News Article | May 11, 2017
HANOVER, NH - Investigators at Dartmouth's Geisel School of Medicine announced that two new studies of DAR-901, their investigational vaccine against tuberculosis (TB), have moved it to the forefront of new vaccines in development for global control of this deadly infectious disease. "We are very pleased with the results of these two studies" said Ford von Reyn, MD, professor of medicine at Geisel and principal investigator for the DAR-901 booster vaccine. "They represent major milestones on the path to approval of DAR?901 and the global fight against tuberculosis." Tuberculosis is the leading infectious disease cause of death in the world and there is a global effort to eradicate it by 2035. According to modeling by the World Health Organization a new vaccine will be required to meet this ambitious elimination goal. The Dartmouth candidate, DAR-901, is an inactivated vaccine made from a non-pathogenic bacterium that is genetically related to Mycobacterium tuberculosis, the cause of human tuberculosis. An earlier form of the vaccine was used in the DarDar Trial, a seven-year study in Tanzania sponsored by the U.S. National Institutes of Health involving patients with HIV infection who at birth had received BCG, the current tuberculosis vaccine. In that trial, the inactivated vaccine was effective as a booster in preventing tuberculosis. The DarDar Trial remains the only trial in which a new tuberculosis vaccine has shown efficacy in humans. Dartmouth and Aeras subsequently collaborated to develop an improved and scalable method for manufacturing the vaccine, now designated DAR-901. The two new studies on DAR-901 conducted in collaboration with Aeras were published in the journal PLOS ONE. In the pre-clinical study, BCG was administered first followed by a booster immunization with either DAR-901 or a second dose of BCG. Protection against subsequent tuberculosis challenge was greater with the DAR-901 booster than with the BCG booster. In the clinical study, being published today, DAR-901 was administered to adults living in the United States who had received BCG at birth. A three-dose series of the vaccine was safe and well-tolerated. In addition, DAR-901 induced immune responses that were similar to those seen with the vaccine shown effective in the DarDar Trial. "Taken together, these two studies suggest that the new scalable vaccine formulation is likely to prove as effective as the original formulation - which would make it the first protective TB vaccine in humans since BCG, which was introduced almost a century ago," said Professor Ajit Lalvani, Director of the Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London and a member of the DAR-901 development team. Based on the study published today, a larger randomized trial is underway in Tanzania to determine if DAR-901 prevents the earliest stage of infection with tuberculosis, before symptoms are apparent. In February, the 650 adolescents in this "prevention of infection" study completed receiving 3 doses of DAR-901 or placebo. The vaccine was again observed to be safe and well-tolerated. The trial is sponsored by Global Health Innovative Technology Fund (Japan) and results of vaccine efficacy will be available in late 2018. Additional collaborators on the DAR-901 development team include Timothy Lahey, MD, Lisa Adams, MD, and Richard Waddell ScD, at Geisel, Robert Arbeit, MD, at Tufts University School of Medicine, C. Robert Horsburgh, MD, at Boston University School of Public Health, and Kisali Pallangyo, MD, and Patricia Munseri, MD, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam Tanzania. The team is now developing plans for a large, randomized, placebo-controlled Phase 3 trial to support regulatory approval of DAR-901. The study is targeted to begin within two years. To read the latest study at PLOS ONE: http://journals. (link live 5/11/17 at 2:00 PM Eastern Time) The studies were supported by Dartmouth College, Aeras (Rockville, MD) and the Jack and Dorothy Byrne Foundation. About the Geisel School of Medicine at Dartmouth Founded in 1797, the Geisel School of Medicine at Dartmouth strives to improve the lives of the communities it serves through excellence in learning, discovery, and healing. The Geisel School of Medicine is renowned for its leadership in medical education, health care policy and delivery science, biomedical research, global health, and in creating innovations that improve lives worldwide. As one of America's leading medical schools, Dartmouth's Geisel School of Medicine is committed to training new generations of diverse leaders who will help solve our most vexing challenges in health care.
Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: HEALTH.2010.3.4-3 | Award Amount: 2.19M | Year: 2011
This project will add new research training capacity at Sub Saharan African (SSA) universities, for health systems and services strengthening. The focus is doctoral and post doctoral training, institutional strengthening for education, financial and administrative research management, and South-South network building. Novel capacity building approaches will reduce brain-drain, be more climate friendly and encourage gender equity with south based training. Internet mounted downloadable modules in quantitative (e.g., epidemiology), qualitative (e.g., anthropology) and economic methods will support excellent interdisciplinary courses. Our EU and African partners have many successful previous collaborations, e.g., web based training modules; joint PhD degree with Uganda. Health systems strengthening is research intensive, incremental improvement to service delivery, implementation and evaluation. Therefore SSA countries need to grow their own health services and systems research (HSSR) capacity: interdisciplinary, rigorous and relevant. ARCADE-HSSR will support evidence informed service delivery by producing a stream of well trained young HSSR scientists, the next generation of health system leaders and researchers in SSA. Activities will be aimed at individuals, institutions and at the network. Makerere University(MU) and Stellenbosch University (SU) are two strong SSA universities with HSSR focus. They will act as hubs in a South-South network including MU, SU, and initially, Muhimbili (MUH) and Malawi (MA). Working with strong northern HSSR institutions (Karolinska Institute KI, Sussex University Institute for development Studies, IDS, and Norwegian Knowledge Centre for Health Services KS) this region-wide approach will draw skills, resources and students to a new south-south HSSR capacity development network. We will expand our unique north-south joint PhD degree programme (KI-MU: 20 Ugandan graduates), to south-south joint PhD degrees (MU-SU).
Agency: European Commission | Branch: FP7 | Program: CP-SICA | Phase: HEALTH-2007-3.5-4 | Award Amount: 3.74M | Year: 2009
Besides a dramatic lack of financial and human resources in developing countries, health care is additionally endangered by quality deficiencies caused by low staff motivation. This lack of motivation leads to an insufficient translation of knowledge into optimal utilization of resources. The know-do gap represents a challenge that must be addressed to strengthen health services performance towards achieving the Millennium Development Goals (MDGs). This is in particular true for some sensitive sectors like pre-natal and maternal health care. General objective of this research is to improve maternal health through better pre-natal and maternal care services offered by better motivated health workers. A computer-assisted clinical decision support system (CDSS) will be developed, implemented and tested aiming at (I) quality improvement of maternal and newborn care and (II) assessment of providers performance. Based on this tool a commonly agreed incentive scheme to increase motivation will be shaped and tested in three SSA - countries, namely Burkina, Ghana, and Tanzania. The incentive scheme might contain both non-monetary and monetary incentives and will be designed according to the human resource policy in the three countries. The planned approach is an implementation study with control arms containing one hospital and 6 first line health facilities in each of the study districts and an equal number of facilities in the control arm. A set of indicators for measurement of changes in quality of delivered services will be identified in order to follow up the sustainability and effectiveness of the strategies after their implementation. The study findings will allow understanding the important factors of staff motivation and facilitate adequate management for improvement of maternal and neonatal health care. Knowing is not enough, we must apply; Wanting to do, is not enough, we must do it - J.W. v. Goethe
Agency: European Commission | Branch: FP7 | Program: CP-FP-SICA | Phase: HEALTH-2009-4.3.2-1 | Award Amount: 3.97M | Year: 2010
The purpose of this project is to develop research-based, culture- and gender-sensitive, sustainable, community-based interventions to promote sexual- and reproductive health among adolescents aged 12-14 years in southern and East Africa, with schools as the gateway for delivery. In two sites (Cape Town and Dar es Salaam), comprehensive, best practice, effectiveness studies will be implemented. The aim of the interventions for these studies is that the adolescents use condoms correctly and consistently, postpone sexual debut, or reduce the number of sexual partners. In two other African sites (Limpopo and Kampala), we shall carry out focused efficacy studies. The innovation in the proposal derives from the manner and extent to which we address gender-based violence; parent-child communication on sexuality; culture-specific norms, attitudes and beliefs; active involvement of school students in peer education; contextual factors (physical, organizational and cultural aspects of environments); and action planning. The evaluation includes a process evaluation utilising mainly qualitative methods, and an outcome evaluation involving intervention and comparison groups at all sites. The sample for the effectiveness studies will consist of 15 matched pairs of schools (6000 students), with one school in each pair being randomly allocated to each of the groups in each site. The sample for the efficacy studies will consist of 40 school classes (1200 students) in each group in each site. The theoretical framework draws from social cognition and community mobilisation models. Statistical analyses will exploit current advances in structural equation modelling and multilevel analysis. The use of a biological marker (HSV2) as a proxy for sexual practices will be explored in the first two years of the project. This proposal is perfectly consistent with priorities described under area 188.8.131.52 Strategies and interventions for improving reproductive health (SICA).
Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: HEALTH.2010.3.4-3 | Award Amount: 2.23M | Year: 2011
The APARET fellowship programme will catalyse independent research activities of graduates of Field Epidemiology Training Programmes (FETP) and Field Epidemiology Laboratory Training programmes (FELTP) in Africa. APARET fellows will be employed as research associates by African APARET partners for 2 years (salary provided by host institute). During the first year of their contract they will be embedded in the EU-supported APARET programme. A core part of the fellowship will be the application for a major research grant. The APARET programme will consist of: - Workshops: a two-week initiation workshop with face-to face contact between fellow and mentor and workshops on topics such as research funding, project management, ethical issues; a one-week proposal writing and project-planning workshop; a one-week final seminar, where fellows will present their result. - A mentoring programme linking each fellow with a local supervisor and an external mentor providing support for scientific and grant writing activities - Small research grants enabling the fellows to perform independent scientific activities at their host institutes. - Embedding the fellows in a network of African and European epidemiologists APARET can be credited towards a PhD degree of the respective university. EU-funding covers 3 successive cohorts of fellows. APARET will support the fellows in meeting the following objectives: I) Main objective: Prepare, write and submit a proposal for a major research grant. II) Additional objectives: 1. Plan, develop and conduct an epidemiological research project. 2. Perform epidemiological analyses 3. Submit a scientific manuscript to a peer-reviewed journal. 4. Critically review and provide feedback on a scientific paper. 5. Participate in the training of other epidemiologists. APARET supports well-trained epidemiologists in establishing a career in Africa.
News Article | November 4, 2016
Five-year study in Tanzania, Africa seeks to determine whether combining diabetes and hypertension screening with HIV screening will increase uptake of HIV testing and care The success of HIV treatment programs depends upon the identification, enrollment, and retention of HIV-infected individuals, but public health officials have learned that there are numerous barriers to such success at every point in this care continuum. HIV-centric programs carry a stigma, patients' transportation to the HIV clinics can be a problem, and patients tire of repeat visits to learn whether they have become eligible for HIV treatment. Chronic noncommunicable diseases such as diabetes and hyptertension are another growing global epidemic, accounting for 38 million deaths annually, with three quarters of those deaths occurring in low- and middle-income countries. Michael D. Sweat, Ph.D., professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina and director of the Center for Global Health, has worked with American and Tanzanian scientists and other colleagues since 1994 to study ways to increase HIV screening and care in Tanzania. Sweat is the principal investigator for the $3.1M NIH grant received in October by the Center for Global Health to study the integration of diabetes and hypertension screening into HIV screening. This study will evaluate the efficacy and cost-effectiveness of the novel integration of diabetes and hypertension screening and care with HIV screening and care. An earlier pilot study led by Sweat indicated that this approach is likely to increase HIV testing, a finding that is relevant throughout the world, including rural, impoverished areas of the U.S. "Global health is everyone's health," said Sweat. "The greatest burdens of disease in the world--HIV, diabetes, and hypertension, among others--know no borders. This grant will enable us to discover better and more efficient ways to address these threats to health, no matter where they arise." Sweat's institutional collaborators will be Clemson University's Department of Bioengineering, which has worked with Arusha Technical College in Tanzania in the past to develop low-cost health technology solutions for resource-poor settings, and Muhimbili University of Health and Allied Sciences, which will provide clinical services and collaborate on data collection and analysis. "HIV and AIDS continue to be a huge problem in Tanzania," said Jessie Mbwambo, M.D., professor in the Department of Psychiatry and Mental Health at Muhimbili University of Health and Allied Sciences. "However, we cannot neglect other growing health needs such as diabetes and hypertension. We believe that by integrating diabetes and hypertension care with HIV care we can likely improve health in all these domains much more effectively and at a lower cost." Delphine Dean, Ph.D., Gregg-Graniteville Associate Professor of Bioengineering at Clemson University, will direct the development of low-cost, diagnostic devices in her laboratory and provide technical support to the health clinics in Tanzania. Dean's laboratory recently developed a low-cost glucometer designed to print (on an inkjet printer) test strips on filter paper loaded with reagents to which a drop of blood is applied to determine the patient's blood sugar level. A patent on the glucometer was filed through the Clemson University Research Foundation. "The lack of medical equipment, devices, and tests in resource-poor areas such as rural Tanzania limits clinicians' ability to diagnose and treat," said Dean. "By working together, we can improve accessibility to technology and improve global health." Patient enrollment is projected to begin in the fall of 2017. Founded in 1824 in Charleston, The Medical University of South Carolina is the oldest medical school in the South. Today, MUSC continues the tradition of excellence in education, research, and patient care. MUSC educates and trains more than 3,000 students and residents, and has nearly 13,000 employees, including approximately 1,500 faculty members. As the largest non-federal employer in Charleston, the university and its affiliates have collective annual budgets in excess of $2.2 billion. MUSC operates a 750-bed medical center, which includes a nationally recognized Children's Hospital, the Ashley River Tower (cardiovascular, digestive disease, and surgical oncology), Hollings Cancer Center (a National Cancer Institute-designated center), a Level 1 Trauma Center, and Institute of Psychiatry. For more information on academic or clinical services, visit musc.edu. For more information on hospital patient services, visit muschealth.org.
Nyamhanga T.M.,Muhimbili University of Health and Allied Sciences
Global health action | Year: 2013
This article presents part of the findings from a larger study that sought to assess the role that gender relations play in influencing equity regarding access and adherence to antiretroviral therapy (ART). Review of the literature has indicated that, in Southern and Eastern Africa, fewer men than women have been accessing ART, and the former start using ART late, after HIV has already been allowed to advance. The main causes for this gender gap have not yet been fully explained. To explore how masculinity norms limit men's access to ART in Dar es Salaam. This article is based on a qualitative study that involved the use of focus group discussions (FGDs). The study employed a stratified purposive sampling technique to recruit respondents. The study also employed a thematic analysis approach. Overall, the study's findings revealed that men's hesitation to visit the care and treatment clinics signifies the superiority norm of masculinity that requires men to avoid displaying weakness. Since men are the heads of families and have higher social status, they reported feeling embarrassed at having to visit the care and treatment clinics. Specifically, male respondents indicated that going to a care and treatment clinic may raise suspicion about their status of living with HIV, which in turn may compromise their leadership position and cause family instability. Because of this tendency towards 'hiding', the few men who register at the public care and treatment clinics do so late, when HIV-related signs and symptoms are already far advanced. This study suggests that the superiority norm of masculinity affects men's access to ART. Societal expectations of a 'real man' to be fearless, resilient, and emotionally stable are in direct conflict with expectations of the treatment programme that one has to demonstrate health-promoting behaviour, such as promptness in attending the care and treatment clinic, agreeing to take HIV tests, and disclosing one's status of living with HIV to at least one's spouse or partner. Hence, there is a need for HIV control agencies to design community-based programmes that will stimulate dialogue on the deconstruction of masculinity notions.
Lwoga E.,Muhimbili University of Health and Allied Sciences
Campus-Wide Information Systems | Year: 2012
Purpose: This paper seeks to assess the extent to which learning and Web 2.0 technologies are utilised to support learning and teaching in Africa's higher learning institutions, with a specific focus on Tanzania's public universities. Design/methodology/approach: A combination of content analysis and semi-structured interviews was used to collect data. Semi-structured interviews were conducted with ICT personnel from six of the eight public universities in Tanzania in 2011. Findings: The study found that the adoption of e-learning and Web 2.0 technologies is still in its infancy in Tanzania's public universities. However, there was much enthusiasm amongst respondents for developing the potential of e-learning and Web 2.0 tools in their universities. Practical implications: The study seeks to promote academic inquiry about the need for innovative Web 2.0 technologies in learning and teaching and the adoption of these emerging technologies in Africa's higher learning institutions. Originality/value: The study provides empirical findings on the use of e-learning and Web 2.0 for higher education, specifically in the Tanzanian context. The study provides a basis for further research on the use of Web 2.0 technologies in higher education. © Emerald Group Publishing Limited.
Semali I.A.,Muhimbili University of Health and Allied Sciences
BMC Health Services Research | Year: 2010
Background. Of global concern is the decline in under five children mortality which has reversed in some countries in sub Saharan Africa (SSA) since the early 1990 s which could be due to disparities in access to preventive services including immunization. This paper is aimed at determining the trend in disparities in completion of immunization using Tanzania Demographic and Health Surveys (DHS). Methods. DHS studies randomly selected representative households from all regions in Tanzania since 1980 s, is repeated every five years in the same enumeration areas. The last three data sets (1990, 1996 and 2004) were downloaded and analyzed using STATA 9.0. The analysis included all children of between 12-23 months who would have completed all vaccinations required at 12 months. Results. Across the time periods 1990, 1996 to 2004/05 the percentage of children completing vaccination was similar (71.0% in 1990, 72.7% in 1996 and 72.3% in 2005). There was no disparity in completion of immunization with wealth strata in 1990 and 1996 (p > 0.05) but not 2004. In 2004/05 there was marked disparity as most poor experienced significant decline in immunization completion while the least poor had significant increase (p < 0.001). All three periods children from households whose head had low education were less likely to complete immunization (p < 0.01). Conclusion. Equity that existed in 1990 and more pronounced in 1996 regressed to inequity in 2005, thus though at national level immunization coverage did not change, but at sub-group there was significant disparity associated with the changing contexts and reforms. To address sub-group disparities in immunization it is recommended to adopt strategies focused at governance and health system to reach all population groups and most poor. © 2010 Semali; licensee BioMed Central Ltd.
Kaaya S.F.,Muhimbili University of Health and Allied Sciences
AIDS care | Year: 2013
The objective of the study was to assess the effectiveness of group counseling, using a problem-solving therapy approach, on reducing depressive symptoms and increasing prenatal disclosure rates of HIV status among HIV-positive pregnant women living in Dar es Salaam, Tanzania. A randomized controlled trial was performed comparing a six-week structured nurse-midwife facilitated psychosocial support group with the standard of care. Sixty percent of women in the intervention group were depressed post-intervention, versus 73% in the control group [Relative Risk (RR) = 0.82, 95% confidence interval (CI): 0.67-1.01, p=0.066]. HIV disclosure rates did not differ across the two study arms. However, among those women who disclosed, there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88%) compared to the control group (62%; p=0.004). The results indicate reductions in the level of depressive symptoms comparable with major depressive disorder (MDD) for HIV-positive pregnant women participating in a group counseling intervention. Although the psychosocial group counseling did not significantly increase disclosure rates, an improvement in the level of personal satisfaction resulting from disclosure was associated with the intervention. This suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure. Public agencies and non-governmental organizations working in Tanzania and similar settings should consider offering structured psychosocial support groups to HIV-positive pregnant women to prevent poor mental health outcomes, promote early childhood development, and potentially impact HIV-related disease outcomes in the long term.