Malawi Program Boosts Efforts to Prevent HIV in Infants

A 7-fold increase in the number of pregnant and breastfeeding women with HIV infection who sought antiretroviral therapy resulted from a new prevention program in Malawi. (Image: Michael Utech)

A 7-fold increase in the number of pregnant and breastfeeding women with HIV infection who sought antiretroviral therapy resulted from a new prevention program in Malawi. (Image: Michael Utech)

A new approach toward preventing mother-to-child HIV transmission in Malawi boosted the number of pregnant and breastfeeding women living with HIV who started antiretroviral therapy (ART) by more than 7-fold in 1 year, federal health officials reported today.

Malawi’s Ministry of Health launched the program, known as Option B+, in July 2011 with support from the US President’s Emergency Plan for AIDS Relief. Instead of treating pregnant women with HIV infection based on their disease stage or CD4 cell count, the program offered lifelong ART to all pregnant and breastfeeding women with confirmed infection. Antiretroviral therapy is capable of reducing mother-to-child transmission rates from approximately 40% to 5%. Continue reading

JAMA Forum: State Health Exchanges, a Skeptical Public, and the Role of Health Care Professionals

Diana Mason, PhD, RN

Diana Mason, PhD, RN

Imagine the following scenario: it’s October 2013, you’re a health care professional, and Sara Smith, a 45-year-old woman with diabetes, arrives in your clinic for the first time in more than 4 years. You ask her why it’s been so long since her last visit.

“My husband lost his job right after I last saw you, and we can’t afford the health insurance that my job provides,” she replies.

“Why don’t you contact the state health exchange for coverage?” you ask.

She looks baffled. “What’s that?” Continue reading

Author Insights: Incidence of Advanced Breast Cancer May Be Increasing in Young US Women

Rebecca H. Johnson, MD, of Seattle Children’s Hospital and the University of Washington, and colleagues found an increase in the incidence of advanced breast cancer in young women.

Rebecca H. Johnson, MD, of Seattle Children’s Hospital and the University of Washington, and colleagues found an increase in the incidence of advanced breast cancer in young women.

More young women in the United States apparently are being diagnosed with advanced breast cancer than in the past, a trend not seen among older women, according to a study appearing today in JAMA.

Although the numbers remain small, the finding is a concern, because breast cancer in young women tends to be more aggressive disease and is associated with lower survival rates than breast cancer in older women. In 1976, the rate of diagnosis of advanced breast cancer (cancer that has metastasized to parts of the body away from the breast such as the brain, lungs, or bones) among women aged 25 to 39 years was 1.53 cases per 100 000 women; by 2009, the rate had climbed to 2.90 cases per 100 000, an annual increase of 2.07%. The study is based on data from 3 US National Cancer Institute Surveillance, Epidemiology, and End Results databases spanning 1973-2009, 1992-2009, and 2000-2009. Continue reading

Consensus Builds Against Vitamin D and Calcium Supplementation for Postmenopausal Women

There is no evidence that calcium and vitamin D supplementation by otherwise healthy postmenopausal women prevents fractures, according to a new recommendation from a US advisory group. Image: Denise Bush/iStockphoto.com

A review found no evidence that calcium and vitamin D supplementation by otherwise healthy postmenopausal women prevents fractures. Image: Denise Bush/iStockphoto.com

It may be time for many postmenopausal women to put down the calcium and vitamin D supplement bottles for good, as the latest in a string of influential health care organizations has recommended against the use of such supplements to prevent fractures.

Today, in the Annals of Internal Medicine the US Preventive Services Task Force (USPSTF) officially joined the chorus of groups recommending against calcium and vitamin D supplementation in postmenopausal women as a means to reduce fracture risk. In a review of evidence from 6 randomized trials evaluating the use of vitamin D and calcium to prevent fractures in postmenopausal women who are not living in a nursing home or other institution, the task force found no evidence of a benefit from supplementation with 400 IU of vitamin D3 and 1000 mg of calcium. Additionally, the review found evidence of an increased risk of kidney stones, with 1 in every 273 women who take these supplements for 7 years developing this problem.

Continue reading

Life Expectancy Increased Substantially During South African HIV Treatment Program, Study Shows

Life expectancy increased sharply in a South African community after widespread HIV treatment became available, according to a new study. (Image: alexskopje /iStockphoto.com)

Life expectancy increased sharply in a South African community after widespread HIV treatment became available, according to a new study. (Image: alexskopje /iStockphoto.com)

After South Africa rolled out large-scale antiretroviral therapy (ART) programs for people with HIV infection during the early 2000s, life expectancy in 1 rural community increased sharply and treatment was proven cost-effective, according to new research in today’s Science.

Researchers from the Harvard School of Public Health in Boston analyzed data in household surveillance surveys collected between 2000 and 2011 in a district of KwaZulu-Natal that is one of the poorest in South Africa. Some 29% of adults in the community have HIV infection, and more than half of all deaths there were HIV-related a decade ago.

In 2004, however, South Africa launched public ART programs with the goal of treating everyone who met certain disease-stage criteria. The first patients in KwaZulu-Natal were enrolled in September of that year. By July 2011, 13.8% of community residents aged 15 years or older sought care in the program and 7.4% in that age group started ART. Continue reading

JAMA Forum: The Forecast Slowdown in Medicare Spending: Is More Coming?

By David Cutler, PhD, and Nikhil Sahni, MBA, MPA/ID

the jama forum logoThe President pushed his budget in last week’s State of the Union address, but the show was stolen by the Congressional Budget Office (CBO) 2 weeks ago, when it released its 2013 Budget and Economic Outlook.

The biggest news was the “baseline”—defined as the CBO’s projections of federal revenues and spending assuming current laws remain unchanged. As has happened annually since 2010, the CBO lowered its forecast of federal health spending growth, independent of any policy action. Medicare and Medicaid costs combined are expected to be 15% lower in 2020 than was forecast just 3 years previously. In dollars, the savings for Medicare over the next 7 years are nearly $400 billion, about two-thirds as much as the revenue from the expiration of some of the high-income tax cuts that happened this January. Continue reading

JAMA Forum: Great Expectations and the Affordable Care Act

Larry Levitt, MPP

Larry Levitt, MPP

The Congressional Budget Office (CBO) recently projected that 7 million people will enroll in new health insurance exchanges under the Affordable Care Act (ACA) next year when the exchanges come online. This is out of tens of millions of people who are potentially eligible to buy insurance in the exchanges and receive subsidies from the federal government to make their premiums more affordable. The CBO further estimates—based on assumptions about expanded Medicaid coverage as well—that 44 million Americans will remain uninsured in 2014.

The CBO forecasts that exchange enrollment will then ramp up quickly over several years, reaching 27 million by 2018. And as a result, the number of people remaining uninsured will decrease. However, as we fast approach the first open enrollment period under the ACA in October of this year, people’s perceptions of the health reform law may very well be formed during the initial stages of implementation. Continue reading