Canada is Leading the Fight to End AIDS, TB and Malaria for Good

 

Introduction by Patrick Bidulka 

McGill University was fortunate to participate in the Global Fund Replenishment conference held in Montreal this September. The Global Fund side event at McGill, organized by the McGill Global Health Programs office, saw a high turn-out of world-class global health researchers and students. With its contribution of nearly $800 million, Canada has repositioned itself as a key contributor to the field of global health, and a stakeholder in the mission of the Global Fund to end HIV/AIDS, TB, and Malaria for good. However, as the Honorable Jane Philpott said as she addressed the event, these goals will not translate into tangible results until society collectively deems current health disparities as “outrageous, and solvable”. It is outrageous that a third of the world is infected with TB, with the majority of those infected being in developing countries. It is outrageous that here in Canada, we have a TB epidemic concentrated in our Aboriginal communities, where the rate of TB in Indigenous populations is 34 times higher than in non-Indigenous Canadians. It is outrageous that here in Canada, there are 50 new infections of HIV every week, and this rate has not changed in the last two decades. And so, it is these glaring inequalities that must be recognized, and deemed outrageous by more than just researchers and health care workers, but collectively by the global population. Progress has been paralyzed by barriers such as stigma, racism, gender inequality, and prejudice against LGBTQ people. It is not until these basic issues surrounding human rights are resolved that we can truly put an end to AIDS, TB and Malaria. As Mark Dybul, CEO of The Global Fund said at the McGill side event, “To end these diseases, we must become better humans”.

Panelists at the McGill event (from left to right): the Honourable Jane Philpott, Mark Dybul, Lucica Ditiu, Peter Singer, Mark Wainberg, Philippe Gros, and Marcel Behr.

Panelists at the McGill event (from left to right): the Honourable Jane Philpott, Mark Dybul, Lucica Ditiu, Peter Singer, Mark Wainberg, Philippe Gros, and Marcel Behr.

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Dr. Madhukar Pai & Dr. David Eidelman

As Montreal gears up to host the biggest leaders in global health, it is our hope that Canada will go well beyond provision of international aid, and find a way to harness the abundant scientific talent in Canada. Doing so will not only amplify the financial contributions by Canadians, but also show our global solidarity.

The past year has seen the re-emergence of Canada in the international development arena. In addition to maternal and child health, if there is one area where Canada is showing tremendous leadership, it is in the fight against the “big three” — AIDS, tuberculosis, and malaria — infections that kill over 3 million people each year.

To tackle the big three, The Global Fund to Fight AIDS, TB and Malaria was created in 2002. The Global Fund raises resources, engages a variety of partners, and invests funds in supporting programs to tackle the epidemics. Programs supported by theGlobal Fund have saved 20 million lives, by providing 9.2 million people with antiretroviral therapy for HIV, 15.1 million people with testing and treatment for TB, and 659 million mosquito bed nets to prevent malaria.

Canada is blessed with some of the best academic researchers and innovators working in global health.

If the Global Fund is to continue making progress towards ending these epidemics for good, it needs to be replenished by donor governments, private foundations, corporations, and philanthropists — and Canada is showing the world how to get this done!

On September 16-17, 2016, the Government of Canada will host the Fifth Replenishment Conference in Montreal that will bring world leaders to set funding for the next three years. The Global Fund has set a target of raising US$13 billion. Canada has already pledged CAN$785 million, a 20 increase compared to the last round. The USA has pledged up to US$4.3 billion, France has pledged €1.08 billion, and Germany has pledged €800 million. These pledges, hopefully, will inspire others to contribute and meet the target of US $13 billion which can save an additional 8 million lives.

In addition to supporting the Global Fund, the Government of Canada has made a renewed investment of CAN$85 million for the Stop TB Partnership’s TB REACH initiative, to reach, treat and cure many of the 3.6 million people affected by TB who every year go without proper care. The Government of Canada has also invested inGrand Challenges Canada, an agency that is funding several innovative projects in TB, HIV and Malaria.

We can be proud of all these developments that show commitment and leadership from the Canadian Government. However, in addition to providing development assistance, Canada has much more to offer. Canada is blessed with some of the best academic researchers and innovators working in global health. For example, an experimental Ebola vaccine developed by Canadian scientists has already attracted international attention.

In the area of HIV, TB and Malaria, Canadian researchers are making valuable contributions. Canada has led the way in identification of anti-retroviral drug targets, development and promotion of the Treatment as Prevention strategy, development and evaluation of new diagnostics, treatment of HIV and hepatitis co-infections, and leadership roles in prestigious societies to influence policy and advocacy.

Epidemics such as SARS, Ebola and Zika have shown us that infectious diseases respect no boundaries.

Canada has a rich history of research in tuberculosis, a disease that still affects our Aboriginal communities. Canadian researchers have identified the genetic basis of susceptibility to TB, used innovative DNA fingerprinting methods to track the epidemic, evaluated novel tests for TB, conducted clinical trials to develop shorter drug therapies, and contributed to international policies. Canadian researchers have identified promising malaria drug targets, documented malaria strain variations, and developed a global molecular surveillance system for drug-resistant malaria.

McGill University and its affiliated hospitals are home to several teams that focus on HIV, TB and parasitic diseases. With over 100 scientists working on infectious diseases, McGill has much to offer in global health, from fundamental science to policy, and, in particular, training of the next generation of researchers. McGill Global Health Programs coordinates the University’s global health work, and is making strategic investments and partnerships to make sure McGill’s faculty and students are actively engaged as global citizens, in solving the biggest global health challenges.

Epidemics such as SARS, Ebola and Zika have shown us that infectious diseases respect no boundaries. We are excited that Canada is showing impressive leadership in global health, and particularly thrilled that the Global Fund Replenishment Conference is being held in Montreal. We hope the Global Fund replenishment targets will be met, and Canadian researchers will be actively engaged to translate the dollars into saved lives.

Madhukar Pai is the Director of McGill Global Health Programs, and the Associate Director of McGill International Tuberculosis Centre. (@paimadhu)

David Eidelman is the Vice Principal of Health Affairs at McGill University, and Dean of the Faculty of Medicine. (@VPDeanEidelman)

This article was originally published in The Huffington Post. See the original article here.

Notes from the AIDS2016 Conference in Durban, South Africa

Kara Leigh Redden

In July, I had the amazing opportunity to not only participate in the AIDS2016 International AIDS Conference in Durban, South Africa, but to also present my research on the prevention of mother-to-child transmission of HIV with my Haitian co-investigator.

Kara and her co-investigator presenting their work at the AIDS2016 conference in Durban, South Africa.

Kara and her co-investigator presenting their work at the AIDS2016 conference in Durban, South Africa.

It was our first time in South Africa and our first time at such an internationally organized event focused on HIV/AIDS. The weeklong conference was jam packed with activities, events, speaker series, presentations and much more—so much more that it was impossible to fit everything in the five days we were there.

Among the many leaders speaking, we heard from Charlize Theron on the importance of recognizing HIV/AIDS as a human rights issue.

Actress Charlize Theron speaking on human rights issues surrounding HIV/AIDS.

Actress Charlize Theron speaking on human rights issues surrounding HIV/AIDS.

We also heard from Elton John and Prince Harry remarking on the importance of recognizing youth’s voices and vulnerability in efforts to end the burden of HIV/AIDS.

Sir Elton John speaking at the AIDS2016 conference.

Sir Elton John speaking on youth vulnerability at the AIDS2016 conference.

Most impressive was the participation of some of the most vulnerable groups affected by HIV—healthcare workers, trans-men and -women, sex workers, homeless populations, and members of aboriginal communities as well as the lesbian and gay community. While we still have a long way to go to ensure that the voices of these groups are represented, it was refreshing to be among those who are the most affected by HIV and the barriers that affect access to HIV care and services.  Because of this, we were graced by many leading HIV/AIDS activists who have spent their life standing up to big corporations and governments to make sure that those who need care the most can get access to that care.

Any trip to South Africa would not have been complete without paying homage to the great Nelson Mandela. We visited Mandela’s capture site where a monument was erected in his honour, constructed out of the very bars that held him captive for over 27 years.  I hope that he would have been proud of the great work being done in his country.

The monument marking Nelson Mandela's capture site in the South African province of KwaZulu-Natal.

The monument commemorating Nelson Mandela’s capture site in the South African province of KwaZulu-Natal.

Kara graduated in May 2016 with a Masters of Nursing and a concentration in Global Health Studies. During her studies, she travelled to Haiti to conduct research on the prevention of mother-to-child transmission in collaboration with their partner site, Zanmi Lasante. Kara has been involved in various Global Health activities since 2012 and hopes to continue to contribute to this field as a nurse.

Why The World Needs An Essential Diagnostics List

Lee Schroeder, Timothy Amukele and Madhukar Pai

This article was originally posted on Forbes website. See the original post here.

Without diagnostics, medicine is blind. And yet, diagnostics receive much less attention than vaccines and drugs. Imagine a sick infant with bacterial sepsis in sub-Saharan Africa. Without diagnostics, they will likely get incorrectly treated for malaria. Every year, 1 million patients with TB in India are either not diagnosed or not reported. Pregnant women with anemia, syphilis and diabetes are often missed in low-income countries where laboratory capacity is severely lacking. And where there is testing, it is often of low quality.

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Hepatitis and HIV diagnostic tool. Photo by Dr. Nitika Pai.

recent NEJM article proposes a simple way to improve access to critical diagnostics: make a list. In 1977, the World Health Organization started (and has since maintained) a Model List of Essential Medicines (EML). The EML, a global health success, has improved access to medicines. Sadly, there is no equivalent Model List of Essential Diagnostics (EDL). Such a list would be impactful for these reasons:

1.  Improve patient care and clinical outcomes

Patients will get consistent access to quality essential diagnostics that will be affordable and always available. When a diagnostic is added to an EDL, governments, funders and manufacturers will work to ensure availability and access.

2. Help detect emerging infectious threats

The Ebola and Zika epidemics have underscored the need for surveillance. While many countries have reference laboratories, laboratory capacity at lower health system tiers is often weak. By increasing laboratory capacity at all tiers, an EDL could help countries better prepare for epidemics and implement international health regulations.

3. Increase affordability

Bulk and advanced purchasing, volume discounts and pooling mechanisms are widely used for vaccines and drugs. Without such mechanisms, quality diagnostics can be unaffordable. Xpert MTB/RIF is a good TB test, but affordability is limited. An EDL could promote group purchasing by international organizations (e.g., Global Fund). With larger, predictable volumes, manufacturers can lower prices. Countries can use EDL to impose price controls and waive import duties to ensure affordability.

4. Reduce antimicrobial resistance (AMR)

Indiscriminate antimicrobial use drives AMR. Without adequate diagnosis,antimicrobials get widely abused. In half of malaria-endemic African countries over 80% of malaria treatments are applied without diagnostic testing, leading to legitimate concern for the emergence of drug resistance.

5. Improve regulation and quality of diagnostics

Unlike developed countries, regulatory agencies that approve the accuracy of diagnostic devices either do not exist or are weak in resource-poor settings. An EDL could focus such agencies on priority tests and help to harmonize regulation at the regional level. An EDL could aid in the identification of sub-standard diagnostics, as is already occurring formalaria rapid tests.

6. Facilitate laboratory accreditation and training

Even if a diagnostic test is of high quality, its impact can be crippled by improper use. In Kampala, Uganda, 95% of all laboratories failed to get the lowest score on the WHO laboratory quality checklist. Country-level laboratory accreditation groups could use the EDL to establish targeted and appropriate quality assurance programs. An EDL could also help shape in-country training of laboratorians.

7. Improve supply chain and laboratory infrastructure

As is too often the case in low-income settings, poor infrastructure and inconsistent supply chains render laboratory devices unusable. An EDL could encourage ministries of health to strengthen necessary infrastructures and develop targeted supply chains for the essential tests.

8. Facilitate change in healthcare provider behavior

Healthcare professionals trained in countries where laboratory testing is either unavailable or of low quality are likely to treat based on clinical suspicion. The impact of the Xpert MTB/RIF TB test has been blunted because of such issues. Likewise, in several settings, providers continue to give anti-malarial therapies, despite negative rapid test results. An EDL could improve providers’ confidence in test results and strengthen thediagnostic-treatment cascade.

9. Inform new technology development

Several teams are now developing point-of-care diagnostics for global health. An EDL could help develop target product profiles that can inform new product development. In fact, such initiatives already exist for several key diagnostics.

10. Facilitate epidemiological surveys, program evaluation and disease elimination

Policy makers need data on disease burden. An EDL could support national surveys and help track changes in disease burden and efficacy of interventions (e.g., diagnostics to support polio elimination).

Xpert cartridges [1032133]

TB diagnostic tools. Photo by Dr. Madhukar Pai.

In summary, essential medicines require essential diagnostics. The NEJM article has proposed an EDL to set the ball rolling. While many agencies could establish an EDL, WHO is the obvious choice, since they maintain the EML, make health policies, run prequalification programs and oversee international health regulations. So, we call upon WHO to take the lead in creating a List of Essential Diagnostics. We also call on key stakeholders (e.g., FINDPATHTDRCHAIASLMGHTCStop TB PartnershipRoll Back MalariaUNAIDS), civil society (e.g., MSFTAGACTION) and donors (e.g., Global FundBill & Melinda Gates FoundationUNITAIDUSAID) to support WHO to make this happen.

 

Dr. Lee Schroeder is assistant professor at the University of Michigan,  where he is director of Point-of-Care Testing and associate director of Chemical Pathology. Dr. Timothy Amukele is an assistant professor at the Johns Hopkins University School of Medicine, where he is the director of the Bayview Medical Center Clinical Laboratories. Dr. Madhukar Pai is a Canada Research Chair in Epidemiology & Global Health at McGill University, Montreal, Canada. He serves as the director of McGill Global Health Programs and associate director of the McGill International TB Centre.

 

This article was originally posted on Forbes website. See the original post here.

McGill Summer Institute 2016 – An Infectious Series of Presentations!

groups together 1

Patrick Bidulka

And that’s a wrap! The 2nd annual Summer Institute on Infectious Diseases and Global Health has ended after two weeks of exciting discussion covering a variety of topics including TB, HIV, worms, malaria, and more worms. With the addition of two courses to the Summer Institute arsenal, things got pretty busy!

small group

TB Research Methods Small Group Session

As a member of the organizing team for the Summer Institute, I had the opportunity to observe the mechanics of what goes on front and back stage. As participants got to hear from an extensive lineup of top-quality researchers and diagnostic industry specialists, the Institute’s top-notch organizing committee worked tirelessly to ensure operations went as smoothly as possible — easier said than done. Between organising the catering, and dashing between classrooms pretending to be an AV specialist, I managed to slip into a few lectures to get a feel for what the Summer Institute is all about.

The 2016 edition of the Summer Institute offered 5 different week-long courses:

1. Global Health Diagnostics

2. TB Research Methods

3. Advanced TB Diagnostic Research

4. Molecular & Genetic Epidemiology *New*

5. Tropical & Parasitic Diseases (including Ultrasound and Microscopy tutorials) *New*

ultrasound

Clinical Ultrasound course at the Summer Institute

All the courses provided lectures in varying format, including tech pitches from industry specialists, clinical case studies, panel discussions, and small group sessions. During breaks, participants from all different courses had the chance to mingle, and discuss the hottest topics in global health research (all while drinking record amounts of coffee!)

panel

Global Health Diagnostics Course Panel Discussion

Some personal highlights from the Summer Institute:

• Having my entire abdomen, from bladder to heart, examined via ultrasound in front of the Tropical and Parasitic Disease Ultrasound class, held at the Glen Site

• Being reassured that everything in my ultrasound was normal (phew!)

• Seeing my global health-fanatic McGill professors Drs Pai and Gyorkos debating diagnostics and treatment centre stage

• Lunch!

• And finally, being introduced to so many accomplished global health professionals, and hearing the energetic debate these people brought to the conference

lunch SI

Lunch at the Summer Institute

Boasting about 400 participants from 46 different countries, the Summer Institute was a huge success. The conference fostered a welcoming environment for global health experts and novices alike, to engage in academic discussions centred around pertinent global health issues the world faces today. See the Summer Institute 2016 Dashboard for a brief overview of the conference statistics.

I’m glad I had the opportunity to be a part of such a fast-paced and information-packed two weeks! Taking part in the conference gave me valuable insight into the many different facets of global health, and allowed me to envision which stream I would like to pursue as I move towards my own post-graduate education.

Planning is already underway for 2017’s Summer Institute – stay tuned at the Summer Institute and the McGill Global Health Programs websites for more details to come!

patrick

 

About the author:

Patrick is a recent graduate from the undergraduate pharmacology program at McGill. Now working at the GHP office, Patrick is happy to be immersed in the field of global health. His interests include infectious diseases, learning languages, and ‘The Office’.

Jackie in South Africa: Post-Travel Report

 
 
 
 
 
 
 
 
 
Jacqueline Roberge-Dao

Award won:

SPOT Global Health Travel Award

Bio:

DCIM101GOPRO

Jackie in South Africa

I am Jackie Dao, about to graduate from a master’s in Occupational Therapy (M2). I’ve always been fascinated with travelling and meeting new people. A previous trip to rural Peru working at a centre for children with disabilities gave me the travel bug and motivated me to discover new cultures.

Project Overview:

In Cape Town, I had the opportunity to intern in the largest public hospital of the Western Cape, the Groote Schuur Hospital. I split my 8 weeks between 3 different rotations: neurology, paediatrics and general medicine. As the beds needed to be cleared quickly in general medicine, my role was to quickly assess and discharge with outpatient referrals, assistive equipment and/or self-management education. In neuro and peds, cases were much more intense which required intensive daily rehab for remediation of function.

A story I would like to share happened one day on the neuro ward. An elderly woman was admitted displaying total body paralysis, but brain scans revealed everything was working normally; the team didn’t know what to do. I spent three hours just talking to her about her life experiences and my own (therapeutic use of self). I learned that her husband had passed a couple of years ago, that she was carrying an enormous burden of responsibility for her multi-generational family, and that she had just been diagnosed with HIV. As we explored her grief, guilt and attachments, she revealed to me that this was the first time in many years that she was able to express herself and feel heard. The next day, I returned to see her and a miracle happened: slowly but surely, I was able to get her out of the bed – she was no longer paralyzed. We took a walk outside that day, and she cried thanking me. This made me appreciate that no matter where we are born or what experiences we’ve been through, we are, at our core, the same. And sometimes magical things can occur when we remember that love is real and that connection and empathy can go a long way.

Looking ahead:

This field work has influenced my future career plans in that I will be extremely willing to accept an opportunity that takes me abroad. I overcame many personal fears during this trip which helps me move forward and push my boundaries of what is possible in terms of working whilst travelling. I have witnessed disparities in health and realized the immense need for powerful figures that will advance the system and humanity as a whole.

 

See also the McGill School of Physical and Occupational Therapy (SPOT) blog, and their website!
 
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