Kaisernetwork.org (Washington, DC)
5 January 2009
Across The Nation
New York Times Examines Pilot HIV Testing Program in Emergency Departments
[Jan 05, 2009]
The New York Times on Sunday examined a CDC pilot program that began Dec. 1, 2008, at three Connecticut hospital emergency departments and provides no-cost HIV testing to patients. Connecticut is one of 26 states participating in the program -- which offers testing regardless of whether HIV symptoms are present -- at EDs, community health centers and clinics for sexually transmitted infections.
The hospitals involved in the program will conduct routine HIV testing for a two-year period, after which the program might be expanded to other hospitals. According to the Times, CDC in 2006 revised its guidelines to recommend routine HIV testing for patients ages 13 to 64. CDC estimates that about 25% of the 1.1 million people living with the virus in the U.S. are unaware of their HIV status. Steven Aronin -- medical director of the Infectious Diseases Clinic at Waterbury Hospital, which is participating in the program -- said Connecticut has a disproportionate number of people living with HIV/AIDS and ranks fifth nationwide in the number of cases per capita. Aronin said cities such as Bridgeport, New Haven and Waterbury have the most HIV cases, with Waterbury having as many as 1,200 HIV-positive residents, 300 of whom are unaware of their status. The other two Connecticut hospitals involved in the program are Yale-New Haven Hospital and Lawrence & Memorial Hospital in New London, Conn.
According to the Times, the traditional role of EDs has been to provide "triage for the sick and injured and not to act as testing facilities" for STIs. However, the Times reports that some physicians have said that role might "have to change as [EDs] become the only place the uninsured and low-income patients ever have contact with physicians." Some physicians have been "skeptical" of adding STI testing to the workload of EDs, which are already overcrowded, but physicians involved in the pilot program are "optimistic it will work," the Times reports. Chris Andresen, a manager with Connecticut's Department of Public Health's AIDS and chronic disease unit, said that 20 people who were unaware of their HIV status have tested positive in the last year through the program, which has already been operating in the state through the same federal funding as the pilot program. He said, "The early intervention is key. If they find out early, they can stay healthier longer and not transmit it to others" (Gordon Fox, New York Times, 1/4).
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Hawaii Grant Helps AIDS Research Program Recover After Losing Federal Funding
[Jan 05, 2009]
The Hawaii AIDS Clinical Research Program has raised more than $20 million to support research and care for HIV-positive people since 2007 when the state Legislature allocated $1.2 million to the program after it lost a $1.6 million grant from the National Institute of Allergy and Infectious Diseases because some clinical trial units were closed, the Honolulu Star-Bulletin reports.
Cecilia Shikuma, director of the program and a professor of medicine at the University of Hawaii, said the program lost access to data management and other services when it lost federal funding and has "had to reinvent for our site how to do all those things." Shikuma said that although it has been "hard work" to adjust to the funding changes, program officials are "very pleased" with the outcome. She added that the program is "still financially shaky but it's allowing us to survive."
According to the Star-Bulletin, the program is designed to create and maintain an HIV research program that is nationally competitive and to provide access to and improve health care for people living with HIV/AIDS. There are more than 2,700 HIV-positive people living in Hawaii, and the clinic provides services for about 439 patients on Oahu and the neighboring islands. According to Shikuma, a "needs-assessment" study conducted by the program to examine how HIV care can be maintained in areas that lack HIV specialists found that Hawaii "faces particular problems in maintaining an adequate HIV medical care delivery system" because of the "relatively small" and "geographically segment[ed]" population of people living with the virus, the aging of physicians in the community who provide HIV care and the "lack of interest in HIV specialization among young physicians." The program recommended a system that allows people living with HIV, particularly in rural areas, to recover from the departure of a physician and to offer multiple patient care options.
According to the Star-Bulletin, the program is one of eight university sites funded by the National Heart, Lung and Blood Institute to examine the effects of HIV on cardiovascular risk and study ways to decrease the risk. The program also conducts HIV training and research in Southeast Asia in partnership with the South East Asia Research Collaboration with Hawaii and trains Vietnamese military physicians to address HIV/AIDS cases through the Vietnam President's Emergency Plan for AIDS Relief program. Shikuma said the program plans to apply for a new federal grant from NIH in 2009 (Altonn, Honolulu Star-Bulletin, 12/24/08).
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In The Courts
Court Orders California To Implement Program Providing Care to HIV-Positive People
[Jan 05, 2009]
A Superior Court judge in Los Angeles late last month ruled that the California Department of Health Care Services must provide medical care to low-income state residents living with HIV in compliance with a 2002 state law, the AIDS Healthcare Foundation announced, Bloomberg reports (Pettersson, Bloomberg, 12/23/08). The ruling follows a Dec. 5 decision by the Los Angeles County Superior Court that said DHCS failed to enact the 2002 state law (AB 2197) that calls for the implementation of a program to provide medical care to low-income HIV-positive people. The Dec. 5 ruling came in response to a lawsuit filed last year by AHF claiming that DHCS failed to expand coverage under Medi-Cal, the state's Medicaid program, to HIV-positive residents who had not developed AIDS.
The law, signed by former Gov. Gray Davis (D) in September 2002, calls for the state to provide full Medi-Cal benefits to HIV-positive people who already are enrolled in the state's AIDS Drug Assistance Program, "who are not disabled and who would otherwise qualify for benefits under the Medi-Cal program." Before the law was passed, only people with an AIDS diagnosis who were considered disabled were eligible for benefits under Medi-Cal. To fund the program's expansion, the law suggested moving Medi-Cal beneficiaries with AIDS from the current fee-for-service system to a less expensive managed care program. The money saved would go toward financing the expansion of Medi-Cal benefits to people with HIV (Kaiser Daily HIV/AIDS Report, 12/5/08).
In a statement, AHF President Michael Weinstein said, "Despite an excellent record on AIDS issues," Gov. Arnold Schwarzenegger (R) "has been ill-served by his administration, which for six years has failed to enact this crucial -- and ultimately cost-saving -- health care legislation." DHCS spokesperson Anthony Cava said it was not possible to implement the law in a "cost-neutral environment" and that the law was "very clear that it should not be implemented if the costs could not be offset by savings." Cava added that DHCS "will continue to work with its partners to implement the law in a cost-neutral manner, just as the legislature intended" (Bloomberg, 12/23/08).
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Science & Medicine
HIV-Positive Infants More Likely To Develop TB, Study Finds
[Jan 05, 2009]
HIV-positive infants are about 20 times more likely to develop tuberculosis than infants without HIV, according to a study recently published in the journal Clinical Infectious Diseases, Reuters/Yahoo! News reports. Researchers from the Desmond Tutu TB Center at Stellenbosch University in South Africa, led by Anneke Hesseling, analyzed the prevalence of HIV and TB among infants attending the hospital between 2004 and 2006. The researchers found that 245 infants were confirmed as having TB, and they estimated that the incidence of TB was 1,596 cases per 100,000 population among HIV-positive infants and 65.9 cases per 100,000 population among HIV-negative infants. The report said, "HIV-infected infants were at a 24.1-fold higher risk of pulmonary tuberculosis and a 17.1-fold higher risk of disseminated tuberculosis."
Hesseling suggested that the higher TB incidence among the HIV-positive infants could be explained by their increased exposure to TB, immune depression associated with HIV and reduced efficacy of the BCG vaccine. She added that one way to reduce the incidence of TB among infants born to HIV-positive women is to implement TB testing among pregnant women. Hesseling also suggested routine HIV testing among infants with TB, prophylactic treatment for TB, improved HIV treatment access and newer vaccines as methods to curb the spread of TB (Shankar, Reuters/Yahoo! News, 12/29/08).
An abstract of the study is available online.
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PBS Program Features Discussion of HIV/AIDS
[Jan 05, 2009]
PBS' The Charlie Rose Show last week featured a discussion with David Ho -- director of Aaron Diamond AIDS Research Center -- and Anthony Fauci -- director of NIH's National Institute of Allergy and Infectious Diseases -- about new approaches to curbing the spread of HIV/AIDS and the search for a vaccine. Fauci said that the HIV/AIDS epidemic is still a "great challenge" but that "the greatest advances have been made in the development of therapies which, if given appropriately to people, can really transform the lives of HIV-[positive] individuals." However, he added, "The sobering news is ... for every person who gets on therapy, you have a few more who get infected." Fauci said that prevention, especially with a vaccine, is "one of the major challenges," adding, "We've come a long way, but there is much, much more to be done."
Ho agreed with Fauci, saying that therapeutic advances have been substantial in the U.S. and other wealthy countries, making HIV/AIDS "a very manageable disease, even though we don't have a cure." He added, "But the holy grail in AIDS research is to come up with a vaccine that will work ... I think it's still a couple of years away."
The program included a further discussion about efforts to develop a vaccine, which Fauci said includes scientific obstacles that he is "cautiously optimistic" researchers will be able to move past. He also said that scientists are examining different types of approaches, including pre-exposure prophylaxis, along with preventive measures, such as male circumcision in some developing nations. According to Ho, HIV/AIDS in the U.S. in terms of treatment is "doing quite well," and the disease is "much more manageable." He continued, "In terms of prevention, I think much more could be done." Fauci emphasized that the number of new infections in the U.S., which has remained at about 56,300 annually for 10 years, is "completely unacceptable." Fauci continued that "the majority of the new infections that are being spread are being spread from someone who doesn't know that he or she is infected. And that's just something that really needs to turn around," adding that more widespread testing and identification of people who require treatment is needed.
In terms of President-elect Barack Obama's HIV/AIDS agenda, Ho said that he believes "we still have to treat [HIV/AIDS] as one of the worst plagues in human history. We can't treat our way out of this epidemic. ...We have to halt the spread of the virus." Fauci suggested that more focus on prevention and better access to treatment is needed, adding that "because of the nature of the virus, cure in the classic sense is going to be very difficult." Ho added, "For whether it is a cure for HIV or a vaccine for HIV, I think the science is not quite there. So we don't have a blueprint" (Rose, "The Charlie Rose Show," PBS, 12/30/08).
Link to this story.
FDA Approves New HIV Blood Test That Screens Blood, Tissue Donations For Less Common Strains
[Jan 05, 2009]
FDA last week approved a new HIV test manufactured by a Roche subsidiary that screens for two less common forms of the virus in the U.S., in addition to the most common forms of HIV and hepatitis, the AP/Miami Herald reports. The test is designed to screen blood and tissue samples from donors for infectious diseases. According to FDA, the TaqScreen MPX Test is the first to be able to detect HIV-2 and HIV-1 Group O strains of the virus at the same time (AP/Miami Herald, 12/30/08). Jesse Goodman, director of FDA's Center for Biologics Evaluation and Research, said, "With the MPX test, blood donor testing laboratories will be able to use nucleic acid technology to screen for additional HIV strains, further assuring that donated blood and tissue are free from infection and providing better protection for patients" (Dooren, Dow Jones/Wall Street Journal, 12/30/08). According to the AP/Herald, the two HIV strains are most commonly found in Africa but have recently been detected by FDA in the U.S. (AP/Miami Herald, 12/30/08).
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Global Challenges
Efforts To Curb HIV Among Drug Users in Vietnam Show Success, Still Face Challenges
[Jan 05, 2009]
The Vietnamese government's efforts to increase access to HIV/AIDS prevention and treatment programs among injection drug users are showing success, the Wall Street Journal reports. According to the Journal, the country is attempting to bolster public education and aid efforts targeted at high-risk groups, including IDUs. For example, the Journal reports that the success of six outpatient methadone treatment clinics -- which opened in April 2008 and can treat about 250 people annually -- has prompted the government to make plans to open six additional clinics. In addition, more than 11,000 people living with HIV/AIDS in Vietnam are receiving no-cost antiretroviral drugs through a government program that receives support from the President's Emergency Plan for AIDS Relief, according to the Journal.
The Journal reports that the efforts have "eased medical worries and lifted some of the stigma surrounding the disease." Nguyen To Nhu of Family Health International said the government's efforts are "really a breakthrough step on drug treatment in Vietnam, aiming to reduce HIV transmission among heroin-injecting users." However, stigmatization and criminalization of drug use continue to pose challenges, and the government requires its employees to report active drug users, the Journal reports. Jean-Marc Olive, the country's World Health Organization representative, said that these requirements can lead to negative attitudes among health care workers toward IDUs and prevent drug users from participating in treatment services.
According to the Journal, officials with PEPFAR hope to develop initiatives in Vietnam -- the only PEPFAR focus country outside Africa and the Caribbean -- that could be used in other countries where the primary method of HIV transmission is injection drug use (Vo, Wall Street Journal, 12/26/08).
Link to this story.
New York Times Profiles Former UNAIDS Executive Director Piot
[Jan 05, 2009]
The New York Times on Tuesday profiled Peter Piot, former executive director of UNAIDS who left the agency on Dec. 31 after 13 years. The article also examined efforts to reduce the impact of HIV/AIDS worldwide during Piot's tenure. According to the Times, Piot is the "person most responsible" for educating heads of state on the economic, political and social implications of "a pandemic that rivals the worst in history." According to Piot, since its creation by the United Nations in 1996, UNAIDS has increased global public concern and financial support to fight the pandemic; helped to decrease the cost of antiretroviral drugs in low-income countries; and reached out to stigmatized groups who are at an increased risk of HIV, such as injection drug users and men who have sex with men. Piot said that when UNAIDS was established, "AIDS was definitely not on the world's political agenda, and now it is." He added that the initial budget for the program has increased from about $250 million in 1996 to about $10 billion currently, and that "if we had the kind of money that we have today 10 years ago, we would never have had an epidemic so out of control."
According to the Times, Piot also is responsible for helping the Untied Nations "characterize AIDS as a global security issue" and adding the disease "to the agendas of world economic forums." Critics of UNAIDS argue the agency's "narrow focus" on HIV/AIDS "can diminish the attention to other health problems," the Times reports. However, Piot said that millions of people would have died without the efforts made by UNAIDS. The agency "works and that is what matters," he said, adding that "well-focused organizations have much greater impact than those with broader mandates." Piot attributes his successes in the fight against HIV/AIDS to basing policy recommendations on scientific evidence, the Times reports (Altman, New York Times, 12/30/08). Michel Sidibe -- who served as deputy executive director of UNAIDS for the past two years and began working for the organization in 2001 as a director of country and regional support -- succeeded Piot as executive director of UNAIDS on Jan. 1 (Kaiser Daily HIV/AIDS Report, 12/2/08).
Link to this story.
Opinion
Development Assistance Must Remain Important in Fight Against HIV/AIDS, Opinion Piece Says
[Jan 05, 2009]
As the new year begins, "it is well to remember the importance of keeping the promise to help developing countries fight AIDS and build stronger health systems," former U.S. President Clinton, founder of the William J. Clinton Foundation, and Philippe Douste-Blazy, chair of UNITAID and special advisor to the United Nations' secretary general on innovative financing for development, write in an International Herald-Tribune opinion piece.
They write that development aid is "good economic policy," adding that successes in reducing disease burden provide "lessons in what aid can save and a reminder that we should define investments in development assistance by their long-term return, not their short-term cost." According to the authors, partnerships between governments and nongovernmental organizations, "do[ing] more while spending less," and innovative research and development have made possible the "remarkable progress" in treatments for HIV/AIDS and other diseases possible.
Clinton and Douste-Blazy add "[w]e know what works, but we still have much to do," as the number of new HIV infections "continues to outstrip the pace at which we reach people with treatment." In addition, Clinton and Douste-Blazy say, "Much of the capacity needed to deliver health care still needs to be built." They write that "wealthy governments must do their part by meeting the ambitious development assistance targets they themselves set," noting that the "engine of change for any government is the will of its citizens" (Clinton/Douste-Blazy, International Herald-Tribune, 1/2).
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