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Archives for Health

Working Together to End Stigma and Discrimination Against HIV/AIDS

An activist sets up a red ribbon during the commemoration of the World AIDS Day in San Salvador, on December 1, 2010. AFP PHOTO/ Jose CABEZAS

Stigma and discrimination are two factors that continue to drive the HIV/AIDS epidemic forward. Employees face discrimination at work, women and men are afraid to get tested and run the risk of being ostracized by family and friends, and children are turned away from schools.

Stigma and discrimination based on HIV status are wrong, and the U.S. government does not condone stigmatization or discrimination of HIV-positive persons. USAID takes stigma and discrimination seriously, and we work with our partner countries to make sure the effect of this type of thinking is understood.

Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. is proud to be making a historic commitment to combat HIV/AIDS. PEPFAR is driven by a partnership between the U.S. government and the nations where it works, along with other donors, multilateral organizations, nonprofit groups, faith-based organizations, and people living with HIV, to make smart investments to save lives.

With support from USAID, U.S. government country programs have been addressing stigma since the beginning of the epidemic and with increased intensity with the advent of PEPFAR in 2003. Reducing stigma and discrimination is a prominent goal of PEPFAR’s current Partnership Framework agreements. Through this mechanism, the U.S. government actively works in partnership with countries to end stigma and discrimination.

Centrally, the U.S. government funds activities that reduce stigma and discrimination, such as providing the tools necessary for networks of HIV-positive individuals to engage in evidence-based advocacy. USAID’s recently completed Health Policy Initiative (HPI) worked with partners to develop indicators to measure various aspects of stigma and discrimination. By participating in expert working groups, the program built consensus for common action and took the lead on a Health Facility and Provider Stigma Measurement Tool. HPI also increased private sector engagement and encouraged religious leaders to speak out against stigma and discrimination.

Now, through the Health Policy Project (HPP), USAID continues work globally to strengthen policy and advocacy support for the reduction of stigma and discrimination, especially as it relates to HIV prevention, care and treatment services.

All of us who work on global AIDS issues are aware of the negative impacts of stigma and discrimination, and are committed to creating equal access to quality care and services for those living with HIV worldwide.

World TB experts convene, work to blaze the trail to slow disease spread

As featured in Science Speaks by Meredith Mazzotta

“As you and I both know, people that dedicate their lives to global health are special,” said U.S. Agency of International Development (USAID) Administrator Dr. Rajiv Shah at the opening session of the Stop TB Partnership Coordinating Board Meeting, taking a moment to recognize the passing of his colleague, former USAID Tuberculosis (TB) Team Lead Susan Bacheller. He then asked for a moment of silence in her honor.

“She is deeply missed.”

Shah addressed an audience of physician-scientists, industry representatives, advocates and government officials that make up the Stop TB Partnership Coordinating Board, in addition to the ministers of health from Lesotho, Swaziland and South Africa. Shah commented on the current status of TB control efforts around the world, noting that, “we won’t meet the overall Millennium Development Goals (MDGs) unless we make some fundamental changes,” he said.

Part of the 6th MDG is to have halted by 2015 and begun to reverse the incidence of major infectious diseases including tuberculosis.

“We need to take some bold actions and risks and introduce new innovations, new technologies, new drug regimens and new ways of working to reach the outcomes that we all seek,” Shah said.

The changes he highlighted were the need for new technologies in diagnostics and treatment including for drug-resistant forms of TB. He noted that the development and deployment of the Gene Xpert rapid TB test is encouraging, but continues to be quite costly. He encouraged the audience to think about what types of strategies might exist to try to introduce these diagnostics to better understand their value and performance in the field, while looking for opportunities to reduce their cost.

The reality of treatment targets, Shah said, is our ability to reach them or not to reach them is not tied to our immediate budget, “but rather if we can continue on the path to reduce the cost per unit of treatment.  I hope we will greatly exceed these targets,” even in an environment where we are facing serious constraints on our ability to invest, here and abroad, he said. Using efficiency gains to achieve and exceed new targets, Shah said, could make a much stronger case for future investment in TB as a means of furthering overall global health targets.

Assistant U.S. Secretary for Health Dr. Howard Koh noted that even the U.S. still sees 11,000 cases of TB every year.  “We had a goal of eliminating TB in the U.S. by 2010 and we have not reached that goal,” he said, adding that the health of every nation affects the overall health of the globe.

During a question and answer session with an extended panel, Lesotho Minister of Health Dr. Mphu Ramatlapeng listed her thoughts on the three most important unmet needs inhibiting real progress against tuberculosis. First, she cited the need for diagnostic and other technologies that can be used across diseases. For example, “there is work underway with the Gene Xpert so that it also can be used to detect [sexually transmitted infections] and other diseases,” she said. Gene Xpert developer FIND announced in February that the company was investigating potential rapid HIV viral load measurement to be added to the current machine. Ramatlapeng also noted the need for fixed-dose combination drug regimens, “because they will make life very easy for all involved,” and better access to drugs as key to success in fighting TB.

When asked how the ministers were addressing the spread of TB among the mine workers in Lesotho and South Africa, Ramatlapeng said she is working with the World Bank to convene a meeting with the ministers responsible for natural resources and mining, as well as the ministers of finance to more holistically address how to move ahead.

Other future goals in TB control mentioned at the meeting included ensuring successful roll out of new technologies to those who need them most, access to health systems to ensure new cases are detected as early as possible, achieving the most value for investment, and making certain that TB is a party of primary health care that is universally accessible.

On World Health Day WHO takes on Drug Resistance

Featured on Science Speaks by Meredith Mazzotta

In honor of World Health Day 2011 (April 7), the World Health Organization (WHO) released a six-point policy package to combat the spread of antimicrobial resistance, a problem the organization says is not new but is becoming increasingly burdensome, dangerous and costly.

“The world is on the brink of losing these miracle cures,” said WHO Director-General Dr. Margaret Chan in a press release. “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.” Chan authored a special statement in honor of World Health Day driving home the message that “no action today means no cure tomorrow.”

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World Health Day: Combating Drug-Resistant Tuberculosis

By: TB Alliance

MDR-TB can be transmitted through the air, and therefore patients like John are advised to wear masks at all times. Photo Credit: TB Alliance

John* can’t remember the names of all the medications he takes—there are just too many. In the morning, nurses watch him swallow 10 pills and give him an injection, and in the evening, they stop by with another two tablets. The regimen is tiresome, says John, but he is sick and has no other options. John is a multidrug-resistant tuberculosis (MDR-TB) patient at Kibo’ngoto National TB Hospital in Tanzania, one of few local facilities equipped to handle TB patients that have grown resistant two or more of the four drugs that comprise the standard treatment for TB.

John is only partially through his expected six-month stay at Kibo’ngoto, but even when he returns home, many more months of daily treatment await. John says it’s easy for patients to become depressed and despondent—and give up hope that they will ever get better.

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“No Action Today, No Cure Tomorrow”

Also posted at DipNote, the U.S. Department of State Official Blog

USAID representatives joined the Afghanistan Ministry of Public Health, the World Health Organization (WHO), members of Parliament, health officials, and the international community on April 6, 2011, to celebrate World Health Day in Kabul. Under the theme “No Action Today, No Cure Tomorrow,” the event highlighted the growing threat of antimicrobial resistance and called attention to the need for policymakers, civil-society and patient groups, health practitioners and prescribers, pharmacists and dispensers, as well as the diagnostic and pharmaceutical community, to develop a comprehensive plan to minimize health risks from exposure to microbes.

Antimicrobial resistance, and its global spread, threatens the continued effectiveness of many medicines used today to treat infectious diseases. Antimicrobial resistance is not a new problem, but one that is becoming more dangerous. Urgent and consolidated efforts are needed to avoid regressing to the pre-antibiotic era.

For World Health Day 2011, the WHO is calling for intensified global commitment to safeguard antibiotics and other antimicrobial medicines for future generations. USAID Senior Deputy Mission Director Robert Hellyer said, “USAID is proud to be working in partnership with the Ministry of Public Health to strengthen pharmaceutical systems, and promote rational medicine use and good dispensing practices.”

Around Afghanistan, USAID is supporting national and provincial hospitals in developing drug and therapeutic committees, training pharmacists in modern pharmaceutical management practices, and raising public awareness of the importance of proper medicine use. This week, USAID’s Strengthening Pharmaceutical Systems project began regional training workshops on good dispensing practices for 112 pharmacists working at the Ministry of Public Health. Good dispensing practices include the delivery of the correct drug to the right patient, in the required dosage and quantities, in a package that maintains acceptable potency and quality, and with clear drug information. Training will take place in Balkh, Hirat, and Kabul provinces and will continue through the month of April.

For more than 20 years, the world has celebrated World Health Day on April 7. This day was chosen to commemorate the adoption of the WHO constitution on April 7, 1948. Around the globe, thousands of events mark the importance of good health for productive and happy lives.

From U.S. Aid Recipient to Donor Partner: The Republic of Korea’s Health Ministry Honors USAID

For nearly 50 years USAID has been in the business of providing assistance to individuals in need to alleviate suffering, save lives, and foster a brighter future for families around the world.

Our mission here at USAID is a unique one: to put ourselves out of business.  We seek to carry out development so effectively that people around the world no longer need the assistance we provide.  To achieve our mission, we partner with countries, at their request, to assist them in the process of developing national structures that ultimately can function independently, without foreign aid.

Today, on the behalf of USAID, I accepted an award from the Republic of Korea’s (South Korea) Health Minister Chin Soo-Hee to honor a history of partnership that helped transform a once-struggling nation into a donor partner.

The collaboration began in 1954, when the International Cooperation Association, the predecessor to USAID, coordinated an agreement between the University of Minnesota and Seoul National University that facilitated the post-war exchange of medical education and research at a critical period in Korean medical reconstruction.

In subsequent years, USAID continued to provide health assistance that promoted the ongoing development of the Korean medical system. Today, we recognize the Republic of Korea as one of our longest-standing partners and identify them as a world leader in medical research and technology.

Once a recipient of U.S. development assistance, the Republic of Korea is now a donor partner that itself provides assistance to help the world’s poorest and most vulnerable people.  Today, the country produces high-quality, affordably priced vaccines that have played an invaluable role in preventing disease and childhood death around the world.

In 2010, the Republic of Korea became the newest member of the OECD Development Assistance Committee, or the DAC.  Its DAC membership marks the only time since the OECD was established in 1961 that a country has joined the “advanced nations’ assistance club” after transitioning from an aid recipient to a donor.  To have made this transformation in just a few decades truly speaks to the Republic of Korea’s extraordinary economic rise, the compassion of its people, and its commitment to effective and coordinated assistance.

We are very proud of the role USAID played in helping the Republic of Korea achieve its development goals. Its remarkable transformation in such a short time span is an inspiration and a reminder. It reminds me that our mission is achievable.

An Ancient Disease, A Modern Day Development Challenge, A Child Who Deserves a Future

By: Clydette Powell, Medical Officer, Division of Infectious Diseases

We need a game changer that puts innovation for Tuberculosis diagnosis and treatment at the forefront of our global health agenda. Unsanitary and unhealthy realities bred by third world conditions provide the perfect opportunity for this ancient disease to continue to spread through vulnerable populations. There is one vulnerable population in particular that is greatly affected by this disease and often go unnoticed: children. We don’t have a good estimate of the disease burden in this population; we only know that the numbers of cases continue to increase, or go undiagnosed and untreated or improperly treated;

  • the current diagnostic test dates back to 1907 and is fraught with challenges;
  • newer laboratory diagnostic tests in the pipeline are largely not being tested in this vulnerable population;
  • the “preventive” vaccine we have been using is based on “technology” which is 90 years old;
  • that vaccine has limited efficacy and does not protect against the most common form of the disease;
  • the most recent drug to treat this population was developed in 1967;
  • a full course of treatment consists of up to 1,000 pills, and more if drug resistant;
  • this population continues to experience disability and death from complications of this disease;
  • those who have this disease often acquire it from household contacts, that is, those closest to them – those who are more likely to be diagnosed and treated; yet, few public health staff trace those contacts;
  • preventive measures, which are safe and available, are generally not applied to the vulnerable ones in those households with this disease. Is that fair and just?

So, what is this problem that cries out for a game change? It is childhood TB. Tuberculosis.
Yes, that neglected disease that has been around since 6000 BC. A disease that Moses described as the “fiery consumption” among the Israelites, that knocked downed Incans, Egyptian pharaohs, many in the world of the fine arts, and the wife of one 20th Century American president.

Ka-quarta, an eight year old Angolan boy who suffers from TB of the spine, with Clydette Powell, Medical Officer from USAID’s Division of Infectious Diseases. Photo Credit: USAID/Global Health.

Meet Ka-quarta. An eight year old Angolan boy, whose name loosely means “Wednesday’s child.” Do you recall the rhyme ”Wednesday’s child is full of woe”? Ka-quarta has TB of the spine. That makes him full of woeful TB. He lives away from his rural village family and stays at the local hospital where each day he receives many pills, injections and one meal a day. He will do this for up to one year. Yet, he is hardly full of woe in the other sense of the word.

Flashing a smile, he met me at the entrance to the hospital in Benguela Province, extending a hand from beyond the deformed spine that shortened him, slowed him down and made him an unwelcomed standout in the crowd. He offered me a hospital tour, beginning with the wards he knew best: the TB wards. It was in these wards that Ka-quarta lived, slept and ate with other adults. For one whole year. For 1,000 pills. He hoped for a cure, to someday stand taller than he was, now squatted by the gross deformity of his spine. He hoped to play soccer, to keep up with his friends, to be able to sit in a chair and lean back without his spine arriving much sooner than the rest of his thin frame.

Ka-quarta is the best advocate on two legs for fighting childhood TB. Without a single word, his body tells the community why we need to fight this disease in children. The next time I visited Angola, I sent Ka-quarta a little doctor’s kit, complete with a plastic stethoscope and a play X-Ray viewing box, that conveniently displayed an image of a set of lungs. I am rooting for Ka-quarta to be the local TB specialist, when he grows up in both years and stature, if not the authority on childhood TB for his country. Why not?

So what about you? How about that game change? How about taking some first steps towards eliminating childhood TB? Or would you like us to serve you up 1,000 pills starting today?

Making TB Personal: An Ancient Disease and the Need for Innovative Solutions

By: Christy Hanson, Chief of Infectious Disease Division, USAID

When I began my career working with Tuberculosis twenty years ago, the outlook for future progress against this biblical disease looked very different than it does today.  From 1990 to 2009, the TB community has made tremendous progress—TB related deaths have declined by more than one-third, and incidence is declining globally. The emergence of new diagnostic technologies has made it easier to quickly detect multi-drug resistant TB.

Today, the global incidence rate is falling slowly, and 5 of the 6 regions of the world are on track to meet the UN Millennium Development Goal target to halve TB prevalence and deaths by 2015. We are now looking beyond this goal and are focusing on providing universal access to TB care. This is an effort that will require engaging all providers in the public and private sector, people in communities, and TB patients themselves.

It gives me pause to think this is the same disease that has plagued mankind as far back as the ancient Roman civilization. To understand how this disease has survived for millennia, it is important to know how it works.

This is a disease that is inextricably linked to the socioeconomic realities of the impoverished. TB is activated when an individual’s immune system is weakened by any number of causal factors: old age, malnutrition, pregnancy, HIV, and other concomitant illness, such as diabetes. It is estimated that more than one-third of the population in the developing world who are exposed to these conditions are infected with the disease.

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U.S. and World Bank Strengthen Water Partnership on World Water Day

On March 22nd, Secretary of State Hillary Clinton and World Bank president Robert Zoellick signed a Memorandum of Understanding (MOU) committing to a stronger partnership on water issues.  The agreement, signed at a World Bank ceremony on World Water Day, will bring the U.S. government and World Bank together to work on global water and sanitation challenges.

The need for a combined effort on water issues could not be clearer.  An estimated 880 million people lack access to an improved water source.  More than 5,000 people—most of them women and children—die every day from causes linked to unsafe water, sanitation, and hygiene.  The current outbreak of cholera in Haiti is a stark reminder of this reality.  Beyond health, water is central to a number of development challenges, such as climate change, food security, conflict, energy, and gender.

Secretary Clinton providing remarks at the MOU signing with the World Bank. USAID’s Deputy Administrator Don Steinberg and World Bank President Zoellick looking on. Photo Credit: State Department

The work promised at the signing has already begun: USAID and the World Bank have started to develop a prize to stimulate the development of new technologies related to drinking water and sanitation.  The World Bank is also working with NASA to provide remote sensing technologies around the world.  As speakers at the ceremony emphasized, this type of cooperation is necessary because water issues cannot be confined to just one area.

“The water crisis is a health crisis, it’s a farming crisis, it’s an economic crisis, it’s a climate crisis, and increasingly, it is a political crisis,” Secretary Clinton noted.  “And therefore, we must have an equally comprehensive response.  Now our experts in the United States Government are working on water issues at nearly two dozen agencies – of course, from State and USAID, but also the Millennium Challenge Corporation, NASA, NOAA, EPA, Treasury, and so much else.”

As a result, the United States is one of the largest bilateral donors on water and sanitation; USAID and the Millennium Challenge Corporation together invested more than $770 million in the water sector and on sanitation-related activities in developing countries in fiscal year 2009.

Secretary Clinton highlighted several USAID projects launched since her speech at last year’s World Water Day, which are representative of the new direction set for the U.S. government water program:

-       In Indonesia, USAID has begun a five-year, $34 million water, sanitation, and hygiene project to reach more than 2 million of Indonesia’s urban poor.  USAID also launched a project in Haiti to teach women about sanitation and hygiene so they could better take care of their households.  In India, USAID is supporting a project to provide slum dwellers in eight states with municipal water and sanitation systems.

-       USAID and the Qatar National Food Security Program convened representatives from 17 water centers in 10 countries across the Middle East and North Africa to create a regional network to share technical knowledge to solve the complex water challenges they face.

-       In Kenya, USAID is working with local water utilities, a local cell phone company, and a local microfinance institution to create new ways for poor people to pay for water. They receive a microloan to cover the initial cost of connecting their homes with water systems, then they repay those loans using micro-banking services on their cell phones.

-       In the Philippines, Japan and the United States have worked together to establish a water revolving fund to leverage private investment to improve water and sanitation for more than 100,000 people in 36 villages. Last year, the first USAID guaranteed loan for $2.5 million was granted.

-       To promote science and technology, USAID is working with NASA to use satellite images to monitor and forecast ecological changes in the Himalayas, including the monitoring of glacial melt. USAID has also worked with the private sector to open a ceramic water filter factory in Cambodia.  With ceramic filters, people no longer need to boil water to make it safe to drink, so they don’t need to burn as much wood or charcoal, which in turn reduces greenhouse gases.  The plant has even applied to receive carbon credits for future sales.

At the 2010 World Water Day event, Secretary Clinton stressed the U.S. government’s commitment to strengthening its partnerships; the MOU with the World Bank is reflective of that commitment.

Under the new agreement, the United States and the World Bank will work together in a number of areas, including rehabilitating wetlands, improving irrigation practices, and mobilizing public-private partnerships and private capital to support water projects around the world.

Progress in these areas depends upon the efforts of numerous organizations.  NGOS, private industry, foundations, and international bodies were all represented at the event.  Many of them have ongoing projects with USAID and the World Bank across the globe.  As USAID Deputy Administrator Donald Steinberg emphasized, “our presence here today reflects a basic truth in the development challenges we face: no single government, international institution, civil society group, or private corporation has a monopoly on good ideas, dedicated commitment, or ground truth.”

Our Common Fight – TB in Eastern Europe and Eurasia

Several weeks ago, I visited the Central Tuberculosis Research Institute (CTRI) of the Russian Academy of Medical Sciences in Moscow. It plays a central role in Russia’s battle with tuberculosis (TB)  as the country’s top TB treatment hospital, research center, and medical training facility. Russians with the most difficult multi-drug resistant (MDR) – TB  and extensively drug-resistant  (XDR) -TB are treated there. I was struck by the determination of the Russian doctors in the face of the continued threat of MDR-TB and XDR-TB and I am glad that USAID counts them as partners in our common fight.

As we commemorate World Tuberculosis Day on March 24, it is important for all of us to recognize that Eastern Europe and Eurasia continue to have the highest rates of MDR-TB and XDR-TB infections in the world.  According to the World Health Organization (WHO), 12 countries have reported proportions of MDR-TB of 6% or more among new TB cases: all of these countries are in Eastern Europe and Eurasia. Five countries report MDR-TB proportions of 50% or more among previously treated cases: all of these countries are also in Eastern Europe and Central Asia. The WHO estimates that in Russia, 42.4% of previously treated TB cases are MDR-TB; in Azerbaijan, 55.8%; in Georgia, 27.4%; and in Ukraine, 44.3%.

A TB patient receives care at the Central Tuberculosis Research Institute of the Russian Academy of Medical Sciences in Moscow, an institute dedicated to treating Russians with MDR and XDR-TB. Photo Credit: David Grout/ USAID

In our interconnected planet where people constantly cross borders and millions of people fly every day, not only are U.S. citizens travelling abroad vulnerable to MDR and XDR-TB, but Americans from Georgia to Maine could face this threat at home. Therefore, we have a national security interest in stopping TB around the world and we need the grit of those dogged Russian doctors I met in Moscow.

Tuberculosis is curable but potentially deadly. It is spread through the air and is second only to HIV among infectious killers worldwide. Tuberculosis exacts an enormous personal and economic toll, often striking people in their most economically productive years.  MDR-TB and XDR-TB are major risks to effective TB control. MDR-TB is resistant to the two most important first-line drugs used in the treatment of TB. XDR-TB is resistant to additional drugs. The usual six-month treatment with first-line TB drugs is not effective for MDR-TB and XDR-TB. The treatment for MDR-TB and XDR-TB is more expensive, less effective, with greater side effects, and it requires two years to complete—if that form of TB is treatable at all.

MDR-TB and XDR-TB arise due to a number of controllable factors, such as high patient treatment default rates, late diagnosis, irregular treatment, easy access to first and second line drugs in private sector pharmacies without prescription, and, in some cases, population displacement due to unrest. Therefore, it is possible to prevent and control MDR-TB and XDR-TB.

USAID missions through the Eastern Europe and Central Asian regions are working with host countries to combat MDR-TB and XDR-TB.  There is hope. For example, USAID in Georgia supported the National TB Program and provided technical assistance to create DOTS spots—special TB outpatient centers located inside of the general urban outpatient clinics. As a result, in the capital city of Tbilisi, the clinics reduced treatment defaults from 23% in 2003 to 9% in 2008. With lowered treatment default rates, the risk of MDR and XDR-TB are lessened.  With USAID-supported technical and financial assistance, MDR-TB reported cases decreased in the Balkans from 14.4% in 1996 to less than 9% in 2003. In Ukraine, USAID assisted implementation of laboratory quality control procedures in 8 regions, resulting in 92% of USAID-supported laboratories demonstrating high proficiency in laboratory-based TB diagnosis. These successes show that USAID support is yielding results and helping to control MDR and XDR-TB.

USAID is helping to save thousands of lives and showing the goodwill of the American people.  Together with the people of Europe and Eurasia, we must continue to fight MDR and XDR-TB for their sake and our own national interest. Let us not lose focus, take decisive action and curb the spread of MDR-TB and XDR-TB. It is the right thing to do morally, economically, and for our national security.

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