MALARIA

1. 35% of Malaria Drugs Sold in Africa Substandard, Study Says
[May-07-2008]

2. Increased Risk of Malaria in Myanmar After Cyclone, WHO Says
[May-07-2008]

3. Kenya, Uganda To Receive Multimillion Dollar Grants for Malaria Research, Scientific Training
[May-06-2008]

4. China Donates Bulk Supply of Malaria Drugs to Uganda
[May-05-2008]

5. Malaria Drug Candidates Pass Toxicity Tests in Animals
[May-02-2008]

6. Misdiagnosis of Malaria in Mali Increasing Drug Resistance, Causing Diseases To Go Untreated
[May-02-2008]

TUBERCULOSIS

7. Kenya Launches Campaign To Increase TB Screening Among HIV-Positive People
[May-08-2008]

8. Additional Research Sites Could Be Added to Moxifloxacin Global TB Drug Trials
[May-07-2008]

9. Drug-Resistant TB Cases Increasing in United Kingdom, Study Says
[May-05-2008]

10. TB Cases Often Go Undiagnosed Among Immigrants in Australia, Study Says
[May-05-2008]

11. New Study Examining TB Iron Transportation Could Aid in Drug Development, Researchers Say
[May-08-2008]

GLOBAL HEALTH

12. Global Fund Might Consider Loans for Countries That Become Too Wealthy To Qualify for Grants, Executive Director Says
[May-05-2008]

13. FDA To Unveil 'Priority Review' Vouchers for Neglected Disease Research
[May-06-2008]

14. British Prime Minister Brown Holds Conference on Role of Businesses in Efforts To Meet MDGs
[May-07-2008]

15. '60 Minutes' Profiles Partners in Health Co-Founder Paul Farmer
[May-06-2008]

MALARIA

Substandard malaria drugs are widespread in Africa, with more than one-third of medicines failing to pass quality tests, according to a study published Wednesday in PLoS One, Reuters reports. The study found that about 35% of malaria drugs sold in six African cities failed to dissolve properly or did not contain high enough levels of an active ingredient.

For the study, researchers sent agents to act as customers at randomly selected pharmacies. The study tested 195 different packs of malaria drugs (Fox, Reuters, 5/6). The pharmacies were in Ghana, Kenya, Nigeria, Rwanda, Tanzania and Uganda. One-third of the packs tested contained artemisinin monotherapies. Of these packs, 42% failed quality tests, and 78% were manufactured after the World Health Organization prohibited the use of monotherapies in January 2006.

In May 2007, the World Health Assembly resolved to stop the production and marketing of artemisinin monotherapies. However, only 40 of the 74 global manufacturers of artemisinin therapies have agreed in principle to stop production, according to WHO. In addition, 42 countries, 18 of which are in sub-Saharan Africa, still allow companies to market the monotherapies (Health-e, 5/6). The researchers did not name the manufacturers of the drugs tested in the study.

Roger Bate of the American Enterprise Institute, who led the study, said the research "shows that efforts to increase access to quality antimalarial drugs in Africa are increasingly important." He added, "Substandard drugs not only endanger lives today, but also jeopardize future malaria treatment strategies by accelerating parasite resistance." Substandard malaria drugs cause about 200,000 avoidable deaths annually, according to the researchers.

The researchers recommended that the World Trade Organization "enact rules prohibiting the international trade in artemisinin monotherapies" and reduce "tariffs on proper medicines to zero" (Reuters, 5/6).

The study is available online.

Back to Top

The World Health Organization on Tuesday said that an increased risk of malaria and other diseases is one of the agency's "biggest concerns" in the wake of a cyclone that hit Myanmar last week, the AP/Yahoo! News reports. WHO is waiting for permission from the country to send in medical teams to prevent mosquito-borne diseases, including malaria (Mason, AP/Yahoo! News, 5/6).

Myanmar's military government has been denying foreign relief workers access to sites in the country, AFP/Yahoo! News reports. International SOS -- which has an office in Yangon, Myanmar -- recently issued warnings about the risk of malaria and other diseases (Gibson, AFP/Yahoo! News, 5/7).

UNICEF said it plans to distribute insecticide-treated nets and other supplies in the country, according to the AP/Yahoo! News. Vismita Gupta-Smith, the spokesperson for WHO's regional office in New Delhi, said that demolished infrastructure could hamper early efforts to prevent disease outbreaks. She added that WHO is waiting for Myanmar's military leaders to request aid from a regional emergency fund that was created last year to fill the time gap between international donor pledges and the arrival of medical supplies. About $175,000 currently is available in the fund, she said (AP/Yahoo! News, 5/6).

On Wednesday, Australian Foreign Minister Stephen Smith said his government will give three million Australian dollars, or about $2.8 million, in immediate relief aid to Myanmar. Smith said Australia's contribution is aimed at "key priorities," which include ITNs and other tools to prevent the spread of malaria. He noted that the money will be divided among the aid agencies CARE, Caritas Internationalis, United Nations World Food Program, UNICEF and World Vision (Asia Pulse, 5/7).

In addition, Thailand's Ministry of Public Health on Wednesday dispatched drugs and medical supplies worth $157,000 to Myanmar, TNA/Mathaba reports. Health Ministry Permanent Secretary Prat Boonyawongvirot said local health officials have been working with Myanmar authorities to prevent disease outbreaks on the border between the two countries. Thailand's health ministry has prepared 20 mobile medical teams and 20 teams of disease survey experts trained to identify emerging health issues in the areas. The units are set to leave for Myanmar immediately if requested by the government, he added (TNA/Mathaba, 5/7).

Back to Top

Kenya and Uganda are set to receive the majority of a $40 million grant from the Wellcome Trust for research into malaria and other diseases, as well as science training, the East African Standard reports.

The Kenya Medical Research Institute will receive $18 million for its tropical diseases research program, which includes malaria research. The Makerere University-London School of Hygiene and Tropical Medicine research project in Uganda will receive nearly $2 million for infection and immunity research and training within the country. Both countries also will share a $14 million grant to support training for African scientists to conduct malaria research at local universities.

In addition, South Africa's University of Cape Town is set to receive $6 million to establish a center for clinical infectious disease research.

Mark Walport, director of the Wellcome Trust, said, "Excellent scientists also need outstanding facilities in order to pursue their work and careers." He added, "We are working with African universities and research institutes to develop programs to support the institutional infrastructure that is essential to provide a thriving environment for research and for the education of future generations."

Kevin Marsh, director of the KEMRI-Wellcome Trust Research Program, said, "Strengthening research capacity needs a long-term, strategic approach, which this funding will enable." He added, "It's about building scientific leadership and recognizing that researchers need a critical mass of support from trained research and nonresearch staff" (Kimani, East African Standard, 5/5).

Back to Top

China has donated a $400,000 supply of malaria drugs to Uganda's Ministry of Health to assist in control efforts and promote economic growth, Chinese Ambassador to Uganda Sun Heping said recently, the New Vision reports.

The donation includes 159,000 doses of the artemisinin-based combination therapy naphthoquine, 96,000 doses of the ACT piperaquine and laboratory equipment for a malaria treatment center. Heping said that the Chinese government donated its first supply of malaria drugs to Uganda in 2007 and that it plans to help establish a malaria prevention and treatment center at Mulago Hospital this year.

Ugandan Health Minister Stephen Mallinga said the donation is timely because the ministry recently began recommeding the use of ACTs to treat malaria, the New Vision reports. Mallinga said the ministry's malaria control strategy focuses on prompt case management, indoor insecticide spraying and the use of insecticide-treated nets.

Sam Zaramba, director-general of health services, said Chinese researchers plan to train 60 Ugandan health workers in malaria prevention and treatment techniques this month (Nakagwa, New Vision, 5/4).

Back to Top

Canadian biotechnology company Upstream Biosciences recently announced that its new malaria drug candidates have proven to be safe in toxicity tests with animals, Panapress/Afrik.com reports (Panapress/Afrik.com, 5/2).

Upstream scientists have been working with colleagues at Makerere University in Uganda to develop the treatments, the Monitor reports (Kirunda, Monitor, 5/1). The drug candidates were discovered using an advanced computational approach, according to an Upstream release. Tests in February suggested that the new malaria drugs have the potential to add to the treatment of drug-resistant forms of malaria.

The drug candidates were "well-tolerated, with no signs of serious toxicity at likely therapeutic dosages suggested by initial in vitro efficacy experiments," the release said. Joel Bellenson, CEO of Upstream, said the results "mark an important step in our program to develop safe and effective drugs to fight this pervasive condition" (Upstream Biosciences release, 4/28).

Bellenson said researchers can begin testing the drugs in sick animals, although he said it is difficult to know when human trials would start. "Drug development has several stages and sometimes requires taking one step back to make two steps forward," he said. "When we get the animal efficacy data, it will tell us whether we need to use our artificial intelligence software to make the drugs more potent or less toxic," he added (Monitor, 5/1).

Back to Top

Misdiagnosis of malaria in Mali is increasing drug resistance and allowing other illnesses to go untreated, health experts said recently, IRIN News reports.

Health workers often diagnose people with malaria on assumption without testing for the disease, according to Fatou Faye, an infectious diseases researcher and trainer at the Charles Merieux Center in Bamako, Mali. "The patients then buy antimalarial drugs in the street and build up a resistance to treatment," Faye said. As a result, people are not treated for other diseases, which can lead to further illness or death, according to research by Imelda Bates of the Malaria Knowledge Project. Misdiagnosis can also increase poverty because of loss of productivity from prolonged illness and money spent on incorrect treatment, IRIN New reports.

Michel Van Herp, an epidemiologist for Medicins Sans Frontieres, said most health clinics in Mali, particularly those in rural areas, cannot afford costly malaria diagnostic equipment and lack trained staff to operate it. Faye said most of the 82 public laboratories around the country lack the appropriate equipment and trained staff to diagnose malaria. In addition, people who develop a fever often self-treat because they either live too far away from a health clinic or do not want to pay the money for a consultation, IRIN News reports.

The Charles Merieux Foundation has set up a laboratory in Bamako to diagnose malaria and train technicians from around the country. The European Union also is sponsoring equipment for laboratories, IRIN News reports. However, Van Herp said that "simple, low-technology malaria test kits" are needed rather than "expensive equipment" and "in-depth trainings, which is hard to do in rural areas." He said it will cost $61 million to cover Mali's diagnostic needs and require serious commitment from governments and donors (IRIN News, 5/1).

Back to Top

TUBERCULOSIS

The Kenyan government on Tuesday launched a 60 million shilling -- or about $975,000 -- campaign to increase the number of HIV-positive people who are screened for tuberculosis at public hospitals, the Nation reports. The campaign also aims to educate health workers to test people with TB for HIV.

About half of the 1.2 million HIV-positive people in Kenya also have TB, James Nyikal, public health and sanitation permanent secretary, said at an event to mark the launch of the campaign at Mbagathi District Hospital in Nairobi, Kenya. He added that health workers detect about 20% of TB cases among HIV-positive people. According to Nyikal, there is a "strong link" between TB and HIV/AIDS. "That is why we want our health workers to ensure all patients are tested for both diseases in public, private and mission hospitals," he said (Mwaniki, Nation, 5/7).

Nyikal also said health workers are not immune to the stigma often associated with TB and HIV/AIDS, Africa Science News Service reports. He said a number of health workers reported knowing colleagues who seek treatment for HIV/AIDS in distant health clinics to avoid discrimination. "Health workers need to be encouraged to recognize the benefits of disclosure to support their work and health," Nyikal said. He also acknowledged that Kenya faces challenges in fighting HIV/AIDS- and TB-related stigma (Neondo, Africa Science News Service, 5/6).

According to Nyikal, Kenya has received a shipment of 800,000 doses of the BCG TB vaccine. A recent government shortage put more than 200,000 infants at risk of contracting the disease. There were 117,000 cases of TB in Kenya last year, and the disease killed about 74,000 people, the Nation reports (Nation, 5/7).

Back to Top

Research sites in China, Hong Kong, India and Kenya could be added to an international trial to test whether the antibiotic moxifloxacin shortens the length of tuberculosis treatment regimens, Melvin Spigelman, director of research and development for the Global Alliance for TB Drug Development, said recently, the Times of India reports.

The $20 million study will recruit about 2,400 people who have TB for trials in more than 20 sites worldwide, which could make it one of the largest TB drug trials ever conducted, according to the Times. Spigelman said that four sites in South Africa, Tanzania and Zambia currently are recruiting participants.

The study is receiving most of its funding from the TB Alliance and the Bill & Melinda Gates Foundation, Spigelman said. The final results from the study are expected by early 2011.

According to Spigelman, current TB treatment regimens are "complicated." He said that the goal is not to add another drug to treatment regimens. "We want to see if moxifloxacin, which has shown excellent safety profile and proved highly effective in clearing the TB bacteria within four months during Phase II trials, actually cures faster when it substitutes existing drugs ethambutol or isoniazid," he said.

Reducing treatment to four months "would mean less exposure to drugs for the patient and less interaction with health services, thereby reducing their workload," Andrew Nunn of the Medical Research Council said.

India's Christian Medical College, TB Research Center and the National Tuberculosis Institute are three sites being considered to host drug trials in the country, the Times reports (Sinha, Times of India, 5/6).

Back to Top

Cases of drug-resistant tuberculosis are increasing in the United Kingdom primarily because of immigration and a lack of TB control in prisons, according to a study published on Thursday in BMJ, BBC News reports.

For the study, a team of researchers from the Health Protection Agency examined 28,620 cases of TB in England, Northern Ireland and Wales between 1998 and 2005. They found that the number of cases increased from 170 in 1998 to 336 in 2005. The findings showed that 5.6% to 7.9% of the TB cases were resistant to first-line TB drugs (BBC News, 5/2). The number of multi-drug resistant TB cases also increased from 23 to 39 during the study period, according to researchers, the Guardian reports.

In addition, the findings showed an increased resistance to the TB drug isoniazid among people outside London, which likely is related to immigration from sub-Saharan Africa and India (Sample, Guardian, 5/2). In 2006, about 8,000 TB cases were reported in England, Northern Ireland and Wales, possibly because of an increase of the disease among immigrants from those regions, researchers said.

"[I]n our experience, much of the resistant TB is found in patients who come form abroad, emphasizing the need for screening at the earliest possible opportunity," Geoffrey Pasvol, a researcher at Imperial College London, said (Kahn, Reuters, 5/1).

"The observed increases highlight the need for early case detection, rapid testing of susceptibility to drugs and improved treatment completion," Michelle Kruijshaar, an HPA researcher who led the study, said. The researchers also said that methods to control TB in prisons are inadequate. According to the team, a 1999 outbreak of drug-resistant TB continues to affect prison inmates and drug users in London (BBC News, 5/2).

Related Commentary
In a related BMJ commentary, James Lewis of the London School of Hygiene and Tropical Medicine called for strengthening TB control efforts and increasing research into diagnostics and medications. "The sooner we can do something about [drug-resistant TB] and stop it rising further, the better," Lewis wrote (Guardian, 5/2). However, he added that "[g]iven the population size of England, Wales and Northern Ireland, multi-drug resistant TB is still rare and remains the exception" (BBC News, 5/2).

The study and an extract from the commentary are available online.

Back to Top

Immigrants in Australia often are not diagnosed with tuberculosis until a decade after they arrive in the country, according to a study recently published in the Medical Journal of Australia, the West Australian reports.

For the study, Michelle McPherson, an epidemiologist from Victoria's Department of Human Services, and colleagues examined TB diagnosis rates in the state of Victoria between 1990 and 2004. They found that more than one-third of TB cases among immigrants were not diagnosed until at least 10 years after they moved to Australia.

The findings showed that immigrants from countries in the European Union and Western Europe were most likely to be affected. However, there was little TB transmission from immigrants to the broader population, and most diagnoses were from reactivated latent TB, McPherson said.

Paul Van Buynder, director of communicable disease control at the Western Australia Department of Health, said that the study focused on immigrants who arrived in Australia before 1980, when TB rates in Europe were higher than they are now.

Researchers recommended that refugees and immigrants from countries with high TB burdens be screened for latent TB when they arrive in Australia and then receive follow-up testing for at least 10 years, the West Australian reports.

"Further efforts to improve detection and treatment of latent TB infection, along with the realization that the risk of infection persists beyond the first decade after migration, may help to minimize the burden of TB in Australia," McPherson said. She added that more sensitive testing techniques for latent TB should be integrated into screening programs.


Van Buynder said that Western Australia has a comprehensive initial TB testing program that can identify people with latent TB upon arrival to the country. "These people are then offered treatment or put on long-term follow up," he said. He added that in Western Australia there "is no evidence of any increase in TB cases in the group described in the [study] and no evidence of significant transmission of TB within the community" (Guest, West Australian, 5/5).

The study is available online.

Back to Top

Researchers have identified the methods that tuberculosis bacteria use to transport iron, which could help scientists develop new drugs to treat the disease, ANI/Yahoo! News reports. The findings were published in a study in the May 7 issue of PLoS One.

Seyed Hasnain of the University of Hyderabad Institute of Life Sciences led the study. Hasnain and colleagues conducted the experiment both outside and inside living organisms to examine how TB bacteria import iron from the cell where they live. The researchers also studied how the bacteria survive in human hosts, where the environment is low in iron.

The researchers identified two genes that work with another binding protein as an exporter-importer system. Previously, the genes were thought of as importers only. They also found that iron-binding molecules, known as siderophores, were actively exported outside the micobacterial cell instead of passively diffusing, which was what scientists previously had thought. These three genes increase the iron uptake in the cell. They also provide feedback for the export of non-iron bound siderophores and import of the iron-bound forms.

The researchers believe these findings could boost global efforts to understand the survival method of TB, which could help with the development of new treatments (ANI/Yahoo! News, 5/7).

The study is available online.

Back to Top

GLOBAL HEALTH

The Global Fund To Fight HIV/AIDS, Tuberculosis and Malaria might begin extending loans to countries that become too wealthy to qualify for grants, Executive Director Michel Kazatchkine said Sunday at an HIV/AIDS conference in Moscow, Reuters reports. Kazatchkine said that by including a loan repayment program in its mandate, the Global Fund could help increasingly wealthy countries that do not yet have the infrastructure to effectively fight HIV/AIDS, TB and malaria. "To us it's important that when the world's money for aid is being distributed, it not only takes into account economic factors but also, for example, burden of disease," Kazatchkine said.

The Global Fund has committed $1.2 billion to Eastern Europe and Central Asia through to 2010, about 55% of which is going to fight HIV/AIDS. Ten countries from the regions -- including Kazakhstan, Russia and Turkey -- will not be eligible for Global Fund grants by the end of 2009 because they will be classified as upper-income countries, Reuters reports.

Kazatchkine said there has been significant progress in developing nongovernmental organizations in the two regions. However, some advocates worry that without Global Fund financing, NGOs could be marginalized by governments, Reuters reports. "These are societies" in which the "relationship between public sector and the nongovernmental sectors haven't been established and do not run as smoothly as Western societies," Kazatchkine said.

According to Kazatchkine, Russia set the precedent for the possibility of including loans in the Global Fund's work. The country in 2006 pledged to repay 80% of its $320 million Global Fund grant. "What I'm saying is that with the Russian example, we may find ways of basically a free loan that would allow these countries to access resources now but also behave as a donor," Kazatchkine said.

Kazatchkine also said that Kazakhstan could benefit from a Global Fund loan. The country's economy has grown rapidly during the last 10 years, but it still is experiencing an increase in HIV/AIDS cases. Kazakhstan has received more than $67 million in Global Fund grants in previous years. "The challenge for Kazakhstan is how to manage in the future," Kazatchkine said, adding, "I wonder whether we couldn't consider, as an international community, whether Kazakhstan instead of not being eligible at all in the future could potentially be eligible but then commit to reimburse by 2015 or 2020 or whatever."

According to Reuters, the annual number of new HIV/AIDS cases in the Eastern Europe and Central Asia regions has declined from 210,000 in 2001 to about 150,000 in 2007 (Kilner, Reuters, 5/4).

Back to Top

FDA in August is expected to unveil a new voucher program that will reward drug companies for research into neglected diseases by accelerating drug reviews, the Financial Times reports.

The "priority review vouchers" will grant drug companies a six-month review period if they receive FDA approval for drugs to treat certain diseases, such as malaria and tuberculosis. These reviews usually take between 10 months and 18 months.

According to the Times, the vouchers are designed to stimulate research into tropical diseases, "for which there is little commercial market." They can be sold to other companies, which can use them for any drug, the Times reports.

There is no guarantee that FDA will approve a drug that receives a PRV. However, by enabling a drug to be launched early vouchers, could be a "powerful incentive" for new research, the Times reports. According to some estimates, the vouchers could be worth up to $500 million.

The idea of the vouchers has received support from some large pharmaceutical companies, biotechnology groups and venture capitalists. However, "there are concerns" that FDA has not clarified whether PRVs can be sold only once or whether additional trading will increase their value, the Times reports (Jack, Financial Times, 5/1).

Back to Top

Multinational companies need to increase their efforts to address development issues worldwide, British Prime Minister Gordon Brown said on Tuesday ahead of a conference on global businesses and the United Nations Millennium Development Goals, AFP/Google.com reports. The MDGs include targets to curb the spread of diseases such as HIV/AIDS, tuberculosis and malaria. "This year must be a year of action if we are to tackle the development emergency we face," Brown said in a statement released ahead of the London conference, which will include the heads of more than 80 global businesses and leaders from countries such as Ghana and Rwanda.

The conference will highlight work being done by more than 12 companies, such as Citi, Coca-Cola, Diageo, Microsoft, Sumitomo Chemical, Thomson Reuters and Vodafone. Brown said that he hopes such work will inspire other businesses to help reach the MDG targets by the 2015 deadline. Kemal Dervis from the U.N. Development Programme said in a statement that the private sector is "one of the greatest untapped resources" to help meet MDG targets (AFP/Google.com, 5/5).

Brown in December 2007 called on at least 20 of the largest multinational companies to help global efforts aimed at meeting the MDGs. Brown said he will call for an MDG meeting during the U.N. General Assembly in September 2009 to galvanize efforts to accomplish the targets. Brown also will use a meeting of the Group of Eight industrialized nations in Japan this summer to provide incentives to meet the MDGs (Kaiser Daily HIV/AIDS Report, 12/11/07).

Back to Top

CBS' "60 Minutes" on Sunday profiled Paul Farmer, co-founder of Partners in Health, which provides no-cost medical care for people with HIV/AIDS, tuberculosis, malaria and other conditions in Haiti and eight other countries worldwide. The group's work focuses on increasing access to medical care by lowering treatment costs and training local residents to provide care.

Jim Kim, professor at Harvard Medical School and a co-founder of Partners in Health, said that when Farmer "stared treating people in 1998 in Haiti, everyone said he was absolutely nuts," adding, "And here we are, you know, not even a decade later, where the goal is to treat every single human on the planet who needs HIV treatment with the right drugs."

According to "60 Minutes," Kim and Farmer also have worked to lower prices for drugs to treat multi-drug resistant TB by improving access to generics. In addition, the organization trains community health workers to visit HIV/AIDS and TB patients at home to ensure they adhere to their treatment regimens (Pitts, "60 Minutes," CBS, 5/4).

Back to Top

Please forward this notice to interested colleagues. __________________________________________________________________

GlobalHealthReporting.org Weekly TB/Malaria Report

The GlobalHealthReporting.org Weekly TB/Malaria Report is published for GlobalHealthReporting.org, a project operated by the Kaiser Family Foundation with major support from the Bill and Melinda Gates Foundation. (c) 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Larry Levitt, editor-in-chief, kaisernetwork.org; vice president, Kaiser Family Foundation