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Charles Holmes MD, MPH, FIDSA Profile picture
@CharlesBHolmes
Jun 13, 2019 • 5 tweets • 4 min read • Read on X
Great news at the #saaids2019 conference in Durban! The #ECHO trial shows #NoLink between contraceptive method and HIV who.int/reproductivehe….
The #ECHO trial was needed due to concerns from observational studies that progestogen-only injectable contraception (e.g., DMPA) could be linked to HIV acquisition in women. This concern has at long last been put to rest: health-e.org.za/2019/06/13/saa…
There are now #NoExcuses -- we must accelerate efforts to integrate #SRH/HIV responses and support women to make the choice of contraception that is best for their circumstances
We should also be spurred to action by the high rate of background HIV incidence in all three arms of the trial. 397 new #HIV infections occurred during the #ECHO trial @UNAIDS_ZAF @HIVpxresearch
WHO's @rbaggaley “Women deserve better access to HIV testing & prevention in FP settings. Women already have contact with healthcare workers, it’s an ideal opportunity not only to receive contraception choices but also to be offered HIV testing & a range of prevention"

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More from @CharlesBHolmes

Charles Holmes MD, MPH, FIDSA Profile picture
Mar 16, 2021
Last month South Africa halted rollout of the AstraZeneca #COVID19Vaccine because it provided "minimal protection" against the B.1.351 variant first identified there.

We now know more details about what drove this decision, and it's concerning. (1/6)

statnews.com/2021/02/07/sou…
Study data published in @NEJM today found the A-Z vaccine "had no efficacy against the B.1.351 variant in preventing mild-to-moderate Covid-19." There were no severe cases in vaccine or placebo group, so we don't know if it prevents severe COVID. (2/6)
nejm.org/doi/full/10.10…
There's currently no evidence this vaccine is unsafe (despite concerns in Europe). But lack of efficacy against the B.1.351 strain has major implications for vaccination campaigns in low/middle income countries, especially in southern Africa. (3/6)

bmj.com/content/372/bm…
Read 6 tweets
Charles Holmes MD, MPH, FIDSA Profile picture
Jan 27, 2021
One week ago today President Biden took the oath of office. For those of you keeping track, here are the concrete steps @POTUS has taken in his first 7 days to implement a national strategy to beat #COVID19:
✅ ↑ weekly vaccine distribution to states/tribes/territories by 16% (an extra 1.4 m doses per week)

✅ ↑ USG’s total vaccine order by 50% to 600 million doses – enough to fully vaccinate all adults by the end of the summer or early fall. 2/
✅ Announced a federally-led vaccination strategy that will build the infrastructure to deliver these 600 million doses, and directed @FEMA to stand up the first federally supported community vaccination centers. 3/
Read 8 tweets
Charles Holmes MD, MPH, FIDSA Profile picture
Oct 8, 2020
Pence said many things last night that bothered me, but one line in particular stuck in my head this morning. He said, President Trump and I have the same plan as Joe Biden - we’re talking about testing, creating new PPE, and developing a vaccine.

But, here’s the truth. 1/
Public health is about doing the right things at the right time. You don’t get credit for a testing strategy if millions couldn’t get tested when they needed it. You don’t get credit for creating PPE in Oct if health workers were dying because they lacked N95s in April. 2/
You certainly don’t get credit for a vaccine if you rush an untested candidate to market in order to score political points, and in so doing undermine public trust in vaccines. 3/

cnn.com/2020/10/05/hea…
Read 8 tweets
Charles Holmes MD, MPH, FIDSA Profile picture
Oct 6, 2020
As an infectious diseases physician & someone who has practiced public health for the last 25 years, I'm appalled by @VP Pence's lack of respect for basic protective measures. This disregard for science- and more importantly, the health of those in the room with him- is stunning.
With President Trump & many other senior staff ill, the @VP has cast aside CDC guidance by breaking quarantine. Putting aside concerns about continuity of government, ask yourself - would I want to be maskless in a room with someone who had his exposures?

cdc.gov/coronavirus/20…
Especially in light of CDC's new guidance on the potential for airborne spread of the virus (meaning it can linger in the air for minutes or hours), the Trump administration should be taking *more* precautions with meetings and tomorrow's VP debate.
washingtonpost.com/health/2020/10…
Read 7 tweets
Charles Holmes MD, MPH, FIDSA Profile picture
Oct 4, 2020
The President’s medical team started him on the steroid dexamethasone yesterday. Of the COVID therapeutics I’ve discussed this weekend, dex is the only one shown to reduce mortality in patients w/ severe COVID-19. But it can also be risky for patients with mild illness. 1/7
Data published earlier this year showed that dex reduced deaths by one-third in COVID patients who had been sick >7 days and were on mechanical ventilators. Among patients receiving oxygen by less invasive means it reduced deaths by one-fifth. 2/7

nejm.org/doi/full/10.10…
However, here’s a key point: patients given dex who weren't on respiratory support died at a *higher* rate than similar pts who didn’t get dex. This wasn’t statistically significant, but if there’s no benefit & may be harmful, this is not a drug you start w/out good reason. 3/7
Read 7 tweets
Charles Holmes MD, MPH, FIDSA Profile picture
Oct 3, 2020
Americans are getting a crash course in novel therapies for #COVID19. This is a hotly debated topic, even among physicians. As we saw with hydroxychloroquine, the decisions Trump/his docs make affect what patients expect in their own care, so it’s worth talking about remdesivir.
Remdesivir is an antiviral originally developed to treat hepatitis C and later tried as a treatment for Ebola & Marburg. It didn’t work against those viruses, but it appears to have an effect on coronavirus (a good reminder that research on rare viruses can benefit us all)
2/n
Initial data from clinical trials were promising enough that the FDA granted emergency use authorization on May 1 for use in severely ill COVID-19 patients. In August FDA expanded this to apply to any hospitalized patient (the category Trump apparently falls under).
3/n
Read 12 tweets

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