In the first of two linked posts, Mike Frick of Treatment Action Group (TAG) and Audrey Zhang of Harvard College argue that patient-centered approaches in treatment for drug-resistant and drug-sensitive tuberculosis are needed.
In “A Walk to Work with Dr. Vivan Cox,” the first short film in the series Tuberculosis: Behind the Numbers commissioned by TAG, director Jonathan Smith introduces an innovative approach to address multidrug-resistant tuberculosis (MDR-TB). In Khayelitsha, South Africa, Médecins Sans Frontières (MSF) is treating patients in community healthcare centers instead of confining them to hospitals. Vivian Cox, Deputy Medical Field Coordinator of Médecins Sans Frontières’ TB program in Khayelitsha, describes MDR-TB as “a community disease… that very often affects or infects whole families.” Dr. Cox describes how the dominant approach of confining MDR-TB patients to hospitals for up to two years can “tear families apart.”
Sara Gorman explores the interconnectedness of infectious and chronic diseases.
The headlines are everywhere. “Non-communicable diseases outsmart infectious diseases.” “Non-communicable diseases leading cause of deaths worldwide.” “Non-communicable diseases take center stage.” Non-communicable diseases are certainly on the rise worldwide and represent a growing concern for global health systems. But are chronic diseases truly taking the place of infectious diseases? In a world of global health systems that tend to focus on one disease or one category of disease at a time, should we be shifting our focus from HIV, tuberculosis, and malaria to asthma, heart disease, and diabetes?
In a thought-provoking article, Alanna Shaikh, a global health professional and writer, convincingly argues “not so fast.” The old view of the epidemiological transition, whereby non-communicable diseases “replace” infectious diseases as the primary threats to health, is probably too simple. Instead, communicable and non-communicable diseases are combining in new ways to present new threats. Shaikh takes the intersection of diabetes and tuberculosis as one prominent example. People with diabetes have a risk for tuberculosis infection 2-3 times greater that among people without diabetes. Even worse, people with diabetes have a higher risk of dying during TB treatment or confronting treatment failure, largely due to the fact that people with diabetes have difficulty tolerating TB drugs. Of course, diseases such as TB and malaria are largely irrelevant in developed countries, but in developing countries, the rise of chronic disease could mean devastating setbacks in the control of infectious diseases.
The following new articles are publishing this week in PLOS NTDs:
Soares Magalhães RJ, Fançony C, Gamboa D, Langa AJ, Sousa-Figueiredo JC, et al. (2013). PLoS Negl Trop Dis 7(10): e2321. doi:10.1371/journal.pntd.0002321
In contrast to all other known virus species in the genus Lyssavirus of the family Rhabdoviridae, Mokola virus is unique in that it appears to be exclusive to Africa and its reservoir host has not yet been identified. As only limited sequence information is available Joe Kgaladi and colleagues set out with this study to significantly contribute to the understanding of the genetic diversity and relatedness of Mokola viruses.
Improved understanding of the differential diagnosis of endemic Treponematoses is needed to inform clinical practice and to ensure the best outcome for a new global initiative for the eradication of yaws, bejel and pinta. Here, Oriol Mitjà and colleagues review the dilemmas in the diagnosis of endemic Treponematoses, and advances in the discovery of new diagnostic tools.
Unni Karunakara and Jean-Christophe Dollé describe the challenges faced by Médecins Sans Frontières’ TB programme as the organisation withdrew from Somalia in response to increasing violence.
On August 14th 2013, Médecins Sans Frontières (MSF) took one of the most difficult decisions in our history and closed all of our medical humanitarian aid operations in Somalia after more than 22 years of assisting people who have suffered decades of war, epidemics, man-made and natural disasters.
What would force MSF, known as one of the last organisations to leave an active war zone, to withdraw? Put simply, we have found the level of violence against our staff and the lack of respect from authorities for humanitarian action unbearable. We have been confronted with extreme attacks on our staff in an environment where armed groups and civilian leaders increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers.
Sixteen MSF staff have been killed in Somalia since 1991 and we have endured dozens of attacks on our staff, ambulances and medical facilities. We can intervene only if our presence is accepted by warring parties and communities and only if those groups agree to respect the safety of patients and our staff. This acceptance, always fragile in conflict zones, no longer exists in Somalia today.
This week, PLOS Medicine publishes the following new articles:
Image credit: Dave Proffer, Flickr
Using nine increasingly sophisticated mathematical models, Jan Hontelez from Erasmus MC, University Medical Center Rotterdam, Netherlands, and colleagues tested the time frames in which expanded access to antiretroviral viral therapy could lead to HIV elimination in South Africa. The current antiretroviral treatment policy in South Africa could lead to elimination of HIV within the country over the next 24 to 34 years, but a universal test and treat (UTT) approach could achieve elimination 10 years earlier, according to the research. All of the researchers’ models replicated the prevalence of HIV in South Africa (the proportion of the population that was HIV-positive) between 1990 and 2010, and all predicted that UTT would result in HIV elimination (less than one new infection per 1,000 person-years). The simplest model predicted that UTT would eliminate HIV after seven years, but the more complex, realistic models predicted elimination at much later time points. The most comprehensive model predicted that although elimination would be reached after about 17 years of UTT, the current strategy of ART initiation for HIV-positive individuals at a CD4 cell count at or below 350 cells/μl would also lead to HIV elimination, albeit ten years later than UTT.
Co-leads of the Open Access Button Project, David Carroll and Joseph McArthur announce the launch of the Open Access Button. 18th November 2013.
10 years ago today. 19 organisations signed the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities to use the Internet for the “further promotion of the new open access paradigm to gain the most benefit for science and society”.
To this day, the idealism of the Berlin Declaration has yet to be made a reality. We’ve made great strides since that day – with realistic ways of achieving this aim having become clear. The reality is though that everyday people are still denied access to research on a monumental scale. These people are doctors, scientists, researchers, students, patients, politicians and journalists.
For the individual this denial of access to information is at best a frustration, but at worst highlights the potentially deadly gap between the information rich and information poor. This artificially created information inequity between the information rich and poor that’s an indictment of our current system. The system has evolved over the past 100 years – but is yet to respond to the current environment we live in. The difference between where we are now, and the world imagined by those who signed the Berlin declaration is not one of technology, or money. It is one of will and imagination.
Tagged open access
The following new articles are publishing this week in PLOS NTDs:
Zou C-G, Tu Q, Niu J, Ji X-L, Zhang K-Q (2013). PLoS Pathog 9(10): e1003660. doi:10.1371/journal.ppat.1003660
Two safe and effective oral cholera vaccines are recommended by the World Health Organization for cholera prevention and control; however, concerns about the acceptability, potential diversion of resources, cost and feasibility of implementing timely campaigns has discouraged their use. Francisco Luquero and colleagues examine the use of one of the oral cholera vaccines, Shanchol, by MSF staff working during the 2012 cholera outbreak in Guinea and how it fits into existing outbreak response strategies.
Treatment of cutaneous leishmaniasis typically involves the use of toxic antimonials, but the distinctive mode of action of defensis with low susceptibility to resistance and low toxicity to mammalian cells makes them suitable candidates for anti-leishmanial agents. In this study, Sara Dabirian and colleagues used rHNP-1 against both the promistagote and amastigote forms of L. major.
The Maternal Health Task Force (MHTF) and PLOS Medicine are delighted to announce the addition of 15 recently published articles for the Year 2 Collection on the theme ‘Maternal Health Is Women’s Health’.
Image Credit: Jack Zalium and Richard Basset
This theme was created to highlight the need to consider maternal health in the context of a women’s health throughout her lifespan. While pregnancy is limited to women of reproductive age, maternal health is influenced by the health of women and girls before pregnancy. The effects of key health issues such as the impact of poor nutrition, poverty, lack of available quality healthcare and low socioeconomic status can occur during childhood, adolescence, throughout the pregnancy and beyond. These issues can heavily influence a woman’s maternal health, heightening the risk of complications in pregnancy, such as obstructed labor in adolescent girls or increasing the likelihood of HIV infections due to a woman’s physical susceptibility and her relative disempowerment.
Ginny Barbour, Medicine Editorial Director at PLOS, reflects on a recent move to sunnier climes.
Image Credit: Jan Smith, Flickr
My name is Brisbane, and we have a sun problem or, as a new acquaintance said to me, “Welcome to Brisbane, the skin cancer capitol of the world”, adding helpfully, “you’ll fry in about 5 minutes here.”
It’s 8.10 am in the Southern Queensland Spring, and according to the weather forecast in the Australian, it’s time to put the sun cream on. If acceptance of a problem is the first step to addressing it, Queenslanders are well on the way. The danger of the sun is a common theme among every Queenslander we have met in our short time here. Everyone has someone close to them who has had skin cancer of one sort or another. For a British family abroad in a hot climate, we find ourselves in the unusual position of not being the most pale skinned among a tanned local population. My daughter is probably the most tanned of her peers and this is regarded with some raised eyebrows; no one wants to be tanned.