Gates Foundation’s Dr. Bertozzi talks about what’s to come for HIV and TB

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Stefano Bertozzi, MD, PhD

Stefano Bertozzi, MD, PhD, director of HIV and tuberculosis programs at the Bill & Melinda Gates Foundation, oversees grants in HIV vaccine development, biomedical prevention research, diagnostics development and resistance monitoring, and strategies for introduction and scaling-up of interventions. He has held past leadership roles at UNAIDS, the World Health Organization, the World Bank, and the National Institute of Public Health (INSP) in Mexico. He spoke with Science Speaks about what he saw as the key developments in HIV/AIDS and TB in the last year and a half, as well as important trends coming up.

What do you see as the most important developments in AIDS in the past year?

If you ask me about recent developments, I think about it in terms of what we are doing with the tools we are already using and the tools we hope to have soon. In the midst of a global financial crisis, we need to get the most out of the money we are spending. We need to put more people on treatment, we need to do better work on prevention and we need to have more TB cases detected and treated.

In that regard, we had very encouraging news on the programs scaled up rapidly in the last few years. The cost per-patient, per-treatment is coming down rapidly. There are very encouraging signs of getting more treatment for our money. Those are trends we need to accelerate.

As far as the tools we don’t yet have available, in the almost 30 years that I’ve been around issues related to HIV, I don’t think we have had a year and a half like we just had. Last September, we had results from the first positive HIV vaccine trial. That really reinvigorated the whole area of searching for an HIV vaccine. We’re figuring out how to make the next trial work, not only in Thailand, but in Africa. We also hope the next trial will have greater efficacy than we did in the partial efficacy we saw in Thailand.

Over the past year we also saw positive results in the area of vaginal microbicides, which a woman can use to stop the transmission of HIV. We’ve been trying to do this since I’ve been involved in HIV, since the late 1980s. It’s really exciting we have a new product. It’s something a woman can use to protect herself.

The other really exciting development was the announcement at the end of last year that taking a combination (antiretroviral) drug on a daily basis to prevent being infected with HIV is also successful in preventing transmission. Those results were incredibly exciting. Like prevention of mother to child transmission, for those who took the drugs regularly, the suggestion was 90 percent of them were successful in preventing transmission.

What about developments in medical male circumcision, including Swaziland’s plan to scale up a plan to do circumcisions nationally? What are the prospects for scaling up male circumcision in eastern and southern Africa?

I’m very optimistic in some places and hopeful in others. Kenya has shown real leadership. They were the first out of the gates. In most areas of Kenya, a traditional circumciser will do the circumcisions, but western Kenya does not. They have been very successful in scaling up rapidly in western Kenya. Then we have South Africa, where again much of the population practices male circumcision. But the largest population in KwaZulu-Natal does not. The Zulu people did traditionally circumcise but that was stopped during the Bambatha rebellion (because of the danger). But after President Zuma announced an expansion of male circumcision, there’s lots of movement now in KwaZulu-Natal. Swaziland is the only national level effort. It’s very ambitious and it’s really to be celebrated.

What’s been holding up expansion of medical male circumcision? Funding? Acceptance by groups in countries?

I don’t think funding for male circumcision is a significant problem. The Global Fund is open to the possibility of reprogramming some of its funding for male circumcision, and the U.S. government also is open to that. Everyone is cautious about something linked to culture, in that we don’t want to be seen as dictating something that is culturally sensitive.

But the fact is the economics of medical male circumcision are so convincing. It is so cost effective that it saves money if you do it. It’s not just a humanitarian intervention. It’s just a good deal. It costs money not to do it.

With the global financial crisis putting pressure on global health funding from donors, are you concerned that a recent story showing corruption in a few Global Fund grants could reduce funding?

In this environment, any sort of negative press obviously raises concerns. In this case, it’s really a puzzle to me why this became a media story. The Global Fund is perhaps the most transparent international organization that I know of. These instances of fraud were publicized on the Global Fund website last year. This has been completely transparent and open. And the Global Fund has been seeking out repayment in incidences where money is misused. All of which is something we should be celebrating. I don’t know how it could be twisted in the recent coverage. The fraud identified was one-third of one percent of Global Fund funding.

You’ve stated in the past much support for more attention to TB detection and treatment. Where do things stand now overall in the fight against TB?

When I look at the Gene Xpert TB diagnostic tool, it is potentially a transforming factor in the context of HIV/TB co-infection. A person who is recently diagnosed with HIV is at high risk of contracting TB, if they don’t already have active TB. That person should receive treatment for TB if they have it, or should receive prophylaxis for TB if they don’t have it. But far too many people who are diagnosed with HIV receive neither. Just one-third of people diagnosed with HIV are getting screened for TB. That is something we are really hopeful to turn around.

With the Gene Xpert, in two hours they know if they have TB or not, which can give a doctor confidence on whether they should start treatment for TB. I’m hopeful we can scale up the Gene Xpert in areas of high HIV/TB co-infection. That will not only help the patient but it will have an effect in the whole community beyond, because they will be protected from infection.

7 thoughts on “Gates Foundation’s Dr. Bertozzi talks about what’s to come for HIV and TB

  1. Pingback: Tweets that mention Gates Foundation’s Dr. Bertozzi talks about what’s to come for HIV and TB | Science Speaks: HIV & TB News -- Topsy.com

  2. francesco miglino

    L’ APPORTO DEI PADRI COSTITUENTI DELL’ UNIVERSO INTERNETTIANO AL PROGRESSO DELL’ UMANITA’ NON HA EGUALI NELLA STORIA DI TUTTI I TEMPI.
    Di francesco miglino

    Mentre il mondo è inondato da produzioni inutili e troppo spesso nocive imposte dal marketing con massicce campagne pubblicitarie, tollerate dalle corrotte classi politiche conniventi, i Padri costituenti dell’ universo internettiano coordinano i migliori ricercatori d’ avanguardia per dare risposte mirate ed efficaci per soccorrere la sofferenza, il disagio, l’ ignoranza e salvaguardare il pianeta riscattando l’ umanità ostaggio dei cacciatori di profitto.

    Liberati dalle informazioni deviate dei possessori delle rotative, gli uomini si sono incontrati nell’ immensa agora’ dell’ universo internettiano ed hanno conosciuto realtà nascoste, acquisito saperi prima irrangiungibili, hanno confrontato il proprio vissuto, intessuto dialoghi e scoperto che le mostruose contraddizioni e violenze dei gruppi di potere e dei politici asserviti, hanno creato artatamente dipendenze afflittive e degrado finalizzati all’ asservimento sociale. Ma a marcare la miseria morale delle industrie e degli Stati è l’ abbandono nel dolore di terribili malattie dei propri simili perchè le ricerche per cure possibili non rendono profitto.

    Non contagiate nè vincolate alle ferree tradizioni delle famiglie della vecchia imprenditoria spesso egoistiche e predatorie, le fresche generazioni imprenditoriali, cresciute grazie alle proprie creazioni informatiche messe in rete e premiate dagli utenti per la genialità e validità, avvertono un impellente bisogno di devolvere parte della loro ricchezza per dare risposte giuste alle diffuse ed intollerabili violenze sull’ uomo e sull’ ambiente. Questa disposizione a donare, molto diffusa nell’ universo internettiano, che si traduce in progettualità per dare soluzioni ai bisogni, si chiama INTERNETTIANESIMO.

    Contrapporre ad Enti burocratizzati lenti, con personale strapagato, demotivato e di obbedienza politica, fondazioni dinamiche dirette dai padri fondatori dell’ universo internettiano, che hanno impellenze morali e che a proprie spese esplorano per empatia terreni nuovi, rivitalizzano ricerche di nicchia abbandonate perchè non profittevoli, danno risposte urgenti con terapie efficaci al solo scopo di debellare il disagio e l’ indigenza di milioni di uomini abbandonati dagli Stati , e’ INTERNETTIANESIMO.

    Scegliere uomini eccezionali e considerare la loro genialità patrimonio prezioso da incentivare affinchè dia frutti da mettere gratuitamente a disposizione di tutti, è INTERNETTIANESIMO.

    Finanziare con fondi propri ricerche al solo scopo di alleviare le sofferenze di coloro che hanno contratto l’ Hiv e l’ Aids, è INTERNETTIANESIMO.

    Preoccuparsi per le prevedibili carestie e crisi alimentari globali ed incentivare la ricerca di una varietà di riso che resista alla siccità, è INTERNETTIANESIMO.

    Promuovere gratuitamente ricerche con corposi investimenti al solo scopo di debellare la mortalità infantile, è INTERNETTIANESIMO .

    Promuovere con risorse proprie l’ istruzione al solo scopo di liberare dall’ ignoranza milioni di persone , è INTERNETTIANESINO.

    La fondazione BILL & MELINDA GATES ha eletto direttore della ricerca Hiv e tubercolosi STEFANO BERTOZZI, economista e scienziato di genialità italiana.

    Reply
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  4. m.bhaskara rao

    i am a servent in GOD for the poor HIV by Home based care with my Tith I am very enthostically to do more what I have to do the situation is so sad certenly everyone needs help if you ask I will send their full particulars with photographes.

    Reply
  5. m.bhaskara rao

    I need a plan to do more, presently I am doing Home Based Care for the needy HIV patients, by Daycare system I have to do much for them what I have to do please Pray for me and my ambition.

    Reply
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