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New drug initiative announced. Pilot study to distribute HIV treatment, prophylaxis in developing world.
AIDSLINK. 1997 Nov-Dec; (48):4-5.On November 5, 1997, the Joint UN Programme on HIV/AIDS (UNAIDS) announced the launching of the "UNAIDS HIV Drug Access Initiatives." The initiative will make available a range of HIV/AIDS-related drugs, including antiretrovirals for underlying HIV infection, antimicrobials for the prevention and treatment of opportunistic infections, and antibiotics for the treatment of sexually transmitted diseases. The long-term goal of the initiative is to facilitate a mutually beneficial relationship between pharmaceutical companies and health care providers to continue increasing access to drug therapies to persons with HIV/AIDS in developing countries. For this to succeed, each country must establish an HIV-related national drug policy. The activist group Act-Up Paris raised the issue of participant selection and the inappropriate allocation of funds. Despite criticisms, the UNAIDS proposal has given hope to people around the world living with HIV/AIDS.
AIDS TREATMENT NEWS.. 1997 Nov 21; (283):7.The Joint United Nations Program on HIV/AIDS (UNAIDS) announced the launching of the HIV Drug Access Initiative on November 5, 1997. The HIV Drug Access Initiative is a pilot program developed to make AIDS-related treatment more available to 90% of the people in developing countries. This collaborative effort between pharmaceutical companies and health officials in developing countries was designed with the realization that money, major training and infrastructures affects the provision of effective treatment. Creation of two new entities in each country entails the development of a national HIV/AIDS drug advisory board, which will devise a coordinated national policy for the provision of HIV-related drugs; and appointing of a nonprofit company as a clearinghouse for placing orders and receiving drugs on behalf of the government. This initiative will include HIV drugs, antimicrobials to prevent and treat opportunistic infections, and antibiotics for treatment of other sexually transmitted diseases. Funds from a variety of sources, such as the UNAIDS will support this effort, which further aims to provide information in determining whether HIV/AIDS-related drugs can be obtained and distributed effectively in developing countries.
NATURE MEDICINE. 1997 Dec; 3(12):1307.The Joint UN Program on HIV/AIDS (UNAIDS) has launched the pilot phase of an HIV drug access initiative in 4 developing countries: Viet Nam, Chile, Uganda, and the Ivory Coast. Sites were selected on the basis of their geographical diversity, political stability, commitment to the program, existing community health structures, and lack of standing AIDS programs. UNAIDS will contribute more than US$1 million to the program and pharmaceutical companies are supplying antiretrovirals, drugs to treat opportunistic infections, and antibiotics for sexually transmitted diseases at discounts of at least 50%. A national HIV/AIDS drugs advisory board will be created in each country, under the Minister of Health, to devise national policy for the provision of drugs and a nonprofit company will be established to serve as a clearinghouse for drug ordering and distribution. The goals are to develop a workable model that can be applied in other developing countries and to develop an infrastructure for ongoing, expanded care after the pilot phase.
Geneva, Switzerland, WHO, Global Tuberculosis Programme, 1997. , 35 p. (WHO/TB/96.216)Drug resistance is becoming an increasing threat to the effectiveness of national tuberculosis programs in many parts of the world. Knowledge of the prevalence of antituberculosis drug resistance is essential for evaluating and improving national tuberculosis control efforts. However, there are few rigorously documented, directly comparable statistics in this area. This document presents guidelines to assist national programs in adopting standardized methods for drug resistance surveillance. This surveillance should adhere to three principles: 1) the sample of specimens should be representative of the patients from the area under study and the sample size should be determined to permit standard epidemiologic analyses, 2) the patient's history should be carefully obtained and available medical records reviewed to clearly determine whether the patient has received prior antituberculosis drugs in order to distinguish between primary and acquired drug resistance, and 3) the laboratory materials for susceptibility testing of antituberculosis drugs should be selected from among those that are internationally recommended. This report includes chapters on choice of drugs, definitions of resistance, laboratories and diagnostic centers, sampling strategies, organization of surveys, intake of patients, the national reference laboratory, and data management and analysis.
Geneva, Switzerland, WHO, Action Programme for the Elimination of Leprosy, 1997. , 27 p. (WHO/LEP/97.4)The World Health Organization's (WHO's) Action Program for the Elimination of Leprosy made considerable progress in 1997, largely as a result of the continued reliability of multidrug therapy (MDT). At the beginning of 1997, there were about 1,150,000 leprosy cases worldwide, 888,340 of which were registered for treatment. MDT has fully cured more than 8.4 million people of leprosy since its introduction in 1981 and the number of countries with prevalence rates above 1/10,000 population has declined from 122 in 1985 to 55 at the beginning of 1997. The target of eliminating leprosy as a public health problem by the year 2000 by reducing the prevalence to below 1/10,000 should be reached. However, the drive to distribute MDT must continue since there may be provinces, districts, or even a limited number of high-endemicity countries where prevalence exceeds this rate. The Seventh WHO Expert Meeting (1997) shortened the drug regimen for multibacillary leprosy from 24 to 12 months. In patients with paucibacillary leprosy with only one skin lesion, a single dose of three antileprosy drugs in combination was deemed sufficient to produce a cure. These chemotherapy simplifications are expected to ease the burden of both patients and health services. This 1997 status report updates the situation in terms of leprosy trends in the 28 endemic countries, progress with MDT coverage, chemotherapy, and monitoring and evaluation. An appendix presents statistics on registered cases, prevalence, case detection rates, MDT coverage, and cumulative number of cases cured in endemic countries.
Geneva, Switzerland, WHO, Action Programme for the Elimination of Leprosy, . vi, 106 p. (WHO/LEP/97.7)Elimination of leprosy by the year 2000--a goal set at the 1991 World Health Assembly--is a realistic possibility as a result of 10 years of successful experience with multidrug therapy. Almost all major endemic countries have implemented action programs to eliminate the disease. Key to leprosy elimination is making the World Health Organization (WHO)-recommended antileprosy drugs accessible to all patients, including those living in remote areas. This guide was prepared by WHO's Action Program for the Elimination of Leprosy to enable health workers in endemic countries (especially field workers) to contribute to this goal. It can be used for self-learning or for training courses. The pocket-sized guide includes information on the leprosy elimination strategy, diagnosis, classification of leprosy, organizing diagnostic services, treatment, management of complications, patient care and referral activities, and organizing multidrug therapy services.
AFRICA HEALTH. 1997 Nov; 20(1):7.UNAIDS has launched an 'HIV Drug Access Initiative' in the Ivory Coast, Uganda, Chile, and Vietnam; the pilot project will attempt to improve access to HIV drugs. Public and private sector efforts will be coordinated. The Glaxo Wellcome, Hoffman-La Roche, and Virco pharmaceutical companies will participate. Each country will 1) adapt its present system with regard to HIV and 2) establish both an HIV drug advisory board and a non-profit company which will import the drugs. Health ministries within each country will be required to find sources of funding for the programs. Uganda will probably use funds from its sexually transmitted disease (STD) program, which is supported by the World Bank; the Ivory Coast will combine corporate contributions, new tariffs, and non-profit insurance system monies into a 'solidarity fund.' UNAIDS funds will be used for oversight and evaluation. UNAIDS also released a review of 68 studies which examined the impact of sex education on the sex behavior of young people; it indicated that, in 65 of the studies, sex education did not increase the sexual activity of youth. UNAIDS concluded that quality programs helped delay first intercourse and often reduced the number of sexual partners, resulting in reduced rates of STDs and unplanned pregnancy. UNAIDS further concluded that effective sex education should begin before the onset of sexual activity, and curriculums should be focused. Openness in communicating about sex should be encouraged, and social and media influences on behavior should be addressed. Young people should be taught negotiating skills (how to say 'no' to sex and how to insist on safer sex).
Lancet. 1997 Dec 13; 350(9093):1759.Antiretroviral drugs, used to prevent HIV infections from progressing to AIDS, will be used in a pilot project in Uganda, the Ivory Coast, Chile, and Viet Nam, beginning in January 1998. The project was announced at the AIDS in Africa conference (December 7-12, 1997) in Abidjan. Approximately 3000 patients from each country will be given 2- and 3-drug combinations. The countries selected for the project had to guarantee consistency of drug supplies. Patients most in need of therapy will be recommended by physicians in 4 or 5 centers in each country. Although it is being played down by UNAIDS, this method of selection has created some controversy. UNAIDS stresses the need for a cross-section of the population and for realistic drug prices. Prices must be low enough for people in developing countries to afford them and high enough to maintain the interest of drug companies. Nonprofit organizations in the countries are negotiating prices with drug companies (Glaxo Wellcome, Virco, and Roche). Compliance is also a concern; without it, resistant HIV-1 strains could emerge. The director of the Harvard University School of Public Health believes that treatment seen as a family issue would ensure compliance. The European Commission (EC) AIDS advisor states that the EC believes the money would be better spent on community prevention.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1997; 75(6):491-503.Lymphatic filariasis, which infects 120 million people in 73 countries each year, is a serious public health problem in Africa and the Indian subcontinent. Elephantiasis, lymphoedema, and genital pathology afflict 44 million people, while another 76 million have parasites in their blood and hidden internal damage to their lymphatic and renal systems. New parasitic disease strategies combine transmission control through mass treatment programs and disease control through individual patient management. Annual single-dose administration of ivermectin plus diethylcarbamazine or albendazole reduces blood microfilariae by 99% for a full year; even a single annual dose of just 1 drug can result in a 90% reduction and interrupt disease transmission. New approaches based on the prevention of bacterial superinfection have the potential to halt or even reverse lymphoedema and elephantiasis. Given these technical advances, the Fiftieth World Health Assembly urged the World Health Organization and its Member States to establish the global elimination of lymphatic filariasis as a priority public health problem.
The use of essential drugs. Seventh report of the WHO Expert Committee (including the revised Model List of Essential Drugs).
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1997; (867):v-vi, 1-74.The World Health Organization (WHO) Expert Committee on the Use of Essential Drugs met in December 1995 to update and revise the Model List of Essential Drugs. At present, more than 120 countries use essential drug lists for the procurement of needed drugs, training health workers, developing standard treatment guidelines for encouraging local pharmaceutical production of drugs of adequate quality, and reimbursement of costs in health insurance schemes. The selection of essential drugs for a country's primary health care system is based on the pattern of prevalent endemic diseases, the national health infrastructure and treatment facilities, the experience and training of available personnel, financial resources, medicinal drug promotion, and demographic and environmental factors. The first section of this report provides guidance for countries wishing to establish national programs for essential drugs. It discusses quality assurance, post-registration drug studies, drug information and educational activities, research and development, antiviral drugs, and the use of reserve antimicrobials. The second section presents the ninth revised model list, along with details of changes that have been made since 1993, a glossary of terms, and an alphabetical listing of all the drugs included. Cited, for each drug, are the route of administration and dosage.