A WHITAKER GROUP PUBLICATION JANUARY-FEBRUARY 2009

AFRICA HEALTH NEWS

HIV/AIDS

PEPFAR REPORT HAILS for an HIV-Free Generation,

a global PPP initially piloted
SUCCESS OF PARTNERSHIPS in Kenya to advance youth-fo-
cused HIV prevention, and the
The President’s Emergency Plan for AIDS Relief (PEPFAR) is suc- creation of a Wellness Center
cessful in large part because of the public-private partnerships (PPPs) in Uganda in partnership with
the US government has developed with host country governments, Becton, Dickinson and Compa-
NGOs, faith and community-based groups and the private sector, ny and the International Coun-
said PEPFAR’s outgoing Coordinator, Ambassador Mark Dybul, in cil of Nurses. The center will
January. serve 29,000 health workers in
“We have the resources, but the leadership, the brilliance, the real Uganda and their families.
success, is of the people and the countries,” he said at the release of In 2008, PEPFAR contin-
PEPFAR’s annual report. “That’s really one of the geniuses of this pro- ued to expand its partnerships,
gram...that leads with country ownership, that pushes good governance, working with 2,667 organiza-
results-based approaches, all sectors being engaged.” tions up from 1,588 in 2004, of
In today’s resource-constrained world, PPPs are the key to sustain- which 86% were local.
ability. In addition, they help facilitate increased interventions and le- PEPFAR has also worked with
verage private sector resources to multiply impact. PEPFAR supported its international implementing PHOTO: EJ MUNOZ

eight large-scale, multi-country PPPs in 2008, as well as an array of
country-level PPPs and workplace programs with local private sector
entities.
Two such initiatives mentioned in the report are the Partnership
PEPFAR ACHIEVEMENTS 2004-2008
☑ Supported treatment for more than 2.1 million people,
saving nearly 3.28 million adult years of life.
☑ Increased the share of those receiving treatment who are
children from 3% in 2004 to 8% in 2008.
☑ Supported care for more than 10.1 million people affect-
ed by HIV/AIDS, including more than 4 million orphans
and vulnerable children.
☑ Supported HIV counseling and testing for nearly 57 mil-
lion people.
☑ Supported tuberculosis treatment for more than 395,400
HIV-infected patients through September 2008.
☑ Reached an estimated 58.3 million people to prevent
sexual transmission of HIV through the ABC approach.
☑ Distributed more than 2.2 billion condoms.
☑ Supported prevention of mother-to-child HIV transmis-
sion during nearly 16 million pregnancies, providing anti-
viral prophylaxis for nearly 1.2 million HIV-positive preg-
nant women, allowing nearly 240,000 infants to be born
HIV-free.
☑ Partnered with 2,667 organizations, of which 86% were
local.
☑ Supported an estimated 3.7 million training and retrain-
ing encounters for health care workers.
partners to develop strategies A baby receives care at a PEPFAR-
for handing over programs as funded clinic in Addis Ababa,
local organizations increase Ethiopia.
their capacity to work directly
with the US government.
Goals for future PPPs, the report stated, include expanding private
health insurance options and strengthening health systems, including
human resource capacity and expanding information communications
and technology offerings.
Ambassador Dybul also emphasized that PEPFAR investments are
building Africa’s health care capacity across the board and ultimately
strenthening democracy by building accountability frameworks. “Peo-
ple feel a sense of accountability and development that we haven’t had
before,” he said.
Launched by former President George Bush in 2003, PEPFAR has so
far spent $18.8 billion and exceeded its goal of supporting anti-retrovi-
ral therapy (ART) for two million people by 2008. As of September 30,
2008, the initiative has provided ART for more than 2.1 million people
worldwide, of which the great majority are in the 12 focus countries in
sub-Saharan Africa. These include Botswana, Côte d’Ivoire, Ethiopia,
Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanza-
nia, Uganda and Zambia.
In July 2008, the US Congress reauthorized PEPFAR with $48 billion
in funding through 2013. The initiative also includes funding for tuber-
culosis and malaria. Between 2009 and 2013, PEPFAR plans to work
in partnership with host nations to support treatment for at least three
million people, prevent 12 million new infections, and care for 12 mil-
lion people, including five million orphaned and vulnerable children. It
also plans to support training for at least 140,000 new health workers.
PEPFAR is expected to receive strong support from the new US Ad-
ministration because both President Barack Obama and Vice President
Joseph Biden were sponsors of the PEPFAR reauthorization. The fund-
ing, though authorized, is still to be appropriated by Congress.
PAGE TWO
BUILDING CAPACITY
NEW PARTNERSHIP SEEKS TO STRENGTHEN
TANZANIAN HEALTH WORKFORCE
Tanzania’s Muhumbili University of Health
Allied Sciences (MUHAS) announced in Jan-
uary that it will partner with the University of
California, San Francisco (UCSF) to develop
and implement strategies to enable MUHAS
and other African institutions to meet their
countries’ health workforce needs.
Student dentists training at Muhimbili
University in Tanzania
REGIONAL COOPERATION
GLIA PROGRAM TO PROTECT LONG HAUL
TRUCK DRIVERS FROM HIV SHOWS RESULTS
The Great Lakes Initiative on AIDS (GLIA),
a regional collaboration between six East Af-
rican governments ratified by treaty in 2005,
is starting to see the results of its program to
educate long distance truck drivers about the
dangers of unprotected sex and the need to
be tested for HIV infection.
Working with National HIV Coordinat-
ing Commissions and truck and workers’
unions, in 2007 GLIA helped launch the pro-
gram among its member states - Burundi,
Democratic Republic of Congo (DRC), Kenya,
Rwanda, Tanzania and Uganda - to address the
problem of HIV infection in a highly mobile
and vulnerable population.
A key facet of the program is to encourage
the truckers themselves to ‘know their epidem-
ic’ and plan and institute their own response.
Since then, the results have been impressive:
■ In Kenya, more than 11,000 truckers have
undergone voluntary HIV testing and coun-
seling, many at a well-equipped truck stop on
the well-traveled Mlolongo Road.
The project, funded by a $7.5 million grant
from the Bill & Melinda Gates Foundation,
seeks to harness the resources of the two uni-
versities to develop an institutional partner-
ship that can be replicated in other low-re-
source settings.
Faculty from MUHAS and the MUHAS
School of Public Health will work with their
counterparts at the UCSF schools of medicine,
nursing, pharmacy and dentistry to share cur-
ricula and educational technologies, and de-
velop collaborative research programs.
“Through this collaboration, MUHAS
will recruit and train faculty, strengthen the
academic environment for education and re-
search, and revise undergraduate and post-
graduate curricula in order to increase its out-
put of health professionals to serve the needs
of the country,” said MUHAS Vice Chancellor
Professor Kisali Pallangyo.
The partnership builds on an already estab-
lished relationship between the two universi-
ties, which are both public health institutions
that train doctors, nurses, pharmacists, den-
tists and allied health professionals.
■ In Rwanda, 60% of truckers now know
their HIV status.
■ In Uganda, workers’ unions have distrib-
uted condoms, carried out voluntary counsel-
ing and testing and held behavioral change
sessions.
■ In Tanzania, truckers living with HIV have
openly declared their status and formed a sup-
port and advocacy group. One spillover effect
is that sex workers at truck stops have begun to
use condoms more consistently.
■ In DRC, truck drivers report they are hav-
ing fewer sex partners and increasing condom
use.
To support this progress, GLIA has con-
tracted with an international NGO, Constella-
tion for AIDS Competence, to educate leaders
of trucker networks on HIV response and to
encourage them to pass the training on.
GLIA is funded with a $20 million grant
from the World Bank. Its objective is to imple-
ment HIV/AIDS interventions regionally to
add value to individual country efforts.
COLLABORATION
NEW INITIATIVE TO
IMPROVE HEALTH
OUTCOMES IN UGANDA
Uganda’s Makerere University has launched
a new partnership with the Johns Hopkins
University in Baltimore to improve health
outcomes in Uganda by extending the educa-
tion capacity of Makerere’s College of Health
Sciences.
The first phase of the project, made possible
by a $4.97 million grant from the Bill and Me-
linda Gates Foundation, focuses on aligning
Makerere’s education and research with the
Government of Uganda’s national health goals
and priorities, as well as identifying strategies
to ensure the long-term sustainability of the
university’s efforts to address evolving health
priorities and health manpower needs.
Working with the Johns Hopkins Center for
Global Health, Makerere will develop and test
effective teaching, research and practice strate-
gies with a focus on translating research into
policy implementation.
“We see this project as a major stepping
stone to ensure that Makerere will be the
hub for capacity building and influencing the
health sector to improve lives in Uganda and
the East Africa region for years to come,” said
Dr. David Peters, Associate Professor in the
Department of International Health at Johns
Hopkins Bloomberg School of Public Health.
The project will be led by Dr. Peters and
Dr. George Pariyo, Head of the Department
of Health Policy, Planning and Management
at the Makerere University School of Public
Health.
One of the early focus areas for the initia-
tive will be to reduce neonatal and maternal
mortality by removing constraints on women
giving birth in hospitals.
“We want to test strategies to reduce the
barriers for maternal mortality like reduction
in hospital fees. We are proposing that we test
out ways of subsidizing costs, for example,
through vouchers,” Dr. Pariyo told the Monitor
newspaper.
Dr. Ibingira Charles, Dean of the School of
Biomedical Sciences at Makerere, described
the project as a bridge between students and
the community. “Students have been learning
but there has been a disconnection between
them and the community through integrat-
ing learning and service delivery,” he said.
“We hope to impact communities by looking
at how we can translate research into policy.
Once we are able to do this, it will be easier to
directly impact the lives of Ugandans.”

GUINEA WORM DISEASE ERADICATION
GLOBAL PARTNERS BEGIN FINAL PUSH
TO ERADICATE PARASITE
The Bill & Melinda Gates Foundation and
Britain’s Department for International De-
velopment (DfID) announced in December
that they were jointly committing $55 mil-
lion to the effort led by the Carter Center to
finally eradicate Guinea worm disease.
“Guinea worm is poised to be the second
disease eradicated from Earth, ending need-
less suffering for millions of people from one
the world’s oldest and most horrific afflic-
tions,” said former US President Jimmy Carter,
whose Atlanta-based center has been working
for more than two decades on the eradication
effort.
He said that cases of Guinea worm disease
reached an all-time low in 2008 with less than
5,000 cases reported in six African nations,
down from 3.5 million cases in 1986 in 20 na-
tions in Africa and Asia.
In the first 10 months of 2008 only 4,410
incidents of Guinea worm were reported in
Ethiopia, Ghana, Mali, Sudan, Niger and Ni-
geria. It is already suspected that the last cases
DIABETES
NOVO NORDISK TO SUPPLY AFFECTED
CHILDREN WITH FREE INSULIN
Danish bio-pharmaceutical company Novo
Nordisk announced in December that it
would provide diabetes care and free insulin
to 10,000 children in the Democratic Repub-
lic of Congo, Guinea-Conakry, Tanzania and
Uganda beginning in 2009.
The five-year program, called “Changing
the Future for Children with Diabetes,” will be
based on a hub-and-spoke concept with satel-
lite centers around existing hospitals and clin-
ics. With an estimated cost of $25 million, it is
aimed at building sustainable solutions for im-
proving availability, accessibility, affordability
and quality of diabetes care for children with
type 1 diabetes.
An estimated 38,000 African children have
type 1 diabetes, the majority of whom die
within a year of diagnosis due to lack of ac-
cess to insulin. While still relatively rare in
Africa, type 1 diabetes is on the rise due to
increased urbanization and changes in dietary
and exercise habits. “The premature death of a
child caused by lack of insulin is unacceptable,
when a life-saving solution is available,” said
have been reported from Nigeria and Niger,
according to the Carter Center.
The Gates Foundation is contributing $40
million as a challenge grant to the Carter Cen-
ter. It includes an outright contribution of $8
million and encourages other donor organiza-
tions and individuals to provide an additional
$32 million that the Gates Foundation will
match one-to-one. The British government
has pledged about $15 million. The funds will
be shared equally between the Carter Center
and the World Health Organization (WHO).
Guinea worm disease will be the first disease
to be wiped out without a vaccine or medicine.
Interventions include health education, free
cloth filter distribution and larvicide applica-
tions. To date, about $225 million has been in-
vested in the eradication effort.
“The drive to eradicate Guinea worm dis-
ease is one of the world’s most impressive
global health success stories,” said Dr. Regina
Rabinovich, Director of Infectious Diseases
Development at the Gates Foundation.
Dr. Jean Claude Mbanya, President-elect of
the International Diabetes Foundation (IDF).
“We must work together across borders to
keep these children from dying. This is why I
welcome this new program being launched by
Novo Nordisk.”
The bio-pharmaceutical company aims to
collaborate with as many local partners as pos-
sible, including governments and diabetes as-
sociations, and regional chapters of the IDF. In
addition to providing free insulin, it will focus
on helping to improve the health care infra-
structure of the host countries.
“This project will not only provide insu-
lin free of charge to an extremely vulnerable
group, it is also designed to build long-term
solutions for insulin distribution and sustain-
able diabetes care for all people with diabetes
in the world’s poorest countries,” said Mr. Lars
Rebien Sǿrensen, President and CEO of Novo
Nordisk A/S.
Novo Nordisk hopes to expand the program
beyond the initial four participating coun-
tries.
PAGE THREE
LOCAL PRODUCTION
EAST AFRICA NOW
A KEY SUPPLIER OF
ARTEMISININ
East Africa has become the third most im-
portant growing region in the world for Ar-
temisinin, the active ingredient in the most
effective antimalarial, the United Nations
(UN) reported in January.
Until recently, almost all Artemisia annua
plants, native to Asia, were grown in China
and Vietnam, but in 2002 a handful of Kenyan
farmers contracted with the local company
Botanical Extracts EPZ Ltd. (BEEPZ) to plant
40 hectares of the plant.
Artemesia annua cultivation now supports
at least 40,000 smallholder farmers growing
4,000 hectares of the crop in Kenya, Tanzania
and Uganda.
Commercialization of the plant was made
possible by grants from Britain’s Department
for International Development (DfID) and
the Swiss pharmaceutical company Novartis.
BEEPZ pays between $550 and $600 per met-
ric ton. One hectare can produce up to two
metric tons of dry leaves.
Cultivation of the plant in Africa is consid-
ered critical to ensuring a less expensive supply
of the drug that has taken over from the older
quinine-based medicines no longer considered
effective against several forms of malaria.
According to the UN, the Kenyan govern-
ment buys about 17 million doses of Artemis-
inin drugs annually at a cost of $24 million for
free use at government clinics. At private phar-
macies, the cost per dose ranges from about
$5.50 to $8.20.
In 2006, BEEPZ paid out $1.7 million to
farmers. The company completed an Artemis-
inin extraction plant in 2007 and now supplies
Novartis with enough Artemisinin for more
than 22 million doses of the drug.
Workers cultivate Artemisia annua plants in
Tanzania
PAGE FOUR
AIDS OUTLOOK/09
UN REPORTS PROGRESS ON FIGHT
AGAINST HIV/AIDS EPIDEMIC
Fewer people in the world are becoming in-
fected with HIV, fewer are dying from AIDS-
related illnesses and more of those infected
with HIV are receiving treatment, a new UN-
AIDS report states.
New infections have declined from three
million in 2001 to 2.7 million in 2007, the
number of children becoming infected through
mother-to-child transmission has dropped to
370,000 in 2007 from 450,000 in 2000, and an
estimated two million people died from AIDS-
related illnesses in 2007 - down from 2.2 mil-
lion in 2005. A total of three million people in
the developing world are now receiving anti-
retroviral therapy (ART), 10 times more than
were being treated in 2002.
But, the report cautions, the total number
of people living with HIV is increasing due to
new infections, the longer life span of those
receiving treatment and population growth. It
estimates that about 33 million people world-
wide are infected, of which 22 million are in
sub-Saharan Africa.
Despite improvements in treatment, the re-
port stated, only 25% of those in need of ART
receive it and 88 out of 113 developing coun-
tries reported that fewer than half of mothers
received services to prevent the transmission
of HIV to their children. Seventy-five percent
of all AIDS-related deaths worldwide are in
Africa.
The report, entitled “AIDS Outlook/09,”
highlights progress made in several African
countries with high prevalence rates in lower-
ing new infections and enabling more of those
who are infected to gain access to treatment.
According to the report, changes in sexual
behavior in Rwanda and Zimbabwe have led to
a decline in the number of new HIV infections,
while young people in Burkina Faso, Ethiopia,
Ghana, Malawi, Uganda and Zambia are wait-
ing longer before becoming sexually active.
Increasingly, the report states, African gov-
ernments are making greater efforts to under-
stand and respond in a targeted way to the
particular dynamics of the disease in their
countries.
In 16 sub-Saharan countries - Benin, Bo-
tswana, Burkina Faso, Côte d’Ivoire, Ethiopia,
Ghana, Kenya, Lesotho, Malawi, Mozambique,
Nigeria, Senegal, Swaziland, Tanzania, Uganda
and Zambia - national HIV experts have just
produced, or will soon produce, transmission
analyses that pinpoint how HIV infection oc-
Couples counseling and testing is
increasingly being adopted
curs in their countries.
One example cited in the report is that of
Uganda, where transmission analysis showed
that approximately 43% of new HIV infections
occurred among ‘low risk’ couples in which
one partner was HIV positive and one HIV
negative. An estimated 44% of new infections
came from those with multiple sex partners,
including their regular partners, and about
11% were related to sex work.
Based on these findings, the Government
of Uganda is focusing prevention efforts on
people in marriages or long-term relation-
ships. Prevention strategies include promot-
ing couples counseling and testing, efforts to
reduce the number of sexual partners and em-
phasis on consistent condom use for couples
in which one partner is HIV positive and one
HIV negative.
“A number of things are happening with
those couples in long-standing relationships.
First, they don’t use condoms. Second, they do
not test as much. We need to encourage them
to test - and not only to test, but also to disclose
to their partner,” said Professor Fred Wabwire-
Mangen, the team leader of the Uganda modes
of transmission study and Associate Profes-
sor of Infectious Disease Epidemiology at the
Makerere Unversity School of Public Health in
Kampala.
Lesotho, which has one of the highest infec-
tion rates in the world, is also reformulating
its national strategy based on its transmission
analysis.
“With this information we have fine-tuned
our behavioral change and communication
strategy and future programming of preven-
tion interventions,” said Mr. Keketso Sefeane,
CEO of the Lesotho National AIDS Commis-
sion.
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LEADERS IN HEALTH
DR BABATUNDE OSOTIMEHIN:
MINISTER OF HEALTH, NIGERIA
When Nigerian President Umaru
Yar’Adua appointed Dr. Babatunde
Osotemehin his new Minister of Health
last December, it was a signal that he
was making HIV/AIDS the top priority
in his country’s health agenda.
An eminent research scientist in sex-
ual and reproductive health, Dr. Osote-
mehin was most recently the Director-
General of Nigeria’s National Agency
for the Control of AIDS and the Project
Manager of his country’s HIV/AIDS Pro-
gram Development Project. He was also
the Coordinator of the Social Sciences
and Reproductive Health Research Net-
work in Ibadan, Nigeria, and a Professor
of Clinical Pathology at the University of
Ibadan’s College of Medicine.
In an interview with SciDev.Net, a
London-based NGO that provides in-
formation on science and development
to developing countries, he said his pri-
orities would be “research for evidence-
based healthcare,” increased rollout of
anti-retroviral drugs to fight HIV/AIDS,
community health insurance and a great-
er emphasis on routine immunization,
especially for polio, which has seen a re-
surgence in Nigeria in recent years.
“We have to improve the capacity of
the ministry to deliver quality service to
the Nigerian people,” he told SciDev.net.
“That capacity is not limited to physical
access, but includes competence through
training and financing.”
Dr. Osotimehin, who earned medical
degrees from the University of Birming-
ham in Britain and the University of
Ibadan, did post-doctoral study at Me-
morial Sloan Kettering Cancer Center
in New York and the Harvard Center for
Population and Development Studies in
Cambridge, Massachusetts.
Dr. Babatunde Osotimehin