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Methadone treatment for HIV prevention-feasibility, retention, and predictors of attrition in Dar es Salaam, Tanzania: a retrospective cohort study

A retrospective cohort study led by Dr. Barrot Lambdin of Pangaea has been published in Clinical Infectious Diseases. Read below for the abstract and click the link below to access the full text.


Background : People who inject drugs (PWID) in Dar es Salaam, Tanzania, have an estimated human immunodeficiency virus (HIV) prevalence of 42%-50% compared with 6.9% among the general population. Extensive evidence supports methadone maintenance to lower morbidity, mortality, and transmission of HIV and other infectious diseases among PWID. In 2011, the Tanzanian government launched the first publicly funded methadone clinic on the mainland of sub-Saharan Africa at Muhimbili National Hospital.


Identifying programmatic gaps: Inequities in harm reduction service utilization among male and female drug users in Dar es Salaam, Tanzania.

A study led by Dr. Barrot Lambdin of Pangaea has been published in PLoS One. Read below for the abstract and click the link below to access the full text.

Introduction : Current estimates suggest an HIV prevalence of 42% among people who inject drugs (PWIDs) in Dar es Salaam, while HIV prevalence is estimated to be 8.8% among the general population in the city. To address the HIV epidemic in this population, the government of Tanzania began establishing HIV prevention, treatment and care services including outreach and medication assisted treatment (MAT) for PWIDs in 2010. We assessed gender inequities in utilization of outreach and MAT services and evaluated differences in HIV risk behaviors between female and male PWIDs.


Consultative Meeting on Optimal Models of Care for People who Inject Drugs

HIV and drug abuse are serious inter-related health problems around the world. Recent estimates indicate that there are 16 million people who inject drugs (PWID) throughout 148 counties, among which three million (range 0·8—6·6 million) are living with HIV. In most countries, the prevalence of HIV among PWID is higher compared to the general population due injection-related and sexual risk behaviors associated with drug use. Despite increased HIV risk among PWID, harm reduction and HIV prevention programs among this group are limited, especially in resource-constrained countries.

Supported by the Bill and Melinda Gates Foundation, the consultative meeting on “Optimal Models of Care for People who Inject Drugs” was organized to identify best practices and models of care that provide comprehensive, evidence-based interventions, promote successful linkage to HIV testing, care and treatment, and integrate collaborative TB and HIV services for people who inject drugs. Recommendations from this meeting are intended to inform the World Health Organization’s (WHO) 2014 consolidated treatment guidelines for key populations (KP).

Helping Tanzania Fight Injection Drug Use and HIV

Our Work in Tanzania

In the mid-1980s and the early 1990s, East Africa became an important stop along international drug trafficking routes, thereby introducing heroin in the region. In 2009, 40-45 tons of opiates were trafficked into Africa, most entering through the eastern countries by air and sea, and 34 of those tons were consumed in the region, highlighting it only as a transiting hub, but also a place for consumption. Currently, an estimated 533,000 opiate users live in eastern Africa.

Statement on Paul Semugoma

Pangaea is relieved to learn that Dr Paul Semugoma has been released by the South African Ministry of Home Affairs at Oliver Tambo International Airport Johannesburg, and has removed the threat to deport him to his native Uganda where he is at risk of persecution under the country's anti-LGBT legislation. We are enormously grateful to the South African AIDS Council Civil Society Sector, Treatment Access Campaign, Health4Men and other South African, Pan African and international groups for leading the campaign for his release.

Newsletter - Scaling Up HIV Treatment in Africa: What Works And Why

Pangaea is launching a new program to identify and document effective HIV treatment programs across East- ern and Southern Africa emphasizing programs that link the best in medical services with community-based organizations.

Treatment Optimization: An Outline for Future Success

In the November issue of Current Opinion, Charles Flexner (John Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA), Ben Plumley (Pangaea Global AIDS Foundation, Oakland, CA. USA) and David Ripin (Clinton Health Access Initiative, Boston, MA, USA) provide a comprehensive overview of current activities aimed at optimizing global HIV treatment. HIV treatment optimization is a process intended to enhance the long-term efficacy, adherence, tolerability, safety, convenience, and affordability of combination ART. The ultimate goal of this process is to expand access to well tolerated and effective lifetime treatment to all those in need.

Two recent conferences, the first and second Conference on Antiretroviral Drug Optimization (CADO), brought together experts from academia, governments, foundations, the pharmaceutical industry, and community activists to develop a global HIV-treatment research agenda for the coming decade focused on better therapies and how to make them accessible to a broader population of people living with HIV. Important recommendations included a focus on more efficient process chemistry for antiretroviral drugs, investigation of antiretroviral dose reduction as a possible optimization strategy, recognition of the increasing importance of concurrent infections and comorbidities especially tuberculosis and aging-related diseases, and identifying a highly effective and affordable nontoxic, once-daily fixed-dose combination regimen for first-line treatment. 

To access the full article for free, please click here.

The HIV Treatment Optimization website is also providing a comprehensive overview of past and current activities for global HIV Treatment.

Related documents: 2013 WHO Consolidated Guidelines, CADO 1 ReportCADO 2 Report.

The Second Conference on Antiretroviral Drug Optimization (CADO 2) - Meeting Report April 2013

Budgets for global HIV treatment and prevention in resource-limited settings will continue to be pressured, and, because the need for treatment scale-up is urgent, the emphasis on value for money has become an increasing priority.

The first CADO in 2010 focused on developing a research agenda to optimize the doses and combinations of existing approved drugs, including through role of process chemistry, and recommended a research development agenda for HIV drug optimization. The conference identified a portfolio of projects with the potential to significantly optimize treatment while achieving major cost reductions. Projects included improvements in process and formulation chemistry and dose reductions as intermediate technologies with an imperative to focus future resources on developing better regimens and formulations.

The goals and objectives of CADO2 were to identify and facilitate the development of novel, affordable, optimized drug regimens in resource-limited settings, within a public-health approach. CADO2 participants looked further into the future, to review drugs in the development pipeline, and to highlight gaps in drug development programs.  Underpinning the meeting was the commitment to a single global standard for the equitable treatment of everyone, in both resource-rich and resource-poor settings. Potent, durable and affordable drug regimens are needed to sustain the contribution of universal access to HIV treatment to reversing the global AIDS epidemic. 

The full report is available for download at or by clicking here 


Pangaea Research Published in JAIDS

Integration of HIV Care and Treatment in Primary Health Care Centers and Patient Retention in Central Mozambique: A Retrospective Cohort Study


A retrospective cohort study by Dr. Barrot Lambdin of Pangaea has been published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS). Use the link below to access the study, and read below for the abstract:




Background: In 2004, the Mozambican Ministry of Health began a national scale-up of antiretroviral therapy (ART) using a vertical model of HIV clinics colocated within large urban hospitals. In 2006, the ministry expanded access by integrating ART into primary health care clinics.


Methods: We conducted a retrospective cohort study including adult ART-naive patients initiating ART between January 2006 and June 2008 in public sector clinics in Manica and Sofala provinces. Cox proportional hazards models with robust variances were used to estimate the association between clinic model (vertical/integrated), clinic location (urban/rural), and clinic experience (first 6 months/post first 6 months) and attrition occurring in early patient follow-up (≤6 months) and attrition occurring in late patient follow-up (>6 months), while controlling for age, sex, education, pre-ART CD4 count, World Health Organization stage and pharmacy staff burden.


Results: A total of 11,775 patients from 17 clinics were studied. The overall attrition rate was 37 per 100 person-years. Patients attending integrated clinics had a higher risk of attrition in late follow-up [hazard ratio (HR) = 1.75; 95% confidence interval (CI): 1.04 to 2.94], and patients attending urban clinics (HR = 0.57; 95% CI: 0.35 to 0.91) had a lower risk of attrition in late follow-up. Though not statistically significant, clinics open for longer than 6 months (HR = 0.71; 95% CI: 0.49 to 1.04) had a lower risk of attrition in early follow-up.


Conclusions: Patients attending vertical clinics had a lower risk of attrition. Utilizing primary health clinics to implement ART is necessary to reach higher levels of coverage; however, further implementation strategies should be developed to improve patient retention in these settings.


LINK: click here

PEPFAR Blueprint: Creating an AIDS-free Generation

On Thursday November 29, Secretary of State Hillary Rodham Clinton commemorated World AIDS Day 2012 and unveiled the PEPFAR Blueprint: Creating an AIDS-free Generation that provides a roadmap for how the U.S. government will work to help achieve an AIDS-free generation. Secretary Clinton will be joined by Ambassador Eric P. Goosby, U.S. Global AIDS Coordinator.

Secretary Clinton was joined by:
Ambassador Eric P. Goosby, U.S. Global AIDS Coordinator
Michel Sidibe, UNAIDS Executive Director
Dr. Nkosazana Dlamini-Zuma, Chairperson of the African Union Commission
Florence Ngobeni-Allen, Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation

The PEPFAR Blueprint is available here:

If, when and how to tell: a qualitative study of HIV disclosure among young women in Zimbabwe

This month, Pangaea published a paper in a preeminent journal of women’s health, Reproductive Health Matters.  This paper summarizes data from Pangaea’s SHAZ! Project, a study working to increase access to HIV services and improve health outcomes for adolescent women living with HIV in Zimbabwe.  Findings highlight the complex and critical nature of disclosure of HIV status among this age group to achieve good HIV and reproductive health outcomes.  Programs and services must do more to help young women living with HIV negotiate the complexities of disclosure in the context of achieving desired fertility.   

Abstract: In the Shona culture of Zimbabwe, a high regard for childbearing contributes to strong pressures on women to have children. For young women living with HIV, consequently, disclosure of HIV status
can be a central strategy to garner support for controlling fertility. This paper reports findings from
qualitative interviews with 28 young women aged 16–20 living with HIV in urban Zimbabwe and discusses
how these findings can contribute to better policies and programs for this population. Regardless of their
current relationship status, interview participants described disclosure as a turning point in romantic
partnerships, recounting stressful experiences with major ramifications such as abuse and abandonment
on the one hand, and support and love on the other. All but one participant had been in a committed
relationship, and most had disclosed to a previous or current partner, with about half of disclosure
experiences resulting in adverse reactions. Findings suggest that sexual and reproductive health services
must do more to help young women living with HIV negotiate the complexities of disclosure in the context
of achieving desired fertility. © 2012 Reproductive Health Matters

Full article available at:

The Leadership of Affected Communities in Delivering HIV Prevention, Testing and Treatment

Pangaea is launching a new report, “The Leadership of Affected Communities in Delivering HIV Prevention, Testing and Treatment”, with recommendations from two consultations held in Zimbabwe and Thailand organized with the World Health Organization (WHO), UNAIDS, the Zimbabwe Ministry of Health and Child Welfare, and the Asian Network of People Living with HIV (APN+). These recommendations have been presented to WHO for consideration as it develops new consolidated HIV treatment guidelines for release in 2013. The report distills lessons learned from HIV treatment community organizations from over 30 countries.

Is Your City a Shadow City?

What is a Shadow City?

"A city, municipality or other jurisdictional area that is overshadowed, and thus overpowered by a larger city that is global in nature and possesses more resources such as expertise, enterprise, money, and national government investment."

— Marsha Martin (2011), Get Screened Oakland, an initiative of the Office of the Mayor of Oakland


Local Residents Trained As ‘Influence Agents’ Most Effective In Persuading African Couples On HIV Counseling And Testing

Dr. Barrot Lambdin, Pangaea's Director of Implementation Science, was lead author of  "Local Residents Trained As 'Influence Agents' Most Effective In Persuading African Couples On HIV Counseling And Testing," published in Health Affairs in August of 2011.


Patient Volume, Human Resource Levels, and Attrition From HIV Treatment Programs in Central Mozambique

Dr. Barrot Lambdin, Pangaea's Director of Implementation Science, was lead author of  Patient Volume, Human Resource Levels, and Attrition From HIV Treatment Programs in Central Mozambique published in JAIDS in July 2011.

Lambdin, Barrot H PhD, MPH; Micek, Mark A MD, MPH; Koepsell, Thomas D MD, MPH; Hughes, James P PhD, MS; Sherr, Kenneth PhD, MPH; Pfeiffer, James PhD, MPH; Karagianis, Marina MBChB; Lara, Joseph MPH; Gloyd, Stephen S MD, MPH; Stergachis, Andy PhD, MS

JAIDS Journal of Acquired Immune Deficiency Syndromes:

1 July 2011 - Volume 57 - Issue 3 - pp e33-e39

doi: 10.1097/QAI.0b013e3182167e90

Implementation and Operational Research: Epidemiology and Prevention

Full text of article available here.


SHAZ! Facilitator Manuals - Empowering Young Women to Avoid Sexual Risk Behaviors

Pangaea researchers have led the development of SHAZ! (Shaping the Health of Adolescents in Zimbabwe) – an HIV prevention intervention and research study in Zimbabwe that empowers adolescent female orphans to avoid sexual risk behaviors by improving economic opportunities and linking them to life skills-based HIV education and clinical care. As a resource for others in the field, Pangaea is pleased to be able to make available the SHAZ! Facilitator's Guide.


Report from the Expert Consultation on Implementation Science Research

Pangaea convened an expert consultation in July 2009 in Cape Town, South Africa on behalf of the Office of AIDS Research (OAR) at the National Institutes of Health (NIH), aimed at addressing the growing imperative for analyses to inform and improve uptake of proven interventions and to scale up HIV/AIDS programs.


HIV Prevention Among Injection Drug Users: Strengthening U.S. Support for Core Interventions

HIV Prevention Among Injection Drug Users: Strengthening U.S. Support for Core Interventions, CSIS Global Health Policy Center, April 2010 

This report examines data on the burden of HIV among IDUs and access to and receipt of MAT, needle and syringe programs (NSP), and ART services in 14 countries.