$93.0m annual program spend • PATH is a global leader in identifying, developing, and introducing affordable, effective, and easy-to-use essential medicines, such as vaccines and drugs. We work with governments, nongovernmental organizations, private companies, educational institutions, and other groups to shepherd these innovations from bright idea to large-scale use.(continued. Our portfolio includes more than two dozen vaccine products in development or already in use, with an emphasis on the leading infectious causes of child deaths and disease worldwide.for example, in 2017, we continued to partner with countries to expand coverage of japanese encephalitis (je) vaccine, which PATH helped develop and shepherded through the global regulatory process. With support from PATH, the government of myanmar launched a new series of je immunization campaigns, followed by routine immunization. In indonesia, PATH provided technical assistance in the lead-up to je vaccination campaigns in the province of bali. We also continued to evaluate the long-term immune responses to menafrivac, a low-cost vaccine developed by PATH, the world health organization, and vaccine manufacturer serum institute of india pvt. Ltd. This vaccine protects children and young adults from debilitating and often deadly serogroup a meningococcal meningitis. In 2017, we initiated with our partners a phase 2 study of a vaccine to protect against other serogroups of meningococcal meningitis.to prevent malaria, PATH is accelerating the development of a wide variety of malaria vaccine candidates and approaches. In 2017, PATH continued to work with the world health organization and other partners to prepare for pilot implementation of the rts,s vaccine in selected areas of ghana, kenya, and malawi. With partners, PATH continued to advance research into whether, by reducing dose level and delaying the administration of vaccine doses, rts,s has the potential to aid malaria elimination efforts. Field testing of the delayed fractional dose regimen began at a research center in ghana in the fall of 2017.PATH's defeat diarrheal disease initiative, housed within cvia, continued its ongoing work to generate investments in rotavirus, enterotoxigenic escherichia coli, and shigella vaccines. In 2017, we developed and disseminated a comprehensive report on diarrheal disease burden and the tools available to reduce mortality and morbidity. We continued educating our target audiences on the lifelong consequences of repeated infections.in 2017, PATH continued to support south african vaccine manufacturer the biovac institute in preclinical development of a vaccine against group b streptococcus, a leading cause of sepsis and meningitis in young infants worldwide. The intended vaccine population is pregnant women-part of a strategy that boosts immunity against the bacterium and transfers protective antibodies to the developing baby. Also in 2017, PATH began a new project to coordinate a consortium of nine research institutions to collate and synthesize existing evidence and evaluate new data on the potential for single-dose delivery of human papillomavirus (hpv) vaccine. Although many countries have introduced hpv vaccines into their national immunization schedules on a two- or three-dose schedule, rollout in low- and lower-middle-income countries has often lagged due to financial, logistical, or other barriers. For these countries, a single-dose regimen could accelerate introduction of hpv vaccine into national immunization schedules.drug developmentPATH and our partners develop and advance affordable drugs to prevent and treat diseases that disproportionately affect people in low-income countries, including enteric and diarrheal diseases, neglected tropical diseases, hiv/aids, and malaria. Drawing on an enduring commitment to health equity and a unique partnership approach that spans the academic, private, and nonprofit sectors, this work demonstrates that it is possible to reach the world's most vulnerable people with the medicines they need. This year, our work continued to overturn barriers to health at every stage of drug development and use-from early research to broad scale-up.in 2017, we continued our work to break the cycle of infections with soil-transmitted helminths. These intestinal parasitic worms thrive in areas with limited sanitation and hygiene, where they are transmitted through contact with soil and water contaminated by the practice of open defecation. Globally, they affect more than a billion people. Through a multipronged approach that includes drugs and diagnostics as well as improved sanitation, PATH is working to break the cycle of chronic infections and reduce the burden of illness worldwide, including our commitment to seek us food and drug administration (fda) approval for the drug tribendimidine as a significantly improved periodic presumptive treatment for hookworm infections. Fda approval is the initial step in a plan to incorporate tribendimidine into mass deworming campaigns in low-resource settings where soil-transmitted helminth infections cause significant morbidity. In collaboration with other groups and with funding from the united kingdom's department for international development, PATH also continued to expand and strengthen the portfolio of tools and treatment options for diarrheal and enteric diseases. Efforts include developing new therapeutics for cryptosporidium, one of the key PATHogens responsible for diarrheal morbidity in children under five years of age; advancing innovative treatment for environmental enteric dysfunction; and developing the investigational new drug iowh032 as an antisecretory therapy for the treatment of acute secretory diarrhea.
$78.0m annual program spend • PATH's public health portfolio focuses on three primary areas. First, we work to combat infectious diseases, with emphasis on malaria, hiv/aids, tuberculosis (tb), and neglected tropical diseases. We also work to support the health of key populations-including newborns, children, adolescents, and mothers-and to improve women's health and sexual and reproductive health. Finally, we target emerging issues through our work on digital health solutions, noncommunicable diseases, nutrition innovations, and health systems strengthening and epidemic preparedness.(continued. More than 200 PATH staff members work on malaria in more than 30 countries. Our strategy includes optimizing the delivery of current tools and approaches to ensure they reach the people who need them, developing new strategies for elimination, developing next-generation tools to overcome emerging challenges, and creating innovative partnerships and funding models to ensure that our programs are sustainable and efficacious. PATH-pioneered approaches have contributed to remarkable progress toward controlling and eliminating malaria, with nearly 7 million lives saved since 2000.in 2017, our malaria control and elimination partnership in africa (macepa) program continued to support the governments of ethiopia, senegal, and zambia in their malaria elimination goals by scaling up prevention and treatment, evaluating sensitive diagnostic tools, establishing rapid reporting systems, and continuing to support population-wide, drug-based strategies such as mass drug administration. PATH also continued efforts to improve data for malaria control decision-making and surveillance. In zambia, the visualize no malaria project-a groundbreaking partnership with a Seattle-based software company and a coalition of other technology companies-continued to expand. This project equips health workers and officials with the real-time data visualization tools they need to see and understand where malaria is appearing so they can appropriately deploy resources to halt its spread. Furthermore, to bolster surveillance in western kenya, PATH assessed the potential contribution of malaria testing data from pregnant women attending antenatal clinics.in 2017, PATH also continued to work with the world health organization and other partners to prepare for pilot implementation of the rts,s malaria vaccine in selected areas of ghana, kenya, and malawi. Vaccinations are due to begin in 2019. Among the new tools developed and evaluated by PATH in 2017 were next-generation indoor residual spraying (in partnership with the innovative vector control consortium, the us president's malaria initiative, abt associates, and the global fund) and attractive targeted sugar baits. PATH also supported the development of a new, highly sensitive rapid diagnostic test that offers a greater than tenfold improvement in detection of the most common malaria parasite. In addition, we advanced work on a point-of-care diagnostic test for glucose-6-phosphate dehydrogenase deficiency, a condition that can complicate malaria treatment. Hiv epidemic controlPATH continued to contribute to hiv epidemic control in 2017 by focusing programming on the key and high-priority populations of adolescent girls and young women, people coinfected with hiv and tb, sex workers and their clients, men who have sex with men, and people who inject drugs. We advanced programming across multiple technology and service delivery platforms-from devices, tools, and diagnostics to service delivery innovations and advocacy. To develop more affordable and improved hiv diagnostics, PATH explored new product designs for an oral fluid hiv self-test that could be affordably manufactured. PATH also advanced alternative, low-cost methods to deliver microbicides and antiretroviral medications for hiv prevention (pre-exposure prophylaxis, or prep) and treatment. This included work on use of microarray patches to deliver both antiretrovirals and contraceptives and use of a thin-film polymer subcutaneous implant for sustained release of antiretrovirals for infection prevention.through the aids, population, and health integrated assistance program plus (aphiaplus) project in western kenya, PATH helped to integrate services for hiv/aids, tb, sexual and reproductive health, noncommunicable diseases, and other illnesses to help more people access a greater spectrum of services. As of december 2017, the project had tested more than 6.7 million individuals for hiv and supported more than 110,900 people living with hiv/aids who were receiving treatment. With funding from the us president's emergency plan for aids relief dreams initiative, aphiaplus intensified efforts to reach more than 67,000 adolescent girls and young women with interventions to reduce their vulnerability to hiv and improve their access to services. This work included piloting prep among 1,465 young women, among whom 84 percent were retained on prep at the end of december 2017. In the democratic republic of the congo (drc), PATH focused hiv/aids programming in the high-prevalence provinces of haut katanga and lualaba under the integrated hiv/aids program funded by the us agency for international development (usaid). PATH provided technical assistance to 153 facilities across 16 health zones to increase targeted testing efforts, enroll all identified hiv-positive individuals on treatment, scale up viral load testing, and roll out differentiated care models to improve retention in treatment through viral suppression. PATH continued to pilot innovations to reach most-at-risk populations in vietnam. PATH equipped social and support groups operated by members of key populations to generate demand for services among their peers through targeted outreach via social media, linkages to hiv testing services through Mobile applications, and scale-up of hiv self-testing and prep. Tuberculosis PATH brings global health expertise and innovative approaches to the fight against tb. In india, we implemented the public-private interface agency (ppia) to improve private-sector health care providers' contributions to tb control in mumbai's slums. PATH and our indian partners recognized that many of the most vulnerable people in india seek care from informal, often untrained, private health care providers (such as traditional healers), who often cannot accurately diagnose or treat tb. The ppia project focused on developing and enhancing the national tb reporting mechanism "e-nikshay" to better incorporate private-sector patients into the national reporting system. PATH also continued to support a voucher mechanism to connect patients from local informal providers to qualified physicians, diagnostic services, and treatment support. Ppia has dramatically improved access to tb services. In south africa, PATH and our partners developed and implemented a behavior change communication intervention to train health care workers on tb infection prevention and control practices. PATH developed and piloted a training curriculum and developed, pretested, and produced job aids for nurses to reinforce their learning while on the job. In vietnam, PATH built on the breath for life program, in which we piloted a model to strengthen childhood tb case detection and early treatment. Activities focused on concluding project evaluations and documenting achievements and challenges. In tanzania, PATH trained and supported community volunteers, community-based organizations, and former tb patients to deliver community-based tb interventions. Community workers held events to increase awareness of tb, screened and referred people for tb testing, and conducted household visits to families of tb patients for education, screening, and testing referrals. Our contributions to the global response to multidrug-resistant tuberculosis (mdr-tb) included establishing a "test and refer" model in the private sector in mumbai, india, where we focused on connecting the private and public sectors. As private-sector patients received confirmation of mdr-tb diagnoses, PATH linked them to a public-sector mdr-tb treatment center and provided social support (for example, peer-group meetings and connections with community groups). In ukraine, PATH worked on transitioning the national mdr-tb treatment program to an ambulatory care model to allow patients to live at home and to work when they can rather than spend two years in a treatment facility. PATH also collaborated with usaid to implement a pilot study for use of bedaquiline in extremely drug-resistant tb patients. PATH worked with the national government to ensure the drug was allowed in country for the pilot and monitored patients' progress.
$51.4m annual program spend • In 2017, PATH's international development portfolio supported work in more than 70 countries, ranging from small-scale pilots to large, multicountry efforts. Examples of our 2017 international development work are highlighted below, focusing on the drc, vietnam, and zambia.(continued. Recently, our work in the drc has expanded to include global health security. In collaboration with the drc ministry of health and us centers for disease control and prevention, PATH outlined a plan to build an emergency operations center (eoc), where designated public health emergency management personnel can assemble to coordinate strategic management of public health events and emergencies. The aim of the eoc is to bolster the capacity of national systems to rapidly detect and prevent epidemics.PATH also coordinated a visit by drc health officials to an established eoc in senegal. This visit helped the officials better understand how the drc eoc should be operationalized and organized. Although the drc eoc was not yet operational during the 2017 ebola outbreak in the likati health zone, technical support from PATH and other partners was critical for ensuring a coordinated national response that rapidly contained the outbreak. The outbreak was contained because of the prompt alerts and rapid response from the government, PATH, and other partners. In 2017, PATH also completed activities for two large projects funded by usaid: provicplus and malariacare. Provicplus worked in five provinces, offering comprehensive hiv/aids clinical services in more than 100 health facilities as well as innovative, high-impact maternal and neonatal services in 15 pilot health facilities. Malariacare worked across 14 provinces and in kinshasa to scale up high-quality diagnostic and treatment services for malaria and other febrile illnesses.finally, PATH led two immunization advocacy projects in the drc with support from the bill & melinda gates foundation and gavi, the vaccine alliance. These projects promoted expanded coverage, equitable access, and sustainable financing for lifesaving immunization programs. We also advocated in the drc for better care related to human african trypanosomiasis (sleeping sickness), a neglected tropical disease.in vietnam, PATH continued to strengthen partnerships with the government, the private sector, and community-based organizations. In 2017, PATH expanded the communities for healthy hearts project, which aims to increase awareness of, access to, and quality of hypertension services for low-income households in ho chi minh city. In collaboration with the vietnam general department of preventive medicine and local partners, the project introduced an innovative community-based model for the screening, treatment, and control of high blood pressure. As part of this project, PATH developed and used an interactive blood pressure management software application (ehtn tracker). Through PATH's global health security partnership with the us centers for disease control and prevention, we provided technical assistance to the ministry of health in vietnam to improve infectious disease surveillance systems through better data use and management, real-time surveillance, reporting, and development of emergency operations centers (eocs). The first eoc opened in hanoi in 2016, and PATH supported the opening of additional eocs in 2017. The healthy markets project, funded by usaid, aims to grow viable commercial markets for hiv-related goods and services that can meet the needs of populations facing the greatest hiv risks. In 2017, the project helped to increase private-sector and local investment in the market for condoms and other hiv-related goods and services, demand for those goods and services among key populations, and the private-sector supply of goods and services. In zambia, PATH has been actively involved in strengthening health systems since 2005, when we joined the government of zambia's ministry of health and the roll back malaria partnership to launch a national plan for tackling malaria and implementing a comprehensive prevention program. In collaboration with the national malaria control center, clinics, and community health workers, PATH continues to lead a number of malaria projects in zambia. Through the malaria control and elimination partnership in africa (macepa), PATH is supporting the ministry of health to develop a comprehensive set of strategies to reduce cases and deaths from malaria in target areas by scaling up use of existing tools, such as bednets and indoor spraying of insecticides. PATH helped the zambian government set up a rapid reporting system in one-third of the country's health facilities to provide near real-time data on malaria cases and available supplies. With data entry and data submission by cell phone, health officials no longer need to wait months for the information they need to make decisions and allocate resources in the fight against malaria. To achieve the goal of zero malaria transmission, PATH continues to advance more sensitive diagnostic tools, test new treatment approaches, and combine new diagnostic and treatment methods to permanently stop malaria transmission. This has led to the creation of "malaria-free zones," bringing zambia closer to malaria elimination.in addition, PATH partnered with the government of zambia in the usaid-funded program for the advancement of malaria outcomes project. This project strengthens malaria prevention and case management activities at health facilities and at the community level; builds management capacity at the district and provincial level to provide oversight of malaria interventions; improves data reporting, analysis, and use for decision-making; and empowers communities to take ownership of the malaria problem. PATH also led the eradicate tb project in zambia. With a focus on six of zambia's ten provinces, the project partnered with the national tuberculosis control program and other organizations to improve diagnosis and treatment success rates.