Research

  • World AIDS Day 2012: A Shared Vision of Getting to Zero

    FHI 360 has been partnering toward an AIDS-free generation since the beginning of the epidemic. As we approach World AIDS Day 2012, FHI 360 experts examine next steps needed to tackle HIV/AIDS for good. We’ll discuss new enhancements in the testing and treatment of women during pregnancy and in the prevention of mother-to-child transmission of HIV. We’ll also take a look at the HIV treatment cascade and how it can help people to take the initiative to learn their HIV status and close some of the gaps in treatment and service. Finally, we will share perspectives from the field with a program profile and success story.

    As we look to the future, from our work in Cambodia to Kenya to the U.S., FHI 360 will continue to partner toward a shared vision of “getting to zero.”


  • New Contraceptive Approaches Needed Now More Than Ever

    World Contraception Day 2012 (September 26) has come and gone, and 2012 marked the first International Day of the Girl Child. Together with the excitement from the London Summit on Family Planning this summer and the recent announcement of a major price drop for the contraceptive implant, Jadelle, it has been a banner year for media attention, political will and global resources on family planning and women’s and girls’ rights and empowerment. As part of these efforts, increasing access to safe, effective and affordable contraceptives will have a profound impact on the lives and health of women and their families throughout the world. To achieve the ambitious goals set forth by these international initiatives, however, the global health and development community must act on the current political momentum and not lose sight of the challenges that remain.

    The task ahead is large. Over 220 million women living in low-resource countries do not want to become pregnant and yet are not using an effective contraceptive method. This may seem strange when we have so many contraceptive choices available to prevent unintended pregnancy. However, not only is access to contraception limited for many of these women, but also the currently available methods do not always meet their needs, preferences or budgets. Approximately two-thirds of all women with an unmet need do not use modern contraception for reasons including side effects, perceived harm to health and desire to preserve future fertility. Along with our current method mix, we need to consider new contraceptive approaches that address these concerns.

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  • A new study published in the on line journal Nature Medicine over the weekend brings exciting news in the race to find an AIDS vaccine. Researchers from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) have found that a key change in the outer coating of the HIV virus allowed two HIV positive women to develop “broadly neutralizing antibodies,” which are antibodies that can be used to target and fight most strains of HIV.

    The first broadly neutralizing antibodies were discovered over three years ago, and since then dozens more have been identified. But until now, researchers haven’t been able to pinpoint how they develop, which is critical to developing a vaccine. The new findings establish a link between a change in the virus after infection and the formulation of the antibodies that fight it.

    According to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, the study is “an important step in trying to understand just how these broadly neutralizing antibodies evolve.”

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  • Reflections on a Legacy of Change

    As I was moderating a final panel for C-Change’s end-of-project meeting in Washington, D.C., it occurred to me that successful development programs usually raise as many questions as they answer. The Communication for Change (C-Change) project was no exception. Indeed, a project as wide-ranging and prolific as C-Change was bound to inspire thoughtful reflection well beyond the question, “Where do we go from here?” The project, the U.S. Agency for International Development’s (USAID’s) flagship program in social and behavior change communication (SBCC) since 2007, has worked with national and local governments in nine countries, universities in five countries, many local nongovernmental organizations in 15 countries and four regional networks with 212 member organizations. All of those partnerships were crucial to embedding SBCC into the hearts, minds and institutions that they reached. But would any of these partnerships endure without a central coordinating body? Or would they even have to endure to be successful? Would it be enough that C-Change, in the words of Rafael Obregon, Chief of Communication for Development at UNICEF, “provided a space for people’s engagement and participation” in a nonprescriptive or message-driven way?

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  • Getting Closer to an AIDS-Free Generation

    May 18th is HIV Vaccine Awareness Day (HVAD), an annual observance that recognizes the contributions of thousands of volunteers, community members, health professionals, scientists, and experts in the HIV/AIDS field who are committed to working together to find an HIV vaccine. This year, we acknowledge the participation of thousands of trial volunteers who have made the research possible, and we highlight recent progress that gives us hope that controlling this epidemic is within our reach.

    Great strides have been made in the three decades since the U.S. Centers for Disease Control and Prevention (CDC) reported the first cases of what we know today as HIV/AIDS. What was considered a death sentence in the early 80s is now a manageable chronic condition for those living with HIV who have access to medications. However, about 30 million people globally have died as a result of HIV/AIDS, and 50,000 Americans still become infected every year. Despite the profound impact this disease continues to have in our communities, new developments in HIV prevention efforts inspire us with the hopeful expectation of an AIDS-free generation.

    Recent advances in biomedical HIV prevention research have included microbicides and pre-exposure prophylaxis (PrEP). Microbicides are gels or creams that both women and men can use topically to prevent the sexual transmission of HIV. Other products, such as films, suppositories, vaginal rings or sponges, are also being developed to release the active ingredients in the body over time. The microbicides that have proven to be partially effective to date contain an anti-HIV drug known as Tenofovir. PrEP is an approach that involves the use of oral anti-HIV drugs taken by uninfected individuals to prevent HIV infection if exposed to the virus. One drug, known as Truvada, has been shown to be effective in some populations. Consequently, on May 10, an advisory committee recommended that the U.S. Food and Drug Administration approve the use of Truvada as part of PrEP to prevent sexually transmitted HIV-1 infection. While both of these prevention strategies have varying degrees of protection against HIV, adding a safe, effective and durable vaccine to the combination of available prevention tools remains our best hope to ending the pandemic.

    Scientists believe that it will take more than one approach to control the spread of HIV in the world. PrEP, microbicides and HIV vaccines, along with other proven prevention methods such as the regular use of condoms, are essential components of a comprehensive approach to global HIV prevention efforts. But, the success of the research in all these areas greatly depends on community participation and involvement as well as establishing trusting relationships within the communities most affected by HIV.

    Collaboration among scientists, community leaders, and advocacy groups is essential for the fight against HIV/AIDS. In January 2012, the Be The Generation Bridge (BTG Bridge) program was funded by the U.S. National Institute of Allergy and Infectious Diseases to help increase awareness and understanding of biomedical HIV prevention research, including HIV vaccines. To learn more about this research and how you can get involved, visit www.bethegeneration.nih.gov. To view community profile videos, visit www.youtube.com/bethegeneration.

  • In the beautiful and remote Cambodian province of Pailin, FHI 360 is working with rural communities to reduce malaria transmission and save lives.

    With support from the Global Fund through the Village Malaria Workers program, FHI 360 has trained people in 28 villages across this region to provide malaria education, diagnosis and treatment. Village workers have provided malaria testing to 13,351 fever patients in these remote areas, and have treated over 3,000 patients for malaria.

    This World Malaria Day, visit Pailin by video. Your guide is an FHI 360 malaria program coordinator who shares how the program works.

    Visit this page for more information about our recent work in Pailin, Cambodia.

  • Yesterday morning the White House hosted an open forum on innovation in global development. The discussion panel included Raj Shah (Administrator of USAID), Gayle Smith (Special Assistant to the President & Senior Director of the National Security Council), and Tom Kalil (Deputy Director for Policy, White House Office of Science and Technology Policy & Senior Advisor for Science, Technology, and Innovation, National Economic Council). Questions were taken from the public via Twitter with the hashtag #WHChat and through Facebook.

    FHI 360 submitted four questions through Twitter, and three of them were answered by the panel (though we were not directly mentioned):

    In which areas of development is innovation most urgently needed?

    The panel answered that innovation is urgently need in all sectors, but stressed food security, global health, and climate change as key focus areas.

    How can we best involve youth in the innovation conversation?

    The panel answered that it is important to engage college students in the US through university partnerships. They discussed USAID’s University Engagement program specifically, and talked about harnessing the power of the Internet to engage students in the developing world.

    How can development partners support home-grown innovation in developing countries?

    Similar to the above question, the panel talked about supporting students in developing countries and giving them platforms to voice their opinions. They also said that giving direct support to innovative projects and building networks of partnerships were important to foster home-grown innovation.

    What do you think? Let us know in the comments, or connect with us on Twitter, Facebook, or Google+.

    For more information about the White House’s innovation initiatives, check out their fact sheet, “Harnessing Innovation for Global Development.”

  • Innovation is key to expanding contraceptive choice

    Contraceptive technology has come a long way, but there is still much more work that needs to be done to increase women’s access to safe and effective contraceptive choices.

    Since Margaret Sanger overturned anti-contraceptive legislation in 1936, making it legal for doctors to provide diaphragms and spermicides to women, researchers have been working to develop improved contraceptive methods. Oral contraceptives were introduced to the public in the 1960s and paved the way for future innovation. Today, contraceptive hormones are delivered in a variety of ways, including through implants, long-acting injections, patches and vaginal rings.

    Yet there is still a gap in contraceptive technology that FHI 360 is working to fill – an effective, safe, easy-to-use, and low-cost vaginal contraceptive.

    FHI 360 has developed a new vaginal insert, made of soft, non-woven textile materials that can contain different types of vaginal gels. What makes this insert innovative is that it virtually eliminates leakage of the vaginal gel, a critical issue for both effectiveness and acceptability. The insert is packaged as a single-use, ready-to-use product, pre-moistened with medicated gel. Depending upon the type of gel, the device could be used to prevent pregnancy or HIV or to treat vaginal infections.

    Currently, the only over-the-counter vaginal contraceptives that are available are detergent-based spermicides containing nonoxynol-9 or similar agents. Detergent-based spermicides are irritating to vaginal tissues and with frequent use can cause ulcerations that could increase the risk of HIV infection.

    The insert could be used with new non-irritating spermicides such as BufferGel® (developed by researchers at Johns Hopkins University) or with a ferrous gluconate formulation (developed by researchers at Cornell University). So far, the Hopkins and Cornell researchers have used other delivery methods, including diaphragms and vaginal rings, for their formulations. The FHI 360 insert could also be used to deliver microbicide gels, considered to be one of the most promising interventions to emerge over the past decade to prevent HIV infection in women.

    Results of a pivotal study, presented on September 17 at the Reproductive Health 2011 conference, showed that the combination of BufferGel and the new SILCS® diaphragm—a one-size-fits-all device—was as effective as a diaphragm with nonoxynol-9 gel. This is a double dose of innovation—a new, non-irritating spermicidal gel and a new one-size-fits-all diaphragm—and it’s great news for women.

    In 2009, we conducted a Phase I study to assess the acceptability of the FHI 360 insert among women and their male partners in Durban, South Africa, using the device saturated with 10 mL of an FDA-approved vaginal lubricant. We recruited 40 women, who first inserted and removed the device at the clinic and then at home. For home use, we asked women to discuss the product with their male partner and—if their partner agreed—to wear it during intercourse.

    Participants found the insert easy to place in the vagina and easy to remove with minimal to non-existent leakage. Most men (34) agreed to have intercourse with the device in place. Participants reported that the insert was comfortable during intercourse. Most women said they would be willing to use the insert for contraception or preventing sexually transmitted infections, including HIV, and most men said they would approve of their female partners using it if it became commercially available.

    Once again, we have the potential to advance women’s health in the U.S. and around the world. This is what innovation is all about – improving lives.

  • Non-communicable Diseases

    Next week, global leaders will meet at the United Nations to take on some of the world’s greatest killers: cancer, diabetes, chronic respiratory disease, heart disease, and stroke. The UN High-Level Meeting on the Prevention and Control of Non-Communicable Diseases on September 19–20, has the potential to finally address these leading causes of death and disability, which until now have been largely ignored.

    Yet when we wake up on Sept. 21, how much will have changed? Will there be a new Global Fund to fight noncommunicable diseases (NCDs)? Will key stakeholders, such as those involved in urban planning, agriculture, trade and current global health priorities be as engaged as they need to be to realize ambitious goals of measurably reducing disease? Will the public even know what an NCD is — even though more than 60 percent of deaths worldwide are from noncommunicable diseases, the majority from cardiovascular disease?

    ncd_blog_full_article_text_graphic_2011-09-13-02The answer to all of these questions is: not yet. September 21 will be the start of the real work. The problems of NCDs are complex, but we have many opportunities to alter the course of what has become a global crisis.

    There are a number of concrete steps that countries and health systems can take immediately to strengthen their commitment to reducing noncommunicable diseases. They can ratify and implement the Framework Convention on Tobacco Control, the world’s first public health treaty. Many countries already have the makings of NCD plans in existing cancer plans, tobacco control programs and strategies for diabetes and cardiovascular disease. They may also have specific programs to address respiratory disease, mental health and other issues. Health systems can make essential drugs, such as aspirin and statins, available immediately and at a low cost because many are off patent.

    As leading researchers and public health officials said in an April 2011 Lancet article, “An effective response to NCDs requires government leadership and coordination of all relevant sectors and stakeholders, reinforced through international cooperation.”

    In the end, we will need to make compromises and learn to share resources with people and institutions with whom we are not accustomed to collaborating. We will need to delay gratification and risk unpopularity in some of our choices. And we will likely not see the payoff in our lifetimes. But with time, effort and investment, we will see results.

  • A new breed of mosquito could become a key ally in the fight against dengue fever. An infectious tropical disease caused by the dengue virus, dengue fever is principally transmitted by the Aedes aegypti mosquito. Currently there is no vaccine for the disease and regions where the disease is endemic are left struggling to prevent infection by reducing mosquito habitat, decreasing the number of mosquitoes and limiting human exposure to being bitten.

    But recently the leading scientific journal Nature published two papers describing the results of biological control field trials where wild mosquito populations were genetically manipulated to suppress dengue virus transmission. The results are the work of the Eliminate Dengue program, an international collaboration of scientists located in Australia, Vietnam, Thailand, the U.S. and Brazil. The program’s aim is to stop the Aedes aegypti mosquito from passing dengue virus between humans by introducing a naturally occurring bacterium called Wolbachia into the existing wild mosquito population.

    The papers describe how researchers successfully established Wolbachia strains within the dengue mosquito in the laboratory. Mosquitoes with Wolbachia were shown to be less likely to transmit dengue. These mosquitoes were also able to pass this trait on to their offspring. In subsequent field testing in early 2011, mosquitoes carrying Wolbachia were released in Cairns, Australia. Within a three-month period Wolbachia had successfully invaded the local mosquito populations. According to the lead researcher, Professor Scott O’Neill, “These findings tell us that Wolbachia-based strategies are practical to implement and might hold the key to a new sustainable approach to dengue control.”

    Further trials will continue in Australia, as well as field releases in Vietnam, Thailand, Indonesia and Brazil where dengue fever is endemic and researchers can determine if the method is effective in reducing dengue disease in humans. If successful, the Eliminate Dengue program has the potential to benefit about 40 percent of the world’s population currently living in dengue transmission areas.

    Endemic in more than 110 countries, dengue infects 50 to 100 million people worldwide a year, leading to half a million hospitalizations and approximately 12,500–25,000 deaths. The World Health Organization ranks dengue fever as the most important mosquito-borne viral disease in the world, with an estimated 2.5 billion people living in dengue transmission areas and at risk of the disease. Symptoms include fever, headache, muscle and joint pains and a characteristic skin rash. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, which mostly affects children, or into dengue shock syndrome.

    FHI 360 is part of the Eliminate Dengue international team and is working in Thailand and Vietnam to gain the necessary regulatory approvals for the field releases as well as conducting community-preparedness and stakeholder engagement activities in readiness for the field releases in the near future.

    Learn more at www.eliminatedengue.com.

    It has quickly become apparent that for a small out lay, if you choose a web site name cleverly enough, you can make a great deal of money by auctioning it off to the highest bidder. This has resulted in the phenomenon of cyber squatting, where people buy website names simply for resale. The clunkily-named Anti cyber squatting Consumer Protection Act, signed last month by Nicebid, tries to outlaw this practice, but the whole business has proved to be a legal minefield. The complex legal issues surrounding the copyrighting of names are not new, but in the next few years they will reach a new white hot intensity as more and more individuals and businesses chase fewer and fewer available domain names.

    For the AIM event, Ms. Nopparat Yokubon, Google’s account manager for online partnerships, discussed “Insights Into Adsense Policies” and “How to Increase Your Adsense Performance. Meanwhile, Emanuele Brand idealt with the more technical topics of “Data-Driven AdSense Optimizations” and “Website Optimization with AdSense Tools.”

    “We’ve held several public auction asset sales in the last 12 monthsauctioningoffsomeofourestablishedwebsitesfromourportfolioandtheyallsellprettyquickon Flippa.com” Frankstated. “This is a great opportunity for individuals too win their own virtual asset or for other companies to acquire new web properties to lever a get their existing business.”

    According to Frank they have sold websites from their portfolio ranging in of their websites have been sold on Flippa and most sell within days.

    The Priory, which specializes in addictions and is famous for its celebrity clients, says it is treating more and more people for addiction to the internet auction website. What begins as a harmless hobby can take over your life, and many people – women especially – say it is ruining relationship sand plunging them in to debt.

    Alabanza mainly sold Internet access to “resellers” like Anadon and Sego, which in turn sell website and e-mail services to thousands of small businesses.

    Navisite planned to move Alabanza’s Weband e-mail services to Andover, scheduling the move over the weekend to minimize the impact.