Global HIV/AIDS Quarterly Sep 2012

Director’s Message From Dr. Debbi Birx

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e have a lot to celebrate – hearty congratulations to the many DGHA staff who were nominated for or won CDC/ATSDR Honor Awards and CDC CGH Director’s Honor Awards! It is my greatest pleasure to see your skill, dedication, and hard work recognized and I applaud your achievements and service. Thanks also to the many who contributed by taking the time to write up the nominations to honor our colleagues.

Updated epidemic data – kudos and challenges Even more of DGHA’s outstanding work is reflected in the 2011 data released recently by UNAIDS in their report, “Together We Will End AIDS.” The data reveal amazing progress in many critical areas in the battle against global HIV/AIDS. The report also features some important epidemiological data that show regional trends in new HIV infections in Africa and the work we need to do with our new HIV incidence assay in key populations throughout Africa and in areas like Eastern Europe and Central Asia. For more on the updated UNAIDS data, see p. 3 of this issue for a summary of epidemic key facts and p. 22 for a link to the UNAIDS report.

Highlighting your work This issue of the Quarterly features articles that highlight the incredible impact and diversity of work you do. Read updates on our outstanding science and technical programs that are moving us further along the path to an AIDS-free generation, meeting reports from around the globe, achievements and celebrations in the field, and important staff news. Be sure to peruse the whole issue, and keep those great articles coming in so we can share your progress and achievements!

Thanks from the field Finally, I would like everyone to take ownership and pride in a painting (see photo) that was presented to DGHA at the PEPFAR exhibit at the International AIDS Conference in Washington, DC this summer by a representative from the Tanzania Youth Alliance. The painting depicts a lively village scene featuring a health clinic in the center, and includes hand-painted logos for CDC, HHS, and PEPFAR. This is truly a heartfelt expression of thanks, and honors the important work you do in saving lives and transforming societies across the world. The painting will be framed and displayed at headquarters in the lobby of Building 1 in Corporate Square. (See p. 4 for more images from the conference.)

Again, many thanks for all your hard work. There is much to be accomplished on the path to end AIDS and I am proud to work with each of you as we strive toward that inspiring goal. 

In This Issue Director’s Message............................................................. 1 Science Features CDC/PEPFAR Launch EA in Nine Countries .................. 2 PEPFAR, Partners Announce “Labs for Life” ................. 3 Key Facts on Global HIV/AIDS Epidemic from UNAIDS (2012) ....................................................... 3 Meeting Reports Snapshots from the AIDS 2012 Conference ................. 4 West Africa Workshop on HIV Case Surveillance ........ 5 Siem Reap Workshop on Surveillance in Key Populations ........................................................... 6 Reports from the Field Traditional Birth Attendants Increase Service Uptake in Ethiopia .......................................................... 7 CDC-Kenya’s Lab Chief Honored .................................... 8 CDC-Namibia Celebrating 10 Years ............................... 9 Secretary Clinton Visits Uganda HIV Clinic ................. 10 Inspiring a New Generation in Pretoria ....................... 10 Rwanda Retains Patients, Quality after Transition................................................................ 11 Siyayinqoba: Beat It! Conquers Fear of Testing ........ 12 CDC Helps Next Generation of Uganda Public Health Leaders ................................................................ 13 New CDC Lab in Uganda Responds to Ebola............. 13 CDC-Vietnam Celebrates International Laboratory Accreditation .................................................................. 14 Staff Updates ...................................................................... 15 Resources UNAIDS Report..................................................................... 22 PEPFAR Infographic............................................................ 22 From WHO ............................................................................. 22 Book Review: The Origins of AIDS ................................. 22 JAID Special PEPFAR Issue................................................ 22 Health Affairs PEPFAR Issue ............................................. 22 Upcoming Events.............................................................. 23

Science Features CDC/PEPFAR Complete Expenditure Analysis Phase I, Launch in Nine Countries Making programs more efficient, impactful, accountable

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hrough PEPFAR, CDC has led efforts to pioneer the development and use of expenditure analysis (EA) tools to better understand where resources are going and what outputs are produced by these investments. Designed for timeliness and usability, the EA tools allow PEPFAR teams to identify potential sources for efficiency gains and best practices, and ensure adoption of efficient program practices to save money.

Successful pilot In July, PEPFAR released a report of an EA pilot program (link) that took place in six countries from 2009 to 2012. The report summarizes the principal lessons learned, including the importance of collaborative planning; intensive technical assistance to implementing partners, who were responsible for reporting data; and having an understanding of the program context to interpret results correctly. The report also provides a set of country examples that show how EA data can be used. (See below for South Africa example.)

Using Expenditure Analysis Data Example: Informing Joint Planning with the South African Government The South Africa PEPFAR team is actively engaged with the government in a strategically planned transition of clinical service provision and support from PEPFAR to the South African government (SAG). Expenditure analysis completed in 2011 is providing key data for the discussions with SAG. By tracking expenditures, PEPFAR can align its funding with SAG’s National Strategy Plan Objectives. The SAG and US government must also understand how PEPFAR support is distributed across program areas and major cost categories in order to make concrete budgets and plans for transitioning program responsibility. The figure at right shows the distribution of PEPFAR expenditures from the pilot by program area and by cost category. [Source: U.S. President’s Emergency Plan for AIDS Relief, Report on Pilot Expenditure Analysis of PEPFAR Programs in Six Countries (July 2012)]

South Africa Expenditure Analysis Pilot, 2011: Distribution of PEPFAR Expenditures by Cost Category and Program Area (N=23 implementing partners)

Phased rollout PEPFAR has embraced the EA tools as a cornerstone of their plan to accelerate program efficiency, impact, and accountability. This fall, CDC, through PEPFAR, is rolling out the tools to nine countries: Ethiopia, Kenya, Mozambique, Namibia, Nigeria, South Africa, Tanzania, Uganda, and Zambia.

EA data from these countries will be incorporated into routine annual reporting to PEPFAR and shared with partner governments. The data will be used to help PEPFAR programmers and national governments make rapid course corrections to improve planning and effectiveness and avoid inefficient use of resources. PEPFAR expects to roll out the EA tools to all supported countries by 2013.

Broad coordination EA is also part of PEPFAR’s efforts toward transitioning to country ownership by facilitating joint resource planning through harmonization of expenditure tracking methods with partner governments. PEPFAR is coordinating with national and multilateral partners (such as UNAIDS and the Global Fund) to create a harmonized global practice of expenditure tracking. 

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Science Features PEPFAR and Partners Launch “Labs for Life” Builds on prior CDC successes

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n July, PEPFAR and Becton, Dickinson and Company (BD) announced a 5year, $20 million “Labs for Life” collaboration. The public-private partnership (PPP) builds on the success of CDC’s initial efforts in strengthening laboratories in sub-Saharan African countries severely affected by HIV/AIDS and TB. The new initiative includes Uganda, Kenya, Ethiopia, and Mozambique and also expands outside of Africa to India.

Labs for Life will focus on • • • •

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Quality improvement for laboratory services to attain national, regional, or international accreditation Laboratory human resources training on pathology, forecasting, and optimization Curriculum development and training on equipment maintenance Collaboration with the African Centre for Integrated Laboratory Training and the African Society for Laboratory Medicine to strengthen local capacity and promote country ownership and sustainability.

Use of HIV systems to address non-communicable diseases (such as diabetes) and creation of capabilities in health systems to adopt point-of-care technologies.

Success of previous collaboration PEPFAR and BD also revealed the results of a third-party assessment of their prior PPP to strengthen laboratories. Aligning with PEPFAR’s priority of strengthening health systems, the initial collaboration addressed national needs to improve quality and accuracy of laboratory test results to support clinical decision-making for initiation and monitoring patients in Uganda, Ethiopia, Mozambique, and South Africa. CDC field staff and BD worked with Ministries of Health to develop a sustainable model integrating technology transfer, local workforce, and health infrastructure development. The assessment by Cardno, an external auditing company, reported that countries where capacity-building took place had not only improved the quality of services available to local populations, but also became regional centers of excellence in Africa. 

UNAIDS 2012 Update: Key Facts on the Global HIV/AIDS Epidemic Facts from the recently released report, “Together We Will End AIDS” (link) • In 2011, more than 8 million people had access to antiretroviral therapy ­ An increase of 20% in just one year from 2010 to 2011 • In 2011, 2.5 million people were newly infected with HIV ­ A reduction of 20% since 2001 • Around 330,000 children were newly infected with HIV in 2011 ­ A reduction of 24% in just two years, from 2009-2011 • Some 1.7 million people died from AIDSrelated causes in 2011 ­ A decline of 24% since the peak in 2005 • In 2011, 34.2 million people were living with HIV ­ More than ever before due to the lifeprolonging effects of antiretroviral therapy • TB remains the leading cause of death among people living with HIV. • Young people aged 15-24 years account for 40% of all new adult (15+) HIV infections.

• Globally, infection rates in young women 15–24 years old are twice as high as among men of the same age.

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Meeting Reports Snapshots from the International AIDS Conference, July 22-27, 2012, Washington, DC Secretary Clinton: ”We will not back off, we will not back down!”

DGHA Booth at AIDS 2012 Conference Featured 30-Year Timeline, Videos

To the cheers of thousands who had stood in line to gain admission to the plenary session at which she would speak, Secretary of State Hillary Clinton reaffirmed the U.S. government commitment to creating an AIDS-free generation, reported on notable progress in PEPFAR’s combination prevention strategy, and announced that an additional $37 million would be invested in reaching key populations (defined by UNAIDS as sex workers, men who have sex with men, and people who inject drugs). Read her remarks (link).

(Photo: AIDS 2012 website) 

Many attendees stopped by the DGHA booth in the PEPFAR exhibit to learn more about CDC’s activities in the global fight against HIV/AIDS. In addition to a timeline featuring three decades of CDC’s scientific and technical achievements since the start of the epidemic (see photo), the booth featured videos created for the conference and fact sheets on a broad diversity of DGHA activities. The timeline, videos, and fact sheets are all available on the DGHA website (link). 

AIDS Memorial Quilt on Display

South African Orphan Tower

Individual panels from the AIDS Memorial Quilt – which, in its entirety, now measures more than 50 miles laid side-by-side and weighs 54 tons – were displayed this summer around Washington, DC, including at the Walter E. Washington Conference Center, the venue for the International AIDS Conference. The quilt commemorates the lives of nearly 94,000 people who have died from AIDS-related causes, a loving remembrance sewn together by friends and family members.

The quilt was nominated for a Nobel Peace Prize in 1989 and remains the largest community art project in the world. [Photo: AIDS Memorial Quilt website (link)]

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A 10-foot tall tower made up of 634 small beaded cloth dolls was displayed at the Walter E. Washington Convention Center – the conference venue – to help viewers understand the impact of the AIDS epidemic in South Africa. The tower represents 634 young orphans who live in Dannhauser Village just outside of Dundee in rural KwaZulu-Natal, South Africa. According to the posted description, the current statistic for children orphaned by AIDS in South Africa stands at 3.7 million. Depicting the full magnitude of this tragic situation would require 5,835 such towers.

[Read more detail on the tower (link)] 

Meeting Reports West Africa Workshop Builds Capacity for HIV Case Surveillance

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he rapid-scale up of HIV prevention, care, and treatment services in sub-Saharan Africa has spurred the development of clinical and laboratory monitoring systems. HIV case surveillance – the observation and recording of new cases of HIV – was not feasible until those systems were in place. Case surveillance is a key tool for tracking and predicting the course of the epidemic in a country, and is useful for planning HIV prevention, care, and treatment programs.

Participants

Delegations of 4-5 participants from Ministries of Health, National AIDS Councils, U.S. government agencies, and key international organizations were invited from Cameroon, Cote A West Africa/Francophone Regional HIV Case D’Ivoire, Democratic Surveillance Workshop was held in Dakar, Senegal Representatives from six countries attended the West Republic of the Congo, on May 21-24, 2012 to focus on the added value, Africa/Francophone Regional HIV Case Surveillance Workshop Mali, Mauritania, and held in May in Dakar, Senegal. benefits, and cost-efficiencies of integrating HIV Senegal. The workshop case-based surveillance into current surveillance was organized by facilitators from CDC, the National Association of systems, case surveillance methods, and the alignment of such State and Territorial AIDS Directors (NASTAD), and WHO. Senegal’s methods with existing patient-level data systems, resources, and Centre Hospitalier Universitaire Laboratory Le Dantec and Cheikh practice.

Anta Diop University (recipient of CDC PEPFAR funds) provided To date, other surveillance methods have been used to monitor the logistical support and participants. Each facilitator worked with one epidemic; these include antenatal care sentinel surveillance and country team for group work sessions throughout the workshop. population-based surveys. Monitoring and evaluation activities CDC staff acted as both facilitators and participants. They included based on these methods have largely relied on aggregate data Nicolas De Kerorguen, Jacob Dee, Chris Murrill, and Thierry Roels (all reporting, which do not offer the same flexibility in de-duplicating CDC headquarters); Roger Legre Lobognon and Amassanh Nicoue and analyzing data as do individual-level data sets. As clinical, from Cote d’Ivoire, Adama Ndir from Mali, Mpingulu Minlangu from laboratory, and other individual-data sets are implemented and the Democratic Republic of the Congo, and Keleko G Leonard Colince functioning, such systems can be leveraged as a source of from Cameroon. surveillance data in a manner that is both more cost-effective and higher quality than existing, largely paper-based monitoring efforts.

Accomplishments and expected outcomes

Workshop objectives

Workshop facilitators successfully trained participating country teams on HIV/AIDS case surveillance concepts, methods, and components. Participating countries considered the strengths and weaknesses of their existing programs and surveillance data to propose the development and implementation of a case surveillance system using data routinely collected through facilities and programs, such as electronic medical records (EMR) and records and registers from care and treatment, prevention of mother-to-child HIV transmission, and early infant diagnosis sites. In addition, countries drafted action plans and next steps to present to their respective Ministries of Health and other stakeholders and to progress toward piloting and implementing these HIV case surveillance systems. 

The main objectives of the workshop were the following: • Build capacity and understanding of Ministries of Health in HIV case-based surveillance methods and their potential to provide key information through analysis, interpretation, and dissemination.

• Identify in-country opportunities to implement HIV case surveillance through the availability of notifiable disease surveillance systems, unique identifiers, and paper-based and electronic clinical, programmatic, and laboratory data systems.

Develop an action plan to move towards case-based surveillance.

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-Thierry Roels, DGHA

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Meeting Reports Siem Reap Workshop Focuses on HIV Surveillance in Key Populations in Asia-Pacific Region

Global experts and Asia-Pacific based health professionals working in HIV surveillance met in Siem Reap in June to discuss the best ways to monitor and analyze HIV data to ensure the best strategies to control the HIV epidemic across the region.

During the sessions, health workers from government, non-governmental organizations, and donor agencies learned cutting-edge surveillance methods appropriate for concentrated HIV epidemics and shared lessons from recent evaluations in adaptive sampling, population-size estimation, HIV incidence estimation, and surveillance system coverage. Attendees also discussed issues unique to Asia, such as monitoring population migration patterns, and shared their challenges and successes. Regional stakeholders made up the majority of participants, and decided on the most relevant issues for discussion to address challenges specific to their setting. The workshop format also facilitated linking participants with appropriate experts for focused, one-on-one technical assistance discussions and follow-up.

A sense of belonging Participants indicated that such regional workshops allow them to be better equipped and informed to monitor and analyze the HIV/AIDS epidemic across the region. Dr. Keith Sabin, WHO epidemiologist and HIV surveillance expert, stressed that for attendees the value of the workshop extended far beyond the five days.

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sia’s Third Biennial Asia Regional HIV Surveillance Workshop was held on June 4-8, 2012 in the northwestern city of Siem Reap, Cambodia. The theme for this year’s workshop was “Challenges and Successes in Monitoring the HIV Epidemic – the Asia Experience.”

The gathering brought together 65 public health professionals from 14 Asian-Pacific countries and global experts in HIV surveillance. The countries or regions represented were Bangladesh, Cambodia, Central Asia (Kazakhstan, Tajikistan, Uzbekistan), China, Indonesia, Lao, Malaysia, Mongolia, Pacific islands, Philippines, Thailand, and Vietnam.

Discussion topics With support from CDC Strategic Information teams in Cambodia, Thailand, and Vietnam, and the regional WHO surveillance unit, attendees discussed the most effective ways to collect and use HIV data to better plan, implement, and evaluate HIV programs across the region. The key affected populations in Asia are primarily marginalized communities such as people who use drugs, commercial sex workers, and men who have sex with men. Identifying the best ways of observing and understanding the burden and trends of the HIV epidemic among these populations is a complex and challenging process, but is critical to HIV control and was the focus of the workshop.

“There is no good way to measure the sense of belonging to a social or professional network, which develops Dr. Dongbao Yu (WHO/Western through commiserating over data entry Pacific Regional Office) speaking at the Third Biennial Asia Regional HIV errors, difficult data analyses, and Surveillance Workshop. political pressure to provide a single number when you know all the sub-epidemics in your country requires five numbers to really describe what is happening,” he added. “Not only did participants learn there was hope for easier analysis of RDS [respondent-driven sampling] data, but that they were not alone in their struggles, and now they know who to call when things get bleak. It’s the latter that is invaluable and immeasurable.”

Workshop a success The third biennial Asia Regional Surveillance workshop in Cambodia was a success in terms of providing a forum for technical sharing, assistance, and networking. As the forum wrapped up, countries indicated that they were ready to start making changes in their surveillance activities based on the week’s discussions, and participants are already sharing ideas for the next workshop that is planned for 2014.  - Joel Katz, CDC-Vietnam

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Reports from the Field Traditional Birth Attendants Increase Uptake of Antenatal, PMTCT Services in Ethiopia

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he use of services to prevent mother-to-child HIV transmission (PMTCT) remains low in Ethiopia, where maternal mortality is a primary cause of death. In the rural community of Dire Dawa, the prevalence of HIV/AIDS is among the highest in Ethiopia at 4.9%, yet PMTCT and antenatal (pre-birth) service uptake is only 32% and 55%, respectively. Women and children are more vulnerable to HIV/AIDS in rural communities like Dire Dawa due to limited use of health services, high illiteracy rate, and widespread traditional practices.

Engaging the community In response to this serious situation, the CDC-funded National Alliance of State and Territorial AIDS Directors, in collaboration with the Dire Dawa Regional Health Bureau and other partners, recruited and trained traditional birth attendants from nine rural “kebeles” (neighborhoods) as voluntary community anti-AIDS promoters in 2010. The objective of the program was to promote antenatal care and institutional delivery to increase the use of services that decrease the risk of mother-to-child-HIV transmission.

Program organizers held a meeting for the volunteers in the presence of religious and community leaders, who acted as referral agents for the program. Attendants were introduced to the health facility staff and health extension workers to strengthen collaboration and coordination. Regular supportive supervision and review meetings were conducted with stakeholders to monitor the program’s progress.

Traditional birth attendants from nine rural ‘kebeles’ (neighborhoods) were recruited and trained to promote antenatal care and institutional delivery in Ethiopia.

Program a clear success Findings from the program evaluation reveal that the attendants visited more than 3,500 households and referred about 500 pregnant mothers to the nearest health facility or health extension workers for antenatal care and institutional delivery. All pregnant mothers who came for antenatal care were tested for HIV and given services accordingly.

Findings include the following: • According to Biyoawale health center, 257 pregnant women were seen in the antenatal care unit from September 2010 to February 2011, an increase of almost 95% from the same period in the previous year (when 132 women were seen).

• • •

In Harla health post, antenatal care uptake increased to 67 women as compared to 20 the previous year.

Similar findings were recorded in Adada and Ejanani health posts, where 132 and 49 pregnant mothers were seen for antenatal care, respectively, compared to none in the previous year.

By comparison, the Jeldesa health center, where the program had not been introduced, experienced only a 16% increase in antenatal care.

This evaluation clearly shows that using traditional birth attendants as voluntary community anti-AIDS promoters significantly improves the uptake of antenatal care, institutional delivery, and PMTCT in rural communities.  - Submitted by Sofia Yilma, CDC-Ethiopia for Tibebe Shenie, Workneh Demissie, Birhan Mengsitu , Tsigereda Kifle, and Wubit Admase of the National Alliance of State and Territorial AIDS Directors

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Reports from the Field CDC-Kenya’s DGHA Lab Chief Receives Embassy Honor

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ith one of CDC’s largest global HIV/AIDs country office programs, CDC-Kenya relies on Dr. Jane Mwangi’s exceptional leadership and ability to collaborate with diverse partners in developing and improving HIV laboratory services and systems. For her service to the U.S. government and the people of Kenya, Dr. Mwangi, Chief of the Laboratory, Blood Safety, and Infection Control Branch in the Division of Global HIV/AIDS (DGHA), was awarded the U.S. Embassy Mission Locally Employed Staff of the Year Award, the first time a CDC staff member has received the award in Kenya.

Building laboratory capacity

Dr. Jane Mwangi (center) is pictured with Suzanne Theroux, Deputy Director of DGHA-Kenya (left), and Dr. Robert Breiman, CDC-Kenya Country Director (right).

As the senior laboratory scientist on Kenya’s PEPFAR interagency team, Dr. Mwangi has led collaborations with the government of Kenya to achieve a number of important and innovative projects to build Kenya’s laboratory capacity. Some examples follow.

Moving toward accreditation. Accreditation of laboratories is critical to improving quality diagnostic services in Kenya. Dr. Mwangi and her team of nine worked closely with the National HIV (NHRL) and TB Laboratories to prepare and implement the WHO Stepwise Process Toward Laboratory Accreditation (SLMTA) in 21 labs across the country. They also developed a strong quality assurance program in NHRL, with more than 4,000 registered HIV testers enrolled in the HIV proficiency panel system that provides quarterly evaluation and supervision for testers who perform poorly. With their success, the NHRL has been asked by the Kenya Ministry of Public Health and Sanitation to serve as the model for rollout of similar systems to other national laboratories.

Collaborating to expand services. A key to developing sustainable country-led programs is strengthening the capacity of ministries to lead the implementation of laboratory and blood safety services. Dr. Mwangi and team supported development of plans for ministry-led product evaluations and the introduction of advanced HIV and TB

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Locally Employed Staff: The Backbone of PEPFAR Dr. Jane Mwangi stands as a shining example of CDC’s locally employed (LE) staff. LE staff are locally employed host country nationals or permanent residents, ordinarily resident Americans (such as Eligible Family Members), and locally recruited Third Country Nationals. They are the backbone of the PEPFAR program.

Approximately 75% of the implementing agency field-based staff working on PEPFAR are locally employed. We could not have a program without them, and we cannot be successful without them.

LE staff contribute institutional knowledge, local contacts, and exemplary work to complement the efforts of the American rotational staff.

diagnostics. They successfully coordinated rollout of Early Infant Diagnosis for HIV at one of the provincial hospitals in collaboration with the Clinton Health Access Initiative, USAID, and national laboratories and institutes.

Building partnerships for training. Another key to sustainable programs is the implementation of successful public-private partnerships (PPP) to extend the reach of PEPFAR’s technical support. Dr. Mwangi helped lead the implementation and roll out of a successful PPP with Becton Dickinson and Company (BD) to develop training in safe phlebotomy practices. This collaboration of BD, PEPFAR, and CDC – the “Kenya Safer Blood Collection Initiative” – was honored with a 2011 Global Business Coalition Award for Business Action on Health, competing among many other well-known companies and judged by a panel of corporate responsibility and public health experts.

A group effort Dr. Mwangi credits her staff and CDC on her success. Of her award, she said, “I acknowledge that this is truly recognition for ALL of CDC. Strong support systems have been established to enable personnel to function optimally. I have worked in places that make me realize that one cannot take for granted a clean and comfortable working environment, timely logistics for meetings and travel, access to modern means of communication, supportive technical teams, and facilitative leadership.”  - Nadine Sunderland, CDC-Kenya

Reports from the Field CDC –Namibia: Celebrating 10 Years in Windhoek

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hen CDC-Namibia’s first Country Director, Tom Kenyon, moved to Windhoek in 2002, the country’s HIV prevalence was estimated to be rapidly climbing toward a peak of 22%, one of the highest prevalence rates in all of Africa. For Kenyon, who arrived in Namibia after serving as CDC Country Director in Botswana, the situation presented a unique challenge – and an incredible opportunity. “Here was a country that had one of the highest prevalence rates in all of Africa,” he said.

“And yet the Minister of Health at the time, Dr. Libertina Amathila, was convinced the tide could be turned with a sustained push for universal access to antiretroviral therapy (ART).”

First ART program launched It was a daunting task. In 2002, Namibia had not yet started a public ART program, and neither PEPFAR nor the Global Fund to Fight AIDS, Tuberculosis and Malaria existed. Even so, thanks to Namibian Government commitment and with support from CDC since 2002, Dr. Amathila’s vision of a public ART program was achieved in May 2003 and has since rapidly expanded into what is now a quality assured program that delivers treatment to patients nationwide.

Although Namibia received some U.S. government funding when the ART program first began (through a U.S. initiative to support the prevention of mother-to-child transmission of HIV), substantial external funding for Namibia’s HIV/AIDS response did not exist until the launch of PEPFAR in 2004. Dawn Broussard, who served as CDCNamibia’s Deputy Director from 2006 to 2009 states, “I was always impressed by the country’s ability to build its care and treatment program on its own. There were no Track 1 international partners in Namibia. It was just the Ministry of Health.” PEPFAR came along at exactly the right time – Namibia was receiving leadership and direction from the Government, but lacked the resources necessary to match the rapidly growing need.

Expansion with PEPFAR funding Since 2004, PEPFAR has invested $632 million in Namibia and the number of citizens enrolled in the ART program has risen to 70,000 – approximately 93% of the estimated number of HIVinfected people in need of treatment. “It’s an impressive result,” said Jeff Hanson, who followed Kenyon as Country Director from 2007 until 2011.

Shifting responsibility Namibia’s program continues to develop. David Lowrance, CDCNamibia’s current Country Director, adds that shifting financial responsibility for HIV and TB service delivery to the host government has allowed CDC to focus on evolving towards a technical assistance model, with greater emphasis on capacity building, innovative operations research, and continuous quality improvement. “Fundamentally we’re still focused on supporting Namibia with what CDC does best – disease epidemiology and surveillance, laboratory strengthening and quality assurance, and monitoring and evaluation of clinical services.”

Ella Shihepo, the director of the Social Services’ Directorate for Special Programmes, with whom CDC-Namibia works closely, summarized the country’s progress well: “The last 10 years have been an incredible building period. Now we’re celebrating our successes in saving lives and looking forward to sustaining the gains we have made together, especially with the women and girls of Namibia, who have borne the brunt of this epidemic.”  -John Pitman, DGHA (recently CDC-Namibia)

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Reports from the Field Secretary Clinton Visits CDC-Funded HIV Clinic in Uganda Secretary of State Hillary Rodham Clinton traveled to Africa July 31 through August 10, making stops in Senegal, South Sudan, Uganda, Kenya, Malawi, South Africa, Nigeria, Ghana, and Benin. In Uganda, the Secretary not only met with President Yoweri Museveni to encourage strengthening of democratic institutions and human rights and promotion of regional security, but she also highlighted U.S. support in the fight against HIV/AIDS with a visit to a longtime CDC partner under PEPFAR—the ReachOut Mbuya HIV/AIDS Initiative (ROM) in Kampala.

John Robert Engole (far left), the first person in the world to receive treatment through PEPFAR, talks with Secretary of State Hillary Clinton in Kampala. Also pictured are ROM Executive Director Dr. Stella Alamo Talisuna and Uganda Minister of Health Dr. Christine Ondoa.

ROM is an indigenous, faith-based organization offering comprehensive, communitybased HIV care and treatment services. ROM was founded in 2001 to provide HIV/AIDS care to the urban poor in the Mbuya Catholic Parish, and, since 2004, CDC—through PEPFAR—has provided over $17 million to support ROM’s activities. ROM also bears the distinction of being the site at which the first patient in the world, John Robert Engole, was enrolled in treatment under PEPFAR. The Secretary met and spoke with him during her visit (see photo).  -Erik Friedly, CDC-Uganda

Inspiring a New Generation in Pretoria In February, Seymour Williams (photo at left), CDC’s resident advisor for South Africa’s Field Epidemiology and Laboratory Training Program, led a group of more than 70 young South Africans in a lively discussion about African Americans and their achievements in medicine. The gathering took place at the Mae Jemison Science Reading Room in Pretoria. Students learned about inspirational African-American doctors and researchers and discussed common obstacles to high achievement in their communities and the need for hard work and innovation to overcome them.

Dr. Williams’ talk was part of a series organized by the Outreach Bureau at the U.S. Embassy, which connects U.S. Mission staff and family members with South African audiences.  - Helen Savva, CDC-South Africa

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Reports from the Field One Year after Transition, Rwanda Proves Successful in Retaining Patients, Maintaining Quality

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he Rwanda Ministry of Health (MOH) was one of the first governments to assume direct responsibility for PEPFAR-supported HIV clinical services.* In 2012, CDCRwanda helped to complete the final transition of responsibilities for HIV clinical services at 76 PEPFARsupported health facilities from implementing partners (IPs) to the MOH.

Milestone toward sustainability

Monitoring for Service Quality Post-Transition The Rwanda MOH, CDC, and IPs conducted visits to facilities to monitor HIV clinical services quality at baseline and every 6 months after transition. Clinical performance indicators were verified from routinely collected data, including the national HIV monitoring system (TracNet) and PEPFAR performance reports. The analysis included baseline, 6-month, and 12-month data for three HIV care and treatment and two PMTCT clinical indicators from 70 transitioned health facilities. Results are summarized in the graphs below.

The Rwanda MOH now manages all aspects of HIV care and treatment service delivery, which is a critically important milestone toward achieving long term program sustainability. The program currently provides clinical care and treatment services to over 30,000 HIVinfected patients. To ensure continued high standards of care, CDC provides on-site technical assistance and mentoring.

Factors critical to success One year post-transition, an analysis of data collected during monitoring by the MOH has shown that approximately 86% of HIV-infected patients are retained on antiretroviral treatment (ART) after 12 months , and that the quality of critical HIV care and treatment and services to prevent mother-to-child transmission (PMTCT) of HIV is maintained (see sidebar).

The Rwanda MOH noted several factors critical to their success: continuous monitoring of clinical indicators, quality improvement initiatives, and targeted technical assistance from CDC and IPs. Results were presented at the International AIDS Conference last July in Washington, DC. ď ś - Pratima Raghunathan, DGHA * Rwanda was one of 13 countries in PEPFAR’s Track 1.0 Antiretroviral Therapy program. These services already are or are in the process of being fully country owned and operated. Local partners are expected to achieve identified benchmarks over the next several years. CDC is working with MOH and U.S. partners to monitor program performance and service quality during and after the transition.

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Reports from the Field Siyayinquoba: Beat It! Conquers Fear of HIV Testing

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iyayinqoba Beat It!, a South African magazine show produced by the Community Health Media Trust (CMT), discusses hard-hitting topics about people living with HIV. Not content with using just one mass medium to reach out on a national level, CMT goes one step further: with funding from PEPFAR through the CDC, the team has rolled out a comprehensive social mobilization campaign using the catchy Siyayinqoba brand to reach out to communities. In addition to maintaining a local presence, the campaign reaches a national audience by using tactics such as thought-provoking radio talk shows, news articles, and even taxis branded with HIV prevention messaging.

CMT’s new project team, based in rural Mthatha in the Eastern Cape, works with local nongovernmental organizations and community platforms to create a communication cascade that ensures the flow of HIV prevention and health information messaging to all communities in the predominantly isiXhosa province. CMT also works closely with the PEPFAR-funded TB/HIV Care Association, which provides staffing for local clinics and mobile units that transport HIV, TB, and sexually transmitted infection (STI) testing and screening resources to the people.

Community outreach, testing, and screening On the ground, CMT holds regular door-to-door campaigns followed by “open days,” particularly focusing their efforts on the two districts with the highest HIV prevalence – the OR Tambo and Alfred Nzo health districts. During open days, traditional chiefs, leaders, and ward councilors lead discussions about HIV and other health issues central to these communities, while guest speakers provide expert knowledge on treatment and prevention.

Representatives from the TB/HIV Care Association attend every open day, providing immediate HIV counseling and testing and TB screening.

Open days and door-to-door drives aim to dispel the fear of testing that is, too often, the result of stigma and ignorance. Nothobile Pasekile Mbele is a 49-year-old woman who was recently tested through this campaign when CMT and the TB/HIV Care Association arrived in her hometown of Maluti. “I am not afraid of the results as I’d rather know in time so that I can get the necessary treatment, should the need arise,” she said before testing.

A traditional leader encourages people to step forward and test for HIV.

Campaign a success People like Nothobile are the champions who drive the success of these campaigns. Since the start of this project in March 2012, CMT has participated in 12 open days, reaching nearly 7,000 people. More than 620 people have received HIV counseling and testing and more than 200 have been screened for TB. The eight door-to-door campaigners have managed to visit more than 1,000 households in these hard-to-reach rural villages and have visited a total of 5,435 people, of which 20% were referred to local clinics for a range of preventative health services.

With this waterfall of messaging and services, CMT will continue to empower communities and conquer the fear of HIV counseling and testing. As one Mthatha resident declared when visited by a door-to-door educator, “I’ve seen Siyayinqoba on the TV, I heard Siyayinqoba on the radio talking about HIV, and now you’re here at my house!”  - Helen Savva, CDC-South Africa

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Reports from the Field CDC Helping to Grow the Next Generation of Uganda’s Public Health Leaders

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lobally, a shortage of qualified health professionals is among the most significant constraints in achieving the three healthrelated United Nations Millennium Development Goals: reduce child mortality, improve maternal health, and combat HIV/AIDS and other diseases, such as tuberculosis and malaria. Program managers in the developing world often lead and manage both public and private health organizations with little or no formal management and leadership training or experience. Recognizing the impact this lack of training can have, CDC has made human resources for health a core focus of its global health systems strengthening activities.

degree in a health-related field. A total of 1,308 individuals have graduated the program to date and over 88% are currently employed in institutions registered in Uganda, indicating an extremely high level of country retention.

From focus to action In Uganda, CDC is helping to develop the next generation of public health leaders through a longstanding partnership with the Makerere University School of Public Health (MakSPH), known as the MakSPH-CDC Fellowship Program. The partnership was established in 2002 in response to Uganda’s rapidly expanding HIV/AIDS programming and increased funding from global initiatives such as PEPFAR. Because management of these crucial public health programs and the massive influx of funding posed numerous leadership and programmatic challenges in the country, the fellowship program was designed to train individuals in various aspects of HIV/AIDS program management.

Training public health leaders This two-year, full-time, non-degree fellowship is offered on a competitive basis to Ugandan nationals who possess a postgraduate

The program recently graduated its most recent class of nine fellows at a ceremony in Kampala at which Dr. Tadesse Wuhib, CDC-Uganda Country Director, was guest of honor. Dr. Wuhib called on the graduates to utilize the skills and abilities they have acquired to mitigate the challenges of Uganda’s ongoing HIV/AIDS pandemic.

“You are joining the HIV/AIDS world at a critical but also opportune moment—a moment at which there is a need for Uganda to renew its commitment to the HIV/AIDS response,” he said. “CDC-Uganda is confident that by strengthening the capacity of Ugandans through programs such as this one, we can significantly impact both the public and private health sectors in Uganda for the long term.”  - Erik Friedly, CDC-Uganda

New CDC Lab Responds Rapidly to Ebola Outbreak in Uganda

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n July, the Uganda Virus Research Institute (UVRI), in collaboration with CDC-Uganda, confirmed the presence of the deadly Sudan Ebola Virus in samples obtained from three individuals in western Uganda. The investigation and response were greatly helped by CDC’s new state-ofthe-art laboratory in Entebbe that can rapidly diagnose deadly viruses. The unique nature of the facility and its critical role in this response attracted the attention of Nature (link) as well as ABC News, who sent Dr. Richard Besser, former acting CDC Director and now ABC’s chief medical correspondent, to Uganda to follow the investigation with the CDC team (link).

The story of CDC’s role in rapidly detecting and containing the Ebola virus is an example of how CDC’s strong partnerships with Ministries of Health, its in-country presence, and the public health platform it has established throughout the world—much of it built as a result of PEPFAR— is one of collaboration, leveraged expertise, and strong systems for monitoring and assessing emerging health risks. It is these core strengths that make CDC the “go-to” agency in a public health crisis—no matter where in the world they might occur.  - Erik Friedly, CDC-Uganda

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Reports from the Field CDC-Vietnam Celebrates Accreditation of Laboratories to International Standard

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n August, CDC-Vietnam celebrated the first two laboratories to successfully attain international accreditation, thanks to support from CDC-PEPFAR. The laboratories, at Pham Ngoc Thach Hospital and the HCMC Preventive Medicine Center, have received ISO 15189 accreditation and are already producing more accurate results in shorter wait times. At the celebration, which took place in Ho Chi Minh City, U.S. Consul General An T. Le spoke of the visionary leadership and determination to build stronger health systems in Vietnam. “The U.S.-Vietnamese collaborative effort in fighting the HIV epidemic has reduced mortality, saved lives and provided an opportunity to build and invest in a healthier future for all Vietnamese citizens,” he said.

Importance of accreditation Accreditation to principles created by the International Organization for Standardization (ISO) allows medical laboratories to operate at globally recognized standards, improves efficiency, ensures more reliable test results, and enhances overall healthcare for patients. Achieving this gold standard for laboratories has played an important role in improving national healthcare systems worldwide.

To date, a total of seven Vietnamese laboratories have now achieved the prestigious ISO accreditation - with assistance from CDC. These include the two HIV reference laboratories, two tuberculosis reference labs (national and large regional) and the microbiology laboratory in the largest hospital in Vietnam. (See link at right to a video celebrating ISO accreditation at Hue General Hospital).

A strong partnership Through PEPFAR and CDC, the United States has been the leading bilateral donor for laboratory quality improvement activities in Vietnam, committing more than $7.5 million over the past three years. This is a small part of the strong healthcare partnership between Vietnam and the United States. Since 2004, PEPFAR has provided over $500 million to support HIV/AIDS programs in Vietnam.  - Joel Katz, CDC-Vietnam

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U.S. Consul General An T. Le (center) celebrates the international accreditation of Pham Ngoc Thach Hospital and HCMC Preventive Medicine Center with institution leaders.

With CDC support, this lab technician from Pham Ngoc Thach Hospital now works in an environment that operates at international standards, which ensure more reliable diagnostic testing and strengthen Vietnam’s healthcare system.

Video Celebrates CDC-Supported Accreditation View a four-minute video celebrating the international-level accreditation of the microbiology laboratory at Hue General Hospital, supported by CDC. The celebration took place in April of this year (link).

Staff Updates DGHA staff updates will now be published in the Weekly Update instead of the Quarterly. Please send your staff updates to gapweeklyupdate@cdc.gov.

Zara Ahmed, MPP, MPH joined CDC-Namibia as the Health Policy and Communications Advisor in June 2012. She holds an MPP and an MPH, with concentrations in health economics and global health policy, respectively. Prior to arriving in Namibia, Zara was the Health Systems Strengthening Advisor for CDC-Rwanda.

Joy O. Amafah joined CDC-Nigeria as a Public Health Management Assistant in the Office of the Director, where she will provide administrative support for cooperative agreements. Joy earned her BS in chemistry.

Simon Antara, MPH, MSc, MBChB joined CDC-Namibia as the Field Epidemiology and Laboratory Training Program’s (FELTP) resident advisor in March 2012. He is a medical doctor and epidemiologist.

Prior to his current assignment, he was the epidemiology resident advisor for the Rwanda FELTP. He holds an MPH from the University of Ghana, an MSc in applied epidemiology from the Jomo Kenyatta University of Agriculture and Technology in Kenya and a Bachelor of Medicine, Bachelor of Surgery degree from the Kwame Nkrumah University of Science and Technology in Ghana.

Martin Ashikoto joined CDC-Namibia in March 2012 as a driver.

Educated in Windhoek, he worked for the Ministry of Defence for 11 years, including with the UNMIL mission in Liberia. He has a certificate in personnel administration.

Getahun Aynalem, MD, MPH joined CDC-Ethiopia as an Epidemiologist/Resident Advisor/FETLP. Getahun previously worked as Chief Epidemiologist and Director of Epidemiology Unit, STD Program, Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California and earned an MPH from University of North Carolina (UNC), School of Public Health, Chapel Hill, NC in 1992. Getahun completed his Post-Doctoral Fellowship in Health Economics and Epidemiology from the UNC School of Medicine, Chapel Hill, NC in 1991 and his MD from University of Sarajevo, Medical Faculty, Yugoslavia in 1980.

Virginia (Ginny) Baresch, RN, MPH will join CDC-Namibia in October 2012 as the Deputy Director for Management and Operations. Ginny has worked in global public health for over 30 years, including as a Public Health Advisor with CDC from 2006 to 2010. She will be moving to Namibia from CDC-Rwanda, where she is the Deputy Director for Management and Operations. She earned her MPH from the University of Hawaii and has a BS in nursing.

James Barnes, MSc joined CDC-Rwanda as a Health Systems Strengthening Advisor and Technical Public Health Analyst. James has previously served as Deputy Branch Chief of DGHA’s International Laboratory Branch. He earned his MS in international affairs from the Georgia Institute of Technology and his BA in history from the University of Denver.

Christopher Barry, MPH will join CDC-Namibia in October 2012 as an Association of Schools of Public Health (ASPH) fellow in Strategic Information. He earned his MPH from the Columbia University Mailman School of Public Health. Prior to joining CDC-Namibia, Christopher worked with Helen Keller International.

Odume Bethrand, MPH joined CDC-Nigeria as the new Senior Program Specialist for TB/HIV on the HIV Continuum of Care and Treatment Team, where he provides activity management support.

Odume holds a bachelor of medicine, bachelor of surgery degree and an MPH degree.

Miranda Bodfish, MA joined DGHA’s Country Operations Branch as Country Officer for Central Asia Region, China, India, Russia, and Ukraine. She earned her MA in international development practice at Emory University with a concentration in gender and development, and her BA in international studies and black studies from Denison University, where she also studied French. Miranda has experience working both domestically and internationally and has previously worked with CARE, Heifer International, Americorps, and Literacy Source.

Kimberly Boer, PhD, MSc joined CDC-Rwanda as the new Associate Director for Science. Kimberly previously served as the Country Director for the Amsterdam Initiative for Global Health and Development in Rwanda and Uganda. She earned her PhD in clinical epidemiology from the Academic Medical Center at the University of Amsterdam in the field of sepsis and surgical interventions and her MSc in epidemiology, with a focus in communicable disease epidemiology, from the London School of Hygiene and Tropical Medicine. Kimberly has received additional training on evidencebased healthcare implementation in African settings. (see Updates, page 16)

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Updates (from page 15) Omotayo Bolu, MD, MPH joined CDC-Cameroon as the Country Director in May 2012. Omotayo has served DGHA as the Prevention of Mother to Child Transmission (PMTCT)/Pediatrics Technical Working Group co-chair and acting PMTCT team lead. She was one of the pioneers of the U.S. President’s PMTCT initiative in 2002 after completing her two-year Epidemic intelligence Service (EIS) officer fellowship at CDC. She previously worked with USAID, Family Health International, and Population Services International. Omatayo received her MPH from the London School of Hygiene and Tropical Medicine in 1998 and her MD from the College of Medicine, University of Lagos, Nigeria, in 1991.

Frank Burkybile, MPH joined DGHA’s Program Budget and Extramural Management Branch as a Presidential Management Fellow/ Public Health Analyst with the Special Response Team. A US Navy veteran and AmeriCorps alumni, Frank comes to CDC with research experience in West and Southern Africa gained while earning his MPH in epidemiology and global health from the University of Alabama at Birmingham and his BS in anthropology from Missouri State University.

Subrat Das, MS joined CDC-Nigeria as Technical Public Health Advisor. Subrat holds a MS degree with a focus in information science from Alabama A&M University, and a BS degree in biology from Stewart Science College in India, and has previously worked as a Public Health Analyst/Country Officer in DGHA’s Country Operations Branch.

Kevin M. De Cock, M.D., F.R.C.P. (UK), D.T.M. & H., is the new DGHA Country Director for Kenya. Dr. De Cock served as the Director of CGH since 2010 and Director of the WHO Department of HIV/AIDS from 2006-2009. He joined CDC in 1986 as an Epidemic Intelligence Service Officer, and served as Director of CDC Kenya and Director of the Division of HIV/AIDS Prevention, Surveillance, and Epidemiology. He received his medical degree from the University of Bristol and a Diploma in Tropical Medicine and Hygiene from the University of Liverpool, and completed a fellowship in hepatology at the University of Southern California.

Mamadou Otto Diallo, MD, MPH joined DGHA’s Maternal and Child Health Branch as an HIV Pediatrics Health Scientist. He has served as the Epidemiologist for Monitoring and Evaluation at ICAP-Columbia University in New Jess Celentano, MS joined DGHA as a Country York, a Senior Technical Advisor for HIV care Officer for the Asia Regional Office, Cambodia, and treatment at CDC-Zimbabwe, and an CDC-Nigeria Deputy Director Subroto Papua New Guinea, Thailand, and Vietnam. She Epidemiologist with the Trachoma Control Banerji greets Secretary Clinton during her earned her MS in global health and population Program at the Carter Center/Emory University. visit to Abuja last summer, where she met with Mission staff and families as a part of from the Harvard School of Public Health, He started his public health career at Project her Africa tour.

(Submitted by Subroto where she focused on emerging technologies RETRO-CI and joined CDC as an Epidemic Banerji; photo by Idika Onyukwu) advancing access to critical health services for Intelligence Service Officer in 1999. Mamadou marginalized populations. Jess served as a earned his MD in Mali and received his MPH in research and teaching fellow for the Maternal Health Task Force epidemiology from the University of California at Berkeley. within Harvard’s Women’s Health Initiative. Prior to graduate school, Shane Diekman, PhD, MPH joined CDC-Barbados as the lead Jess was a member of the Sub-Saharan Africa portfolio at the Global Behavioral Scientist to the Country Director. Shane currently serves as Fund for Women and earned her BA from Bates College in the lead of the Home and Recreation Team at CDC’s National Center anthropology and French. for Injury Control and Prevention and has worked at the University of Stewart Coulter joined CDC-Nigeria as a Public Health Advisor. He North Carolina Highway Safety Research Center and at CDC in the previously worked for eight years as a Public Health Analyst/Project Office of HIV/AIDS and in the Fetal Alcohol Syndrome Prevention Officer in CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Branch. Shane earned his PhD from the University of North Carolina at TB Prevention. Stewart earned his BA in health services administration Chapel Hill and his MPH from Emory University, both with a focus in in 1991 from St. Mary’s College of California. behavioral science and health education. (see Updates, page 17)

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Updates (from page 16) Eric Dziuban, MD joined the Maternal and Child Health Branch as an HIV Pediatrics Medical Officer. He earned his MD from Duke University, and completed pediatric residency at the University of Michigan. As a medical student, he was a CDC Experience fellow at the Parasitic Diseases Branch. More recently, he received a diploma in tropical medicine at Baylor College of Medicine. Eric’s previous employment was at the Baylor Clinic in Mbabane, Swaziland, where he was focused on clinical treatment of pediatric HIV for the last two years.

Peter Ehrenkranz, MD, MPH is the new DGHA Country Director for Swaziland. Dr. Ehrenkranz served as Care and Treatment Team Lead in Swaziland for the last 2.5 years. Prior to joining DGHA, Dr. Ehrenkranz served as the Medical Director of the Clinton Health Access Initiative's programs in Liberia. Dr. Ehrenkranz received his undergraduate degree in the History of Science and Medicine from Yale University, and medical and public health degrees from Emory University. He trained in internal medicine-primary care at the University of Pennsylvania where he also completed a fellowship in the Robert Wood Johnson Clinical Scholars Program.

Folorunsho Eyitayo joined CDC-Nigeria as a Public Health Management Assistant on the Administrative Operations Team, where he will provide facility maintenance. Folorunsho earned his BS in economics.

Nicholas Gaffga, MD, MPH joined CDC-Lesotho as Country Director. Until June, Nicholas was DGHA’s Country Director for Angola. He joined DGHA after serving as a Medical Epidemiologist in CDC’s Division of STD Prevention. Prior to CDC, he consulted on the University of Alabama’s short course on applied epidemiology in Ulaanbaatar, Mongolia. Nicholas earned his MD and MPH from the University of Alabama.

Wangeci Gatei, PhD, MSc joined CDC-Rwanda as a Senior Laboratory Advisor from his position of Senior Service Fellow at DGHA in Atlanta, Georgia. Previously, Wangeci served as a veterinarian and as a scientist at the Kenya Medical Research institute in Nairobi. He earned his PhD in Tropical Medicine from the University of Liverpool, School of Tropical Medicine in the United Kingdom, his DVM from the University of Nairobi in Kenya, and his MSc in molecular parasitology from the University of Prince Edward Island, Canada.

Dylan Green, MPH joined the Health Economics and Finance Team within the Health Economics, Systems and Integration Branch, as a Health Economist. Dylan’s responsibilities include aiding in the rollout of the PEPFAR Expenditure Analysis to nine countries in the fall, as well as performing ad hoc analyses and reporting to country offices on pilot data. Dylan has contracted with USAID Ethiopia and Mozambique, where he designed databases, managed study data, and assisted in performing monitoring and evaluation analyses. Dylan obtained a BA in anthropology from University of Florida and an MPH in global health at Emory University.

Debem Henry, MS joined CDC-Nigeria as a Monitoring and Evaluation Program Specialist on the Epidemiology and Strategic Information Team. Debem earned his MS in pharmacology and his BS in microbiology with a focus in epidemiology. He is currently enrolled in a PhD program in public health with a focus in epidemiology.

Neil Jacobs, MMed, MBL joined CDC-Namibia in May 2012 as the Health Management Information Systems advisor. He has over 25 years of experience in health informatics and was previously the HMIS team leader for CDC-South Africa. Neil holds a master of medicine degree in clinical physiology from the University of Pretoria and a master of business leadership degree from the University of South Africa.

James Kariuki, MPH joined the Health Economics, Systems and Integration Branch as a part of the Health Information Systems Team under the Public Health Informatics fellowship. He holds an MPH in health services management from Kenya's Moi University and a BSc in computer science and engineering. James has designed, developed, and implemented electronic medical records systems, helping to set up OpenMRS at Academic Model Providing Access to Healthcare, which currently manages the medical records of over 120,000 HIV/AIDS patients. James has also developed and implemented mobile health technology for home-based counseling and testing.

Nancy Knight, MD joined CDC-South Africa as Country Director in July 2012. She was Country Director in Kenya since July 2010 and served as Nigeria’s Medical Officer from 2006 to 2008 and Country Director from 2008 to 2010. Nancy’s U.S. government career started in 2001 as Branch Chief and Deputy Director for the Health Resources and Services Administration’s Division of Medicine and Dentistry, and she has since worked in the Cincinnati Health Department. Nancy holds her BA from Washington University and MD from the University Of North Carolina School Of Medicine at Chapel Hill. (see Updates, page 18)

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Updates (from page 17) Austin Lawry joined DGHA’s Program Budget and Extramural Management Branch in March 2012 as a student intern for the Country Management and Support (CMS) team. In that capacity, she has worked closely with representatives throughout CGH/DGHA in order to close out CMS I and both refine and begin CMS II country visits. Austin graduated from Georgia Institute of Technology in May 2012 with degrees in international affairs and modern languages. Austin will begin her MPH in behavioral science and health education at the Rollins School of Public Health this fall.

Philip Lederer, MD joined the HIV Care and Treatment Branch as an Epidemic Intelligence Service Officer on the TB/HIV team. Philip’s previous role was that of Clinical Director for University of California- San Diego (UCSD) and for Maputo Central Hospital Educational Collaboration in Maputo, Mozambique. He also previously served as a Health Sciences Assistant Clinical Professor at UCSD. Philip graduated from the University Of Pennsylvania School Of Medicine in 2008.

Spencer Lloyd, MD, MPH, DTM&H joined the HIV Care and Treatment Branch as an Epidemic Intelligence Service Officer on the Adult Treatment Team. Spencer previously served as a faculty member at the University of Utah’s Infectious Diseases Division and a visiting researcher and instructor at Hubert Kairuki Memorial Hospital in Dar es Salaam, Tanzania, where his focus was on pediatric malaria. Spencer graduated from the University of Utah School of Medicine and Master of Public Health Program in 2005.

Edgar Monterroso, MD, MPH joined CDC-Mozambique as a Country Director in July 2012. For the past four years, Edgar served as DGHA Country Manager for Brazil, Dominican Republic, and Guyana as well as the Caribbean and Central American Region. Prior to that, he served as CDC’s Epidemic Intelligence Service Officer for the Louisiana Office of Health and worked for CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in the Division of HIV/AIDS Prevention. Edgar received his MD from the Universidad de San Carlos de Guatemala in 1986 and his MPH from Harvard University in 1988.

Emily Morris, MPH joined DGHA’s Program Budget and Extramural Management Branch as a Public Health Analyst on the Extramural Team. Emily recently earned her MPH from the University of Texas School of Public Health, where she conducted tobacco cessation research and promoted public health policy. A former Peace Corps volunteer in Senegal, West Africa, Emily is excited to work on PEPFAR projects in the Africa region. Emily earned her BA in journalism from Pennsylvania State University in 2003 and worked for several years as a newspaper reporter, where she discovered a passion for public Bruce Struminger, MD (at right) received health.

Vietnam’s top award for health cooperation at a ceremony hosted by the Ministry of Health in Hanoi in August. The ceremony recognized his contributions to Vietnam’s health system as he completed three years of service as CDC-Vietnam’s Director. He is pictured at the award ceremony with (left to right) David Shear (U.S. Ambassador to Vietnam) and Tran Thi Giang Huong (a Professor at the Vietnamese Ministry of Health).

(Submitted by Joel Katz, CDC-Vietnam)

Michelle McConnell, MD is the new DGHA Country Director for Vietnam. Dr. McConnell joined CDC as an Epidemic Intelligence Service Officer in 2001 in the Global AIDS Program, served as Chief of the Epidemiology Section in GAP Thailand and led Thailand activities in the DGHA Southeast Asia Regional Office. In 2010, Dr. McConnell moved to Vietnam as the DGHA Vietnam Associate Director. Dr. McConnell received her B.S. in Foreign Service from Georgetown University, her medical degree from Northwestern University, did her clinical training at the University of California San Francisco, and is board certified in General Pediatrics.

Caryn Morrow, MPP joined DGHA’s Country Operations Branch as Country Officer for Brazil, the Central America Region, the Caribbean Region, the Dominican Republic, and Guyana. She earned her Master in Public Policy degree, with a concentration in political and economic development, at the Harvard Kennedy School of Government. She has carried out research in Brazil on the social impact of a government-run program in low-income communities and has consulted with various development organizations, including UNICEF Chile, Ashoka, and Enterprise Solutions to Poverty. Caryn is fluent in Spanish and Portuguese and also reads and understands basic French. (see Updates, page 19)

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Updates (from page 18) Mary Mulholland, MA joined CDC-Swaziland as Deputy Director. She previously served with AmeriCorps and with CDC’s National Immunization Program. Mary also worked with CDC-Kenya, both as an International Emissions Trading Association fellow and eventually Deputy Director for Management and Operations. She has been a part of CDC’s International Operations Team, and served as Acting Deputy Branch Chief for DGHA’s Country Operations Branch for much of 2011.

Mary earned her BA and MA in anthropology, with an emphasis on cultural and medical anthropology, from Bryn Mawr College, and was awarded a Thomas J. Watson Fellowship.

Abner Ndangi Iifo joined CDC-Namibia in June 2012 as a driver. Educated in Onyaanya, Namibia, he has worked as a driver and chauffer for the Ghana High Commission and the Embassy of Algeria.

Jared O. Omolo, MD, MSc joined CDC-Rwanda as the Epidemiology Resident Advisor for Rwanda’s Field Epidemiology and Laboratory Training Program (FELTP). Jared previously served as Program Director for Kenya’s FELTP. He earned his MD form Moi University and his MSc in applied epidemiology at Jomo Kenyatta University of Agriculture and Technology in Kenya.

Dickson O. Oseghale joined CDC-Nigeria as a Public Health Management Assistant in the Office of the Director, where he will support budget and finance activities.

Dickson earned his BS in banking and finance.

Gregory Parent, PhD, MS joined the Health Economics, Systems and Integration Branch as an Economist. He will be working with the Congratulations to 15 members of the Folashade Odejimi joined CDC-Nigeria as a Health Economics and Finance Team. His CDC-Cameroon team who took home past professional experience includes work Cooperative Agreement Management Assistant in multiple awards in June at the U.S. as a National Science Foundation’s the Office of the Director, where she will provide Embassy Awards Ceremony in Yaounde.

Integrative Graduate Education and cooperative agreement management and financial Pictured are Sidouanne Signing and U.S. Research Traineeship fellow and University management support. She earned a Higher Ambassador Robert P. Jackson. of Florida and Field Economics Research National Diploma in accountancy and is a (Submitted by Todd Wilson, CDCCameroon) Consultant, working on projects in Africa professional (Associate-ACA) member of the with Oxfam and the Wildlife Conservation Institute of Chartered Accountants of Nigeria Society. Gregory obtained his BA in economics and international (ICAN). development from McGill University and his MS in natural Obinna Ogbanufe, MS joined CDC-Nigeria as the new Care and Support resource economics at the University of Florida. Gregory also Senior Program Specialist with the HIV Continuum of Care and holds a PhD with a focus on resource and development Treatment Team, where he provides activity management support. economics.

Obinna earned his MS in health management and BS in medicine and John Pitman, MPH, MS rejoined the Blood Safety Team in surgery.

DGHA’s HIV Prevention Branch in August as a Health Scholastic Ogechukwu Obianyor joined CDC-Nigeria as a Public Health Scientist. John was a member of the branch from 2006 to 2009, Management Assistant, where she will provide TDY support to the when he moved to Namibia to join DGHA as a technical advisor Administrative Operations Team. Ogechukwu earned her BS in brewing for health policy, communications, and blood safety. There, John science and technology. also served as Acting Deputy Director from February to July 2012. John has an MPH in epidemiology from Yale University, an Joy P. Okomba joined CDC-Nigeria as an Administrative Clerk in the MS in journalism from Columbia University, and is working Office of the Director. She earned her BSc/Ed in social studies and a post toward a PhD in blood transfusion epidemiology at the graduate diploma in business management.

University of Groningen in the Netherlands.

Fagbamigbe Omodele joined CDC-Nigeria as the Prevention of Mother (see Updates, page 20) to Child Transmission Program Specialist on the HIV Prevention Team, where he will provide activity management support. Fagbamigbe earned his bachelor of medicine, bachelor of surgery degree.

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Updates (from page 19) Heather Rothenbuescher, MA joined CDC-Nigeria as a Program Specialist in the Office Orphans and Vulnerable Children with the HIV Continuum of Care and Treatment Team, where she will provide activity management support. Heather earned her ME in special education and BS in finance.

from Berry College in May 2011 with degrees in government and English and, in December, will earn her MS in international affairs with focuses on international political economy and international security from Georgia Institute of Technology’s Sam Nunn School of International Affairs.

Daniel C. Rutz, MPH joined CDC in 2002 as a Communications Specialist in public health emergency response and news media training/engagement. He is a visiting professor in the Emory University Rollins School of Public Health and previously worked as Senior Medical Correspondent for CNN, where he reported extensively on HIV/AIDS. He will now work with the biomedical team in DGHA’s HIV Prevention Branch to advance male circumcision as a key HIV prevention measure across eastern and southern Africa. Dan earned his BA in speech with a broadcast emphasis, and his MPH with a focus in prevention science.

Odafe Solomon, MPH joined CDC-Nigeria as the new Senior Program Specialist for HIV Treatment on the HIV Continuum of Care and Treatment Team, where he will provide activity management support. Odafe holds an MPH with a focus in epidemiology and a bachelor of medicine, bachelor of surgery degree.

Madeleine Schlefer, MPH will join CDC-Namibia in October as an Association of Schools of Public Health fellow in program management.

She earned her MPH from the Johns Hopkins Bloomberg School of Public Health and, prior to her graduate studies, worked with the New York State Department of Health AIDS Institute.

Amee Schwitters, PhD, MPH joined the Health Systems and Human Resources Team within the Health Economics, Systems and Integration Branch as an Epidemic Intelligence Service Officer. Amee’s work will focus on global health systems research, and her initial project involves evaluating Uganda’s Prison Service TB/HIV Surveillance System. She will also assist the team with ongoing health systems studies in east, central, and southern Africa. Amee earned her PhD in medical anthropology from the University of Montana, with an emphasis on sexuality and HIV prevention in rural environments, and her MPH, with an emphasis on community health education.

Daniel Singer, MD, MPH joined CDC-Malawi as a Medical Officer.

Previously, Daniel served as the Associate Director for Global Health Research and International Activities at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Daniel was the Senior Medical Policy Advisor in the U.S. Department of State’s Office of International Health and Biodefense, served as the eighth Luther Terry Fellow in the HHS Office of Disease Prevention and Health Promotion, and as an officer of the Epidemic Intelligence Service at CDC. Taylor Smith, MS joined DGHA’s Program Budget and Extramural Management Branch in March 2012 as a student intern for funding opportunity announcements and objective review panels. In that capacity, she worked closely with representatives throughout CGH/DGHA to close out the first round of country management and support (CMS) visits and both refine and begin CMS II. She graduated

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Brian Stone, MPA, MA joined DGHA’s Country Operations Branch as Country Officer for Cote d’Ivoire, DRC, Mali, and Senegal. He graduated from the Maxwell School of Citizenship and Public Affairs at Syracuse University with his MPA and MA in international relations, and graduate certificates in health services management and policy and in national security studies. Brian also lived and worked as a Peace Corps volunteer in Tanzania for three years. He can communicate effectively in Swahili and also has a background in German, French, and Spanish.

Negussie Taffa, PhD joined CDC-Namibia in August as the Senior Monitoring and Evaluation Advisor. He trained as a clinician at Addis Ababa University in Ethiopia and holds a PhD in international health from Oslo University in Norway. Negussie came to Namibia from CDC-Botswana, where he worked for seven years in a similar position.

Edward Tendekai Nyambawaro, MSc joined CDC-Rwanda as a Health Systems Strengthening Advisor. Edward previously served as the West Africa Regional Talent and Leadership Development Advisor with World Vision International and earned his MSc in leadership and change management from Leeds Metropolitan University in the United Kingdom. He also holds certificates in organizational development and international teaching and training and holds diplomas in human resources management, personnel and industrial relations, training management, and business administration. (see Updates, page 21)

Updates (from page 20) Greg Thorne, MPP, MBA joined the Country Operations Branch as a new Presidential Management Fellow and will be serving as the Country Officer for Angola, Botswana, Mozambique, Swaziland, and Zimbabwe. Prior to joining DGHA, Greg completed his graduate work at the University of Michigan, where he earned his masters of public policy and business administration degrees. While at Michigan, Greg focused on the intersecting roles that private, public, and social sectors play in international development and global public health.

Greg earned his undergraduate degree in mechanical engineering from the University of California, Berkeley.

Brandon Toliver, MBA joined CDC-Ethiopia in Addis Ababa, Ethiopia as a civil engineer. Brandon holds an MBA in project management, a BS in civil engineering, and is currently pursuing his MS in international relations. Brandon previously worked for the Department of Defense at Kadena, Okinawa US Air Force Base as a civil engineer and was awarded the Global War on Terrorism award for civilian service and a NATO medal. He provided comprehensive engineering and QA/QC support to the provincial reconstruction team and is a US Navy Nuclear Power veteran.

Alfredo Vergara, PhD joined CDC-Mozambique as an Epidemiologist. Prior to coming to CDC, Alfredo was Assistant Professor of Preventive Medicine and Associate Director for Program Implementation at the Vanderbilt’s Institute for Global Health. He is a graduate of the Epidemic Intelligence Service program at CDC, where he worked for 12 years. Between 2000 and 2006, Alfredo served as Chief of Party for CDC and Public Health Attaché at the U.S. Embassy in Mozambique, during which time he founded and led CDC’s first office in Mozambique.

Paul Rashad Young, MD joined the Maternal and Child Health Branch as a Medical Officer. He formerly worked as a Pediatric AIDS Corps physician at the Baylor College of Medicine Center of Excellence in Lesotho from 2008 to 2012. His work there was highlighted in a New York Times interview. A native of Savannah, Georgia, he received his BS from the University of Georgia in Athens and received his MD from the Mercer University School of Medicine in Macon, Georgia. His residency in pediatrics was at the Children’s National Medical Center and at the Howard University Hospital. 

Lake Victoria at sunset as seen from the Kalangala Ferry (Photo by Erik Friedly, CDC-Uganda)

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Resources From UNAIDS

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“Together We Will End AIDS,” a report released in July by

UNAIDS, (link) contains the latest data and provides an overview of international and domestic HIV investments and the need for greater value for money and sustainability.

[Photo (left to right): UNAIDS Executive Director Michel Sidibé and PEPFAR Global AIDS Coordinator Ambassador Eric Goosby.]

From PEPFAR: First Infographic

From WHO

See full infographic (link)

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WHO HIV Drug Resistance Report (link)

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The Strategic Use of Antiretrovirals To Help End the HIV Epidemic (link)

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Use of Devices for Adult Male Circumcision in Public Health HIV Prevention Programmes (link)

Book Review by Dr. Kevin De Cock •

The Origins of AIDS (Emerging Infectious Diseases, Volume 18, Number. 7, July 2012 (link) Dr. De Cock says this book is “…essential reading for anyone deeply interested in the early history and dissemination of HIV/AIDS.”

Special PEPFAR Issues of JAIDS and Health Affairs with Articles by DGHA Authors • •

JAIDS (Journal of Acquired Immune Deficiency Syndromes) (August 15, 2012, Volume 60, Supplement 3) “The United States President’s Emergency Plan for AIDS Relief (PEPFAR): It’s Vision, Achievements and New Directions” (link) Health Affairs (July 2012; Volume 31, Issue 7): “Assessing the President’s Emergency Plan for AIDS Relief” (link) Also available: Keynote remarks by Ambassador Eric Goosby at a Health Affairs briefing on this special issue (link).

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Upcoming Events •

World AIDS Day December 1, 2012

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First International Conference of the African Society for Laboratory Medicine (link) Cape Town, South Africa, December 1-7, 2012

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20th Conference on Retroviruses and Opportunistic Infections (link) Atlanta, March 3-7, 2013

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DGHA Annual Meeting Atlanta, March 11-15, 2013

Global HIV/AIDS Quarterly Published by the Division of HIV/AIDS in CDC’s Center for Global Health All submissions welcome! Send articles, photos, story ideas, and staff updates to DGHApolicycomm@cdc.gov.

Next issue: December 2012 Deadline for submissions: November 2 DGHA staffers can also find news and valuable resources on www.PEPFAR.net and www.CDCGlobalHealth.net.

Not registered? Go to www.register.pepfar.net or www.register.cdcglobalhealth.net

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