Description
Statement of WorkUSAID/CDC IAA FY2016 Scope of Work Title describing the activity: La Vivienda Segura/The Healthy Household: An educational intervention model for primary and secondary prevention of mosquito transmitted infections and sexually transmitted infections that impact reproductive health, pregnancy, and perinatal life stages in women and men in Mexico Agreement Officer: USAID/GH/AA, Deputy Assistant AdministratorIAA agreement end date: December 31, 2018Center/Division and Project Officer at CDC the activity was negotiated with: NCEZID/DGMQ Margarita Elsa VillarinoBureau or Mission contact at USAID following the activity:Country: MexicoTotal Funding included in this SOW: $ 553,312Total new funds to be obligated: $ 553,312Extramural: $ 553,312 Fund Source: WashingtonTimeframe: 2 years from date of obligationI. Background and Rationale:Zika virus is a mosquito-borne flaviruses transmitted primarily by Aedes aegypti mosquitoes. The most common symptoms include fever, rash, joint pain, and conjunctivitis. The illness is usually mild and self-limited with symptoms lasting for several days to a week. No vaccine is available and treatment is supportive. Prior to 2015, Zika virus outbreaks have occurred in areas of Africa, Southeast Asia, and the Pacific Islands. In May 2015, WHO reported an outbreak of Zika in Brazil. In December, the Brazil Ministry of Health estimated that 440,000–1,300,000 suspected cases of Zika virus disease had occurred in Brazil in 2015. To date, locally-transmitted cases had been reported to the Pan American Health Organization from 24 countries and U.S. territories in the Americas.There is growing concern about the spread of Zika virus infection to North America. As such it is extremely important to make sure public health systems in Mexico are prepared to detect, monitor and respond to this threat. This proposal focus on assisting our partners in Mexico in the fields of epidemiology, monitoring, laboratory diagnosis, prevention, and enhanced surveillance.II. Program Objectives and Benchmarks:Specific objectives:1. Implement communication strategies, such as gender-sensitive educational workshops on prevention and control measures against the bite of the mosquito vector, and implement family planning strategies to women and men in reproductive age and pregnant women and their partners, in order to promote optimal health conditions.2. Provide enhanced public health surveillance of pregnant women, including the early detection of infectious diseases such as syphilis, HIV, DENV, CHIKV, and ZIKV, that have a potential of affecting the mother and child,3. Implement laboratory capacity to detect Zika infection in pregnant women. III. Full Time Equivalents (this information is necessary for the Congressional Notification):Total number of FTEs: 0IV. Activities:Total number of Activities: 4Gender: Gender considerations are key to Zika prevention, control and response activities. All prevention, control and response activities will be based on (and respond to) contextual gender analyses. Specifically, some important areas include recent statistics on the age of marriage (% early marriage), laws and informal codes surrounding access and barriers to contraception for both women and men, level of education and literacy and house-hold decision making power and ownership opportunities. Gender roles, the distribution of labor, access and control over resources play an important part in the biosecurity, control, prevention and response to infectious diseases and emerging pandemics. Gender inequalities interact with other inequalities such as ethnicity, socio-economics class and age. Gender differences, barriers and opportunities will be addressed and incorporated into all communication activities including awareness/education campaigns, associated materials and messaging. All messaging will also be gender sensitive and synchronized (same information given to all populations, but contextualized to ensure maximum understanding of key messages). Title Activity 1: Conduct a gender-sensitive awareness and education campaign in utilizing diverse educational material, including APPS for mobile phones, for teaching about the prevention of mosquito bites and/or sexual transmission of Zika virus in men and women of reproductive age and their familiesDescription:There is evidence for an association between Zika virus infection during pregnancy and brain abnormalities, including microcephaly, and other adverse pregnancy and infant outcomes.There is an urgent public health need to understand the impact of Zika virus infection during pregnancy and infant outcomes in different affected populations, with different ecological conditions. Of the three North American countries in our continent, Mexico is the only one expected to have significant transmission of Zika virus and also the only one that shares the most frequently crossed controlled international land boundary in the world with the U.S. As of November 2015, Zika virus disease is nationally notifiable disease in the Mexican Infectious Diseases Surveillance System of the Ministry of Health of Mexico.In recent years, about 50% of confirmed cases of DENV in Yucatan State, in the country of Mexico, have concentrated in the city of Merida, and almost 80% of cases have been reported in districts III, IV, V, VI and VII, which are areas of high priority for the State Ministry of Health and Services of Yucatan. The areas selected for the “Vivienda Segura/Safe Housing" community intervention are the “colonias” (neighborhoods) called "Juan Pablo II" and "Los Vergeles" in Merida Yucatan. Activities will also include a high risk community in Progreso, Yucatan. Dependencies: None.Ability to Leverage other work:The project has existing funds because they are a dengue vaccination clinical trial site that continues working on the long term follow up of recipients of the dengue vaccine for the occurrence of disease and estimation of the duration of vaccine protection.In addition, the project is expecting to receive the results of a request for funding from the Mexican funding agency “Consejo Nacional de Ciencia y Tecnología “CONACYT” (a funding agency with a role similar to the NIH in the US). Leverage work of local gender-sensitive organizations to ensure messaging/campaign takes into account gender considerations and differences in women’s and men’s roles, responsibilities and norms that impact both genders.There is complete political support from the State of Yucatan Public Health Authorities for this effort. Existing projects or offices in location:The office of the Director, CDC Mexico is located in Mexico City, Mexico, and has been in existence since March 2013. Proposed Mechanism of Support:CDC has an existing Cooperative Agreement (Award Number: CK000191) with FUMEC (Fundacion Estados Unidos Mexico para la Ciencia). FUMEC is a binational nonprofit organization created in the context of the North American Free Trade Agreement. FUMEC operates projects funded by governmental institutions of the U.S. and Mexico, as well as academic and philanthropic institutions from both countries. FUMEC will establish a subcontract with the Autonomous University of Yucatan for conducting the proposed work. Purpose: To educate the public on the topics of how to prevent vector-borne and sexually transmitted zika infections in men and women of reproductive age and their families in Merida Yucatan, MexicoOutputs with success indicators:Community acceptance and educational activities reaching equal or greater 70 percent of the targeted population Expected Results:•A comprehensive and educational management on protective measures against mosquito bites and mosquito vector control, through the program "Safe housing," along with the distribution of repellents and education for preventing mosquito borne disease.•Workshops for counseling on contraceptive (including condoms) and nutritional methodology for women and men of reproductive age, as well as pregnant women and their partners, to ensure their optimal state of health during conception and pregnancy.•An immediate educational intervention on vector control, family planning options, contraception and condom use, aimed to women and men of reproductive age in selected areas•This significant information in a large North American population will continue to inform on the appropriate public health education and communication response needed to prevent Zika and other vector borne infections, this information will be critical for enhancing prevention and planning for public health services. Collaborating partners:This project has intellectual partners and collaborations with the Tropical Medicine Institute of Antwerp, Belgium, and the Pedro Kuri Institute for Infectious Diseases of Habana Cuba.Activity budget: $126,952.00Gender: Are there gender considerations for this activity, if so, please describe. N/A. Title Activity 2: Procurement of supplies for detecting Zika and other vector-borne viruses.Description: There is evidence for an association between Zika virus infection during pregnancy and brain abnormalities, including microcephaly, and other adverse pregnancy and infant outcomes.There is an urgent public health need to understand the impact of Zika virus infection during pregnancy and infant outcomes in different affected populations, with different ecological conditions. An enhanced surveillance system will provide regional North American information on the association between Zika virus infection during pregnancy and a spectrum of adverse pregnancy, birth, and infant outcomes.Dependencies:NoneAbility to Leverage other work:The project has existing funds because they are a dengue vaccination clinical trial site that continues working on the long term follow up of recipients of the dengue vaccine for the occurrence of disease and estimation of the duration of vaccine protection.In addition, the project is expecting to receive the results of a request for funding from the Mexican funding agency “Consejo Nacional de Ciencia y Tecnología “CONACYT” (a funding agency with a role similar to the NIH in the US). There is complete political support from the State of Yucatan Public Health Authorities for this project. Existing projects or offices in location:The office of the Director, CDC Mexico has been in existence since March 2013. As needed, epidemiologic and laboratory consultations from the clinician researchers in Merida Yucatan will involve this office. In addition, short-term, a TDY CDC SME(s) will be invited to come to Merida and collaborate on the project. The project is expected to be managed fiscally by FUMEC (US-Mexico Fundation for the Sciences/ Fundacion Estados Unidos Mexico para las Ciencia), and intellectually, operationally, by the Mexican researcher(s) from the Autonomous University of Yucatan.Proposed Mechanism of Support:CDC has an existing Cooperative Agreement (Award Number: CK000191) with FUMEC (Fundacion Estados Unidos Mexico para la Ciencia). FUMEC is a binational nonprofit organization created in the context of the North American Free Trade Agreement. FUMEC operates projects funded by governmental institutions of the U.S. and Mexico, as well as academic and philanthropic institutions from both countries. FUMEC will establish a subcontract with the Autonomous University of Yucatan for conducting the proposed work. Purpose: To add evidence to the association between Zika virus infection during pregnancy and brain abnormalities, including microcephaly, and other adverse pregnancy and infant outcomes and to add information regarding possible mechanisms of action for this cause-effect relationship. In addition, to identify pregnant women at risk for poor outcomes associated with Zika infection. Expected Results:Enhanced surveillance of pregnant women with Zika virus infection in the country of Mexico, the only country in North America expected to have a significant public health crisis with clustered outbreaks and eventually endemic and epidemic transmission of this mosquito borne viral infection. This significant information in a large North American population will continue to inform on the appropriate Mexican public health response needed to meet the challenge of the association between Zika virus infection and fetal and early childhood outcomes. This information will be critical for enhancing Mexico’s prevention programs and planning for public health services. A post-birth surveillance of children of women who were infected with Zika virus during pregnancy for long term assessment of possible adverse outcomes including those not immediately apparent at birth. A database of biological specimens and laboratory results that is un-linked to the surveillance data on Zika virus infection in pregnant women and their offspring.Collaborating partners:This project has intellectual partners and collaborations with the Tropical Medicine Institute of Antwerp, Belgium, and the Pedro Kuri Institute for Infectious Diseases of Habana Cuba. Activity budget: $ 264,000 $341,000.00 Title Activity 3: Conduct trainings of the laboratory staff and the ultrasound/prenatal diagnosis specialists, and the neuro-epidemiologists and developmental specialistsDescription: Workforce capacity training and cross-training with CDC subject matter experts.Dependencies NoneAbility to Leverage other workThe project has existing funds because they are a dengue vaccination clinical trial site that continues working on the long term follow up of recipients of the dengue vaccine for the occurrence of disease and estimation of the duration of vaccine protection.In addition, the project is expecting to receive the results of a request for funding from the Mexican funding agency “Consejo Nacional de Ciencia y Tecnología “CONACYT” (a funding agency with a role similar to the NIH in the US). There is complete political support from the State of Yucatan Public Health Authorities for this Research Center/University population-based interventionExisting projects or offices in location:The office of the Director, CDC Mexico has been in existence in Mexico City Mexico since March 2013. Proposed Mechanism of Support:CDC has an existing Cooperative Agreement (Award Number: CK000191) with FUMEC (Fundacion Estados Unidos Mexico para la Ciencia). FUMEC is a binational nonprofit organization created in the context of the North American Free Trade Agreement. FUMEC operates projects funded by governmental institutions of the U.S. and Mexico, as well as academic and philanthropic institutions from both countries. FUMEC will establish a subcontract with the Autonomous University of Yucatan for conducting the proposed work. Purpose: To create a highly trained workforce for antenatal diagnosis of zika-related brain abnormalities and other adverse pregnancy and infant outcomes.Outputs with success indicators:Measures of time-to-correct diagnosis of antenatal infection and time-to-correct classification of adverse pregnancy and infant outcomes.Expected Results:The Regional Research Institute “Hideyo Noguchi” of the Autonomous University of Yucatan, through the CDC Country Office in Mexico City Mexico, propose a working collaboration with the Centers for Disease Control and Prevention (CDC), Atlanta, Fort Collins and Puerto Rico, to enhance the laboratory and surveillance program of Zika virus infection in pregnant women, building on top of their infrastructure for post dengue vaccination outcomes and efficacy. An enhanced surveillance system will provide regional North American information on the association between Zika virus infection during pregnancy and a spectrum of adverse pregnancy, birth, and infant outcomes.Collaborating partners:This project has intellectual partners and collaborations with the Tropical Medicine Institute of Antwerp, Belgium, and the Pedro Kuri Institute for Infectious Diseases of Habana Cuba.Activity budget: $ 27,500 Title Activity 4: APP for mobile phone that community can use for participatory surveillance and that provides the community with Zika up-to-date health risk communication, alerts and education Description: Users respond to a weekly survey of symptoms and daytime mosquito bites on Android/iPhone appDependencies:NonePartners:Skoll Foundation and University of ArizonaProposed Mechanism of Support:DGMQ/CDC Atlanta has a mobile APP developed by small business specialized in the development of the architecture of mobile APPS. The APP is available in English and will soon be translated into Spanish.Purpose:With the mobile APP users visualize aggregate user data and confirmed zika virus disease cases on a map, and this is used as a form of participatory community surveillance work for the benefit of planning and connecting the public with local public health resources and agencies.Outputs with success indicators:Community acceptance and use of the mobile APP of equal or greater 70 percent.Expected Results:Community participation, alongside public health authorities in Nogales Sonora, Mexico, Nuevo Laredo, Tamaulipas, and Merida Yucatan , on the combined effort to control aedes vectors in their community.Collaborating partners:DGMQ/CDC, Skoll Foundation, University of Arizona, Mexican Northen Border States and CENAPRECE (Centers for Prevention and Control Program) of the Ministry of Health MexicoGender: Are there gender considerations for this activity, if so, please describe. N/A.Activity budget: $ 57,860, EXTRAMURAL