Global Health Projects: Africa
Bill & Melinda Gates Foundation
Global maternal and neonatal mortality rates are unacceptably high. More than 98% of these deaths occur in low-resource settings. Strategies to reduce maternal and neonatal deaths need to incorporate improved access to appropriate diagnostic, curative and preventive interventions, especially in home and community settings, where over half of the more than 60 million births per year occur.
Foundations, governments and the global health community plan to invest in the development of new or adapted technologies to reduce maternal, fetal, and neonatal deaths in low-resource settings.
Optimal allocation of resources requires an understanding of the impact a potential technology could have on saving lives in each of these settings.
The Bill & Melinda Gates Foundation is providing support to RTI International to create a framework that will enable the global community to approximate and compare the potential of a portfolio of maternal and neonatal technologies to save lives in low-resource settings. This initiative, entitled Maternal and Neonatal Directed Assessment of Technology (MANDATE), will create a model that will have broad appeal to inventors, investors, donors, and researchers aspiring to use technology to maximize maternal and neonatal lives saved.
Team members include RTI economists, epidemiologists, and engineers, as well as consultants and subcontractors, including Dr. Robert Goldenberg, an obstetrician with broad clinical and research experience in low-resource settings; Dr. Alan Jobe, a neonatologist with extensive research experience in newborn health; and Applied Strategies, a company with broad experience developing computational models for global health applications. MANDATE will utilize the input from key frontline practitioners in India and sub-Saharan Africa.
Assessment and prioritization of the technology needs will inform the global evidence base on options for investment in the discovery and development of appropriate technologies for mothers and newborns in low-resource settings. MANDATE's overarching goal is to produce an interactive, computer-based, quantitative model that compares the potential number of lives saved across maternal and neonatal technologies. Users will be able to identify and isolate the potential impact of a technology by patient category, region, country, and setting. The tool will be available for public use free of charge.
United States Agency for International Development
Indoor residual spraying (IRS) is one of four key interventions that will be used in the President’s Malaria Initiative (PMI). Introduced in 2005, PMI aims to reduce malaria-related mortality by 50 percent in 15 African countries.
To provide technical and financial support to countries supported by the PMI to expand the use of IRS as an intervention for malaria prevention and control. The goal of the initiative is to reduce malaria-related mortality by 60 percent by reaching 85 percent of the vulnerable population.
Activities and Results
IRS is the application of small amounts of insecticide to the interior walls of houses to kill or sometimes repel malaria-transmitting mosquitoes. RTI is helping expand the use of IRS in the following countries: Angola, Benin, Ethiopia, Ghana, Madagascar, Malawi, Mali, Mozambique, Rwanda, Senegal, Tanzania (including Zanzibar), Uganda, and Zambia.
National Institute of Allergy and Infectious Diseases
In recent years, highly active antiretroviral therapy (HAART) has become increasingly available for HIV-infected populations in developing countries. Compared to populations in the United States and Western Europe, these populations often have higher background rates of opportunistic infections, malnutrition, and infectious diseases that can reduce antiretroviral therapy (ART) efficacy and increase ART toxicity. As ART programs are introduced to broader and more diverse segments of the population, an acute need has arisen for the collection of data that allows for evaluation of ART effectiveness in these developing country settings. In 2006, the National Institute of Allergy and Infectious Diseases (NIAID) established the IeDEA project, a global research consortium in seven world regions that aims to gather and harmonize HIV/AIDS data, particularly on the use of ART. Large, harmonized data sets from diverse populations will allow IeDEA partners to identify new, high-priority research questions, improve generalizability of study results, stream-line HIV research, and more accurately monitor the HIV epidemic in various regions as well as globally.
To establish international regional centers for the collection and harmonization of data and the establishment of an international research consortium to address unique and evolving research questions in HIV/AIDS.
Activities and Results
From 2006-2011, RTI led the Central Africa regional data center for IeDEA (which consisted of 13 research units in Burundi, Cameroon, the Democratic Republic of Congo, and Rwanda) and was the coordinating center responsible for logistical components and communication for all cross-regional collaborations.
RTI developed the administrative and technical infrastructure to support research activities at all participating research units in Burundi, Cameroon, and the Democratic Republic of Congo (DRC). All necessary hardware and software required to enter, manage, and transfer data were installed and the appropriate staff identified. IRB and administrative approvals from the Ministry of Health and National AIDS Committee were obtained. Data collection in the DRC began in May 2007, and primary data collection began in Burundi and Cameroon in March 2008. At the completion of data collection activities, data were collected from 24,569 adults and 474 children. An initiative to identify and register AIDS-related malignancies was conducted in Cameroon from 2008-2009, followed by a case-control study to identify risk factors among HIV+ and HIV- persons with Kaposi's Sarcoma from 2010-2011. As coordinating center, RTI organized the IeDEA Executive Committee meetings to promote collaboration with investigators external to the IeDEA consortium, and also developed a website to provide a central collaborative workspace and information service to participating members of the IeDEA project. To date, RTI has collaborated on nine peer-reviewed publications and continues to present these data at global conferences.