USAID Impact Photo Credit: USAID and Partners

Archives for Health

Nothing About Them, Without Them: Including Youth in Transition Services for Adolescents Living with HIV

Heather Bergmann, of John Snow Inc., is the Technical Officer for USAID’s AIDSTAR-One project

No one born since 1985 knows a world without HIV. Nearly half of the world’s population is under 25, and far too many of these young people know all too well how the virus can devastate a family or community.

I had the pleasure of meeting a remarkable group of young people living with HIV at a recent technical consultation co-sponsored by the President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID).

Thanks to advances in AIDS treatment, a new generation of HIV-positive youth is surviving childhood and preparing to “age out” of pediatric HIV services—at a critical moment in their lives.

Youth living with HIV face many challenges.  Not only are they—like others their age—exploring new romantic and sexual relationships, but they must also learn to manage their own HIV care.

Without proper support, many young people can become overwhelmed, a response that can challenge adherence to AIDS medicines and lead to negative health consequences. This is why it’s imperative to create health services that are appropriate and accessible for youth living with HIV.

Young people have an important role to play in HIV program and policy development. They can provide unique insights into how best to reach their peers and which messages resonate with youth living with HIV and AIDS.

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MAMA Bangladesh – Connecting Health Information and Services to Mothers Through Mobiles

Kirsten Gagnaire is the Global Partnership Director of the Mobile Alliance for Maternal Action (MAMA).

IDEA/Mobile Solutions is an office at USAID that champions the use of mobile technology for development issues. Mobile Solutions provides support to mobile technology initiatives implemented by USAID pillar bureaus, such as mAgriculture and mHealth. One of the most prominent mHealth initiatives, launched by Secretary Hillary Clinton on Mother’s Day last year, is the Mobile Alliance for Maternal Action (MAMA).

MAMA is a Global Development Alliance founded by USAID and Johnson & Johnson, with support from the mHealth Alliance, United Nations Foundation and BabyCenter. In March, MAMA board representatives visited Bangladesh to meet with MAMA country partners and conduct field visits to meet pregnant women, new mothers and family members who have subscribed to the MAMA mobile phone service, which is called ‘Aponjon’ in Bangladesh. This blog post comes from MAMA Global Partnership Director, Kirsten Gagnaire, and is part of the “blog tour series” reporting on the site visits and experience in Bangladesh. Read how USAID is helping women connect to health services in the developing world.

In Bangladesh, as in so many low-income areas across the globe, pregnant women and new mothers don’t have access to timely, reliable and culturally relevant information about how to best care for themselves and their babies.  Although there has been some improvement over the past ten years, it remains a fact that death due to pregnancy, childbirth and infancy-related causes are high in Bangladesh. And these deaths are often preventable with basic knowledge and care.

A young mother in Bangladesh using a cell phone. Photo Credit: MAMA

The Mobile Alliance for Maternal Action (MAMA) was created to provide new and expectant moms with vital stage-based information via mobile phones. Subscribers who register indicate their expected due date, or the birthday of their recently-born child, and receive weekly messages timed to the stage of pregnancy or the age of their newborn. MAMA’s first in-country program is an initiative catalyzed by USAID and local partner D.Net. Catalyzing the support of a public-private coalition in country, with strong support from the Prime Minister’s Office and the Ministry of Health, MAMA Bangladesh has developed and piloted an mHealth service called Aponjon, the Bengali word for “trusted friend”. Aponjon works as a mobile-messaging based service, providing moms and the gatekeepers within their families (usually spouses, mothers, and mothers-in-law) with information about how to take care of themselves and their babies, and includes an entirely separate service for husbands that reinforces messages that their wives are receiving and includes information on how to best care for their loved ones during pregnancy and early childhood.

MAMA messages include information on self-care during and after pregnancy, as well as information on when to seek care and how to care for a newborn. MAMA Bangladesh recognizes the need for linking subscribers to local health services, and has  built strong relationships with local health providers.

“I can only visit my clients once each month,” one community health worker told us during a site visit. “But the mobile phone messages continue to provide information between visits; more information than I would be able to share during a single visit.”

The importance of the connection between information about health and information on where to seek assistance was highlighted during one of our site visits.  When asked what was the most important message they received, Shoma and Sale, new parents, beamed at their healthy baby and said that it was a message that discussed the signs of newborn respiratory illness.  They realized their baby was exhibiting the symptoms which required care, according to the message they received.  They were able to connect with their local clinic, where their baby was treated and recovered.

Messages to moms and their families are one of the first, and critically important, steps in educating people about their health, connecting them to care and changing behaviors. MAMA Bangladesh has registered 1,800 women in three districts thus far, and aims to launch nationwide later this year.

To learn more about MAMA, visit http://www.mobilemamaalliance.org/.

 

White House Easter Prayer Breakfast: Gathering Leaders — and Partners

In his opening remarks to over one hundred Christian leaders at the White House Prayer Breakfast, President Obama said that “I’m even more grateful for the work that you do every day of the year — the compassion and the kindness that so many of you express through your various ministries.”

President Obama addresses the audience at the 3rd Annual White House Easter Prayer Breakfast. Photo Credit: USAID

Many of the ministries that the President referred to are focused outside of the U.S.  They are ministries, organizations and initiatives that partner with and complement the work of USAID.  From efforts to increase the bounty of agricultural work with Feed the Future, to helping provide medical care that helps children reach their fifth birthday with the Global Health Initiative to literally freeing persons chained into human trafficking together with our Counter Trafficking in Persons efforts, the leaders and their supporters strengthen and extend their own goals of the goals of USAID.

After the Prayer Breakfast, the religious leaders took part in a briefing that included hearing about the tremendous progress that has been achieved in the last few decades in child survival from USAID Deputy Assistant Administrator for Global Health Amie Batson. In the past two decades child deaths have fallen dramatically, from 12 million in 1990 to 7.6 million in 2010. In fact, the goal of ending preventable child deaths is possible –  if the world works together.  Along with strong country ownership, partnership with faith-based and community organizations will be critical to make this a reality.

This is where you can help!  In close collaboration with UNICEF, the United States is co-convening a Call to Action in June 2012 to set the course towards the end of preventable child deaths.  We need your help to raise awareness and drive collective action! If you’re interested in learning more and want to partner with us, please email:  FBCI@usaid.gov for more information.

Echoing the President’s remarks, thank you for you continued leadership, passion and dedication to helping the most vulnerable.  Together we can create a world where every child, no matter where he or she is born, has an equal opportunity to survive and grow.

 

On the Road Again: USAID’s Mobile Medical Teams Resume Serving Yemen’s Marginalized People

During my recent visit to Yemen I had the opportunity to view many of the ways in which USAID is supporting development in the country. I was particularly impressed by USAID’s successful effort to provide local communities with basic medical services.

Assistant Administrator Rudman inaugurates an MMT van, marking the resumption of the MMT program. Photo Credit: USAID

Yemen faces many challenges, but few are as daunting as providing medical care to its displaced and marginalized populations. Currently, just a quarter of rural Yemenis have access to medical care.

One way in which USAID has assisted Yemen in responding to this challenge is by developing mobile medical teams (MMTs), clinics on wheels that travel regularly to marginalized communities. USAID launched the first of its 15 MMTs in the remote governorate of Marib in February 2011.

The MMTs struggled to operate during the civil disturbances of the past year and had limited opportunities to visit local communities. But now they are back on the road. I had the pleasure of joining one such team on a sunny February morning.

It did not take long for a huge crowd to form around the MMT van when it rolled into a gray and dusty Sana’a neighborhood in the district of Sawan. A flurry of excited activity accompanied the arrival of the USAID MMT van. It was clear that these MMTs constitute a critical lifeline for many already at-risk Yemenis. The fully equipped MMT offers basic primary care, maternal and child care, diagnosis, immunization, and medications—all for free—to needy and marginalized people. On this day, however, I was told that the reappearance of the MMT vehicles after weeks without them created even more of a stir.

After a short ceremony marking the resumption of the MMT program, local men, women, and children lined up to receive basic medical services, including blood pressure readings, vaccinations for the young, and medication for the sick. I was impressed both by the warm welcome the community offered and the efficiency and effectiveness the medical team displayed.

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Achieving an HIV- and TB-Free Generation

Originally posted to the Elizabeth Glaser Pediatric AIDS Foundation blog

Too many people around the world have forgotten about the dangers of tuberculosis – particularly for mothers and children.

TB is a highly contagious bacterial infection that can be spread in saliva, most often through coughing, sneezing, or exhaling in close quarters.

While TB has a lower profile today, an estimated one-third of the world’s population is infected – and in sub-Saharan Africa, that infection is often paired with HIV.

As we mark the 30th World TB Day on March 24th, we remember that tuberculosis remains a danger for millions, and an important issue affecting maternal and child health.

While it’s the second-leading cause of death from an infectious disease worldwide, it’s the third-leading cause of death for women overall. And the World Health Organization (WHO) estimates that at least half a million infants and children become infected with TB every year, and 70,000 die from it.

Through my work at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), I’ve witnessed how mothers and children living with HIV are among the most susceptible to TB, particularly in sub-Saharan Africa.

HIV-positive pregnant women are ten times more likely to contract TB, and those with TB have a greater likelihood of passing HIV on to their infants through mother-to-child transmission. TB infection also leads to a much higher mortality rate for both mothers and babies.

For children, TB is a largely overlooked and neglected issue. Early detection and diagnosis of TB in children remains a challenge, particularly for HIV-positive children, who often have other HIV-related lung conditions and symptoms that mimic those of TB.

Children living with HIV have a higher risk of dying of TB because their immune systems are weaker, and treatment options are more limited. Medicines to treat TB in children lag behind the treatment options available to adults, and are often difficult to administer to young children.

The good news is that TB is preventable and treatable, and treating HIV and TB together can be highly successful. The WHO’s TB treatment guidelines point to combining TB treatments and antiretroviral therapy (ART) as an effective way to limit TB incidence by up to 90% in individuals.

This week, the WHO and the Stop TB Partnership highlighted the issue of pediatric TB, and how to reach zero TB deaths in children.

Working with USAID, the Elizabeth Glaser Pediatric AIDS Foundation is committed to reducing the risk of TB among children and HIV-positive mothers by improving integration of TB services within existing programs to prevent mother-to-child transmission (PMTCT) of HIV, and within broader maternal and child health (MCH) services.

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An Excellent ‘Xpert’ Diagnostic Test for Tuberculosis Infection

There is some really exciting news in the world of TB diagnostics.  If you haven’t heard already, there is a new molecular diagnostic test developed by Cepheid that has the potential to transform how TB is detected.  The GeneXpert MTB/RIF assay can detect TB and mutations associated with rifampicin resistance in less than two hours with far greater accuracy than smear microscopy.  The MTB stands for the mycobacterium that causes the Tuberculosis infection.  The RIF means Rifampicin resistance, one of the most potent and important of the drugs to fight TB.  If the mycobacterium is resistant to Rifampicin, it is an indication that the person also has an infection that is resistant to the other most important drug to fight TB, this is then called multi-drug resistance.  TB is an extremely difficult disease that requires 2 years of treatment with toxic drugs.

In addition, this new test will help to detect more people who are infected with both TB and HIV since most of these people cannot be detected by smear microscopy alone. Since undiagnosed and untreated TB is the greatest killer of people living with HIV, the Xpert test should help to save many lives, especially in Africa.

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Our Continued Common Struggle – World Tuberculosis Day 2012

Last year on this blog, I wrote about why the United States and Eastern Europe and Eurasia need to work together to fight against multi-drug resistant (MDR) – tuberculosis (TB) and extensively drug-resistant (XDR) –TB. In the world of modern travel, these diseases are a plane ride away from our shores.

As we commemorate World Tuberculosis Day this year, Eastern Europe and Eurasia continue to have the highest rates of MDR-TB and XDR- TB in the world.  Of the 27 countries with a high burden of M/XDR-TB, 10 are in the Europe/Eurasia region.  MDR-TB is a national security interest and a global health interest for the region and for the world.

Tuberculosis is largely curable but also potentially deadly. It exacts an enormous personal and economic toll, often striking people in their most economically productive years.  Diagnosis and treatment of MDR-TB and XDR-TB are more complicated and expensive.  MDR-TB for example requires 24 months of treatment vs. 6 months for drug-susceptible TB and the treatment is more than 260 times more expensive.  As a result, M/XDR-TB constitute major risks to effective TB control.

Europe and Eurasia are of particular concern because they have shown the world’s highest rates of MDR-TB.  A 2011 USAID-funded survey in Minsk, Belarus found the highest MDR-TB rates recorded to date.  Prior to that, one region in Russia and Baku, Azerbaijan had the highest recorded rates.

The picture of TB in the region is unique, fueled by inadequate diagnostics, poor compliance with treatment and insufficient infection control. The growth of HIV/AIDS further contributes to TB rates.  In addition, TB programs historically have been implemented in a silo fashion separate from the rest of the health care systems, and drug regimens have been improperly prescribed and/or incompletely followed by patients.

In response to alarming new rates of MDR-TB USAID, working in collaboration with national TB programs and the Global Fund, has invested strategically and targeted areas where it can have the highest impact: strengthening surveillance systems, improving the quality of data collection and monitoring, strengthening laboratories, improving infection control, strengthening treatment services,  bolstering drug management practices, and improving policies and protocols.

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In TB Fight, a Call for More Teamwork

Guest blogger Joanna Breitstein is the Director of Communications at the TB Alliance.

At an event heralding the launch of a new clinical trial that tests tuberculosis drugs in combination, Robert Clay, Deputy Assistant Administrator in USAID’s Global Health Bureau, said that he wants researchers and those who oversee programs in countries to work more closely together.

Clay told a packed audience at the Kaiser Family Foundation in Washington, D.C. that “past polarization of research and implementation is really something that we have to overcome.”

“The researchers have to understand the barriers that implementers are facing to work through these programs, and the implementers have to understand the kinds of studies that are being carried out, and looking at these results to translate that in real time to policymakers,” he said. Clay said these kinds of working relationships were especially important in a time of tight financial resources. Speaking about efforts to fight TB, he said, “No one group can address this alone. … We’re going to have to be working together to grow the pie.”

The event, which was organized by the Critical Paths to TB Drug Regimens, featured the announcement by TB Alliance of a Phase 2 clinical trial involving a three-drug combination therapy. Two were novel drug candidates and the third is now being used in other regimens. The Alliance aims to hold back several TB drugs at once in hopes of finding new regimens that can cure strains of TB that are resistant to many current medications. The new clinical trial, which was launched on Monday, will take place in eight countries over the next two months. Results won’t be known for another year.

Clay said that the current situation in fighting TB – no new drugs in 47 years, a vaccine that is not effective for adults, and the most common diagnostic tool more than a century old – is the price paid for long-time neglect. “For diagnostics, a lot of what we are doing is relying on a 19th century tool, the microscope. Unless we have new technologies, we are not going to meet the goal of TB elimination in 2050.” If efforts succeed in finding new drugs, he said, “it will likely be more cost effective, be a shorter drug regime, reduce lost work time, and lessen the economic impact of TB, which will benefit the individuals. It also will help stabilize families and communities and save and enrich the lives of millions of children.”

You can watch the event on the TB Alliance Vimeo account.

A Deciding Moment for Women, Girls, and HIV

For the past two weeks, the buzz in Washington, DC and at the White House, is all about women and girls.

Yesterday, to mark National Women and Girls HIV/AIDS Awareness Day, the Administration announced a new initiative to help local communities and grassroots organizations fight HIV/AIDS and gender-based violence.

U.S. Global AIDS Coordinator for the President’s Emergency Plan for AIDS Relief (PEPFAR), Ambassador Eric Goosby, and Ambassador-at-Large for Global Women’s Issues, Melanne Verveer, highlighted how $4.65 million in small grants to civil society organizations will help promote gender equality and prevent HIV among women and girls in local communities.

With women accounting for over 64 percent of HIV-positive people worldwide, addressing the needs of women and girls living with HIV and AIDS worldwide is essential. Equally important is improving our response to gender-based violence, given that violence against women and girls increases their vulnerability to HIV.

Partnerships between US agencies, civil society, private corporations, and international institutions, are key to tackling these issues.

For its part, USAID is working to integrate gender-based violence into all of our HIV/AIDS programs. According to Carla Koppell, Senior Coordinator for Gender Equality and Women’s Empowerment at USAID, the intersection between domestic and international HIV/AIDS and gender-based violence programs is crucial.

USAID-supported projects like the Go Girls! Initiative, which worked in several countries, including Botswana, Malawi, and Mozambique, have made significant gains in this area. By helping to prevent HIV infection in adolescent girls through the development of youth-focused materials, Go Girls! made gender a central issue to tackling HIV/AIDS.

Private companies are also helping to fight gender-based violence and HIV/AIDS. Yesterday we heard from the MAC AIDS Fund, one of several partners teaming up with national governments to fight poverty and promote HIV prevention around the world.

In South Africa, I’ve seen first-hand how successful these types of partnerships can be.

A recent collaboration between the South African government, USAID, MAC AIDS Fund, and other partners provides support for Thuthuzela Care Centres, which offer important counseling and health services for women and girls to combat sexual violence and HIV. More engagement from partners and private corporations will go a long way in turning the tide against both gender-based violence and HIV/AIDS.

While the events over the last few weeks have done much to highlight women and girls, our work to improve their wellbeing in the context of HIV/AIDS and gender-based violence is only just beginning. To truly tackle these issues, we must continue to work together with all of our partners to create a generation free of HIV and improve the lives of women and girls around the world.

Video: Health Research and Development in Kenya

USAID’s  health research strategy (PDF) includes assessing health conditions in developing countries and developing, testing, adapting, and introducing appropriate products and interventions within the context of strengthening local health systems.

See that strategy in action in this new video from Global Health Technologies Coalition about our health research and development work in Kenya.

Watch this video on YouTube.

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