Kaisernetwork.org (Washington, DC)
23 June 2008
Global Challenges
G8 Countries To Discuss Health Worker Shortages, Set Targets During July Summit
[Jun 23, 2008]
The Group of Eight industrialized nations plans to discuss setting numerical targets to address the global shortage of health workers, particularly in Africa and Asia, during its July summit in Japan, the Kyodo News reports. According to sources close to the negotiations, G8 members are considering including in a set of guidelines the World Health Organization goal of having at least 4.1 health service providers and support workers per 1,000 people by 2015. Of the 4.1 providers, 2.3 would be health workers such as physicians, nurses and midwives, according to Kyodo News.
Although the G8 does not plan to make new commitments to address health worker shortages, it likely will mention the WHO figures as a target for strengthening its financial and other support to train and retain health workers, the sources said. They added that a draft of the plan stresses the urgency for international cooperation, while also calling for a better method to deliver aid because this year marks the midpoint of the United Nations Millennium Development Goals. The draft also emphasizes the need for a multisectoral approach to lessen health worker shortages -- a target included in the MDGs along with other development goals, such as curbing the spread of HIV/AIDS, tuberculosis and malaria. Representatives from G8 countries also are discussing implementing a "follow-up mechanism," such as having an annual report to ensure accountability. However, the lack of comprehensive plans to secure basic infrastructures; train physicians, nurses and other health workers; and provide funds to retain a skilled work force through better salaries remain issues in efforts to reduce the shortage.
According to the Kyodo News, 57 countries, mostly in Africa and Asia, face severe health work force crises. Although sub-Saharan Africa has 11% of the world's population and 24% of the global burden of disease, it has 3% of the world's health workers. WHO estimates that filling the shortage in Africa would require training 1.5 million additional health workers, which would cost at least $7 billion annually (Tang, Kyodo News, 6/22).
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Drug Access
India's Patent Office Rejects Boehringer's Application for Pediatric Antiretroviral
[Jun 23, 2008]
India's Patent Office in New Delhi earlier this month rejected German drug maker Boehringer Ingelheim's application for a pediatric version of the antiretroviral drug nevirapine, consequently allowing local generic pharmaceutical companies such as Aurobindo and Cipla to continue marketing low-cost versions of the medicine in the domestic market, the Business Standard reports. The decision follows objections to the potential patent from civil society groups in the country (Mathew, Business Standard, 6/20).
According to the Lawyer's Collective, a New Delhi-based socio-legal group, this is the first decision on 13 patent oppositions filed by civil society groups against HIV-related drug applications (Economic Times, 6/20). The Indian Network for People Living With HIV/AIDS and the Positive Women's Network in 2006 filed a pre-grant opposition to Boehringer Ingelheim's application, arguing that it was not patentable under the Indian Patent Law (Mukherjee, Times of India, 6/20). The law states that new forms of known substances cannot be patented unless their efficacy has been significantly enhanced (Economic Times, 6/20). According to the Times of India, if the patent had been granted, the price of pediatric nevirapine could have increased.
P. Kousalya, president of PWN, said, "We opposed the patent application on nevirapine hemihydrates (syrup) to ensure that it remains available for our children and to make sure that the government doesn't say it is too expensive to provide" (Times of India, 6/20). Kousalya also said, "Accessing appropriate pediatric formulations of AIDS drugs is a particular problem around the world, and we hope this decision can be a first step in making them more available." K.K. Abraham, president of INP+, said he hopes other patent offices throughout the country "will take note of this decision and subject other patent applications on important medicines to strict scrutiny" (Business Standard, 6/20).
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Across The Nation
Delaware House Approves Bill That Would Mandate HIV Testing for Accused Sex Offenders
[Jun 23, 2008]
The Delaware House recently approved a bill (HB 424) that would require HIV testing for sexual assault defendants under certain circumstances, the AP/Bethany Beach Wave reports. According to bill sponsor Rep. Debbie Hudson (R), the measure would allow assault survivors to begin prophylactic treatment immediately (AP/Bethany Beach Wave, 6/19). The bill, which passed the House Judiciary Committee earlier this month, would amend an already existing state law and require an accused sex offender to submit to HIV testing within 48 hours of arrest if requested by the alleged assault survivor or a court order. If considered appropriate, the defendant also would have to submit to follow-up tests, even if initial tests were negative.
Unlike the existing law, some indication that HIV might have been transmitted, such as an exchange of bodily fluids, would not be necessary before a defendant undergoes testing. The bill also would mandate testing around the time of arrest, instead of around the time of arraignment, when a defendant is more likely to be represented by an attorney. In addition, a defendant would be required to pay the cost of testing unless deemed unable to do so (Kaiser Daily HIV/AIDS Report, 6/9).
If approved, the bill would allow the state to apply for federal grants under the Violence Against Women Act, the AP/Beach Wave reports (AP/Bethany Beach Wave, 6/19).
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Science & Medicine
Treating Genital Herpes Does Not Reduce Risk of HIV, Study Finds
[Jun 23, 2008]
Treating genital herpes does not reduce the risk of HIV, according to a study published on Friday in the journal Lancet, the AP/Newsweek reports (Cheng, AP/Newsweek, 6/19). Herpes simplex virus-2 has been shown to increase the risk of HIV by as much as threefold, so the researchers examined whether treating HSV-2 might reduce the risk of HIV, Bloomberg reports.
For the study, Connie Celum of the University of Washington-Seattle and colleagues enrolled 3,172 men and women in Africa, Peru and the U.S. (Britt, Bloomberg, 6/20). All the participants were HIV-negative and HSV-2-positive at the start of the study. The researchers enrolled participants who had similar HIV/AIDS risk levels, and the participants were questioned monthly about risky sexual behavior with recent partners.
About 50% of the participants were given aciclovir, a drug that can suppress outbreaks of HSV-2, and half were given a placebo. The study -- funded by NIH's National Institute of Allergy and Infectious Diseases, GlaxoSmithKline and other government agencies -- found that the participants given aciclovir were not less likely to contract HIV than those given placebos. The study found that after a year-and-a-half, 75 people out of the 1,581 participants who received the drug contracted HIV, compared with 64 in the placebo group (AP/Newsweek, 6/19). In addition, the researchers found that aciclovir reduced genital ulcers by 47% and genital ulcers linked with HSV-2 by 63%.
"Our results show that suppressive therapy with standard doses of aciclovir is not effective in reduction of HIV-1 acquisition," Celum said, adding, "Novel strategies are needed to interrupt interactions between HSV-2 and HIV-1." Researchers need to determine why the drug failed to reduce the risk of HIV and did not reduce genital ulcers as much as expected, Celum noted. She said that it might be because the drug is not absorbed well or because it is metabolized too quickly (Bloomberg, 6/20). According to the AP/Newsweek, the study's findings do not "necessarily mean that the theory of treating herpes to avoid HIV is incorrect," according to researchers. "It's probably likely that we need considerably more potent interventions than we have," Celum said.
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