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It is a Time for Solutions, Says Prof Tulio de Oliveira in Face of US Funding Cuts

On By ModernMedia
Professor Tulio de Oliveira. (Photo: Supplied)

By Biénne Huisman

Cuts to United States spending on aid and medical research have caused widespread havoc and anxiety in the last month. Professor Tulio de Oliveira sat down with Spotlight’s Biénne Huisman to talk through what it might mean for health research in South Africa.

As the Trump administration moves to freeze foreign aid, halting vital humanitarian health programmes and medical research trials worldwide – leaving patients cut off from lifesaving medicines and scientists in a bind – Professor Tulio de Oliveira argues that the United States stand to lose far more from this move than its 1% government investment in foreign aid.

The non-partisan Pew Research Center recently released figures showing that of the American government’s total 2023 budget, 1.2% or about $71.9 billion was spent on foreign aid. Of this foreign aid budget, 14.7% or about $10.6 billion was earmarked for the “ongoing battle against HIV/AIDS” and 2% or about $1.5 billion for “combatting pandemic influenza and other emerging public health threats”.

Speaking to Spotlight in a boardroom at the Centre for Epidemic Response and Innovation (CERI) at Stellenbosch University, De Oliveira says: “Spending on biosecurity is an investment in the future – I think the United States benefits much more from our research and our work than what we cost them.” Biosecurity refers to measures designed to protect populations against harmful biological or biochemical substances.

During the height of the COVID-19 pandemic, De Oliveira, a professor in bioinformatics, shot to global attention for leading the South African team credited with discovering the Beta and Omicron variants of SARS-CoV-2. Now, in the face of a new global health upheaval, he insists that cross-border scientific collaboration is critical for combating the global spread of disease.

“Pathogens don’t need passports, they don’t care about nationality,” he says, referencing former World Health Organisation Director-General, Dr Margaret Chan, who first used the phrase at the 2007 World Health Assembly.

Professor Tulio de Oliveira. (Photo: Supplied)

De Oliveira is a native Brazilian who speaks accented English. During his interview with Spotlight, his demeanour is calm and his speech unrushed as he expands: “It’s of great interest to America to keep investing – not as a kind of donation, or because we’re entitled to it – but because of how it helps them. We just came out of a pandemic and America actually had much bigger waves of infection than many of the poor countries.”

He lists recent global population health threats: “Like with Covid, now we have influenza; and the virus is mutating, transmitting through multiple animals. We just had an outbreak of Marburg in Rwanda and another one in Kenya. We had an emergence of mpox in central Africa. We had an emergence in Sudan of a strain of Ebola. In Uganda, a growing rate of malaria drug resistance.

“And in the last year, the US saw the biggest number of TB cases ever. So it’s of critical interest that these pathogens get quickly identified, are quickly controlled, that you treat people so that it doesn’t spread to other countries. In the end, it’s the health of the global population, it doesn’t matter which country we live in or how wealthy people are.”

Major funding cuts

Scores of South African research groups (many who provide affiliated public healthcare services) have in the past received funding from United States government entities – including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), USAID, and the President’s Emergency Plan for Aids Relief (PEPFAR).

Many of these funding flows have been paused in recent weeks by the Trump administration. As a result, several important clinical trials have been stopped. The impacts are far-reaching – around 28% of the South African Medical Research Council’s (SAMRC) 2025/2026 budget was set to be funded by US government entities. Professor Ntobeko Ntusi, President of the SAMRC, told Spotlight that it would be catastrophic if the funding is cut.

Adding further uncertainty, prominent vaccine sceptic Robert F. Kennedy has been confirmed as the US’s health secretary under the Trump administration. Kennedy has argued that the NIH should reduce its focus on infectious diseases and dedicate more resources to non-communicable diseases like diabetes. The US government has until now been by far the biggest funder of both HIV and TB research.

De Oliveira appears unflustered. At CERI, of which he is the founding director, he says only 7% of funding is from the NIH – “and we have reason to believe that the current NIH grants that we have will not be discontinued”. One such grant was for R40 million over five years awarded in 2023 to CERI’s Professor Frank Tanser for designing HIV prevention strategies.

In fact, De Oliveira says CERI and the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP) which he also heads, are expanding. Both centres use state-of-the-art genomics – the study of the DNA of organisms – to identify new variants of pathogens and to prevent disease.

“Yes, the opposite, we’re in an expansion phase,” says De Oliveira.

“Just last week, we advertised five post-doctoral fellowship positions. We hope that we can even absorb some of the great talent that may be lost from groups that were unfortunately more reliant on American funding.”

He stresses the importance of having a diversified funding portfolio, saying the work of CERI and KRISP is funded through 46 active grants with another 9 in the offing. “We have multiple grants from multiple funders from multiple countries. So again, I know it’s easily said, but I think it’s something that we should learn going forward, not to grow too reliant on one funder.”

Filling the gap

If the United States pulls back permanently from its leadership role in providing global aid – and medical research funding in particular – who might fill the gap?

The New Yorker quotes Clemence Landers, vice-president of the think tank Centre for Global Development, suggesting that China might come forward.

In response, De Oliveira says: “China could fill the gap. But people don’t realise the biggest foundation in the world at the moment is called the Novo Nordisk Foundation in Denmark which is linked to the company that had the massive breakthrough with Ozempic. They could easily fill the gap if they wanted. There are others as well. I would not be surprised if a completely unexpected foundation came forward to fill the gap.”

Reflecting further, he expresses hope that “people with noble causes step up”.

In 2022, TIME Magazine named De Oliveira one of the world’s 100 most influential people, and in 2024 he cracked the magazine’s top 100 health list. Has this public recognition made it easier for him to attract funding? He shrugs this off.

“We’re really committed to having a global impact that saves lives. And that commitment is not centralised in the director, but in our vision shared across principal investigators. And this is really important for the sustainability of organisations. I get offered good jobs every couple of weeks, and I mean even though I don’t intend on going anywhere, anything could happen. For example, two weeks ago I was skateboarding and cracked my ribs.”

In a moment of levity, he elaborates: “And this is the fifth time I cracked my ribs. Once was while skateboarding, another while snowboarding, surfing, once while mountain biking and another time falling from a children’s tractor.”

De Oliveira moved to South Africa in 1997, as the AIDS crisis was heading toward its peak. He says he feels “eternally grateful” for the boost PEPFAR brought to South Africa’s HIV-programme, adding that today the country might be in a “better position to absorb the loss of the funding than say five, ten years ago”.

He notes that 17% of South Africa’s HIV/AIDS spending was from PEPFAR, but that this does not include the procurement of antiretrovirals. “So yes, I think as South Africans we might be in a position to come up with solutions, as the programme is very well run.”

De Oliveira’s concern is for more vulnerable African countries – he singles out Mozambique – which are reliant on foreign aid for the procurement of medicines like antiretrovirals.

Needless to say, these recent events are a setback in the quest to develop an HIV vaccine. “When you decrease investment in research and science, you keep further away from developing the solutions,” he says. “But in terms of HIV/AIDS, luckily there are antiretroviral therapies that are very efficient.”

As we wrap up the interview, De Oliveira zooms out to the bigger picture: “Unfortunately, we are destroying the environment, there’s increased globalisation and crazy urbanisation, and this is making it easier for infectious diseases to spread.

“This is a challenging time for scientific and medical research. A time to develop solutions.”

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Categories : Cancer GeneticsTags : Leave a comment

Research Challenges the Understanding of Cancer Predisposition Gene NF-1

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Photo by National Cancer Institute on Unsplash

Despite what was previously thought, new research has shown that genetic changes alone cannot explain why and where tumours grow in those with genetic condition neurofibromatosis type 1 (NF-1). Understanding more about the factors involved could, in the future, facilitate early cancer detection in NF-1 patients and even point towards new treatments.

Researchers from the Wellcome Sanger Institute and collaborating institutions, focused on NF-1, a genetic condition that causes specific types of tumours, and investigated how and why these developed.

The study, published in Nature Genetics, reports that the genetic changes thought to cause tumours can be found in normal tissues throughout the body, suggesting that other factors are also necessary for tumour development.

They also uncovered a pattern of changes in the affected gene, NF1, that may explain why the nervous system in particular is a common site for these tumours to develop.

Understanding what other factors are involved in developing these tumours could help inform monitoring programmes for patients with NF-1, who require regular screening to detect tumours early on and could potentially require multiple surgeries and chemotherapy.

In the future, refining our knowledge of why tumours grow in some places and not others may help us identify the patients most likely to need early medical intervention.

This model of tumour development is not unique to NF-1, raising the possibility that similar events occur in related genetic conditions, meaning many more could benefit from tailored management.

NF-1 is a genetic condition that causes brown skin patches, similar to birthmarks, and tumours1. While the tumours are often benign, they can become cancerous over time and may cause a range of symptoms depending on where they are1. For example, NF-1 can cause soft tissue and brain tumours that may restrict movement and vision.

The symptoms and impact of NF-1 can vary greatly from person to person. It is one of the most common inherited genetic conditions, impacting around one in 2500 people. Those with NF-1 have a genetic change that means one copy of the gene encoding the neurofibromin protein, NF1, does not work. It was previously thought that tumours and brown skin patches occurred when the second copy of the gene was lost.

In a new study, researchers from the Sanger Institute, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital, Cambridge University Hospitals NHS Foundation Trust, and their collaborators, studied nearly 500 tissue samples from a child with NF-1 and compared them to tissues from children without the condition.

They found that changes causing a loss of NF1 gene function were not limited to tumours and skin changes but instead can be found throughout other tissues of the child with NF-1 as well. This suggests, whilst advantageous to the affected cells, the mutation is insufficient to cause tumour formation.

For this research, the team applied a new sequencing technology that allowed them to look at genetic changes at a higher resolution than was previously possible and studied additional tissue samples from nine adults with NF-1, showing similar findings.

The team found a pattern of mutations across all patients that showed these were particularly common in tissues of the nervous system. This is a common place for tumours to form in those with NF-1, which can help explain why these tissues are specifically impacted.

“We were astonished to see such extensive genetic changes in the normal tissues of patients with NF-1, seemingly without consequence. This is contrary to our understanding of tumour development in the condition and other related conditions. Additional factors must clearly play a role, perhaps including the cell type and anatomical location affected. Whilst further investigation is needed, I hope this work represents the first step towards developing more personalised care for these patients, such as better identifying who is at greater risk of developing tumours, and adjusting screening to intervene early on and minimise complications.”

Dr Thomas Oliver,co-first author from the Wellcome Sanger Institute and Cambridge University Hospitals NHS Foundation Trust

“NF-1 can have many different impacts on a person’s life. In order to better treat and support those with NF-1, we have to understand more about what is going on at a biological and genetic level, especially in the parts of the body that are most affected, such as the brain and nervous system. Our study showed that these areas of the body have a different pattern of DNA changes, suggesting that if we look further, there could be a potential target for new therapies to help treat or stop tumour development.”

Professor Thomas Jacques,co-senior author from UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital

“Loss of the second NF1 gene had always been thought to cause tumours in individuals with NF-1. Our findings fundamentally question this decade-old paradigm and force us to rethink how tumours arise, to pave the way for better screening, prevention, and treatment of cancers.”

Professor Sam Behjati,co-senior author from the Wellcome Sanger Institute and Cambridge University Hospitals NHS Foundation Trust

Source: Wellcome Trust Sanger Institute

Categories : DermatologyTags : Leave a comment

Dermatology Researchers Discover New Skin Disease with Innovative Approach

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Picture by Macrovector on Freepik

In a recent paper published in Scientific Reports, researchers from the University of Maryland School of Medicine described a new skin disease in a male patient with erythroderma, causing 80% of his skin to be covered with red, exfoliating skin lesions that itched and burned. After undergoing months of treatment with traditional therapies for erythroderma, which included the steroid prednisone, anti-itch creams, and immunosuppressive drugs, the patient experienced little relief.

“We isolated individual circulating blood cells and created a new blood test using flow cytometry to identify specific cytokine signatures,” said study corresponding author Shawn Kwatra, MD, the Joseph W. Burnett Endowed Professor and Chair of Dermatology at UMSOM and Chief of Service Dermatology at the University of Maryland Medical Center (UMMC). The authors received a patent for this new method, involving “peripheral blood flow cytometry-based immunophenotyping enabled us to identify a novel form of a severe and potentially life-threatening skin disease.”

Erythroderma is a rare but severe and potentially life-threatening inflammation that occurs on most of the body’s skin surface. It causes redness and scaling of the skin that spreads over the body and causes the skin to slough off. This can lead to problems with thermoregulation and can cause protein and fluid loss, leading to severe complications.

To determine which of the immune system’s components were driving the inflammatory disease, Dr Kwatra and his team used a new flow cytometry platform technique, for which they received a patent, to immunophenotype skin diseases. They found that two of these cytokines, called interleukin-13 and interleukin-17, were at increased levels in this patient compared to healthy controls as well as when compared to patients with other known causes of erythroderma. Subsequently, targeted treatment with biologic inhibitors of IL-13 and IL-17 reversed the patient’s disease.

“We found a new role for interleukin-13 and interleukin-17 in the blood samples taken from this patient which supported the use of those two particular medications,” said study first author Hannah Cornman, MD, an incoming dermatology resident at the University of North Carolina who conducted the research as a medical student at UMSOM.  “These cytokines appeared to be the key cytokines in defining the disease.”

When the patient was treated with a dual therapy of two monoclonal antibodies, dupilumab and secukinumab, his symptoms dramatically decreased and eventually resolved, essentially curing him of his erythroderma. The authors also identified the cell sources of these pathological cytokines and monitored the decline in immunopathogenic (disease-causing) cell numbers, and the decline of interleukin-13, and interleukin-17 levels in the patient’s blood throughout the treatment course. 

“We created a new diagnostic test to discover a previously undescribed skin disease and initiate appropriate treatment. We are now exploring developing our diagnostic test to a range of other inflammatory skin,” said Dr Kwatra.

Source: University of Maryland School of Medicine

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Simple Ways to Improve the Wellbeing of Paediatric Critical Care Staff

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Photo by RDNE Stock project

Paediatric critical care (PCC) staff are known to experience high levels of moral distress, symptoms of post-traumatic stress disorder (PTSD) and burnout, but often feel little is offered to help them with their mental health. The SWell team at Aston University, led by Professor Rachel Shaw from the Institute of Health and Neurodevelopment, realised following a literature review that there are no existing, evidence-based interventions specifically designed to improve PCC staff wellbeing. Initial work by SWell identified the ‘active ingredients’ likely to create successful intervention designs.

Together with a team from NHS England, the Aston University researchers set up the SWell Collaborative Project: Interventions for Staff Wellbeing in Paediatric Critical Care, in PCC units across England and Scotland. The aim of the project was to determine the feasibility and acceptability of implementing wellbeing interventions for staff working in PCC in UK hospitals. In total, 14 of the 28 UK PCC units were involved. One hundred and four intervention sessions were run, attended by 573 individuals.

Professor Shaw said: “The significance of healthcare staff wellbeing was brought to the surface during the COVID-19 pandemic, but it’s a problem that has existed far longer than that. As far as we could see researchers had focused on measuring the extent of the problem rather than coming up with possible solutions. The SWell project was initiated to understand the challenges to wellbeing when working in paediatric critical care, to determine what staff in that high-pressure environment need, and what could actually work day-to-day to make a difference. Seeing PCC staff across half the paediatric critical care units in the UK show such enthusiasm and commitment to make the SWell interventions a success has been one of the proudest experiences in my academic career to date.”

The two wellbeing sessions tested are low-resource and low-intensity, and can be delivered by staff for staff without any specialist qualifications.

In the session ‘Wellbeing Images’, a small group of staff is shown images representing wellbeing, with a facilitated discussion using appreciative inquiry – a way of structuring discussions to create positive change in a system or situation by focusing on what works well, rather than what is wrong.

In the ‘Mad-Sad-Glad’ session, another small group reflective session, participants explore what makes them feel mad, sad and glad, and identify positive actions to resolve any issues raised.

The key ingredients in both sessions are social support – providing a psychologically safe space where staff can share their sensitive experiences and emotions without judgement, providing support for each other; self-belief – boosting staff’s self-confidence and ability to identify and express their emotions in response to work; and feedback and monitoring – encouraging staff to monitor what increases their stress, when they experience challenging emotions, and what might help boost their wellbeing in those scenarios.

Feedback from staff both running and participating in the SWell interventions was very positive, with high satisfaction and feasibility ratings. Participants like that the session facilitated open and honest discussions, provided opportunities to connect with colleagues and offered opportunities for generating solutions and support.

One hospital staff member responsible for delivering the sessions said:

“Our staff engaged really well, and it created a buzz around the unit with members of the team asking if they could be ‘swelled’ on shift. A really positive experience and we are keeping it as part of our staff wellbeing package.”

The team concluded that even on busy PCC units, it is feasible to deliver SWell sessions. In addition, following the sessions, staff wellbeing and depression scores improved, indicating their likely positive impact on staff. Further evaluations are needed to determine whether positive changes can be sustained over time following the SWell sessions.

Donna Austin, an advanced critical care practitioner at University Hospital Southampton paediatric intensive care unit, said: “We were relatively new to implementing wellbeing initiatives, but we recognised the need for measures to be put in place for an improvement in staff wellbeing, as staff had described burnout, stress and poor mood. SWell has enabled our unit to become more acutely aware of the needs of the workforce and adapt what we deliver to suit the needs of the staff where possible. Staff morale and retention has been the greatest outcomes from us participating in the SWell study and ongoing SWell related interventions.”

Read the paper about the SWell interventions in the journal Nursing in Critical Care.

Source: Aston University

Categories : Diseases, Syndromes and ConditionsTags : Leave a comment

Scans of Viking Skulls Reveal a Harsh Life of Disease

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Photo by Gioele Fazzeri on Unsplash

Sweden’s Viking Age population appears to have suffered from severe oral and maxillofacial disease, sinus and ear infections, osteoarthritis, and much more. This is shown in a study from the University of Gothenburg in which Viking skulls were examined using modern X-ray techniques.

About a year ago saw the publication of research based on the examination of a large number of teeth from the Viking Age population of Varnhem, known for its thousands of ancient graves and excavations of well-preserved skeletons.

Now, odontologists at the University of Gothenburg have taken this research further, looking at not only teeth but also entire skulls, by using modern computed tomography, also known as CT scans.

The results, presented in British Dental Journal Open, suggest that the 15 individuals whose skulls were examined suffered from a broad range of diseases. The CT scans show pathological bone growths in the cranium and jawbone, revealing infections and other conditions.

Detailed image analysis

Several individuals showed signs of having suffered from sinus or ear infections that left traces in the adjacent bone structures. Signs of osteoarthritis and various dental diseases were also found. All the skulls came from adults who died between 20 and 60 years of age.

The study lead, Carolina Bertilsson, is an assistant researcher at the University of Gothenburg and a dentist within Sweden’s Public Dental Service. The study was performed with specialists in dental radiology at the University of Gothenburg and an archaeologist from Västergötlands museum.

About a year ago saw the publication of research based on the examination of a large number of teeth from the Viking Age population of Varnhem in the Swedish province of Västergötland. Varnhem is known for its thousands of ancient graves and excavations of well-preserved skeletons.

Now, odontologists at the University of Gothenburg have taken this research further, looking at not only teeth but also entire skulls, by using modern computed tomography, also known as CT scans.

The results presented in British Dental Journal Open suggest that the 15 individuals whose skulls were examined suffered from a broad range of diseases. The CT scans show pathological bone growths in the cranium and jawbone, revealing infections and other conditions.

Detailed image analysis

Several individuals showed signs of having suffered from sinus or ear infections that left traces in the adjacent bone structures. Signs of osteoarthritis and various dental diseases were also found. All the skulls came from adults who died between 20 and 60 years of age.

The study lead, Carolina Bertilsson, is an assistant researcher at the University of Gothenburg and a dentist within Sweden’s Public Dental Service. The study was performed with specialists in dental radiology at the University of Gothenburg and an archaeologist from Västergötlands museum.

“There was much to look at. We found many signs of disease in these individuals. Exactly why we don’t know. While we can’t study the damage in the soft tissue because it’s no longer there, we can see the traces left in the skeletal structures,” says Carolina Bertilsson, and continues:

“The results of the study provide greater understanding of these people’s health and wellbeing. Everyone knows what it’s like to have pain somewhere, you can get quite desperate for help. But back then, they didn’t have the medical and dental care we do, or the kind of pain relief – and antibiotics – we now have. If you developed an infection, it could stick around for a long time.”

The study is described as a pilot study. One important aspect was to test CT as a method for future and more extensive studies.

“Very many of today’s archaeological methods are invasive, with the need to remove bone or other tissue for analysis. This way, we can keep the remains completely intact yet still extract a great deal of information,” says Carolina Bertilsson.

Source: University of Gothenburg

Categories : Healthcare Politics and Regulations HIVTags : Leave a comment

US Funding Remains Frozen for Many Life-saving Services

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Despite waivers, court judgments and assurances from the embassy, USAID funding for projects that provide HIV medication has not resumed

The Ivan Toms Centre for Health building in Green Point, Cape Town. Photo: Jesse Copelyn

By Jesse Copelyn

Numerous South African health projects funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) remain closed. This is despite a federal court judgment which ordered President Donald Trump’s administration to lift the blanket freeze on global aid.

A waiver on life-saving humanitarian services appears to have had little effect. Funding remains frozen for many projects that provided services explicitly covered by the waiver, such as antiretroviral (ARV) medicines for people with HIV.

A spokesperson for one of these projects said that the United States Agency for International Development Aid (USAID) had not provided any communication regarding the waiver, despite requests for information.

A second organisation said USAID instructed it to provide an adapted budget that only covers services included in the waiver. The organisation submitted it, but it has not yet been approved. The organisation supports orphaned children living with HIV.

CDC funding

PEPFAR is a US initiative that provides billions of dollars a year toward combating HIV in different parts of the world. These funds are primarily distributed through two agencies: USAID and the Centers for Disease Control and Prevention (CDC).

In late January USAID issued stop-work orders to the organisations which it funds. A few days later, the CDC did the same. This was after an executive order by Trump which paused foreign development funding for 90 days pending a review. As a result, US-funded health organisations across South Africa were forced to close their doors. In some cases, HIV patients were left without ARVs.

Last week the CDC issued notifications to its recipient organisations rescinding the stop-work orders. The CDC stated that this was because of a temporary restraining order issued by a federal judge in Rhode Island that halted the Trump administration’s ability to freeze congressional funds. Since then, many South African organisations that get money from the CDC have reopened.

See also: How USAid freeze sent shockwaves through Ethiopia published in The Guardian

But USAID did not send out similar notifications. PEPFAR funds from this agency largely remain frozen.

In a separate judgment on 13 February, a federal judge in Washington DC blocked the implementation of Trump’s executive order to freeze foreign aid. The administration’s lawyers have argued that the US government can continue to freeze aid via other channels unrelated to the executive order.

Dangerous disruption

GroundUp and Spotlight visited three health centres in South Africa funded by USAID, and found all three remained closed. Representatives from a fourth USAID-funded organisation confirmed that its funding has not been restored, and that its partner organisation was in the same boat.

The first centre that we visited is a clinic in Rosebank, Johannesburg, run by OUT LGBT Wellbeing. It provided free HIV testing, ARVs, and the daily HIV-prevention pill (this is referred to as Pre-exposure Prophylaxis or PrEP). It’s one of several US-funded clinics that OUT operates around the country.

Its services are geared toward men who have sex with men. The reason is that rates of HIV are high among this group, and stigma may prevent some from seeking help in general healthcare settings.

When we visited the centre in Rosebank, a note was tied to the gate, stating: “Regrettably our clinic is temporarily closed and consequently no health services are available”. It encouraged patients to go to their nearest health facility.

According to OUT spokesperson Luiz De Barros, the clinics were forced to halt immediately after stop-work orders were issued. This prevented them from making alternative plans, leaving many people without ARVs or PrEP.

He said the centres had a total of 84 staff, who are now “at home without pay”, and about 5000 clients. Without their ARVs, De Barros worries that many clients are at risk of falling ill or developing drug-resistant HIV. Stopping HIV prevention services like PrEP will also “heighten the spread of HIV within communities,” he noted.

De Barros said they had not yet received any communication from USAID about the limited waiver, despite asking for information.

A clause in the waiver says it does not apply to “gender or DEI [diversity, equality and inclusion] ideology programs”. The Trump administration has not spelled out exactly what these terms mean, but it appears that DEI includes any health project which targets particular groups, like LGBTQ people.

GroundUp and Spotlight visited a second health centre in Hillbrow run by the WITS Reproductive Health Institute (RHI). A sign on the gate stated: “USAID has served the WITS RHI Key Populations Programme a notice to pause programme implementation. As of Tuesday, 28 January, we are unable to provide services until further notice.”

WITS RHI’s annual reports suggest that USAID has previously sponsored its projects to treat and prevent HIV, including among high-risk groups like sex workers and transgender people.

The third health facility that we visited is the Ivan Toms Centre for Health, based in Green Point, Cape Town. A temporary closure notification hung from the door. The centre provided HIV and TB testing, ARVs, PrEP, and counselling services – all focused on men who have sex with men.

Representatives from a fourth organisation, NACOSA, told GroundUp and Spotlight that it had been forced to halt all of its USAID-funded services. Subsequently, USAID instructed the organisation to provide a revised budget which only includes activities listed under the waiver. As part of this limited budget, NACOSA proposed retaining a project which helps orphaned and vulnerable children living with HIV in the Western Cape.

Dr Ntlotleng Mabena, a technical specialist at NACOSA, said the project provides these children with psychological support and connects them to health providers. Clinical workers linked to the ANOVA health institute (which is also US-funded) provide the children with ARV treatment, she said.

NACOSA submitted the revised budget with the hope of restarting this service, but they are still awaiting approval. Mabena stated that ANOVA was also waiting for permission to continue. In the meantime, the service remains closed.

The US embassy in South Africa maintains that Trump’s funding cuts do not affect PEPFAR initiatives that provide life-saving services as defined in the limited waiver.

Yet all of the life-saving PEPFAR services that we investigated on Thursday are closed. The only services which have reopened are those funded by the CDC, which is unrelated to the waiver.

Sign outside a Wits RHI clinic in Johannesburg. Photo: Ihsaan Haffejee

Published by GroundUp and Spotlight

Correction on 2025-02-21 12:29

Three paragraphs were removed from the article after publication because of confusion that arose as to whether they were on the record or not.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Read the original article.

Categories : Obstetrics & GynaecologyTags : Leave a comment

Ensuring Safe Motherhood: The Need for Quality Maternity Care

On By ModernMedia
Photo by Shvets Production on Pexels

As we observe Pregnancy Awareness Month this February, it is crucial to reflect on the journey of motherhood and the importance of comprehensive maternity care. According to the latest data from 2024, South Africa’s maternal mortality rate stands at approximately 119 deaths per 100 000 live births1. This statistic underscores the urgent need for improved maternity care services across the country.

Pregnancy is a transformative time, and the right support can make all the difference. From prenatal education to quality healthcare services, expectant mothers require tools and support to navigate this journey confidently. Focus must remain on education, enhancing maternity care services, and addressing the unique challenges faced by South African mothers to ensure that we promote healthy pregnancies and safe motherhood.

Empowering Mothers Through Education

“Education is the cornerstone of empowerment,” says Margot Brews, Head of Health Risk Management Strategy at Momentum Health. “By providing expectant mothers with accurate information about prenatal care, nutrition, and the stages of pregnancy, we can help them make informed decisions that benefit their health and the health of their babies.”

Margot Brews, Head of Health Risk Management Strategy at Momentum Health. Photo: Supplied.

Early antenatal care is crucial, as it allows for the early detection and management of potential complications such as hypertension, diabetes, and infections. In South Africa, where maternal and neonatal mortality rates remain a concern, education can be a powerful tool in reducing these numbers.

Enhancing Maternity Care Services

Quality maternity care is essential for ensuring safe pregnancies and healthy births. In South Africa, access to quality healthcare services can be disparate, with rural areas often facing significant challenges.

“Maternity care is critically important as it directly impacts the health and well-being of both mothers and their babies,” Brews emphasises. “Comprehensive maternity care includes not only medical care but also emotional and psychological support for expectant mothers.”

Early and regular antenatal visits are crucial for detecting and managing potential complications, such as hypertension, diabetes, and infections. Additionally, providing mental health support as part of maternity care can help address anxiety and depression, which are common during pregnancy and postpartum.

Efforts to enhance maternity care services must focus on improving infrastructure in healthcare facilities, training healthcare providers, and ensuring the availability of essential medicines and equipment. “By addressing these challenges, we can create a supportive environment that promotes healthy pregnancies and safe motherhood for all women in South Africa,” Brews adds.

Addressing the Challenges Faced by Mothers

South African mothers face a range of challenges, from financial constraints to social stigma. Teenage pregnancies, in particular, pose significant risks to both the mother and the child. Additionally, teenage mothers often face barriers to continuing their education, which can impact their long-term economic prospects.

“To address these challenges, we must create supportive environments which encourage young mothers to seek prenatal care and continue their education. This should start before pregnancy in the form of guidance and support within the context of broader sexual reproductive health. Community-based programs that provide childcare support, financial assistance, and educational opportunities can make a significant difference in the lives of young mothers and their children,” says Brews.

The Role of Partners and Families

Pregnancy is not only a journey for the mother; it involves the entire family. Partners and families play a crucial role in providing support and creating a nurturing environment for the expectant mother. This involvement can help strengthen the family unit and ensure that the mother receives the emotional and practical support she needs.

“Partners and families are integral to the pregnancy journey, specifically within the cultural context of South Africa,” Brews notes. “Their support can make a significant difference in the emotional and physical well-being of the expectant mother.”

Promoting Maternal Mental Health

Mental health is a critical aspect of maternity care that is often overlooked. Pregnancy and childbirth can be emotionally challenging, and many women experience anxiety, depression, or other mental health strains during this time. It is essential to provide mental health support as part of comprehensive maternity care.

“February presents an opportunity to reflect on the importance of empowering mothers and enhancing maternity care in South Africa,” says Brews. “By working together, we can ensure that every mother has the resources and support she needs for a healthy and positive pregnancy journey.”

Momentum Health believes that by prioritising maternity care, a significant difference can be made in the lives of mothers and their babies. Education and advocating for quality maternity care for all is critical and more must be done to improve maternal care, address disparities in healthcare access, and provide comprehensive support to expectant mothers and mothers in general. “Together, we can make a significant difference in the lives of mothers and their babies, creating a healthier and brighter future,” concludes Brews.

Categories : CancerTags : Leave a comment

Caner Signals may Promote Blood Clot Formation in the Lungs

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Thrombophilia. Credit: Scientific Animations CC4.0.

Blood clots form in response to signals from the lungs of cancer patients—not from other organ sites, as previously thought—according to a preclinical study. Clots are the second-leading cause of death among cancer patients with advanced disease or aggressive tumours.

While blood clots usually form to stop a wound from bleeding, cancer patients can form clots without injury, plugging up vessels and cutting off circulation to organs. The study, published in Cell, shows that tumours drive thrombosis by releasing chemokines, secreted proteins which then circulate to the lung. Once there, the chemokines prompt macrophages to release small vesicles that attach to platelets, forming life-threatening clots.

The findings may lead to diagnostic tests to determine blood clotting risk and safer therapies that target the root of the problem to prevent blood clots.

“This work redefines the concept of how thrombosis develops in cancer patients, compared to the traditional view that factors on blood vessel walls or tumour cells themselves are responsible,” said study lead Dr David Lyden, professor in paediatric cardiology, and cell and developmental biology at Weill Cornell Medicine. “It’s a revolutionary concept that thrombosis is initiated in the lung, which wasn’t appreciated before.”

Tumors in the Driver’s Seat

“We reviewed post-mortem studies and found that up to 60% of cancer patients died because of clots rather than cancer itself,” said first author Dr Serena Lucotti,  instructor of cell biology in paediatrics at Weill Cornell Medicine. “It is unfortunate because we have drugs that can prevent clots, but we can’t give them unconditionally to all patients because they can cause excessive bleeding in some. At the same time, we can’t predict who is at high risk for clots and would benefit from the drugs.”

In a series of experiments in mice and human tissues, the researchers showed that different tumours release varying amounts of the chemokine CXCL13. Breast cancers and melanomas release relatively small quantities of CXCL13. However, if these tumour cells spread to the lung, they can trigger clot formation by releasing CXCL13 and locally influencing interstitial macrophages. “In contrast, pancreatic cancer secretes high levels of CXCL13 into the bloodstream,” said Dr Lyden. “It’s so high that it circulates all the way to the macrophages in the lung, so these tumour cells don’t need to be close by.”

Blocking Clots—and Metastases

Other experiments revealed that after interacting with CXCL13, lung interstitial macrophages send out small vesicles loaded with an adhesion molecule, integrin β2, on their surface. The integrin β2 is in an open conformation that can attach to platelets and trigger clot formation.

Mice treated with an antibody that blocks vesicle-bound integrin β2 from binding to platelets had no side effects and didn’t have excessive bleeding. Strikingly, mice with early or advanced cancers that were treated with the antibody not only had fewer clots, but also had significantly fewer metastases than untreated controls. “This is important because there aren’t effective treatments for patients with metastases and will be further investigated,” Dr Lucotti said. She is developing a human antibody to block the integrin β2-platelet interaction in patients.

The researchers are also hopeful that integrin β2 can be a biomarker that indicates a patient’s risk for developing clots. As proof of concept, the team analyzed blood samples from some pancreatic cancer patients from Moores Cancer Center at the University of California San Diego Health. By analyzing blood samples collected before and after the patients experienced blood clots, the authors could easily and accurately distinguish between low-risk and high-risk patients based on integrin β2 levels on extracellular vesicles in the blood.

The study highlights that cancer is a disease that can affect many parts of the body. “Cancer is a systemic disease. We have to pay attention to not only future sites of metastasis, but other organs that may be affected independent of metastasis by systemic complications such as thrombosis, leading to morbidity and mortality,” Dr Lyden said.

Source: Weill Cornell Medicine

Categories : Expert Opinion Pain ManagementTags : Leave a comment

Continuation of Opioids for Chronic Pain: Experts Divided

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Photo by Usman Yousaf on Unsplash

Chronic pain is complex and difficult to treat. Prescribing opioid pain medications has become controversial but may help some patients.

With the goal of informing clinician practice, a new study explores the harms and benefits of continuing and of discontinuing the long-term prescription of opioid medicines to adults with chronic pain. The authors analysed the opinions of 28 experts on the harms versus benefits of maintaining, tapering or terminating opioid pain medication prescriptions for chronic pain, a common condition worldwide that is typically quite difficult to treat.

The study authors found a lack of consensus among the experts on how to treat chronic (lasting three or more months) non-cancer pain. Slightly more than a third of the experts (36%) believed that long-term opioid therapy is beneficial, while an equal percentage indicated that it should be discontinued.

More than half of the experts believed that patients can experience harm from overly rapid tapering and discontinuation, while some recommended attempting a slow taper (even with a prior unsuccessful taper), possibly with addition of medications to manage withdrawal) in order not to maintain opioid therapy.

Some of the experts advocated for switching patients to buprenorphine, which diminishes the effects of physical dependency to opioids, such as withdrawal symptoms and cravings, and is used to treat pain. Some considered adding non-opioid pain therapies (including re-trying these therapies even if they were unhelpful in the past) as well as engaging in shared decision-making with the patient, although there was little consensus on how to accomplish these options.

Some, but not all of the experts, noted the benefit of addressing co-occurring conditions related to patient safety, such as alcohol use, mental health symptoms and opioid side effects.

Few of the experts brought up assessing or addressing opioid use disorder or overdose risk.

“The potential harms of opioid pain medication are well known, nevertheless patients can become habituated to them and want their physicians to continue prescribing them. Taking patients off opiates may result in return or worsening of chronic pain, mental health issues, drug seeking and potentially overdose and death. Additionally, these drugs could be used by someone else, possibly winding up on the street,” said study co-author Kurt Kroenke, MD of the Regenstrief Institute and the Indiana University School of Medicine. “On the benefit side, these drugs may be helping relieve the patient’s often debilitating pain which can impact the ability to interact with family, to hold a job, participate in social activities and many other aspects of life.”

A substantial number of people who are prescribed opioid pain medications continue to experience chronic pain. Dr Kroenke notes that these individuals may be good candidates for tapering to a lower dose, prescription discontinuation and moving on to effective, safer treatments for pain.

The authors conclude their analysis of the experts’ opinions, “Guidelines on whether to continue or taper opioids prescribed long- term may be difficult to utilize given professional liability concerns, changing regulations and health system initiatives, differing provider-patient perspectives on long-term opioid benefits and harms, and some providers’ beliefs that opioid dependence interferes with patients’ objectivity. In the meantime, individual care decisions that involve weighing relative harms should draw on longstanding norms of ethical medical care that call for informed consent and patient-provider conversations grounded in mutual respect.”

The study is published in the peer-reviewed journal Pain Practice.

Source: EurekAlert

Categories : Dermatology Diet and NutritionTags : Leave a comment

Plant-rich, Low Saturated-fat Diet Linked to Reduced Psoriasis Severity

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Photo: CC0

A new study by researchers at King’s College London, published in the British Journal of Nutrition, has found significant associations between diet quality and the severity of psoriasis. The findings provide novel insights into how dietary patterns may be related to psoriasis severity in non-Mediterranean populations.

Psoriasis is a long-lasting inflammatory skin disease which causes flaky patches of skin that form scales. It affects millions worldwide and is believed to be caused by a problem with the immune system.

The research analysed data from 257 adults with psoriasis who had completed an online survey. Participants’ adherence to various diet quality scores, including the Mediterranean Diet Score, the Dietary Approaches to Stop Hypertension (DASH) score, and the Healthy Plant-based Diet Index, was assessed using a food frequency questionnaire. Psoriasis severity was self-assessed using a validated questionnaire.

Key findings from the study indicate that individuals with very low adherence to the DASH diet index and the Healthy Plant-based Diet Index were significantly more likely to report higher psoriasis severity.

Further analysis of the different elements of the DASH dietary pattern revealed that greater red and processed meat intake was associated with more severe psoriasis even when body mass index (BMI) was considered. Fruits, nuts and legume intakes were also associated with less severe psoriasis, but this relationship was not independent of BMI.

The study was published as part of the Asking People with Psoriasis about Lifestyle and Eating (APPLE) project and funded by the Psoriasis Association.

Our findings point to the potential benefits of dietary interventions in improving patient outcomes. Given the impact of psoriasis on physical and psychological well-being, incorporating dietary assessments into routine care could offer patients additional support in managing their condition.

Sylvia Zanesco, PhD student from the Department of Nutritional Sciences at King’s College London who led the research

The DASH dietary pattern was originally designed to lower blood pressure and emphasises fruits, vegetables, whole grains, low-fat dairy foods and lean meats while limiting salt, sugar, and saturated fats. A high Healthy Plant-based Diet Index characterises a dietary pattern rich in healthy plant foods including fruits and vegetables, whole grains, nuts and seeds, legumes and plant oils rich in unsaturated fats, as well as being low in animal foods and unhealthy plant foods such as sugary foods and drinks and refined starches.

The study accounted for several confounding factors, including age, sex, smoking status, alcohol, energy intake, and mental health, ensuring a comprehensive analysis of dietary patterns that are independently associated with psoriasis severity.

This research brings much-needed evidence that there may be a role for dietary advice, alongside standard clinical care, in managing symptoms of psoriasis. Our next steps will be to explore whether diets rich in healthy plant foods can reduce symptoms of psoriasis in a controlled clinical trial.

Professor Wendy Hall, Professor of Nutritional Sciences at King’s College London and senior author of the study

The findings of the study contribute to the growing body of evidence supporting dietary modification as a complementary strategy in psoriasis management to potentially alleviate disease severity and improve patients’ quality of life.

Source: King’s College London