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SF Pledges Extra $1.2M to Cut Number of New HIV Cases to Zero

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PBS NewsHour

San Francisco bolsters anti-AIDS campaign with new funding


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JOHN CARLOS FREY: At Ward 86, a bustling outpatient HIV clinic at San Francisco General Hospital, nurse Diane Jones drops everything when this pager goes off. It means that someone in the city just tested HIV positive.

DIANE JONES: So, I’m going to make him an appointment.

JOHN CARLOS FREY: Jones is following a protocol called ‘RAPID’ which is designed to get new HIV positive individuals into treatment immediately.

DIANE JONES: Just got diagnosed today, last negative was June.

JOHN CARLOS FREY: Jones scrambles to make plans for the new patient who is seen just hours later.

It’s part of an ambitious plan in San Francisco to completely end new HIV infections.

Each year about 50,000 people in the United States are infected with HIV. And while the disease has moved off the front pages as treatment has made infection more of a manageable chronic condition, an estimated 13,700 people still die from AIDS in the U.S. each year.

Globally, an estimated 1.5 million people are killed. It’s the 6th leading cause of death.

In San Francisco there are relatively few new HIV infections — 302 in 2014, the latest year statistics are available, and it overwhelmingly afflicts gay men. The number of new HIV infections has been falling for eight years.

Today, public health officials, doctors, and activists are increasing their efforts to bring that number all the way down to zero.

DIANE HAVLIR: We are talking about ending the HIV epidemic.

JOHN CARLOS FREY: Dr. Diane Havlir is chief of the HIV/AIDS division at San Francisco General Hospital and a founder of the city’s ‘Getting to Zero’ Consortium.

DIANE HAVLIR: HIV is one of the worst epidemics of its time. It’s taken a huge toll on our city, a huge toll all around the world. We know how to prevent this disease, we know how to treat this disease. So why would we not want to prevent every single infection, and prevent every single death?

JOHN CARLOS FREY: In San Francisco, which has spent 400 million dollars fighting HIV over the last decade, this plan calls for controversial new drugs as well as established prevention strategies. But it starts with immediate treatment for new HIV infections.

DIANE HAVLIR: It did, okay.

JOHN CARLOS FREY: One of Dr. Havlir’s patients, Jose, who is openly gay but asked that we conceal his identity because his family doesn’t know about his health issue, went through the ‘RAPID’ protocol when he was diagnosed with HIV almost a year ago.

DIANE HAVLIR: Say ahhhh.

JOHN CARLOS FREY: Within 24 hours of being diagnosed Jose was here at Ward 86, and days later receiving HIV medication.

JOSE: I was on medication on the third day. And undetectable within less than 30 days.

JOHN CARLOS FREY: Undetectable, meaning his HIV viral load had been reduced by medication to the point where it couldn’t be detected.

And the faster a new patient is undetectable, the faster he reduces his chance of transmitting the virus to others. In San Francisco, about two-thirds of HIV-positive individuals are virally-suppressed, like Jose, more than double the national average. But that requires an enormous effort.

SANDRA TORRES: They might end up in the hospital, that’s when we’re going to meet them again.

JOHN CARLOS FREY: We followed social worker Sandra Torres on the bus as she checked up on a few patients who needed extra help keeping up with their appointments. She and other social workers are continually tracking people down.

SANDRA TORRES: We’re going to knock on the door.

JOHN CARLOS FREY: In the gritty Tenderloin district, we went to a single-room occupancy hotel where an HIV-positive patient was staying. He’s an intravenous drug user and not taking medication.

SANDRA TORRES: Hi Honey, how you doing?

JOHN CARLOS FREY: Torres dropped off an appointment reminder, and I asked her about the patient afterward.

JOHN CARLOS FREY: It seems like an enormous effort for one person.

SANDRA TORRES: That’s what it’s gonna take, though. That is absolutely what it’s gonna take.

JOHN CARLOS FREY: But in San Francisco, getting to zero is also banking on the expanded use of a new tool: a drug that protects individuals from becoming infected with HIV.
It’s called Truvada.

SCOTT WIENER: If you take the pill once a day, and you take it consistently, you will reduce your risk of HIV infection by, at least, 90 percent, and perhaps as high as 99 percent.

JOHN CARLOS FREY: Scott Wiener is an elected city supervisor and a member of the ‘Getting to Zero’ consortium.

SCOTT WIENER: It just makes sense for people to consider-this additional prevention tool. It made sense for me. And I’m I’m glad that I’m on it.

JOHN CARLOS FREY: Wiener, who represents the largely gay Castro district and who is gay himself, went public about his own use of the drug regimen last Fall and makes taking the once-a-day-pill part of his routine each morning.

SCOTT WIENER: My decision to disclose is really to raise awareness, so more people know about it and look into it, to try to increase access and provide momentum– for better access and to try to reduce stigma. So whatever stereotypes people have, maybe we can help break those stereotypes.

JOHN CARLOS FREY: Including the stereotypes raised by some critics that taking a pill that prevents HIV infection would lead to more promiscuous behavior.

JOHN CARLOS FREY: We’re talking about a drug that in some circles has a stigma of opening the door to a free-wheeling sex society. HIV’s no longer a threat and we don’t have to worry about unprotected sex. Do you get any of that backlash?

SCOTT WIENER: There are some people who have that view. And it’s really the same argument as when people would argue if you give women access to the birth control pill, you’re just gonna encourage them to be promiscuous.

Or if you vaccinate young girls against HPV you’re gonna turn them into, I think one person said, “You’ll turn them into nymphomaniacs.”

Or if you give Sex Ed to high-school students or middle-school students you’re gonna encourage them to be promiscuous. These are completely specious arguments. This is about giving people every tool available to protect their sexual health.

JOHN CARLOS FREY: The Food and Drug Administration approved the drug Truvada for HIV prevention three years ago. And last year The Centers for Disease Control issued guidelines recommending the drug for anyone with a substantial risk of HIV infection.

In San Francisco, researchers believe that wider adoption of Truvada could dramatically reduce new HIV infections.

JOHN CARLOS FREY: In a study published in September, San Francisco’s largest private health insurer, Kaiser Permanente, found that not one of its 657 clients taking Truvada had become infected with HIV during an observation period of more than two years.

Another study published this month in the Journal of the American Medical Association showed similar results: out of 437 individuals taking Truvada for a year, only 2 contracted HIV after not properly taking the drug

But so far only a few thousand San Franciscans have taken Truvada in the last year. So why isn’t the use of this drug more widespread?

There are some side effects, as well as speculation that doctors may be hesitant to prescribe a preventative drug to healthy patients, and then there’s the price. Although covered by most insurance, Truvada, is listed at more than $1000 a month

Even so, it’s not nearly the solution that its proponents make it out to be according to Michael Weinstein, president of the AIDS Healthcare Foundation, one of the largest AIDS organizations in the world.

MICHAEL WEINSTEIN: I think the evidence shows that it is not a good public health strategy.

JOHN CARLOS FREY: Why is that?

MICHAEL WEINSTEIN: Well, because people don’t adhere.

JOHN CARLOS FREY: While studies have shown that the regimen can be over 90% effective when taken everyday, Weinstein points out that the efficacy drops off when people miss their daily dose. He also says that relying on a pill instead of a condom may lead to a rise in other sexually transmitted diseases.

MICHAEL WEINSTEIN: The motivation that people have for taking Truvada is to be able to have sex without a condom.

JOHN CARLOS FREY: Do you think that people don’t want to wear condoms either?

MICHAEL WEINSTEIN: I think men in general don’t wanna wear condoms. That’s just an absolute truth. I mean, and it’s not surprising. But, you know, we don’t wear seatbelts either, you know, or helmets or a lot of other things. But they’re a necessity.

JOHN CARLOS FREY: So wouldn’t it be better then to just take a pill every day instead of worrying about transmitting H.I.V.?

MICHAEL WEINSTEIN: You know what? If it was guaranteed that everybody would take it every day as prescribed. Obviously our attitude about it would be completely different if we didn’t have to rely on the person to take that pill every single day.

JOHN CARLOS FREY: While Kaiser Permanente’s recent study of Truvada users found that none had contracted HIV, it also showed that 41 percent of participants reported a decrease in condom use, and after one year of Truvada use, 50 percent were diagnosed with another STD.

JOHN CARLOS FREY: San Francisco Department of Public Health Chief Barbara Garcia says the city is working to make sure the drug is taken as prescribed, and that doesn’t lead to other safe sex practices being abandoned.

BARBARA GARCIA: We have already started in trying to educate young people, particularly about this. And that’s one of the challenges of having even if we had a cure, that would be the same challenge we would have.

JOHN CARLOS FREY: Do you see that happening though? I mean, obviously, if you’re having unsafe sex, you’re going to be transmitting other sexually-transmitted diseases here

BARBARA GARCIA: And, in fact, we’ve seen a little bit of a rise in S.T.D. here in San Francisco. And we’re addressing that as well.

JOHN CARLOS FREY: It’s not clear that an increase in STDs is related to an increase in the use of Truvada. And Garcia is committed to the drug regimen being a part of ‘Getting to Zero’ in San Francisco. And believes that the city’s approach to ending HIV, including the lives and money it will save, will eventually trump any controversy.

JOHN CARLOS FREY: You can prove to them that you can save money by your model?

BARBARA GARCIA: Absolutely. An H.I.V. prevention versus an H.I.V. positive client in care, yes, we can.

JOHN CARLOS FREY: San Francisco has made tremendous advances in battling an epidemic that his this city harder than most. And according to Dr. Havlir actually getting to zero is within reach.

DIANE HAVLIR: I think we would all acknowledge that it is going to be difficult to do, but I think if, as we say, if anybody can do it, we think that we can show people how it can be done starting here.

JOHN CARLOS FREY: San Francisco’s Mayor Ed Lee announced last month that he is allocating $1.2 million a year for “Getting to Zero.” The funding will increase rapid testing programs, expand the use of Truvada, and enlarge the number of HIV positive patients who receive care.

The post San Francisco bolsters anti-AIDS campaign with new funding appeared first on PBS NewsHour.

Fewer plans, less choice for low-income seniors shopping Medicare drug coverage

Denise Scott, 66, of Cleveland, Ohio, gets a subsidy from Medicare to help her pay for some of her prescription drugs.
         But, next year, some a premium increase may mean some low-income Medicare drug beneficiaries must pay a larger share for their
         medicine. Photo by Lynn Ischay/Kaiser Health News

Denise Scott, 66, of Cleveland, Ohio, gets a subsidy from Medicare to help her pay for some of her prescription drugs. But, next year, a premium increase may mean some low-income Medicare drug beneficiaries must pay a larger share for their medicine. Photo by Lynn Ischay/Kaiser Health News

Even though health problems forced Denise Scott to retire several years ago, she feels “very blessed” because her medicine is still relatively inexpensive and a subsidy for low-income Medicare beneficiaries covers the full cost of her monthly drug plan premiums. But the subsidy is not going to stretch as far next year.

That’s because the premium for Scott’s current plan will cost more than her federal subsidy. The 64-year-old from Cleveland is among the 2 million older or disabled Americans who will have to find new coverage that accepts the subsidy as full premium payment or else pay for the shortfall. As beneficiaries explore options during the current Medicare enrollment period, there are only 227 such plans from which they can choose next year, 20 percent fewer than this year, and the lowest number since the drug benefit was added to Medicare in 2006, according to the Centers for Medicare & Medicaid Services.

It was only when Scott called a counselor at the Benjamin Rose Institute on Aging on Cleveland, a social service agency helping her with Medicare questions, that she learned she would have to pay the difference between the subsidy and new higher premium. So she switched to a different plan that will be premium-free.

“I would’ve gotten into something I really can’t afford,” Scott said. Because she has a limited income, she said any new expenses “can end up putting a strain on my budget.”

Eight million people in traditional Medicare have drug plan subsidies, also called “Extra Help.” To qualify for the full subsidy, an individual must have an income below $17,655 in 2015 and less than $13,640 in assets.

Some beneficiaries who do not choose a new plan will be randomly assigned to one. It’s up to these beneficiaries to check if their new plan covers their drugs.

Even beneficiaries with drug plans that will continue to be premium-free next year may still want to switch, said Christina Dimas-Kahn, program manager for Self-Help for the Elderly in San Mateo, California, which is part of the California Department of Aging’s Health Insurance Counseling and Advocacy Program. Like anyone else shopping for Medicare drug coverage, they should make sure the new plan covers their medicine and check whether there are restrictions that can make it more difficult to get the drugs their doctors prescribed. They also should confirm what pharmacies are in the plan’s network.

There used to be a dozen or more premium-free plans in most states in the early years of the program, said Juliette Cubanski, associate director for the Program on Medicare policy at the Kaiser Family Foundation. (KHN is an editorially independent project of the foundation.) But after insurance market consolidation and federal rules discouraging duplicative options, the number of drug plans has fallen, she said. In 2016, 22 states will have six or fewer premium-free plans, according to a KFF study released last month. Florida will have just three.

The subsidy is recalculated annually using the average of premiums for standard drug plans in a particular region.

Health insurers “strongly support proposals to ensure low-income beneficiaries remain in their plans without facing additional costs,” said Clare Krusing, a spokeswoman for the America’s Health Insurance Plans, a trade association. “However, the soaring price of prescription medications has resulted in an unprecedented increase” in health insurance costs, which have led “to higher premiums in many plans,” she said.

Scott is concerned about how much Medicare will pay for her prescriptions in the future. Eight million people in traditional
         Medicare plans get help affording their prescription drugs. Photo by Lynn Ischay/Kaiser Health News

Scott is concerned about how much Medicare will pay for her prescriptions in the future. Eight million people in traditional Medicare plans get help affording their prescription drugs. Photo by Lynn Ischay/Kaiser Health News

Enrollment ends Dec. 7 for 2016 drug plans and Medicare Advantage, the private insurance policies that are an alternative to traditional Medicare. After Jan. 1, most plan subscribers are locked into their plans for a year. But there’s an exception for subsidy beneficiaries.

Semanthie Brooks, Benjamin Rose’s director of community advocacy, said some people with low-income premium subsidies don’t know they can switch plans anytime, and “believe they are stuck paying a higher cost.” And then there are others who are afraid to take a chance with a new insurance company even if they can’t afford the added expense.

“They will pay more for peace of mind and give up something else.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

The post Fewer plans, less choice for low-income seniors shopping Medicare drug coverage appeared first on PBS NewsHour.

Liberian boy dies after new Ebola cases emerge

The Ebola virus treatment center in Paynesville, Liberia, where four people were being treated for the disease on  July
         16, 2015. Liberia, months after being declared Ebola-free in September, has seen its first fatal case Monday. Photo James

The Ebola virus treatment center in Paynesville, Liberia, where four people were being treated for the disease on July 16, 2015. Liberia, months after being declared Ebola-free in September, has seen its first fatal case Monday. Photo James Giahyue/Reuters

After a fresh round of Ebola cases were announced in Liberia last week, a 15-year-old boy has died of the disease, the first fatal case for the embattled country after it was twice declared Ebola-free this year, health officials said Tuesday.

Nathan Gbotoe died Monday night at an Ebola treatment center near Monrovia, Liberia’s capital, where his father and brother are also being treated for the disease, said Francis Kateh, chief medical officer of Liberia’s Ebola Case Management System.

Health officials are monitoring more than 160 people, including several health workers, who are at risk for contracting Ebola after they had direct contact with the boy, the Associated Press reported.

Liberia said it requested the help of two experts from the Centers for Disease Control and Prevention in the U.S. to determine the cause of the new cases, the AP reported.

In a press briefing Monday, the World Health Organization said the boy had “no obvious history of exposure to the virus because [he] hadn’t traveled or had not been exposed to someone with Ebola.”

WHO added that the organization believed the latest flare-up in Liberia could have started when someone came in direct contact with a virus that had persisted in an individual, a long-term effect of the virus.

WHO previously declared Liberia to be Ebola-free on May 9, but a crop of new confirmed cases led to two more deaths in June. The country was able to bring the number of transmissions to zero again on Sept. 3 until Gbotoe and his family, including the boy’s mother and two other siblings who were considered “high risk contacts,” were isolated at an Ebola treatment center last week.

What looks like an ordinary greenhouse is actually an around-the-clock Ebola vaccine factory. At a facility in Kentucky, plants are being injected with a protein in order to spur them into producing one of the three antibodies used in the experimental drug ZMapp. Video by PBS NewsHour

Liberia, one of three West African nations hardest hit by the Ebola virus, has seen more than 10,600 Ebola cases and more than 4,800 deaths, according to WHO. Since the virus was detected in March 2014, more than 11,300 deaths have been recorded.

Sierra Leone was declared free of the virus on Nov. 7, and unless a new confirmed case emerges, Guinea recently started its own countdown of 42 days, or two incubation periods, to end Ebola transmission.

The post Liberian boy dies after new Ebola cases emerge appeared first on PBS NewsHour.

How to grow an Ebola vaccine with a tobacco plant

LIFE AFTER EBOLA mon ebola virus image

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GWEN IFILL: we turn to the search for a treatment for Ebola.

West Africa is still dealing with the aftermath of the worst outbreak of the disease in recorded history. Last week, Liberia reported a handful of new cases, just months after the World Health Organization said the country was free of the disease.

And this weekend, not one, but two panels said the WHO needs to substantially reform and change the way it deals with international health crises.

Special correspondent Mary Jo Brooks has a report on the hunt to finally stop the virus.

MARY JO BROOKS: It looks like an ordinary greenhouse filled with plants basking under light, but at this facility just outside Owensboro, Kentucky, the plants themselves have become a labor force, working around the clock to manufacture a cure for Ebola.

HUGH HAYDON, CEO, Kentucky Bioprocessing: These plants are 27 days old.

MARY JO BROOKS: Three days earlier, these plants were injected with a genetic blueprint for one of three antibodies used in the experimental drug ZMapp.

Hugh Haydon of Kentucky Bioprocessing explains how it works.

HUGH HAYDON: The plant recognizes that gene and its machinery turns on and it starts to manufacture that protein for us. And it’s really that simple. It becomes a little bitty factory.

MARY JO BROOKS: ZMapp was still in the developmental stage when Ebola first broke out in West Africa in March of 2014. The disease has since claimed more than 10,000 victims. But a handful of people were successfully tweeted with ZMapp, including Dr. Kent Brantly.

DR. KENT BRANTLY, Ebola Survivor: Today is a miraculous day. I am thrilled to be alive, to be well and to be reunited with my family.

MARY JO BROOKS: Since then, the drug has being undergoing clinical trials in West Africa and the FDA has granted it fast-track approval status.

Larry Zeitlin and Kevin Whaley are the scientists from San Diego who developed the ZMapp antibodies, which were designed to quickly attack the Ebola virus.

KEVIN WHALEY, Inventor of ZMapp: In a vaccine, you give a person a protein that stimulates your own body to make antibodies. In this case, we’re giving antibodies directly to you, so your body doesn’t have to make them.

LARRY ZEITLIN, Inventor of ZMapp: And unlike the vaccine, where it takes you weeks to months to build up protective immunity, as soon as the antibodies are provided to the patients, they’re protected against that disease.

MARY JO BROOKS: Speed is the name of the game in fighting infectious disease. And it is the reason that Whaley and Zeitlin decided to manufacture their drug using plants, rather than the traditional animal protein method.

They chose an Australian relative the American tobacco plant in a process that is quick and relatively simple. Just three weeks after the seeds go into the soil, the plants are mature enough to be dipped into a liquid which contains proteins to be replicated.

The plants grow those proteins for another week, and then are harvested and chopped up. The resulting green liquid is filtered and tested and, by day 40, it’s ready to be shipped out.

HUGH HAYDON: It’s a very fast system. And if it’s faster, it costs a little bit less on the front end particularly. It gives you a lot of flexibility in terms of developing a product.

You get your protein. You look at your protein. Is it what you wanted? If it doesn’t have the exact characteristics that you want, you do it again. You reengineer it and do it again until you get exactly where you want to be.

MARY JO BROOKS: The system of biofarming could be useful for a number of drug therapies that must ramp up production quickly. The Canadian company Medicago uses tobacco plants to manufacture flu vaccine, which needs to change seasonally.

At its large greenhouse in Raleigh-Durham, North Carolina, workers and robots tend to the growing plants.

DR. MICHAEL SCHUNK, Vice President of Operations, Medicago: They produce the vaccine over about a week.

MARY JO BROOKS: So it’s a very quick, efficient process.

DR. MICHAEL SCHUNK: It’s very quick, very efficient, very adaptable.

MARY JO BROOKS: Michael Schunk is the vice president of operations.

DR. MICHAEL SCHUNK: This plant technology can respond in about half the time of the traditional flu manufacturing technologies, so that’s what started us into the flu, and we have just continued to grow with that.

MARY JO BROOKS: Medicago is in the final stage of clinical trials to receive FDA approval for its flu vaccine. Once granted, the company says it will be able to make 30 million doses a year. It has also begun producing an Ebola drug similar to ZMapp.

Both Medicago and Kentucky Bioprocessing received Defense Department money to develop their pharmaceuticals. The hope is that the technology could be used to quickly counter a pandemic or bioterrorism attack.

DR. MICHAEL SCHUNK: This facility is about 27,000 square feet.

MARY JO BROOKS: But Michael Schunk says the technology holds promise for all kinds of drugs. He’s especially optimistic that developing nations will use this method to manufacture vaccines on their own soil, since the cost of building the facilities is much less than traditional drug factories.

DR. MICHAEL SCHUNK: This is not a very complicated technology. It’s certainly transportable. Every country has greenhouses, so every country has the potential to have a facility that can be used to produce vaccines that maybe are more a concern to that particular country.

MARY JO BROOKS: Schunk and other biofarming proponents predict that soon drugs to treat herpes, HIV, MRSA, and other infectious diseases will routinely be grown in plants. Of course, the irony of using a version of tobacco to save lives is not lost on anyone, including Hugh Haydon.

HUGH HAYDON: There is some irony. There is no question about that.

But what our business is about and what we have — what we have always been about is using the plant to create things and to do positive things. Our focus has been biopharmaceuticals and using the plant to yield those kind of proteins. And it works really well for that.

MARY JO BROOKS: Biopharmaceuticals, plants that one day could be used routinely to wipe out infectious diseases.

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