Global Pulse Blog

Today, the second annual International Conference on Family Planning (ICFP)  in Dakar, Senegal began. This conference is co-hosted by The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Ministry of Health and Prevention in Senegal to bring together participants to share research, best practices, and progress on national strategies to deliver family planning services, with the ultimate goal of universal access to family planning.

Currently, over 215 million women worldwide want but do not have access to family planning tools. “We’ve made a lot of progress in putting maternal health on the global agenda; now we must call on leaders to put family planning on their to-do list. Every individual deserves this – women, men, and young people,” said Jill Sheffield, President and Founder of Women Deliver.

These speakers reinforced the importance of the demographic dividend – the concept that health and social development, enabled by full access to contraception, are inextricably linked with strong economic growth. They provide examples of success in Asia, where declining fertility, spurred by rising contraceptive use, have led to increased education, improved health, and market-driven economic policies which have allowed for significant income growth.  With an expanded world population of over seven billion, “Now is the time to prioritize family planning – as a strategy to reduce maternal mortality, to improve the lives of women and their families, and ultimately, to enable broad and enduring economic development,” said Dr. Amy Tsui, Director of the Gates Institute for Population and Reproductive Health, Professor at Johns Hopkins Bloomberg School of Public Health, and a lead conference organizer.

To proceed into the future, investments must be made in the health sector maintaining adequate numbers of midwives, OB/GYNs, facilities, etc. and examining past successes around the globe. As Hon. Stephen O’Brien stated, “having a child should bring joy” not dying in childbirth and women must be able to plan for the future. Family planning is smart and cost-effective. As Dr. Osotimehin stated, we must empower young people to take control of their futures along with the future of their countries and make sure that economic and social justice drives this process. Issues of family planning are issues of human rights.

According to Judy Manning from USAID, their priorities include: 1) Improve existing methods to make them more acceptable, easier to use and more affordable like injectable forms of contraceptives. 2) Develop new contraceptives to fill gaps such as duration of effectiveness between 3 month injectables and 5 year inserted rings. 3) Develop technologies that simultaneously prevent pregnancy, HIV & other STDs like the silk diaphragm which delivers tenofovir.

Clearly there is an immense need for family planning access, affordability, and effectiveness. Fortunately, there are also attainable solutions. Meetings such as ICFP brings together a wealth of scientific knowledge, family planning experience, and critical discussions to help ensure that universal access to family planning becomes a reality.

With World AIDS Day coming up on December 1st, I had the opportunity to join in a call with Stefano Bertozzi Director of HIV and TB at the Bill & Melinda Gates Foundation.

World AIDS Day is a time to renew our commitment to the 34 million people living with HIV/AIDS worldwide and the recent developments revolving around HIV, including several scientific breakthroughs in HIV prevention research and Secretary Clinton’s recent remarks declaring that it is possible to reach an AIDS-free generation, make this an especially exciting time to reflect on the epidemic.

According to Dr. Bertozzi, the strategy of the Bill & Melinda Gates Foundation includes both decreasing new infections and improving quality of life of those currently infected. A large focus of this strategy is on the delivery of current strategies in large part through the Global Fund as well as smaller national programs.

Despite the proven effectiveness of existing prevention approaches, there are limitations. For example, many women are not in a position to insist that their partners wear condoms and daily adherence to prophylactic treatments is difficult. The development of a vaccine and other new prevention options is critical for successfully fighting the epidemic, especially in developing countries. The largest investment in newer technologies is currently in trying to develop a HIV vaccine. As such, a focus is on the success of the RV144 HIV vaccine trial, which recently showed encouraging results in Thailand and advancing that to the next generation of the vaccine with hopes of increased efficacy.

They are also investing heavily on products that can be used by individuals to protect themselves either topically in the vagina or systemically. While daily use of vaginal microbicides has shown mixed results, many reasons may contribute to this, especially lack of adherence which is a common problem with daily use products. To address these challenges, they are working on products which are less dependent on adherence such as a vaginal ring which slowly releases the antiretroviral compound dapivirine and can be left in for up to a month.

Another strategy is systemic daily antiretroviral prophylaxis which has also had mixed results and faces problems with adherence, but looks promising. They are focusing on injectables which can be injected every 1 to 3 months, decreasing the need for adherance. The Gates Foundation is currently supporting clinical trials to evaluate the effectiveness of Pre-exposure prophylaxis (PrEP) such as this for HIV prevention.

Images from the Bill & Melinda Gates Foundation

Additional efforts are on enhancing the delivery of male circumcision and scaling up these programs with fewer resources. Despite three clinical trials demonstrating the protective benefit of the procedure, donors and countries have been slow to invest in voluntary male circumcision for HIV prevention. The foundation is investing in advocacy efforts to encourage more rapid scale-up of male circumcision for HIV prevention and funding research on new technologies and methods for performing male circumcision safely and less expensively. This strategy is so cost effective that it costs more money to NOT implement such programs due to the future treatment savings.

The Gates Foundation is also working towards improving the delivery and effectiveness of current programs. With decreasing funding in a faltering global economy, scale up of treatment has continued at the same pace by improving efficiency of programs. Fortunately this has been happening in HIV treatment. Continuing efforts to reduce the cost of drugs, design and implement more efficient delivery systems and further task shifting and sharing among health providers is needed without compromising care and can even lead to improved quality of care.

Today’s guest blog post by Anand Reddi was originally published yesterday in The Huffington Post. Anand Reddi was a Fulbright Scholar in 2005, assisting the Sinikithemba HIV/AIDS clinic at McCord Hospital in Durban, South Africa. Currently, Mr. Reddi is a medical student at the University of Colorado, School of Medicine. Here, he reflects on Secretary Clinton’s speech earlier this week and the importance and potential of a Global Health Service Corp.

Stay tuned to Global Pulse Blog for more views on this monumental speech and its implications.

Yesterday, Secretary of State Hillary Rodham Clinton declared the U.S. government’s intent to create an “AIDS-free generation.” Secretary Clinton outlined a bold plan to reduce new HIV-infections, globally, including the eradication of pediatric HIV by 2015. This new strategy builds upon the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. program that addresses HIV/AIDS in resource-limited settings.

A notable feature of Secretary Clinton’s “AIDS-free generation” initiative is to strengthen healthcare systems in sub-Saharan Africa. Clinton stated:

“We know we can’t create an AIDS-free generation by dictating solutions from Washington. Our in-country partners — including governments, NGOs, and faith-based organizations — need to own and lead their nation’s response. So we are working with ministries of health and local organizations to strengthen their health systems so they can take on an even broader range of health problems.”

Strengthening African healthcare systems is a view echoed by many eminent voices in the global health community. Last year, the Institute of Medicine (IOM) of the National Academy of Sciences authored a report entitled: “Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility.” The IOM report recommended the urgent need to increase African healthcare workforce capacity to address the HIV epidemic.

I offer Secretary Clinton a solution to assist African healthcare workforces and ensure the success of the “AIDS-free generation” initiative. Last year, in an editorial in The New England Journal of Medicine, Vanessa Kerry, Sara Auld, and Paul Farmer reintroduced the idea of enacting a Global Health Service Corp (GHSC). The GHSC, compromised of U.S. healthcare professionals, would provide medical education and technical assistance to enhance the healthcare workforces in low-income countries. The GHSC’s goal would “go beyond that of filling a human resource void to focus on infrastructure development, knowledge transfer, and capacity building.” The GHSC could also offer partial student loan forgiveness for U.S. corps members who engage in service abroad for a specified time period similar to the loan forgiveness offered by the National Health Service Corp.

To address the African healthcare workforce shortage, I encourage Secretary Clinton to adopt the principles of the GHSC. The success of the “AIDS-free generation” initiative depends on the availability of skilled healthcare workers in African resource limited settings. Additionally, the eventual transition from a U.S. to African led HIV/AIDS response requires the U.S. to teach and train healthcare personnel in recipient countries through collaborative partnerships that eventually lead to African ownership of their domestic healthcare needs.

Some may argue that enacting the GHSC, especially in the era of U.S. government austerity measures, is not prudent. However, the funding for the GHSC already exists. In addition to HIV/AIDS prevention and treatment, PEPFAR’s congressional mandate requires the program to “strengthen partner government [healthcare] capacity to lead the response to this epidemic and other health demands.” Last year alone, PEPFAR committed over $734 million in healthcare capacity building initiatives.

Global health is the moral litmus test of our time. As Secretary Clinton asserted: “An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” The U.S. should enact the GHSC to ensure the success and sustainability of the “AIDS-free generation” initiative.

-Anand Reddi, The Huffington Post

If you are interested in supporting the Global Health Service Corp please sign the petition to show your support. http://www.globalhealthservicecorps.org/index.php/petition/

Additionally, the Medical Student Section of the American Medical Association is considering a resolution endorsing the GHSC at its 2011 Interim Meeting in New Orleans, Louisiana.

Check out our next guest blog series from The Global Health Technologies Coalition. GHTC’s Kim Lufkin traveled to Kenya recently to visit global health research projects going on there and view the impact of these projects on the Kenyan people. Below are some of her reflections, originally published on GHTC’s blog.

Some of the most incredible health research is taking place in Kenya right now. Because of this work, we are on the cusp of the most exciting new tools in global public health in recent years—the first ever malaria vaccine, gels women can use to protect themselves from HIV, new drugs for neglected diseases that affect the poorest of the poor. Kenya is also rolling out an array of lifesaving new health products that research has already made available, like HIV/AIDS drugs, vaccines to protect children from pneumonia, and insecticide-treated wallpaper that prevents malaria inside people’s homes.

During the GHTC’s recent trip to Kenya, I was fortunate to visit several of these global health research projects, most of them run by our dedicated coalition members like the Drugs for Neglected Diseases initiative (DNDi), PATH, the International Partnership for Microbicides (IPM), Aeras, and the International AIDS Vaccine Initiative (IAVI).

We also saw firsthand how the US is making a huge impact in health research in the country, through the work of agencies like the US Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and the Department of Defense (DoD).

3935 – Siaya, Kenya – Kayla Laserson is the Director of the KEMRI/CDC Field Research Station . Photo: Evelyn Hockstain/PATH.

Although we visited a range of projects, I was left with the lasting impression that much of this research is so close to producing new health tools that can lead to amazing innovations in public health. “We are on the verge of breakthroughs in malaria and in TB and in other diseases,” Kayla Laserson, director of the CDC/KEMRI Field Research Station in Kisian, said. “What we really need is continued support so we can get the job done, we can finish it, we can show the impact, we can save hundreds of thousands of lives here and globally.”

We also saw how past commitments to research are already saving lives. For example, research that led to the development of antiretroviral drugs is one of global public health’s biggest success stories.  Rister Kageha, a woman living with HIV close to the town of Kakamega, told us how these drugs had not only saved her life, but also prevented her daughter Sylvia from contracting HIV. Because of these drugs, “I expect to live long,” Rister said, adding that she also hopes for a long life for Sylvia due to the drugs that kept her daughter HIV-negative.

Rister Kageha says antiretroviral drugs saved her life. Photo: Evelyn Hockstein/PATH.

And while past research has led to some health tools already in use, and current research is producing breakthroughs we could see in next five years, other innovations aren’t as far along down the research pipeline. This is why continued US support is critical to sustain the momentum around these new tools, from discovery to delivery. US support for microbicides, for example, has been vital to recent research successes, and must continue while the research continues over the next several years.

A microbicide “is one of the tools that gives us the opportunity that we could actually end the epidemic,” Elizabeth Bukusi, deputy director at the Kenya Medical Research Institute (KEMRI) who works with IPM, said. “I think we can move towards a complete AIDS-free generation that will completely stop the epidemic in its track using microbicides as part of the armament.” She added that the “US has been a critical partner in providing catalystic funds and also in funding a large number of the trials that have looked at microbicides. So US funding is absolutely critical to moving this agenda forward.”

The same can be said of US support for all global health tools, not just microbicides. Fortunately, if Kenya is any indication, the US has a long history of supporting research for health products like vaccines and drugs.This long history should not end anytime soon. It’s imperative that this historical leadership continues, so the groundbreaking research the GHTC saw in Kenya can produce the next generation of lifesaving health tools.

-Kim Lufkin, GHTC

For the past 10 years, the Botswana-UPenn Partnership has been “building a healthy future together.”  This initiative between the Government of Botswana, the University of Pennsylvania and the University of Botswana was originally formed in 2001 to build capacity in Botswana in response to the HIV/AIDS epidemic and has evolved to take a broad interdisciplinary approach to train health care personnel throughout Botswana, to develop medical training programs in Botswana, to form partnerships and joint research and clinical programs and to offer experiences in global health to trainees and faculty.

During the week of October 10-14, 2011, the Botswana-UPenn Partnership celebrated its ten year anniversary with events highlighting the past, present and future of the program. Check out the archives to learn more about this program, its history and where it is going!

Continuing our series of guest blog postings from Partners in Health, this piece originally published on the PIH blog by Jenna LeMieux gives insight into the experiences behind the Program Management Guide introduced in the first posting. This former project manager in Malawi experiences are documented in the new guide, and here she shares more about the connections and her work.

By Jenna LeMieux, PIH Director of Programs

	Construction on Neno District Hospital in 2007.
	Construction of staff housing in Neno, Malawi.

When I began working for Partners In Health in January of 2007 as a program manager, I thought I had a good sense of the scope and responsibilities of the position I had accepted. I was to help launch the new PIH-supported site in Malawi, Abwenzi Pa Za Umoyo (APZU). I spent about two months in Boston before I moved to Malawi, and during that time was able to make valuable connections to colleagues with expertise in finance, procurement, and human resources. Little did I know how valuable those connections would become.

Looking back now, I am amazed by the complexity and volume of work that awaited our team. I had no idea how varied and lengthy my “to-do” list would be. Partnering with the Ministry of Health, we wanted to immediately begin supporting and improving the care available to patients in Neno District. We set to work on substantial renovations at several health centers, with the goal of providing dignified and well-equipped settings in which patients could receive care. We began planning for the construction of a brand new, two-story district hospital. And we began constructing 26 housing units for the Ministry of Health staff and ourselves.

We hired cleaners, guards, nurses, cooks, and administrative staff. We worked with Village Headmen to identify community health workers. We partnered with local community-based organizations to understand grassroots activities already taking place to educate people about HIV transmission and prevention, and to understand how we could support those activities. We established relationships with hospital equipment and supplies vendors in the nearest large city, and began to renovate a large building that would serve as a warehouse.

Explore the Guide

Our long list of goals was informed and shaped by my colleagues at PIH who had engaged in similar start-up activities in Rwanda and Lesotho, among other places. Their collective experience and wisdom guided our work, and helped us prioritize among a dozen urgent and competing demands. When I first began working in Neno, I was fortunate to have access to individuals who could answer the dozens of questions I had on a daily basis. Their advice and counsel was invaluable, and the Program Management Guide represents our effort to share that collective experience with others.

My work in Neno was supported by a robust network of experienced professionals willing to offer their time and expertise to help guide our work. Those same individuals have pored over this guide, adding the content and stories, sharing their knowledge and advice, which is rooted deeply in PIH philosophy and based on decades of field experience. We hope it will serve as a practical and useful tool for program managers, and for others engaged in this work around the globe.

Check out PIH’s new Program Managment Guide.

Malawi’s Neno District Hospital today.

The African Leaders Malaria Alliance (ALMA) recently launched a new Malaria Scorecard for Accountability and Action.  This tracking tool  allows African leaders, governments and global donors to be held accountable for progress against malaria, encouraging transparency in global health efforts. ALMA is an alliance of African Heads of States and Governments from 40 countries. The new scorecard tracks various stakeholder’s progress toward vital targets such as financing, devlivery of malaria commodities (mosquito nets, etc.), malaria policy, malaria mortality and maternal & child health indicators. The hope is that this new tool will support the achievement of the global goal of near zero malaria deaths by 2015, building on recent successes including the fact that 11 African nations have reduced malaria by more than 50%.

“Africa is pursuing ambitious targets against malaria and having timely, trusted data is critical to reaching our goals,” said Joy Phumaphi, Executive Secretary of ALMA. “Armed with this information, African leaders and partners can make policy decisions and demand action that will help countries rapidly improve their efforts against malaria.”

People in the Democratic Republic of Congo rarely use condoms despite the country’s high prevalence of HIV. Amy Lockwood explains why and offers a solution from a marketing point-of-view. Watch here:

http://www.ted.com/talks/amy_lockwood_selling_condoms_in_the_congo.html

Medical students are invited to apply for the third annual Beyond the Biological Basis of Disease: The Social and Economic Causation of Illness, an on-site immersion course in social medicine offered at Lacor Hospital in Gulu, Uganda from January 9, 2012 through February 3, 2012.  This intensive course designed for 15 international medical students (clinical years) and 15 Ugandan medical students (3rd-5th year) from Gulu University intersects the study of clinical medicine in a resource-poor setting with social medicine topics such as the social determinants of health, globalization, global health interventions, war, human rights, community-based health care, and narrative medicine.  This highly interactive course is taught through a combination of lectures, small and large
group discussions, films, community field visits, ward rounds, and clinical case discussions. Credit for away-rotations can be arranged.

Short videos of previous courses can be viewed by clicking the desired year: 2010:
http://www.youtube.com/watch?v=gLHGpY4EDwg&feature=related and 2011:
http://www.youtube.com/watch?v=Z2UCUFcXAas.

If you have any questions or are interested in applying, please email
social.medicine@yahoo.com.  Applications are due July 31, 2011.

According to a study published in the May 13th edition of Science, researchers at the Johns Hopkins Bloomberg School of Public Health have identified a bacterium in mosquitos caught in the wild in Zambia which halts the development of Plasmodium falciparum. This Enterobacter bacterium occurs naturally in the mosquito’s gut microbial flora and kills the parasite which causes malaria in humans by producing reactive oxygen species (free radicals). The bacterium killed 99% of plasmodium both in the mosquitoes and in test tubes. Around 25% of mosquitoes caught in the sample had Enterobacter in their guts.

Field workers in Macha Zambia capture mosquitoes with traps.

Image from JHSPH website

According to the study’s senior author George Dimopoulos, PhD, “We’ve previously shown that the mosquito’s midgut bacteria can activate its immune system and thereby indirectly limit the development of the malaria parasite. In this study we show that certain bacteria can directly block the malaria parasite’s development through the production of free radicals that are detrimental to Plasmodium in the mosquito gut.”

This finding suggests that mosquitoes of the same species and strain sometimes have different resistance to the Plasmodium parasite. Scientists hope that this discovery could lead to new methods to reduce the spread of malaria, for example, by exposing mosquitoes in the wild to this bacterium.

For more on malaria and recent developments in the fight against this global killer, check out our recent blog posting on World Malaria Day.