierra Leone is an example of how to provide free health care for the very poor and vulnerable, with good planning and financial backing from political leaders and international donors.

***The Impact of Reducing Financial Barriers on Utilisation of a Primary Health Care Facility in Rwanda (Ranu Dhillon, Matthew Bonds, Max Fraden, Donald Ndahiro, Josh Ruxin, Global Public Health, July 6, 2011)
Though the government of Rwanda has greatly expanded access to health care, the community-based health insurance program requires point-of-service co-payments on a sliding scale which can significantly deter patients from seeking care. This article examines the effect of subsidizing these fees and finds that by removing financial barriers, utilization rates tripled. The results highlight the fact that requiring a co-payment, however slight, prohibits patients from seeking care.

HIV/AIDS

Pivotal Study Finds That HIV Medications are Highly Effective as Prophylaxis Against HIV Infection in Men and Women in Africa (University of Washington Partners PrEP Study, July 13, 2011)
Results were released last week that should have a groundbreaking effect on approaches used to prevent HIV infections. The pre-exposure prophylaxis (PrEP) study, led by the University of Washington’s International Clinical Research Center, found that the likelihood of becoming infected with HIV was cut by more than half among uninfected individuals who took HIV/AIDS drugs daily as preventive therapy. These exciting findings confirm and expand on results announced by the Center for Disease Control: http://www.hanc.info/resources/Documents/CDC%20TDF2%20Media%20Materials.pdf. With medical advances come the questions of which populations to target with initial programs and how to ensure that those who stand to benefit the most from PrEP will have access to the medications that dramatically prevent transmission.

Medicines Patent Pool Signs License Agreement with Gilead to Increase Access to HIV/AIDS Medicines (Medicines Patent Pool and UNITAID Press Release, July 12, 2011)
The first-ever license agreement between a pharmaceutical company, Gilead, and a Medicines Patent Pool (MPP) was announced on July 12. The MPP can now offer licenses to Indian companies to make generic versions of five HIV/AIDS medications, three of which are still in the pipeline. Though the Gilead license agreement to the MPP is an important step towards achieving universal access to essential medications, there are limitations. Areas for improvement include: (1) expanding the territorial scope of the agreement to include all low- and middle-income countries; (2) expanding manufacturing partners beyond Indian generic companies; (3) expanding sourcing for active pharmaceutical ingredients beyond Gilead other Indian licensees; and (4) reducing royalties in countries without patents.  PIH applauds the progress of the MPP and encourages other patent holders to swiftly follow suit. For more analysis, see Tina Rosenburg’s “Sharing Patents to Wipe Out AIDS”: http://nyti.ms/oMwZid.

TUBERCULOSIS

An Evaluation of Drug-Resistant TB Treatment Scale-Up (Partners In Health, Medicins Sans Frontieres, Treatment Action Group, July 6, 2011)
Partners In Health, Medecins Sans Frontieres (MSF) and the Treatment Action Group (TAG), released a report assessing reasons for the slow progress of expanding detection and treatment of multidrug-resistant tuberculosis (MDR-TB). The report also provides recommendations for improving programs. In 2008 there were an estimated 440,000 cases of MDR-TB; but the World Health Organization estimates that less than 1% received adequate treatment and a mere 7% of these cases were reported.

What is Thwarting Tuberculosis Prevention in High-Burden Settings? (Edward Nardell and Gavin Churchyard, The New England Journal of Medicine, July 7, 2011)
Ongoing transmission and reinfection are fundamental factors inhibiting tuberculosis prevention in high burden settings. Intensified case finding and rapid diagnosis can control these high rates of transmission and reinfection and ensure effective treatment through the use of new Xpert MTB/RIF technology. PIH continues to work in partnership with our sister organizations to strengthen MDR-TB care in the resource poor settings by increasing the capacity for rapid diagnosis tests.

MULTIMEDIA

Paul Farmer Examines Haiti ‘After the Earthquake’ (WBUR, July 11, 2011)
Listen to Paul Farmer discuss his new book, Haiti After the Earthquake, on NPR’s Fresh Air. In this interview, he reflects on the critical challenges following the January 12, 2010 earthquake, including a weak and underfunded public sector, and the devastating cholera epidemic which "exploded like a bomb" last October.  Paul stresses Partners In Health’s commitment to working in partnership with the government to generate jobs and strengthen public sector institutions. Near the end of the interview, Paul points to lessons learned from the Rwandan experience that should inform Haiti’s rebuilding process.