BOSTON — Researchers are reporting that injections of long-lasting AIDS drugs protected monkeys for weeks against infection, a finding that could lead to a major breakthrough in preventing the disease in humans.
Two studies by different laboratory groups each found 100 percent protection in monkeys that got monthly injections of antiretroviral drugs, and there was evidence that a single shot every three months might work just as well.
If the findings can be replicated in humans, they have the potential to overcome a major problem in AIDS prevention: that many people fail to take their antiretroviral pills regularly.
A preliminary human trial is to start late this year, said Dr. Wafaa El-Sadr, an AIDS expert at Columbia University’s Mailman School of Public Health, but a larger trial that could lead to a treatment in humans may still be some years away.
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But on Wednesday, the existence of a second such baby was revealed at an AIDS conference here, leaving little doubt that the treatment works. A leading researcher said there might be five more such cases in Canada and three in South Africa.
And a clinical trial in which up to 60 babies who are born infected will be put on drugs within 48 hours is set to begin soon, another researcher added.
If that trial works — and it will take several years of following the babies to determine whether it has — the protocol for treating all 250,000 babies born infected each year worldwide will no doubt be rewritten.
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As a direct result of state budget cuts that eliminated state funding for HIV prevention and testing, the number of HIV tests administered by California’s public health agencies declined dramatically between 2009 and 2011, the researchers write in the journal Heath Affairs, The state targeted the remaining federal allocation for HIV prevention to the 15 counties (other than Los Angeles and San Francisco) with the greatest prevalence of HIV/AIDS. Counties with lower HIV/AIDS prevalence lost all their state support and saw the number of publicly funded tests plummet by 90 percent. Although testing dropped precipitously, HIV diagnoses fell by a much smaller amount. The 90 percent drop in testing in low-burden areas from 2009 to 2011 resulted in a decline in new diagnoses of only 15.7 percent in those counties. New cases of HIV/AIDS “declined by 6.7 percent in high-burden jurisdictions, despite the fact that their HIV prevention funding was halved and the numbers of HIV tests supported by public funds fell by 19 percent,” the researchers write.
The level of new diagnoses remained high because public health officials responded nimbly to the elimination of state funding, the researchers report. “By targeting the remaining federal resources to the most affected areas and allowing local jurisdictions the flexibility to allocate support to the most effective strategies and the populations at highest risk,” the state reduced the impact of the cuts, Leibowitz said.
“Across-the-board cuts would have resulted in delivering many fewer tests and identifying smaller numbers of new HIV/AIDS cases,” she added.
Although the agencies were able to mitigate the impact of the cuts, prevention activities were still reduced. Agencies were forced to scale back or eliminate risk-reduction and education programs, restructure program staffing, and seek external funding for testing and operations. In the sea of red ink, public health officials clung to a raft of testing regimens above other prevention methods.
“HIV testing is a crucial first step in identifying people living with HIV, who can then begin treatment to maintain their health,” Leibowitz said. “Treatment is also a key prevention strategy because it dramatically reduces transmission of the virus to others.” Even with the increased emphasis on testing, however, the reduced funding pool meant that “fewer than 520 Californians a year were not informed that they had been infected with HIV,” the researchers write.
Now that California’s budget outlook is improving, HIV testing should be strengthened and expanded, Leibowitz said. “California’s improved fiscal situation could allow for restoring resources for free, publicly-funded HIV testing, so necessary to the ‘HIV treatment as prevention’ strategy,” she said.
The article, “HIV Tests And New Diagnoses Declined After California Budget Cuts, But Reallocating Funds Helped Reduce Impact,” appears in the March 2014 issue of Health Affairs. Leibowitz’s coauthors are Karen Byrnes, Adriane Wynn and Kevin Farrell of UCLA’s California HIV/AIDS Policy Research Center. Support came from the UCLA Center for HIV Identification, Prevention, and Treatment Services, which is funded by a grant from the National Institute of Mental Health. The California HIV/AIDS Research Program and the UCLA AIDS Institute also sported this research.
Executive Director, Communications
UCLA Luskin School of Public Affairs
Dr. Kathy Sanders-Phillips (17) presentation slides
Kathy Sanders-Phillips, Ph.D.
Professor, Department of Pediatrics
Howard University College of Medicine
George Washington University
“HIV/AIDS Risk in South Africa-Implications for Research in the U.S.”]]>
Reed Vreeland was born with HIV, which means he has struggled for most of his 27 years deciding how and when to inform people about his illness. His mom was infected, but his dad was not.
Dozens of states criminalize HIV exposure, or perceived exposure, through sex, shared needles or, in some states, exposure to “bodily fluids” that can include saliva. Reed works for an organization, the Sero Project, that fights these state HIV criminalization laws.
Vreeland has very clear memories about the day his dad told him about his HIV. “I immediately just started crying, because we’d read in our first grade class a book about HIV and AIDS,” he tells NPR’s Rachel Martin. “I remember the first thing I thought of was ‘Oh, I’m like the kids in the book.’ … And the book was about AIDS in Africa and about kids in Africa dying of AIDS.”
His own mother died of AIDS when he was 10, and “the pain of losing her was even more intense,” Vreeland says, “because I knew I had what she had.” She had many complications in her last few years, and grew extremely weak. “I could beat her in an arm wrestle as a 10-year-old and she was just so fragile. It’s just so hard to see a parent in that state and then know you could be next.”
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UCLA CFAR/AIDS Institute
Special Interdisciplinary Grand Rounds
Nathalia Holt, Ph.D.
Author of, “Cured: How the Berlin Patients Defeated HIV
and Forever Changed Medical Science”
“Chasing a Cure: The Story of the Berlin Patients”
until March 9, 2014 Midnight
To Apply Click here
Information for Protégés Applying to APA Cyber Mentors Program
APA Cyber Mentors protégés participate in a two-year, e-collaboration and distance learning mentorship program designed to prepare doctoral-level behavioral and social scientists for careers as independent researchers in the area of HIV/AIDS and health disparities among populations of color and other communities disproportionately affected by the virus. Cyber Mentors utilizes state-of-the-art e-collaboration, and distance learning technologies (e.g., social media, webinars, etc.) to assist protégés achieve three major goals:
The Cyber Mentors program, funded by the National Institute of Mental Health, matches early career protégés with mentors who are leaders in the field with a strong history of receiving National Institutes of Health-supported grants.
Mentoring is conducted through regular interactions over an Internet social media platform, by telephone and at face-to-face meetings. In addition to one-on-one mentoring, protégés participate in monthly, interactive, web-based seminars that address various research, methodological, ethical and administrative topics relevant to research careers in HIV/AIDS. Protégés also participate in small-group, research-development sessions every other month. These online, small-group sessions focus on the application of concepts learned in seminars to research proposals of protégés. Protégés also participate in a series of mock reviews where research proposals are reviewed, scored and discussed at length.
Protégé/mentor pairs have the opportunity to apply for up to $5,000 to support research or career development activities (e.g., preliminary data collection, attending additional conferences, etc).
For additional information click here]]>
The purpose of the conference was to bring together researchers, representatives of technology development companies, public policymakers, HIV service providers, and members of the HIV/AIDS community to share cutting-edge research and real-world application of social media, web-based, and mobile technologies for HIV prevention and care. The conference began with opening remarks by Dr. Steve Shoptaw, Co-Director of CHIPTS, and Dr. Sean Young, a CHIPTS investigator whose research focuses on social media and mobile health technologies. The event included keynote presentation from Dr. Indu Subaiya, CEO and Co-Founder at Health 2.0, and presentations from leading experts in the field of technology-based HIV prevention and care, such as Dr. Brian Mustanski of Northwestern University, Dr. Marguerita Lightfoot of the Center for AIDS Prevention Studies at the University of California, San Francisco, Dr. Lynn Miller and Dr. Eric Rice of the University of Southern California, Dr. Nina Harawa of Charles R. Drew University, Dr. Cathy Reback of Friends Research Institute, as well as CHIPTS investigators, Dr. Dallas Swendeman and Dr. Ian Holloway.
To provide a counter-point to the scientific presentations focusing on intervention development and implementation, there was a policy panel discussion that brought together experts in health technology development, HIV service delivery and law and policy to comment on the benefits and challenges to providing technology-based HIV prevention and care. Panelists included Mr. Ramin Bastani, Founder and CEO of HULA (www.GetHula.com), Mr. Brad Sears, JD, Executive Director of the UCLA Charles R. Williams Institute, Dr. Tina Henderson, Project Manager at JWCH Institute of Los Angeles, and Ms. Risa Flynn, Program Manager for Research at the Los Angeles Gay and Lesbian Center. Each brought their individual perspectives to bear on the issue of health information security and privacy protection.
The conference ended with presentations from Dr. Susannah Allison, Program Officer at the National Institute of Mental Health (NIMH) within the Infants, Children and Adolescents Research Program in the Division of AIDS Research, and Dr. Jacqueline Lloyd, Deputy Branch Chief and Health Scientist Administrator in the Prevention Research Branch in the Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse (NIDA). Dr. Allison and Dr. Lloyd presented on the currently funded technology-based HIV prevention and care research, future directions and funding priorities for HIV and technology-based research at NIMH and NIDA.
The conference was attended by over 130 participants. Forty percent of the participants were staff from a community-based organization, 30% were researchers, faculty, staff, and/or student from a university/academic institution, 15% were representatives from a technology-development company, 10% were representatives from a health department or government entity, and 6% were members of the local community planning body and or consumers.
Event Agenda (163)
Event program (33)
CHIPTS HIV Tech Flyer (135)
Event sign (27)
Dr. Indu Subaiya (123) presentation slides
Dr. Brian Mustanski (129) presentation slides
Dr. Lynn C. Miller (10) presentation slides
Dr. Margureita Lightfoot (136) presentation slides
Dr. Ian Holloway (138) presentation slides
Dr. Eric Rice (136) presentation slides
Dr. Nina Harawa (149) presentation slides
Dr. Cathy Reback (74) presentation slides
Dr. Susannah Allison (133) presentation slides
Dr. Jacqueline Lloyd (132) presentation slides
For a copy of the slides, please click here SPT 2014-01-13 CHIPTS (69)
CHIPTS Cross-Core Meeting Keynote Address
Single-patient (n-of-1) trial:
A pragmatic clinical decision methodology for patient-centered comparative effectiveness research
Naihua Duan, Ph.D.
Division of Biostatistics, Department of Psychiatry, Columbia University
Monday, January 13 3:00-4:00pm
Single-patient trials (SPTs, a.k.a. n-of-1 trials) are multiple-period crossover trials conducted within individual patients to evaluate the comparative effectiveness of two or more treatments for each specific patient (Duan, Kravitz, Schmid, 2013, J. of Clinical Epidemiology). SPT has the potential to serve a rather unique dual role, both to inform individual treatment decisions in clinical care, and to support pragmatic patient-centered comparative effectiveness research. Dr. Duan gives a brief overview of the core methodology for SPT, and discuss key implementation issues, including:
• Indications and contraindications for clinical conditions and treatments suitable for evaluation with the SPT;
• Pros and cons for blinding and washout as design features for SPTs; and
• Statistical and information technology infrastructure for the implementation of SPTs.
Dr. Duan also discuss the interpretation of the SPT as human subjects research vs. quality improvement, and the broader issues involved in the production and consumption of generalizable knowledge in human subjects research vs. local knowledge that is often needed in quality improvement investigations.
Duan N, Kravitz RL, Schmid CH. Single-patient (n-of-1) trials: a pragmatic clinical decision methodology for patient-centered comparative effectiveness research. J Clin Epidemiol. 2013 Aug;66(8 Suppl):S21-8.
Kravitz RL, Duan N, eds, and the DEcIDE Methods Center N-of-1 Guidance Panel (Duan N, Eslick I, Gabler NB, Kaplan HC, Kravitz RL, Larson EB, Pace WD, Schmid CH, Sim I, Vohra S). Design and Implementation of N-of-1 Trials: A User’s Guide. AHRQ Publication No. 13-EHC122-EF. Rockville, MD: Agency for Healthcare Research and Quality; in press, www.effectivehealthcare.ahrq.gov/reports/final.cfm.
Cheung K, Duan N. Design of implementation studies for quality improvement programs: an effectiveness-cost-effectiveness framework. Am J Public Health. 2014 Jan;104(1):e23-30. Epub 2013 Nov 14.
Mohr DC, Cheung K, Schueller SM, Hendricks Brown C, Duan N. Continuous evaluation of evolving behavioral intervention technologies. Am J Prev Med. 2013 Oct;45(4):517-23.]]>