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Dr. Prakash Mishra, director of the Regional TB Centre in Pokhara, Nepal, looks at a chest X-ray of a patient. Photo by Kiran Panday

KATHMANDU, Nepal – In a walk-up doctor’s office, off a busy street in Kathmandu, Dr. Dirgh Singh Bam sees patients every day in relative anonymity. His walls, though, reveal a history of being in the limelight: plaques and ribbons and framed photographs covering every inch, highlighting Dr. Bam’s efforts in leading Nepal’s TB control program from 1995 to 2004.

With assistance from the World Health Organization, Bam and a dedicated team of health workers ushered in an era of DOTS – directly observed treatment, short-course – by traveling all around the mountainous country to ensure that the strategy was followed. Health workers had to watch each patient swallow their TB pills every day.

“We made sure we had a DOTS committee in every sub-health post, every health post, every district hospital and the central hospital,’’ Bam said. “We went to mosques, temples, churches, all religious organizations, just to make sure they supported us.’’

In five years, Nepal installed the DOTS strategy across the country. In 1995, Nepal’s TB cure TB rate was around 45 percent; today it is 90 percent.

These advances made Nepal a model country around the world in TB control. But the question today is whether the country can remain a leader.

It has a major new challenge: controlling the spread of multi-drug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB). (more…)

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The following is a guest blog posting by Peg Willingham, the Senior Director of the Aeras Global TB Vaccine Foundation.

World leaders are meeting at the United Nations in New York this week to discuss the ambitious global poverty reduction agenda set forth in the Millennium Development Goals (MDGs).  With five years left in the timeline set out to halve global poverty through health, education and environmental programs, there is an urgent need to address issues that cut across the MDGs, such as tuberculosis, a devastating disease of poverty that continues to kill nearly 2 million men, women and children every year.  New tools to fight TB are urgently needed and momentum in TB vaccine research provides an opportunity for optimism.

Simultaneous to the MDG Summit in New York, TB vaccine researchers and stakeholders from around the world  are meeting in Tallinn, Estonia for the 2nd Global Forum on TB Vaccines to assess a decade of progress in the search for more effective TB vaccines and to chart a path forward to sustain the momentum over the next decade. (more…)

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The Center for Strategic and Informational Studies (CSIS) hosted the second debate of the year-long series “Fault Lines in Global Health” on Tuesday. The topic this time discussed whether the Global Fund to Fight AIDS, TB and Malaria should be transformed to become the broader “Global Fund for Health.”

CSIS invited the former U.S. Global AIDS Coordinator George Mark Dybul from Georgetown University to argue in favor of the transformation, and Julian Schweitzer of the Results for Development Institute to argue against.

Mark Dybul, left, debates issues surrounding the Global Fund with Julian Schweitzer, right, and moderator Susan Dentzer, editor-in-chief of Health Affairs.

Both agreed that a transformation was needed to instead address overall health.  Consequently, the debate focused on what that transformation would look like and how to address the broader health goals rather than the 3 global pandemics. What the debate was missing was a voice that supported the Fund’s concentration on AIDS, TB and Malaria.

“What we care about is not a bureaucracy; we care about a person in a village. What does that one person need for their health and the health of their family and village?” Dybul said. “The Fund needs to be transformed to support an integrated approach of health.  You still have reporting on all indicators, but you’re delivering the services not by thinking about those indicators, but by treating that one person.” (more…)

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Join us on Wednesday, Sept. 15th at a Global Health Council event looking at integrated health programs and how to achieve the sixth Millennium Development Goal — which pledges to halt and begin to reverse the incidence of AIDS, TB and Malaria by 2015.

The event will start with a screening of “The Test,” a 20-minute film demonstrating the principles of the Global Health Initiative at work on the ground; in this case how HIV is integrated with other infectious diseases and the overall impact on a community and household.   After the showing, there will be a panel discussion on the film and the implementation issues through the lens of a government panel and civil society.  

The Center’s Christine Lubinski will be moderating the event, which will take place from 4 to 7 pm at The Historical Society of Washington, DC – 801 K Street, NW – in The Theatre.

Introductory remarks will be made by Mikkel Vestergaard Frandsen, CEO of Vestergaard Frandsen SA.

Panel discussion participants include: Ambassador to the United States from Kenya, Elhanah Odembo; Director of the Centers for Disease Control and Prevention Tom Frieden, MD, MPH (invited); Lucy Chesire, an internationally known HIV/TB patient and advocate from the Kenyan AIDS NGO Consortium; and the Center’s invited guest David Hoos MD, MPH, Senior Implementation Director and Assistant Professor of Clinical Epidemiology at the Mailman School of Public Health.

Please RSVP to rsvp@globalhealth.org with your name and affiliation.

Refreshments will be served following the panel discussion

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There are remaining openings for fee-bearing physicians from Europe and North America for a Short course in tropical medicine in Tanzania and Uganda, taking place Oct. 4 to Nov. 12, 2010. The fee is $3,500 and includes all teaching, accommodation and transport within East Africa. Participants pay separately for their international flights and food. African postgraduate doctors will also join the course.

This short course is half the length of a traditional Diploma in Tropical Medicine & Hygiene with twice the amount of clinical contact. The emphasis is on experiential learning and the majority of teaching is in small groups. The course explores recent advances in the practice of medicine in East Africa from community-based healthcare programs to cutting edge diagnostics. All tutors are actively involved in clinical practice and research in the tropics, and many are international leaders in their field. This course is being organized as a pilot for a proposed DTM&H to be launched in 2011.

Weeks 1-3 will be spent in Moshi, Tanzania at Kilimanjaro Christian Medical College covering clinical assessment, diagnostic parasitology and special topics. Weeks 4-6 will be held at Makerere University concentrating on field placements, HIV and TB, and outbreak control.

For more information and a detailed curriculum please email kwillis@accordiafoundation.org

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The Foundation for AIDS Research (amfAR) is soliciting proposals for funding for projects that address HIV/AIDS among men who have sex with men (MSM) in Africa.  Awards of up to $20,000 are available to grassroots organizations in low and middle income African countries with budgets less than $1 million. Desired proposals include innovative HIV/AIDS-related, community-led projects that increase access to HIV/AIDS services among MSM.  to support project-related costs for up to 12 months. Funding is provided by Aids Fonds and will support project-related costs for up to 12 months. Visit www.amfar.org/grants for detailed information.

The application deadline is Oct. 5, 2010. The request for proposals is part of amfAR’s MSM initiative, which aims to empower grassroots MSM organizations, build understanding and awareness of HIV epidemics among MSM, and advocate for effective policies and increased funding.

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Note: this posting has been revised from the previous version.

An analysis developed with the aid of the USAID-funded Deliver Project shows that Zambia is facing a massive gap in the financing required to reach country targets for expanded access to antiretroviral therapy (ART).

The gap goes from $8.2 million for 2011 to a whopping $57.6 million in 2015.  The Deliver Project supports the national group chaired by the Ministry of Health to revise these estimates on a quarterly basis, and the latest can be downloaded here.

Pharmacy shelves stocked with antiretroviral medication in Zambia.

The gap could sabotage plans for scale up of life-saving treatment.  The country aims to increase the overall number of patients receiving ART by about 24 percent from 2010 to 2015.  This scale up would include about a 40 percent expansion in the number of mothers and babies receiving prevention of mother-to-child transmission (PMTCT) from 2010 to 2015.

The Deliver Project, run by USAID contractor John Snow, Inc. (JSI), has been deeply engaged in helping Zambia improve its capacity to forecast resources and plan procurement.  Walter Proper, the country director for JSI, told our congressional delegation he was concerned about the gap.  He said achievement of cost efficiencies in the delivery of treatment will not be adequate to bridge the gap.  Due to lack of service capacity, enrollment of new patients for ART has stopped in some locations.

Prospects for U.S. support for scale up are unclear. The initial draft of the President’s Emergency Plan for AIDS Relief (PEPFAR) Partnership Framework for Zambia, now being finalized, said the U.S. government would “endeavor” to expand ART coverage “as available resources may allow.”  The gap analysis assumes that the U.S. government support for ART expansion will increase to $30 million in FY 2011 and then fall flat to $27 million for each of the remaining years. However, it is expected that the US will be providing soon some additional resources specifically for PMTCT scaleup. (more…)

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