SOUTH AFRICA: Fighting drug-resistant TB spread from hospitals

A few relatively inexpensive, simple practices in hospitals could cut the number of new extensively drug-resistant TB (XDR TB) cases by half, suggests a new study by South African and US researchers.

The study used Tugela Ferry, where in 2006 XDR TB killed all but one of 53 infected patients in one of the earliest, largest clusters of the disease in South Africa.

All were HIV co-infected, and most died within two weeks of diagnosis. More than two-thirds had visited the hospital before they became ill, suggesting hospital-based “transmission of XDR tuberculosis might be a driver of this epidemic,” the study said.

If no preventive measures were taken in Tugela Ferry, the study predicted 1,300 new XDR TB cases would emerge there by 2012. However, the combined use of masks, reduced hospitalization time, and shifting to outpatient care could cut new XDR TB cases by a third. Adding to these interventions – by improving natural ventilation; testing for drug resistance; testing for and treating HIV; and isolating TB patients – “could avert nearly half of XDR TB cases in Tugela Ferry over the next five years,” researchers said.

However, the involuntary confinement of XDR TB patients would increase any outbreak as it would discourage those infected from seeking treatment, the authors said.

In a related commentary, University of California epidemiologists Travis Porco and Wayne Getz endorsed the study’s proposals. However, stopping XDR TB is more than a local problem, they wrote.

“Multidrug and extensive drug resistance are monsters of our own creation,” they wrote. Effective interventions for XDR TB control “are national and international responsibilities, and the world community ignores this message at great peril.”

The full report, “Prevention of Nosocomial Transmission of Extensively Drug-Resistant Tuberculosis in Rural South African District Hospitals: An Epidemiological Modeling Study,” and the commentary, “Controlling Extensively Drug-Resistant Tuberculosis,” were published in The Lancet (2007;370(9597):1500-1507 and 1464-1465, respectively). (Marlowe Hood, Agence France Presse)

AFRICA: AIDS activist concerned with nurses being poached from Africa

At a recent nurses conference in Canada, Stephen Lewis, the former UN special envoy on AIDS in Africa, expressed concern about Western nations taking skilled nurses away from developing ones, especially when they are needed to battle AIDS. Speaking before the 33rd annual meeting of the New Brunswick Nurses Union in Fredericton, Lewis said that while some African nurses are filling positions in Canada, many more are being actively recruited by the United Kingdom. He cited Swaziland as one country where recruitment efforts are ongoing, and urged Canadian nurses to spend time in Africa to help countries there fight AIDS. (Canadian Press)

UNITED STATES: Many US TB patients also HIV-infected: Report

On Thursday, CDC released a study on HIV-TB co-infection that found many US TB patients are still not being tested for HIV.

Worldwide, TB is the leading opportunistic infection that kills people who have HIV. In the United States, CDC recommends routinely testing TB patients for HIV infection. Patients who are co-infected are five times likelier to die during TB treatment than patients who are not co-infected, according to CDC.

“HIV increases TB progression, and TB increases HIV progression. And they result in a synergy that can be deadly,” said Suzanne Marks, a CDC epidemiologist and an author of the report.

Analyzing 1993-2005 TB reports from every state but California, the researchers found that 9 percent of patients with active TB in 2005 were HIV-infected. However, the HIV status remained unknown for 31 percent of TB patients, either because they had refused HIV testing or were not offered it. In 1993, 65 percent of US TB patients were of unknown HIV serostatus.

Of patients who are TB-HIV co-infected, nearly two-thirds are black, the report found. One in six black TB patients had HIV, compared to one in 20 white TB patients.

“High rates of both HIV infection and TB disease among non-Hispanic blacks emphasize the need in this population to prevent, diagnose early, and provide access to care for both conditions,” recommended the report. “Increased promotion of routine HIV testing and rapid HIV tests might increase acceptability of testing, which would allow health care providers to know the HIV status of a greater percentage of TB patients and enable them to provide optimal care.”

The study, “Reported HIV Status of Tuberculosis Patients – United States, 1993-2005,” was published in the Morbidity and Mortality Weekly Report (2007;56(42):1103-1106). (Will Dunham, Reuters)

UNITED KINGDOM: British schoolgirls to receive Cervical Cancer vaccine

Next year, Britain will introduce a mass campaign to vaccinate schoolgirls ages 12 to 13 against human papillomavirus (HPV), the primary cause of cervical cancer.

The programme will begin next September for girls enrolled in their first year of high school. Girls up to age 18 will also be vaccinated under a two-year “catch up” program slated to start in late 2009.

The £100 million campaign is expected to save 400 women’s lives each year, said Health Secretary Alan Johnson. “As a society we need to do more to prevent disease and not just treat it,” he said. “Now, more than ever before, we need to make the [National Health Service] a service that prevents ill health and prioritizes keeping people well. This means a shift in focus from a sickness service to a well-being service.”

The UK Department of Health is considering extending the HPV vaccine program to include females ages 18-25.

Britain is one of the last countries in Europe to start vaccinated schoolgirls against HPV. Australia began its program in April, with 12- and 13-year-olds vaccinated for free. (Belinda Tasker, Australian Associated Press)

RUSSIA: Global business leaders warn of economic consequences of Russia’s HIV/AIDS crisis

Government inaction on AIDS and a lack of public awareness are putting Russia in “terrible, terrible danger,” Richard Holbrooke said Thursday in Moscow.

“I’m terribly sorry to say this is not a political statement,” said the former US ambassador to the UN. Holbrooke now heads the Global Business Coalition on HIV/AIDS, TB and Malaria (GBC) – an alliance of 220 international companies – and he made his remarks at a conference organized by the coalition.

Russia’s official count of 390,000 HIV cases is thought by international experts to be a vast underestimate; they believe a more accurate figure would be almost 1.6 million cases. That number is anticipated to grow 30 percent by 2010. GBC says 80 percent of Russia’s HIV cases are ages 15 to 30, making AIDS a huge threat to the nation’s economic viability.

Ninety percent of HIV-positive people in Russia and Ukraine will learn they are infected only once they progress to an AIDS diagnosis, Holbrooke said. “Over the next few years, they will be spreading it unintentionally, and on, and on, and on. It’s a bottomless pit.”

Russian journalist Vladimir Pozner, who moderated the meeting, lamented the absence of prominent Russian business leaders. “They did not come because they were not told [by the authorities] to come. Otherwise, they would have come,” he said. (Associated Press)