Sierra Leone: President Bio Launches US$156 Million New Global Fund Grant to Strengthen Healthcare Systems, Boost COVID-19 Responses

Sierra Leone President Dr Julius Maada Bio has launched a $156 million new Global Fund Grant to strengthen healthcare systems and the control of Malaria, tuberculosis, HIV/AIDS and the new Delta Variant of the Covid -19 pandemic in the country.

The Global Fund is a partnership designed to accelerate the end of AIDS, Tuberculosis, and malaria as epidemics. The Fund was created in 2002 to support programs run by local experts, including governments, civil societies, technical agencies, the private sector, and people affected by the diseases. Since 2004, the Global Fund has invested over $347.3 million in Sierra Leone.

Its Executive Director, Peter Sands, thanked President Bio for his leadership in the fight against COVID-19 and praised his commitment to being the co-funding partner in the fight against Malaria, HIV/AIDS, Tuberculosis, and the current scourge of the Coronavirus. He added that the Ministry of Health and Sanitation and the Catholic Relief Services, CRS, were the two main principal recipients who would work alongside other sub-recipients to roll out the 2021-2024 programme of the Global Fund.

Peter Sands further noted that in 2004 Sierra Leone received the first Global Fund grant and since that time the country had continued to benefit immensely from the Fund in the response to HIV/AIDS, Tuberculosis, and malaria, adding that they had enabled the country fight those three diseases. 

“Significant results have been achieved through the Global Fund in Sierra Leone. The ambitious target would have great implication on the people to build a prosperous future for the country,” he told the meeting.

Minister of Health and Sanitation, Dr Austin Demby, said it was a special day in the relationship between the government of Sierra Leone and the Global Fund to fight AIDS, TB and malaria, adding that as the principal recipient of the Fund, his ministry was determined to intensify surveillance and epidemiology efforts to better understand the burden of HIV infections in the country, to reduce stigma, and to intensify efforts towards attaining the 95/95/95 goals and epidemic control of HIV.

The 95-95-95 strategy was announced by UNAIDS in 2014, aiming to end the AIDS epidemic by 2030 by achieving 95% diagnosed among all people living with HIV, 95% on antiretroviral therapy among diagnosed, and 95% virally suppressed among treated.

“We remain steadfast in our commitment to working with our partners to set ambitious targets and associated metrics to measure progress gained in the march towards the global goal of TB elimination by 2035,” he assured.

President Julius Maada Bio noted that in spite of disruptions occasioned by COVID-19, he believed that it was possible to get back on track in the country’s fights against the burdens of HIV/AIDS, TB, and Malaria, noting that getting back on track would require significant resource mobilisation.

“That is why my Government has been working hard to establish strong partnerships with reputable institutions and donor partners around the world. One such partner is the Global Fund.

“I am also pleased to further inform you that the Government of Sierra Leone has committed additional funding of $9,465,377 (Nine Million, Four Hundred and Sixty-Five Thousand, Three Hundred and Seventy-Seven United States Dollars) as counterpart funding to fight HIV/AIDS, TB, Malaria and Health system strengthening for the period spanning financial year 2021-2024,” he said.

The President further reiterated the fact that the Global Fund had been the largest investor in grants to build resilient and sustainable health systems in the country, adding that their investments in tools, systems, health workers, and laboratory resources were underpinning the government’s COVID-19 responses and other disease burdens in the country.

“Be assured that Sierra Leone will continue to be a strong ally in all your high-level advocacy campaigns for strengthening health systems,” he concluded.

The Clock is Ticking: as TB claims some 1.4 million lives in 2019

More than a century has passed since the March 24, 1882, announcement by Robert Koch that Mycobacterium tuberculosis (Mtb) bacteria cause tuberculosis (TB), but the disease still ranks as one of the world’s great killers, claiming some 1.4 million lives in 2019 alone.

The National Institute of Allergy and Infectious Diseases (NIAID) of the United states on Wednesday joined the World Health Organization and others in acknowledging the need for continued, concerted efforts to combat TB, even as the world stand in the shadow of the COVID-19 pandemic, which threatens to slow or reverse progress in global TB control.

“The 2021 World TB Day theme, The Clock is Ticking, reminds us that time is of the essence. We cannot delay the research needed to identify, develop, test, and deliver new or improved TB diagnostics, treatments, and vaccines. On this World TB Day, NIAID stands with the global health community in a renewed commitment to ending this disease”.

TB-causing bacteria spread through the air and the disease usually affects the lungs, although other organs and parts of the body can be involved. Most people infected with the disease can co-exist with the bacterium for months, years or a lifetime without ever developing symptoms (termed latent TB infection.)

By some estimates, up to a quarter of the world’s population has latent Mtb infection. People with latent TB infection cannot transmit the bacteria to others. However, they have a 5-to-10% lifetime risk of developing active TB. Symptoms of active pulmonary TB disease include cough, fever, and weight loss. Malnourished individuals, smokers, people receiving immunosuppressive therapies, and those with compromised immune systems, including those with untreated HIV infections, are at increased risk of developing active TB.

In collaboration with the Bill and Melinda Gates Foundation, NIAID is funding studies to analyze clinical samples collected in trials of BCG and M72/AS01 E vaccines. These studies aim to define the immunological basis of the observed protection from TB disease. Defining how and which immune responses correlate with high degrees of disease protection allows investigators to design new and improved TB vaccines.

To further advance the development of potential TB vaccines, NIAID established three Immune Mechanisms of Protection Against Mycobacterium tuberculosis (IMPAc-TB) Centers in 2019. Multi-disciplinary research teams in the Centers are elucidating the immune responses involved in preventing initial TB infection, establishing latent TB infection, or transitioning from latent infection to active TB disease. Findings are informing development of novel TB vaccine candidates.

NIAID says the clock is indeed ticking, and on World TB Day 2021, NIAID takes time to reflect on the dedication of scientists, clinicians, trial volunteers, and others who work tirelessly to make TB a disease of the past.

“We stand with global health partners in firm resolve to apply cutting-edge research, investment, and collaboration to make that day come soon.”

New WHO recommendations to accelerate progress on TB

WHO has issued new guidance to improve treatment of multidrug resistant TB (MDR-TB). WHO is recommending shifting to fully oral regimens to treat people with MDR-TB.

This new treatment course is more effective and is less likely to provoke adverse side effects. WHO recommends backing up treatment with active monitoring of drug safety and providing counselling support to help patients complete their course of treatment.

The recommendations are part of a larger package of actions designed to help countries increase the pace of progress to end tuberculosis (TB) and released in advance of World TB Day.

“The theme of this year’s World TB Day is: It’s time to end TB,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We’re highlighting the urgent need to translate commitments made at the 2018 UN High Level Meeting on TB into actions that ensure everyone who needs TB care can get it.”

Since 2000, 54 million lives have been saved, and TB deaths fell by one-third.But 10 million people still fall ill with TB each year, with too many missing out on vital care.

The WHO package is designed to help countries close gaps in care ensuring no one is left behind. Key elements include:

• An accountability framework to coordinate actions across sectors and to monitor and review progress
• A dashboard to help countries know more about their own epidemics through real-time monitoring – by moving to electronic TB surveillance systems.
• A guide for effective prioritization of planning and implementation of impactful TB interventions based on analyses of patient pathways in accessing care.
• New WHO guidelines on infection control and preventive treatment for latent TB infection
• A civil society task force to ensure effective and meaningful civil society engagement

“This is a set of pragmatic actions that countries can use to accelerate progress and act on the high-level commitments made in the first-ever UN High Level Meeting on TB last September,” said Dr Tereza Kasaeva, Director WHO’s Global TB Programme.

On 22 March, key partners will come together at a World TB Day symposium at WHO in Geneva to develop a collaborative multi-stakeholder and multisectoral platform to accelerate actions to end TB. WHO will present the new package at the meeting.  

TB is the world’s top infectious disease killer, claiming 4 500 lives each day. The heaviest burden is carried by communities facing socio-economic challenges, those working and living in high-risk settings, the poorest and marginalized.

Tuberculosis Diagnosis in People with HIV Increases Risk of Death Within 10 Years

NIH-Supported Analysis Identified Elevated Mortality in Large Latin American Cohort

Dr. Samuel Pierre examines a patient at the GHESKIO clinic in Port-au-Prince, Haiti. 
Credit: NIAID

Among people with HIV in Latin America, those diagnosed with tuberculosis (TB) at an initial clinic visit were about twice as likely to die within 10 years as people not initially diagnosed with TB, according to findings from a large observational study. This increased risk persisted despite the availability of TB treatment and mirrored patterns seen previously in HIV-negative populations, according to research supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Investigators from the NIAID-supported Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet) presented the findings today at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

People with HIV are at greater risk of TB disease than HIV-negative people without HIV due to HIV-related immune system damage as well as geographical and behavioral risk factors shared by both diseases. In 2017, the World Health Organization estimates there were 920,000 new TB cases among individuals with HIV globally, and approximately 300,000 people with HIV died from TB. Due to this large burden of HIV and TB co-infection, NIAID supports research to improve TB prevention, diagnosis, and treatment in the context of HIV infection.

“Tuberculosis remains the leading cause of death for people with HIV globally,” said NIAID Director Anthony S. Fauci, M.D. “This new analysis shows how devastating TB can be for people with HIV and underscores the need to do more to prevent and treat this co-infection.”

Investigators analyzed the clinical records of 15,999 people with HIV who received care in CCASAnet clinics in Brazil, Chile, Haiti, Honduras, Mexico and Peru. Each participant remained in care for at least 9 months after their first clinic visit; they had not received antiretroviral drugs to treat HIV infection before arriving at the clinic. 

Researchers found that 1,051 individuals—nearly 7 percent—were diagnosed with TB during their first visit and were prescribed anti-TB and HIV medications. After 5 years of observation, approximately 10 percent of patients with TB had died, compared with fewer than 6 percent of those without TB at their initial visit.  This pattern continued: after 10 years of observation, more than 19 percent of the group initially diagnosed with TB had died, compared with 10.5 percent of the group without an initial TB diagnosis. Investigators measured 5- and 10-year survival rates beginning at 9 months after each patient’s initial clinic visit, at which time most people recover from TB with standard treatment. 

“In recent years, the research community has observed that tuberculosis—even when treated and cured—is associated with an increase in an HIV-negative person’s long-term risk of mortality,” said Serena P. Koenig, M.D., M.P.H., assistant professor at Harvard Medical School and a lead study investigator. “Now we know this is also true for people living with HIV, but many questions remain as to why that is and how to lower that risk.”

In addition to an initial TB diagnosis, lower CD4 T-cell counts, older age and lower education levels also were associated with an increased risk of death in the 10-year follow-up period. The analysis did not take cause of death or personal health history—including previously cured TB infections—into account. Researchers also did not confirm how many individuals who received TB and HIV treatment continued treatment as directed, achieved HIV suppression to an undetectable viral load, cured their TB or experienced additional TB infections after successfully clearing TB disease identified at their initial clinic visit. The severity of TB infection was also not included in the analysis.

“Many factors may play a role in this increased risk of death among people with HIV,” said Catherine C. McGowan, M.D., associate professor at the Vanderbilt University Medical Center and co-principal investigator of the CCASAnet network. “Our study has revealed an important pattern in clinical outcomes, but further research is needed to improve our understanding of the relationship between HIV and tuberculosis coinfection and to guide evidence-based treatment recommendations for this significant population.”

Reference:  Morality after presumed TB treatment completion in persons with HIV in Latin America.  S Koenig et al. Conference on Retroviruses and Opportunistic Infections, Seattle. March 6, 2019. 

NIAID-Funded Researchers Predict TB Relapse Risk

Each year, tuberculosis (TB) kills more people than any other single infectious disease. Although tuberculosis can often be treated through a long and grueling course of antibiotics, not everyone is completely cured.

A scanning electron micrograph of Mycobacterium tuberculosis bacteria. Credit: NIAID

Even among patients who are infected with Mycobacterium tuberculosis (Mtb) strains that are considered to be susceptible to the standard treatment regimen, 5 percent of patients relapse within six months of completing standard treatment. Scientists supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and through NIAID’s Tuberculosis Research Units Network (TBRU-N), found that a more refined analysis of TB strains collected from volunteers before treatment could accurately predict whether those volunteers would be likely to relapse after standard treatment was completed.

The consequences of TB relapse can reach beyond an individual patient, as any bacteria that remain in the patient after treatment has ended are more likely to be resistant to antibiotics. Multidrug-resistant tuberculosis is often much more difficult to treat, and its spread is a serious concern.

If health professionals could know whether a patient might relapse after standard treatment, they could decide to prescribe a different, or longer, treatment regimen. However, predicting whether a patient will relapse can be difficult. Research published in the New England Journal of Medicine in August sought to determine if identifying the level of drug required to kill the Mtb strains in a new patient’s sputum, a viscous mucus, could predict whether the patient would relapse later, once treatment was complete.

The researchers used data and samples from volunteers who had participated in a prior study run by the Tuberculosis Trial Consortium(link is external) of the Centers for Disease Control and Prevention. Roughly 1,000 adult volunteers from the United States and Canada, all of whom tested positive to drug-susceptible TB, enrolled in the study between April 1995 and February 2001. Before the study began, volunteers gave samples of sputum, which were stored for later testing. Volunteers then underwent both eight weeks of standard antibiotic therapy and an additional 16 weeks of either once-per-week rifapentine and isoniazid treatments, or twice-weekly rifampicin and isoniazid treatments. For two years after treatment completion, researchers followed the volunteers, noting who relapsed.

In this current study, researchers analyzed the TB strains in the volunteers’ stored sputum. They studied Mtb strains collected from all 57 volunteers who relapsed after completion of treatment and whose sputum bacteria could be cultured, and from 68 randomly selected volunteers who were cured as controls. The researchers cultured the bacteria isolated from the sputum of the 125 volunteers before they started TB treatment and tested for the bacteria’s susceptibility to isoniazid and rifampicin at different concentrations. The researchers found that strains collected from volunteers who relapsed required higher concentrations of isoniazid and rifampicin to halt their growth, on average, as compared to strains collected from patients who were cured. Based on these results, researchers developed a model to predict how likely a patient with drug-susceptible TB will relapse.

The researchers then conducted a follow-up study to validate their model using a group of volunteers enrolled in a different study led by NIAID’s Division of Microbiology and Infectious Diseases at sites in Brazil, the Philippines, and Uganda. These volunteers, who had also been diagnosed with drug-susceptible TB, also provided sputum samples prior to undergoing standard treatment with isoniazid, rifampin, ethambutol, and pyrazinamide, followed by two months of isoniazid and rifampin. Some volunteers were randomly assigned to an additional two months of isoniazid and rifampin. Using the model developed in the first study, researchers demonstrated that bacteria in pre-treatment sputum samples from 11 volunteers who experienced a relapse required higher concentrations of drugs to be killed in culture, as compared to bacteria cultured from pre-treatment sputum from 14 volunteers who did not relapse.

The results of this study provide a first step in identifying which patients are likely to relapse after completion of TB standard therapy. This has the potential to improve TB treatment success rates and decrease the development of drug-resistant Mtb.

ARTICLE:

Colangeli, R. et al. Bacterial Factors that Predict Relapse after Anti-Tuberculosis Therapy(link is external). The New England Journal of Medicine. DOI: 0.1056/NEJMoa1715849(link is external) (2018).

Novel Intervention Halves Rate of Death Among People Living with HIV Who Inject Drugs

NIH-Supported Study Finds Intervention Boosts Treatment Participation, HIV Suppression

An intervention designed to facilitate treatment for HIV and substance use was associated with a 50 percent reduction in mortality for people living with HIV who inject illicit drugs, a study has found.

In addition, the people who received the intervention were nearly twice as likely to report being in treatment for HIV and substance use after one year as those who received their national standard of care. They also were about twice as likely to have suppressed their HIV to undetectable levels after one year. The intervention consisted of psychosocial counseling along with guidance and support navigating the healthcare system. These findings were reported today in the journal The Lancet.

People who inject drugs often have high rates of HIV infection, poor access to and use of treatment for HIV and substance use, and high mortality in the United States and globally. Needle sharing among people who inject drugs is the main route of HIV transmission in some parts of the world.

“People living with HIV who inject drugs often encounter multiple obstacles to beginning and adhering to treatment for HIV infection and substance use,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. “This study demonstrates that providing guidance and counseling can help such individuals overcome barriers to starting and staying in care and treatment, leading to a significantly higher rate of HIV suppression and a much lower rate of death.”

NIAID co-funded the study with the National Institute on Drug Abuse (NIDA), also part of NIH. The NIH-funded HIV Prevention Trials Network (HPTN) implemented the trial, called HPTN 074.

“People who inject drugs and are living with HIV have potentially fatal co-occurring conditions, yet they and their at-risk partners often face different and confusing care delivery systems,” said NIDA Director Nora D. Volkow, M.D. “This study shows that integrated interventions, including help from systems navigators, can dramatically reduce mortality for both conditions.”

None of the few new HIV infections in the trial occurred among the injection partners of people living with HIV who received the study intervention. Scientists could not draw a firm conclusion about the impact of the intervention on HIV transmission through injection drug use, however, because the study was not statistically powered to measure that effect.

HPTN 074 took place in three countries with HIV epidemics driven by injection drug use: Indonesia, Ukraine and Vietnam. The study team enrolled 502 men and women ages 18–60 years who are living with HIV and inject drugs, and 806 HIV-uninfected men and women who inject drugs with them (injection partners). At least one injection partner of every person in the study living with HIV enrolled. The people living with HIV were assigned at random to receive either the national standard of care for HIV infection and substance use or the standard of care plus an integrated and flexible intervention designed to facilitate treatment. The study participants were followed for one to two years.

Study participants assigned to receive the intervention were immediately referred to local health-care providers for anti-HIV therapy to treat their infection, prevent sexual transmission of HIV, and potentially prevent HIV transmission via needle sharing. In addition, each participant who received the study intervention was assigned a systems navigator who helped the participant identify and overcome structural barriers to starting and staying in care and treatment for HIV and substance use. Such barriers could include unfamiliarity with how to enroll in medical care for HIV or difficulty keeping treatment-related appointments. Finally, psychosocial counselors helped each study participant overcome their unique psychological obstacles to starting and staying in treatment, such as lack of interest in therapy, difficulty establishing a medication-taking routine, or stigma.

In addition, all study participants, including the HIV-uninfected injection partners, received their country’s standard of care for people who inject drugs. This typically included referral for treatment of substance use; referral to needle/syringe exchange programs, if legal and available; injection risk reduction counseling; sexual risk reduction counseling; HIV counseling and testing; and referral for diagnosis and treatment of sexually transmitted infections, hepatitis B and C viruses, and tuberculosis, as appropriate. Those study participants living with HIV who received only the standard of care also were referred to local health-care providers for anti-HIV therapy according to national guidelines for when to start treatment.

At the end of the study, 15 percent of participants with HIV who had received the standard of care had died, compared to seven percent of participants with HIV who had received the intervention, corresponding to a 53 percent reduction in mortality.

Some 26 percent of deaths among study participants who had HIV were considered clearly HIV-related, and 3 percent were due to drug overdose. Among the 42 percent of deaths with unknown cause, 24 percent occurred among people whose immune systems were in poor health. Non-HIV-related medical events caused 21 percent of deaths overall, and trauma and suicide accounted for the remaining eight percent.

After one year, 41 percent of study participants who received the intervention had undetectable levels of HIV in their blood, compared to 24 percent of participants who received only the standard of care. Also, 72 percent of study participants who received the intervention reported being in treatment for HIV at the end of one year, compared to 43 percent of those who received only the standard of care. Forty-one percent of study participants who received the intervention reported being in treatment for substance use at the end of one year, compared to 25 percent of those who received only the standard of care.

“The intervention in this study had a remarkably positive impact on people living with HIV who inject drugs,” said Protocol Chair William C. Miller, M.D., Ph.D. “It was designed to be scalable to other settings, and we hope that it can help this important population worldwide.” Dr. Miller is professor and chair of the Division of Epidemiology at The Ohio State University College of Public Health in Columbus.

Previous studies have demonstrated that when a person takes anti-HIV medication that suppresses the amount of virus in the blood to undetectable levels, it both protects the health of the individual and prevents sexual transmission of the virus. Whether viral suppression also prevents HIV transmission through needle sharing with injection partners remains unknown. The HPTN 074 study was not designed to determine whether the intervention would reduce the rate of HIV infection among injection partners of the participants living with HIV, but rather to determine the feasibility of a larger study that could measure this effect. In HPTN 074, seven injection partners of participants living with HIV who received only the standard of care became infected, while no injection partners of participants living with HIV who received the study intervention became infected. This result is promising, according to the investigators, but because the overall HIV incidence among injection partners was so low, a larger clinical trial to test the effect of the study intervention on HIV transmission among injection drug users would not be feasible.

Given the success of the study intervention at reducing mortality and increasing the rates of both participation in treatment and viral suppression, investigators have offered the intervention to all the HPTN 074 study participants living with HIV. In addition, all participants living with HIV are being followed for a second year to determine whether the positive effects of the intervention are maintained.

You are the key to your good health

By Alpha Bedoh Kamara

Except in situations beyond your control, such as being poor, mentally challenged, physically challenged, and living in a community where public health policies are poor or not implemented, and access to healthcare is poor, you have the key to your good health.

What you eat, drink, and breathe, affect your health

There is a prevalent of poor healthcare infrastructures and poor public health policies in most developing countries such as in Africa, where access to sustainable clean pipe-borne water, electricity, and standard education are poor and unavailable.

Healthcare disparities are also a concern in some developed countries with minority communities suffering the brunt due to high rate of unemployment, illiteracy, poverty, and the lack of better insurance coverage.

However, inspite of the challenges people could protect themselves from most of the major causes of diseases by taking positive measures to stay away from the ravages of ill-health.

According to the World Health Organization (WHO), “more than half of all deaths in low-income countries in 2016 were caused by the so-called “Group I” conditions, which include communicable diseases, maternal causes, conditions arising during pregnancy and childbirth, and nutritional deficiencies. By contrast, less than 7% of deaths in high-income countries were due to such causes. Lower respiratory infections were among the leading causes of death across all income groups.

“Noncommunicable diseases (NCDs) caused 71% of deaths globally, ranging from 37% in low-income countries to 88% in high-income countries. All but one of the 10 leading causes of death in high-income countries were NCDs. In terms of absolute number of deaths, however, 78% of global NCD deaths occurred in low- and middle-income countries.

“Injuries claimed 4.9 million lives in 2016. More than a quarter (29%) of these deaths were due to road traffic injuries. Low-income countries had the highest mortality rate due to road traffic injuries with 29.4 deaths per 100 000 population – the global rate was 18.8. Road traffic injuries were also among the leading 10 causes of death in low, lower-middle- and upper-middle-income countries.”

Cigarette smoking increases the risk of coronary heart disease by itself. When it acts with other factors, it greatly increases risk. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot – American Heart Association

The WHO indicator points to the top ten causes of death worldwide and it is not surprising that Respiratory Infections, Diarrhoeria, Heart Disease, HIV/AIDS, Stroke, Malaria, Tuberculosis (TB), Road Accidents,  Alzheimer’s Disease, Diabetes, Lung Cancer, Trachea and Bronchus, Chronic Obstructive Pulmonary Disease (COPD), Lower Respiratory Infections, Stroke, and Ischaemic Heart Disease (coronary artery disease), stand out as the culprits.

These diseases could be prevented and millions of lives saved, and you are the key to your good health!

An estimated 4.2 million premature deaths globally are linked to ambient air pollution – WHO

One of the keys to addressing the challenges of some of these diseases is practicing positive lifestyles and advocating and lobbying for health policies to protect the community from environmental hazards.

Do you know that what you eat, drink, and breathe, affect your health?

You may not have the money or insurance cover for hospital check-up, especially for the millions of poor people in developing countries, but you have the ability to practice positive lifestyles, to choose what to eat and drink, and to engage and lobby your electorates to pass laws to protect the environment from pollution.

Also, remember to drive responsibly, SPEED KILLS!