In-country Partners Research Articles

Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007

BackgroundSince 2003, the Global Fund has supported the scale-up of HIV/AIDS, tuberculosis and malaria control in low- and middle-income countries. This paper presents and discusses a methodology for estimating the lives saved through selected service deliveries reported to the Global Fund.MethodsGlobal Fund-supported programs reported, by end-2007, 1.4 million HIV-infected persons on antiretroviral treatment (ARV), 3.3 million new smear-positive tuberculosis cases detected in DOTS (directly observed TB treatment, short course) programs, and 46 million insecticide-treated mosquito nets (ITNs) delivered. We estimated the corresponding lives saved using adaptations of existing epidemiological estimation models.ResultsBy end-2007, an estimated 681,000 lives (95% uncertainty range 619,000-774,000) were saved and 1,097,000 (993,000-1,249,000) life-years gained by ARV. DOTS treatment would have saved 1.63 million lives (1.09 - 2.17 million) when compared against no treatment, or 408,000 lives (265,000-551,000) when compared against non-DOTS treatment. ITN distributions in countries with stable endemic falciparum malaria were estimated to have achieved protection from malaria for 26 million of child-years at risk cumulatively, resulting in 130,000 (27,000-232,000) under-5 deaths prevented.ConclusionsThese results illustrate the scale of mortality effects that supported programs may have achieved in recent years, despite margins of uncertainty and covering only selected intervention components. Evidence-based evaluation of disease impact of the programs supported by the Global Fund with international and in-country partners must be strengthened using population-level data on intervention coverage and demographic outcomes, information on quality of services, and trends in disease burdens recorded in national health information systems.

Assessing experiences of international students in Haiti and Benin

This article presents an assessment of a series of international educational initiatives that have been pursued over the past decade in the arena of development and management of groundwater resources in Haiti and Benin. Projects pursued ranged from short-term service efforts to long-term research efforts. These initiatives are compared in terms of project objectives relative to U.S. undergraduates, U.S. graduate students, in-country partners, and local populations in the project country.

Sea Grant in Latin America?

This paper explores the application of the US Sea Grant model of applied research, extension, and education to two case studies in Latin America: Coastal Ecuador and the Gulf of Fonseca. The analysis is based on a series of meetings and roundtables with in-country partners and leaders of the US Sea Grant program. We conclude that the Sea Grant model provides an institutional structure that Latin America lacks and the model's features would improve governance of marine and coastal resources through more effective linkages between coastal communities, universities, and policy/decision makers at local, national, and international levels.

Uganda is learning from its Global Fund grant suspension

When in Kampala Victor Bampoe East Africa portfolio manager for the Global Fund to Fight AIDS Tuberculosis and Malaria (GFATM) works in an office with panoramic views of the downtown area of Ugandas capital city. In mid- November this area was thronged with riot police and dotted with cars torched by crowds protesting at Ugandan President Yoweri Kaguta Musevenis decision to jail his principal political opponent. Yet when Bampoe was recently asked how he was coping with the ongoing unrest he was momentarily confused about whether the question referred to the political protests or the Global Fund. Indeed the decision by the Geneva-based GFATM secretariat to suspend Ugandas five grants--totalling US$367 million--sent shock waves through a country whose robust response to AIDS is a point of national pride. At a meeting during the 11-week suspension one finance ministry staffer said: "This almost brought the country down." While this is more than a slight hyperbole the suspension did tarnish Ugandas reputation for AIDS programmes in sub-Saharan Africa. So the lifting of the suspension on Nov 10 was welcomed as an opportunity for the country to restore its reputation. (excerpt)

CDC International HIV Prevention Research Activities Among Injection Drug Users in Thailand and Russia

The Centers for Disease Control and Prevention (CDC) has participated in collaborative HIV prevention research activities in injection drug users (IDUs) with the Bangkok Metropolitan Administration (BMA) in Bangkok, Thailand, from 1995 to the present and with the Orel AIDS Center in Orel Oblast, Russia, from 2001 to 2003. Studies in Bangkok have included an HIV prevention trial preparatory cohort from 1995 to 1998, a seroconverter cohort from 1998 to the present, a phase III trial of the AIDSVAX B/E gp120 HIV vaccine from 1999 to 2003, and a phase II/III HIV prophylaxis trial with tenofovir scheduled to begin in 2005. Activities in Orel included a review of HIV surveillance data in 2001, focus group discussions and a case-control study with HIV-infected and -uninfected IDUs in 2001, a cross-sectional study with the female sex partners of male IDUs in 2002, and a community outreach intervention in 2002-2003. In Bangkok, 1,209 IDUs were enrolled in the preparatory cohort which revealed an HIV incidence of 5.8% per 100 person-years; 133 HIV-infected IDUs have been followed in the seroconverter cohort with >85% follow-up and HIV and tuberculosis care provided; 2,546 IDUs were enrolled in the HIV vaccine efficacy trial which was successfully completed with a follow-up rate of >95%, although the vaccine was not shown to be effective at reducing HIV incidence; and 1,600 IDUs will be enrolled in the daily tenofovir HIV prophylaxis trial in 2005. In Orel, initial focus group discussions and epidemiologic studies revealed low HIV knowledge and high rates of unsafe injecting and sexual practices among IDUs and their female sex partners; and educational campaigns and the community outreach intervention were developed and implemented. A steady decline in new HIV infections in IDUs was then observed in Orel in 2002-2003. CDC has participated in the conduct of successful collaborative HIV prevention research activities in Thailand and Russia over the past decade. The establishment of long-term relationships with in-country public health and community partners has been instrumental in the success of these efforts.

Towards a universal framework for democracy assessment

Assessing the state or quality of a country's democracy has become an increasingly widespread undertaking over the past ten years, whether to construct league tables of democratic attainment, to explore correlations between democracy and economic condition or performance, or to identify likely recipients and projects for international aid. This article reports on a civil society-based programme and framework for democracy assessment in which the author has been involved, whose purpose is to contribute to public debate about a country's democracy, to monitor its progress over time, and to identify pressing areas for reform. Distinctive features of the methodology are the derivation of assessment criteria from clearly articulated democratic values, its relevance to new and established democracies alike, and the comprehensiveness of the assessment framework, covering citizen rights and the rule of law, institutions of representative and accountable government, civil society and participation, and international dimensions of democracy. The article explores the intellectual underpinnings of the assessment methodology in the universal validity of democratic norms and a common imperative for democratization in developed as well as developing countries; and argues for the framework's usefulness in teaching as well as research. It concludes with a brief report on the comparative findings from pilot assessments undertaken with in-country partners in eight countries from across the world.