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Essential medicines for mothers and children: a key element of health systems. Access to medicines and public pharmaceutical policy.
Entre Nous. 2009; (68):14-15.Medicines, when used appropriately, are one of the most cost effective interventions in health care. European countries spend an important part of their health budget on medicines, from 12% on average for the EU countries to more than 30% for the Newly Independent States (NIS) countries. Whereas in EU countries the larger part of the medicines expenditures are publicly funded through taxes and/or social health insurance, in the NIS and in the south eastern European countries it is often the patients who have to pay directly for the drugs themselves. This means that many patients simply do not get the drugs they need because they cannot afford them, and also may force families to incur enormous expenses as they sell their belongings in order to pay for their drugs and their health care.
Journal of Tropical Pediatrics. 2007 Jun; 53(3):147-149.Tuberculosis (TB) kills about 2 million adults and around 100 000 children every year. One-third of the world's population are currently infected with Mycobacterium tuberculosis and many have active disease. In Europe TB emerged as a major disease in the latter part of the 14th century. The industrial revolution saw rapid growth of urban centres where overcrowding with poor living conditions provided ideal circumstances for the spread of the disease. Great impact was made by streptomycin and isoniazid, so that by the 1970s TB was no longer being considered a problem in the developed world. But beginning in the 1980s the number of new cases of TB in USA and across Europe rose sharply. The pattern was repeated in many countries and worldwide throughout the 1990s and into the new millennium. The incidence of TB climbed to over 9 million cases every year. In 1993 the World Health Organization (WHO) declared TB as a global emergency. During the 1990s multidrug resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, emerged as a threat to TB control. MDR-TB requires the use of second line drugs that are less effective, more toxic and costlier. In a global survey of 17 690 TB isolates during 2000-04, 20% were MDR and 2% were extremely drug resistant (XDR). XDR-TB is defined as MDR plus resistance to any fluoroquinolones and at least one of three injectable second line drugs kanamycin and amikacin, or capreomycin or both. Currently one in ten new infections is resistant to at least one antituberculosis drug. (excerpt)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In 1991, the 44th World Health Assembly set two key targets for global tuberculosis (TB) control to be reached by 2000: 70% case detection of acid-fast bacilli smear-positive TB patients under the DOTS strategy recommended by WHO and 85% treatment success of those detected. This paper describes how TB control was scaled up to achieve these targets; it also considers the barriers encountered in reaching the targets, with a particular focus on how HIV infection affects TB control. Strong TB control will be facilitated by scaling-up WHO-recommended TB/HIV collaborative activities and by improving coordination between HIV and TB control programmes; in particular, to ensure control of drug-resistant TB. Required activities include more HIV counselling and testing of TB patients, greater use and acceptance of isoniazid as a preventive treatment in HIV-infected individuals, screening for active TB in HIV-care settings, and provision of universal access to antiretroviral treatment for all HIV-infected individuals eligible for such treatment. Integration of TB and HIV services in all facilities (i.e. in HIV-care settings and in TB clinics), especially at the periphery, is needed to effectively treat those infected with both diseases, to prolong their survival and to maximize limited human resources. Global TB targets can be met, particularly if there is renewed attention to TB/HIV collaborative activities combined with tremendous political commitment and will. (author's)
The Global Drug Facility: a unique, holistic and pioneering approach to drug procurement and management.
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006-2015, which describes the actions and resources needed to reduce tuberculosis (TB) incidence, prevalence and deaths. A fundamental aim of the Global Plan is to expand equitable access to affordable high-quality anti-tuberculous drugs and diagnostics. A principal tool developed by the Stop TB Partnership to achieve this is the Global Drug Facility (GDF). This paper demonstrates the GDF's unique, holistic and pioneering approach to drug procurement and management by analysing its key achievements. One of these has been to provide 9 million patient-treatments to 78 countries in its first 6 years of operation. The GDF recognized that the incentives provided by free or affordable anti-tuberculosis drugs are not sufficient to induce governments to improve their programmes' standards and coverage, nor does the provision of free or affordable drugs guarantee that there is broad access to, and use of, drug treatment in cases where procurement systems are weak, regulatory hurdles exist or there are unreliable distribution and storage systems. Thus, the paper also illustrates how the GDF has contributed towards making sustained improvements in the capacity of countries worldwide to properly manage their anti-TB drugs. This paper also assesses some of the limitations, shortcomings and risks associated with the model. The paper concludes by examining the GDF's key plans and strategies for the future, and the challenges associated with implementation. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories' functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB. (author's)
WHO training course for TB consultants: RPM Plus drug management sessions in Sondalo, Italy, September 28 - October 1, 2006: trip report.
Arlington, Virginia, Management Sciences for Health, Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus, 2006 Oct 18. 26 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ACI-323)WHO, Stop-TB Partners, and NGOs that support country programs for DOTS implementation and expansion require capable consultants in assessing the capacity of countries to manage TB pharmaceuticals in their programs, developing interventions, and providing direct technical assistance to improve availability and accessibility of quality TB medicines. Beginning in 2001, RPM Plus, in addition to its own formal courses on pharmaceutical management for tuberculosis, has contributed modules and facilitated sessions on specific aspects of pharmaceutical management to the WHO Courses for TB Consultants in Sondalo. The WHO TB Course for TB Consultants was developed and initiated in 2001 by the WHO Collaborating Centre for Tuberculosis and Lung Diseases, the S. Maugeri Foundation, the Morelli Hospital, and TB CTA. The main goal of the course is to increase the pool of international level TB consultants. As of December 2005, over 150 international TB consultants have participated in the training, a majority ofwhom have already been employed in consultancy activities by the WHO and international donors. In 2006 fiscal year RPM Plus received funds from USAID to continue supporting the Sondalo Course, which allowed RPM Plus to facilitate sessions on pharmaceutical management for TB at four courses in May, June, July, and October of 2006. RPM Plus Senior Program Associate, Edgar Barillas, traveled to Sondalo from September 28 to October 1 to facilitate the TB pharmaceutical management session at the WHO course for TB Consultants in Sondalo, Italy. (excerpt)
Bulletin of the World Health Organization. 1954; 11:513-520.Residual-insecticide spraying methods may lead to the eradication of malaria from a country or from an area of it, and therefore to the possibility that the spraying campaign may eventually be discontinued. This is the final target to be aimed at in planning national malaria-control campaigns. As it is now known that some anopheline vector species may develop resistance to insecticides, a plea is made that control programmes should be planned to cover such large areas and with such criteria of efficiency as to eradicate malaria and to enable the campaign to be discontinued before resistance may have developed. (author's)
Rational Pharmaceutical Management Plus. Technical Advisory Group (TAG) -- 2nd Meeting on Tuberculosis: trip report.
Arlington, Virginia, Management Sciences for Health [MSH], Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus, 2005 Oct. 15 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00)RPM Plus has been substantially involved in TB activities in the E&E region both at the country and regional level since 1998, providing technical leadership to StopTB partners and technical assistance to countries in streamlining TB drug management systems as part of overall WHO DOTS strategy. In recognition of the RPM Plus role as a leader in pharmaceutical management, RPM Plus Program Manager for TB Andrey Zagorskiy was elected a member of the WHO/Euro Technical Advisory Group (TAG), with the first meeting in 2004 in Sinaia, Romania. In 2005, RPM Plus continued to provide technical leadership in pharmaceutical management for TB to WHO/Euro TAG, and participated in the second meeting in September 2005, in Copenhagen, Denmark. (author's)
Connections. 2006 Jan;  p.In September 2005, the World Health Organization (WHO) awarded Ukraine a 2.5 million dollar grant to combat the country's growing tuberculosis epidemic, according to Mykola Polischuk, who was Minister of Health at the time the grant was awarded. This funding will provide for the purchase of high-quality medications and allow for the cost-effective treatment of 75,000 patients over three years beginning in January 2006. The new treatment program will employ the DOTS (Directly Observed Therapy-Short Course) strategy, which has been recognized as the world's best strategy for fighting TB largely due to its reliance on cheaper microbiological methods of diagnosis rather than X-rays. Patients are first identified using microscopy services then prescribed the correct dosage of anti-TB medicines for a period of six to eight months. If administered accurately, DOTS can successfully treat TB in 99 percent of cases. Ukrainian President Viktor Yushchenko echoed WHO's decision to increase TB funding in October when he pledged to increase health funding, restore the country's failing health system, and fight the spread of HIV and tuberculosis, according to the Associated Press. (excerpt)
Lancet Infectious Diseases. 2005 May; 5:263.The fight to control tuberculosis has made major headway in recent years but more needs to be done to close the implementation gap in case detection and expand treatment in high burden countries, says the WHO’s Global Tuberculosis Control Report 2005. The main residual problem in the implementation strategy for tuberculosis control is “to improve case detection, now about 45% worldwide, which is quite a long way still from the 70% target for 2005”, says Christopher Dye, WHO coordinator for tuberculosis monitoring and evaluation. By contrast, treatment has a high success rate—on average, 82% in 2002, a fraction below the 85% target for 2005. “By implementing the DOTS strategy, we can force down the burden of tuberculosis in line with what is required for the millennium [development] goals [MDG]”, said Dye. The MDG target is to reverse the trend of tuberculosis and to halve the tuberculosis prevalence and death rates by 2015. (excerpt)
BMJ. British Medical Journal. 2004; 328: p..Multidrug resistant tuberculosis in parts of eastern Europe and the former Soviet Union is 10 times as common as in most parts of the world, a new report from the World Health Organization said this week. The report, which is WHO's third on drug resistant tuberculosis, contains new data obtained from the WHO/IUATLD (International Union Against Tuberculosis and Lung Disease) Global Project on Anti- Tuberculosis Drug Resistance Surveillance. Speaking at the report's launch in London this week, Dr Paul Nunn, coordinator of tuberculosis, HIV, and drug resistance at the Stop TB department of WHO, said: "We see about nine million cases worldwide every year and about two million deaths." He said: "This report . . . covers 77 geographic settings, most of which are countries—except in certain instances like China, where several settings are in one country. Thirty nine of the settings are new, and 67 657 cases were tested. (excerpt)
A dose escalation study of docetaxel and oxaliplatin combination in patients with metastatic breast and non-small cell lung cancer.
Anticancer Research. 2003 Jan-Feb; 23(1B):785-791.Objectives: To determine the maximum tolerated dose (MTD) and the dose-limiting toxicities (DLTs) of docetaxel in combination with oxaliplatin (L-OHP) as first-line treatment of patients with advanced breast (ABC) and non-small cell lung cancer (NSCLC). Patients and methods: Fifty-two patients (26 with NSCLC and 26 with ABC), who had not received prior chemotherapy for metastatic disease, were enrolled. The patients' median age was 64 years, and 42 (71%) had a performance status (WHO) 0-1. Docetaxel was given as a 1-hour infusion after standard premedication on day 1 and L-OHP as a 2 to 6-hour infusion on day 2 every 3 weeks. Doses were escalated at increments of 10mg/m2. Results: The DLT1 was reached at the doses of docetaxel 75mg/m2 and L-OHP 80mg/m2. The addition of rhG-CSF permitted further dose escalation (DLT2: docetaxel 90mg/m2 and L-OHP 130mg/m2). The dose-limiting events were grade 4 neutropenia, febrile neutropenia, grades 3 or 4 diarrhea and grade 3 fatigue. Out of 239 delivered cycles, grades 3 or 4 neutropenia occurred in 22 (9%) cycles with 5 (2%) neutropenic febrile episodes. There was one septic death. Grades 3 or 4 fatigue was observed in seven (13%) patients and grades 3-4 diarrhea in five (10%). Out of 42 patients evaluable for response, seven (27%) patients with ABC and five (19%) patients with NSCLC experienced a partial response. Conclusion: The combination of docetaxel and oxaliplatin is a feasible and well-tolerated regimen. The recommended doses for future phase II studies are 75mg/m2 for docetaxel on day 1 and 70mg/m2 for L-OHP on day 2 without rhG-CSF support and 85mg/m2 and 130mg/m2, respectively, with rhG-CSF support. (author's)
Epidemic of sexually transmitted diseases in Eastern Europe. Report of a WHO meeting, Copenhagen, Denmark, 13-15 May 1996.
Copenhagen, Denmark, WHO, Regional Office for Europe, 1996. , 14 p. (EUR/ICP/CMDS 08 01 01)In response to the alarming rise in sexually transmitted diseases (STDs) in the newly independent states, the WHO Regional Office for Europe, WHO headquarters and the Joint United Nations Programme on AIDS organized a meeting of experts from the most affected countries to exchange information and to identify priority actions for the control of the epidemic. The participants included 15 experts from Belarus, Kazakhstan, Latvia, the Republic of Moldova, the Russian Federation and Ukraine. The participants called for urgent action, including a careful assessment of the existing systems for STD control, reallocation of resources among the various activity areas and strong advocacy to generate awareness at the top level of government and strengthen its support for the recommended initiatives. They also urged that national coordination of programmes to promote sexual health and prevent STDs and HIV be strengthened, that statutory services be made more accessible and acceptable to patients and that efforts be made to ensure that all health workers managing patients with STDs, including those in the private sector, provide high-quality care. (author's)
Unintended consequences: drug policies fuel the HIV epidemic in Russia and Ukraine. A policy report prepared for the UN Commission on Narcotic Drugs and national governments.
New York, New York, Open Society Institute, International Harm Reduction Development program, 2003. 16 p.Taking action now to reduce HIV transmission rates and treat those already infected is critical. With the goal of avoiding adverse effects on social welfare and public health, the Russian and Ukrainian governments should reconsider how they interpret international treaties. Policy changes should be made in the following areas: Harm reduction. The governments should play an active role in establishing and supporting a large, strategically located network of harm reduction programs that provide services for IDUs, including needle exchange, HIV transmission education, condom distribution, and access to viable treatment programs such as methadone substitution. Similar services should be available in all prisons. Education. Simple, direct, and dear information about HIV transmission should be made available to all citizens-especially those most at risk. Similarly, society at large should be educated about the realities of drug use and addiction as part of an effort to reduce stigma. Discrimination and law enforcement abuse. Public health and law enforcement authorities should take the lead in eliminating discrimination, official and de facto, toward people with HIV and marginalized risk groups such as drug users. Authorities must no longer condone or ignore harassing and abusive behavior, including physical attacks, arrest quotas, arbitrary searches, detainment without charges, and other violations of due process. HIV-positive people, including IDUs, should be included in all policy discussions related to them in the public health and legal spheres. Legislation. Laws that violate the human rights of people with HIV and at-risk groups should be repealed or restructured to better reflect public health concerns. Moving forward with the above strategies may make it appear that the governments are backing away from the goals and guidelines of the UN drug conventions. They may be criti- cized severely by those who are unable or unwilling to understand that meeting the goals of the conventions, some of which were promulgated more than 40 years ago, is far too great a price to bear for countries in the midst of drug use and HIV epidemics. Governments ultimately have no choice, though, if they hope to maintain any semblance of moral legitimacy among their own people. (excerpt)
[Unpublished] 1986. 80 p. (WHO/CDD/84.17)This listing of research projects funded since 1980 by the Diarrheal Diseases Control Program of the WHO is arranged by broad priority area and scientific working group. Project title, investigator, and budget allocation for each are listed. Scientific working groups which are included are: bacterial enteric infections, parasitic diarrheas, viral diarrheas, drug development and management of acute diarrheas, global/global groups, global/regional groups, and research strengthening activities. Projects are also classified according to geographic area: African region, American region, Eastern Meditterranean region, European region, Southeast Asia region, and Western Pacific region.
[Unpublished] 1984. 51 p.This listing of research projects funded since 1980 by WHO's Diarrhoeal Diseases Control Programme, is arranged by project title, investigator and annual budget allocations. Project titles are listed by Scientific Working Grouping (SWG) and include research on bacterial enteric infections; parasitic diarrheas; viral diarrheas; drug development and management of acute diarrheas; global and regional groups and research strengthening activities. SWG projects are furthermore divided by geographical region: African, American, Eastern Medierranean, European, Southeast Asian and Western Pacific. The priority area for research within each SWG is specified.
Price of vital TB drugs reduced by as much as 94% through WHO partnership. Press release. [Reducción de hasta el 94% en el precio de fármacos vitales contra la tuberculosis gracias a asociación con la OMS. Comunicado de prensa]
Geneva, Switzerland, WHO, 2001 Jul 19 2 p. (Press Release WHO/35)Outbreaks of multidrug-resistant tuberculosis (MDR-TB) in public institutions in the US, Europe, and Latin America have caused many deaths and raised concerns about epidemic transmission of MDR-TB. Despite the availability of high quality "second line drugs,” their high cost prevents many people, especially those who are poor, to have access to such drugs. In this perspective, the WHO, Medecins Sans Frontieres, and Harvard Medical School made collaborative efforts to reduce TB drug prices and to a system designed to promote the use of the drugs in the most effective manner. Some countries will be able to save as much as 94% of their existing spending on the drugs needed to treat MDR-TB. The WHO is also working to ensure proper use of these drugs via a multiagency collaboration known as the "Green Light Committee." The cut in drug prices coupled with ensuring rational use will help to provide treatment to patients and contribute to the rapid development of a global policy on the treatment of MDR-TB.
Geneva, Switzerland, WHO, 2001 Oct 15 2 p. (Press Release WHO/43)The WHO estimates that about 5800 people develop tuberculosis (TB) in Moldova every year. Due to a shortage of quality TB drugs, Moldova's Premier Vasile Tarlev adopted the Direct Observation Treatment, Short-course (DOTS) in June 2001. DOTS is the internationally recommended strategy for controlling and treating TB, to fight the epidemic. Through a global TB partnership initiative, the Global TB Drug Facility (GDF), TB drugs are made available for the treatment of nearly 4000 TB sufferers in Moldova. The arrival of the high-quality TB drugs in the country represents the first delivery through the Facility. The GDF, which supports DOTS expansion, has been established with the aim of increasing access to high-quality TB drugs worldwide. Through standardization of drug products, which involves a bulk buying procurement system, and a competitive bidding process, the Facility has slashed TB drug prices to just US $10. In addition to Moldova, 11 other countries have qualified for support under the GDF.
AFRICA HEALTH. 2001 May; 23(4):37.Since AIDS has been considered the greatest public health challenge, the encouragement of the participation of drug companies and other "partners" in the fight against AIDS will be the personal priority of UN Secretary-General Kofi Annan. During a meeting in Amsterdam, where he met with top executives from the biggest drug companies--companies such as Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo SmithKline, Hoffman-La Roche, Abbot Laboratories, and Pfizer--he was promised an improvement in the accessibility to AIDS treatments in developing countries. This commitment has achieved price reductions of HIV/AIDS treatment drugs, with Bristol-Myers Squibb having achieved the biggest price reductions. A guide on the use of antiretroviral treatments for HIV/AIDS patients lists methods of undertaking these treatments in resource-limited settings.
Lancet. 1992 May 23; 339(8804):1287.1200 delegates from 175 member countries attended the 45th World Health Assembly in Geneva. Everyone at the Assembly ratified measures to prevent and control AIDS. 12 countries intended to do long term planning for community based care for AIDS patients. Further the Assembly denounced instances where countries and individuals denied the gravity of the AIDS pandemic. In fact, it expressed the importance for urgent and intensive action against HIV/AIDS. The assembly backed proposals to prevent and control sexually transmitted diseases that affect AIDS patients, especially hepatitis B. For example, in countries with hepatitis B prevalence >8% (many countries in Sub-Sahara Africa, Asia, the Pacific region, and South America), health officials should introduce hepatitis B vaccine into their existing immunization programs by 1995. By 1997, this vaccine should be part of all immunization programs. The Assembly was aware of the obstacles of establishing reliable cold chains for nationwide distribution, however. Delegates in Committee A objected to the fact that >50% of the populations of developing countries continued to have limited access to essential drugs. They also expressed disapproval in implementation of WHO's 1988 ethical criteria for promotion of drugs which WHO entrusted to the Council for International Organisations of Medical Sciences (CIOMS). CIOMS lacked WHO's status and thus could not effectively monitor drug advertising. In fact, the pharmaceutical industry as well as WHO provided the funds for a meeting of 25 experts to discuss principles included in the ethical criteria. At least 4 countries insisted that WHO have the ultimate authority in monitoring drug advertising. Delegates did adopt a compromise resolution on this topic which required that industry promotion methods be reported to the 1994 Assembly via the Executive Board. The Assembly requested WHO to establish an international advisory committee on nursing and midwifery and to improve the network of WHO collaborating centers which help national nursing groups.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1986 Jun. , 31,  p. (USAID Contract No. DPE-5927-C-00-5068-00)In the mid 1980s, the Government of The Gambia (GOTG) sought funds from the World Bank and other donors to restructure and strengthen its health system. Since the World Bank thought that recurrent cost obligations that the GOTG would find unacceptable should accompany the implementation of the National Health Project (NHP), this study was undertaken. The Italian Government agreed to fund US $9.8 million to NHP, most of the funds going to renovating and refurbishing the pediatric ward and central laboratory at Royal Victoria Hospital in Banjul. Trends in health sector expenditures showed that the devaluation of the dalasi continued to bring about shortfalls in nonsalary costs, especially in drugs and dressings. Therefore the GOTG must address the shortfalls before even considering expansion of the already inefficient health delivery system. It also needs to develop a cost recovery system for drugs which maintains a reliable source and adequate supplies of drugs in the proper amounts, effectively distributes the drugs, and manages the finances effectively. The GOTG should also develop the Ministry of Health's ability to coordinate donor support and to develop a process of budgeting, spending, and planning. The study team also recommended consolidating staff rather than expand staff in light of financial constraints. A flotation policy and exchange rates less favorable to the dalasi may grant the GOTG more access to exchange within the banking system.
MMWR. Morbidity and Mortality Weekly Report. 1986 Jan 24; 35(3):35-46.As of September 30, 1985, 1573 cases of acquired immunodeficiency syndrome (AIDS) had been reported by the 21 European countries that are participants in the World Health Organization (WHO) European Collaborating Center on AIDS. An average increase of 27 new cases/week has been noted. Of the total cases, there have been 792 deaths, for a case-fatality rate of 50%. The greatest increases in numbers of AIDS cases have occurred in the Federal Republic of Germany, France, the UK, and Italy. The highest rates exist in Switzerland (11.8), Denmark (11.2), and France (8.5). 65% of European AIDS patients have 1 or more opportunistic infection. 20% had Kaposi's sarcoma, alone, and 13% had opportunistic infections with Kaposi's sarcoma. 92% of cases have involved males, and 42% fall into the 30-39-year age group. Of the 1330 (85%) cases involving Europeans, 78% were homosexual or bisexual men, 70% were intravenous drug abusers, and 2% had both these risk factors. Africans have contributed 10% of European AIDS cases. A questionnaire on public health measures related to blood transfusion found that systematic screening of blood donors for lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) antibodies became effective in 16 of the 21 European countries between June-November 1985. Screening is compulsory in 13 countries. The test used is the enzyme-linked immunosorbent assay (ELISA). Portugal is the only country to have organized a national register of seropositive blood donors, although Norway is considering such a register. Methods to exclude donors at risk have been taken in all the countries except Czechoslovakia, Finland, and Portugal. Although male homosexuals account for 69% of reported AIDS cases in Europe, there has been an increase in cases among intavenous drug abusers from 2% of the total in July 1984 to 8% in September 1985. Over 40% of AIDS cases in Italy and Spain occurred in this group. Moreover, several studies carried out in 1985 showed a high frequency (20-50%) of serologic markers of LAV/HTLV-III infection in intravenous drug abusers.
MMWR. Morbidity and Mortality Weekly Report. 1985 Sep 27; 34(38):583-9.As of June 30, 1985, 1226 cases of acquired immunodeficiency syndrome (AIDS) had been reported by the 18 countries participating in the World Health Organization (WHO) European Collaborating Center on AIDS. 285 new cases were reported by the 17 countries that were corresponding with the Center on March 31, 1985, for an average increase of 22 new cases/week. The greatest increases in numbers of cases were observed in France, Federal Republic of Germany, and the United Kingdom. The highest rates of AIDS cases/millon population in 1985 occurred in Switzerland (9.7), Denmark (9.4), and France (7.0). A total of 626 deaths were reported for the 1226 AIDS cases, yielding a case-fatality rate of 5.1%. 795 (65%) of cases presented with at least 1 opportunistic infection. 245 (20%) had Kaposi's sarcoma alone and 171 (14%) had opportunistic infections with Kaposi's sarcoma. Males accounted for 91% of cases, and 42% occurred in the 30-39-year age group. 29 cases involving children under 15 years of age have been reported. 82% of total cases in Europe have involved Europeans, 3% have involved Caribbeans, and 12% have involved Africans. Of the European patients, 80% were homosexual or bisexual, 5% were intravenous drug abusers, and 1% were from both risk groups. AIDS patients belonging to the male homosexual risk group comprise 60-100% of the total number of AIDS cases in 11 of 15 European countries, but less than 50% of cases in Belgium, Greece, Italy, and Spain. Patients not belonging to any identified risk group contribute the 2nd largest number of cases. 9 countries have reported cases among intravenous drug abusers, 9 have reported AIDS in hemophilia patients, and 5 have reported cases among blood transusion recipients. 3 patterns have been noted: 1) in northern Europe (Denmark, Finland, Netherlands, Norway, and Sweden), most cases occur among male homosexuals; 2) in certain countries in southern Europe (Italy, Spain), most cases occur among those with no identifiable risk factor, but intravenous drug abusers seem to be more affected than in other countries; and 3) in Belgium, most cases occur among patients from central Africa.
British Journal of Family Planning. 1984 Jul; 10(37):37.This editorial takes a broad, international look at the worldwide implications of decisions taken in the United Kingdom (U.K.) and the US with regard to family planning. National authorities, like the U.K. Committee for Safety of Medicines (CSM) of the US Food and Drug Administration, address issues concerning the safety of pharmaceutical products in terms of risk/benefit ratios applicable in their countries. International repercussions of US and U.K. decision making must be considered, especially in the area of pharmaceutical products, where they have an important world leadership role. Much of the adverse publicity of the use of Depo-Provera has focused on the fact that it was not approved for longterm use in the U.K. and the US. It is not equally known that the CSM, IPPF and WHO recommeded approval, but were overruled by the licensing agencies. The controversy caused by the Lancet articles of Professors with family planning doctors. At present several family planning issues in the U.K., such as contraception for minors, have implications for other countries. A campaign is being undertaken to enforce 'Squeal' laws in the U.K. and the US requiring parental consent for their teenagers under 16 to use contraceptives. In some developing countries, urbanization heightens the problem of adolescent sexuality. Carefully designed adolescent programs, stressing the need for adequate counseling, are needed. Many issues of international interest go unnoticed in the U.K. International agencies, like the WHO and UNiCEF, have embarked on a global program to promote lactation both for its benficial effects on an infant's growth and development and for birth spacing effects. It may be of benefit to family planning professionals in the U.K. to pay attention to international activity in such issues.