Solutions for COVID-19 and beyond Unitaid News - October 2020


In this issue:

The interview: Unitaid and Wellcome on treatments for COVID-19

Four ways the fight against HIV, TB and cervical cancer carries on

News in brief


Treatments for COVID-19: providing an end-to-end solution

Interview with Dr Philippe Duneton, Unitaid Executive Director a.i., and Paul Schreier, Chief Operating Officer at Wellcome

Dr Philippe Duneton, Unitaid Executive Director a.i., (M.Orlovic/Unitaid) and Paul Schreier, Chief Operating Officer at Wellcome (Wellcome)

Why is it so crucial to research treatment-based solutions to COVID-19 at the same time as vaccines?

PhD: We will only bring this pandemic to an end if we use vaccines together with effective treatments and tests. Medicines can play a key role at all stages of the illness: they can prevent infection, stop it from getting worse, halt transmission of the virus and treat post-COVID complications. They can also be vital for people at higher-risk, such as the elderly who respond less well to vaccines. The clinical trials that are currently taking place are crucial. Results will be available in the coming weeks.

PS: Treatments, in combination with vaccines and tests will be needed even when a vaccine becomes available. The global roll-out of a vaccine will take time and may not reach full protection. The world will still need to test and treat those who continue to fall ill, as has often been the experience in managing previous infectious diseases. We’ve started to see the promise of lifesaving treatments come through. For example, since the start of the crisis, we have made significant clinical gains, discovering that dexamethasone and hydrocortisone can save the lives of the most seriously ill patients.

What are the most promising treatments currently being looked at?

PhD: COVID-19 is a complex disease that we are still learning about. There will not be one single miracle cure. Only a combination of treatments adapted to every stage of the disease, and to different environments, will lead to an overall effective treatment option. Likewise, access to treatments needs to be organised in a coordinated manner, alongside other tools such as oxygen to have a treatment-based response that works.

The disease has three phases: a viral phase; an immune-reaction phase with pulmonary, vascular and neurological effects; and a third phase of after-effects. Medicines should respond to those different phases with one clear aim: saving lives.

Three types of medicines are being looked at right now. Antivirals that are already being used to treat other illnesses and can be repurposed for use against COVID-19. Monoclonal antibodies are an option showing promising results but they are expensive, difficult to introduce in poor countries and with low manufacturing capacity available. They could be used for the most severe forms of COVID-19 and prevent symptoms from getting worse. The third category brings together new antivirals, specifically designed to treat COVID-19.

PS: While we have treatment options for patients in a serious condition, we are yet to have effective, proven treatments for most patients, including for the prevention of mild symptoms worsening or for prophylaxis.

To address this, the ACT-Accelerator Therapeutics Partnership analysed over 1,700 ongoing clinical trials to identify promising treatments that could be scaled up. Following this analysis, we expect that monoclonal antibodies and new antivirals have considerable potential. Monoclonal antibodies are particularly exciting because they are safe and could work across different age groups and blood types.

4 ways the fight against HIV, TB and cervical cancer carries on

Unitaid's efforts to transform the fight against major diseases continue in COVID-19 times. The Secretariat and implementing parnters are collaborating to protect the gains against diseases such as HIV/AIDS, TB and cervical cancer –and to advance 21st century solutions for these old-time challenges. Here, several partners reflect on the effort to continue delivering on the various initiatives with Unitaid's support:

Redefining community engagement to cut new HIV infections: Wits-RHI and Fiotec-Fiocruz

Bringing preventive treatment (PrEP) to people at high risk of HIV in an important strategy to reduce new infections. But how to stay in touch with vulnerable groups in the face of movement restrictions and people's reluctance to go to health facilities? The implementors of Unitaid's PrEP investments ensured the safety of their staff with Unitaid's support. Then, they redefined the way they engage with target populations by taking services online and closer to communities.

In South Africa, for example, Wits-RHI accommodates beneficiaries by scheduling convenient drop-off points and working with community-based organizations. "We identified hotspots where participants might be found, such as shopping centres and social grant pick-up points, and opened new communication channels via Whatsapp, phone and online chatbots," says project director Saiqa Mullick. She also notes that Unitaid's flexibility has been essential to adapt the project: "For instance, we received swift approvals to hire short-term health care staff to fill the positions of those who were isolating or quarantined."

"The learnings on how our PrEP initiative adapted to the COVID-19 pandemic have been invaluable and have been shared locally and internationally" –Saiqa Mullick, Wits-RHI

Fiotec-Fiocruz brings PrEP to transgender women, adolescents and men that have sex with men in Brazil, Peru and Mexico. "Telehealth allows us to continue providing social and mental health services, and we have also resorted to home delivery of PrEP pills and HIV self-tests," says project director Inês Dourado, noting the increased risk of depression and domestic violence during the coronavirus pandemic. Digital participant recruitment and peer support via SMS and social media are other good practices they have adopted and shared with the broader global health community. "Unitaid's financial and technical support has been flexible and responsive," she says.

"We are slowly, but steadily, resuming face-to-face PrEP enrolment, and Unitaid's support has been essential for the procurement of the necessary personal protective equipment"–Inês Dourado, Fiotec-Fiocruz
Staff using personal protective equipment during the delivery of HIV-preventive pills in South Africa and Brazil, and project directors Saiqa Mullick (Wits-RHI) and Inês Dourado (Fiotec-Fiocruz). In the past months, these initiatives delivered joined digital sessions at major conferences and exchanged strategies such as the use of online chatbots to address people's queries in COVID-19 times. Photos: Wits-RHI, Fiotec-Fiocruz

Empowering national actors to fight TB and cervical cancer: EGPAF and CHAI

The CaP TB initiative with EGPAF seeks better ways to diagnose and treat paediatric TB, which has been long neglected. The limitations to travel due to COVID-19 disrupted the organization's presence at trial sites, but there was a silver lining to that. The new coronavirus has brought attention to lung diseases and opened discussion spaces about TB prevention and care, says project director Mikhael de Souza."Also, increased virtual support through phone calls and virtual means has proven to be efficient and led to the forceful empowerment of colleagues at ministries of Health, who continued conducting activities on the ground," he says. As such, he believes the pandemic may have been a pilot for future handover processes.

"Unitaid was flexible and showed genuine interest in the success of the initiative"–Mikhael de Souza, EGPAF

The CHAI-led initiative on testing and treatment of cervical cancer provides another example of local empowerment. The team in the state of Madhya Pradesh, India, has developed a hybrid training and mentoring model for medical doctors and nurses in collaboration with the Ministry of Health. "We decided to deliver online courses and complement them with on-site trainings for small groups. These are followed by teleconsultations so trainees can share their concerns and present case studies," says Parth Bahuguna.

"Unitaid’s deep understanding of the challenges posed by COVID-19 and its support to the state of Madhya Pradesh have been critical. Especially, for the development of creative solutions that allow health services to continue alongside the pandemic response" –Parth Bahuguna, CHAI
Hands-on training session on cervical cancer screening for healthcare workers at the primary and secondary level facilities in India. All participants are wearing appropriate personal protective equipment. Photo: CHAI


News in brief

COVID-19 diagnostics breakthrough

COVID-19 tests that give results in 15 minutes will be delivered to dozens of low and middle-income countries, thanks to Unitaid and partners.

Announced last month, the new tests are a game-changer in the fight against COVID-19 around the world, enabling quick results that do not rely on complex and expensive laboratory equipment.

120 million units from developers SD Biosensor and Abbott will be made available in the next six months, at a maximum cost of $5 per test.

They are designed to be used in a variety of settings, but will be particularly useful in remote health settings with limited or no testing resources.

This end-to-end solution is the result of a collaboration between Unitaid, The Bill & Melinda Gates Foundation, The Global Fund, FIND and Africa CDC to each take responsibility for different stages of the plan, from securing volume guarantees to working on in-country preparedness.

Unitaid and Africa CDC will work together to start rolling out the tests in up to 20 countries in Africa this month.

Unitaid’s acting executive director Philippe Duneton said: “Access to these point-of-care rapid tests with be a game changer in the fight against COVID-19.

“We are working to support countries to rapidly deploy and use these new tests in the best possible way. This news shows what the ACT-A partners working together can deliver in our efforts against the COVID-19 pandemic.”

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