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Independent research & practical ideas for global prosperity
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Independent research & practical ideas for global prosperity
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 Posts:February 19, 2010Death Toll from Haiti’s Earthquake in PerspectiveBy Mead OverThis is a joint post with Owen McCarthy. The January 12th earthquake in Haiti is the most lethal natural disaster of the past 20 years. On February 12th, the Associated Press reported that official Haitian government estimates of the dead had been revised upwards, now reaching 230,000 dead. Furthermore, the number could be much higher, since the government admits they have not yet been able to count all the bodies and they have excluded those buried by families or in private cemeteries. As the figure below shows, this new total surpasses the 225,000 dead in the 2004 Indian Ocean tsunami, and dwarfs the death tolls from recent earthquakes in Pakistan-controlled Kashmir and Sichuan, China. Read More… 5 Comments »January 26, 2010Adult Male Circumcision as an HIV Prevention Tool: Should the Scale Up of an Efficacious Intervention Be Evaluated?By Mead OverThe results of the three randomized controlled trials (RCTs) of medical adult male circumcision have all agreed. As recently reviewed by the Cochrane Collaboration, male circumcision reduces the odds that a man will become HIV infected by somewhere between 38 % to 66 % over a period of 24 months. Furthermore, the incidence of “adverse events” was deemed low. For an overview of the last five years of findings on male circumcision, see UNAIDS web site on the topic here and here. Wow! A vaccine this efficacious would be cause for celebration. Read More… 13 Comments »January 8, 2010Clinton Stresses the Need to Re-balance Health Assistance Away from AIDS TreatmentBy Mead OverSecretary Hillary Clinton’s ’s vision of the future role of foreign assistance in US foreign policy, as outlined in her address hosted here at the CGD on January 6, is ambitious, nuanced and inspiring. Bill Easterly takes issue with Clinton’s list of priority interventions, saying that it is too long to be consistent with her stated intention to “target” and to be “selective,” but I disagree. From which of these areas would Easterly want to rule out US assistance in all countries of the world? And by focusing on a few of these areas in any given country, the US assistance program can attain focus and accountability at the country level. Furthermore, sometimes wise allocation of resources requires less selectivity, not more. Read More… Comment »December 8, 2009How Will PEPFAR Reach 4 Million AIDS Patients on Treatment by 2014: Expanded Access or Earlier Recruitment? Millions of Years of Life Hang in the BalanceBy Mead OverOn December 1 the White House announced a new five-year strategy for PEPFAR which aims to increase the number of patients PEPFAR directly supports on antiretroviral therapy from the current 2.4 million to 4 million by 2014. This quite specific policy objective is the subject of this post, which further develops the analysis in my December 1 post: Should Poor Countries Follow WHO’s New Advice on When to Start AIDS Treatment? PEPFAR managers can meet the new goal of increasing the number of people on treatment to 4 million by 2014 in two ways that cost about the same: they can recruit earlier, that is, start HIV infected people on treatment before they are very sick as counseled by the new WHO guidelines; OR they can expand access, that is, direct the drugs to people who have been infected longer and are therefore sicker. The second choice seems to be the more humane and equitable: give the medicine to the patients who need it most. However, because the prognosis of these patients is generally less good than that of people more recently infected, recruiting patients earlier in their illness actually averts more deaths. Read More… 1 Comment »December 1, 2009Should Poor Countries Follow WHO’s New Advice on When to Start AIDS Treatment?By Mead OverWHO and UNAIDS have just put poor country AIDS treatment program managers on the spot. Will they choose to follow the new WHO advice to push patients to begin treatment earlier – when many are still healthy? Or will they turn their backs on the new advice and push instead for expanded access to those in need. In conjunction with World AIDS Day on December 1, WHO and UNAIDS have released new treatment guidelines for AIDS patients. Until this week, WHO’s official position has been that AIDS treatment programs should strive to start patients on antiretroviral therapy when the number of CD4 cells in their blood drops from normal levels of between 800 and a 1,000 per cubic millimeter down to 200 per mm3. The fact that poor countries have not been able to achieve this goal accounts for WHO’s current estimate that there are about 5 million people currently needing treatment, twenty percent more than the 4 million receiving it. Read More… 2 Comments »October 30, 2009Will the New White House Initiative for Rigorous Evaluation Elicit a Response from the U.S. Foreign Assistance Agencies?By Mead OverThis October 7 memo from Peter Orszag is interesting not only for its emphasis on evaluation, but also for its use of a carrot approach instead of (in addition to?) a stick approach to getting the participation of the various agencies and bureaus of the US government. (Thanks to Mattias Lundberg for flagging this memo for me.) Read More… 2 Comments »August 4, 2009Will a New NIH-Funded Study Tell Us Whether Immediate AIDS Treatment Slows HIV Transmission?By Mead OverEach year in Sub-Saharan Africa there are about 2-million new cases of HIV infection, most of whom would not need antiretroviral therapy (ART) under current guidelines for 8 to 12 more years. Since donors have not managed to place on treatment more than about half of those needing it each year, the 8 to 12 year lag between infection and need for treatment has been seen as a breathing space. But a radical new idea discussed at last week’s Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa would start the 2-million newly infected people on ART within days or weeks of their infection. Would immediate treatment work as a prevention strategy? At the IAS meeting, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease, told the South African Times that “[w]e will be doing research to determine the feasibility of several assumptions underlying [the immediate treatment strategy].” Now the University of North Carolina’s Institute for Global Health and Infectious Disease has announced that researchers William Miller and Audrey Pettifor have been awarded a $3.5 million, four-year research grant to test some of the assumptions flagged in Dr. Fauci’s conference talk. Read More… 7 Comments » |
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