Targeted treatment

Lakhs of HIV deaths can be averted as India follows WHO’s recommendations

Two years after the World Health Organisation (WHO) recommended that antiretroviral

therapy (ART) be initiated in people living with HIV irrespective of the CD4 (a type of

white-blood cell) counts, India has aligned its policy with the guideline. In a major shift,

Union Health Minister J.P. Nadda had recently said that any person who tests positive for

HIV will be provided ART “as soon as possible and irrespective of the CD count or clinical

stage”. Nearly 4.5 lakh deaths can be averted through this move.

It was in 2002 that the WHO first issued its ART guidelines. In the absence of AIDS-defining

illnesses, the WHO set CD4 count less than 200 cells per cubic millimetre as the threshold to

begin ART treatment. Over time, it changed its guidelines and, in 2013

increased the threshold to CD4 count less than 500 cells per cu. mm.

Change in WHO guidelines

The recommendation was based on the evidence that an earlier initiation of ART will help

people with HIV live longer, remain healthier and “substantially reduce” the risk of them

transmitting the virus to others. The availability of safer, affordable and easy-to-manage

medicines that could help to lower the amount of virus in the blood played a key role in the

WHO’s decision. Earlier initiation could avert an “additional three million deaths and prevent

3.5 million more new HIV infections between 2013 and 2025,” noted the WHO in 2013.

In 2015, the WHO once again changed its guidelines. Based on evidence from clinical trials

and observational studies since 2013, it became clear that an earlier use of ART, irrespective

of the CD4 count, results in better clinical outcomes. Accordingly, it recommended that ART

be initiated in HIV-positive people at any CD4 cell count.

As per 2015 estimates, India has 2.1 million HIV-positive people, of which only 1.6 million

have been diagnosed and about a million are on treatment. But over half a million people are

not even aware of their HIV status.

With the government changing its treatment guidelines, the 0.6 million who have been

diagnosed but not been on treatment are now eligible for treatment. Of the 0.6 million, about

0.25 million have been enrolled for pre-ART care and can be started on treatment almost

immediately. But the biggest challenge will be to identify the 0.35 million who have been

diagnosed but not on treatment and the 0.5 million who have been infected but have not been

diagnosed. Also, nearly 80,000 people get infected each year.

Even as efforts are on to expand the 1,600 treatment delivery sites that are currently

operational, there should be greater focus now on identifying people with HIV. The

government has plans to start community-based testing to bring it closer to those in need, and

target special groups that are more vulnerable to infection such as partners of people who are

HIV-positive.

Source: The Hindu

http://www.thehindu.com/opinion/op-ed/targeted-treatment/article18358522.ece 

India to screen 25 lakh people for hypertension through May

India is set to embark on the largest-ever screening of its population for hypertension in 
one go. Starting tomorrow (May 1), the Indian Council of Medical Research (ICMR) in

association with local collaborators will reach 25 lakh Indians for high blood pressure

screening.

“This is the largest-ever screening undertaken in the country for hypertension. India has

decided to join an initiative of the World Hypertension League which will screen people

across nations for high BP to mark this year’s World Hypertension Day on May 17. 
Indian target population of 25 lakh is the highest globally,” Dr Meenakshi Sharma, the 
scientist handling non-communicable diseases in ICMR, told The Tribune today.

India doesn’t have an official national-level estimation of high blood pressure, the silent 
killer responsible for 10 per cent of all deaths annually across the world. Available 
estimations of prevalence come from local studies that cover a section of Indian states 
at the most.

The ICMR, government’s apex research body, has decided to partner The Public Health

Foundation of India (PHFI) for the exercise. Only recently, the government had cancelled

PHFI’s licence under the Foreign Contributions Regulation Act barring it from receiving

foreign funds, citing some irregularities. The NGO’s local operations remain unaffected.

“The exercise will be jointly conducted by the ICMR, Public Health Foundation of India 
and the Centre for Chronic Diseases and Prevention. The aim is to encourage doctors for

opportunistic screening of people entering healthcare settings. It is seen that doctors don’t

normally screen patients for hypertension and lose the opportunity. Partners have now

developed an application for doctors, which they can download on Android and even from

the Internet to feed in details of screening and hypertension investigation throughout May,”

said Dr Prabhakaran from CCDP and Council Member, International Society of

Hypertension.

The screening will happen through May with ICMR calling the activity “May Measurement

Month (May 1 to 31) to reach 2.5 million Indians”.

“Current estimates say 40 per cent urban Indians above 30 years are hypertensive and 
25 per cent rural population above this age group has high blood pressure. High BP is 
linked to strokes, heart attacks, heart failures and kidney diseases but 50 per cent of 
those with hypertension don’t know it,” said Dr Prabhakaran.

Largest-ever exercise

The Indian Council of Medical Research has tied up with Public Health Foundation of 
India to embark on the largest-ever exercise to screen people for the silent killer

The screening will happen through May with the ICMR calling the activity “May

Measurement Month to reach 2.5 million Indians”. It will get a chance to assess high 
blood pressure burden in large sample size.

Source: The Tribune

Malaria vaccine to be tested in 3 African nations

POOR COUNTRIES HAVE THE CHALLENGE OF DELIVERING THE REQUIRED 4 DOSES OF THE VACCINE FOR EACH CHILD

JOHANNESBURG : Three African countries have been chosen to test the world’s first malaria vaccine, the World Health Organization announced Monday.

Ghana, Kenya and Malawi will begin piloting the injectable vaccine next year with hundreds of thousands of young children, who have been at highest risk of death.

The vaccine, which has partial effectiveness, has the potential to save tens of thousands of lives if used with existing measures, the WHO regional director for Africa, Dr. Matshidiso Moeti, said in a statement. The challenge is whether impoverished countries can deliver the required four doses of the vaccine for each child. Malaria remains one of the world’s most stubborn health challenges, infecting more than 200 million people every year and killing about half a million, most of them children in Africa.Bed netting and insecticides are the chief protection. Sub-Saharan Africa is hardest hit by the disease, with about 90 percent of the world’s cases in 2015.

Malaria spreads when a mosquito bites someone already infected, sucks up blood and parasites, and then bites another person.

A global effort to counter malaria has led to a 62% cut in deaths between 2000 and 2015, WHO said. The vaccine will be tested on children five to 17 months old.

Source: Hindustan Times

After Much Delay, UP Gets Moving on Family Planning

MISSION PARIVAR VIKAS Govt plans free condom boxes, saas-bahu meets... Akhilesh
ignored Centre's directive on family welfare sent last November.

Free condom boxes at strategic locations in cities and villages, a kit for newly-wed couples
with packs of condoms, emergency contraceptive pills and a pregnancy testing kit, and saasbahu
sammelans are Uttar Pradesh government's latest tools to drive home the message of
family planning in its post populous districts.

The Yogi Adityanath government has decided to roll out a new central family planning
scheme, `Mission Parivar Vikas' in UP, which his predecessor Akhilesh Yadav ignored
despite the centre's directions last November.

On November 10, the union health ministry had written to seven states, seeking family
planning intervention to address maternal and infant mortalities. It said 145 high-fertility
districts in UP, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam with
total fertility rate (TFR) of 3 and above account for 28% of India's population and 30% of
maternal deaths and nearly 50% of infant deaths.

The scheme targets 145 districts in the seven states which have a Total Fertility Rate (TFR)
of 3 and overimplying a woman on average bears three or more children here. UP has the
highest 57 of its 75 districts under the scheme.

UP as a whole has a 3.3 TFR and contributes most to India's high population growth.

“It is directed that the scheme, which as per the centre's direction was to be started from
November 10, 2016, will stand initiated from the date of this order,“ UP's additional chief
secretary , Arun Kumar Sinha, said in an order issued on April 24. The order has been sent to
DMs and chief medical officers of 57 districts.The scheme aims to bring down TFR in these
districts to 2.1 by 2025. In UP , 11 districts have TFR above 4 including Bahraich and
Balrampur at 4.8 and Siddharthnagar at 4.9.

Among the districts with low fertility rates, and hence out of the scheme's purview, are
Varanasi (TFR 2.3), Rahul Gandhi's Amethi, and the CM's Gorakhpur (TFR 2.7). Urban
districts like Kanpur, Noida, Ghaziabad and Lucknow also have low fertility rates. The new
scheme includes measures like a family planning kit for newly-weds in rural areas worth `220
which will include two packs of three condoms, a marriage registration form, five
contraceptive pills and two pregnancy test kits.

Free condom boxes will be put up at strategic locations like health facilities and gram
panchayat bhawans. A new contraceptive injection is being rolled out, where women opting
for it will be paid an incentive of Rs 100 per shot.

Nearly 47000 nurses and Asha workers would be trained to give these injectables. Financial
incentives for those undergoing sterilisation procedures like tubectomy and vasectomy have
been hiked under the scheme by 50% to Rs 2000 and Rs 3000.

Saas-bahu sammelans are planned for rural areas to facilitate improved communication
between mothers-in-law and daughters-in-law through interactive games and exercises to
bring about change in attitudes.

Raise Awareness, Empower Women
The UP government's focus to have a stable population and ensure improved access for
womens' healthcare is welcome. Priority should also be given to programmes that educate
women to influence their health and consequently their overall wellbeing. Raising awareness
will empower them to take critical decisions. This is superior to incentivising sterilisation.

Source: The Economic Times

New cause of high BP discovered

Researchers have discovered a new cause of high blood pressure which could lead to major

changes in managing the disease.

In a study published in the journal JCI Insight, the researchers named the new cause as

Connshing syndrome which is linked to the over production of the stress hormone cortisol.

In up to 10% of hypertensive patients, the over production of the adrenal hormone

aldosterone — a condition known as primary aldosteronism or Conn syndrome — is the

cause of disease.

Patients are left untreated for cortisol excess.

Source: The Hindu

A pinprick to detect cancer

 Drawing on genetics, Indian companies are offering blood tests to ferret out cancers

While the humble blood test has for long been the touchstone to catch diabetes, malaria and

HIV, companies are now drawing on knowledge from human genetics to make blood tests

smart enough to fish out several kinds of cancers.

Earlier this month, Strand Life Sciences, a Bengaluru-based company, began offering a test

called ‘STRAND LB’ that claims to be able to detect traces of a tumour “from a simple blood

draw”.

MedGenome, another company based in Bengaluru — also announced the launch of

“ONCOTRACK”, another ‘liquid biopsy’ test. “Management of cancer will undergo a

massive transformation in India with NGS (next-generation sequencing)-based liquid

biopsies… ONCOTRACK is one such offering,” says MedGenome chairman Sam Santhosh

in a press statement.

Liquid biopsies

NGS refers to techniques to scan genes and look for mutations that may cause cancer.

Traditionally, ferreting out cancer requires scooping out tissue from a suspected organ and

testing them for the disease. Depending on the location of the cancer, this frequently involves

invasive surgery.

Moreover, even after surgery or chemotherapy, several more biopsies are continually

required to check if the cancer has disappeared or worse, relapsed. Biopsies are also required

to check if the cancer is caused due to specific kinds of mutations that would render certain

kinds of treatment ineffective.

Liquid biopsies, as these tests are called, involve being able to catch free-floating pieces of a

tumour or particular pieces of tumour DNA in the blood. These are then analysed to see if the

DNA contains mutations that are known to be linked to particular kinds of cancer.

The trouble usually is that they are present in amounts too minuscule to be detected. To have

a shot at capture, any test has to be sharp enough to fish out about one molecule in 1,000.

“STRAND LB can detect tumour DNA traces in as many as 35% of patients with early-stage

cancer, going up to 70-90% in patients with locally advanced or metastatic cancer. These

figures are on a par with the best in the world,” says Dr. Vijay Chandru, chairman and

managing director, Strand Life Sciences. These numbers spanned a wide variety of cancer

types, including lung, colorectal, breast, and bladder cancer.

According to Dr. Chandru, liquid biopsy tests couldn’t yet be a replacement for traditional

biopsies but there were a variety of situations that made them useful — for instance, lung

cancer patients who couldn’t afford to part with enough tissue. These are important to

determine if their tumours carry mutations in genes such as EGFR, making them eligible for

specific treatments. It can also be used to monitor the very same patients for the emergence of

resistance to these treatments.

The cost barrier

Liquid biopsy tests approximately cost ₹ 15,000-₹ 20,000, making them roughly three-four

times as costly as solid biopsies. However, proponents say the world over, liquid biopsies are

considered an emerging technology and it was quite likely that in the next five years there

would be blood tests powerful enough to find out if a seemingly healthy person has been

struck by cancer. “At least in the case of breast cancer, research shows that liquid biopsies are

extremely effective,” says Shantanu Chowdhury, a cancer researcher at the CSIR-Institute of

Genomic and Integrative Biology in Delhi.

India is likely to have over 1.73 million new cases of cancer and over 8,80,000 deaths due to

the disease by 2020. Around 70% of all cancer patients approach the doctor when the disease

has advanced and chances of a cure are very low.

Source: The Hindu

Robotic surgery