Partners In Health

GH11-1193: STRENGTHENING INTEGRATED HIV AND CHOLERA CARE,

REINFORCING HIV CLINICAL SERVICES WITHIN A NETWORK OF PUBLIC HEALTH INSTITUTIONS IN THE CENTRAL PLA

STRENGTHEN & EXPAND ARV TREATMENT THROUGH THE PROVISION OF SOCIAL SUPPORT

COMMUNITY-BASED WORKFORCE TO INCREASE COVID-19 VACCINATIONS IN UNDERSERVED COMMUNITIES

HUMANITARIAN ASSISTANCE

COVID-19 RESPONSE

GH10-1003: BUILDING CAP. TO PROVIDE CERVICAL CANCER SCR. AND TREATMENT IN HAITI,

RAPID RESPONSE, CCCS, SOCIAL MOBILIZATION, AND PROTECTION ACTIVITIES IN SIERRA LEONE.

REACH FOR HEALTHY NAVAJO COMMUNITIES

POLICY, SYSTEM AND ENVIRONMENTAL CHANGE FOR HEALTHY NAVAJO COMMUNITIES

ACCOUNTABLE HEALTH COMMUNITIES: TRACK 2 - BUILDING HEALTHIER COMMUNITIES: SCREENING, NAVIGATING AND CONNECTING VULNERABLE COMMUNITY DWELLING BENEFICIARIES WITH NEEDED COMMUNITY RESOURCES.

DISASTAR ASSISTANCE: IDP CAMPS

TO SUPPORT THE DEVELOPMENT OF A MODEL THAT WILL PERMIT ADEQUATE HIV/AIDS PREVENTION-TO-CARE ACTIVITIES ALONG THE HAITIAN/DOMINICAN BORDER AND TO ESTA

HUMANITARIAN ASSISTANCE

PROGRAM FOR EMERGENCY RELIEF AND REBUILDING OF HEALTH CARE SERVICES.

TO STOP THE COVID-19 TRANSMISSION CHAIN AND SECURE THE HEALTH OF VENEZUELAN MIGRANTS AS WELL AS HOST COMMUNITIES

STRENGTHENING THE NATIONAL HEALTH SYSTEM THROUGH THE INTEGRATED PROVISION OF SERVICES FOR NONCOMMUNICABLE DISEASES, MENTAL HEALTH, AND SEXUAL AND REPRODUCTIVE HEALTH FOR REFUGEES AND MIGRANTS IN LIMA AND CALLAO.

SUPPORT FOR PROTECTION ACTIVITIES IN RESPONSE TO COVID-19 IN PERU.

POLICY, SYSTEM AND ENVIRONMENTAL CHANGE FOR HEALTHY NAVAJO COMMUNITIES

GLOBAL HEALTH SECURITY PARTNER ENGAGEMENT: EXPANDING EFFORTS AND STRATEGIES TO PROTECT AND IMPROVE PUBLIC HEALTH GLOBALLY

USAID ASSISTANCE

2007 COMMUNITY PARTNERSHIPS TO ELIMINATE HEALTH DISPARITIES

TREATMENT OF ISONIAZID-RESISTANT TUBERCULOSIS: CLOSING EVIDENCE GAPS ON SAFETY, EFFECTIVENESS, AND PHARMACOKINETICS OF THE STANDARD REGIMEN - PROJECT SUMMARY. TUBERCULOSIS (TB) IS A DANGEROUS DISEASE THAT, PRIOR TO THE ADVENT OF COVID-19, WAS THE LEADING CAUSE OF DEATH FROM AN INFECTIOUS AGENT. M. TUBERCULOSIS RESISTANCE TO ANTI-TB DRUGS WORSENS CLINICAL OUTCOMES AND POSES A SERIOUS THREAT TO GLOBAL TB CONTROL. RESISTANCE TO ISONIAZID, THE FIRST-LINE DRUG WITH THE MOST POTENT EARLY BACTERICIDAL ACTIVITY, IS THE MOST COMMON FORM OF RESISTANT TB AND REDUCES THE EFFICACY OF STANDARD 6-MONTH TREATMENT. BASED ON A META-ANALYSIS OF OBSERVATIONAL REPORTS, THE WHO, THE US CDC, AND SEVERAL SCIENTIFIC SOCIETIES, HAVE RECOMMENDED AN ALTERNATIVE REGIMEN FOR ISONIAZID-MONO-RESISTANT TB THAT SUBSTITUTES LEVOFLOXACIN FOR ISONIAZID AND INCLUDES A 6-MONTH COURSE OF LEVOFLOXACIN ALONG WITH RIFAMPICIN, ETHAMBUTOL, AND PYRAZINAMIDE (6LFX-REZ REGIMEN). TO DATE, THIS IS A WEAK RECOMMENDATION BECAUSE IT IS BASED ON EVIDENCE RATED AS VERY LOW QUALITY. IT IS ALSO ACKNOWLEDGED THAT THE PROLONGED ADMINISTRATION OF PYRAZINAMIDE ENTAILS A CONSIDERABLE RISK OF LIVER TOXICITY, AND IT MAY BE NECESSARY TO INCREASE THE DOSE OF RIFAMPICIN AND LEVOFLOXACIN TO BOOST EFFICACY, WITHIN SUFFICIENT SAFETY CRITERIA, BECAUSE IT LACKS THE BACTERICIDAL ACTION OF ISONIAZID. THE PREVALENCE OF ISONIAZID-MONO-RESISTANT TB IN PERU IS SIGNIFICANT; IN LIMA, 20% OF TB CASES ARE ISONIAZID-RESISTANT BUT HALF OF THEM ARE STILL SENSITIVE TO RIFAMPICIN. ADDITIONALLY, THE 6LFX-REZ REGIMEN IS BEING APPLIED ACROSS THE NATION FOLLOWING NEW NATIONAL TB GUIDELINES. HERE, WE PROPOSE A STUDY TO FILL IN SOME OF THE GAPS IN THE EVIDENCE SUPPORTING THE SAFETY, TOLERABILITY, EFFECTIVENESS, AND DRUG DOSAGES OF THIS REGIMEN. WE WILL RECRUIT PATIENTS IN PRIMARY HEALTH CARE CENTERS THROUGHOUT METROPOLITAN LIMA AND USE RAPID MOLECULAR AND PHENOTYPIC TESTS TO IDENTIFY 218 ISONIAZID-RESISTANT AND RIFAMPICIN-SENSITIVE TB PARTICIPANTS WHO RECEIVE THE 6LFX-REZ REGIMEN. THROUGH ACTIVE PHARMACOVIGILANCE OF THESE PATIENTS WITH PHONE CALLS EVERY TWO WEEKS AND PERIODIC MEDICAL EXAMINATIONS WITH LABORATORY TESTS, WE WILL ASSESS THE SAFETY AND TOLERABILITY OF THE REGIMEN. WE WILL MEASURE SUSTAINED EFFECTIVENESS UP TO 12 MONTHS POST-ENROLLMENT WITH PERIODIC SPUTUM CULTURES AND ASSESS THE ACQUISITION OF ADDITIONAL RESISTANCE IN INDIVIDUALS WHO FAIL TREATMENT OR RELAPSE. WE WILL ALSO DETERMINE PHARMACOKINETIC (PK) AND PHARMACODYNAMIC (PD) PARAMETERS OF LEVOFLOXACIN AND RIFAMPICIN AT WEEK 8 IN A SUBSET OF PARTICIPANTS, OVERSAMPLING THOSE WHO FAIL TO CONVERT THEIR CULTURE TO NEGATIVE TO DETERMINE THE MINIMUM INHIBITORY CONCENTRATIONS OF BOTH DRUGS IN BASELINE ISOLATES. WE BELIEVE THAT THIS STUDY WILL OFFER USEFUL INFORMATION ABOUT THE REGIMEN USED TO TREAT THE MOST PREVALENT TYPE OF DRUG-RESISTANT TB. THE DATA WILL BE TRANSFERABLE TO ENVIRONMENTS WITH A HIGH PREVALENCE OF RESISTANT TB. FINALLY, WE BELIEVE THAT THIS PROSPECTIVE COHORT DESIGN WILL PROVIDE HIGH-QUALITY EVIDENCE PROMPTLY WHILE ALSO STRENGTHENING THE CLINICAL RESEARCH CAPABILITIES OF THE PARTICIPATING PERUVIAN INSTITUTIONS.

DEVELOPMENT OF A LOCALLY PRODUCED BEAN-BASED READY-TO-USE THERAPEUTIC FOOD IN RWANDA

OCEAN FREIGHT - FISCAL YEAR 2024 OCEAN FREIGHT - 2024/2025

TOOLS TO FACILITATE PREVENTIVE THERAPY FOR CHILDREN AND ADOLESCENTS IN PRIMARY CARE. - SUMMARY CHILDREN AND ADOLESCENTS EXPOSED TO TUBERCULOSIS (TB) IN THEIR HOMES (I.E. HOUSEHOLD CONTACTS) ARE AT HIGH RISK FOR DEVELOPING ACTIVE TB DISEASE IF THEY DO NOT RECEIVE TB PREVENTIVE TREATMENT (TPT). THE MANAGEMENT OF CHILD AND ADOLESCENT HOUSEHOLD CONTACTS IS HAMPERED BY THE LOW SENSITIVITY OF BACTERIOLOGICAL DIAGNOSTIC TOOLS AND LIMITED ACCESSIBILITY OF CHEST-X RAY (CXR) IN PRIMARY CARE SETTINGS OF LOW- AND MIDDLE-INCOME COUNTRIES. PRIMARY CARE PHYSICIANS, WHO TYPICALLY MANAGE HOUSEHOLD CONTACTS, WILL NOT PRESCRIBE TPT IF THEY CANNOT DECIDE WHETHER A CONTACT HAS TB DISEASE. THERE IS A NEED FOR TOOLS TO HELP PRIMARY CARE PHYSICIANS DISTINGUISH BETWEEN CHILD AND ADOLESCENT HOUSEHOLD CONTACTS WHO REQUIRE FURTHER EVALUATION FOR ACTIVE TB DISEASE AND THOSE WHO CAN SAFELY INITIATE TPT IMMEDIATELY. CXR IS IMPORTANT FOR DETECTING INCIPIENT LESIONS OF TB DISEASE, BUT CAPACITY FOR CXR IS LIMITED IN PRIMARY CARE SETTINGS IN LOW- AND MIDDLE-INCOME COUNTRIES. EVEN IN THOSE PLACES WHERE CXR CAN BE ACCESSED, THERE IS NOT ENOUGH CAPACITY AMONG PRIMARY CARE PHYSICIANS TO CORRECTLY INTERPRET THE RADIOLOGICAL FINDINGS. OUR PROPOSAL WILL (1) DERIVE A RISK SCORE TO PREDICT CXR ABNORMALITIES AMONG CHILD AND ADOLESCENT HOUSEHOLD CONTACTS AND (2) EVALUATE THE PERFORMANCE OF COMPUTER-AIDED DETECTION (CAD) SOFTWARE FOR DETECTING CXR ABNORMALITIES IN CHILDREN AND ADOLESCENTS CONTACTS. THE RISK SCORE, MEANT TO AID CLINICIANS IN PLACES WITH LIMITED CXR CAPACITY, WILL BE DERIVED USING DATA FROM A PREVIOUS COHORT STUDY OF 6001 CONTACTS 0-19 YEARS OLD. WE WILL CONSIDER 21 CANDIDATE PREDICTORS THAT CAN BE COLLECTED EASILY DURING A SIMPLE CLINICAL EVALUATION. PRIMARY CARE PHYSICIANS WILL BE ABLE TO USE THIS RISK SCORE TO IDENTIFY CHILDREN AND ADOLESCENTS WHO SHOULD BE REFERRED FOR FURTHER EVALUATION WITH CXR, AND CAN PRESCRIBE TPT TO THE REST. FOR SETTINGS THAT HAVE ACCESS TO CXR BUT WHERE PRIMARY CARE PHYSICIANS LACK EXPERTISE IN READING CXRS FOR TB, WE WILL EVALUATE THE PERFORMANCE OF THREE CAD SOFTWARE SYSTEMS AMONG CHILDREN AND ADOLESCENTS: CAD4TB VERSION 7 (DELFT IMAGING), QXR VERSION 3.0 (QURE.AI), AND INSIGHT CXR VERSION 3.1.0.0 (LUNIT INC). THESE SYSTEMS HAVE LARGELY BEEN VALIDATED IN ADULTS BUT NOT CHILDREN AND YOUNGER ADOLESCENTS. USING 1600 STORED RADIOGRAPHS FROM A LARGE-SCALE COMMUNITY SCREENING PROGRAM, WE WILL PERFORM A RECEIVER OPERATING CHARACTERISTIC ANALYSIS FOR EACH CAD SOFTWARE USING A PULMONOLOGIST’S DECISION OF CXR ABNORMALITY AS THE REFERENCE STANDARD. WE WILL COMPARE PERFORMANCE AMONG SYSTEMS AND BETWEEN CHILDREN AND ADOLESCENTS. THIS RESEARCH WILL CONTRIBUTE TO THE DEVELOPMENT OF SIMPLE TOOLS THAT FACILITATE THE CLINICAL DECISION-MAKING OF PRIMARY CARE PHYSICIANS TO PRESCRIBE TPT. INCREASING THE PRESCRIPTION OF TPT TO CHILD AND ADOLESCENT HOUSEHOLD CONTACTS WILL REDUCE THE INCIDENCE OF TB AND TB-ASSOCIATED MORTALITY AMONG CHILDREN AND ADOLESCENTS WORLDWIDE, HELPING TO ACHIEVE THE GOALS OF END TB STRATEGY.

OCEAN FREIGHT - FISCAL YEAR 2021 OCEAN FREIGHT - 2022/2023

OFR

HEALTHCARE ACCESS

GLOBAL HEALTH SECURITY PARTNER ENGAGEMENT: EXPANDING EFFORTS AND STRATEGIES TO PROTECT AND IMPROVE PUBLIC HEALTH GLOBALLY

GH10-1003: BUILDING CAP. TO PROVIDE CERVICAL CANCER SCR. AND TREATMENT IN HAITI,

GH11-1193, HAITI: STRENGTHENING INTEGRATED HIV AND CHOLERA CARE