“Author Archive”
Stories written by Tomorrow Global
By Tomorrow Global
One thing has been reliable in recent years: we’re always making progress on HIV treatment.(Image credit: www.lgbtmap.org) A few weeks ago I wrote a piece that was a bit of a downer, rounding up some depressing news from the realm of prevention. And while I haven’t seen anything recently that has flipped my mood on how well we’re preventing HIV (in fact, this week another vaccine trial failed), there has been some good news trickling in on treatment. Since I got my start in HIV working on clinical trials, I can’t help but mention that we’re seeing some good news on the types of treatment available for fighting HIV. When raltegravir, the first integrase inhibitor, was approved in 2007, it opened a new class of antiretrovirals. This meant increased treatment options for people whose virus had developed resistance to other classes of drugs, and a new, tolerable option for treatment naive individuals. And now, we’re on the verge of adding a second integrase inhibitor, dolutegravir, which could be taken once daily. In addition, a whole new class of ‘boosting’ medication is being developed to play a role similar to ritonavir, which has long been the only thing available to make protease inhibitors more effective; in short, a new boosting drug might mean more effective options for people who are intolerant to some of the current regimens. While it will take time for all of this to be widely available in the international realm, the good news is that Cobicistat trial is ongoing in a range of countries, including the US, Mexico, the Dominican Republic and Thailand, meaning that results should more easily translate to the international setting if the drug is proven to be a viable alternative. Perhaps more to the taste of the global health crowd, we’ve also got some good news on how we administer treatment to adults, specifically for child-bearing women. If you still weren’t convinced from an ethical standpoint that women who give birth should have 100% access to ARVs even after pregnancy, new evidence from Malawi reinforces the concept of “Option B+,” which allows women who are pregnant or breastfeeding to start on ARVs regardless of CD4 count (a major barrier for some women who would be clinically indicated but do not have access to a laboratory that can do CD4s). This option also allows women to stay on medication for their lifetime (not only until the risk of transmission to fetus/infant has passed), and early results have show retention comparable to the national average. And, finally, some more good news on how we get treatment to people – particularly, children. A study from China shows high retention and low mortality on the country’s free pediatric treatment program, and is a resounding ‘yes’ to the question of whether to scale-up early, accessible treatment for children. Though the data aren’t without their weaknesses, there’s power in numbers, and rarely does anyone have larger numbers to share than China. Additionally, there’s some good news about the long-term cardiac effects of ARVs on children: an optimized regimen seems to be protective against the effects of HIV on the heart. With so many unknowns about the effects of life-long treatment, this is just one more concern to strike off the list of concerns about long-term, consistent use of ARVs in kids. While progress in treatment can’t make up for short-comings in prevention (after all, ‘treatment as prevention’ is just one aspect of a combination prevention approach), it is nice to have some good news now and again – and with important decisions like the PEPFAR re-authorization looming, the more evidence we have on how to better invest treatment dollars, the better
May 6th, 2013 | Posted in HIV/AIDS,Infectious Disease | Read More »
By Tomorrow Global
No matter what you call them – vulnerable, most-at-risk, key affected populations, key populations – the world of HIV work is abuzz with how we can better target the right groups of people to end the epidemic. There tend to be two camps, or ways of thinking about who the key populations are. A more global vision is to look at some of the most marginalized populations, who have both high risk for contracting HIV, and limited access to services based on stigma and discrimination. The most common among these are people who inject drugs (PWID), sex workers (SW), and men who have sex with men (MSM) – populations that often show HIV prevalence in the double digits. Another way of looking at key populations is to define locally who is most-at-risk. As I mentioned a few weeks ago, in many countries this can mean other populations besides PWID, SW and MSM – like adolescent girls in sub-Saharan Africa. When we look at key populations this way, an often-overlooked group at risk emerges: older people, from those just over the age of 50 to the elderly. As HIV moves into its fourth decade, we need increasing attention on prevention, testing and treatment for older populations.Image credit: www.grayingofaids.org Prevention vs Disinhibition In countries of North America and Europe, the sexual risk-taking of people over 50 has come into sharper focus in recent years, with everything from popular media to the Centers for Disease Control and Prevention taking a look at the issue. The main theme is one of sexual disinhibition; people, particularly women beyond child-bearing age, engage in higher risk sex more freely without the potential consequence of pregnancy. And, because prevention messaging for HIV and other sexually transmitted infections (STIs) is generally targeted towards youth and those of child-bearing potential, they do so without knowledge of the other risks. While new cases among older populations may still account for a relatively small percentage (~10% in the US), they are significant in that these populations are less likely to seek timely care.
April 28th, 2013 | Posted in Aid,HIV/AIDS,misc | Read More »
By Tomorrow Global
The term isomorphic mimicry has been getting a lot of use lately. In biology, it means shapes and structures that are similar in appearance but not function. Based on some quick web searches, the term has been almost entirely coopted by development wonks. For development types, “isomorphic mimicry” is a baroque way of saying that institutions in and of themselves don’t have a meaningful impact on development.
April 25th, 2013 | Posted in Human Rights,misc,Policy & Systems | Read More »
By Tomorrow Global
News Raiding Grandma’s Medicine Cabinet – Maggie Koerth-Baker | NY Times This piece primarily explores pre-antibiotic treatment methods (particularly serum therapy and bacteriophages) that may need to be incorporated into present-day treatment strategies. [audio] A strategy to deal with antibiotic resistance – Richard Di Natale & Dr Peter Collignon | Radio National A senate inquiry into antibiotic resistance initiated by Senator Richard Di Natale is currently being held and is due to be tabled next month. This is a radio segment looking into the key issues being raised by medical practitioners and clinicians in the field whether or not the final report will recommend action that these industry players deem as necessary. Nashville voices take concerns about antibiotic resistance to Washington – Tom Wilemon | The Tennessean A group known as “Supermoms against Superbugs” is in Washington D.C. to push for laws to curtail the use of antibiotics in livestock farming in an effort to preserve the effectiveness of antibiotics.
April 20th, 2013 | Posted in Infectious Disease | Read More »
By Tomorrow Global
Resilience. In the wake of the horror in Boston yesterday, the earthquake in Iran/Pakistan today, and the wave of bombs in Iraq this week trying to keep people from voting, I’m thinking a lot about resilience. Merriam-Webster defines resilience as: 1 : the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress 2 : an ability to recover from or adjust easily to misfortune or change The first time I ran into resilience was when I was still in graduate school on my very first field assignment. I was researching the effectiveness of psychosocial programming on former child soldiers in Northern Uganda.
April 18th, 2013 | Posted in Mental Health | Read More »
By Tomorrow Global
The first thing we think of when we consider the first of cities is urbanization. It is certainly true that the number of megacities is on the rise; rural-urban migration isn’t stopping any time soon. There is more going on, however, than a simple story of growing city populations. Here are three things to consider about the future of cities: 1. The climate. Climate matters in two different ways.
April 16th, 2013 | Posted in misc | Read More »
By Tomorrow Global
Earlier this week, the Huffington Post published a piece that speculated on whether the end was near for the War on Drugs. It opened by saying: “For four decades, libertarians, civil rights activists and drug treatment experts have stood outside of the political mainstream in arguing that the war on drugs was sending too many people to prison, wasting too much money, wrenching apart too many families — and all for little or no public benefit.” But this statement left out one important group among the dissenters: public health experts – and especially public health experts who work in HIV. An abstinence-based approach to use of narcotics has failed to produce any change in rates long-term drug use over the last 40 years.(Image credit: http://noyonews.net/?p=7942) I don’t mean to belittle the drug treatment experts, or imply that they can’t also be part of the public health crowd – many times they are – but there are a lot of us who specialize in things other than drug treatment who stand steadfastly against the war on drugs. We do so on the basis of not (or not only) the ‘public benefit‘ that the Huff Post cites, but the public health benefit. And today, because it’s Friday and this is what I do on Fridays, I’m going to reflect a bit on why the HIV crowd in particular opposes the War on Drugs. A (Very) Brief History of the War In 1971, American President Richard Nixon declared a War on Drugs. While the United States had long had a prohibitionist stance against many narcotics, this effort was more accurately termed a ‘war’ based on active military involvement in the effort. Since that time, the US has led partner countries around the world in an aggressive, abstinence-based effort to reduce drug use. Harsh punishments for individuals who use drugs, and a practically unfathomable budget (about $15 billion per year) to combat drug use are the centerpieces of this strategy in the US, and spill over into many other countries around the globe. Its Casualties While hard-line policies to reduce drug supply and demand might seem like they’d have a positive impact on health, the reality has turned out to be very different
April 13th, 2013 | Posted in HIV/AIDS | Read More »
By Tomorrow Global
News Antibiotic resistance on the rise in India [video] – CNN IBN All antibiotics, tuberculosis drugs, and other habit-forming medicines may soon have a label warning users against over the counter medication, according to the latest draft notification by the health ministry. Antibiotic prescribing rates vary by region: report – USNews Health Different areas have different rates of antibiotic prescription – this piece covers the desired “quick fix” factors that lead to prescription as well as its relation to the growing problem of antibiotic resistance. Researchers warn against TB drug-resistance – Jessica Berman | Voice of America Because isoniazid can dramatically reduce TB transmission, many public health experts promote its use in communities with large populations of HIV-positive people (who have high rates of secondary TB infections). However, widespread use of isoniazid could speed the emergence of drug-resistant strains of TB. Research Scientists use nature against nature to develop an antibiotic with reduced resistance – XPress Scientists at Rockefeller University have developed a broad-range antibiotic that has, in mice, been found to kill a wide range of bacteria, including drug-resistant Staphylococcus that do not respond to traditional drugs.
April 12th, 2013 | Posted in Infectious Disease | Read More »
By Tomorrow Global
North Korea’s official IMR is 26.2, approximately the same as Guatemala The international development community is better at collecting, analyzing, remixing and deploying data than we’ve ever been before. The combination of mobile technology, cheap and powerful computers, and the internet presents some amazing opportunities for data-driven decision making in international development. We can spend an hour crunching numbers that would have taken a month in the past. It’s exciting, but in the face of this excitement, we need to remember that not all data are created equal. In fact, not all data is true
April 11th, 2013 | Posted in Technology | Read More »
By Tomorrow Global
Plans that look great on paper can go awry in real life, bringing us back to reconsider our methods for preventing HIV in some of our most vulnerable populations.(Image credit: photobucket.com) I try to keep our Friday HIV updates generally positive, looking for opportunities for improvement and glimmers of hope, but sometimes we just have to talk about failures, and when and how we need to go back to the drawing board. These are two bits of recent information that I find particularly depressing: A study in South Africa, Uganda and Zimbabwe (presented at CROI last month) showed that pre-exposure prophylaxis (PrEP)for women isn’t effective – at least not in the way it was done in this case. There were two oral intervention arms here, and one vaginal gel arm; none of them were deemed to be effective. And, for better or worse, it wasn’t the drugs that were ineffective here, it was the behavior. Particularly among younger, unmarried women, PrEP was used inconsistently, and this led to an insignificant effect on HIV prevention. This is a particular blow to the long-standing hope that a vaginal microbicide might be the Holy Grail of HIV prevention. The academic journal AIDS & Behavior has published a systematic review of MSM prevention interventions in the United States that shows that the overwhelming majority of behavior change interventions (73%!!) used are non-evidence-based – that is, they don’t actually change behavior. While this is a study confined to the US, it seems unlikely to me that we’d see much better results in other countries where MSM remain highly stigmatized and are often under-emphasized in terms of resources devoted to prevention. There is, of course, some good news that comes out of each of these potholes on the road to reducing HIV incidence. For instance, long-term microbicide use in Uganda (in a separate study released recently) seems to be effective with older, better-adhering married women. And for the MSM interventions from the review above, there were some evidence-based interventions that work, particularly peer-driven outreach and those that engage the community in design.
April 6th, 2013 | Posted in HIV/AIDS,Hub Selects,misc | Read More »
By Tomorrow Global
News Antibiotic resistance of strains isolated from community-acquired urinary tract infections between 2007-2001 in Algeria – Bentroki et al | Uro Today A study on the rate of drug-resistance in the main bacteria of urinary tract infections based on research done in Algeria. The highest rate of acquired resistance of Escheria coli was observed with ampicillin (70%). Avoiding an ‘antibiotic apocalypse’ requires shift in doctor/patient attitudes & expectations – Dr James Aw | National Post Dr Aw explains why doctor-patient relationships and time pressures often result in the unnecessary prescription of antibiotics. Concern over spread of drug-resistant TB – Al Jazeera Al Jazeera’s Tarek Bazley with a video report on the spread of drug-resistant tuberculosis. Will Astra-Zeneca be next?
April 5th, 2013 | Posted in Infectious Disease,Tuberculosis | Read More »
By Tomorrow Global
I’ve been thinking a lot about the TED talk Pallotta gave a few weeks ago and Alanna’s post on it. I’ve been a grant writer for over ten years now, and figuring out how to represent overhead to donors in a way they’ll find acceptable (read: low enough) and provides the organizations I’ve worked for with all the resources they need to actually implement good programs has always been a constant struggle. Alanna stated it perfectly when she wrote, “Overall, the obsession with overhead costs takes time and effort away from real work planning and evaluation even when it doesn’t actually make programs worse by forcing the inclusion of useless donations or limiting staff availability.” Just the other day I heard someone in a senior management position say that they didn’t want to create a program department that is badly needed, because they wanted to keep the organization’s overhead low. Um, what? As a sector, we’re apparently willing to sacrifice program quality so that donors will see us as more “efficient” as defined by a low overhead.
April 4th, 2013 | Posted in Financing,Policy & Systems | Read More »
By Tomorrow Global
It’s an exciting time for people who care about global health and want to learn more. The last few months have seen the launch of new resources, including three new journals. I am especially excited about this first one. Global Health: Science and Practice is aimed especially at global health practitioners, with a focus on bringing grey literature into general access. In terms of providing high quality science that’s immediately useful, this could be a game changer.
April 2nd, 2013 | Posted in Educational Resources,misc | Read More »
By Tomorrow Global
One Acre Fund just wrote an interesting article for Devex this week about how they’re a nonprofit that operates like a business. More and more NGOs using this model are cropping up every day including the organization I currently work. There’s a lot of merit to operating like a business – clear, defined goals and targets, strategic planning that demands concrete results, efficient systems and in many cases built-in scalability and sustainability. I found myself nodding throughout the article and recalling my time working for a for-profit development firm in Afghanistan. Despite all the negative hype that contractors get, implementing development programs with a business was refreshing and probably some fondest memories I have from my field days in terms of good work accomplished
March 29th, 2013 | Posted in Aid,Aid & Development,Hub Selects,misc | Read More »
