WIDESPREAD disruption is expected at hospitals and clinics because health workers have rejected the government's "final pay offer" and decided to go on strike. The threat of a full-blown public servants' strike, which unions have warned would paralyse the state, is looming large now after two of the largest unions, the National Health and Allied Workers' Union (Nehawu), largely representing health workers, and the SA Democratic Teachers' Union (Sadtu), rejected the government's latest offer. Nehawu general secretary Fikile Majola said the union had decided to go on strike. Nehawu represents 250 000 workers, who could cripple hospitals and clinics throughout the country if they go on strike. The state revised its offer last week, leaving the wage increase unmoved at seven percent while increasing the housing allowance from R630 to R700 a month. Unions are demanding an 8.6 percent increase and a R1 000 housing allowance. The government has suggested that it may implement the offer unilaterally, saying state coffers could not meet the further R1.3 billion needed to meet union demands. Hospersa, a smaller union representing healthcare workers, has also rejected the government's offer. Hospersa general secretary Noel Desfontaines, said if government wanted to avert a strike, it was going to have to come up with something much better. Meanwhile, public sector doctors will not go on strike over their pay but want their own bargaining structure so that they can negotiate salary increases and other services issues directly with government. The South African Medical Association (Sama) is consulting labour attorneys about negotiating the change. Sama said sector-specific concerns were not being addressed and it wanted to extract itself from the bargaining structure, so that it could deal directly with the employer. Mark Sonderup, vice-chairman of Sama, said the organisation was prepared to take this as far as the Constitutional Court.

 The Cape Times/The star, 17 August 2010

HEALTH Minister Aaron Motsoaledi has called for a re-launch of the HIV/AIDS-testing campaign, which has slumped because of the World Cup. Motsoaledi said that "millions of people" had been tested since the HIV-counselling and testing campaign was launched four months ago. But he said he was not satisfied with that result, and plans were being made to re-launch the campaign "in about a month's time". Referring to the UN's Millennium Development Goals and South Africa's failure to reduce its child mortality rate, and to the fight against HIV, Motsoaledi said the pandemic was far from being over. The Minister has met with Business Unity SA and appealed to its members for help "in cash or kind" to raise awareness about HIV testing. Motsoaledi said he wanted business to help by distributing condoms or running a "massive circumcision drive". Business Unity CEO Jerry Vilakazi said business had "a vested interest" in helping prevent HIV infection. He said the category that was highly infected were those who were economically active, in the age group between 25 and 39 - the drivers of the economy. Vilakazi said that business leaders had agreed to provide advertising expertise to the Health Department to "design campaigns that will speak to the young and funky generation". Meanwhile, private hospital group Life Healthcare said it will offer free HIV testing and counselling at 10 of its hospitals and at 60 clinics, in support of the government's campaign to get 15-million South Africans tested for HIV by June next year. Life Healthcare's Keith Shongwe said it was imperative for the private sector to join hands with government. The Times, 17 August 2010

THE incidence of doctors dispensing medication illegally is on the rise, according to a Pharmacy Council inspector, but the SA Medical Association (Sama) has hit back, asking that pharmacists also be investigated for irregular practices. Shaheen Sattar, an inspector for the Pharmacy Council, said general practitioners were "getting away with murder" because they were left unchecked, and that during interviews with pharmacists several claims of misconduct by doctors had emerged. Among the complaints were that medicines were incorrectly labelled, and patients turned up at pharmacies to ask how their medication should be taken.

Pharmacists also found that some medicines were prescribed in excessive amounts. Sattar said he was in possession of medicines given to patients that had not been labelled at all, and where the practitioners were not in possession of a dispensing licence. Under the Medicines Control Act, only pharmacists and doctors who are licensed to dispense are allowed to handle, possess and sell scheduled medicines. Yet Sattar said he had come across these medicines being packed and prepared in unhygienic conditions by doctors' administrative staff.

During investigations, Sattar found in some instances that clerical staff and cleaners had access to medicines in the absence of doctors. Dr Norman Mabasa, the chairman of Sama and the National Convention for Dispensing, condemned any contravention of the guidelines of dispensing, whether it was doctors or pharmacists who transgressed. While storage and handling of medication was of grave concern, he said, the fact that pharmacists dispensed drugs without examining patients also needed to be addressed. He also charged that pharmacists dispensed scheduled medicines without prescriptions. Sattar confirmed that this did happen, and encouraged people to report incidents to the council so that guilty pharmacists did face sanction. He said dispensing doctors were encroaching on the domain of pharmacists, but were not inspected to establish whether their surgeries were suitable and if they were qualified to dispense medicine.

Dispensing licences are obtained through the Department of Health. Mabasa said the guidelines were adequate, but only on paper. Provision was made for the Pharmacy Council to inspect doctors annually, he said, but this was never implemented because of a lack of manpower. Lize Nel, the spokeswoman for the Health Professions Council of SA (HPCSA), confirmed that such transgressions had been reported to the council for investigation. Depending on whether they were repeat offenders, guilty doctors could have their names erased from the council's register, effectively prohibiting them from practising medicine. Other penalties could include a conditional suspension or a fine. The Cape Argus, 15 August 2010

Aspen spends a truck-load of money buying an Australian company, and the share price goes up. That's strange. After the catalogue of South African failures in Australia, it seems unusual that the market should applaud Aspen's agreed offer to acquire the pharmaceutical business of Sigma for R5,9bn.

After the deal was announced, the share price rose to close to about 1,5% better, which is a great turn-up for the books. Why is there enthusiasm for an acquisition in the graveyard of the best and brightest? They always say the situation is different, but in this case it seems the situation is different.

First, Aspen has been successfully present in Australia for years. Second, Aspen management have credibility. Third, the purchase gives Aspen real fire-power in the Australian market, about a third of total sales. Fourth, Aspen is not buying the whole company but just a part of it which dovetails neatly with what they already do in SA. And fifth, the company is taking over the business on a debt-free basis, a big improvement on the previous arrangement. The deal still needs shareholder and regulatory approval, but it's a stressed sale which regulators tend to facilitate because otherwise they get accused of destroying jobs. And it does not result in a big market realignment. The proposal is a credit to Aspen's deal-making ability. Business Day 17 August 2010

SA'S biggest drug maker, Aspen Pharmacare, still intent on extending its foothold in Australia and the Asia-Pacific region, has announced a scaled-back offer of R5.8 billion to buy part of the troubled Australian pharmaceutical company Sigma. Aspen originally said in May that it was considering buying the whole company for A$0,60 a share, but revised its offer down to A$0,55 after reviewing Sigma's books. Sigma, which has lost half its value in the past year, also has a wholesale business and owns retail pharmacy chains Amcal and Guardian.

If Sigma shareholders approve the deal, it would take Aspen from a relatively small player in Australia to that country's largest manufacturer and supplier of prescription medicines and give it a quarter of the Australian generics market, according to Aspen CEO Stephen Saad. Aspen's Australian business, which delivered revenue of A$180m for the year to June 30, at present only markets and distributes pharmaceuticals. Durban-based Aspen's bid for Sigma's drug business is the latest in an increasingly complex network of arrangements that enable it to distribute drugs to different markets from multiple manufacturing bases, including its facilities in SA. It has almost two dozen agreements with pharmaceutical companies, including international giant GlaxoSmithKline, that enable it to distribute medicines to about 100 countries. Saad said Sigma was the number two in generics in Australia. He said it provided an opportunity to give them a pipeline from the products Aspen manufactured in SA or had under license. He added that Aspen could also utilise some of their intellectual property in other markets, including SA and Latin America.

The deal will also strengthen Aspen's presence in the Asia-Pacific region. Saad said it would enable Aspen to manufacture closer to these markets, which include Japan, the Philippines, Taiwan, Thailand, New Zealand and Australia. Aspen said it would pay for Sigma with cash reserves and raise additional funds from banks. Saad said the purchase of Sigma would be "a fundamental part" of future earnings. Neil-Stuart Findlay, an investment analyst at Investec Asset management, said the revised offer would allow Aspen to focus its attention on the turnaround opportunity presented by the Pharmaceutical division, while leaving Sigma to optimise its wholesaling business, an area in which historically Aspen has not had significant experience.

Jonathan Larcombe, an equity analyst with Old Mutual Asset Management, said the macro picture was very challenging in that market, as it was a very regulated and the government had clear cost-saving programmes for the next few years. Theo Botha, an equity analyst at Stanlib, said buying just the pharmaceutical business was a much better deal for Aspen. Botha said Aspen would realise cost savings and stood to gain critical mass in Australia. David Low, a healthcare analyst at Deutsche Bank in Sydney, said Aspen more likely than not got a good deal. He said there was some risk with generics, but a number of the other parts of the business had solid earnings and an attractive outlook, such as treatments for rare diseases and manufacturing operations. In the year to January, the whole Sigma group reported a loss of A$389 million (R2.53bn). Sales in the pharmaceutical business totalled A$671m.

Aspen has been operating in Australia for the past nine years through a wholly owned subsidiary, which markets and distributes its products as well as medicines licensed from other companies. It is one of the top 10 suppliers of medication by number of prescriptions written. In the year to June, sales in the country were about A$180m. Australia is a country with a swelling population of ageing citizens, a lucrative market for prescription drugs. Sigma has a 25 percent market share of the generics space in Australia. Sigma said its directors would recommend voting for the deal. If the sale does not proceed for reasons relating to Sigma, Aspen would be entitled to a break fee of 0,5% of the purchase price. Business Report, 17 August 2010

THE Medicines Control Council (MCC) has fast-tracked the registration of 65 antiretroviral drugs. The anti-AIDS drugs were given priority while the MCC tried to clear a backlog of medicines which have been awaiting registration since 2007 and longer. Health Minister Aaron Motsoaledi said in response to a parliamentary question that the MCC currently still had 1 503 applications on its backlog, which he blamed on personnel, financial and structural problems at the council. All registration applications for ARVs had been reviewed and those still unregistered either did not meet requirements, or the companies had failed thus far to respond to the MCC's recommendations. Health News daily 20100720

The international Agency for Research on Cancer (IARC) this week released GLOBOCAN 2008(an online resource for cancer researchers, policy makers and the media alike, provides worldwide estimates of the numbers of new cases of, and deaths from, cancer for 2008), a new database which provides the most accurate assessment of the global cancer burden. It shows that Cancer will kill more that 13.2 million people a year by 2030, almost double the number who died from the disease in 2008. Information is provided for the overall burden of cancer and for 27 specific cancer types for almost all countries or territories of the world. According to GLOBOCAN, an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008.

The online resource is easy to use and has facilities to produce maps and other graphics. In addition, a series of fact sheets describe the overall cancer burden within specific areas or countries, as well as the major global patterns for eight common cancers. Health-e News Service 20100603

Researchers have started testing the safety a vaginal ring containing an antiretroviral drug in South Africa in the hope that it has potential to prevent HIV infection in women.

The clinical trial, known as IPM 015 will test the safety and acceptability of the dapivirine-containing vaginal ring - which is successfully used in Europe as a delivery method for hormonal therapy and birth control.

Announcing the commencement of the trial at the Women Deliver conference in Washington DC yesterday (Tue), CEO of the International Partnership for Microbicides (IPM) Zeda Rosenberg said the vaginal ring could be well suited to deliver HIV prevention drugs for women in developing countries.

The vaginal ring used in IPM 015 is made of flexible silicone, is durable and would be easy to distribute - making it suited for use in developing countries. Each ring slowly releases 25 mg of the ARV drug dapirivine over the course of 28 days, potentially providing sustained protection against HIV.

The vaginal rings used in this study and can be easily self-inserted. The women participating in the study will use a ring for 4 weeks at a time (plus or minus 4 days), at which point it will be replaced with a new ring, over the course of three months. Participants will be asked to complete a total of 6 visits to the research centre, including a follow-up visit 4 weeks after the last ring is removed.

The vaginal ring containing dapirivine has already been shown to be safe as tested in four prior IPM clinical trials among women in Europe, with another trial ongoing. If IPM 015 further confirms the safety and acceptability of the product among women in Africa, a Phase III program to test the ability of dapirivine rings to prevent HIV infection is scheduled to begin in 2011, with results due in 2015.

This trial is an expanded safety trial that will compare the dapirivine ring with a placebo ring containing no active drung among 280 volunteers aged 18 - 40 across Africa, including South Africa, Kenya, Rwanda, Malawi, Tanzania and Zambia.

Women in south Africa have begun volunteering for the trial and it is hoped that other African nations will start the same study shortly. Jill Sheffield, President of Women Deliver highlighted the importance of arming women and girls with tools to protect themselves against HIV.

"The contraceptive ring has been a formidable tool for women seeking more control over their reproductive health, and it is wonderful to see HIV researchers adapt this technology to tackle the single biggest killer of young women. The simple fact is that we will never be able to fully ensure the health of women and girls globally without halting the spread of HIV and AIDS," said Sheffield

"Biology and gender inequality continue to place women at greater risk of disease and death, particularly in developing countries," said Elizabeth Mataka, the UN Secretary-General's Special Envoy for AIDS in Africa. "All too often, women are not in a position to control their sexual health or protect themselves from HIV infection. By Empowering  women with new tools to protect their health, this ring technology could bring hope where there was none before."

"The roll-out of treatment in the past few years has saved millions of lives, but ther AIDS epidemic continues to spread, with women particurly vulnerable, " said Michel Sidibe, the Executive Director of UNAIDS. "Preventing HIV transmission is essential if we are to protect the health and safety of future generations. If successful, innovations, like microbicides, could have an extraordinary impact."

Every day more than 3,000 women worldwide become infected with HIV. And HIV/AIDS is the leading cause of death for women aged 15 - 49 years in Africa. Despite this challenge, women lack a discreet method to prevent infection. Current prevention options may be impractical for women who lack the power to ensure that their male partners use condoms or remain faithful, and for those who are married, want to have children or are risk of violence. Health - e News service 20100608

KwaZulu-Natal might need to treat many more patients with multi-drug resistant TB in the next month, once four new testing centres are opened.

The centres will use a special genetic test that can identify MDR TB within a week, rather than the six to eight weeks it currently takes.

Provincial health department official Jacqui Ngozo told a meeting in Durban yesterday (27 May) that many people with drug-resistant TB died while waiting to be diagnosed.

“With the new PCR test, we expect double the patients because they will be diagnosed fast and will then need to be put on treatment fast,” Ngozo told the Global Business Coalition on HIV/AIDS, TB and Malaria meeting.

But the province is already short of at least 100 beds for drug-resistant TB patients, who need 24 months of treatment, six months of which is supposed to be in hospital.

The four  new testing sites are at Inkosi Albert Luthuli, Edendale, Ngwelezana and Madadeni Hospitals. They will be opened towards the end of June once staff members have completed their training, said Ngozo.

At present, Inkosi Albert Luthuli Hospital is the only centre that is able to test for drug resistant TB. It currently processes about 15 500 specimens a month.

Last year, KwaZulu-Natal treated 117 600 TB patients. Of these, 1 478 were MDR cases and 199 were deadly extensively drug-resistant (XDR) cases.

Eight out of 10 MDR TB patients were also infected with HIV/AIDS, while almost 70% of those with ordinary TB also had HIV, said Ngozo.

The cure rate was just 63% last year, but this is a vast improvement on the 2005 cure rate of 40%.

Ngozo said the province had opted to treat many drug-resistant patients in their homes, particularly in the Msinga district which has been worst affected by XDR TB.

Almost nine out of ten affected households in Msinga had no income other than social grants, and three-quarters of these households were headed by single women, said Ngozo.

“Imagine what would have happened to their children if we had admitted these women to hospital for six months,” said Ngozo.

She said that the department was expanding its community outreach programme so that it could treat more patients at home. – Health-e News Service.