PrEP Uganda App launched for HIV prevention and management

By Esther Nakkazi

A user-friendly app used to access information about HIV prevention and a daily pill that can prevent HIV has been developed. The Pre Exposure Prophylaxis (PrEP) app called 'PrEP Uganda' assessed on smartphones was initiated by Charles Brown the executive director Preventive Care International (PCI).

PrEP is a daily pill taken by someone who is HIV negative (Uninfected) before they are exposed to HIV. The PrEP Uganda app will be used for adherence and retention and it has a feature that allows the user to get all information about PrEP including - the nearest sites offering PrEP within that location.

It is also mainly targeted for people who are stigmatized, key populations and meant to empower young people to champion the end of new HIV infections through the PrEP Uganda mobile app.

"For any medication to be effective, the person taking it must adhere well. This mobile app enables a person taking PrEP to set reminders for daily swallowing of the pill. A person can also set a reminder to pick drug refills," Brown told journalists attending a media science cafe organized by the Health Journalists Network in Uganda (HEJNU) held on 26th November.

The mobile app that can be assessed for free through the google app store (play store) for all Android users has an interactive session that allows the user to ask questions about PrEP and HIV prevention and get answers from an expert. The version for IOS (iPhone) users is being developed.

Uganda has made great progress towards ending HIV and achieving the 95,95,95 targets but infections among key and priority populations are still high averaging 2 to 4 times the national prevalence.

As high as 570 new infections per week happen among adolescent girls and young women (AGYW) in Uganda. Prompted by the findings from the studies and WHO recommendations, Uganda
adopted PrEP as an additional strategy for HIV prevention.

Roll out of PrEP started in July 2017 and to date over ninety (90) facilities are implementing PrEP across the country. Over 16,000 individuals at substantial risk of acquiring HIV have been enrolled on PrEP including discordant couples, Sex workers, Men who have Sex with Men (MSM) and People who use drugs (PWUD), Transgender, Fisherfolks, adolescent girls and young women (AGYW) among others.

Despite reaching several clients with PrEP, the program has experienced a number of challenges including myths and misconceptions, stigma associated with the use of ARVs among others. These can be addressed through user-friendly technologies like mobile Apps that someone can use to access information.

"As we celebrate World Aids day, we need to make all options for HIV prevention available to everyone to choose what is preferred. We need to create safe spaces for adolescent girls and young women to freely access HIV prevention and reproductive health services. We need to involve AGYW, Key and Priority populations in planning and delivery of services," said Brown.

"Together with duty bearers we need to focus on eliminating all forms of stigma towards people living with HIV and support them to adhere and achieve viral load suppression. Science has proven that when people living with HIV achieve viral load suppression to an undetectable level they can not pass on the virus to other people (Undetectable = Untransmittable). A combination of these interventions while not living anyone behind will enable us to achieve epidemic control," Brown told HEJNU journalists.

In Uganda, an estimated 1.3 million people are living with HIV and 52,000 people become newly infected with the virus annually. According to the National HIV and AIDS Strategic Plan (NSP), 2015/16 – 2019/20, the prevalence of HIV has a geographical heterogeneity with urban residents being more affected. The prevalence of HIV differs among the different subcategories with key and priority populations being affected more than the general population.

Invest in Vaccine Preventable Diseases Surveillance or endure $22.4 billion economic burden - WHO warns Africa

By Esther Nakkazi 

The World Health Organisation (WHO) has launched an Investment Case for Vaccine-Preventable Diseases Surveillance in the African Region 2020-2030 which warns that if if countries do not invest in disease surveillance efforts – including a US$22.4 billion economic burden over the next decade. 

It also sets forth an ambitious vision for Vaccine-preventable disease (VPD) surveillance in the African region by 2030.

The announcement was made at the high-level “Reaching the Last Mile Forum” in Abu Dhabi on 19 November, by Dr. Matshidiso Moeti, WHO Regional Director for Africa. She called on governments to invest in strong disease surveillance systems that will ensure early detection and response to risks and outbreaks.

“Strong surveillance is the backbone of a functioning health information system, empowering health workers with timely, quality evidence to inform decision-making.To curb the spread of life-threatening diseases, governments must invest in strong and functioning surveillance systems,” said Dr Moeti. 

With the African Region on the brink of polio eradication, VPD surveillance remains an issue yet to be prioritized by many health leaders. The burden of VPDs and associated outbreaks remain a major threat to people across Africa.

“Despite extraordinary progress boosting vaccine coverage around the world in the past two decades, one and a half million people are still dying from vaccine-preventable diseases every year,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance.

The Investment Case further indicates that if current disease surveillance efforts are not maintained, there is a risk to reverse progress made, leading to more than 900,000 deaths. 

 More investment in surveillance: 

The WHO Investment Case outlines the need for increased domestic investment for surveillance activities under the overall umbrella of integrated disease surveillance and response, from countries in the African Region as well as mobilization of international resources, in order to ensure strong disease surveillance. 

At least $470 million in operating costs will be needed over the next decade to reach this ambition. WHO predicts that the investment would save over 700,000 lives, prevent 20 million people from falling ill due to vaccine-preventable diseases, and save US$21 billion over 10 years – estimated to be a 44.6-fold return on investment.

Its notable that resources for VPD surveillance have declined markedly over the past two years – and domestic surveillance expenditure in the African Region remains low. 

“The fact that most countries in the African Region continue to rely on external funding for VPD surveillance is a strong indicator of the work that remains to be done,” said Dr. Richard Mihigo, Programme Manager for Immunization and Vaccine Development at the WHO Regional Office for Africa. “Governments have a central role to play to fill upcoming funding gaps and ensure immunization programmes and surveillance remain strong and vigilant.”

A private sector firm has already pledged $5 million over the next five years, beginning in 2020, to support and strengthen VPD surveillance efforts in the African Region. 

“We hope that this first pledge in support of the VPD surveillance investment case will be catalytic, and will encourage other traditional and non-traditional donors to consider this critical area of work, including how the private sector and governments can work closely together to ensure we successfully bridge funding gaps,” said Elizabeth Ivanovich, Director of Global Health at the UN Foundation.

Dr. Rebecca Martin, Director of the Center for Global Health, CDC, issued a statement of support, adding: "CDC is strongly committed to global health security, helping to strengthen health systems that can prevent avoidable epidemics, detect threats early, and respond rapidly to outbreaks."

At the African Union Summit held in Addis Ababa in January 2017, African Heads of State endorsed the Addis Declaration on Immunization (ADI), pledged increased political and financial investments in their immunization programmes. 

Commitment 5 of the ADI outlines the need for “attaining and maintaining high quality surveillance for targeted vaccine-preventable diseases.” Although Member States have endorsed these commitments and pledged to deliver on universal immunization coverage and high-quality surveillance, challenges remain in achieving immunization and surveillance targets.

Still at the African Union Summit held in Addis Ababa, African Heads of State endorsed the Addis Declaration on Immunization (ADI), pledging to ensure that everyone in Africa – regardless of who they are or where they live – receives the full benefits of immunization.

“Our biggest challenge in reducing the horrific toll these diseases still cause is finding the children who are still missing out on vaccines. That’s why improved vaccine-preventable disease surveillance systems are so important, helping health authorities to identify the areas where immunization coverage is weakest and protect those children who are currently being left behind,” said Dr. Berkley.

Vaccine-preventable disease surveillance is a critical component of the integrated disease control strategies and an effective way to detect and respond early to outbreaks – mitigating their impact on national security, the local economy and public health systems. Yet countries in the African Region still face major challenges in both the strategic planning and operation of their surveillance systems.

  

“VPD surveillance is not only a valuable investment that will help countries reach immunization targets,” said Dr. Moeti, “it is a critical component of broader goals such as Universal Health Coverage and the Sustainable Development Goals, and is absolutely essential to protecting all of our health security.”

Ethiopia adopts open access policy

By Esther Nakkazi

Ethiopia has adopted a national policy that mandates all universities and research institutes that receive public funding to make open access. This is expected to transform research and education in Ethiopia’s higher institutions of learning.

Open access builds a knowledge community and allows researchers and research institutions that cannot afford subscription fees to access scientific journals.

The Ministry of Science and Higher Education of Ethiopia (MOSHE) adopted the new national open access policy in September this year and it came into effect immediately.

“Our universities and libraries will have to adapt quickly to comply with the new policy. Each university will have to develop an open access policy to suit its own institutional context, and which is also aligned with the national policy,” blogged Dr. Solomon Mekonnen Tekle, a librarian at Addis Ababa University Library, and EIFL Open Access Coordinator in Ethiopia.

Ethiopia an Electronic Information for Libraries (EIFL) partner country also will benefit from the new agreement ( signed 28 October 2019) signed between EIFL with the academic publisher De Gruyter valid until December 2021, which covers open access publishing and free and discounted access to its (De Gruyter) ’s content.

De Gruyter offers authors from EIFL partner countries the option of publishing their articles in open access for free or at discounted Article Processing Charges (APCs) in its over 440 fully open access and hybrid journals.

Other EIFL countries include Cambodia, Congo, Ethiopia, Georgia, Ghana, Ivory Coast, Kenya, Kosovo, Kyrgyzstan, Laos, Lesotho, Malawi, Maldives, Moldova, Myanmar, Nepal, North Macedonia, Palestine, Senegal, Sudan, Tanzania, Uganda, Ukraine, Uzbekistan, Zambia, Zimbabwe.

Ethiopia’s new national open access policy requires that all published articles, theses, dissertations and data from research conducted by staff and students at the 47 universities that are publicly funded through the MOSHE be open access.

Dr. Tekle says the new open access policy will improve the quality of researchers' work as they will easily critique each other work and it will increase the visibility of Ethiopian research, within the national and international research communities - creating equity, minimizing duplication, thereby saving costs, time and effort.

“There is a strong capacity-building component to the project to train repository managers and administrators to manage their new institutional repositories and open access journals,” said Dr. Tekle.

The policy encourages open science practices including ‘openness’ as one of the criteria for assessment and evaluation of research proposals as such researchers who receive public funding must submit their data management plans to research offices and to university libraries for approval and confirm that the data will be handled according to international FAIR data principles. (FAIR data are data that meet standards of Findability, Accessibility, Interoperability, and Reusability.)

However, two months after it came into effect only three universities - Hawassa, Jimma and Arba Minch universities of the 47 universities under MOSHE have adopted the open access policy but more will comply.

Tekle says at some point the academic community was opposed to open access fearing plagiarism. However, now, ‘researchers and students come to my office in the library and ask for their research to be published in open access so that others, like potential employers, for example, can find and read it’.

However, even if Ethiopia universities have made this move there are concerns over Appointments and Promotions Committees in African universities discriminating against Open Access journal articles which are also perceived and rated lower and given fewer scores.

To date, 46 higher education institutions have signed onto the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities which came into effect in 2003 and is regarded as the milestone of open access movement.

The first African higher education institutions to sign onto it was Stellenbosch University in 2010 but more than 400 institutions worldwide have signed it. It was initiated by the Max Planck Society of Germany, promotes unrestricted access to scientific knowledge and cultural heritage.

A study done in all eight Tanzanian health sciences universities that investigated the faculty's awareness, attitudes and use of open access, and the role of information professionals in supporting open access scholarly communication found that most faculty members were aware of OA issues but did not necessarily translate into actual dissemination of faculty's research outputs through OA web avenues.

The study published in 2013 and entitled ‘Open access behaviours and perceptions of health sciences faculty and roles of information professionals’ found that senior faculty with proficient technical skills were more likely to use open access than junior faculty and the major barriers to OA usage were related to ICT infrastructure, awareness, skills, author-pay model, and copyright and plagiarism concerns.

The study leads author Dr. Edda Tandi Lwoga the directorate of Library Services, Muhimbili University of Health and Allied Health Sciences said most academics used open access venues for accessing scientific works that are freely available on the web more than publishing their own research outputs.

Dr. Williams Nwagwu teaches Informetrics and other quantitative applications in Information Science at the Africa Regional Centre for Information Science (ARCIS), University of Ibadan, Nigeria said university administrators may want to increase the status and visibility of their universities through increase of senior scholars, most of whom achieve this status publishing in low-status open access journals.

Dr. Nwagwu says Africa should not look at the number of journals doing open access or quantity of papers available to address open access - which encompasses many other issues, apart from numbers.

“I acknowledge existing efforts, but there is a need for leadership, consensus building, policymaker engagement etc,” he says.

About the perceived link between 'low status' and open access, Neil Pakenham-Walsh the coordinator Healthcare Information For all (HIFA) Project said this can only be said for predatory journals, but the latter can be regarded an aberration and unrepresentative.

Pakenham-Walsh explained that it is fairly straightforward to identify high-quality open-access journals, and there is no logical reason why they should be trusted any less than subscription-based journals because editorial quality does not depend on whether a journal is restricted-access or open-access.

He argued that if academic institutions have the vision of creating and disseminating knowledge, and if the quality of content is not dependent on restricted versus open, then one might expect academic institutions to actively support open access journals rather than discriminate against them.

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Alarming record breaking temperatures observed over four months globally

By Esther Nakkazi

The Global average temperatures for September 2019 was at par with September 2016, making it the fourth month in a row to be close to or breaking a temperature record according to the Copernicus Climate Change Service (C3S), a European Commission’s flagship Earth observation program.

At a global level, September 2019 also had high temperatures making it the fourth month in a row to be close to or breaking a temperature record at about 0.57°C degrees above average.

June 2019, was the warmest on record and July the warmest month ever recorded while August 2019 settling for the second warmest August. The data was compared against the latest standard thirty-year climatological reference period, 1981-2010,  and September 2019 was.

"September 2019 being on-par with record temperatures now acts as a reminder of the long-term warming trend," said the C3S which delivers freely accessible operational data and information services, which provide users with reliable and up-to-date information related to environmental issues.

“The series of record-breaking temperatures is an alarming reminder of the long-term warming trend that can be observed on a global level. With continued greenhouse gas emissions and the resulting impact on global temperatures, records will continue to be broken in the future,” said Jean-Noël Thépaut, Director of Copernicus ECMWF.

This is close to 1.2°C above the pre-industrial level as defined by the Intergovernmental Panel on Climate Change (IPCC) and about as warm as September 2016 (0.02°C warmer), the previous warmest September in this data record, he said.

The difference in the average temperatures for September 2019 and September 2016 is very small, according to the C3S data, only 0.02°C. It is smaller than the typical difference between the values provided by the global temperature datasets of various institutions, both months will share the top spot together.

Regions with most markedly above-average temperatures include central and eastern USA, the Mongolian plateau and parts of the Arctic. In Europe, temperatures were above average over most of the continent, especially in the south and south-east.

The Copernicus Climate Change Service (C3S) is implemented by the European Centre for Medium-Range Weather Forecasts (ECMWF) on behalf of the European Union. ECMWF also implements the Copernicus Atmosphere Monitoring Service (CAMS). ECMWF is an independent intergovernmental organization, producing and disseminating numerical weather predictions to its 34 Member and the Co-operating States.

The Copernicus Climate Change Service (C3S), Monthly Climate Summaries from the Copernicus Climate Change Service (C3S) routinely publishes monthly climate bulletins reporting on the changes observed on the global surface air temperature, sea ice, and hydrological variables. All the reported findings are based on computer-generated analyses using billions of measurements from satellites, ships, aircraft and weather stations around the world.

More information about climate variables in September and climate updates of previous months as well as high-resolution graphics can be downloaded here: https://climate.copernicus.eu/climate-bulletins

Surface air temperature anomaly for September 2019 relative to the September average for the period 1981-2010. Data source: ERA5. Credit: ECMWF-Copernicus Climate Change Service (C3S)

Technology eliminates cold storage for Chikungunya vaccine

By Esther Nakkazi

Most of the vaccines we use require cold chain storage to preserve them. Now a new type of vaccine technology that does not require this for the mosquito-borne virus Chikungunya vaccine has been developed says a press release from the University of Bristol. 

The vaccine can be stored at warmer temperatures, removing the need for refrigeration, has been developed for mosquito-borne virus Chikungunya. 

The findings, published in Science Advances, reveal exceptionally promising results for the Chikungunya vaccine candidate, which has been engineered using a synthetic protein scaffold that could revolutionize the way vaccines are designed, produced and stored.

Chikungunya, a virus transmitted by the bite of an infected mosquito causes crippling headache, vomiting, swelling of limbs and can lead to death. Even if a fever ends abruptly, chronic symptoms such as intense joint pain, insomnia, and extreme prostration remain. 

Formerly confined to sub-Saharan Africa, Chikungunya has recently spread worldwide as its mosquito host leaves its natural habitat due to deforestation and climate change, with recent outbreaks in the USA and Europe causing alarm.

Researchers from the University of Bristol and the French National Centre for Scientific Research (CNRS) in Grenoble, France, teamed up with computer technology giant Oracle to find a way to make vaccines that are thermostable (able to withstand warm temperatures), can be designed quickly and are easily produced.

“We were working with a protein that forms a multimeric particle resembling a virus but is completely safe because it has no genetic material inside, said Pascal Fender, an expert virologist at CNRS. 

“Completely by chance, we discovered that this particle was incredibly stable even after months, without refrigeration.”

“This particle has a very flexible, exposed surface that can be easily engineered, added Imre Berger, Director of the Max Planck-Bristol Centre for Minimal Biology in Bristol. “We figured that we could insert small, harmless bits of Chikungunya to generate a virus-like mimic we could potentially use as a vaccine.”

To validate their design, the scientists employed cryo-electron microscopy, a powerful new technique recently installed in Bristol’s state-of-the-art microscopy facility headed by Christiane Schaffitzel, co-author of the study. Cryo-EM yields very large data sets from which the structure of a sample can be determined at near-atomic resolution, requiring massive parallel computing.

Enabled by Oracle’s high-performance cloud infrastructure, the team developed a novel computational approach to create an accurate digital model of the synthetic vaccine. University of Bristol IT specialists Christopher Woods and Matt Williams, together with colleagues at Oracle, implemented software packages seamlessly on the cloud in this pioneering effort.

Christopher explained: “We were able to process the large data sets obtained by the microscope on the cloud in a fraction of the time and at a much lower cost than previously thought possible.”

“ Going forward, technologies like machine learning and cloud computing will play a significant part in the scientific world, and we are delighted we could help the researchers with this important discovery,” added Phil Bates, leading cloud architect at Oracle.

The particles the scientists designed yielded exceptionally promising results in animal studies, soundly setting the stage for a future vaccine to combat Chikungunya disease.

“We were thoroughly delighted,” continued Imre Berger. “Viruses are waiting to strike, and we need to have the tools ready to tackle this global threat. Our vaccine candidate is easy to manufacture, extremely stable and elicits a powerful immune response. It can be stored and transported without refrigeration to countries and patients where it is most needed. Intriguingly, we can now rapidly engineer similar vaccines to combat many other infectious diseases just as well.”

“It really ticks a lot of boxes,” concluded Fred Garzoni, founder of Imophoron Ltd, a Bristol biotech start-up developing new vaccines derived from the present work. “Many challenges in the industry require innovative solutions, to bring powerful new vaccines to patients. Matching cutting-edge synthetic biology with cloud computing turned out to be a winner.”

Paper

‘Synthetic self-assembling ADDomer platform for highly efficient vaccination by genetically-encoded multi-epitope display’ byVragniau et al in Science Advances

Traditional healers fuel Ebola spread in DR Congo

By Esther Nakkazi

A 39-year-old woman, a traditional healer, who died in the Salama Health Area in the Madidi district is the new validated case for Ebola Virus Disease in the Democratic Republic of Congo (DRC).

The woman’s death would have been treated like any other but she is a traditional healer and the DRC Ministry of Health has observed the role they play in the transmission of Ebola.

“Traditional health practitioners play a key role in the transmission of the Ebola. Their transmission is by nosocomial infection,”observed the Ministry of health, DRC in a statement it issued in December 2018.

Nosocomial infection is an infection that is acquired in a hospital or other healthcare facility and is spread to the susceptible patient in the clinical setting by various means. The DRC ministry of health officials said a parallel consequence of these nosocomial infections is the contamination of a large number of healthcare providers.

Traditional healers are well-known, widely respected and they remain the health providers of choice in their communities. As such, they remain the first point of contact for some Ebola patients before they consider crossing over to a hospital or health care clinic.

Being a traditional healer, this woman had 45 contacts around her, 3 of whom confirmed positive for Ebola - her husband, mother and son, all admitted to Komanda Ebola Treatment Centre or Centres de Traitement d’Ebola (CTE).

But before that even as a confirmed Ebola case this woman and her family refused to go to a CTE and preferred to self-medicate herself until she had advanced symptoms of Ebola. She was later rushed and hospitalised at the Saint-Pierre Medical Center.

At the Saint-Pierre Medical Center, her case was confirmed and referred to a CTE. Health workers tried to persuade her and her family to go to the ETC but her family outrightly refused.

“The patient was brought home by her family on September 6, where she died at around 10 pm. Oral sampling and dignified and secure burial did not occur by refusal of his family,” said a report from the Ministry of Health, DRC.

Since the beginning of the epidemic, the cumulative number of cases is 3,168, of which 3,057 are confirmed and 111 are probable. In total, there were 2.118 deaths (2007 confirmed and 111 probable) and 975 people healed.

Since vaccination began on August 8, 2018, 227,230 people have been vaccinated. On 25th September 2019, an emergency vaccination was launched in Kisansha. During the 9 days 825,000 children from 6 to 59 months in 24 health zones in the provinces of Equator, Mongala, Kwilu, Kwango, Mai-Ndombe and Kasai Oriental would be immunized.

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Kenya starts Malaria vaccine trial

Kenya has launched the world’s first malaria vaccine today in Homa Bay County, western Kenya.

The malaria vaccine pilot programme is now fully underway in Africa, as Kenya joins Ghana and Malawi to introduce the landmark vaccine as a tool against a disease that continues to affect millions of children in Africa, says the World Health Organisation.

The vaccine, known as RTS,S, will be available to children from 6 months of age in selected areas of the country in a phased pilot introduction. It is the first and only vaccine to significantly reduce malaria in children, including life-threatening malaria.

Malaria claims the life of one child every two minutes. The disease is a leading killer of children younger than 5 years in Kenya.

“Africa has witnessed a recent surge in the number of malaria cases and deaths. This threatens the gains in the fight against malaria made in the past two decades,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa.

“The ongoing pilots will provide the key information and data to inform a WHO policy on the broader use of the vaccine in sub-Saharan Africa. If introduced widely, the vaccine has the potential to save tens of thousands of lives.”

First vaccination: a day to celebrate

Distinguished health officials, community leaders and health advocates gathered in Homa Bay County – one of eight counties in Kenya where the vaccine will be introduced in selected areas – to mark this historic moment with declarations of support for the promising new malaria prevention tool and to demonstrate a ceremonial first vaccination of a 6-month-old child.

“Vaccines are powerful tools that effectively reach and better protect the health of children who may not have immediate access to the doctors, nurses and health facilities they need to save them when severe illness comes. This is a day to celebrate as we begin to learn more about what this vaccine can do to change the trajectory of malaria through childhood vaccination,” said Dr. Rudi Eggers the WHO Representative to Kenya.

Thirty years in the making, the vaccine is a complementary malaria control tool – to be added to the core package of WHO-recommended measures for malaria prevention, including the routine use of insecticide-treated bed nets, indoor spraying with insecticides and timely access to malaria testing and treatment.

Malaria vaccine implementation in Kenya

The Ministry of Health, through the National Vaccines and Immunization Programme, is leading the phased vaccine introduction in areas of high malaria transmission, where the vaccine can have the greatest impact.

The aim is to vaccinate about 120 000 children per year in Kenya across the selected introduction areas, including Homa Bay, Kisumu, Migori, Siaya, Busia, Bungoma, Vihiga and Kakamega counties.

Within the eight counties, some sub-counties will introduce the vaccine into immunization schedules while others are expected to introduce the vaccine later.