This is the second in a three-part series on U.S.-led successes in global health. This post focuses on a question recently posed to me: What game-changing advances lie ahead in fighting HIV/AIDS, tuberculosis and malaria?
As with the rest of medicine, there are many advances from which to choose. I've focused here on advances taking place that especially inspire HIV/AIDS, tuberculosis and malaria experts - the men and women who devote their lives to fighting these scourges.
Malaria: Dedicating Insecticides to Public Health
A key problem in fighting disease is nature's tendency to evolve and evade man-made arsenals. Thus, we see bacteria strains becoming resistant to antibiotics and - in the case of malaria - mosquitoes becoming resistant to insecticides, like pyrethroids.
To make inroads against insecticide resistance, scientists are taking up a novel approach. The Innovative Vector Control Consortium, in partnership with private sector partners, are aiming to create a generation of insecticides dedicated solely to public health use. This is new because virtually every current insecticide was developed first for agriculture, then transferred to public health. Thus, today's insecticides were designed for wide use and are susceptible to relatively rapid insecticide resistance.
For about a decade now, entomologists have been studying some 4.5 million new chemicals and compounds for potential use as insecticides. From these compounds, they have identified a handful of potentially effective ingredients, which will be tested to ensure safety for humans, other mammals and the ecosystem at large. These new ingredients could represent the future of malaria control and would become part of the first insecticides created specifically for public health purposes.
Tuberculosis: New Ways of Engaging with Patients
In the fight to end the epidemic of tuberculosis (TB), there are a couple of major obstacles. One is reaching potential patients who are unaware of their infection or not accessing quality care; approximately 3 million cases of TB are missed each year because many people aren't connecting with the public health systems. A second obstacle is ensuring that patients, once diagnosed, are supported to consistently take medications that can have very unpleasant side effects and take several months or longer.
To address these obstacles, experts are aiming to change the ways health care systems engage with patients. India, for example, recently launched a TB initiative that includes an expansion of access to highly sensitive, rapid diagnostic tests to detect regular and drug-resistant TB, including in rural and remote areas. The country is also taking a more patient-centric approach, including building linkages between private and public health systems and providing free third-line antiretroviral treatment to HIV-positive patients who are co-infected with TB. As for adherence, India has launched a 99DOTS program, a low cost system where patients send a free phone call each time they take their TB medications, allowing health care providers to focus on patients who need extra help and counseling.
HIV/AIDS: Better Implementation of Solid Tools
While the world awaits new drugs or an HIV/AIDS vaccine, there are several solid, known ways to reduce transmission of the disease. These include voluntary medical male circumcision, condom usage and Pre-Exposure Prophylaxis (PrEP), which entails giving antiretroviral medication to a person who is at high risk of contracting HIV/AIDS. Country leaders, HIV/AIDS experts and activists are excited about the potential for making big gains in fighting this disease through better use of these existing tools.
PrEP, for example, has already been approved for use in the United States, Canada, France and Israel and has recently been put forth by the World Health Organization guidelines for implementation worldwide. In line with this, South Africa just became the first country in sub-Saharan Africa to release PrEP guidance, and its government plans to incorporate PrEP into upcoming national guidelines for broader populations. Kenya is also working on PrEP recommendation and demonstration as part of its ongoing HIV prevention roadmap plan, launched in 2014.
Looking Ahead
Bipartisan, U.S. support of global health investments has resulted in stellar outcomes to date. With continued innovations like those above and expanded implementation through the Global Fund, PEPFAR, USAID and the President's Malaria Initiative, we have a historic opportunity. We can bend the curve on these diseases, work to end them as epidemics and save millions of lives.
I feel sure that we Americans will choose to advance this opportunity.