Improving Health and Safety for Under-Resourced Populations in Urban and Rural Communities

Pakistan has the highest prevalence of hepatitis C in the world. In 2019, Integral Global (USA) in collaboration with medical and public health specialists in Islamabad, organized and directed the implementation of a same-day testing and treatment initiation program for adults in marginalized communities, known as slums. Health workers were hired from the same communities and were trained to perform door-to-door testing and referral services for residents to receive curative medicines. The Pakistan federal government selected the 17 slums to be served, and provided a clinical facility for laboratory and dispensary services. The successful outcome of the project captured strong political support. Post-COVID in 2023, the health ministry announced the launch of the national hepatitis C elimination program with an approved budget, to be co-funded by federal and provincial governments of Pakistan. The clinical site adjacent to a major slum continues to be supported by local philanthropists and is recognized by the health ministry as a model of excellence.

Website: Hepatitis C in Pakistan

Poster: Presentation at ILC 2022

Video: Conference Presentation

The COVID pandemic impacted every corner of the world, and was disproportionally devastating to the lower-income populations in many ways. The slum population in Islamabad has limited health literacy, and resulted in higher infection rate which further hampered their earning abilities as domestic helpers or day laborers. Integral Global (USA), leveraging their established infrastructure, organized local community health workers to distribute personal protective products and to teach slum residents basic health and protection techniques. The improvement in public health safety practices allowed the residents to re-enter the workforce.

Liver Foundation West Bengal (LFWB) is a not-for-profit organization in Kolkata with the focus to improve liver and digestive health to northeastern part of India. LFWB implemented a comprehensive care delivery for hepatitis B in Arunachal Pradesh, the rural hill regions of India’s northeast, which has high prevalence of hepatitis B. The community outreach was conducted by a field team from the Baptist Christian Hospital in Tezpur (Assam Province), who traversed the hills to deliver care to villagers in hard-to-reach mountainous locations. A clinical laboratory was built and operated by local medical universities. To ensure quality record-keeping and data collection from remote locations, Global Virus Network headquartered in Baltimore (USA), established a clinical database by developing a software application that runs on mobile platform through cloud servers. The tablet-enabled application was used to connect the field team, clinical labs and research sites where data and analysis from all sites were synchronized and shared.

Publication: A Model of Care Optimized for Marginalized Remote Population Unravels Migration Pattern in India

Website: Liver Foundation, West Bengal

Pakistan is one of the most water-stressed countries in the world. Integral Global (USA), leveraging established local infrastructure that serves the slums of Islamabad, aims to improve prevention and care of enteric diseases caused by microbes and parasites which are associated with unsafe drinking water, Sanitation and Hygiene (WASH) conditions. The program pays primary attention to school age children and adolescents. With a bottom-up approach, the aim is to empower the communities to be their own advocate by providing them with knowledge about WASH practices, and to link them with primary care clinics that can provide vaccination to prevent transmission and treatments for waterborne diseases. 

These programs serve all 17 slums of Islamabad and have the support of the Pakistan federal health authorities and local community leaders.

Website: WASH in Pakistan

The SARS-CoV-2 pandemic prompted the nationwide closure of several countries, including Bangladesh. Being the second largest garment producer in the world, this sector provides 4.4 million jobs and accounts for 80% of the country’s exports earning. Economic pressures led to the premature re-opening of factories, resulting in spikes in infection among workers. Integral Global (USA) developed a safety program to mitigate transmission. Students from Ayat College of Nursing & Health Science (Dhaka, Bangladesh) provided training to factory owners and supervisors, who then trained the workers. The successful outcome of the initiative has motivated national health and industry leaders to expand the program to establish general safety, health and wellness practices to be adapted as standard protocols of the industry.

Website: Covid-19 in Garment Workers in Bangladesh

Website: Garment Worker Health in Bangladesh

People who inject drugs are a marginalized population with high risk of contracting infectious diseases. Previously, a team of physicians and nurses at University of Maryland Baltimore, as part of the DC-Partnership for HIV/AIDS Progress project, established a comprehensive care center near Washington DC. In addition to harm-reduction and day-shelter services, the center provides test-and-cure for hepatitis C, pre-exposure prophylaxis for HIV and medication assisted treatment for opioid use disorder (OUD). The collocation model was proven to be effective in reducing health risks for participants. A long-term program called LOOP is ongoing to follow outcomes in health, drug use and quality of life of participants with OUD.

Tanzania has a prevalence of hepatitis C among people who inject drugs of greater than 75%. Medication assisted treatment (MAT) and needle exchange programs are limited and separate from infectious disease care. Previously, a team at University of Maryland Baltimore successfully showed that offering comprehensive care at a single location, such as harm reduction services, MAT for opioid use disorder, and treatment of HCV reduced hepatitis C in the population. This collocation model, called ANCHORE, is being implemented in a methadone clinic in Dar es Salaam, Tanzania.

The Lake Region Economic Bloc (LREB) in Kenya is a densely populated area with 14 million residents. In 2020, COVID cases caused by the Delta variant of SARS-CoV2 increased exponentially and rapidly in LREB and overwhelmed the region’s health system. In response to the emergency, PharmAccess Foundation in Amsterdam built and subsequently expanded COVID-Dx, a digital information hub that connected local clinics, diagnostics companies, medical equipment suppliers, and government health officials to update surveillance data, provide testing information and results, and implement preventive measures. The data system has been expanded to cover 25 additional infectious diseases. The renamed program, Epi-Dx, tracks the emergence and advances the preparedness for future public health emergencies.

Publication: Digital Health Systems Strengthening in Africa for Rapid Response to COVID-19

Outside of a few African countries, India has the largest number of people living with HIV. HIV disproportionately affects communities that have been socially marginalized. Transgender women (TGW) are at high risk of becoming HIV-positive. In 2021, a clinic called Mitr was opened in Hyderabad with the sole dedication to provide health services to TGW, the first one of its kind in India. This was a part of a large program supported by US governmental and academic funders, and implemented by the YRG Care Clinic (Chennai). Pre-exposure prophylaxis is offered and YRG Care provides Truvada for TGW to be protected from HIV transmission.