HIV/AIDS Newsroom: January 12, 2000
The Cost Effectiveness of Voluntary Prenatal and Routine Newborn HIV Screening in the United States
Journal of Acquired Immune Deficiency Syndromes (www.jaids.com)
12/15/00 Vol 25., No. 5, P. 403; Zaric, Gregory, S; Bayoumi, Ahmed M.; Brandeau, Margaret L.; et al.
Researchers recently investigated the cost efficiency of voluntary prenatal and postnatal HIV testing programs for pregnant women and newborns in the United States. The basis of the study was the number of infections avoided versus life expectancy versus costs and incremental costs incurred. The study found that a voluntary prenatal program would bring an additional 1.1 million women in for annual testing, 527 additional HIV-infected mothers would be identified, and 150 infections of newborns could be prevented, at the total cost of $8,900 per life-year gained. Annual routine HIV newborn HIV testing would encompass 3.9 million infants, identify 1,061 HIV infected mothers, avoid 266 newborn infections, and would cost $7,000 per life-year gained. The researchers concluded that voluntary prenatal HIV screening of women and routine testing of newborns are both cost effective and that increased participation in a voluntary prenatal testing program would help to ensure the mother's personal right to determine whether or not she is tested.
Dr. Peter Kim, the Massachusetts Institute of Technology (MIT) biologist tapped to become the next head of Merck's drug research unit, has discovered a molecule that can prevent HIV from entering a cell by stopping the process known as membrane fusion by which the HIV cell pulls itself to a host cell. Current AIDS treatments attack the virus once it enters a host cell to prevent it from replicating, but this molecule and several others in a class known as "fusion inhibitors" show promise as alternatives for patients who have either become resistant to current drugs or cannot tolerate the myriad side effects associated with HIV drugs. Hoffmann-La Roche is currently working with Trimeris to develop T-20, a fusion inhibitor that is a top priority for the FDA and could be approved by the middle of next year, but Kim's discovery could be even more effective than T-20. Progenics Pharmaceuticals and Schering-Plough are among the companies looking for other ways to stop HIV molecules before they reach host cells, potentially a way to reduce side effects and act more quickly against HIV.
New Taboos: To Help Fight AIDS, Tanzanian Villages Ban Risky Traditions
Wall Street Journal (www.wsj.com)
01/12/01 P. A1; Phillips, Michael M.
In many Tanzanian communities, officials have prohibited a number of traditional social and sexual practices in an effort to halt the spread of HIV. The trend stems from a research project in the Magu district -- where an estimated 2,000 residents contract HIV every year, out of a population of 415,000 -- funded by the Dutch government that attempted to identify possible high-risk spots for HIV transmission, such as dance clubs and abandoned huts. Since those maps were drawn up, however, village officials started using them to pass new legislation to keep people from going such hotspots, hundreds of AIDS experts from around the globe have come to the area, and other parts of Tanzania are trying to copy the project. It is not yet known whether the program has lowered the HIV infection rate, but research suggests that 38 percent of Magu district residents have reported safer behavior in their villages, and teachers say there are fewer pregnancies among schoolgirls. The threat of being caught is real, as militia -- known as sungusungu -- are used to enforce social laws, imposing fines and carrying bows, spears, and clubs. The war against AIDS in Tanzania has changed many types of relationships. For example, while the tradition among one major ethnic group, the Sukuma, has been to pass a dead man's family and property on to his younger brother -- a practice that can put the younger brother and his family at risk if the woman's husband died from AIDS -- an increasing number of widows are following a 1998 law that permits them to keep their family land and property.
Over 700 patients who underwent endoscopic procedures at Foote Hospital in Jackson, Mich., last year were asked to return for disease testing after it was discovered that the equipment used in the procedure was not properly sterilized. A judge recently ruled that the patients have legal grounds to sue the hospital. The overall results of the HIV and hepatitis tests have not been released.
Health officials in Britain are under fire following reports that the National Health Services (NHS) is knowingly recruiting African nurses who are HIV-positive to train and work in its state-run hospitals. The NHS, which is experiencing a severe shortage in nurses, has been forced to seek recruits from abroad. A Department of Health spokesman noted that they were aware of the infections, since all student nurses in England must undergo occupational health testing. The spokesman further explained that the infected student nurses will not be involved in any high-risk procedures, such as surgery, and pointed out that there has been no recorded case in England of HIV being transmitted from an infected worker to a patient.
Zambia has become the object of open and alarmed criticism from the international donor community about the country's commitment to the fight against AIDS. On Wednesday, Zambia announced that, in response to pressure from church groups, graphic HIV awareness advertisements would be temporarily suspended. The war against AIDS in Zambia, where one in five adults is infected with HIV, is financed primarily by international donors; government officials have asked for $559 million for programs over the next few years. However, international donors reportedly voiced concerns that the withdrawal of the ads meant that the Zambian government had changed its priorities in the war against AIDS.
Bhutan, a small country of 2 million people locked between India and China, has reported 15 cases of HIV. For health officials in this tiny Himalayan country, the number of infections is significant enough to cause alarm. According to a Dr. Rinchhen Chophel of the Public Health Programs, the population's increased mobility and its large proportion of teenagers are two factors that could facilitate the virus' spread. Chophel said the 15 infections were identified through blood screening and random checks of prostitutes, and that the actual number of HIV cases in Bhutan is probably higher.
Estonian officials reported 390 new cases of HIV last year, a significant increase from the nine cases reported in 1999. The majority of the reported cases are from high drug abuse regions located near the Russian border, and most of the infections were among injection drug users between the ages of 18 and 24. Nelli Kalikova, head of the nongovernmental AIDS prevention center, said she expected the number of cases to double this year, noting, "This is not just an explosion of disease, this is an epidemic."
In Uganda, prison wardens and inmates are being trained to help take care of HIV and AIDS patients. According to prison officials, the training began in 1995, and has helped to improve the quality of life for HIV-infected inmates. The training was made possible by the British department for International Development.
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.