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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

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Dry-to-rainy Season Integrated Control of NTDs and Malaria

Brian FoyColorado State UniversityFort Collins, Colorado, United States
Grand Challenges Explorations
Community-Based Interventions
6 Oct 2014

Brian Foy of Colorado State University in the U.S. will test whether repeated administration of the anti-parasitic drug ivermectin specifically during the short dry-to- rainy transition in Burkina Faso in combination with distribution of insecticide treated nets will better reduce the incidence of malaria, lymphatic filariasis and soil transmitted helminth infections. Incidence of these diseases remains high despite mass drug administration efforts. They hypothesize that drug treatment and preventative measures will be more effective during the dry-to-rainy season transition (June to October) when the vector and parasites are at relatively low levels. This will be tested by performing a pilot three month randomized trial on a selection of rural villages involving community health workers to administer the drugs, followed by evaluation of disease incidence in young children.

Engineering Mammalian Cell Lines to Support Human Noravirus and Related Enteric Viruses

Ralph TrippUniversity of GeorgiaAthens, Georgia, United States
Grand Challenges Explorations
Enteric Disease Models
6 Oct 2014

Ralph Tripp from the University of Georgia in the U.S. and Carl Kirkwood of Murdoch Children's Research Institute in Australia will engineer mammalian cell lines for the development of vaccines and therapies against human noravirus and related enteric viruses. Noravirus is highly contagious and causes acute gastroenteritis, which can be serious in young children and the elderly. However, studying the virus and developing much needed new therapies has been difficult because mammalian cells are unable to support replication of the virus and grow in culture. They will perform genome-wide screens on two mammalian cell lines using small interfering RNA libraries to identify and remove the genes that block viral replication. After validation, the candidate genes will be modified using so-called CRISPR gene editing to generate stable cell lines for studying viral biology and developing new treatments.

Empowering Communities to Control TB

Carlton EvansAsociación Benéfica PRISMALima, Peru
Grand Challenges Explorations
Behavior Change
6 Oct 2014

Carlton Evans of Asociacion Benefica PRISMA in Peru will use conditional cash incentives to encourage individuals in poor communities that have been newly diagnosed with tuberculosis to help identify neighboring tuberculosis sufferers and encourage them and their families to receive treatment. Effective treatments exist for most forms of tuberculosis, but reaching the poor and most vulnerable individuals has proven challenging. By incentivizing and educating recently diagnosed tuberculosis sufferers in these communities, they hope to stem the spread of the disease and bring treatments to those who were previously left untreated.

Hydrocele and Trichiasis Surveillance and Surgery in Togo

Stephanie RichardHealth & Development International (HDI)Rockville, Maryland, United States
Grand Challenges Explorations
Community-Based Interventions
6 Oct 2014

Stephanie Richard of Health & Development International in the U.S. will run a campaign in Togo to identify and treat individuals with severe chronic morbidities caused by infectious diseases. Although several neglected tropical diseases such as lymphatic filariasis have been well controlled by mass drug administration efforts in Togo, they cause many lasting and severe secondary effects that require expensive treatments such as surgery, and are therefore not widely available. To address this, they will exploit the existing decentralized health structure in Togo by training local health workers to identify severe cases, and provide surgical treatment in those areas with the highest incidence. The health workers will also collect incidence data, which will help to secure additional funding for more treatments.

Predicting Neurodevelopmental Outcome Through Maternal Hair

Philip BakerUniversity of AucklandGrafton, New Zealand
Grand Challenges Explorations
Brain Function/Gestational Age
6 Oct 2014

Philip Baker from the University of Aukland in New Zealand will determine whether the presence of specific metabolites in a mother's hair during pregnancy can be used as an early marker of defective neurodevelopment in the child. Early diagnosis of neurodevelopmental disorders such as autism could lead to better treatment. Because hair stably incorporates chemical compounds, they will use samples of maternal hair from a previous study to search for metabolic markers such as fatty acids and amino acids that may correlate with subsequent developmental defects in the infants. The resulting predictive algorithm will be validated in a new study of over 1000 pregnant women from Malawi and Western China.

Non-invasive Imaging System for Fetal Brain Development

Yoshio OkadaChildren's Hospital BostonBoston, Massachusetts, United States
Grand Challenges Explorations
Brain Function/Gestational Age
6 Oct 2014

Yoshio Okada of Boston Children's Hospital in the U.S. will develop a non-invasive technique to measure the brain activity of fetuses in pregnant women in order to detect abnormalities. Current methods suffer from noise contamination and lack of sensitivity. Their new method involves a dual array of magnetic sensors placed around the entire torso of the mother and will be evaluated for its ability to discriminate fetal brain signals from noise. They are working towards a method that is relatively inexpensive and can also be used in developing countries with minimal training to monitor the fetal heart and brain as well as the maternal heart and gastrointestinal tract.

Monitoring Brain Development in Infants by Eye Measurements

Hans SuperBraingaze S.L.Mataro, Spain
Grand Challenges Explorations
Brain Function/Gestational Age
6 Oct 2014

Hans Super of Braingaze in Spain will develop a low-cost application for smart phones that can measure eye vergence, which is when the two eyes align on one object, as a potential proxy for cognitive development in infants. They will generate software that presents visual images, and incorporate an eye tracking system that records eye position binocularly. The application will be tested on 10 infants between 6 and 24 months old, followed by cognitive performance tests to associate changes in eye vergence with brain development. This would lead to a low-cost, non-invasive, and simple-to-use tool for the early detection of atypical cognitive development.

Textiles as Teaching Device to Prevent Cervical Cancer

Anne De GrootGAIA Vaccine FoundationProvidence, Rhode Island, United States
Grand Challenges Explorations
Behavior Change
5 Oct 2014

Anne de Groot of GAIA Vaccine Foundation in the U.S. will use printed West African Cloth to educate women on the benefits of screening and vaccinating against Human Papilloma Virus (HPV), which causes cervical cancer. Cervical cancer is the second most common and lethal cancer affecting women in West Africa. This is thought to be partly due to a lack of knowledge about the causes of the disease. The patterns on clothing in West Africa often have symbolic meaning, but have not yet been exploited for health education. They have designed and field-tested a brightly colored cloth printed with images representing HPV, the cervix and cancer cells, which they will disseminate in Bamako, Mali. By combining this with a media campaign involving renowned Malian singers, they aim to encourage women to be screened for cervical cancer. The success of the campaign will be evaluated by analyzing subsequent screening rates, and surveying women exposed to the campaign for their feedback.

Agriculture Innovation Changing Health and Nutrition Behaviors

Mary-Lynne LascoINMED Partnerships for ChildrenAshburn, Virginia, United States
Grand Challenges Explorations
Community-Based Interventions
3 Oct 2014

Mary-Lynne Lasco of INMED Partnerships for Children in the U.S. will evaluate whether on-site sustainable food production and associated education in schools improves child health when combined with semi-annual deworming treatments and a new school feeding program in Peru. Many Peruvian children are malnourished, and soil-transmitted helminth infections are endemic and a significant cause of mortality. They will study two primary schools in Peru's Ucayali region, one of which will receive an aquaponic system, comprising fish farming and growing plants without soil, to produce healthy food and to educate children, teachers and parents on the value of eating healthily. They will analyze the effect of aquaponics and integrated education on nutrition and helminth infection rates at the schools, as well as on the attitudes of parents and the community.

Assessing HIV Risk to Create Demand for Male Circumcision

Joseph KagaayiRakai Health Sciences ProgramEntebbe, Uganda
Grand Challenges Explorations
Behavior Change
3 Oct 2014

Joseph Kagaayi of the Rakai Health Sciences Program in Uganda will test whether giving a personalized HIV risk index to Ugandan males will encourage them to undergo safe male circumcision to prevent HIV infection. The multi-item risk index for HIV was developed from the general population of Rakai in Uganda, and will be straightforward for HIV counselors and clinicians to use. He will incorporate the index into a randomized controlled trial involving men aged 15-49 years who are undergoing HIV testing, and evaluate its effect on circumcision rates after 6 months.

Newborn Olfactory Memory Deficits as a Harbinger of Childhood Cognitive Disorders

Alexander DrobyshevskyNorthShore University HealthSystemEvanston, Illinois, United States
Grand Challenges Explorations
Brain Function/Gestational Age
3 Oct 2014

Alexander Drobyshevsky of Northshore University HealthSystem in the U.S. will test whether olfactory learning in newborns can predict cognitive learning and behavior later in childhood. Current tests of learning and memory can only be performed in infants from 4 months old. However, if defects are identified earlier, treatment may be more effective. Olfaction is one of the earliest developed senses and plays an important role in the first days of life. Using a rabbit model of different brain injuries they will measure odor response in newborns and later analyze cognitive performance to link them together. They will also recruit around 100 human newborns and measure their olfactory memory, which will be followed up by cognitive testing when they are 18 months old.

Improving BCG Vaccine to Make it Compatible with Skin Test

Johnjoe McfaddenUniversity of SurreyGuildford, United Kingdom
Grand Challenges Explorations
Human and Animal Health
28 Apr 2014

Johnjoe McFadden of the University of Surrey in the United Kingdom will modify the BCG vaccine currently used against bovine and human tuberculosis, and develop a complementary diagnostic test that can distinguish between tuberculosis infection and vaccination. BCG is the only effective tuberculosis vaccine, however it interferes with diagnostic tests, preventing the distinction between infection and vaccination, which is important for control efforts in developing countries. They will identify genes in the BCG vaccine that can be removed without affecting its activity in cattle and determine which of those genes are potentially strongly immunogenic and therefore easy to detect. Selected genes will be used to develop a complementary diagnostic skin test that would not cross-react with the modified vaccine. Next steps would be developing and evaluating the vaccine and skin test in cattle and subsequently in humans.

Integrating Cash Transfer and Nutrition Promotion With Mobile

Tanvir HudaInternational Centre for Diarrhoeal Disease Research, BangladeshDhaka, Bangladesh
Grand Challenges Explorations
Behavior Change
28 Apr 2014

Tanvir Huda of ICDDRB in Bangladesh will improve care and nutrition for pregnant women and young children by setting up a system whereby mobile phones are used to receive nutritional information and financial incentives for positive health-related behavior, such as attending clinics. They will perform a pilot study in Bangladesh by recruiting 350 pregnant women, providing them with mobile handsets, and establishing trained health workers who will send weekly nutritional advice and supply nutritional supplements. Cash will be transferred using bkash (a mobile banking system) when certain conditions are met, including intake of supplements, prenatal and antenatal care checks, and listening to mobile messages. The approach will be evaluated by discussions with relatives, and assessing birth outcomes and infant growth.

Tools to Improve Parental Recognition of Child Development

Günther FinkHarvard School of Public HealthBoston, Massachusetts, United States
Grand Challenges Explorations
Behavior Change
28 Apr 2014

Günther Fink of Harvard School of Public Health in the U.S. will help parents to assess their child's development, thereby making them more likely to seek necessary treatment. They will test two strategies in a randomized controlled trial involving 600 children from Eastern Zambia. For one group, they will install life-size growth chart posters in selected households along with instructions for use and where to seek help if the child's height is below a critical level. For the other, they will arrange regular community meetings to measure children's heights and offer further advice. They will evaluate their approaches by analyzing parental perceptions and related behavior, along with the effect on child development.

Can a Decision-Making Nudge Improve Birth Outcomes?

Margaret McConnellHarvard School of Public HealthBoston, Massachusetts, United States
Grand Challenges Explorations
Behavior Change
28 Apr 2014

Margaret McConnell and Jessica Cohen of Harvard School of Public Health in the U.S. will evaluate whether motivating pregnant women to choose a health care facility for delivering their baby prior to the onset of labor, along with offering free transportation to that facility, increases the safety of childbirth in Kenya. Currently, maternal and neonatal deaths in developing countries remain high despite the availability of high quality facilities for child delivery. Obstacles to using these facilities include lack of transportation and limited information on their quality, which means many couples avoid deciding and end up either giving birth at home or going to a suboptimal facility, sometimes after a long delay. They will conduct a pilot study by recruiting 1,200 pregnant women in Nairobi, and evaluate whether offering transportation vouchers to a pre-chosen facility positively impacts delivery outcomes and timing of arrival at health care facilities.

A Small Animal Model of ETEC-Mediated Diarrhea

Sandhya VisweswariahIndian Institute of ScienceBangalore, , India
Grand Challenges Explorations
Enteric Disease Models
25 Apr 2014

Sandhya Visweswariah of the Indian Institute of Science in India will generate a mouse model for studying secretory diarrhea, which causes significant mortality in young children. Secretory diarrhea is often caused by the bacterium Escherichia coli, which produces a toxin that binds to a cell surface receptor (the guanylyl cyclase C receptor) in the gastrointestinal tract thereby causing diarrhea. They will genetically engineer a mouse in which they can hyperactivate this receptor specifically in intestinal cells to potentially trigger secretory diarrhea. The effect on the gastrointestinal tract and any accompanying molecular changes will then be analyzed and could lead to the discovery of new therapeutic targets.

Smart Accountability in the Rwandan Coffee Sector

Ranjan ShresthaSNV USABethesda, Maryland, United States
Grand Challenges Explorations
Agricultural Programs
25 Apr 2014

Ranjan Shrestha of SNV (Netherlands Development Organization) in Rwanda will facilitate communication between smallholder coffee producers and district coffee taskforces to boost the coffee sector in Rwanda. District coffee taskforces composed of public, private, and non-profit members meet quarterly to discuss current issues, including production and market access, and to develop action plans. Coffee producers are largely excluded from these proceedings due to communication barriers. A pilot test will be conducted by training youths to record the current concerns of local coffee producers using smart phones, and to visually present the data for ease of transmission to the taskforces via internet. The approach will be monitored by analyzing the numbers and types of issues raised and by who, and how they are addressed, as well as evaluating how the approach is perceived by users.

Durable and Sensitive Tough Hydrogel Condoms

Robert GorkinUniversity of WollongongWollongong, New South Wales, Australia
Grand Challenges Explorations
Next Generation Condom
24 Apr 2014

Robert Gorkin of the University of Wollongong in Australia is developing tough hydrogels as an alternative material to latex for making male condoms with enhanced tactile (touch) sensitivity to improve sexual experience. Tough hydrogels are highly elastic and mechanically tough materials. Unlike latex, they can increase sensitivity to touch, incorporate lubrication, and be coupled to other components, such as stimulants and antiviral drugs. In Phase I, they synthesized candidate tough hydrogel formulations and showed that they had sufficient mechanical and barrier properties to be suitable condom materials, and could be manufactured to international safety standards. A preliminary trial of target users rated tough hydrogels nicer to touch than latex. In Phase II, they will tailor the condoms to the needs of specific communities by surveying target populations to identify desirable properties that will promote use. They will also optimize production and engineer prototypes for a user acceptance and performance trial to evaluate whether they enhance sexual experience.

Gnotobiotic Pig Model for Dysbiosis and Enteric Immunity

Lijuan YuanVirginia Polytechnic Institute and State UniversityBlacksburg, Virginia, United States
Grand Challenges Explorations
Enteric Disease Models
24 Apr 2014

Lijuan Yuan of Virginia Polytechnic Institute and State University in collaboration with Sylvia Becker-Dreps and Andrea Azcarate-Peril from University of North Carolina at Chapel Hill in the U.S. and Samuel Vilchez from University of Nicaragua will develop a pig model with impaired intestinal function and altered types of gut microbes to mimic the condition of many children in developing countries who do not respond to vaccines against rotavirus infection, which causes infectious diarrhea. They will implant stools from vaccine-responsive and non-responsive children in Nicaragua into the pigs and use them to identify factors that improve vaccine-mediated immune responses. This model can also be used to test disease prevention strategies, such as feeding probiotics or special diets.

Transcutaneous Assessment of Gut Function in Enteropathy

Phillip TarrWashington University in St. LouisSt. Louis, Missouri, United States
Grand Challenges Explorations
Enteric Disease Models
24 Apr 2014

Phillip Tarr of Washington University in the U.S. is developing a method to evaluate gut permeability by measuring levels of ingested fluorescent molecules non-invasively through the skin. Gut permeability is increased in infants with environmental enteropathy, which is associated with impaired growth and development, and is prevalent in developing countries. Current tests are problematic due to the required collection and handling of body fluids from young children, and can produce varying results. In contrast, this new method would allow direct measurement in the field, and be suitable for resource-poor settings. In Phase I, they showed that orally ingested pyrazine-based fluorophores could be measured through the skin and could detect gut injury in a rat model of enteropathy. In Phase II, they will optimize the fluorophores to improve solubility, and evaluate them in a preliminary trial in human volunteers.

The Farmer Voice in Agriculture Extension Services

Shaun FerrisCatholic Relief ServicesBaltimore, Maryland, United States
Grand Challenges Explorations
Agricultural Programs
23 Apr 2014

Shaun Ferris of Catholic Relief Services in the U.S. will build and test different ways of obtaining feedback from farmers who are using business-focused agricultural services, which his organization provides. This suite of services, including courses on business planning and production, is designed to improve farmer productivity and profitability using a system of web-based applications and mobile phone information delivery. To transfer the management of some of these services back to the local communities, they need feedback on their performance and value in the field. They will build three different methods of obtaining feedback, including SMS polls and direct calls, into their existing service provision system, and evaluate them for efficacy and cost.

Nanotextured Condoms: Surface Engineering for Better Safe Sex

Charles ChungUbIQ WorldSan Francisco, California, United States
Grand Challenges Explorations
Next Generation Condom
23 Apr 2014

Charles Chung and team from UbIQ World in the U.S. will engineer the surface of male condoms using nanofabrication technology to mimic human skin, thereby enhancing sensation and encouraging use. Current condom materials such as latex are smooth, in contrast to human skin, which is highly textured. They will measure surface properties of the skin, including roughness and hydrophobicity, and use them to engineer a nanotexturized prototype condom that will be evaluated in a double blind study.

Development and Testing of the Female Pleasure Condom

Debby HerbenickIndiana UniversityBloomington, Indiana, United States
Grand Challenges Explorations
Next Generation Condom
22 Apr 2014

Debby Herbenick and Frank Sadlo of Indiana University in the U.S. will design a new female condom that is easier and more comfortable to use, and enhances sexual experience. The new condom will have a more natural elliptical opening as opposed to the more conventional Round one, and will be ribbed on one side to provide directed internal stimulation for the female, making it potentially more enjoyable than using no condom. They will also test an alternative method for securing the condom in place using an additional latex coating at the internal, closed end of the condom, which should be more comfortable. Prototypes will be created for evaluation by couples in India, and performance compared to a conventional female condom.

Condom Materials to Increase Pleasure and Enhance Erection

Shengxi ChenArizona State University FoundationTempe, Arizona, United States
Grand Challenges Explorations
Next Generation Condom
22 Apr 2014

Shengxi Chen of Arizona State University Foundation in the U.S. will produce a male condom using a material to mimic the surface of the skin for a more natural feel, coupled with a chemical to activate erection. The surface of skin cells is both hydrophilic and hydrophobic, however conventional condoms, such as those made from polyisoprene, are hydrophobic and therefore feel unnatural. To mimic the skin surface, they will synthesize the molecule glycosylated PROLI coupled to nitric oxide, which is known to stimulate both male and female physical arousal, and use it to coat a conventional polyisoprene condom. The new condom will be evaluated for strength, biocompatibility with skin cells, and release of nitric oxide.

Exploiting a Bovine Antibody Subset as a Trypanocide

Liam MorrisonThe University of EdinburghEdinburgh, United Kingdom
Grand Challenges Explorations
Human and Animal Health
21 Apr 2014

Liam Morrison and Ivan Morrison of the Roslin Institute, University of Edinburgh in the United Kingdom will develop a new type of drug for treating diseases in animals and humans caused by African trypanosomes, which cause significant disease in sub-Saharan Africa. African trypanosomes evade the host immune system by varying their surface proteins, which can be recognized by conventional antibodies, precluding the development of an effective vaccine. They will exploit an unconventional antibody subtype discovered in cattle, which they hypothesize targets unvarying conserved epitopes on African trypanosomes, as a more effective treatment. They will identify specific antibody fragments that bind to trypanosomes and test whether they can eliminate the pathogen using animal models. Subsequent work will focus on identifying the target pathogen proteins of these unconventional antibodies with a view to developing a vaccine.

Low-Cost Crowd-Solving of Agricultural Development

Rastislav IvanicOliver's Planet, IncSan Diego, California, United States
Grand Challenges Explorations
Agricultural Programs
21 Apr 2014

Rastislav Ivanic of Oliver's Planet, Inc. in the U.S. will develop their online platform using SMS to crowd source expertise from the developing world's rural farmers in order to better design and execute agricultural initiatives and promote their funding. The platform will collect simple statements by SMS directly from the farmers without charge on possible solutions to relevant problems, and use them to build feasible and supported solutions. These possible solutions will then be sent back to the farmers for them to rate. With the help of local collaborators, they will recruit rural farmers to field test the platform with two to four projects and evaluate cost, farmer participation, idea generation, and the ability of crowd-solving to generate workable solutions.

Single Dose, Multivalent Vaccine for Zoonotic Diseases

Charles LongTexas A&M AgriLife ResearchCollege Station, Texas, United States
Grand Challenges Explorations
Human and Animal Health
17 Apr 2014

Charles Long of the College of Veterinary Medicine and Biomedical Sciences in the U.S. will develop a strategy for generating single vaccines against diseases that infect both humans and animals (zoonotic) for use in both species that can be locally produced in goat milk. They will select two antigens from pathogens causing seven zoonotic diseases, including tuberculosis and trypanosomiasis, and incorporate them into vectors for producing the vaccines in lactating dairy goats. The ability of each vaccine to induce a protective immune response in combination with a variety of adjuvants will then be tested in goats. Vaccine-producing goats could be shipped to regions in need where local farmers and businesses would be trained to produce the milk and prepare the vaccines.

Abate: Human-Scented "Trojan Cows" Kill Vectors of Disease

Agenor Mafra-NetoISCA Technologies, Inc.Riverside, California, United States
Grand Challenges Explorations
Human and Animal Health
17 Apr 2014

Agenor Mafra-Neto of ISCA Technologies, Inc. in the U.S. will test whether an artificial lactic acid treatment (called abate) can trick disease-transmitting insects such as mosquitoes into infecting animals rather than their preferred human hosts, thereby reducing infection rates. Malaria-causing parasites are carried by mosquitoes, which identify the human hosts that help them reproduce by detecting the high levels of lactic acid in human perspiration. Cattle are resistant to malaria and many other human diseases transmitted by insects, and are often treated with deworming medication, which has a toxic effect on mosquitoes and their parasites. They will develop a stable formula of abate and test its effect on altering host choice of several disease-transmitting insects to determine which is most effective.

How Did We Do Today? A System to Capture Patient Experience to Inform Reproductive Health Service Improvement in Kenya

Heidi LarsonLondon School of Hygiene and Tropical MedicineLondon, United Kingdom
Grand Challenges Explorations
Behavior Change
17 Apr 2014

Heidi Larson of the London School of Hygiene and Tropical Medicine in the United Kingdom will establish simple touch screens in Kenyan health clinics to gather immediate feedback from young women seeking reproductive and sexual health services on their experience as they leave the clinic. A negative patient experience during a doctor's appointment has a harmful effect on subsequent health decisions. They will design a touch screen interface comprising a simple red and green option along with a data collection tool, and implement them in two high volume provincial facilities in Kenya in consultation with health providers. Summaries of patient ratings will be publicly posted to motivate health providers to improve their services. The data will be analyzed for patient experience, and related to clinical performance.

Flavonoid Antioxidant Embedded Solid Hydropolymer Condom

Mahua ChoudhuryTexas A&M Health Science CenterCollege Station, Texas, United States
Grand Challenges Explorations
Next Generation Condom
16 Apr 2014

Mahua Choudhury of Texas A&M Health Science Center in the U.S. will develop low-cost male condoms from a strong and highly elastic three-dimensional hydropolymer (hydrogel) embedded with an antioxidant to enhance sexual experience and help prevent HIV transmission. Antioxidants such as quercetin act as stimulants that could enhance feelings of pleasure by promoting smooth muscle relaxation, increasing arterial blood flow, and maintaining nitric oxide levels, which helps to stimulate and maintain erection, and they also have anti-HIV activity. They will develop methods to produce a hydrogel that can protect against STD transmission and unwanted pregnancies, and that can be easily coupled to quercetin. Future work will evaluate the safety and performance of these hydrogel condoms.

Evaluation of New Mouse Models for Typhoid Fever

Egil LienUniversity of MassachusettsWorcester, Massachusetts, United States
Grand Challenges Explorations
Enteric Disease Models
16 Apr 2014

Egil Lien with collaborators Beth McCormick and Mike Brehm of the University of Massachusetts Medical School in the U.S. will evaluate two mouse models for studying human typhoid fever. Typhoid fever is a major cause of environmental enteric dysfunction, which is associated with significant morbidity and mortality particularly in young children from developing countries. The causative Salmonella bacterium does not normally infect mice, hindering the development of mouse models for testing new treatments and vaccines. However mice lacking the innate immune receptor toll-like receptor 11 (TLR11) and humanized NOD-SID-IL-2Rg (NSG) mice can be infected. They will analyze the characteristics of typhoid fever in these two mouse models and the effect of current treatments.

Viral Videos for Maternal and Child Health in Burkina Faso

Roy HeadDevelopment Media InternationalLondon, United Kingdom
Grand Challenges Explorations
Behavior Change
16 Apr 2014

Roy Head of Development Media International in the United Kingdom will promote maternal and child health in Burkina Faso by producing short entertaining films on health-related topics in the local language for viewing on mobile phones. The films will each deliver a specific message, such as the benefits of exclusive breastfeeding, hand washing, and early recognition of diseases. They will record the films onto mobile phone memory cards that they will distribute within chosen communities to promote widespread peer-to-peer distribution. Surveys will be used to evaluate distribution along with the effect on behavior.

Poly(glycerol sebacate)-Based Condoms

Lakshminarayanan RagupathyHLL Lifecare LtdTrivandrum, Kerala, India
Grand Challenges Explorations
Next Generation Condom
16 Apr 2014

Lakshminarayanan Ragupathy of HLL Lifecare Limited in India will make a male condom from the biodegradable polymer poly(glycerol sebacate) as an environmentally friendly alternative to conventional condoms with improved performance. In contrast to currently used condoms, poly(glycerol sebacate) may be compatible with oil-based lubricants, and can be more easily combined with other materials, such as anti-viral drugs, contraceptives and vasodilators, to enhance safety and user experience. Poly(glycerol sebacate) is also completely biodegradable, transparent, odorless, and the raw materials are renewable. They will modify some of the mechanical properties of poly(glycerol sebacate), such as tensile strength, to make it more suitable as condom material and to reduce thickness, thereby increasing sensitivity during use. Once the ideal material has been identified, they will produce the condom and evaluate it for safety and biocompatibility.

Photovoice for Gender Responsive and Effective Innovation

Eliane UbalijoroMcGill UniversityMontreal, Quebec, Canada
Grand Challenges Explorations
Agricultural Programs
15 Apr 2014

Eliane Ubalijoro and Myriam Gervais of McGill University in Canada will analyze methods to use the knowledge and expertise of rural women smallholder farmers in developing countries to better inform agricultural development projects. Although women are central players in the production, processing, and distribution of agricultural food products in sub-Saharan Africa, they are often not consulted during the planning of projects related to food security, partly due to communication barriers. They will develop and evaluate participatory methodologies, including appreciative inquiry, which is a particular style of questioning to promote practical responses, and photovoice to supplement words with visual aids, such as videoclips, in order to record the problems faced by women farmers in three districts in Rwanda, and their ideas on how to address them. These records will then be passed on to agriculture development programming staff and policymakers.

From Obstacles to Opportunities for Male Circumcision

Jennifer DownsWeill Medical College of Cornell UniversityNew York, New York, United States
Grand Challenges Explorations
Behavior Change
15 Apr 2014

Jennifer Downs of Weill Cornell Medical College in the U.S. will use the influence of the church to encourage more male circumcision in order to reduce HIV incidence in Tanzania. Male circumcision can inhibit HIV infection, but it is uncommon, particularly amongst non-Muslim communities in African nations due to negative religious and social perceptions. They will train male and female church leaders to educate their congregations on the medical, historical, religious, tribal, and social aspects of male circumcision, and explore ways that they can integrate these teachings into the church. They will compare circumcision rates before and after this intervention, and use matched villages receiving no church-associated training as controls. Their approach could be expanded to neighboring countries.

Less is More: the 5Q Approach

Andy JarvisInternational Center for Tropical AgricultureCali, Colombia
Grand Challenges Explorations
Agricultural Programs
15 Apr 2014

Andy Jarvis of CIAT (International Center for Tropical Agriculture) in Colombia will test a new feedback approach, involving cycles of five simple questions asked to relevant stakeholders, to see whether it can promote the success of agricultural projects in developing countries. Involving local farmers in the design and implementation of agricultural projects is important but mostly bypassed because it is time-consuming and often impractical. To address this, a simple cyclical approach will be designed and tested to collect feedback over the course of a project to monitor progress and inform decisions. The cycle is initiated by a set of five selected questions on a specific project posed to farmers, project implementers, and donors. A web platform will be built to publish the responses, enable the data to be discussed by all stakeholders, and allow subsequent decisions to be communicated via video across all groups. This should lead to a new set of five questions to begin the next cycle. He will engage stakeholders to evaluate the approach to see whether it can increase participation and provide quicker feedback.

A Mouse Model for Heat-Stable Enterotoxin Diarrhea

James NataroUniversity of VirginiaCharlottesville, Virginia, United States
Grand Challenges Explorations
Enteric Disease Models
15 Apr 2014

James Nataro of the University of Virginia in the U.S. is developing new mouse models of environmental enteric dysfunction (EED) to explore how enteric pathogens commonly found among children in developing countries can affect intestinal function and cause growth retardation. In Phase I, they developed mouse models for five of the common pathogens and found that, as in humans, malnutrition (protein or zinc deficiency) enhanced the severity of infection, associated growth retardation, or the presence of intestinal inflammation. In Phase II, they will study the molecular mechanisms involved and analyze human candidate EED-associated biomarkers and metabolic states in their new mouse models to better compare them to the human disease. They will also test the effect of simultaneous and repeat infections on growth, and treat one of the models with alanine-glutamine to determine whether they can be used to evaluate new drugs.

3-D Human Small Intestinal Organoid for Enteric Infections

Cirle WarrenUniversity of VirginiaCharlottesville, Virginia, United States
Grand Challenges Explorations
Enteric Disease Models
15 Apr 2014

Cirle Warren of the University of Virginia in the U.S. will develop a three dimensional cell culture model (organoid) of the human intestine to study diarrheal diseases. They will build the organoids in a bioreactor using three intestinal cell types, and test different scaffolds to simulate the complex cellular and structural architecture of the human gut. The organoids will then be infected with Cryptosporidium, a common cause of diarrhea in developing countries, and analyzed for altered structural and molecular characteristics to gain insight into the host infection response. This model could also be used to identify new drug targets and evaluate candidate drugs.

Integrating GIS/GPS, IVR and Radio for an Effective Feedback

Henry BaffoeCentre for Remote Sensing and Geographic Information ServicesAccra, Ghana
Grand Challenges Explorations
Agricultural Programs
14 Apr 2014

Henry Baffoe of the Centre for Remote Sensing and Geographic Information Services in Ghana will develop an integrated system using existing technologies to gain feedback from smallholder farmers on agricultural projects that can then be analyzed by stakeholders. His team will recruit farmers from a district in Ghana, map their locations using GPS, record the type of farm, and launch an Instant Voice Response (IVR) platform, which collects responses to surveys by recording voice messages sent by mobile phone. The system will be pilot tested with a specific agricultural project and evaluate its impact on project development and farm productivity.

Game-Based Intervention to Prevent HIV in Mexico City

Sergio BautistaConsorcio de Investigación sobre VIH SIDA TB CISIDAT, A.CCuernavaca, Morelos, Mexico
Grand Challenges Explorations
Behavior Change
14 Apr 2014

Sergio Bautista in Mexico (INSP MEXICO and Consorcio de Investigación Sobre VIH SIDA TB CISIDAT A.C.), and his partners Elena Bertozzi (Quinnipiac University) and Raluca Buzdugan (University of California, Berkeley) will develop an online game-based intervention to motivate men who have sex with men in Mexico City to get regularly tested for HIV and adhere to treatment. Along with input from the target group, they will develop a humorous game in the context of an anonymous online community that simulates real-world interactions with potential partners. The game will incorporate HIV-related topics, and reward healthy choices with coupons for free HIV testing and with points on a leader board. They will recruit players to pilot test the game, and assess participant opinion and its value for promoting healthy behavior in this high-risk group.

Integrating ICT-Based Tuberculosis Treatment Innovations

Naoru KoizumiGeorge Mason UniversityFairfax, Virginia, United States
Grand Challenges Explorations
Behavior Change
14 Apr 2014

Naoru Koizumi of George Mason University in the U.S. will evaluate whether offering individuals a choice between different information and communication technologies (ICTs) will increase adherence to treatment for tuberculosis, which lasts six months. Treatment compliance particularly in urban poor populations is low, leading to the emergence of dangerous multi-drug resistant strains of the tuberculosis bacterium. Current methods used to increase compliance, such as sending SMS reminders and financial incentives, do not suit every patient. They will conduct a pilot test in India to determine whether offering tuberculosis patients a choice between different ICT-based options for receiving treatment reminders, recording compliance, and rewarding compliant behavior, rather than selecting the options for them, improves adherence to treatment.

Making Condoms <30µm by Improving Properties of Natural Latex Emulsion

James Zhijun LuRegenex Pharmaceuticals Ltd.Guangzhou, China
Grand Challenges Explorations
Next Generation Condom
14 Apr 2014

James Zhijun Lu of Regenex Pharmaceuticals, Ltd. in China will reduce the thickness of natural latex condoms to enhance sensitivity during use. Current condom thickness is dictated by the relative strength of the material, which must be maintained to prevent disease transmission and unwanted pregnancies. However, thicker condoms inhibit sensation during use. Natural latex is weakened below a thickness of 40?m, mainly due to the formation of different sized aggregates in emulsion. To enable the production of thinner condoms, they will analyze whether optimizing the ratio of these aggregates can increase the strength of natural latex, and develop a new centrifugation process to remove aggregates during condom manufacture. They will also identify conditions, such as temperature, that may inhibit aggregate formation to further reduce thickness while retaining strength.

Health Credits Incentive to Support Facility Visits for MNCH Outcomes

Caroline OchiengStockholm Environment InstituteStockholm, Sweden
Grand Challenges Explorations
Behavior Change
11 Apr 2014

Caroline Ochieng of the Stockholm Environment Institute in Sweden is evaluating an approach to stimulate women in Kenya to regularly visit health clinics during pregnancy and after birth to improve maternal health. Currently, the majority visits only once, and infant and maternal mortality are high. To encourage the women to keep additional appointments they will give them a health credit voucher that can be exchanged for a specific cash amount or retained for a subsequent appointment, for up to four appointments, when they receive another voucher worth twice as much. In Phase I, they enrolled 200 women in a county in Kenya to test the reward scheme, with preliminary results showing 90% went to a second appointment. In Phase II, Stacey Noel, also of the Stockholm Environment Institute in Sweden, will scale up the test to 3600 women across 18 health facilities, and prolong the award scheme to one year after birth, as a way to also promote infant health. They will also analyze the cost-effectiveness of the scheme, and its effect on health by conducting a cluster randomized control trial.

HIV Self-Testing for Partner Screening and Risk Reduction

Harsha ThirumurthyUniversity of North Carolina at Chapel HillChapel Hill, North Carolina, United States
Grand Challenges Explorations
Behavior Change
11 Apr 2014

Harsha Thirumurthy of the University of North Carolina in the U.S. along with colleagues in Kenya will encourage individuals in sub-Saharan Africa to use self-testing HIV kits to screen their current and future sexual partners for HIV status. An oral test for HIV that can be performed by an individual at home has been approved in Kenya, reducing social and economic barriers of testing in a clinic. They will provide between 5 and 10 self-testing kits, along with instructions for use and how to act on the results, to a group of men and women in Kenya who are HIV negative, and encourage them to test their current and future sexual partners. They will monitor their progress over a 3 month period, and evaluate the influence of this intervention on sexual decision making.

Repurposing Human Cancer Drugs to Treat Trypanosome Diseases

Danae SchulzRockefeller UniversityNew York, New York, United States
Grand Challenges Explorations
Human and Animal Health
11 Apr 2014

Danae Schulz and Erik Debler of Rockefeller University in the U.S. will test whether a drug that was originally developed to treat cancer and heart disease can also kill trypanosomes, which are parasites that cause African trypanosomiasis in humans and cattle. Repurposing a drug already approved for a different disease is highly cost-effective as expensive human safety trials are already complete. This particular drug is a bromodomain inhibitor that interferes with the structure of chromatin, and they have shown that it destroys trypanosomes grown in vitro. They will test whether the drug can cure trypanosome infections in mice, and determine how the drug and its derivatives interact with trypanosomes using binding and structural studies. Subsequent studies would test the drug in cattle and humans.

Pleasurable Condom Donning

Steve StraussUltimate Medical Products LLCRockville Centre, New York, United States
Grand Challenges Explorations
Next Generation Condom
11 Apr 2014

Steve Strauss and colleagues at Ultimate Medical Products LLC in the U.S. will refine their condom applicator to promote the use of male condoms by enabling them to be put on more easily and rapidly. Most condoms are applied manually, which can be cumbersome and cause loss of arousal. The applicator they have designed is a simple, inexpensive, and disposable device that can be incorporated into regular condom packaging. It is quick and easy to use, can be applied with one hand, and ensures the condom is correctly fitted to prevent STD transmission and unwanted pregnancy. The applicator design will be optimized, and 36 couples will be recruited to home-test it and evaluate performance compared to conventional condoms.

Recording Gut Dysfunction with Bacterial Sentinels

Scott KernsHarvard UniversityCambridge, Massachusetts, United States
Grand Challenges Explorations
Enteric Disease Models
11 Apr 2014

Scott Jordan Kerns of Harvard Medical School in the U.S. will develop a cell-based model of environmental enteric dysfunction, which causes substantial morbidity and mortality in developing countries. As a living model of the human intestine, he will use a gut-on-a-chip device composed of two microfluidic channels enclosing gut cells growing on a flexible membrane, which is coated with extracellular matrix proteins and other cell types. He will treat the gut-on-a-chip with factors that cause environmental enteric dysfunction, such as pathogenic bacteria, and monitor gut-related functions including nutrient absorption. A validated model could then be used to screen for new treatments. He will also engineer non-pathogenic bacteria as potential early-stage diagnostics and test their ability to sense environmental enteric dysfunction in his model.

Human Enteroid Monolayers as a New Model of Acute Diarrhea

Mark DonowitzJohns Hopkins UniversityBaltimore, Maryland, United States
Grand Challenges Explorations
Enteric Disease Models
11 Apr 2014

Mark Donowitz and Nicholas Zachos of Johns Hopkins University in the U.S. will develop human epithelial cell cultures that mimic the human intestine as a model for acute diarrhea, which is the second leading cause of death worldwide. They will culture the cells as polarized monolayers, which can be infected with disease- causing pathogens, and use them to measure the effect on NaCl absorption, which is blocked in almost all diarrheal diseases. They will also upgrade their model to mimic the mechanical forces experienced by the human intestine during the passage of food. Once validated, this model could be used to test new drugs for treating acute diarrhea.

Modelling Human EED and ASD: a Piglet Approach

Marie LewisUniversity of ReadingReading, United Kingdom
Grand Challenges Explorations
Enteric Disease Models
11 Apr 2014

Marie Lewis of the University of Reading in the United Kingdom will establish pig models of environmental enteric dysfunction (EED) and acute secretory diarrhea (ASD) to develop and test new therapeutic approaches. Rodents are commonly used to model human enteropathies, but their physiology is quite different and often therapies that work in rodents fail in humans. Pigs may be a more valuable disease model as their biology is more comparable to humans. Thus, to promote the clinical success of candidate therapies for EED and ASD, they will develop pig models of human enteropathies by abruptly weaning piglets, feeding them a defined diet, and infecting them with an enteric pathogen. Several weeks later, they will analyze nutrition and growth, the extent of gut dysfunction, and metabolic and gut microbial profiles to assess the value of the models and study the effects of these diseases. In the future, these models could be used to screen for new therapies for these and other gastrointestinal diseases.

Improving the Patient Experience in Primary Care Clinics

Kris AnsinMali Health Organizing ProjectCambridge, Massachusetts, United States
Grand Challenges Explorations
Behavior Change
10 Apr 2014

Kris Ansin of the Mali Health Organizing Project in the U.S. will work to improve the use of primary health clinics in Mali by identifying shortcomings in patients' experiences at the clinics and working with staff to address them. They have already discovered that poor patient reception and hospitality strongly deter individuals from using these clinics. They will identify more specific patient concerns and help overcome them by training staff. They will evaluate their approach by measuring patient satisfaction, clinic usage, and health outcomes.

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