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.

###

 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

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.

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.

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.

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.

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 Children, was 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.

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.

This week the Canadian International Development Agency (CIDA) and EGPAF announced a new partnership to promote increased use of services for maternal and child health (MCH) and prevention of mother-to-child transmission of HIV (PMTCT).

On Monday, EGPAF gave a presentation at the IAC’s Canada Booth introducing our work to support national PMTCT programs, and the types of interventions that will be used through the ACCLAIM project with CIDA.

Read below for a joint press release from CIDA and EGPAF about this partnership:  

New ACCLAIM Program Will Help Expand MCH/PMTCT Services in Swaziland, Uganda, and Zimbabwe

Washington, D.C. – At the XIX International AIDS Conference, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) today announced a new partnership to improve progress toward elimination of pediatric HIV/AIDS. The project, Advancing Community-Level Action for Improving MCH/PMTCT (ACCLAIM), seeks to increase demand and retention in maternal and child health and prevention of mother-to-child transmission of HIV (MCH/PMTCT) services. The project is supported by the Canadian International Development Agency (CIDA), which has pledged CAD $10 million over a four-year period to fund the partnership.

The ACCLAIM Project will focus on changing community norms and attitudes about key health behaviors related to HIV, maternal and child health, and gender through targeted community-based interventions. The project will also use research to assess the behavioral and operational outcomes of selected community-based interventions and their relative effectiveness.

The program will help expand services in Swaziland, Uganda, and Zimbabwe, and will focus on three key interventions:

• Engagement of Community Leaders: Training and capacity-building to generate increased demand for MCH/PMTCT services through development of Community Action Plans
• Community Days: Semi-annual days of information, communication, and activities to generate awareness
• Peer Support Groups: Men’s groups and MCH classes to increase and improve MCH/PMTCT behaviors.

CIDA’s contribution is part of the Canadian HIV Vaccine Initiative, a collaboration with other Canadian federal departments and the Bill and Melinda Gates Foundation. As work towards the development of a safe, effective, affordable, and globally-accessible vaccine continues, HIV prevention efforts must also continue, and CIDA is focusing efforts on the prevention of mother-to-child transmission of HIV.

This work will emphasize the need to scale up prevention of mother-to-child transmission programs and reach more HIV-positive pregnant women with simple and highly-effective – yet underutilized – interventions. It will also support operations research to analyze and overcome existing barriers to delivering prevention of mother-to-child transmission services.

“The Canadian International Development Agency has demonstrated a strong commitment to improving the welfare of women, children, and communities affected by HIV and AIDS,” said Charles Lyons, President and CEO of the Elizabeth Glaser Pediatric AIDS Foundation. “We are proud to work with CIDA on this partnership, which will ensure that more mothers and children have access to essential prevention of mother-to-child transmission services by strengthening community support for those living with HIV and AIDS.”

“Canada is taking action that is saving the lives of women and their children,” stated Minister of International Cooperation, Julian Fantino. “Through our partnership with the Elizabeth Glaser Pediatric AIDS Foundation, we are working to protect women and children from HIV and prevent the transmission of HIV from mothers to their infants.”

While virtual elimination of pediatric HIV/AIDS has been achieved in high-income countries like the United States and Canada, much more needs to be done to protect women and children from HIV in the developing world. Each day, 900 children are needlessly infected with HIV, primarily in sub-Saharan Africa. With the proper medicines and PMTCT services, the risk that a mother with HIV will transmit the virus to her baby can be reduced to virtually zero.

It is critical to link vital facility-based PMTCT services with communities, many of which are rural and far from even the closest clinics. The EGPAF/CIDA partnership will address the need for community-level engagement and support for women, children, and families affected by HIV/AIDS.

The global impacts from this project will be:

• An evidence base for packaged interventions to improve demand, access, retention, and participation in PMTCT programs at the community level;
• Documentation of challenges and lessons learned from community-focused PMTCT-MCH interventions;
• The opportunity to implement community interventions across different contexts, with greater involvement of men in PMTCT programs; and
• The opportunity to contribute to literature on the effects of capacity building of local leaders on HIV/PMTCT outcomes.

Bringing interventions to communities will help ensure uptake and retention in life-saving PMTCT and MCH services, and the healthy survival of mothers, children, and families.

###

About The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF):

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is a global leader in the fight against pediatric HIV and AIDS, and has reached more than 14 million women with services to prevent transmission of HIV to their babies. The Foundation currently works in more than 5,400 sites and in 15 countries to implement prevention, care, and treatment services; to further 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 and www.amothersfight.org.

About the Canadian International Development Agency (CIDA):

The Canadian International Development Agency (CIDA) is Canada’s lead agency for development assistance. CIDA’s aim is to manage Canada’s support and resources effectively and accountably to achieve meaningful, sustainable results. It also engages in policy development in Canada and internationally, enabling Canada’s effort to realize its development objectives.

There is a lot of buzz for point-of-care at the 2012 AIDS conference in Washington, as testing and diagnostic efforts increasingly move closer to the patients.

Point-of-care testing, which is often accomplished through the use of transportable, portable, and handheld instruments, is defined as medical testing at or near the site of patient care, driven by the desire to bring the test to the patient conveniently and immediately.

A session I attended on issues of laboratory monitoring prominently featured point-of-care as an alternative monitoring strategy for anti-retroviral treatment in limited resource settings.

The presentation by the Elizabeth Glaser Pediatric AIDS Foundation showed how using point-of-care machines to determine CD4 count levels in people before they can be put on antiretroviral therapy (ART) led to dramatic increase in CD4 testing and initiation of anti-retroviral treatment to HIV-positive women to prevent mother to child transmission of HIV in Zimbabwe.

Although some questioned the reliability of point-of-care for CD4 test machines due to the breakdown rate, there was general consensus that point-of-care testing serves as a good entry point, and is key to monitoring the quality of HIV care and treatment in resource-limited settings.

From various presentations made – including viral load testing in Malawi and use of dry blood samples to monitor young patients in rural areas on ART in Zimbabwe – there was general agreement that point-of-care increases the likelihood that the patient, physician, and care team will receive the results more quickly – which gives doctors and medical professionals the opportunity to make immediate clinical management decisions.

Participants agreed that viral load and CD4 testing should be made simpler and more available to enhance the quality of HIV care and treatment services.

This discussion was taking place even as an Australian-based manufacturer, Omega Diagnostics, announced a stand-alone, inexpensive, disposable, rapid-point-of-care test for determining CD4 T-cell counts in HIV-infected patients to be released in the market in December of this year.

From a time when CD4 test machines required no less than a single-phase alternating current power source to our new battery-operated rapid CD4 test kit, technology has become a tool to help meet unmet needs and enhance quality HIV care and treatment, even as other initiatives for treatment and cures continue.

Today’s session brought together Track 1.o partners to discuss the progress and accomplishments that HIV programmers have made as part of this eight-year long PEPFAR treatment program.

The Track 1.0 treatment mechanism was the largest single treatment program awarded by PEPFAR, and was administered by the U.S. Centers for Disease Control and Prevention (CDC) Global AIDS Program and the HIV/AIDS Bureau at the Health Resources and Services Administration.

EGPAF’s Dr. Anja Giphart presents on the results of Project HEART.

EGPAF served as a Track 1.0 partner, along with AIDSRelief (Catholic Relief Services Consortium), the Harvard School of Public Health, and the International Center for AIDS Care and Treatment Programs at the Mailman School of Public Health at Columbia University.

The session was led by Deborah Birx, Director of the CDC’s Center for Global Health’s Division of Global HIV/AIDS and John Idoko, Director of Nigeria’s National Agency for the Control of AIDS.

Since 2004, under the Track 1.0 mechanism, partners have initiated more than 1.4 million patients on treatment in sub-Saharan Africa and the Caribbean.

Other accomplishments included contributing to national treatment guidelines, improving diagnostic/laboratory networks to better enroll those found HIV-positive on treatment, strengthening data collection tools and reporting systems (like ICAP’s Unified Reporting System), and building local capacity and transitioning to ensure sustainability of support programs.

Anja Giphart presented on EGPAF’s Project HEART - Help Expand Antiretroviral Therapy to children and families. She discussed how over the past eight years, EGPAF has managed to reach 270,000 HIV-positive women and avert nearly 62,000 pediatric infections in the five Project HEART countries.

Giphart emphasized EGPAF’s work with local partners, and country-specific capacity building. Project HEART trained 7,000 doctors, 11,700 nurses, and 6,900 other health care workers in all 5 countries to support PMTCT and pediatric care and treatment.

She also highlighted our work toward sustainability of programming through transitioning to local NGOs and affiliates in our Project HEART-supported countries.

To learn more about EGPAF’s transition model, click here.