• decrease disease incidence and prevalence
• continued efforts required
• ex: malaria

• zero disease incidence in defined geographic area
• continued efforts required
• onchocerciasis

• zero incidence of a specific agent in a specific geographic area
• continued efforts required
• ex: polio

• zero incidence worldwide
• continued efforts not required
• ex: small pox

• zero indicence
• not in wild or in laboratory
• continuous efforts not required

• rates increase as SES increase
• this hold true regardless of what region of the world you live in

• overwhelming health systems in hardest hit nations
• losing thousands of trained medical staff
• fueling major TB epidemics
• tx costs for 1 AIDS patient ($300 per year) far exceeds per capita health expenditure; most families cannot pay
• AIDS tx has the potential to drain resources from other illnesses

• infrastructure- physical and human
• technical capacity of local partners
• community engagement
• costs to governments
• stigma
• integration of prevention, tx, and care (include VCT)
• going to scale
• case managements of HIV/AIDS

• 1/3 of world infected
• without tx:
  • 1/3 die (1 death every 15 seconds)
  • 1/3 self cure
  • 1/3 remain infectious
• lose 3-4 months of work and 30% of annual income

• SEvAsia- 40% of all TB
• India- 1/3 of global TB burden

• infection- organism present but dormant (can't infect others)
• disease (active TB)- person is sick and can transmit disease to others if in lungs

• lifetime risk w/o HIV- 10%
• annual risk w/HIV- 10%

• ecological change
• population growth
• marginal and fragile health systems
• breakdown of health systems/control
• political upheaval
• population movement
• relaxing of control capacity and political will after eradication effort successes
• marginal populations

It is a disease of poverty and a cause of poverty

• one health year of life is gained for every $1-$8 spent on effectively treating malaria cases
• economic costs
  • loss time at work
  • hampers economic development
  • lose productivity and earnings

• most cases are in Africa
• most deaths are in africa children
• 5th ranked in ID deaths

most morbidity and mortality can be prevented with tools currently available

• 20% of childhood deaths in africa
• affects: anemia, LBW, failure to thrive, neurological problems
• 500,000 kids develop cerebral malaria
  • symptoms
    • fever
    • vomitting
    • headache
    • convulsions
    • coma
    • death in 24 hours

• infrastructure and health systems
• accurate dx and tx, surveillance
• applying combination therapies
• drug adherance, quality
• private sector delivery and regulation
• cost and financing

• extended family of largely parasitic diseases characterized by:
  • low motility but high morbidity and disability
  • disproportionately effect the poorest
  • are not currently vaccine preventable
  • often have very low cost drugs that can effectively treat them
  • often can be controlled by low cost environmental measures