AIDS Conference in Australia
At the International AIDS Conference underway this week in Melbourne, Australia, Mark Dybul, Executive Director of the Global Fund, gave a presentation on how better and smarter investments can lead to a powerful shift in the HIV situation. Dr. Dybul explained how HIV and AIDS are at a tipping point, and could go one of two directions. If the global health community does not change its approach, he argued, infection rates of HIV will start rising again. With a change in mindset and leadership, and with a new focus on specific areas and specific groups of people and a community-minded approach, a completely different result is possible. Scientific advances are providing part of the solution. But even more critical is to differentiate interventions based on risk factors and to focus on “non-health” components like community engagement, equal opportunity for girls and women, and fighting discrimination and stigma.
Understanding communities, understanding individuals and the choices they make, and providing them with a variety of prevention tools, are essential parts of any comprehensive response. Dr. Dybul argued that, above all, we have to re-orient our frame of thinking in order to take HIV from an epidemic to a manageable disease. Harnessing advances in science, epidemiology and delivery of services are essential, and creating a more inclusive human family is also critical.
Engaging with diverse communities is a central pillar of this approach. On the first day of the conference, a community dialogue session was held at the Global Village, a public space where civil society, activists, participants and the general public can interact and exchange views. In a discussion on the new funding model that the Global Fund is fully implementing this year, Dr. Dybul talked about the role of country dialogue in bringing all partners to a common understanding and a comprehensive national strategy on health and education. The discussion was lively. Several participants made suggestions on how to improve inclusiveness and also discussed human rights concerns. Some expressed concerns that funding to middle-income countries, particularly in Eastern Europe, may be reduced and could affect harm reduction programs.
New Drug in TB Response
To counter a growing threat of drug-resistant tuberculosis, the Global Fund will now support countries in efforts to introduce bedaquiline – a new drug that has proven effective. Bedaquiline is the first TB drug to be developed in more than 40 years, and it joins a list of other medicines that the Global Fund supports countries to purchase in their response to the disease.
Bedaquiline was granted accelerated approval by the U.S. Food and Drug Administration in December 2012, and it could provide shorter and more effective treatment. More trials on the drug are underway, but several groups including the Community Research Advisors Group argue that bedaquiline offers an important addition to existing second-line drugs. Current treatment of drug-resistant TB has relatively low treatment success rates, and the disease continues to kill 170,000 a year. The World Health Organization has called drug-resistant TB an alarming danger that threatens progress made in controlling the disease globally.
“Bedaquiline is an important addition to the tools available in the TB and drug-resistant TB response,” said Dr. Eliud Wandwalo, Senior Disease Coordinator at the Global Fund. “It will give the TB community new impetus in fighting against TB.”
Dr. Wandwalo says that countries planning to introduce bedaquiline can request technical assistance from WHO or other technical partners. To access the support, the Global Fund asks that partners meet a number of conditions laid out by WHO, such as making sure that including treatment is closely monitored with proper patient selection and patients’ informed consent. WHO also requires that partners using bedaquiline adhere to principles of multidrug-resistant TB treatment, with an active surveillance process to ensure early detection and proper management of adverse drug reactions. As with all drugs purchased with support of the Global Fund, quality assurance criteria also have to be met.
Leading a New Regiment in Rwanda
Even for a war-hardened soldier, the sight of a man with his intestines spilling out of his abdomen was horrifying. Dr. William Kanyankore witnessed the scene as a medical assistant with the Rwandan Patriotic Front as the group fought to liberate the country from genocidaires. Watching his senior colleagues lay the man on leaves in the bush and mend his gaping gash was a life-changing moment that would define his life forever.
Today, as Dr. Kanyankore, dressed in a white coat, paces up the corridors of Gisenyi District Hospital, he attributes his entry into medical school to that day. Above all, he says, he still draws from the skills and experience gained from those days in the bush. “As military medical personnel our first goal was to save lives, even lives of prisoners of war,” Dr. Kanyankore said. “We would help all civilians of the places we would liberate.” That principle of doing good to all, characterizes the work of his hospital – a Rwandan cross-border medical hub serving the Rwandese and the people of the Democratic Republic of Congo.
The hospital’s lab, which is supported by the Global Fund, has advanced technology to test for diseases such as HIV, TB and malaria. Dr. Kanyankore says he sees many patients stream across the border from DRC to come for the services at the hospital. As the medical director of the hospital, it is a contribution he is tremendously proud of and one for which he has a philosophy. “Diseases are not democratic, diseases do not segregate,” Dr. Kanyankore says. “That is why the government of Rwanda decided to decentralize the medical system to go even beyond the border. If you do not help your neighbors, the diseases will come to you.”
With discipline drawn from Rwanda Patriotic Army – Inkotanyi, now Rwanda Defense Force – and an ethos of hard work and accountability, his hospital stands as a microcosm of the Ministry of Health of his country. Rwanda has registered great efficiency in managing the domestic and international resources invested. “We are properly accountable for all the funds that we receive,” he stressed.
For Gisenyi, Rwanda’s second most populous city, Dr. Kanyankore has a dream of creating a hospital “that can control and prevent diseases before the diseases come to us.” That requires treating those in and outside the hospital with utmost care and respect. It is the principle that underlies the way the hospital puts exceptional emphasis on service. “Customer care is a right not a favour,” declares a sign at the doorway of the hospital.