UNITED STATES: Guidelines for New, Faster TB Test

Thu, 15 Jan 2009 - http://www.upi.com/

CDC has released new guidelines that call for nucleic acid amplification testing to be performed on patients with suspected pulmonary TB. The agency’s recommendations reflect the increasing use of NAA tests in diagnosing the bacterial infection. NAA test guidelines were last updated in 2000. Last summer, CDC and the Association of Public Health Laboratories convened a panel to review existing guidelines and make recommendations to incorporate NAA tests into standard practice. NAA testing can confirm pulmonary TB weeks faster than conventional testing, which includes acid-fast bacilli smear and TB culture. The new guidelines include revised procedures for testing and interpreting results, and provide advice for clinicians to ensure accuracy and cost savings in interpretation of NAA test results. The recommendations, “Updated Guidelines for the Use of Nucleic Acid Amplification Tests in the Diagnosis of Tuberculosis” were published in CDC’s Morbidity and Mortality Weekly Report (2009;58(01):7-10).

CALIFORNIA: AIDS Advocates Worry About Cuts to Medi-Cal

Thu, 15 Jan 2009 - http://ebar.com

AIDS advocates are concerned that proposed cuts in Medi-Cal, California’s Medicaid program, could hurt some AIDS patients’ access to care. “These Medi-Cal reductions will likely lead to poorer health outcomes for the most vulnerable people living with HIV,” said Mark Cloutier, CEO of the San Francisco AIDS Foundation. SFAF said Gov. Arnold Schwarzenegger’s budget seeks to close a projected $41.6 billion budget shortfall through the end of the next fiscal year by raising $14.3 billion in new revenue, reducing spending by $17.4 billion over 18 months, and borrowing money. Medi-Cal’s 2008-09 budget is $38.5 billion, of which $14.4 billion comes from state funds. Included in the state budget is a $1.1 billion cut to Medi-Cal over the next 18 months. The state stands to lose hundreds of millions of dollars in matching federal funds under the proposed budget. HIV-positive people who have not progressed to an AIDS diagnosis are ineligible for Medi-Cal. People with AIDS can be found in any of Medi-Cal’s several programs, said Tony Cava, spokesperson for the state Department of Health Care Service. In 2001, the program for the aged, blind, and disabled was expanded when its income limit was increased from 69 percent of the poverty level to 127 percent, adjusted for inflation. The new proposal would scale back this expansion to the income levels for Supplemental Security Incomes and State Supplemental Payments. The income cutoff limit for SSI and SSP payments is $870 a month, Cava said. This would mean that as of May 1, 73,000 people would no longer be eligible for Medi-Cal, he said. Schwarzenegger’s budget fully funds the AIDS Drug Assistance Program, which will serve some 35,000 Californians in the next fiscal year at a cost of $418 million.

UNITED STATES: Heroin Program’s Deadly Toll

Fri, 09 Jan 2009 - http://public.wsj.com/home.html

Harm-reduction programs do not force users off drugs but rather offer approaches, such as needle exchanges and training to avoid overdosing, that seek to decrease the dangers associated with drug use. In New York City, the rate of new HIV infections among injection drug users fell by more than 75 percent from 1995 to 2002 as the number of clean needles distributed doubled, a study by epidemiologists there found. Yet program workers themselves are sometimes at risk, insiders say. At least five harm-reduction staffers have died of overdoses in New York and San Francisco. Drug abuse is “an occupational hazard” for program workers, said Alex Kral, a San Francisco epidemiologist. Observers cite multiple reasons for the problem. Staffers typically earn little or no money and work in bleak urban environments. Most programs are underfunded and unable to offer the training and support that are standard in other social service areas. Staff may include active or former users as well as volunteers with no previous exposure to hard drugs. While critics say harm-reduction programs should take a harder line on drug use by staffers, some program leaders say such an approach is unworkable. Hilary McQuie, the West Coast director of the New York-based Harm Reduction Coalition, said her group trains workers to self-assess to see if their own drug use is harmful. She maintains it would be “completely hypocritical” to insist that employees get clean when clients are not required to do so. She and other insiders note that staff drug use is also a problem in abstinence-based drug programs that require workers who use to enter rehab or lose their jobs. Advocates say another approach to the issue is to increase funding for harm-reduction programs so workers can receive better training and support. Barack Obama said in 2007 that he might be willing to lift the ban on federal funding of needle exchanges. A bill before the US House would free federal money for exchanges nationwide.

AFRICA: Battle Against Virus Shows Signs of Progress

Sat, 10 Jan 2009 - http://www.ips.org/

New data from UNAIDS show that several African countries with high HIV prevalence rates have made significant gains in preventing new infections. The agency’s latest report says changes in sexual behavior in Rwanda and Zimbabwe have led to a drop in new HIV infections, and young people in Burkina Faso, Ethiopia, Ghana, Malawi, Uganda, and Zambia are delaying the start of sexual activity. Across the continent, AIDS campaigners are calling for people to assess the local situation in terms of what is driving the epidemic and then determine the best way to act on this information. Examples of “knowing your epidemic” include: *In Rwanda, health officials have made a concerted effort to involve male partners in the prevention of mother-to-child HIV transmission. “When I look back to 2004, we just had 6 percent of male partners accompanying their wives to checkup clinics but today we have figures as high as 64 percent,” said Anita Asilmwe of the country’s National AIDS Control Commission. Government data show nearly 90 percent of children born to HIV-positive mothers are uninfected, compared to less than 40 percent two years ago. *In Kenya, HIV prevention messages are shifting from overall AIDS awareness - more than 90 percent of Kenyans are aware of HIV/AIDS - to addressing specific at-risk groups. Omu Anzala, director of the Kenya AIDS Vaccine Initiative, said these include “people who sell sex, people who buy sex, regardless of the kind of sex they buy.” However, in South Africa, home to the world’s largest HIV/AIDS caseload, prevention campaigns remain static. The government still takes a “standardized cookie-cutter approach to prevention,” said Quarraisha Abdool Karim, associate scientific director at the Center for the AIDS Program of Research in South Africa. “We are not targeting our intervention. We do not have adequate coverage of interventions that work; knowledge of HIV status and personal risk is low,” Karim said.

UNITED STATES: Hispanics Respond Poorly to Hepatitis C Treatment

Wed, 14 Jan 2009 - http://www.miami.com/herald/

Latinos appear to respond less well than whites to the current standard drug therapy for hepatitis C, a new multicenter study indicates. The results are similar to those of a 2006 study that found blacks with hepatitis C also respond less to treatment. The open-label, nonrandomized, prospective study evaluated 269 Hispanics and 300 non-Hispanic whites with hepatitis C, who received standard doses of peginterferon alfa-2a (Pegasys) with ribavirin for 48 weeks. Rates of sustained virologic response in patients with HCV genotype 1 were higher among whites than Latinos (49 percent vs. 34 percent). “There’s something different about their [Latinos’] makeup, either genetic or immunological, that makes the virus respond less to the medication,” said Dr. Lennox Jeffers, professor of medicine at the University of Miami and a study co-author. “We don’t know the exact mechanism.” Jeffers said Latinos have been underrepresented in hepatitis C studies. However, more Latinos are enrolled in new research adding protease inhibitors such as telapravir or bocepravir to standard hepatitis C drug regimens. Dr. Paul Martin, chief of hepatology at the University of Miami Medical School and another study co-author, said adding protease inhibitors will increase overall cure rates to 60 percent within two years, and other new drugs are expected to increase cure rates to 70 percent within three to five years. But whether Latinos and blacks will respond to those therapies as well as whites is unknown. The study, “Peginterferon Alfa-2a and Ribavirin in Latino and Non-Latino Whites with Hepatitis C,” was published in the New England Journal of Medicine (2009; 360(3):257-267).

CALIFORNIA: Fremont School Board Adopts Comprehensive Sex Education Curriculum

Thu, 15 Jan 2009 - http://www.contracostatimes.com

By a unanimous vote Thursday morning, the Fremont school board adopted a new comprehensive sex education curriculum for junior high students. The move brings Fremont into compliance with current state sex education standards. Since 2004, California has mandated that districts offering sex education must teach abstinence and medically accurate information about contraception. Following a more than three-hour discussion, trustees approved the “FLASH” curriculum, which was developed by a county health office in Washington. Fremont could have chosen not to offer sex education at all, though figures from the California Department of Education show 96 percent of districts in the state offer such a curriculum. The curriculum the district taught last year stressed abstinence until marriage and did not meet state standards, according to a review by the Public Health Institute. At the board meeting, three teenage mothers spoke in favor of comprehensive sex education for seventh- and eighth-graders. Students are scheduled to begin the FLASH curriculum this spring, following state standardized testing. Parents and guardians will have the chance to review the lessons beforehand. Trustees also adopted a new procedure that requires parental consent before students can participate in the program.

MAINE: Residents Oppose Plan to Cut Sex Education Position

Thu, 15 Jan 2009 - http://pressherald.mainetoday.com/

The Portland school district is planning to vote next Wednesday on a proposal to move its elementary school sex education teacher to an unfilled opening at a middle school, leaving the sex educator’s position vacant. The move would transfer sexuality instruction to regular fourth- and fifth-grade “family living” courses taught by regular classroom teachers; it would be temporary, lasting only one semester. The shift would save $40,000 this fiscal year. It was proposed in response to a $1.8 million budget shortfall that developed in November, when Gov. John Baldacci slashed $27 million in state aid to school districts due to the weakening economy. Interim Superintendent Jeanne Whynot-Vickers said there is no plan to eliminate the sex education program and its three staffers, who are assigned to teach elementary, middle or high school students. Topics covered include sexual harassment and puberty - subjects that are best left to sex educators, program supporters say. “There’s so much misinformation out there,” said Rebecca Hunt, a gynecologist at Maine Medical Center. Andrew Bossie, executive director of the Maine AIDS Alliance, opposed the proposal because he said STD rates are increasing in Maine and nationwide. “Our students deserve, and need, quality health education now more than ever,” he said.

TEXAS: Kilgore College Students Notified of TB Exposure

Thu, 15 Jan 2009 - http://www.news-journal.com

TB testing was offered Wednesday to about 100 Kilgore College students who may have been exposed to the disease. Just before the holidays, the Texas Department of State Health Services sent letters informing the students of the potential exposure. An international student who attended the college in the fall was diagnosed with TB, said Chris Craddock, college spokesperson. The student did not live on campus and is not registered there now. Craddock did not know how many of the contacted students presented for testing.

MAINE: Student Effort Fights AIDS

Wed, 14 Jan 2009 - http://pressherald.mainetoday.com/

In the 22nd annual Ed Wimert Bike/Walk-a-thon for AIDS on Dec. 23, Scarborough Middle School raised more than $23,000 to benefit the Frannie Peabody Center, a Portland AIDS service organization. “It’s really amazing to see the kids getting involved,” said Jacob A. Roberson, the center’s director of development. “This event hits three issues. For us, it cultivates awareness and support for HIV/AIDS in Maine. At a time where childhood obesity is high, this is a healthy and positive event. Walking six miles [or] biking 20 is no small feat for anyone. The event also cultivates social responsibility for young people. We are looking for the next young leaders and supporters of tomorrow for community-based organizations. It’s good to see young people taking an interest.” To learn more about the center, visit www.peabodycenter.org.