University of Alabama at Birmingham (UAB) researchers have found that the cost of preventive antibiotic tuberculosis (TB) therapy for patients infected by human immunodeficiency virus (HIV) is generally less expensive than the reported cost of treating newly confirmed TB cases.

The study, published in The International Journal of Tuberculosis and Lung Disease this summer, relied on treatment-cost estimates from previous research studies and data collected by members of the study’s research team at a TB treatment site in Cambodia.

“We completed this study to provide health-program managers cost and cost-effectiveness data on components of a comprehensive package of HIV care. This data is essential to help establish feasible and effective ways to manage patients with human immunodeficiency virus infection and tuberculosis in a developing country,” said Bryce Sutton, Ph.D., an economist in the UAB School of Business and one of the study’s co-investigators.

The research found that the cost of preventing a single case of TB with intensive screening and preventive treatment with antibiotics in HIV-infected patients prior to their exposure to the disease was approximately $950. Compare that to a cost range of $900-$1500, which is the previously reported range for treating a new smear-positive TB case in a developing country setting after adjusting for inflation.

“Our analysis showed that the costs associated with screening and preventive treatment for TB among HIV-infected patients was comparable to the cost related to treating a patient with a newly confirmed case of TB,” Sutton said. “When you factor in observed high adherence rate to treatment and other cost savings such as averted productivity losses that come with stopping TB’s spread through the preventive care, we believe that this type of integrated care offers a potential savings to governments and health-care agencies.”

Sutton said preventing the spread of TB goes beyond cost-savings and can positively affect local, regional and national developing economies.

“Diseases like tuberculosis in a developing country setting can be catastrophic both in terms of health and the financial burden it places on families,” he said. “Often other family members stop working to become caretakers; children and young adults may be forced to enter the workforce to pay for expenses and forgo receiving an education, which can start a cycle of poverty.

“These are important economic factors that support the adoption of preventive-care TB policies.”

Former UAB Professor of Infectious Diseases Michael Kimerling, M.D., is the study’s co-investigator. Former UAB graduate researchers Phalkun Chheng and Mayra Arias and M.T. Eang from the National Tuberculosis and Leprosy Control (CENAT) Phnom Penh, Cambodia, also are on the research team.

Data used in the study were collected at one of four pilot treatment sites facilitated in Cambodia through the UAB-led Gorgas Tuberculosis Initiative, which was created to establish feasible and effective ways to manage patients with HIV and TB.

Source:
Andrew Hayenga

University of Alabama at Birmingham

A scientist who is helping to treat thousands of people living with HIV and tuberculosis (TB) in South Africa was awarded the Royal Society Pfizer Award at a ceremony last night (27 October). Dr Linda-Gail Bekker’s research looks at how TB epidemiology has changed in the HIV era. Researchers estimate that more than one in ten of all South Africans over 2 years old were living with HIV in 2008. South Africa has also seen a six fold increase in tuberculosis rates in the last 20 years.

The Royal Society Pfizer Award includes a £60,000 award grant which aims to encourage medical research in Africa by supporting young scientists. Pfizer, the world’s leading research-based pharmaceutical company has been supporting the awards for the last four years and has so far granted £240,000 core funding for research work in Africa.

Dr Bekker is deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town and chief operating officer of the Desmond Tutu HIV Foundation. Her doctoral work focused on the host response to TB both with and in the absence of HIV co-infection. Subsequently her research interests have expanded to include programmatic and action research around antiretroviral roll out, TB integration and prevention of HIV.

The funding provided by this award will help with research being carried out at Nyanga Primary Health Clinic in Cape Town. Bekker’s team will collect positive tuberculosis cultures obtained from sputum samples in the clinic with the specific aim of describing the diversity of TB strains among HIV-positive individuals receiving Highly Active Anti-Retrovir al Treatment (HAART), HIV- positive individuals not receiving HAART and HIV negative individuals. They will also explore healthcare-associated transmission of tuberculosis in the clinic and test drug sensitivities of all cultures. It is hoped the research will have lessons for how TB/HIV and ART services are designed and run in southern Africa as well as giving further information on host susceptibility and organism virulence.

Dr Bekker said of her award:

“In 2005, the World Health Organization declared a regional emergency and called for extraordinary measures to be implemented to curb the unprecedented increase in HIV/TB currently occurring in South and southern Africa. I am so honoured to be a recipient of the Royal Society Pfizer Award this year- it will help me and the great team I work with to do our part in investigating urgently what those extraordinary measures should be. More than ever before this public health crisis requires innovative thought and research to find novel answers and effective strategies to turn these numbers around.”

Professor Ralph Kirsch, a colleague of Dr Bekker’s at the University of Cape Town, said:

“Linda Gail marries science and humanity in her approach to patients with HIVAIDS. She is constantly looking at how to provide better care and how to make compliance easier. Her relationship with her patients and with those recruited into her various studies is an important role model to us all.”

Professor Lorna Casselton, Foreign Secretary of the Royal Society, said:

“The Royal Society Pfizer Award recognises the valuable research already taking place in Africa, whilst aiming to expand research capacity. We hope that this award will continue to boost the careers of its winners and the individuals working around them. This year’s winner, Dr Linda-Gail Bekker, has done outstanding research into tuberculosis and HIV co-infections in Africa. Her contribution to several innovative and successful health delivery platforms and capacity building opportunities has been invaluable. We congratulate her and hope that this funding will help her continue her research to its full potential.”

Dr Freda Lewis-Hall, Chief Medical Officer of Pfizer Inc, said:

“Defeating infectious disease means making advances in both prevention and treatment. Pfizer is proud to be a partner with the Royal Society in creating this award, which recognizes essential and inspiring medical and public health research from a new generation of African scientists. Support like this translates into new knowledge, lives extended and saved, and less human pain and suffering.”

The award grant and a £5,000 personal prize were presented to Dr Bekker at a ceremony at the Royal Society in London last night.

Source
The Royal Society

At any given time, over two million people are imprisoned in penal
institutions in Europe. Prisons are extremely high-risk environments for
the transmission of infectious diseases because of a high number of risk
factors, such as overcrowding, poor nutrition, limited access to health
care, continued illicit drug use and unsafe injecting practices,
unprotected sex and tattooing. If prisons are not to become a breeding
ground for infectious diseases, health and medical care, and prevention
and treatment must be an integral part of the penal system. Prison health
policy should be integrated into national policy and prison health should
be closely linked to the public health service. This applies to all health
issues but is particularly important in the case of communicable diseases.

The unintentional punishment

A prison sentence is not always over on release from prison. Individuals
who are healthy on entry have a high risk of leaving prison infected with
HIV or tuberculosis (TB) or with an addiction to drugs. Added to the
stigma of a prison sentence, this hampers their reintegration into society
and makes a normal family and social life difficult. The post-release
period is very important, as ex-prisoners are at greater risk of dying
within the first weeks after release from prison, primarily as a result of
an overdose of illicit drugs. An effective throughcare plan must be
developed between prisons and public health systems.

“Rather than rehabilitating inmates, a prison sentence often makes matters
worse,” says Dr Marc Danzon, WHO Regional Director for Europe. “It is
unacceptable that we allow prisons to encourage unhealthy practices,
meaning that people leave prison in poorer health than when they arrived.
This lowers their chances of reintegrating into society and spreads
infectious diseases beyond the prison walls. Work by countries to protect
the health of prisoners helps not only individuals but the whole of
society.”

The health of prisoners affects the rest of society

Overcrowding, the high turnover in the prison population and the intensive
interaction between prison and society encourages the spread of
communicable diseases. Neglecting the health of prisoners impacts on the
wider public, putting them at risk of infection from diseases like TB and
HIV.

The Madrid Recommendation

An international conference on prison health protection is taking place in
Madrid from 29 to 31 October 2009. Health experts from over 50 countries
have agreed on a set of recommendations to tackle the issue of
communicable diseases in prisons. The aim of the Madrid Recommendation is
to ensure that, rather than making matters worse, prisons are a setting
where health and health behaviour are improved and the risk of reoffending
is reduced. These cost-effective measures include:

— treatment programmes for infectious diseases, including HIV/AIDS,
hepatitis C and TB;
— treatment programmes for drug users;
— harm reduction measures;
— guidelines on hygiene requirements;
— guaranteed throughcare for prisoners on entry to and after release from
prison, in close collaboration with stakeholders;
— mental health support for prisoners suffering from communicable
diseases; and
— training for all prison staff in the prevention, treatment and control
of communicable diseases.

Source
World Health Organization