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Fool Us Once…

TAGline Spring 2014

April 1. This is the day upon which we are reminded of what we are on the other three hundred and sixty-four.
—Mark Twain, Pudd'nhead Wilson

By Tim Horn

We’re being duped by our government agencies. We’re being hoodwinked by the Affordable Care Act (ACA). We’re being bamboozled by pharmaceutical companies and research networks. In this April Fools’ issue of TAGline, we highlight several missteps in research and policy that have required some degree of advocacy to remedy and ensure that the jokes don’t remain on us.

We begin with Jeremiah Johnson’s assessment of the U.S. Centers for Disease Control and Prevention’s High-Impact Prevention (HIP) strategy. With its primary focus on the HIV care continuum and the potential benefits of treatment as prevention, HIP fails to account for the comprehensive needs of at-risk HIV-negative individuals, many of whom may be served well by recent advances in biomedical prevention and expanded Affordable Care Act (ACA) coverage opportunities.

In Mark Harrington’s review of progress made in achieving the goals of the National HIV/AIDS Strategy, a World AIDS Day 2013 report from the White House Office of National AIDS Policy (ONAP) delivers an encouraging update on the state of the U.S. epidemic. Yet shortcomings of the available data and methodological flaws in the analysis undermine the credibility of ONAP’s progress report.

Despite the anti-discrimination mandate of the ACA, many people living with HIV are facing serious challenges securing affordable care and treatment through qualified health plans (QHPs) in state and federal exchanges. As Kenyon Farrow explains, advocates are scrambling to overcome obvious discriminatory practices, notably efforts to block third-party assistance intended to cover the high costs of QHP premiums and out-of-pocket expenditures.

We also focus on curious questions surrounding drug development and treatment optimization. In collaboration with Polly Clayden of HIV i-Base, I review data from a recent clinical trial that suggest we’ve long been using too high a dose of the antiretroviral efavirenz. The question remains, however, whether these better-late-than-never findings will translate into cheaper, safer dosing in the near future.

In the TB treatment arena, Lindsay McKenna investigates the significant taxpayer investments in research and development of drugs that are ultimately priced beyond reach by those who need them the most. And Mike Frick summarizes the scientific challenges associated with a clinical trial attempting to rush two critical questions: the utility of a shortened course of therapy for multidrug-resistant tuberculosis (MDR-TB), and the confirmed safety and efficacy of the new drug bedaquiline for MDR-TB. 

An unavoidable aspect of moving forward with efforts to end the HIV, TB, and viral hepatitis epidemics is having to address potential miscues that have been made along the way, sometimes years after the fact. Determining culpability is invariably part of process. What matters most, however, are the strategies put into place to repair breaches, right wrongful courses, and ultimately turn mistakes into opportunities for advancement.•