From an Ebola response to a PrEP trial, we’re reading why infectious disease responses and health system strengthening go together

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NewWWRWomen in PrEP trial feared they would have to leave study if they reported low adherence – This is a story we’ve heard before — several times now: Women are enrolled in a study to determine the effectiveness of a biomedical method to protect themselves from HIV infection. Earlier studies have indicated the method holds promise, but then it all falls apart. Women enrolled in the trial, stayed in the trial, couldn’t use the method consistently enough to determine its effectiveness, yet often told researchers they did use the method. It happened in the FACTS 001 trial to test an antiretroviral vaginal gel, it happened in the VOICE trial to test vaginal and oral interventions to control the epidemic, and it happened in FEM-PrEP trial of oral pre-exposure prophylactic use of antiretroviral medicine. Each time it raised the question: Couldn’t a good talk up front between researchers and participants have better opened the channels of communication, saved a lot of time and trouble? This comprehensive reporting by Gus Cairns of AIDSmap on the findings from interviews with participants in the FEM-PrEP study gives the sad answer — probably not. Why? Because too often good reliable healthcare can only be accessed by women in resource-limited environments by joining a trial. “The interviews reveal that some participants went to elaborate lengths to disguise their low adherence — underlining that, while they had doubts about the value of the intervention on offer, they greatly valued the medical care the study offered,” Cairns notes.

Pattern of Safety Lapses Where Group Worked to Battle Ebola Outbreak – The Boston-based Partners in Health is all about health access equity, and about building that, collaboratively and patiently, with a combination of local and imported expertise and effort, working with health ministries. When the group responded to the Ebola crisis in West Africa though, that meant unreliable supply chains and inadequate facilities bringing hazards that hobbled efforts. When those conditions exposed health workers to harm, irony came with the inequity of one sick American health worker returned to the U.S. for treatment while a sick African health worker remained in Sierra Leone (efforts finally securing his admission to a British-run center for Ebola stricken health workers in the capital). The article highlights both the chaos of a mission for which the successful nonprofit was unprepared, as well as the importance of the group’s goal — to build health systems that are crisis-ready.

Signing of a Memorandum – So this announcement of an agreement between the U.S. and the African Union to build an African CDC, or African Centres for Disease Control and Prevention is timely. Health initiatives are not isolated from conditions around them, Secretary of State John Kerry noted at the announcement of the agreement yesterday, “They are closely related to the quality of governance and to growth of strong, democratic institutions.” That, as the items above indicate, is a two-way street — with equitable health care access as a foundation for improved social, economic and political stability.

If you haven’t yet, read the IDSA Education and Research Foundation Center for Global Health Policy report:  Redeployment, Opportunities to control HIV and TB in Tanzania, Observations from Dar es Salaam, Mbeya, and Zanzibar.

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