HSPH delegation visits Tanzania and Botswana nutrition, AIDS program

HSPH Dean Julio Frenk (bottom row far left), and Tanzania President Jakaya Kikwete (front row, second from right), with former U.S. Ambassador John Danilovich and his wife Irene (also in the front row). Also pictured are members of the Tanzania government and HSPH faculty members Walter Willett, David Hunter, and Wafaie Fawzi.

March 9, 2011 — A delegation of Harvard School of Public Health friends and faculty – including HSPH Dean Julio Frenk and Dean for Academic Affairs David Hunter – visited HSPH programs in Tanzania and Botswana recently, meeting with government officials in both countries and learning more about the School’s longstanding efforts around AIDS and nutrition in East and Southern Africa.

During the visit, Deans Frenk and Hunter and a small number of HSPH faculty met privately with Tanzania’s President Jakaya Kikwete. The entire delegation also participated in a special ceremony at the Amtulabhai Clinic and Mnazi Mmoja Center in Dar es Salaam, to celebrate a building project that will house a new clinic and training center to be developed jointly by several Tanzanian institutions with assistance from the U.S. government and HSPH.

Thirty-year effort

Deans Frenk and Hunter, HSPH Professors Wafaie Fawzi and Walter Willett, and others in the HSPH contingent met with the Tanzania President Kikwete at the State House in Dar es Salaam to bring him up to date on the activities and scale of the joint activities between the Harvard School of Public Health and a range of Tanzanian academic institutions.

Harvard faculty and investigators have worked in Tanzania for more than 30 years, HSPH has conducted large clinical trials on infectious diseases, maternal and child health, and nutrition, with efforts most recently centered intensively around nutrition and HIV research.

Fawzi – who heads HSPH’s efforts in Tanzania and is a professor of nutrition and epidemiology at the School – has been conducting research and educational programs in the country since he was a postdoctoral fellow at HSPH in 1993. “Our goals over the past 10 years have been to improve public health in Tanzania and to train the next generation of Tanzanian scientists and public health leaders,” says Fawzi.

Fawzi estimates that through programs in Tanzania at HSPH, the School has trained several thousand physicians, scientists, nurses, lab technicians and other health professionals. The programs run by HSPH and its collaborating partners in Tanzania currently employ nearly 1,500 people.

12 million screened for HIV

President Kikwete has been an outspoken proponent of HIV testing and treatment in Tanzania. The president and his wife both publicly took HIV tests to launch a massive HIV screening campaign.

Prior to the screening campaign, it was estimated that only about 500,000 people in Tanzania had been HIV-tested. Today over 12 million have been screened, program leaders estimate. And, as Professor Fawzi told President Kikwete, the Harvard Tanzania PEPFAR program also has assisted Tanzanian staff in enrolling and treating more than 100,000 HIV positive people in Dar es Salaam after antiretroviral therapy became available seven years ago through the Harvard Tanzania PEPFAR (President’s Emergency Plan for AIDS Relief) program, which is funded by the U.S. government.

Dean Frenk and President Kikwete discussed the intersection of prevention and treatment activities for control of the HIV epidemic, and President Kikwete commended Harvard for its commitment to helping build research and teaching infrastructure in Tanzania.

New center to train health leaders with HSPH assistance

While in Dar Es Salaam, Dean Frenk and the HSPH delegation also attended a celebration recognizing the ongoing construction of a new Mnazi Mmoja Center for Excellence in HIV Care and Education situated in the city center. The Center will provide a wide range of outpatient health services to the 634,924 citizens of the Ilala municipality. Scheduled to open in mid-2011, the new four-story center will offer advanced HIV management, receiving and actively managing complicated HIV cases from Dar es Salaam and other regions in Tanzania. Currently, 3,168 patients are enrolled at the Mnazi Mmoja/Amtulabhai Clinic CTC of which 2,008 have been initiated on antiretroviral therapy (ART).

The center will provide services including a general outpatient clinic with family planning services, reproductive and child health services, HIV care and treatment services, and tuberculosis/HIV services. It will also serve as a site for HIV management training to develop nationally recognized leaders in the field. The education and operations research components of the program will be a major focus of HSPH’s work with the Center.

Funding for Mnazi Mmoja CTC comes from the U.S, via the Harvard Tanzania PEPFAR and the U.S. Department of Health and Human Services (HHS) and an agreement with MDH. MDH is a newly registered independent organization in Tanzania, established with support from HSPH, with the aim of sustaining and expanding the existing public health service programs.

”The new Center will help to greatly increase the number of research and clinical staff from across the country and the region who are trained in more advanced HIV techniques,” said Dean Hunter.

HSPH efforts extend to maternal/child health, other infectious diseases

HSPH programs in Tanzania also examine the inter-relationship of nutrition and adverse pregnancy outcomes and examine the effectiveness of providing specific nutritional interventions to pregnant women and children to improve their health. Faculty efforts additionally examine the effectiveness of various approaches to health system strengthening in reducing the significant burden of HIV/AIDS, and improving maternal and neonatal health. Faculty collaborate with various academic centers, particularly Muhimbili University of Health and Allied Sciences and the Ifakara Health Institute, and with the Ministry of Health and Social Welfare.

Equally important, the HSPH programs over the past decade have been focused on training Tanzanian physicians, scientists and researchers. The School’s research and teaching mission on the ground is being enhanced in close partnership with the Africa Academy of Public Health, an affiliate of Harvard University registered in Tanzania.

Learn more about HSPH’s efforts in Tanzania.

Longstanding Botswana-Harvard Partnership studying HIV/AIDS in its 15th year

In Botswana, the delegation attended a session of Parliament and visited the Botswana-Harvard AIDS Institute Partnership (BHP) research center. Established in 1996, the partnership is a collaborative research and training initiative between the Government of Botswana and the Harvard School of Public Health AIDS Initiative.

The BHP has a fully outfitted research laboratory and training center located on the grounds of the Princess Marina Hospital in Gabarone. The Botswana–Harvard HIV Reference Laboratory houses clinical, epidemiologic and laboratory research for such projects as the prevention of mother-to-child transmission of HIV and the genomic analysis of HIV-1C, the viral sub-type predominant in Southern Africa. Research is also conducted on resistance and adherence to antiretroviral drugs, herpes and HIV, and HIV prevention. The Reference Laboratory serves as a training facility, building and expanding the professional infrastructure in Botswana through training the nation’s future researchers and laboratory technicians.

As well as conducting clinical, epidemiologic and laboratory-based research, the BHP is home to the KITSO AIDS Training Program that provides health care professionals in Botswana the opportunity to enrich their HIV and AIDS clinical knowledge and practice. The Partnership is also actively involved in collaborations working toward the development of an HIV vaccine.

The delegation visited Mochudi village, meeting the village elders and learning more about the BHP’s Mochudi Project, in which HSPH and Botswana researchers examine the effectiveness of using multidrug antiretroviral therapies to prevent mother-to-baby transmission of HIV. Recent research from this study has identified a particular drug regimen that can prevent 99 percent of mother-to-child HIV transmission when used by the mothers consistently and appropriately.

“Harvard scientists and our collaborators in Botswana and Tanzania have shown the world how to drive down perinatal HIV transmission rates to almost zero – an achievement that seemed unimaginable as recently as 10 years ago,” said Dean Hunter.

Learn more about HSPH’s efforts in Botswana.

View additional photos from the trip.

–Julie Rafferty