PEPFAR

 {Photo credit: Charles Fred via flickr}HIV poster in Vietnam.Photo credit: Charles Fred via flickr

This post includes portions of the introduction, questions, and answers from the English edition of "Transition Forward, Issue 1, June 2013" (PDF). 

Vietnam has made significant progress in re­cent years responding to the country’s HIV & AIDS epidemic. Under the ongoing leadership of the Government of Vietnam (also known as Viet Nam), the interna­tional community has provided significant technical and financial support to the HIV & AIDS program. As country leadership and ca­pacity to address the HIV epidemic has been strengthened, and as Vietnam’s economy grows stronger, increasing emphasis is being placed on transitioning to a sustained country-led response.

This includes strengthening the health system and civil society, particularly to reach those most at risk.

This week’s Lancet returns the spotlight to Option B+, an innovative strategy for preventing mother-to-child transmission of HIV which was first developed in Malawi with technical assistance from MSH. Four letters respond to the concern that international organizations have too quickly endorsed the Option B+ approach of providing lifelong triple antiretroviral therapy (ART), irrespective of CD4 count, to pregnant women with HIV in high-burden countries.

MSH experts Scott Kellerman, Jonathan Jay and Jonathan Quick argue that “a strong case exists for expanding research on Option B+, but not for impeding countries that pursue it on the basis of available evidence and programmatic experience:”

World TB Day celebration in Ghana (2012). {Photo credit: MSH.}Photo credit: MSH.

Sunday, March 24, 2013, is World TB Day, and MSH staff and partners are promoting global efforts to stop TB throughout the week.

Here are highlights from some of our activities around the world:

The Afghanistan TB CARE I team is working with the national TB program (NTP) to conduct celebration events at 290 health facilities and communities in 13 USAID-supported provinces. TB messages will be aired through local telephone companies to approximately one million people throughout the nation. TB CARE I is also identifying and publicly rewarding high-performing health workers.

The Bangladesh SIAPS TB team will participate in a national rally on March 24 with all TB partners and stakeholders within the NTP network, as well as in a press conference, workshop, and scientific session.

 {Photo Credit: Abel Helebo/MSH.}Silenat with her three-year-old child, her husband Yirga, and Tadele, a TB focal person at the Keraniyo Health Center.Photo Credit: Abel Helebo/MSH.

Silenat Yihune, a 40-year-old woman, mother, and housewife, lives in a remote region of Huletejuenesie District, Ethiopia, which is approximately 20 kilometers from the closest health facility. For nine months Silenat suffered from a cough, chest pain, fever, and weight loss, but was unable to receive treatment. As is common among Ethiopian families, Silenat was economically dependent upon her husband. He refused to pay for her travel to the distant health facility. Several months later, Silenat’s husband, Yirga, started to show similar symptoms and visited the Keraniyo Health Center, where he was diagnosed with tuberculosis (TB).

Keraniyo Health Center is one of the health facilities in Huletejunesie district supported by the PEPFAR-funded, USAID project, Help Ethiopia Address Low TB Performance (HEAL TB), led by Management Sciences for Health (MSH).

Integrating the Leadership Development Program into Guyana's national nursing school training (watch video): Guyana HIV/AIDS Reduction and Prevention, phase two (GHARP II), a PEPFAR-funded and USAID-supported project.

Developing Strong Health Leaders Saves Lives, the newest edition of MSH's Global Health Impact e-newsletter (subscribe), features:

Shelly with her latest trophy after winning first place at a 2012 regional Emancipation Day race. {Photo credit: V. Hinds/MSH.}Photo credit: V. Hinds/MSH.

Shelly has always been very athletic. She competed in both her high school track events and in community races in her hometown of Essequibo, Guyana. In 2010, she was ecstatic after winning a cash prize for placing first in an annual regional championship. However, her life took a turn one year later.

Shelly became pregnant and, during an antenatal care appointment, tested positive for HIV. The news devastated her, as she believed that an HIV diagnosis meant her athletic career was over. Shelly was unaware of how to remain healthy while living with HIV, and so she soon became ill, weak, and lost a significant amount of weight. To add to this, she was unemployed and lacked the means to provide for her newborn son.

Women visit the SDSH-supported Marmont clinic in Haiti’s Central Plateau. {Photo credit: C. Gilmartin/MSH.}Photo credit: C. Gilmartin/MSH.

Late one April night in 2012, 19-year-old Ilionelle was struggling to give birth at her home in rural northwest Haiti. After several hours, she began having seizures, a clear indication of eclampsia, a severe medical disorder that can lead to the death of the mother and/or baby.

Ilionelle’s situation is not uncommon in Haiti, which has the highest maternal mortality rate in the Western hemisphere with 630 deaths per 100,000 live births. Fortunately, Tilma, the traditional birth attendant helping Ilionelle, quickly identified these life-threatening symptoms and arranged for her transport to Beraca Hospital for emergency obstetric care. After being carried on a stretcher for four hours along a steep and treacherous road, Ilionelle arrived at Beraca Hospital where she safely delivered a healthy baby boy. “If it wasn’t for Tilma, both my son and I could have died,” Ilionelle said.

Tilma is among thousands of Haitians working to improve their nation’s health after recent years of misfortune.

Malawi mother and children {Photo credit: MSH.}Photo credit: MSH.

I got a call from the resident doctor to come to exam room 6. As soon as I entered the room, I prepared myself. The little girl, 7- or maybe 8-years-old, didn't look well; she was “floppy,” combative, and not entirely aware of where she was or what we were doing to her. She was HIV-positive, and my colleague needed to get an IV line in her arm to test the latest in experimental treatments for kids with HIV– and needed the four of us interns to help hold her still.

It was 1993 during my residency in pediatrics in Cleveland, Ohio. We were at one of the best children’s hospitals in the world; it didn’t matter. The young girl died a few months later.

With the advent of antiretroviral therapy (ART) a few years later, the whole world changed. The world of HIV medicine blossomed; new drugs and drug combinations literally exploded with amazing effect. HIV-positive mothers could give birth to HIV-negative babies, and HIV-positive children and their moms could get treatment.

Seven-year-old Ladi Muhammed. Nigeria. {Photo credit: S. J. Garlora / MSH.}Photo credit: S. J. Garlora / MSH.

Seven-year-old Ladi Muhammed wants to become a teacher. The third of five children ranging 3 to 20 years old, Ladi and her family live in a poor Nigerian village.

The likelihood of Ladi attending primary school is low.

Public primary education is free in Nigeria, but Ladi’s parents can barely afford to feed their children. The children supplement their parents’ income with menial jobs, such as street trading, which leaves little time or energy for schooling.

Her father, Ahmadu Mohammed, wants to send all of his children to school, but does not have the financial means to do so. “It is my heartfelt desire to send my children to school, but I can’t support them due to the meager salary I earn from my work as a gateman. Our situation is tough; we can barely feed ourselves,” says Mohammed.

Without an education, Ladi’s desire to one day become a teacher appeared a distant dream.

Luke and volunteers construct a new house. {Photo credit: L. Ross/MSH.}Photo credit: L. Ross/MSH.

In January 2011, Amelia and her partner, Luke --- both HIV positive --- began accessing HIV care and support services at the Agape Network through its community home and palliative care program.

Agape Network is one of the NGOs that receives technical support from the PEPFAR-funded, USAID-implemented, Guyana HIV/AIDS Reduction and Prevention Project (GHARP II), led by MSH.

When the Agape staff first met Luke and Amelia, they were living with their two daughters at Luke’s family’s home. The situation was tense because Luke’s relatives did not approve of his relationship with Amelia.

Finally, in December 2011, the tension escalated and Luke, Amelia, and their family were thrown out of the house.

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