Statement from EGPAF and m2m on WHO’s Option B+ Approach to Protect the Health of HIV-Positive Mothers and Their Babies

WASHINGTON, D.C. – July 27, 2012 – At the XIX International AIDS Conference in Washington, D.C., there has been growing global momentum around optimal approaches to prevent transmission of HIV from mother to child and to keep HIV-positive mothers alive and healthy.

The World Health Organization (WHO) recently encouraged countries to consider accelerating the adoption of one of two options for preventing mother-to-child transmission of HIV (PMTCT) that both include added benefits for and emphasis on the health of mothers. Option B includes the use of triple-drug therapy for the mother during pregnancy and breastfeeding, and Option B+ continues that drug regimen for the mother’s lifetime.

The WHO’s three options – Options A, B, and B+ – all afford similar protection against mother-to-child transmission of HIV, but Option B+ has the greatest potential for health benefits for infected women, and can confer protection against transmission of HIV to an uninfected partner.

There is growing consensus that Option B+ represents an evolving best standard for protecting both mother and child from the effects of HIV. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and mothers2mothers (m2m) support the development and implementation of revised WHO technical and operational guidelines, and will assist the implementation of whichever option is chosen by national governments.

Adoption of Option B+ will require careful study of new and existing operational issues. EGPAF is prepared to use its considerable country presence, technical capacity, and research ability to investigate the operational issues that need to be addressed and understood for optimal implementation of this regimen. Issues that should be studied through operations research include acceptability, adherence, drug resistance, retention, safety, and funding. EGPAF has been an instrumental partner in assisting the WHO and individual countries to implement past guidelines, and will continue to assist as new guidelines are updated.

m2m will support country efforts to implement Option B+ by using its simple and effective Mentor Mother model to promote enrollment and retention in care. Because m2m’s Mentor Mothers provide additional human resources – educating and supporting mothers as they learn to understand, accept, and adhere to lifelong treatment regimens – they can further ease the pressure this new protocol might cause already strained health systems. m2m is prepared to use its trusted presence in communities to ensure that all women, especially those not currently accessing care, are able to benefit from Option B+.

As organizations working to implement the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive, we are committed to overcoming any obstacle that prevents us from reaching our goal of ending HIV/AIDS in children and mothers.

There are still large numbers of HIV-positive, pregnant women who cannot access any effective PMTCT services, and so we must ensure that countries are able to accelerate efforts toward universal coverage.

We must also adequately address implementation barriers, such as weak health systems – especially in more rural settings – lack of human resources for health, and a need for significant education and community-based support to promote adherence to lifetime therapy and long-term retention in the health system.

We look forward to supporting countries to overcome these issues as they work toward achieving an AIDS-free generation.

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 About the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF):  The Foundation is a global leader in the fight against pediatric HIV/AIDS, reaching more than 14 million women with services to prevent transmission of HIV to their babies. It currently works at more than 5,400 sites and in 15 countries to implement prevention, care, and treatment services; to advance innovative research; and to execute global advocacy activities in order to bring dramatic change to the lives of millions of women, children, and families worldwide. For more information, visit www.pedaids.org. For live updates and resources from EGPAF at the XIX International AIDS Conference, visit www.EGPAF-IAS.org, and follow us @EGPAF.

About mothers2mothers (m2m):  mothers2mothers (m2m) is eliminating transmission of HIV from mothers to babies and sustaining the health of women and children with its proven Mentor Mother model. Since its inception, m2m has reached more than one million mothers in nine countries. Founded in Cape Town in 2001, m2m is a partner in the United Nations’ Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive. Learn more at m2m.org or follow mothers2mothers @m2mtweets.

Contacts:

Michelle Milford Morse, mothers2mothers; Phone: 323-969-0445; us@m2m.org

Robert Yule, Elizabeth Glaser Pediatric AIDS Foundation; Mobile: 202-390-9540; ryule@pedaids.org

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Filed under Community, EGPAF, Global Plan, IAC 2012, Implementation, Pediatric Treatment, PMTCT, Research

Late-breaking EGPAF-Funded Study on the Effects of TB Vaccine on HIV-Exposed, Breastfeeding Infants

By Robert Yule

Today, Dr. Heather Jaspan – a recipient of an EGPAF Pediatric HIV Vaccine Program Grant – released late-breaking results from her study at the International AIDS Conference.

The study investigated whether early administration of the Bacille Calmette-Guerín (BCG) vaccine for tuberculosis could be associated with an increased risk of HIV infection for HIV-exposed, breastfed infants in South Africa.

Dr. Heather Jaspan presenting her late-breaker study results.

Dr. Jaspan presents the results of her study and their implications below:

Bacille Calmette-Guerín (BCG) vaccine is given to infants at birth in high Tuberculosis (TB) burdened areas such as Southern Africa to protect them from severe forms of TB.

BCG given to monkeys causes immune cells to be active and replicate faster. HIV preferably infects cells that are actively replicating and have the HIV receptors CD4 and CCR5 on their surface. People who are frequently exposed to HIV yet remain negative have lower numbers of these HIV target cells in their blood.

We hypothesized that the routine immunization of neonates with BCG contributes to generalized immune activation in HIV-exposed infants, resulting in increased HIV target cells and increased risk for HIV transmission via breastfeeding.

We randomly assigned HIV-exposed and uninfected newborns to BCG vaccination at birth versus at 8 weeks of age. We determined the proportion of HIV target cells (activated CD4+CCR5+ cells).

Babies in the early BCG group had significantly higher HIV target cells in their blood than those in the delayed arm. This difference persisted at 8 weeks, despite immune stimulation from routine immunizations at 6 weeks in all babies.

No other cells were activated and no other markers of inflammation increased, suggesting the effect of BCG is isolated to CD4 T cells. Therefore BCG vaccination may increase the risk of HIV infection for HIV-exposed, breastfed infants.

However, other results not presented today show that infants with higher target cell activation had better responses to tetanus vaccine given at 6 weeks of age. This suggests that, in addition to protection against severe TB, BCG may have other benefits for HIV-exposed infants.

Therefore, the potential risks and benefits of BCG need further evaluation and investigation.

Our results can inform policy for the optimal timing of BCG vaccination for HIV-exposed infants, and have implications for the use of related vaccines – such as live, weakened bacterial vaccines – as potential future HIV vaccine strategies for newborns.

Dr. Heather Jaspan is a Senior Lecturer at the University of Cape Town and a Senior Scientist at Seattle BioMedical Research Institute.

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Filed under Advocacy, EGPAF, IAC 2012, Pediatric Treatment, PMTCT, Research, South Africa

[VIDEO] Together We Can End AIDS – Florence on Capitol Hill

On Tuesday, EGPAF Ambassador Florence Ngobeni-Allen was asked to speak at a special breakfast on Capitol Hill hosted by Senators Lindsey Graham (R-SC) and Patrick Leahy (D-VT), and Congresswomen Kay Granger (R-TX) and Nita Lowey (D-NY).

The bipartisan event featured an audience of leading U.S. policymakers and remarks from a roster of champions in the fight against AIDS, including Sir Elton John, UNAIDS Executive Director Michel Sidibe, and Florence.

Here is the video of her speech:

Video courtesy of SABC News (http://www.sabc.co.za/news)

Earlier this week, EGPAF Communication Officer Taylor Moore wrote a blog recounting the event.

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Filed under Advocacy, Florence Ngobeni-Allen, South Africa

Cradles Art Exhibit Highlights Needs of Children Orphaned by AIDS

By Samantha Ritter

This week, during the XIX International AIDS Conference, three non-profit organizations have collaborated to draw attention to the plight of orphans and vulnerable children.

This is a group that, despite being at the epicenter of the AIDS epidemic, is often neglected by policymakers and healthcare implementers.

The Cradle Project, hosted at the Washington Studio School and sponsored by the Firelight Foundation and Aid for Africa, displays mostly empty cradles created by artists from across the U.S.

The cradles represent diverse origins and are made of a number of different materials -  from fabrics reminiscent of traditional Nigerian masks to debris from Hurricane Katrina. The colorful cradles are displayed in front of black and white photos of African children, creating a stark contrast to symbolize the lost potential of children orphaned by AIDS.

Of the 18 million children who have become orphans due to the AIDS epidemic, it is estimated that 14.8 million of them live in sub-Saharan Africa. Children infected with and affected by HIV experience life-altering hurdles - including displacement, lack of education, lack of economic and food security, stigma, and discrimination.

The Firelight Foundation, an early supporter of EGPAF’s international programs, has brought The Cradle Project to the nation’s capitol to inspire visitors to action. Providing medical, financial, and psychosocial support to children affected by the epidemic is crucial to create an AIDS-free generation.

The Washington Studio School has extended the showing of The Cradle Project through August 22, and admission is free.

 

Washington Studio School: 2129 S Street, NW, Washington, DC 20008

Exhibit hours:

July 18 to August 22, Monday-Friday 10:00am-4:00pm;

Saturday and Sunday on July 21, 22, 27, and 28 from 11:00am-5:00pm.

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Filed under Advocacy, Art, EGPAF, IAC 2012, Nigeria, OVC

PEPFAR Announces Together for Girls Partnership against Sexual Violence

By Jane Coaston

Today the U.S. Global AIDS Coordinator Ambassador Eric Goosby announced $5 million from the President’s Emergency Plan for AIDS Relief (PEPFAR) for the Together for Girls ( TfG) partnership.

Launched in 2009, TfG is a public/private partnership including the UN and U.S. government to address violence against girls and boys, with a special focus on sexual violence committed against girls.

Recognizing and combating gender-based violence is essential to ending the AIDS epidemic, which disproportionately affects women and girls.

Read more about the announcement here.

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Filed under Advocacy, IAC 2012, PEPFAR, Public-Private Partnerships

David Binder – Documenting the AIDS Epidemic in the U.S. through Photography and Film

By Jane Coaston

On the NPR Shots blog, reporter Ben de la Cruz highlights the work of photographer David Binder. Binder has been photographing the AIDS epidemic for over 25 years.

His documentary about one woman’s struggle with AIDS and the effects on her family, Calling My Childrenwas screened Wednesday at the U.S. Capitol

Gail Farrow, photographed by David Binder

It tells the story of Gail Farrow, a mother of four living with HIV in the late 80s. Like Elizabeth Glaser, she contracted HIV through a blood transfusion, and forced America to confront the reality that AIDS was a problem that affects us all.

Read more about the documentary and watch a video about Binder here.

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Filed under Advocacy, Art, Elizabeth Glaser, Photography, U.S., Video

mHealth in HIV/AIDS Programs: Exploring its Impact

By Michelle Betton

mHealth (mobile health technology) continues to be a big theme at this year’s International AIDS Conference. Wednesday morning, representatives from the Elizabeth Glaser Pediatric AIDS Foundation, Cell Life, the International HIV/AIDS Alliance, and the mHealth Alliance discussed various mobile technology interventions in HIV and AIDS programs.

EGPAF’s Dr. Apolinaire Tiam from Lesotho

mHealth is currently being used for many different interventions, including education and awareness, supply chain management, training for health workers, and monitoring and evaluation. The work of the panel participants focused on HIV/AIDS interventions in South Africa, Kenya, and Lesotho.

Dr. Peter Benjamin of Cell Life described the work of his organization, which uses technology to improve health and to meet social challenges. Cell Life works in 10 countries in Africa, primarily in South Africa, creating open source eHealth (electronic health) technology. Their products are used in social and behavior change communications, health systems strengthening, and policy amongst other topics.

Caricia Catalani of InSTEDD presented a literature review that delved into the question of whether or not evidence exists proving that mHealth is effective. From her findings (based on 62 articles focused on HIV/AIDS program studies), it remains unclear whether or not mHealth is effective overall in combating HIV/AIDS barriers. Several interventions have been quite effective, such as those focused on youth, community health workers, appointment and adherence reminders, and TB care, while others have not shown conclusive evidence of effectiveness. Catalani stressed that increasing local and end user development of mHealth technologies would likely increase the usefulness and effectiveness of these interventions.

Following on Caricia’s presentation, Evelyn Kibuchi of the Kenya AIDS NGOs Consortium (KANCO) described how a mapping system of facilities and clinics across regions makes facilitation and referral of services easier. Consortium member organizations enter their location and contact information into a database that then shows which services are provided in a given region, and exactly where. This makes it easier for clinics to refer clients if necessary, and helps clients facilitate transportation. In future, KANCO intends to begin sending SMS messages with information on services locally available. There is also the possibility of clients finding and receiving home-based care based on organizations in their vicinity.

EGPAF’s own Dr. Appolinaire Tiam discussed the impact of 3G technology and laptops in Lesotho. Because of Lesotho’s mountainous landscape, HIV test results can take up to 12 weeks to return to families. The Foundation’s Lesotho program acquired laptops with 3G technology for district clinical coordinators, allowing the program to receive digital lab results and send them to families in four weeks instead of 12. Tiam noted that, before the 3G-capable laptops, 55 percent of children who waited for more than two months for HIV test results died before receiving then. With 3G technology in clinics, child deaths have decreased to 5 percent.

While evidence is still inconclusive and barriers still exist to optimal effectiveness of mHealth interventions, there is some evidence that mHealth can have a considerable impact on the health of those affected by HIV/AIDS.

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Filed under EGPAF, Kenya, Lesotho, mHealth, South Africa