New Editorial in the New England Journal of Medicine Highlights Importance of Integrating Neglected Tropical Disease (NTD) Treatments Into Existing Control Programs for HIV-AIDs, Tuberculosis and Malaria
June 2, 2011
A new perspective authored by Peter Hotez, Jeffrey Sachs and others in the New England Journal of Medicine reinforces the importance of integrating neglected tropical disease (NTD) control measures into existing control efforts for HIV/AIDS, tuberculosis and malaria.
Highlighting a growing body of evidence from global health interventions over the past several years, the editorial argues that there are significant gains that can be achieved by adding treatments for the seven most prevalent NTDs to prevention and control programs targeting HIV/AIDS, tuberculosis and malaria, including those supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR). Of particular importance:
- With a geographic overlap between HIV/AIDS and schistosomiasis, a clear link has emerged between female genital ulcers caused by schistosomiasis and a substantial increase in the sexual transmission of HIV/AIDS. Girls who receive frequent and periodic praziquantel treatments for schistosomiasis are less likely to acquire HIV; pregnant women who receive anthelminthic drugs are less likely to pass the virus to their fetus; and preventive chemotherapy for all the helminth infections may reduce HIV transmission among children and young adults by reducing viral loads.
- Throughout Africa, tuberculosis is strongly associated with intestinal soil transmitted helminth (STH) infections. The odds of acquiring tuberculosis infection increase with the number of different helminth species with which a person is infected. Patients with both tuberculosis and STH infections often develop more severe symptoms of pulmonary disease (as revealed on radiography) and have impaired immunity to tuberculosis, as well as impaired response to tuberculosis chemotherapy.
- In sub-Saharan Africa, there is a strong geographic overlap between the incidence of hookworm and falciparum malaria, especially among the estimated 50 million school-aged children who are infected with hookworm and more than seven million pregnant women affected by the hookworm parasite. One major consequence is a high rate of hookworm and malaria co-infections, which lead to severe anemia in children and pregnant women.
At approximately 50 cents per person annually, the value of tying NTD control to other major health initiatives poses one of the most cost effective health interventions available.
"Neglected tropical diseases cause widespread devastation throughout the world's poorest countries and yet far too few donor dollars are targeted to address them," said Professor Jeffrey D. Sachs, Director, The Earth Institute, Columbia University. “However, if we incorporate the extremely low-cost interventions available for neglected tropical diseases into the ongoing community-based efforts to fight HIV/AIDS, tuberculosis and malaria, we have the opportunity to make significant progress towards controlling the NTDs and thereby achieving Millennium Development Goal Six (MDG 6),” he continued.
The editorial also outlines the operational synergies of integrating control and elimination efforts into existing health interventions. For instance, community drug distributors who provide ivermectin for onchocerciasis also provide insecticide-treated bed nets for malaria protection, and bed nets appear to interrupt the transmission of lymphatic filariasis (and possibly other NTDs).
Additionally, low-cost anthelminthic drugs can be administered to pregnant women for intestinal helminth infections and schistosomiasis, thereby improving pregnancy outcomes. These drugs could be co-administered with intermittent preventive treatment (IPT) for malaria during pregnancy or with antiretroviral drugs for reducing mother-to-child HIV transmission.
“We are seeing the success of NTD control programs through support from multinational pharmaceutical companies, the U.S. Agency for International Development (USAID), the British Department for International Development (DFID) and the World Bank,” said Dr. Peter Hotez, President, Sabin Vaccine Institute. “If we continue to expand these programs and take a more integrated approach to disease control and elimination by integrating NTDs into initiatives like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, we can build on this success and tackle all of these diseases together in a coordinated, sustainable way.”
NTDs are a group of parasitic and bacterial infections that are the most common afflictions of the world’s poorest people. They blind, disable, disfigure and stigmatize their victims, trapping them in a cycle of poverty and disease. Research shows that treating NTDs lifts millions out of poverty by ensuring that children stay in school to learn and prosper; by strengthening worker productivity; and by improving maternal and child health.
Sabin Vaccine Institute
Sabin Vaccine Institute is a non-profit, 501(c)(3) organization of scientists, researchers, and advocates dedicated to reducing needless human suffering caused by vaccine preventable and neglected tropical diseases. Sabin works with governments, leading public and private organizations, and academic institutions to provide solutions for some of the world’s most pervasive health care challenges. Since its founding in 1993 in honor of the oral polio vaccine developer, Dr. Albert B. Sabin, the Institute has been at the forefront of efforts to control, treat, and eliminate vaccine preventable and neglected tropical diseases by developing new vaccines, advocating use of existing vaccines, and promoting increased access to affordable medical treatments. For more information please visit www.sabin.org.
The Earth Institute
The Earth Institute, Columbia University mobilizes the sciences, education and public policy to achieve a sustainable earth. Through interdisciplinary research among more than 500 scientists in diverse fields, the Institute is adding to the knowledge necessary for addressing the challenges of the 21st century and beyond. With over two dozen associated degree curricula and a vibrant fellowship program, the Earth Institute is educating new leaders to become professionals and scholars in the growing field of sustainable development. We work alongside governments, businesses, nonprofit organizations and individuals to devise innovative strategies to protect the future of our planet. www.earth.columbia.edu
Contact: Richard Hatzfeld, Sabin Vaccine Institute, 202-842-8467, [email protected]