Lessons Learned from Botswana’s AIDS Fight

16 07 2010

In the early to mid-’90s, life expectancy in Botswana was 65 years. Ten years later, it was below 40 years of age due to the impact of AIDS. The children of Botswana were also affected by the pandemic. To date, nearly 100,000 children have lost at least one parent to AIDS

Faced with such losses in a country with a population under 2 million, and determined to save its people, the government took action and the Botswana-Harvard AIDS Institute Partnership (BHP), was founded.

The Institute provides training and research, and acts as point of contact for the efforts to reduce HIV/AIDS in Botswana. In 2001, simultaneous to the opening of a state-of-the-art lab funded by the Institute, the government launched the Masa (or “new dawn”) treatment program, buying antiretrovirals and making them widely available at no cost to infected citizens. The research capabilities of the BHP, along with Botswana’s HIV/ AIDS education, prevention, and treatment efforts, are unparalleled and show impressive results.

Key factors in Botswana’s fight against HIV/AIDS include:

  • International and national funding and research partnerships (represented by the Botswana-Harvard AIDS Institute)
  • Coordination of education efforts at the national level, and targeted to specific populations including school-age children, pregnant and new mothers, and high risk adult populations
  • Education outreach including targeted mobile outreach (involving peer-to-peer education and counseling)
  • Focus on enrolling mothers in the program to prevent mother-child transmission of the disease.

Stemming the tide of mother-to-child transmission of HIV is crucial in halting the spread of disease. In Botswana, peer-to-peer enrollment in the government-sponsored prevention and treatment program slowly increased maternal participation from under 10% to just over 33%.

Both the Masa and the Botswana-Harvard Institute aren’t easily replicated in countries without a similarly high level of financial and governmental support, but the lessons learned can still be applied.

Although it’s unlikely that most developing countries have the resources to accomplish what wealthy Botswana has done, it is a bit of bright news in the otherwise depressing struggle that is HIV/AIDS in Africa.





Placebo Effect

14 07 2010

The placebo effect. For some of a certain age, that phrase brings to mind the M*A*S*H TV show, where Col. Potter and his docs ran out of pain medication and ended up using sugar pills until their supply was replenished. It worked!

OK, it was pretend, but it also works in real life.  Sometimes.

Whether it’s called the “meaning response” or the good old “placebo effect,” we end up in the same place—a fake treatment potentially causing a real, positive result.

Dr. Harriet Hall wrote a piece featured in skeptic.com that compares various studies done over the years. In it, she indicates that the placebo effect is real for some.  Sometimes, the problem and the effect are self-reported, but not measurable using objective data. Other times, the results are measurable, suggesting there may be a  neurobiological response causing the positive result.

Some scientists, like Dr. Mark Crislip, do not believe there is a placebo effect.

The whole thing can be rather confusing.

As parents, we know that placebos or something like them work.  How many of us have given a small child a sip of sugar water or a piece of candy and promised it would make the pain go away?  And then it did.  Subjective?  You bet!

Some of us have children living with chronic diseases, and we employ subterfuge on occasion to get over the small bumps in that road—nothing claiming to cure, just a little something to ease the pain or discomfort.

Is it real?  Is it ethical?  We each have our opinions.  What do you think?

 





Access to ART? Good Luck.

4 06 2010

We know how to control HIV—we do it with antiretroviral therapy (ART). We’re so successful, an HIV infection is now a chronic condition rather than a death sentence . . . for some. For those with access to ART.

Before and after ART

But what about those without access? What about everybody else? As of the end of 2008, just 42 percent of those in lower- and middle-income countries were able to get these drugs.

Why is it so hard to provide this lifeline to those in need? A report put out in May 2010 by Médecins Sans Frontières (a.k.a. Doctors Without Borders), says it’s about the lack of infrastructure, particularly human resources, for the administration of treatment and care, including:

  • Inadequate salaries and poor working conditions, which lead to ‘brain drain,’ attrition, and an inability to attract new health workers
  • National policy barriers that block the possibility to shift tasks to lower level health staff
  • Lack of adequate national and international resources committed to address the health care worker crisis
  • Lack of donor funding for recurrent human resource costs, particularly salaries, due to concerns about “sustainability” and other constraints
  • Limits on spending from ministries of finance and international finance institutions, which can hinder governments’ ability to invest adequately in the health workforce

In addition to infrastructure, the AIDS charity AVERT suggests that barriers to universal access to treatment include:

  • A safe and sufficient supply chain of drugs
  • A life-long commitment on the part of patients to antiretroviral drugs (ARVs) and the ability of healthcare workers to help patients stick to the regimen
  • An awareness of the need for testing and treatment

This group goes on to explain that, “Focusing too heavily on treatment can also be problematic if it detracts too much from efforts to prevent new HIV infections, a scenario which would only add to the eventual treatment burden. Furthermore, unless treatment programmes focus on the vital tasks of monitoring and patient retention, many patients will eventually die from treatment failure.”

The real risk of reducing the work being done in prevention by focusing so much on treatment adds a troubling layer to the discussion.

So, there we are—the usual mountain of reasons why we can’t do what needs to be done. But, what’s a mountain? There are steps we as individuals can take to support universal access to ART:

  1. Press our politicians to stop backing off their commitment to help fund HIV/AIDS services in poorer countries.
  2. Find a reputable charity already in place and doing the work, then do a little fundraising of our own and give it to the charities doing the most good.
  3. Keep talking about these challenges, and if we haven’t been doing so, then start talking.  Silence isn’t an option, given the potential outcomes

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New HCV Drug: Will it work in humans?

18 12 2009

Recently, a new drug, SPC3649, was administered by IV to four HCV-infected chimpanzees over a period of twelve weeks.

Rather than targeting the actual virus, this drug targets a molecule that is found naturally in the liver. The hepatitis C virus uses this molecule to replicate and multiply. The SPC3649 drug attempts to inhibit the molecule to prevent replication of the virus.

In the chimpanzees, the hepatitis C viral load was dramatically reduced in those that received the highest dose. Additionally, the virus did not appear to develop any resistance to the SPC3649 drug.

Trials for SPC3649 in humans with healthy livers are currently in process. Trials for people with hepatitis C will likely start in 2010.

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Researching Health Information on Twitter: Tip#1 – Hash It!

19 05 2009

Twitter_Logo

Social media has made the spread of information lightening fast.

One of the most interactive and helpful social media Websites is Twitter, a microblogging service that lets you make frequent 140 character updates.

As an avid Tweeter myself, I have found quite the handful of useful tools to navigate the Twitterspace. Some of these tools can be used to stay abreast of pertinent health information.

Tip #1 is the hashtag (#). The hashtag lets someone follow a conversation or relate his or her tweet (a.k.a. message) to a topic.

Take a look at one of  PKIDs’ tweets:

Twitter_Post_PKIDs_profile

In the post, there are multiple hashtags (#cellphones, #germ, #health) that, when typed into Twitter’s search box, will allow you to follow the current trends on that subject.

View what the search box looks like below. It’s also featured on the bottom right side of your Twitter profile page (or look at http://twitter.com/pkids).

Twitter_Search_pkids_profile

The search function also shows recent hot topics and allows you to search for topics you’re interested, i.e. #health for health information.

So, why use the hashtag?

Not every hashtag has a conversation attached, but the # attached to a word allows Twitter users to tag relevant posts so others can find them, even if you aren’t following their posts on Twitter. Hashtags before a specific word, like #health, also help exclude irrelevant posts like “I am a health freak,” which wouldn’t teach you much.

Here are a few good hashtag choices for health info:
#health
#wellness
#medicine
#medical

If you want more specific health information use the specific disease or virus name, like #hepatitis or #H1N1.

There are also Twitter-independent tools you can use to follow health information on Twitter, without getting a Twitter account. TweetDeck and Search.Twitter.com are two that are easy and free to use.

And remember, as with all information on the Web, not all of it is credible. Consult your doctor before acting on any health advice from a third party.

Stay tuned next week for another tip on social media and your health.





Nurse Mary Beth on Cuts and Scrapes

7 05 2009

Nurse Mary Beth talks about the care of cuts and scrapes and when a child should be seen by a professional.

Listen now!

Right-click here to download podcast (6mb, 12 min)





MRSA

25 02 2008

MRSA is in the news these days and it can be scary.  MRSA (Methicillin-resistant Staphylococcus aureus) is a bacterium that causes infections in and on the body.

It’s considered the super bug of staph (Staphylococcus aureus) infections because this strain is resistant to some of our antibiotics.  This resistance makes it harder to treat.

A MRSA infection on the skin may cause boils or pimples or it may cause an infection that runs so deep it has to be drained.  Treatment for such an infection may or may not include antibiotics. 

MRSA may also infect wounds or get into the lungs, the bloodstream or the urinary tract.

About 25 percent of us walk around with staph bacteria on our bodies or maybe up our noses, but we don’t become infected.  Of the 25 percent, about one percent carries MRSA. 

Should the staph get into the body through, say, a cut, we could get an infection.  Usually these infections aren’t serious, although it’s possible for them to become dangerous.  They may even cause pneumonia.

The good news is, staph is usually treated with antibiotics.  The bad news is, there are strains of staph, like MRSA, that have developed resistance to some of our antibiotics.  This super bug keeps changing and adapting, making it necessary for us to develop new antibiotics in a hurry.

To the disgrace of everyone involved, MRSA infections are exploding in healthcare settings, with MRSA now causing up to 40 to 50 percent of the staph infections in U.S. hospitals.

MRSA has also expanded from hospitals and other healthcare settings out into the community, where it is referred to as Community-Associated MRSA (CA-MRSA).

CDC tells us that in 2003, 12 percent of MRSA infections were acquired in the community.

Prevention is key to remaining MRSA-free and CDC recommends the following:

  • Wash your hands thoroughly for at least 15 seconds. Use soap and water or an alcohol-base hand sanitizer.
  • Cover your cuts and scrapes with a clean bandage to prevent bacteria from entering the wound.  If you have to touch another person’s wounds or bandages, put a barrier between your hands and the soiled materials or open skin.
  • Don’t share personal care items like nail clippers or scissors, razors, towels and so on. 
  • Wipe down shared gym equipment before and after use.
  • Using the dryer rather than line drying helps kill bacteria.

MRSA is identified with lab tests.  Should your provider determine you have a MRSA infection, there are plenty of antibiotics that do work, although you may not even need to be on antibiotics.





Nurse Mary Beth and Heat Stroke

9 07 2007

Nurse Mary Beth explains the difference between heat exhaustion and heat stroke and what to do about both.

www.pkids.org

Listen now!

Right-click here to download podcast (3MB, 6min)