Strengthening the Strategy: A Call for Integrated Efforts with HIV/AIDS in NTD Control Elimination Initiatives

January 3rd, 2011 by admin Leave a reply

By:  Emma Apatu, MPH & Rebecca Miller, MPH

Over the past few years, policy changes in global health have shed new light on Neglected Tropical Disease (NTDs).  Formerly classified as “other communicable diseases”, NTDs have progressively experienced increased visibility on a global scale, which has in turn led to new and improved strategies—such as disease program integration [1].  Recent funding streams have provided much needed financial support to address the burden of these ”hidden” diseases found in impoverished and rural populations throughout the world.  Although the amount of attention and resources allocated toward NTD programs has improved dramatically over the last five years, there is currently a paucity of sustainable long-term funding mechanisms.  Given the financial focus on HIV/AIDS as one of the “big three” diseases targeted by the Millennium Development Goals and the overlap of NTDs in areas with high HIV/AIDS prevalences, policy makers should work to broaden the scope of historically established HIV/AIDS policies to include NTD control and elimination efforts.

Over one billion people worldwide are affected by NTDs and millions more are at imminent risk for infection [1, 2]. Responsible for an annual loss of 57 million disability adjusted life years [3], NTDs claim over 530,000 lives each year [4] and often inflict severe, permanent and stigmatizing physical debilitation in survivors [5].Over time, NTDs can also cause decreased cognitive output and productivity, which has profound economic implications in countries that are endemic for one or more NTDs [1].

NTDs persist in areas of severe poverty in Sub-Saharan Africa, Latin America and Asia and display strong geographical overlap in areas where HIV/AIDS, Tuberculosis, and Malaria are also endemic [6]. Multiple studies demonstrate that co-infections of HIV/AIDS, tuberculosis, and malaria along with the NTDs accelerate or aggravate disease progression[6]. Fortunately, many NTDs can be effectively treated by “rapid-impact” low-cost interventions—such as preventive chemotherapysome of which can be administered for under $1 per unit [7].  NTD treatments are also touted as extremely cost-effective in economic forecasts [4, 8]. In light of program compatibilities and the continual need to share the financial burden of program costs, global health scientists and program officers have called for the integration of HIV/AIDs treatment programs—which are historically established and well-funded—with NTD control efforts [9]. Despite these calls of action, NTD integration with HIV/AIDS currently remains an unrealized opportunity for cost-sharing, sustainable funding and increased program efficiency.

In recent years, there has been a gradual rise in public and private interest to fund and support NTD initiatives. The U.S. government increased national visibility of NTDs in 2008 through Bush’s Presidential Initiative for Control of Neglected Tropical Diseases and again in 2009 with Obama’s Global Health Initiative[2]. NTDs continued to step into the global spotlight in 2010, when world leaders at the G8 summit meeting in Canada pledged to support the control and elimination of NTDs. In October 2010, WHO unveiled the new recommendations for NTD control and elimination targets for the next few years [1]. Given the increased resolve to tackle NTDs through the creation of new directives and resource streams, funding mechanisms will need to coalesce to create sustainable and streamlined platform NTD initiatives.

Of the promising avenues for integration, the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) has emerged as a viable funding mechanism to shoulder the financial and personnel burden of NTD programs. Since GFATM’s inception in 2002, the fund has committed 21.7 billion US dollars that has supported 600 programs in 150 countries saving millions of lives by supplying necessary AIDS and anti-tuberculosis treatments and insecticide bed nets [10]. By extending the umbrella of the GFATM to include NTD initiatives, these programs will gain the muscle and experience necessary to achieve WHO’s 2015 control and elimination targets.

Integrating NTDs into HIV/AIDS policy and programming offers a promising strategy to capitalize on program strengths, to increase program efficiency, and to generate program sustainability for the field of NTDs. Success stories such as the Guinea Worm Disease eradication campaign have demonstrated that it is possible to bring persistent NTDs to near extinction through effective treatment, prevention, and sustained funding. By approaching NTDs with continued vigilance and with strategies for sustainability, the global health community will be able to echo WHO’s 2010 forecast regarding NTDs: “The concept of neglected is confined to the history of public health”[1].

About the Authors:

Emma Apatu, MPH, is a doctoral student in the Department of Community Health at East Tennessee State University’s College of Public Health.

Rebecca Miller, MPH, is a Program Coordinator in the Leon Research Group at the Rollins School of Public Health at Emory University.

References:

1.         World Health Organization. Working to overcome the global impact of neglected tropical diseases First WHO report on neglected tropical Diseases.

2.         USAID. USAIDs Neglected Tropical Diseases Program.

3.         Sachs, J.D. and P.J. Hotez, Fighting Tropical Diseases Science, March 17, 2006. 311(5767): p. 1521.

4.         Hotez, P.J., et al., Control of Neglected Tropical Diseases. New England Journal of Medicine, 2007. 357(10): p. 1018-1027.

5.         Weiss, M.G., Stigma and the Social Burden of Neglected Tropical Diseases. PLoS Negl Trop Dis, 2008. 2(5): p. e237.

6.         Hotez, P.J., et al., Incorporating a Rapid-Impact Package for Neglected Tropical Diseases with Programs for HIV/AIDS, Tuberculosis, and Malaria. PLoS Med, 2006. 3(5): p. e102.

7.         Hotez, P.J., et al., Incorporating a Rapid-Impact Package for Neglected Tropical Diseases with Programs for HIV/AIDS, Tuberculosis, and Malaria. PLoS Med, 2006. 3(5): p. e102.

8.         Brady, M.A., P.J. Hooper, and E.A. Ottesen, Projected benefits from integrating NTD programs in sub-Saharan Africa. Trends in Parasitology, 2006. 22(7): p. 285-291.

9.         Molyneux, D.H., P.J. Hotez, and A. Fenwick, “Rapid-Impact Interventions”: How a Policy of Integrated Control for Africas Neglected Tropical Diseases Could Benefit the Poor. PLoS Med, 2005. 2(11): p. e336.

10.       The Global Fund to Fight AIDS Tuberculosis and Malaria. About the Global Fund.

This blog post contains the independent views of the authors and does not represent the views and opinions of the Global Network for Neglected Tropical Diseases.

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    • The Global Network for Neglected Tropical Diseases is a major advocacy and resource mobilization initiative of the Sabin Vaccine Institute dedicated to raising the awareness, political will, and funding necessary to control and eliminate the most common neglected tropical diseases (NTDs)--a group of disabling, disfiguring, and deadly diseases affecting more than 1.4 billion people worldwide living on less than $1.25 a day.
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