October 2011

  • Ruwaida Salem

    CCP | Associate Managing Editor, Global Health: Science and Practice


    Recently published research suggests that use of hormonal contraceptives, particularly injectables, may double the risk of HIV (see K4Health blog, October 7, 2011). On October 20, 2011, a global teleconference took place to give advocates, researchers, and policy makers an opportunity to discuss this research and its implications.

    Sponsored by AVAC (Global Advocacy for HIV Prevention), the teleconference included study investigators Dr. Jared Baeten and Renee Heffron of the University of Washington in Seattle, Washington, USA, and Dr. Helen Rees of the University of Witwatersrand in Johannesburg, South Africa. Also on the teleconference were Dr. Mary Lyn Gaffield, Scientist at the World Health Organization (WHO), and Dr. Charles Morrison, Senior Epidemiologist at FHI 360.
    Baeten emphasized that “this kind of international discussion is important…to put the findings into perspective.” After a brief recap of the findings, originally published in The Lancet Infectious Diseases, the speakers answered several critical questions that have been raising concern in the international public health community.
    Do the study findings pertain to hormonal contraceptives in general, or to injectables or oral contraceptives specifically?
    Although the primary analysis of the study was among women using any hormonal contraceptive method compared with women not using a hormonal method, Baeten explained that the data came largely from injectable users. “Most interpretations of the study have focused on HIV risk associated with injectable use. I think that’s the best interpretation,” stated Baeten. Because there were few study participants who used oral contraceptive pills, the study could not make a reliable estimate of HIV risk among pill users. Baeten speculates that the study findings are probably most relevant to the DMPA injectable because it was the most common injectable used in the countries where the study was conducted.
    How do the recent findings compare with findings from previous research on DMPA use and HIV risk?
    Putting the new study findings into historical perspective, Charles Morrison explained that 5 of 14 prospective studies have found a statistically significant risk of HIV with use of DMPA injectables. However, more of the studies showed no increased risk with DMPA use. Furthermore, the studies that did find an increased risk of HIV tended to be among populations at high risk of HIV, such as sex workers—but this was not always the case. In summary, Morrison maintained that the evidence to date has been mixed, which, he argues, points to the need to design a more definitive randomized controlled study.
    What about pregnancy itself being a risk factor for HIV?
    Helen Rees summarized findings from a parallel study that found that pregnant women who were infected with HIV were two times more likely to transmit the infection to their uninfected male partners than non-pregnant women with HIV. While Morrison pointed out that the body of evidence on pregnancy and HIV risk also show mixed results, Rees expressed:
    What this means programmatically is that, if we accept the data, you’ve got a bit of a problem because on the one hand it would appear from this data that DMPA increases the risk of HIV acquisition. On the other hand, if women stop using these methods and get pregnant then their risk of HIV acquisition is also increased…you’ve got quite a dilemma for HIV if you accept these data.

  • Elsie Minja-Mwaniki

    CCP | Communications Specialist

    Jhpiego has been supporting the initiation and scale-up of Voluntary Medical Male Circumcision (VMMC) in the Iringa and Tabora regions of Tanzania. At the October 20th mHealth Working Group meeting, Jhpiego’s James BonTempo, Team Leader for Information and Communication Technology (ICT) for Development, spoke about a program in Iringa and Tabora which used text message data to derive information on behavior change for VMMC.

    With an estimated population of 45 million people, Tanzania has a national adult HIV prevalence of 5.7%--the 12th highest rate worldwide. Among Tanzania’s 26 administrative regions, Iringa has the highest adult HIV prevalence (15.7%). The program, launched in November 2010, used a series of ads and posters asking people to text the word TOHARA (circumcision) if they required general information about VMMC, WAPI (where) for VMMC locations, and BAADA (after) for follow-up appointments.

    Data exhaust mining was used to determine whether there was a statistically significant association between the three text messages. The data showed that a person who texted “WAPI” (“where”) was significantly more likely to receive VVMS. Preliminary findings show this intervention can be linked to the Transtheoretical Model of Behavior Change with TOHARA being the “contemplation stage” in which participants were getting more information on the procedure, WAPI being the “preparation stage” in which participants were considering the procedure, and BAADA being the “maintenance stage” after the participants had already received the procedure.

  • Rebecca Shore

    CCP | Program Officer II

    Last week, CORE Group hosted its Fall Meeting at K4Health partner FHI360’s Washington, DC offices with the theme, Windows of Hope for Health and Well-Being. CORE is a group of health professionals from non-governmental development organizations that value sharing knowledge and ideas about how to best help children survive worldwide. CORE’s mission is to generate collaborative action and learning to improve and expand community-focused public health practices for underserved populations around the world.

    In a meeting filled with powerful messages, one of the most compelling came from keynote speaker Dr. Isatou Jallow of the World Food Program as she shared, “When I discuss gender, I mean women and men . . . because there is not a society in the world that women exist in isolation.”

    Dr. Jallow spoke about the Baby-Friendly Community Initiative (BFCI), which took place in Gambia. BFCI used breastfeeding as a catalyst for change to improve maternal and child nutrition, build local community capacity, and break down traditional gender barriers. BFCI built on the successes of the rural community and added positive behaviors, by talking with elders, pregnant women and their partners, and other community members to find the barriers to and stigmas against exclusive breastfeeding and proper nutrition for mother and child.

    By gathering community feedback, the Initiative created mother-to-mother support groups, the “10 Steps to Successful Infant Feeding” program, and a baby-friendly rest house that allows mothers who return to working in the fields to keep their babies with them and continue to breastfeed exclusively. BFCI also offered  informational sessions for pregnant and lactating women and their spouses on the importance of adequate maternal diet using locally available foods.

  • Laura Raney

    Jhpiego | ‎Strategic Communications & Knowledge Management Advisor



    Haven’t there been times when you so wanted someone—preferably your boss—to tell you that failure is a mark of leadership and innovation? Wayan Vota, Senior Director of Inveneo, said just that at the Fail Faire DC 2011, regaling the audience of 100+ development practitioners with quips about Steve Jobs failing often and spectacularly. Co-sponsored by the World Bank, Inveneo, Development Gateway, and Jhpiego, the hugely popular Fail Faire featured ten shameless presenters, all vying to out-do the others for the biggest failure prize—an OLPC laptop. We can all learn from their lessons and words of wisdom:

    1. You need a good business model. Holy water cannot wash away business model sins is the lesson imparted by Brian Forde.

    2. Your biggest “success” could be your largest commercial failure. Llamadas Pedaleadas (“pedaled phone calls”)—a program to bring pedal-powered cell phone access to remote areas of Nicaragua—was a huge media success, but a practical failure. Why? Because it didn’t address all of the needs of the consumers. Rural villagers flocked to the oddity which led to plenty of curiosity but no privacy for the caller, because the person pedaling the battery-bicycle could overhear the customer’s conversation.

    3. Listen to the end user. If there is no customer demand, you can’t get to the next steps. Also, look for simple solutions. See #2 above about phone booths (not exactly a new technology!) proving to be a better answer to customer needs.

    4. Don’t assume anything—such as: That classrooms have desks. That folks know how to use computers. That women have access to cell phones. That killer bees will not take up residence in your junction box. That a lizard will not fry your computer. (Thanks to Inveneo and MoTeCH, or Mobile Technology for Community Health, for these examples and great photos.)

    5. If it works, don’t change it—and don’t stop. Grameen Foundation’s MTN village phone was a success in Bangladesh, Uganda, and Rwanda, but rather than replicate it globally they abandoned the model.

  • Rebecca Shore

    CCP | Program Officer II

    Sarah V. Harlan

    CCP | Learning Director

    On October 11, 2011 the Knowledge Management Working Group (KM WG) met at the Johns Hopkins Center for Communication Programs (CCP). The meeting, which was facilitated by the CCP Knowledge for Health team, marked the one-year anniversary of the first KM WG meeting. In the year since the KM WG began, over 120 members from over 55 different organizations (representing 17 countries) have participated. Our accomplishments have included:

    • Launch of a collaborative KM toolkit on K4Health's platform
    • Creation of a document outlining the business case for KM
    • Writing of an elevator speech for KM advocacy
    • Development of a Knowledge Management and Exchange Logic Model
    The KM WG meeting included two notable KM experts: Dr. Jay Liebowitz, Orkand Endowed Chair in Management and Technology at the University of Maryland University College, and Dr. Stacey Young, Senior Knowledge Management Advisor for USAID's Policy, Planning and Learning Bureau. Both speakers shared their visions of KM, initiated lively discussions, and contributed ideas to the meeting’s theme of “Advancing Measurement and Learning.”