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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.

Fighting newborn infections: New evidence leads the way

As published on HNN

USAID is proud to be a partner of this research and is already supporting the first national scale-up of chlorhexidine in Nepal.

A newborn baby. Photo: Bangladesh, by Shafiqul Alam Kiron / Save the Children

Exciting new evidence has bolstered our fight against one of the top three causes of newborn deaths around the world. Each year approximately 1 million newborn babies lose their lives to largely preventable severe infections, accounting for nearly one third of the total burden of newborn deaths.  Most of these lives could be saved by improving hygiene and reducing exposure to life-threatening bacterial infections particularly in the first week of life, and by making antibiotics available to newborns who become sick.

Research published this week in The Lancet confirms that a simple solution can prevent newborn infections and dramatically reduce newborn deaths. Findings from studies done in Bangladesh andPakistan show that when chlorhexidine, an inexpensive and widely available antiseptic, is applied to the newborn’s umbilical cord at home and soon after birth, neonatal mortality can be significantly reduced.  The two studies support earlier findings from a field trial in Nepal which showed a 24% reduction in newborn mortality when community health workers applied chlorhexidine to the cord during home visits.

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FY13 Budget: Making Smart Investments

The Fiscal Year 2013 International Affairs budget, which was released on February 13, showcases President Obama’s commitment to making smart, efficient investments to help those in the greatest need while helping to create economic opportunity and safeguarding American security.

It is important to remember that these numbers represent lives around the world that can be supported and saved through our smart investments in agriculture, health, and access to clean water, among other programs.  And these investments come at an incredibly small fraction of our national budget—in the case of development assistance, less than one percent.

Similar investments we made last year demonstrated a number of important results. Thanks to our investments in humanitarian assistance, we were able to save tens of thousands of lives in the Horn of Africa after a devastating drought led to famine and threw over 13 million people into crisis. U.S.  support helped provide lifesaving AIDS drugs to nearly 4 million people, protect 200,000 infants from HIV infection and keep millions of children throughout Africa safe from malaria. And our  agricultural investments are  supporting the goal of lifting 18 million people from a state of hunger and poverty.

Despite those results, we’ve had to make difficult choices this year, consolidating some programs and eliminating others. Our 2013 budget shows a willingness to focus on countries and programs where we believe we can make the greatest impact.

Global health is a key part of our investment in economic and human security.  Our request goes to cost-effective, proven global health interventions delivered through President Obama’s Global Health Initiative. These investments will help achieve a number of the President’s ambitious global health goals, including saving the lives of five million children by the year 2015, and expanding HIV/AIDS treatment. Thanks to the falling costs of health commodities, including contraceptives, malaria bednets and antiretroviral drugs, and increased investments by partner governments, we can now save more lives.

$1 billion of our FY 2013 request is devoted to Feed the Future, President Obama’s landmark food security initiative. These investments will help countries develop their own agricultural economies and  grow their way out of hunger and poverty, rather than relying on humanitarian food aid that costs us seven times as much to deliver. We’ve also designed a results framework so we can transparently measure and demonstrate the impact our investments have made in fighting poverty, hunger and malnutrition.

Our budget request maintains robust funding for our humanitarian accounts. Efficiencies in our use of these resources will ensure we have the necessary means to continue U.S. leadership in responding to natural and man-made disasters, just as we did last year after a devastating drought in the Horn of Africa. In addition, we continue to increase our focus on preventing future crises through disaster risk reduction activities and funding for greater resilience against food shocks through Feed the Future.

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Turning the Corner on HIV and Tuberculosis Co-infection in Brazil

AIDSTAR-One is funded by USAID’s Office of HIV/AIDS. The project provides technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs.

A patient at the CECAP Clinic in São Paulo receives his TB medication from his doctor. Photo Credit: Ed Scholl, JSI

HIV and tuberculosis (TB) affect millions of people worldwide every year. Eighty percent of the world’s cases of HIV are concentrated in the 22 countries—including Brazil—with the largest TB epidemics. Without precise and sustained treatment, HIV and TB can become a deadly combination for men, women, and children.

Adolescents like 17-year old Silvia (name has been changed) from São Paulo need access to medical services to treat both TB and HIV. I met Silvia last November, when she came to a clinic to seek medical care for multi-drug resistant tuberculosis (MDR TB)—a dangerous form of TB that requires special medical care and treatment.

With funding from the U.S. Agency for International Development (USAID), which provides support to medical clinics throughout Brazil for TB and HIV services, Silvia is receiving the care she needs to lead a full, healthy life.

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