Public Dialogue Session: Evaluation of PEPFAR
When: April 1, 2013 (10:00 AM Eastern)
Where: Keck Center (100) • 500 Fifth St. NW, Washington, DC 20001
Topics: Diseases, Global Health, Children, Youth and Families
Activity: The Outcome and Impact Evaluation of Global HIV/AIDS Programs
Boards: Board on Global Health, Board on Children, Youth, and Families
The Institute of Medicine will host a public dialogue session on the Evaluation of PEPFAR report authored by the Committee for the Outcome and Impact Evaluation of Global HIV/AIDS Programs Implemented under the Lantos/Hyde Act of 2008. The session will be held on April 1st from 10:00 a.m. to 5:30 p.m. at the Institute of Medicine Keck Building at 500 5th Street NW, Washington DC. The morning will include presentations by representatives of the evaluation committee and other stakeholders involved in the global response to HIV/AIDS, as well as a participant and panelist discussion. In the afternoon, participants will break out into small groups to explore specific report topics in greater depth.
This event is open to the public, however registration is limited based on space availability. For those unable to attend person, webcasting will be available on this website. To attend this event in person or watch the webcast please RSVP with the registration link provided on this page. More details regarding panelists,discussants, and breakout sessions will also be available on this website within the next few weeks.
For more information, please visit the Institute of Medicine’s Webpage on the event using this link: http://www.iom.edu/Activities/Global/PEPFAR2/2013-APR-01.aspx
CHPIR Director Releases Second Edition of Book on HIV in the South
Whetten Releases Second Edition of Book on HIV in the South
The second edition of “‘You’re the First One I’ve Told’: The New Faces of HIV in the South” by authors Kathryn Whetten and Brian Pence, which is now available for order, provides new details on the HIV/AIDS epidemic in the South while bringing to life the stories and voices of people infected with the disease.
As HIV is explained within the context of individuals’ life histories, beliefs, attitudes and current life situations, the book’s latest edition incorporates new HIV research that gets to a deeper issue. In a recent Duke study, Whetten and Pence found that many people living with HIV in the South have experienced sexual abuse, physical abuse, family violence, early loss or other traumatic experiences. Those who experienced more traumatic events in their lifetime tended to have worse overall physical health and cognitive functioning.
“We found that HIV was simply one more event in a long history of traumatic life experiences,” write the authors in the book. “We believe it is critical to develop HIV medical care models that acknowledge, ask about, and respond to patients’ life histories in order to best promote patients’ health.”
The most Southern states of the U.S., including Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and east Texas, accounted for 36 percent of new AIDS diagnoses in 2009, while only containing 22 percent of the US population. Many of the underlying reasons for the spread of the disease in the region have yet to be been addressed by policy makers. Those issues include ignorance about HIV, reluctance to get tested, non-adherence to treatment protocols, and resistance to behavioral changes.
“The South has been the epicenter of the U.S. HIV epidemic for the last decade, and the authors have used a balanced set of information from both surveys and personal observations to present a poignant and accessible portrait of the complexities of human health and disease,” John Bartlett, professor of medicine and global health at the Duke Global Health Institute.
“Expertly linking patients’ pasts to their current struggles to obtain health care and support, the stories related here contextualize AIDS within the lived experiences of the poor and marginalized communities that bear the greatest burden of HIV in the American South,” said Paul Farmer, professor at Harvard University, and board member at the Duke Global Health Institute. “This book offers indispensable insight into the ways that large-scale social forces shape the lives of those facing AIDS.”
The book was first published in 2002.
CHPIR Faculty, Dr. Jay Pearson, to speak on Racial & Ethnic Inequity on February 27th
Socio-Structural and Socio-Cultural Model of Racial and Ethnic Health Inequity
From: February 27, 2013 at 12:00pm to: 1:00pm
Details: Join us for a Global Health Faculty Research talk by Jay Pearson, PhD, Assistant Professor at Sanford School of Public Policy. This event is open to the public so please spread the word to your colleagues and students. Lunch will be served.
Can’t attend? Join via livecast.
About the talk:
What are the health implications of racial categorization, ethnic identity formation, discrimination and alternative socio-cultural orientations?
A basic tenet of public health is that the relationship between socioeconomic status and health is robust, whereby health improves rapidly from the lowest levels of income, education or occupation to average or median levels, with a detectable , if diminishing, gradient at even higher levels of socioeconomic status.
However, the literature on which this tenet is based is largely research studying white men. The magnitude and, in some cases, direction of this relationship varies considerably for other demographic groups. Dr. Pearson argues that failure to clearly qualify study conclusions when they are restricted to the study of white men and the continued application of poorly conceptualized and un-theorized race and ethnicity variables are an impediment to integrating the range of findings on social characteristics and health.
About the speaker:
Jay A. Pearson’s research examines how various forms of structural inequality influence social determination of health. A native of Hertford County in northeastern North Carolina, Pearson’s early experiences in the rural agricultural south shaped his academic interests and inform his research agenda.
CHPIR’s Director on IOM Committee evaluating PEPFAR
Date: Feb. 20, 2013
FOR IMMEDIATE RELEASE
New IOM Report Highlights PEPFAR’s Successes, Calls on Initiative to Intensify Efforts to Enhance Partner Countries’ Management of Programs and to Improve Prevention
WASHINGTON — The President’s Emergency Plan for AIDS Relief (PEPFAR) has saved and improved millions of lives worldwide and offered proof that HIV/AIDS services can be effectively delivered on a large scale even in countries with high rates of disease and resource constraints, says a new congressionally mandated evaluation conducted by the Institute of Medicine.
Moving forward, PEPFAR needs to intensify efforts to help its partner countries develop the capacity to manage their own programs, sustain the gains that have been made in controlling the HIV epidemic, and improve their citizens’ access to services, said the committee that wrote the report.
Even with PEPFAR’s substantial contributions to the global scale-up of HIV/AIDS services, many needs remain, the report notes, and future progress will require partner countries and donors to work together to make difficult but necessary decisions on how to allocate finite resources. As PEPFAR increases its focus on fostering countries’ ability to take on greater long-term responsibility, results may not occur as rapidly or dramatically as in the past, the committee cautioned.
“During our visits to partner countries, we repeatedly heard PEPFAR described as a lifeline,” said committee chair Robert Black, chair, department of international health, Johns Hopkins Bloomberg School of Public Health, Baltimore. “People credit the initiative with restoring hope. As it moves forward, PEPFAR must continue to be bold in its vision, implementation, and global leadership.”
PEPFAR was established in 2003 through legislation that authorized $15 billion for HIV/AIDS and other related global health issues over five years. In 2008, the legislation was reauthorized, providing up to $39 billion through 2013 for PEPFAR bilateral HIV/AIDS programs as well as U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. PEPFAR has supported HIV/AIDS programs in over 100 countries, with the largest share of the investment currently in 33 partner countries. As part of the reauthorization, Congress requested that IOM evaluate various aspects of the initiative, a task that IOM’s international committee of experts carried out through visits to 13 partner countries as well as the review of volumes of documentation and data. IOM previously evaluated PEPFAR in its initial implementation phase and issued a report in 2007.
Overall, PEPFAR has reset the world’s expectations for what can be accomplished with ambitious goals, ample funding, and humanitarian commitment to a public health crisis, the committee concluded. Working with a wide range of international and local partners, PEPFAR has expanded HIV testing and increased the number of people living with HIV who are receiving care and being treated with antiretroviral drugs. The initiative has trained hundreds of thousands of service providers, strengthened partner countries’ health systems, provided additional nonclinical support services for people living with HIV, and made an unprecedented investment in programs for orphans and vulnerable children living with or affected by HIV.
PEPFAR has successfully increased services to prevent HIV transmission from mothers to their children during pregnancy and birth. The initiative has become increasingly flexible over time in its approach to other prevention strategies, and it has achieved positive results by supporting data collection to better understand the factors driving the epidemic in each country and scaling up prevention programs for the general population and for populations at elevated risk. However, greater attention to a range of prevention strategies is needed, the report says. In particular, countries need to increase the focus on prevention of sexual transmission, which is responsible for the majority of new infections. PEPFAR should lead the way by supporting innovations in strategies to decrease risk factors that contribute to HIV transmission.
The committee underscored the importance of partner countries receiving support to take on greater responsibility for and management of their own HIV/AIDS programs. In recent years, PEPFAR has begun providing less direct support and more technical assistance and support for strengthening partner countries’ health systems and capacity to lead their efforts, a shift that the report deems reasonable and appropriate. PEPFAR’s guidance should reorient from prescribing specific activities to outlining key outcomes and enabling partner countries to determine how to prioritize their efforts to achieve these outcomes.
The study was sponsored by the U.S. Department of State. Established in 1970 under the charter of the National Academ of Sciences, the Institute of Medicine provides objective, evidence-based advice to policymakers, health professionals, th private sector, and the public. The Institute of Medicine, National Academy of Sciences, National Academy of Engineerin and National Research Council together make up the private, nonprofit National Academies. For more information, visit http://national-academies.org or http://iom.edu. A committee roster follows.
Contacts:
Christine Stencel, Media Relations Officer Luwam Yeibio, Media Relations Assistant Office of News and Public Information 202-334-2138; e-mail news@nas.edu
___________________________________________________________________________________________ Pre-publication copies of Evaluation of PEPFAR are available from the National Academies Press on the Internet at http://www.nap.edu or by calling tel. 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above). Additional information is available at http://www.iom.edu/pepfar2.
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INSTITUTE OF MEDICINE
Board on Global Health
and
NATIONAL RESEARCH COUNCIL
Division of Behavioral and Social Sciences and Education Board on Children, Youth, and Families
Committee on Planning the Assessment/Evaluation of HIV/AIDS Programs Implemented Under U.S. Global Leadership Against HIV/AIDS, TB, and Malaria Reauthorization Act of 2008
Robert E. Black, M.D., M.P.H. (chair) Edgar Berman Professor and Chair Department of International Health Bloomberg School of Public Health
Johns Hopkins University Baltimore
Judith D. Auerbach, Ph.D.
Former Vice President of Research and Evaluation San Francisco AIDS Foundation
San Francisco
Mary T. Bassett, M.D., M.P.H.
Director for the African Health Initiative Medical Research Program
Doris Duke Charitable Foundation New York City
Ronald Brookmeyer, Ph.D. Professor
Department of Biostatistics School of Public Health University of California
Los Angeles
Lola Dare M.D., M.Sc.
CEO
Center for Health Sciences Training, Research, and Development International Ibadan, Nigeria
Alex C. Ezeh, Ph.D., M.Sc.
Executive Director
African Population and Health Research Center Nairobi, Kenya
Sofia Gruskin, J.D., M.I.A.
Professor of Preventive Medicine
Keck School of Medicine;
Professor of Law and Preventive Medicine
Gould School of Law; and
Director
Program on Global Health and Human Rights Institute for Global Health University of Southern California
Los Angeles
Angelina Kakooza, M.B.Ch.B., M.D. Pediatrician and Lecturer
Department of Pediatrics and Child Health School of Medicine
Makerere University College of Health Sciences
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Makerere University College of Health Sciences |
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Kampala, Uganda Jennifer Kates, M.A., M.P.A. Ann Kurth, Ph.D., C.N.M. Professor and Director Global Health Initiatives Anne C. Petersen, Ph.D. Douglas D. Richman, M.D. Distinguished Professor of Pathology and Medicine University of California Jennifer Prah Ruger, Ph.D. Deborah L. Rugg, Ph.D., M.A. Director New York City Dawn K. Smith, M.D., M.S., M.P.H. Taha E. Taha, M.D., Ph.D. Professor and Co-Director Infectious Disease Epidemiology Department of Epidemiology Bloomberg School of Public Health Johns Hopkins University Baltimore Kathryn Whetten, Ph.D., M.P.H. Duke University Durham, N.C. Catherine M. Wilfert, M.D. STAFF Kimberly Scott Study Co-Director Bridget B. Kelly Study Co-Director |
Positive Outcomes for Orphans and R21 Supplement in 2012
Positive Outcomes for Orphans (POFO) is a longitudinal, multi-country study tracking the experiences of 3,000 orphans and abandoned children (OAC) and their caregivers in five low and middle-income countries. This study began following the POFO cohort in 2006, and in 2010 the grant for “POFO II” was awarded which allowed the study to continue interviewing the POFO participants as they transition through adolescence and early adulthood.
In 2012, the POFO team completed Round 8 data collection at four of the six POFO study sites (the two Indian sites were awaiting official approval from the Indian Council of Medical Research, which was granted in May 2012, delaying the data collection).
In April 2012, an NIH grant was awarded to Dr. Lynne Messer called “Pathways to Health and Wellbeing”; this grant will conduct additional interviews with the child POFO participants to assess their social and sexual networks.
In June 2012 the sixth paper utilizing POFO data was published by Dr. Thielman (DGHI faculty) in PLoS ONE, called ”Correlates of Poor Health among Orphans and Abandoned Children in Less Wealthy Countries: the Importance of Caregiver Health.” As of November 2012, all six study-sites began administering the Round 9 surveys.
Publications
- O’Donnell K, Murphy R, Ostermann J, Masnick M, Whetten RA, Madden E, Thielman NM, Whetten K, The Positive Outcomes for Orphans (POFO) Research Team. A brief assessment of learning for orphaned and abandoned Children in low and middle-income countries. AIDS Behav 16(2): 480-90, 2012.
- ABSTRACT: Assessment of children’s learning and performance in low and middle income countries has been critiqued as lacking a gold standard, an appropriate norm reference group, and demonstrated applicability of assessment tasks to the context. This study was designed to examine the performance of three nonverbal and one adapted verbal measure of children’s problem solving, memory, motivation, and attention across five culturally diverse sites. The goal was to evaluate the tests as indicators of individual differences affected by life events and care circumstances for vulnerable children. We conclude that the measures can be successfully employed with fidelity in non-standard settings in LMICs, and are associated with child age and educational experience across the settings. The tests can be useful in evaluating variability in vulnerable child outcomes.
- Thielman N, Ostermann J, Whetten K, Whetten R, O’Donnell K (2012) Correlates of Poor Health among Orphans and Abandoned Children in Less Wealthy Countries: The Importance of Caregiver Health. PLoS ONE 7(6): e38109. doi:10.1371/journal.pone.0038109
- ABSTRACT: Poor caregiver health is a strong signal for poor health of Orphans and Abandoned Children. Strategies to support OAC should target the caregiver-child dyad. Steps to ensure food security, foster gender equality, and prevent and treat traumatic events are needed.
In 2012, CHPIR obtained a R21 grant supplement, Pathways to Health and Wellbeing: social networks of orphans and abandoned youth, which further analyzes the cohort from the POFO study in relation to various social networks. The primary goal of this study is to determine key factors that may put youth at a disadvantage as they transition from structured care settings into their adult lives and those that support positive transitions. In order to accomplish this task, researchers will study existing education and employment support networks as well as sexual communities. Researchers will then be able to determine how certain characteristics of these networks are associated with OAC health outcomes, including poor education, ability to generate income, and HIV risk-taking behaviors. Based on prior OAC-related research, this study expects to find that OAC networks are small and lack variability, leading to reduced access to education, fewer positive employment opportunities, and increased sexual-risk behavior. Findings will be used to construct potential interventions to promote OAC health and well-being.
2012 Accomplishments for CHAT and CHAR
Coping and Health in Tanzania (CHAT) is a four-year longitudinal study following a cohort of 1,200 HIV-negative and HIV-positive adults in Moshi, Tanzania, to assess various factors influencing adherence to antiretroviral therapy (ART). Study participants have been interviewed every six months beginning in 2008, and HIV-positive individuals also undergo viral load testing. In 2012, the following study activities occurred:
- Round 7 interviews were completed and the last Round of interviews (Round 8) began.
- Two stakeholder meetings were held in Moshi, Tanzania, in February 2012 and November 2012, and were attended by members of the community as well as local clinical staff and policymakers.
- In April 2012, Kristin Johnson (Economics doctoral student) presented CHAT data from her doctoral dissertation called “Subjective Expectations and Adherence to Antiretroviral Treatment: Evidence from Tanzania” at the annual Society of Behavioral Medicine meeting in New Orleans.
- In May 2012, Dr. Pence (DGHI faculty) published a paper describing CHAT data in PLoS ONE, titled “Prevalence of Psychological Trauma and Association with Current Health and Functioning in a Sample of HIV-infected and HIV-uninfected Tanzanian Adults”
- Elizabeth Reddy (DGHI faculty) presented a poster titled, “The Loliondo phenomenon: Reduced adherence to antiretroviral therapy following mass visits to ‘Babu wa Loliondo’ in Tanzania” at the International AIDS Conference in Washington, DC, in June 2012
- A one-year supplemental grant was awarded in September 2012 to conduct a pilot study in St. Petersburg, Russia, with 500 HIV-positive patients to explore the psychosocial determinants of HIV medication adherence, retention in care, transmission risk behaviors, and disease progression. This grant will collect similar data to those being collected in Tanzania for CHAT.
- In December 2012, Nadya Belenky (UNC Master’s student, epidemiology) presented her Master’s thesis describing CHAT data on depression, stigma, and adherence to ART to faculty at UNC.
The CHAR Study – Coping with HIV and AIDS in Russia one-year supplemental grant was awarded in September 2012 to conduct a pilot study in St. Petersburg, Russia, with 500 HIV-positive patients to explore the psychosocial determinants of HIV medication adherence, retention in care, transmission risk behaviors, and disease progression. This grant will collect similar data to those being collected in the Coping and Health in Tanzania (CHAT) study. CHAT is a four-year longitudinal study following a cohort of 1,200 HIV-negative and HIV-positive adults in Moshi, Tanzania, to assess various factors influencing adherence to antiretroviral therapy (ART). Elizabeth Reddy (DGHI faculty) presented a poster titled, “The Loliondo phenomenon: Reduced adherence to antiretroviral therapy following mass visits to ‘Babu wa Loliondo’ in Tanzania” at the International AIDS Conference in Washington, DC, in June 2012.
Publications & Presentations
- In May 2012, Brian Pence (DGHI faculty) published a paper describing CHAT data in PLoS ONE, titled “Prevalence of Psychological Trauma and Association with Current Health and Functioning in a Sample of HIV-infected and HIV-uninfected Tanzanian Adults”
- ABSTRACT: This study is the first to our knowledge in an HIV population from a low income nation to report the prevalence of a range of potentially traumatic life experiences compared to a matched community sample and to show that trauma history is associated with poorer health-related physical functioning. Our findings underscore the importance of considering psychosocial characteristics when planning to meet the health needs of PLWHA in low income countries.
- There are several other manuscripts in preparation or under review
CADET releases Tool Kit for Congregations to address HIV
HIV/AIDS touches the lives of many people, including those who do not have the virus. The opposite is also true: people who do not have HIV can affect the lives of those who do have the virus . Knowing this, it is important that people who do not have HIV understand how the virus is—and is not—spread. It is also essential to help them understand how to ally with people with the virus, in order to decrease the stigma that comes with HIV. HIV-related stigma makes life worse for those living with the virus, and it keeps everyone living in fear, thereby preventing HIV testing and treatment.
With this in mind, we looked for ways to reach people who do not have HIV, but who could be in a position to support those living with the virus. This led to our speaking with faith leaders of Durham churches, and we learned that most churches no longer have an HIV/AIDS ministry, although their pastors are open to HIV education and to welcoming people with HIV into their congregations. Pastors suggested that we create an HIV training that provides HIV information aligned with their teachings on living a Christian life. They also shared that their congregants would like to learn about chronic diseases other than HIV, and they believe that HIV training attendance would increase if the training also includes information on cancer and diabetes.
We have launched the development of this curriculum, with an expected completion in early December, 2012. The curriculum is entitled, “Health Talk: Tackling Health Topics that Affect Our Congregations and Communities.” It includes three modules that can be offered together or separately:
- Health Talk: Diabetes
- Health Talk: HIV
- Health Talk: Cancer
To access the curriculum described above, use this link: Health Talk: HIV Resource Tool (January 2013)
New Opportunity for Duke Students: Community-Based Mental Health Intervention
A Community Based Mental Health Intervention With Latinos – Bass Connections Projects
| Location: Durham, North Carolina, United States Project Topic: Mental health Status: AvailableApplication Process: To apply, please send the following information to lysa.mackeen@duke.edu by February 22, 2013 1) Name Background Through this pilot program, Duke students will have a unique opportunity to work with multidisciplinary teams of undergraduates, graduate and professional students, faculty in medicine, psychology, and public policy, community agencies, and local churches in order to learn about health disparities in Durham, the process of designing and implementing culturally appropriate interventions to improve health and wellbeing, and collaboration across disciplines and institutions, within a community to enact change. This project is a collaboration between the Center for Health Policy and Inequalities Research at Duke, El Futuro, a community mental health agency for the Durham and Orange County Latino population, and two Spanish-speaking churches in Durham. We will work with mental health providers, clergy, and community members to develop an interpersonal violence and trauma educational intervention and deliver the intervention to the Latino population in church settings. Opportunities The project team will include six undergraduate students, and three graduate/professional students. All participants will receive a stipend. The program will consist of three phases, with students integrally involved in each phase. In the initial three-month phase, students will engage in a series of workshops with faculty to develop skills necessary for carrying out the community-based educational intervention, including sessions on teaching skills, language and cultural issues, trauma, mental health, and effective collaboration with community and religious organizations. Concurrently, students will work with faculty on a formative evaluation of the existing needs, infrastructure, and goals of the partner community and faith-based organizations that will inform development of the intervention and will be shared with the community. The fieldwork component will consist of the final development and implementation of an educational intervention for the community about trauma and its impacts on mental health and well-being. While the final design of the intervention will be informed by the formative evaluation, we anticipate that the intervention will be comprised of a series of four 60 to 90 minute weekly sessions to be held at two different churches in the community. Before and between sessions, students will collaborate with staff at El Futuro and the churches to promote community participation and engagement with the intervention. Post-fieldwork activities will involve development of deliverables that will disseminate information to the broader community. Further, feedback obtained from students, community partners, clergy, and participants will be used to assess acceptability and develop future plans. Project Dates: March-October
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