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Findings prompt more research into anti-HIV gel

The Department of Science and Technology has lent its support to further research into a tenofovir-based gel for preventing HIV infection among women, hoping the investment will ultimately see SA developing the capacity to manufacture and export the product.

The Technology Innovation Agency has a license from the US research organisation Conrad for the African rights to a microbicide containing tenofovir gel, and has an agreement with local firm Cipla Medpro to manufacture and distribute the product should it prove safe and effective.

Recently Deputy Science and Technology Minister Derek Hanekom and US ambassador Donald Gips announced a bilateral initiative to support a phase 3 trial of a microbicide containing the AIDS drug tenofovir. The department has provided R70 million for the study, called Follow-on African Consortium for Tenofovir Studies (FACTS), while the US Agency for International Development (USAID) has committed $18 million (approximately R122 million).

The study seeks to confirm the findings of the Caprisa 004 trial, announced last year. Caprisa 004 was a phase 2b study, involving 900 women from two sites in KwaZulu-Natal. It found that a microbicide containing 1% tenofovir, if used before and after sex, reduced the chances of women contracting HIV by 39%. The gel also halved the risk of contracting herpes, a viral infection that increases vulnerability to HIV. But the findings had a wide margin of error, with the efficacy of HIV protection estimated to lie between 6% and 60%, said FACTS protocol chair Prof. Helen Rees. A larger trial was needed to confirm the Caprisa trial and satisfy regulators of the gel's safety and efficacy, she said.

Click here for information about the GEMS HIV Disease Management Programme.

Source: Tamar Kahn,: Business Day (15 June 2011)

Hope for vaccine discount

South Africa hopes to secure cheaper vaccines on the back of a decision by global drug companies to reduce vaccine prices to the Global Alliance for Vaccinations & Immunisation (Gavi). GSK and Merck have offered Gavi price cuts of 67% for the rotavirus and human papilloma virus vaccines against diarrhoea and cervical cancer.

Pfizer and GSK offered to reduce the price of the pneumococcal vaccine as part of their commitment to supply vaccines at lower and sustainable prices once donor funds for the initial fixed price are used up. The discounted rates are aimed at advancing Gavi's goal of vaccinating at least four million children in low-income countries by 2015. Pneumonia and diarrhoea are responsible for 40% of childhood deaths in these countries.

South Africa does not qualify for the Gavi vaccines because of its "upper middle-income" status but Government is hoping to use the lower Gavi rates to lobby for its own discounted prices, according to the Health Department's Financial Planning Manager, Anban Pillay. He said vaccines were a top item of expenditure in most of South Africa's provinces, so they would benefit from a price reduction. Sanofi Pasteur, GlaxoSmithKline, BioVac and Merck are the main suppliers to South Africa's extended programme on immunisation (EPI), which reaches 89% of children from birth to age six, and the department plans to approach the EPI suppliers.

Pillay said the current vaccine tender was nearing its end and the department would use the opportunity to engage pharmaceutical companies on possible discounts. But, he added, companies were under no obligation to extend the discounts to South Africa. Pillay said the vaccine talks would fit into the department's proposed method of international benchmarking of medicine prices in South Africa to ensure appropriate pricing. Government is likely to lobby hardest for the pneumococcal and rotavirus vaccines, whose inclusion in the EPI in 2009 increased the immunisation budget from R120 million to R850 million.

Source: Xolile Bhengu, The Financial Mail (17 June 2011)

Psychologists on warpath discount

Thousands of people who suffer from depression face unpaid medical aid claims as a showdown looms between psychologists and the Health Professions Council of South Africa. Up to two-thirds of the almost 7 000 practicing psychologists could have empty consulting rooms after being told by the council that they may no longer treat patients with severe stress disorders.

A number of medical aid companies have already refused to meet some members' claims. The dispute started in April last year when the council's professional board for psychology changed the scope of practice for the various disciplines of psychology. In a letter to the Board of Healthcare Funders, the council's Emmanuel Chanza, who manages the psychology section, said patients "whose low mood or anxiety is causing severe stress." should consult either a psychiatrist or a clinical psychologist. Chanza said that counseling psychologists may not treat such patients.

There are concerns that the country's approximately 2 000 clinical psychologists will not be able to cope with the expected deluge of patients once counseling and other psychologists are forced to stop treating them. Chanza's remarks were included in a letter from the Board of Healthcare Funders to its members. It said the Health Professions Council had introduced a new coding system for the disciplines of psychology. The new coding system for the first time differentiates between clinical, counseling, educational, industrial and neuropsychologists. Chanza's letter caused an uproar and on April 11 Henriette van den Berg, a Bloemfontein counseling psychologist who heads the Concerned Psychologists' Action Group, wrote to Tholene Sodi, chairman of the Professional Board for Psychology, expressing her concerns and those of other counseling and educational psychologists about the new scope of practice, as published in the Government Gazette of April 6 2010.

Van den Berg said the funder's implementation of the new coding system had already resulted in medical aid schemes rejecting claims from patients being treated for mood and anxiety disorders. On May 20, Sodi repudiated Chanza's statement. The letter from Chanza to the funders "has been withdrawn", he said and referred questions to Board of Healthcare Funders spokesman Bertha Scheepers. She distributed a copy of the council's stance on the disciplines of psychology. The document confirms Chanza's views. It says educational psychologists should refer patients to the appropriate professional for further assessment or intervention, and that industrial psychologists "do not work in hospitals and may not prescribe medications".

Source: Eddie Botha, The Times (13 June 2011)

SA doctor internationally recognised

A South African doctor from the Tygerberg Hospital Burns Unit in Cape Town will in September receive international recognition for her contribution to burns research. Dr Elbie van der Merwe was announced as the winner of the biannual G Whitaker International Burns Prize competition in April. She will receive the €20 000 (approximately R194 000) prize on 23 September 2011 at the G Whitaker Foundation's headquarters in Palermo, Italy.

The prize was awarded to Van der Merwe for her humanitarian approach to the prevention of burn victims. Her research on burn risks in the poorer settlements and subsequent meetings with parliament and manufacturers made burn prevention obligatory by law. In 1998 she was appointed African Representative at the International Society for Burn Injuries.

Van der Merwe's revolutionary approach between accident surgery and burn therapy, and her pocket handbook on trauma were part of the medical curriculum in South Africa. In May 2004 she co-founded the Pan African Burn Society and hosted the First Pan African Burn Society Conference in Cape Town. The Giuseppe Whitaker Foundation is a non profit-making organisation that aims at recognising the activity of the most qualified experts from all countries in the field of burns pathology and treatment.

Source: SAPA (12 June 2011)

Battle is almost won

Editorial comment: The best news to come out of the National AIDS Conference (in June 2011) is the huge progress the Government has made in preventing HIV-positive mothers from passing the virus on to their babies. Thousands of newborns are being spared a life of constant infections, hospital visits and daily medication thanks to the Government slashing the transmission rate to a mere 3.5%.

Very few government interventions have such a dramatic effect on the lives of South Africans as the prevention of mother-to-child HIV transmission programme and every health worker who has contributed to making the policy such a success should be congratulated. The Health Department's Precious Robinson admitted that the past year had been tough for nurses and health workers working in the antenatal clinics.

The new policy is substantially more complicated than the old one, which simply involved giving mothers and their newborns a single antiretroviral drug called nevirapine. Under the new policy, pregnant women get daily AZT from 14 weeks of pregnancy and three ARVs during birth while their babies get nevirapine syrup for at least six weeks after birth. Pregnant women with CD counts below 350 are immediately put onto three ARVs a day.

This new policy is being implemented by ordinary nurses in public health clinics, who have had to undergo special training. The importance of leadership in this programme cannot be underestimated, flowing nationally from Health Minister Dr Aaron Motsoaledi to provincial and district managers.

It is hard to believe that, nine years ago, the Treatment Action Campaign (TAC) had to go right up to the Constitutional Court simply to get former Health Minister Manto Tshabalala-Msimang to give pregnant HIV-positive women and their babies nevirapine. But the struggle for decent treatment for pregnant women and their newborn babies is finally almost won.

GEMS has an HIV Disease Management Programme to provide support to HIV-positive members. Click here to learn more

Source: Editorial Comment - The Star, 13 June 2011