The value of integrating HIV prevention and contraceptive services

5 Jun

In 2019, the ECHO trial reminded the world of the very high HIV incidence among women in parts of southern Africa. Those high levels of HIV, and of sexually transmitted infections, were found among women accessing routine contraceptive services.

A new joint report by the World Health Organization (WHO) and UNAIDS sets out the steps needed to improve and integrate HIV prevention and contraceptive services in order to reduce new HIV infections among women.

“We need to reflect on the diverse needs of women, including adolescent girls, women with lower levels of education and key populations, who have often been neglected in contraceptive and broader sexual and reproductive health and rights programming. The new approach means more contraceptive choices, additional HIV prevention choices and complementary community activities beyond facilities,” said Paula Munderi, Coordinator of the Global HIV Prevention Coalition at UNAIDS. 

The report clearly states that women at the highest risk of HIV and sexually transmitted infections in southern Africa and women from key populations should be the focus for the most urgent action.

Different approaches in places with different levels of HIV risk are suggested. For example, where there is a high incidence of HIV and sexually transmitted infections, HIV prevention choices, including male and female condoms, and prevention counselling need to be essential elements of contraceptive services and actively promoted. In settings with extremely high HIV incidence in southern Africa, the rapid introduction of pre-exposure prophylaxis (PrEP) within contraceptive services should be considered.

“Sexual and reproductive health and rights and HIV integration have been promoted for more than a decade, yet progress remains limited. Supporting women living with HIV to access contraception in HIV treatment clinics and providing HIV services in contraception services is a critical priority requiring committed funding for concrete action,” said Rachel Baggaley, Unit Head, Testing, Prevention and Populations, Global HIV, Hepatitis and STI programmes at WHO.

In order to understand what women need and want, the report suggests that women be at the centre of decision-making. “HIV prevention and contraceptive choices for women and girls are still not widely available. We need to ensure that the agency and choice of girls and women are promoted by making available a wide range of HIV prevention commodities, ranging from PrEP and microbicides to user-friendly condoms. Women and girls thrive when they are given an opportunity to choose,” said Nyasha Sithole, an advocate for the rights of girls and women from Zimbabwe.

Although people living with HIV who are on antiretroviral therapy and are virally suppressed cannot transmit HIV to their sexual partners, millions of women accessing contraception continue to have unprotected sex with men who do not know their HIV status. As the PopART trial showed, high HIV incidence among young women is also the result of men not accessing treatment. The report proposes concrete steps to strengthen partner prevention, testing and treatment services, including HIV self-tests for men combined with community outreach and gender-transformative prevention approaches.

“Effective integration requires multilayered prevention that can—and should—encompass both sexual and reproductive health and HIV services, including multipurpose prevention technologies. Siloed care, stock-outs and too little input from women themselves are among the long-standing barriers to women’s health care, and COVID-19 exacerbates these difficulties,” said Mitchell Warren, Executive Director of AVAC.

With the physical distancing necessary as a result of the COVID-19 pandemic reducing contact with health services, it will be essential that interactions with health-care providers be optimized through integrating services. “Prevention of HIV and sexually transmitted infections should be the standard of care for contraception information and services provided to women at a high risk of acquiring HIV,” said James Kiarie, Unit Lead, Contraception and Fertility Care, Department of Sexual and Reproductive Health, WHO.

 

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Update on progress on Cystic echinococcosis  control in Mongolia

5 Jun

Cystic echinococcosis (CE) is most common in poor pastoral communities and it is highly endemic in most areas of Mongolia where it presents as a major health burden, especially to the nomadic communities.  In the last few years increased efforts have been made to control echinococcosis in Mongolia.

1. Development of the “Action Plan for the control of CE in Mongolia” 

In October 2018, the National Center for Zoonotic Diseases of Mongolia (NCZD) with the support of WHO organized a multi-sectoral workshop “Developing the National Action Plan for Control of echinococcosis in Mongolia”.  Following the workshop, a cross-sectoral Action Plan for the control of CE in Mongolia was developed during 2019, and it has now been presented to the Ministry of Health and the Ministry of Food and Agriculture for approval.

2. Facilitating tools for the identification and monitoring of active transmission of E. granulosus at the NCZD of Mongolia and creating a baseline in Bayankhongor province.

One of the challenges for the control of CE, has been the lack of diagnostic tools to identify E. granulosus infections in dogs. To overcome this, a project funded by PROBITAS FOUNDATION (www.fundacionprobitas.org/en/home) started in 2019, implemented by the NCZD and the Institution of Veterinary Medicine with the support of WHO and the University of Melbourne. 

The project has two main objectives:

  1. To validate a commercial Chinese copro-antigen test which detects E. granulosus infection in dogs at the NCZD so that it can be used to identify endemic areas and used to monitor future echinococcosis control programs in Mongolia.
  2. To undertake a field survey for E. granulosus infection in dogs by coproantigen test in Galuut, Bumbugur and Baatsagaan soums of Bayankhongor Province.

Progress so far:

Samples have been obtained from 588 dogs, 6 cats, 12 foxes, 5 corsac foxes and 2 ferrets. The University of Melbourne has provided technical advice on the isolation of Echinococcus, and so far, 30 dogs infected with Echinococcus spp. have been detected among 198 specimens. The analysis and validation of the copro-antigen is continuing.

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In October 2019, the project team conducted a field survey in 3 selected soums of Bayankhongor to determine the true host infection with the participation of the Centre for Zoonotic Diseases of Bayankhongor province. It started with a surveillance training for the local researchers. 345 samples of dog were collected, and questionnaires were taken from 276 dog owners.

The project team is preparing to conduct a training for parasitologists of each of the 21 provinces’ veterinary departments and centres for zoonotic disease, to create a nationwide surveillance network and identify the definitive host of Echinococcus spp.  Creating a surveillance network and skilled workers for detection is considered as a priority issue for the implementation of the Action Plan. 

3. Ultrasound training and examination

NCZD specialists in cooperation with other health organizations, conducted an ultrasound examination for 1,977 children aged 6-18 in the three soums of Bayankhongor aimag in October 2019, funded by WHO. The screening survey revealed 8 cases of hydatid echinococcosis. After the screening survey, a training was conducted for doctors and veterinarians of Bayankhongor province on prevention and diagnosis of communicable diseases.

4. Dog treatment

The quarterly deworming of dogs with praziquantel has been approved by the Director General of the Veterinary Services in 2020, and so far, 344,300 pet dogs have been treated with praziquantel. 

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Forest fires: Commission adds planes to rescEU fleet to prepare for summer

5 Jun
To prepare for the risk of forest fires during the upcoming summer, the EU is further reinforcing its European fleet of firefighting aircraft under the rescEU system. The EU is financing purchases by the Swedish government of 2 new firefighting airplanes to add to the reserve. This adds up to a total of 13 airplanes and 6 helicopters that will be part of the rescEU fleet in 2020 and funded by the EU.

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Main results of the video conference of home affairs ministers

5 Jun
Home affairs ministers discussed the response to the COVID-19 pandemic in the field of internal border controls and the free movement of persons. As the overall health situation improves, all member states are in the process of de-escalating and gradually lifting some of the measures that have been applied at national or regional level. This includes the gradual lifting of border controls and the full restoration of the free movement of persons which has been limited due to the pandemic.

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WHO welcomes crucial new funding for vaccines

4 Jun

WHO welcomes funding commitments made at today’s Global Vaccine Summit, hosted virtually by the UK government. The Summit is Gavi, the Vaccine Alliance’s third pledging conference and follows the successful Berlin summit in January 2015.

The new pledges will enable Gavi to protect the next generation and reduce disease inequality by reaching an additional 300 million children with vaccines by 2025. 

“Thanks to vaccines, hundreds of millions of deaths have been prevented. Polio has been pushed to the brink of eradication, and just in the past few years new vaccines have become available for Ebola and malaria,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“But vaccines only realize their true power when they are deployed to protect the poorest and most vulnerable. The COVID-19 pandemic is unravelling many of the gains we have made, with vaccination campaigns for polio, cholera, measles, diphtheria, and meningitis.”

The bold funding commitments mean that the Gavi Alliance will be better able to maintain immunization in lower-income countries, mitigating the impact of the COVID-19 pandemic. They will also help strengthen health systems.

The backdrop of the COVID-19 pandemic is a sobering reminder of how much individual health depends on collective health and the critical role that vaccines play in keeping the global population safe and healthy. The Summit also highlighted how important a safe, effective and equitably accessible vaccine will be in controlling COVID-19.

The Global Vaccine Summit marks 20 years since Gavi was founded. Dr Tedros added: “We join Gavi in celebrating the collective success of this great Alliance. These pledges are not just an investment in the Alliance of which we are a very proud partner; they are an advance on our shared vision of a healthier, safer and fairer world.”

 

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World Food Safety Day 2020: UN experts in Facebook live event on 5 June 2020

4 Jun

On 7 June 2020, the United Nations will mark the second global World Food Safety Day, led by two of its specialized agencies, the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO).

Food safety is a shared responsibility, and everyone has a role to play including governments, industry, producers, business operators and consumers. This is reflected in the theme of the day ‘Food safety: everyone’s business!’

FAO and WHO are supporting their Members in efforts to provide enough safe food for all and to enable people to trust that what they eat is safe. Events such as World Food Safety Day help by highlighting the critical role played by all those who work to ensure that they are not derailed by disruptions and other challenges to continue keeping foods safe.

On Friday, 5 June, ahead of World Food Safety Day 2020, FAO and WHO will hold a virtual celebration including video messages from FAO Director-General QU Dongyu and WHO Director-General Tedros Adhanom Ghebreyesus.

The event will include an interactive Facebook live session in which FAO and WHO experts will discuss the theme of this year’s World Food Safety Day, including how governments, producers, manufacturers, consumers and vendors alike can ensure food safety.

The current global crisis caused by the COVID-19 pandemic has emphasized more than ever before the importance of monitoring and addressing food safety. It has also highlighted the need for food safety systems to be adapted to respond to disruptions in supply chains and ensure continued access to safe food.

World Food Day 2020 is dedicated to all those who have ensured that the crisis has not interrupted supply chains and that safe food remains available, contributing to the consumption of safe and healthy diets.

What:World Food Safety Day 2020 - FAO/WHO event on WHO’s Official Facebook page
Who:WHO Director-General Tedros Adhanom Ghebreyesus (video message)
 QU Dongyu, FAO Director-General (video message)
 Dr Francesco Branca, Director, WHO Department of Nutrition and Food Safety
 Dr Sarah Cahill, Codex Alimentarius, Senior Food Standards Officer
When:Friday, 5 June 2020, 15:00-15:45 (CET)


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Record number of countries contribute data revealing disturbing rates of antimicrobial resistance

4 Jun

Geneva—A record number of countries are now monitoring and reporting on antibiotic resistance - marking a major step forward in the global fight against drug resistance. But the data they provide reveals that a worrying number of bacterial infections are increasingly resistant to the medicines at hand to treat them.

“As we gather more evidence, we see more clearly and more worryingly how fast we are losing critically important antimicrobial medicines all over the world,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO). “These data underscore the importance both of protecting the antimicrobials we have and developing new ones, to effectively treat infections, preserve health gains made in the last century and ensure a secure future.”

Since the WHO’s Global Antimicrobial Resistance and Use Surveillance System (GLASS) report in 2018, participation has grown exponentially. In only three years of existence, the system now aggregates data from more than 64 000 surveillance sites with more than 2 million patients enrolled from 66 countries across the world. In 2018 the number of surveillance sites was 729 across 22 countries.

More countries are also reporting on the recently approved indicator on antimicrobial resistance (AMR) as part of the Sustainable Development Goal monitoring. “The enormous expansion of countries, facilities and patients covered by the new AMR surveillance system allows us to better document the emerging public health threat of AMR,” said Hanan Balkhy, Assistant Director-General for antimicrobial resistance at WHO .

High rates of resistance among antimicrobials frequently used to treat common infections, such as urinary tract infections or some forms of diarrhoea, indicate that the world is running out of effective ways to tackle these diseases. For instance, the rate of resistance to ciprofloxacin, an antimicrobial frequently used to treat urinary tract infections, varied from 8.4% to 92.9% in 33 reporting countries.

WHO is concerned that the trend will further be fueled by the inappropriate use of antibiotics during the COVID-19 pandemic. Evidence shows that only small proportion of COVID-19 patients need antibiotics to treat subsequent bacterial infections and the Organization has issued guidance not to provide antibiotic therapy or prophylaxis to patients with mild COVID-19 or to patients with suspected or confirmed moderate COVID-19 illness unless there is a clinical indication to do so.

Dr Balkhy, said: “We believe this clear guidance  on the use of antibiotics in the COVID-19 pandemic will both help countries tackle COVID-19 effectively  and prevent the emergence and transmission of Antimicrobial Resistance (AMR) in the context of the pandemic.”

WHO remains concerned by declining investment (including in the private sector) and lack of innovation in the development of new antimicrobial treatments - factors that are undermining efforts to combat drug-resistant infections.

“We must bolster global cooperation and partnerships including between the public and private sectors to provide financial and non-financial incentives for the development of new and innovative antimicrobials, added Balkhy.

To support this effort, WHO has released two documents on target product profiles to guide development of new treatments for common resistant bacterial infections and an economic model that simulates the costs, risks, and possible return on investment of antibacterial drug development. 

 

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Main results of the video conference of ministers of justice

4 Jun
Justice ministers covered the proposed regulation on the law applicable to the third-party effects of assignments of claims, the extradition of EU citizens to third countries and the impact of COVID-19 in the area of justice.

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