On the eve of World AIDS Day 2009, AIDS Healthcare Foundation (AHF) praised the World Health Organization (WHO) for its new HIV treatment recommendations which include starting lifesaving antiretroviral treatment (ART) earlier (at a t-cell count of <350 cells/mm³ instead of <200) for all HIV-positive adults and adolescents and earlier treatment initiation for HIV-positive pregnant women who should now begin treatment at 14 weeks into pregnancy, rather than 28 weeks as previously recommended, and continue until the end of breastfeeding.

AHF has been advocating for such changes for more than a year and spearheaded a campaign Save Mothers’ and Infants’ Lives which generated a letter to WHO General Director, Dr. Margaret Chan urging an end to harmful single-dose HIV/AIDS treatment as a recommended treatment for expectant mothers and infants worldwide. The letter was signed by a coalition of hundreds of HIV/AIDS medical care providers and advocates, representing dozens of organizations, expressing concern over WHO’s outdated recommendation of short-course therapy (such as single-dose Nevirapine and/or Zidovudine) for expectant and breastfeeding mothers. Such therapy-standard practice in many resource-constrained settings-has been proven to be less effective at preventing mother-to-child HIV transmission as well as less safe for both mother and child than full-course Highly Active Antiretroviral Therapy (HAART).

“AHF praises WHO for its leadership in updating its HIV treatment guidelines,” said Michael Weinstein, President of AIDS Healthcare Foundation. “We, along with hundreds of AIDS medical providers and advocates, have been urging these changes for some time now in order to put an end to the harmful use of sub-standard single-dose HIV treatment for expectant mothers and their newborns. Study after study has linked the use of single-dose treatments for expectant mothers to viral resistance, jeopardizing the effectiveness of future treatment and lowering the chances of a patient’s survival. Accepting the status quo and treating expectant mothers and infants in low-income countries with low-quality therapy-especially as the number of people accessing treatment increases-has had dire consequences and it is high time for this practice to end.”

“Those of us working in the field welcome these changes to the WHO guidelines, especially as the previous recommendations encouraged the continuation of single-dose treatment for pregnant women to prevent mother-to-child-transmission-a practice that endangers the lives of mothers and infants,” said Terri Ford, Senior Director of Global Policy/Advocacy for AIDS Healthcare Foundation. “Since most developing countries rely on the guidelines to help shape health policy, WHO’s leadership on this issue will go a long way toward widespread implementation of full-course therapy for all expectant mothers and infants. The lives of thousands of women and children will be saved.”

In addition to advocating for earlier treatment initiation for expectant mothers, AHF also led an effort urging WHO to revise its guidelines and raise the recommended treatment initiation threshold from a CD4+ T cell count of <200 cells/mm³ to <350 for all adults and adolescents living with HIV. The ART Initiation at <350 campaign urged this change in light of scientific evidence correlating earlier treatment with vastly improved health outcomes and lower death rates.

“AHF lauds WHO for these crucial changes recommending earlier treatment initiation,” said Jorge Saavedra, M.D., Chief of Global Affairs for AIDS Healthcare Foundation. “Raising the recommended treatment initiation threshold from a CD4+ T cell count of <200 to <350 has removed one more barrier to accessing lifesaving HIV/AIDS treatment and will have a positive economic impact on resource-constrained countries, ultimately reducing the healthcare costs associated with the treatment of preventable HIV/AIDS-related conditions.

He added: “Most importantly, this change will significantly improve health outcomes, increasing the odds of survival for millions of people living with HIV/AIDS around the world.”

Source
AIDS Healthcare Foundation

The National AIDS Fund (NAF) and Bristol-Myers Squibb Company (NYSE: BMY) announced today their intention to launch “Positive Charge,” a new multiyear initiative aimed at helping to break down the barriers that prevent people living with HIV from receiving HIV care, treatment and necessary support. The initiative is slated to launch in January 2010.

“Although we have come a long way in the fight against HIV and AIDS, there are more than a million Americans who are currently living with HIV and an estimated 640,000* people with HIV who, for a myriad of reasons, are either undiagnosed, not in medical care or not receiving HIV treatment,” said Kandy Ferree, president and CEO of The National AIDS Fund in Washington, D.C. “This is a unique example of how the business and community sectors can work side by side to better understand and tackle this important issue.”

Bristol-Myers Squibb commissioned a national survey over the past year to better understand the barriers to HIV testing, care and treatment. The survey concluded that there are significant personal, societal and structural barriers that prevent people from taking action. “It’s sad, but true that in 2009, stigma still plays a huge role in preventing people from getting tested and into care,” said Ms. Ferree. “We are proud to work in collaboration with Bristol-Myers Squibb to help break down these barriers by creating a targeted initiative that supports collaborative and highly coordinated, community-based efforts to reduce barriers and provide the supportive services people living with HIV/AIDS need to effectively access health care.”

The survey also revealed that some health care providers may underestimate the role that personal and societal barriers play in preventing people from seeking care or treatment. For instance, respondents were asked the reasons why people living with HIV were not receiving HIV care or treatment. Health care professionals, including physicians, nurse practitioners, physician assistants, case managers, peer educators/counselors and mental health professionals/social workers, who participated in the survey viewed substance abuse issues, patients struggling financially and basic needs more strongly versus people living with HIV or AIDS. On the other hand, those diagnosed with HIV and not under medical care viewed fear of HIV medication side effects as the number one reason why they were not under care or on treatment; denial of needing treatment or care because they did not feel sick and HIV stigma followed. These findings will be discussed with health care providers and the professional community to encourage better alignment and communication with people living with HIV.

“These findings illustrate the continued need to address the key personal and societal barriers like stigma, fear and denial, as well as structural barriers such as the health care system capacity, lack of transportation and housing. In other words, we need to view the needs of the whole person, not just treat the disease,” said Ms. Ferree. “World AIDS Day is an opportunity for us all to remember that there are a lot of people with HIV/AIDS right here in the U.S. who can’t access medical care and we believe both the business and community sectors must work together to address these issues head on and ensure all people living with HIV/AIDS get the care they need.”

“We know this work is complex, but we are committed to success. This collaboration with the National AIDS Fund is intended to further our commitment to the fight against HIV/AIDS,” said Jill DeSimone, senior vice president, U.S. Virology, Bristol-Myers Squibb. “Over the last 20 years, Bristol-Myers Squibb has been on the forefront of innovation and this collaboration is another example of how we as an organization are committed to making a difference in the lives of people living with or at risk for HIV/AIDS.”

About the National Survey

The findings are the result of a national survey, conducted by a third party, of patients and health care professionals. Bristol-Myers Squibb commissioned a large quantitative survey of patients and health care professionals, including patients who were not being treated for HIV/AIDS and were diagnosed and under care, diagnosed and not under care, or at risk for HIV and health care professionals including physicians, nurse practitioners/physician assistants and allied health care professionals such as case managers, peer educators/counselors or mental health professionals/social workers. Interviews were conducted over the phone, online or in person and lasted approximately 30-45 minutes.

According to the survey, health care professionals were more likely to view substance abuse issues (66%) and patients struggling financially and basic needs (64%) as reasons why people living with HIV were not receiving HIV care or treatment. On the other hand, those diagnosed with HIV and not under medical care selected fear of HIV medication side effects as the number one reason they were not under care or on treatment (73%); denial of needing treatment or care because they did not feel sick (66%) and HIV stigma (60%) followed.

About the “Positive Charge” Initiative

“Positive Charge” is an outreach initiative designed to support programs customized to meet the unique needs of individuals living with HIV, and is dedicated to working with health care providers, community members, advocates, caregivers and families of people living with HIV/AIDS in order to assist them in overcoming the barriers that may be preventing them from getting the HIV care, treatment and support they need.

“Positive Charge” is also designed to make meaningful contributions to the scientific exchange and policy and advocacy dialogues to the benefit of people living with HIV/AIDS.

Source
Bristol-Myers Squibb
National AIDS Fund

Directly observed antiretroviral therapy-in which a health worker or other person watches as an HIV patient swallows their medication-has no effect on treatment outcome compared with self-administered treatment, in a range of high-income and low-income country settings. These are the conclusions of an Article published Online First (http://www.thelancet.com) and in an upcoming edition of The Lancet, written by Dr Nathan Ford, Medecins Sans Frontières, Cape Town, South Africa, and colleagues.

Directly observed treatment for tuberculosis is the WHO standard treatment for this condition; but it is costly and concerns have been raised about lack of effect of this treatment. Since antiretroviral treatment for HIV is lifelong, the concerns about cost-effectiveness are even greater, and clear evidence of benefit of this strategy is needed.

The authors did a meta-analysis of previous randomised controlled trials, which had been carried out on high-risk populations in the USA (drug users, homeless people, and prisoners), and a variety of settings in Africa, to calculate any difference in treatment outcome. The primary outcome was virological suppression at study completion.

The final analysis comprised 10 studies and 1862 HIV patients, and the authors found no statistically significant difference between the two treatment approaches. The authors say: “Our study shows no benefit to virological suppression of directly observed versus self-administered antiretroviral treatment in people with HIV infection. Despite expectations that directly observed therapy could be an effective intervention to promote adherence both for the general population and for groups at high risk of poor adherence, we did not find definitive evidence to support such use.”

They conclude: “Directly observed antiretroviral therapy seems to offer no benefit over self-administered treatment, which calls into question the use of such an approach to support adherence in the general patient population.”

In an accompanying Comment, Dr Julie E Myers and Dr Simon J Tsiouris, Mailman School of Public Health, Columbia University, New York, USA, say: “The conclusion that directly observed therapy might not be suitable to promote adherence in a general patient population is reasonable. Even if the data to support this intervention were more plentiful, a real world, widespread rollout of directly observed therapy would be impractical, notwithstanding further investment.”

Source
The Lancet