Cebile Manzini-Henwood of SWAGAA will partner with Together for Girls and Population Council to adapt the 'The Girl Roster' tool, which has been used effectively in diverse settings to identify the most vulnerable girls within a community, and to test and implement several innovative approaches to working with girls in Swaziland. For nearly a decade, SWAGAA has worked with Crossroads International to implement Girls' Empowerment Clubs in schools to help improve gender equality by strengthening girls' social assets and self-efficacy related to sexual behavior, violence and HIV. This grant will allow SWAGAA to strengthen this work by identifying and involving the most vulnerable girls within and outside of schools, to begin working with boys to engage them with gender equality and transformative social norms, and by establishing health and multisectoral referral networks that help girls to overcome common barriers to accessing post violence and sexual and reproductive health services. Ultimately, the project will generate evidence on reaching and working with girls who are often excluded from development interventions to enhance their empowerment, safety and well-being.

Gerard Cangelosi and colleagues at the UW Foundation in the U.S. will develop an oral swabbing method as a lower-cost safe and simple way to diagnose tuberculosis. Tuberculosis is a major global health threat and prompt diagnosis and treatment are critical for reducing spread. Currently a diagnosis is made by testing sputum from deep in the lungs produced by coughing. This can be difficult to collect and produce particularly for children and hazardous for health care workers. They previously found that DNA from the causative Mycobacterium tuberculosis accumulates on oral epithelial cells in infected adults and can be detected by non-invasively swabbing the mouth followed by quantitative PCR analysis. They will improve the sensitivity of this method in adults by testing different swabbing materials and protocols using around 175 suspected tuberculosis-positive patients in a clinic in South Africa. If successful they will test whether their method can also be used to diagnose tuberculosis in children.

Priya Nanda of the International Center for Research on Women in the U.S. will help young women in India secure decent employment and raise healthy families by giving adolescent girls access to relevant skills, resources, and connections, and engaging schoolboys and male community members to promote gender equality. They will recruit teachers to implement a specialized curriculum in schools, and connect with local businesses to create pathways to employment. Providing women with access to work should improve family health and income as well as promote economic growth and development.

Farhana Sultana of the International Centre for Diarrhoeal Disease Research in Bangladesh will develop and test an approach to bring together all members of a community to improve the health of menstruating girls and motivate them to attend school. Many girls in low-income countries avoid going to school when they are on their period because of poor facilities, lack of sanitation products and support, and social marginalization, which severely affects overall academic performance. In Bangladesh, menstrual hygiene education is limited and generally targets 14-15 year olds, so most girls are unaware of what happens until they actually start their periods. They will test their approach with one-month trials at a range of schools by providing low-cost and safe products and disposal bins, and training and supporting teachers to educate all school children on adolescent health and the effects of puberty. They will also engage parents, school management committees, and local and regional governing bodies to maintain the facilities, and develop girl-friendly school policies.

Poonam Muttreja of the Population Foundation of India will conduct a pilot project using entertainment via digital media as a form of education (edutainment) to change cultural and social norms underlying gender-based violence in India. They will recruit national celebrities to relay messages that motivate young girls to stand up against violence, and show boys that masculinity is not connected with violence. They will also produce six short films and an anthem condemning gender-based violence targeted to young people to be disseminated across various media channels over ten months. Their approach will be evaluated by measuring the changes in knowledge, attitudes, and perception of young people on gender-based violence.

Kanigula Mubagwa of the Panzi Foundation in DR Congo will test whether providing resources that simultaneously improve nutrition, income, and social status can help women and girls getting out of prostitution in the cities of DR Congo successfully reintegrate into more rural societies. Prostitutes and their families suffer from high levels of poverty and malnutrition. Individual strategies to support them often provide only temporary solutions. To address this, they will combine a variety of tested interventions including providing agricultural training, nutritional education, and access to crops and equipment, and engage men and prominent local people to transform social norms. They will recruit ex-prostitutes from Salvation Army Centers to evaluate their approach for improving participants' knowledge and skills in agriculture, nutrition and health, and for promoting gender equality in their communities.

Denise Dunning of the Public Health Institute's Rise Up program's "Let Girls Lead" initiative in the US in collaboration with the Girls' Empowerment Network (GENET) of Malawi, and the International Center for Research on Women (ICRW) will develop and test a multi-armed approach to empower girls with information, leadership skills, and support networks to reduce the incidence of child marriage and associated harmful traditions in Southern Malawi. Malawi has one of the highest rates of child marriage in the world, with half of all girls married by the age of 18. This has serious effects on gender equity, health, and education. They will enroll 800 girls aged 14-18 years from two districts in Southern Malawi and hold weekly workshops over six-months to provide education and skills training. This will be followed by community activities initiated by the girls themselves, such as forming girl clubs and engaging male members of their families and communities to help remove the social and cultural forces that lead to child marriage.

Robert Garcea of the University of Colorado Boulder in the U.S. will develop a method to manufacture ultrastable vaccines by coating them with nanoparticles so that multiple doses can be delivered in a single injection to reduce the costs associated with repeat immunizations and vaccine refrigeration. They have developed a method to heat-stabilize vaccines for transport and storage that involves controlled freeze-drying of antigens with adjuvants embedded in glassy organic matrices. This mixture is then coated with defined atomic layers of aluminum and additional antigens to protect the vaccines and control the release of the primer and booster vaccine at different times. They will further develop these methods to produce single-shot formulations of selected viral antigens for release at defined times and test their stability and ability to trigger a protective immune response in mice.

Michael Schrader of Vaxess Technologies Inc. in the U.S. will develop a microneedle patch that stabilizes vaccines and can deliver multiple doses through the skin at defined times thereby reducing cost waste and the need for repeat immunizations. Vaccinations delivered intradermally via microneedles are at least as effective as intramuscular delivery via injection but reduce the requirement for needles and trained health workers. The patch uses a silk fibroin protein that protects the vaccine against high temperatures removing the need for cold storage and controls the timing of release through the skin. They will refine the material for delivering two doses of inactivated poliovirus vaccine evaluate its safety and activity in animal models and optimize the manufacturing process to ensure reduced costs.

Tarit Mukhopadhyay of University College London in the United Kingdom will develop a manufacturing platform to reduce the production costs of recombinant protein vaccines. Current manufacturing procedures involve serial batch operations in large complex facilities requiring highly trained operators and extensive testing and are inefficient and costly. They will build a platform that integrates and automates key steps to reduce labor costs and capital expenditure and improves product design and control procedures to reduce quality control requirements. Their aim is to maximize the number of doses with the minimal starting material leading to recombinant subunit vaccines at 0.15USD per dose rather than the current costs of several USD per dose. They will develop their approach initially using a rotavirus vaccine candidate.