Visit our poster sessions listed below and/or stop by the URC booth (#208, Hall B1). We’d love to meet you.

The US President’s Emergency Plan for AIDS Relief (PEPFAR)-initiated DREAMS provides a comprehensive, multi-sectoral package of core interventions to address key factors that make girls and young women particularly vulnerable to HIV. These include structural factors, such as gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school. DREAMS applies multiple interventions at once so that adolescent girls and young women (AGYW) receive comprehensive support that keeps them safe from risks, including HIV.

DREAMS Implemented in Uganda

In Uganda, DREAMS is implemented through a collaborative effort between the Government of Uganda, PEPFAR through USAID and DoD program implementers like URC, and local organizations. The partnership focuses on high-burden districts where a large proportion of existing HIV/AIDS clients are AGYW. DREAMS provides educational support, economic empowerment, and health services to AGYW in these districts. Working with the Uganda Peoples’ Defence Forces (UPDF), URC supports the Mubende and Gulu military health facilities to implement DREAMS as part of the DoD Uganda URC Project.

Providing More Support to the Most Vulnerable

Aloyo was among 172 AGYW enrolled at Gulu Military Hospital who received the DREAMS comprehensive package. After further assessment, Aloyo and 56 other beneficiaries were identified as critically vulnerable. These participants were trained in vocational skills for three additional months – 33 in tailoring, 10 in hair dressing, six in baking, and four each in knitting and catering.

These AGYW also participated in trainings, which included financial literacy sessions which included discussions on the advantages of joining Village Savings and Loan Association (VSLA) schemes. Aloyo joined a savings group that has helped her to gain financial stability.

A Change in Course Towards Self-Sufficiency and Wellbeing

Aloyo’s newly acquired skills led her to a new career. “After three months of vocational skilling in catering and bakery, I applied for a position at Acholi Inn Hotel Limited. To my surprise, I was chosen from among the four selected from a pool of nine applicants. DREAMS has transformed my life in ways I never imagined,” she said.

Her journey is a testament to the resilience of girls and women when they have access to tools, resources, and support that contribute to their self-sufficiency and wellbeing. Aloyo’s story is one of countless seen in DREAMS’ graduates, and one where empowerment is only the beginning of a woman’s promising future.

Ersin Topcuoglu

Senior Portfolio Director, Asia, Middle East, & Northern Africa Programs

The expanded use of ultraportable AI-assisted X-ray, coupled with molecular diagnostic tools to screen, test, and diagnose TB in community settings, is changing the global TB response and the patient care experience.

Fundamentally, these technologies bring TB screening, testing, and treatment initiation to the patient. 

This has immense implications in the case of drug-resistant (DR) TB. Before ultraportable X-ray and bacteriological testing using Truenat or GeneXpert became available, presumptive DR-TB patients would need to make multiple visits to a diagnostic center for further testing, diagnosis, and treatment initiation.

A Difficult Path to Care

Many patients face significant barriers to seeking care: distance from diagnostic centers, transportation challenges including difficulty accessing and paying for transportation, coupled with their dependency on their daily wages for survival. Their halted access to care, diagnosis, and appropriate treatment has broad implications – a large number of undiagnosed DR-TB cases allows the disease to run rampant in communities. TB mortality rates also increase due to the insufficient diagnosis and inadequate treatment of many DR-TB patients.

Bringing the Point of Care Home

Ultraportable AI-driven X-ray coupled with Truenat or GeneXpert opens opportunities for individuals with DR-TB to receive point-of-care testing, diagnosis, and treatment initiation. The point of care for these patients is no longer confined to health centers; national TB programs can effectively bring services to the people, eliminating many of the barriers and burdens of seeking care.

We can improve the quality of care for DR-TB patients while addressing one of the three pillars of the Global Plan to End TB 2020-2030 – zero catastrophic cost to the patient. Approximately half of the catastrophic costs experienced by patients are incurred before diagnosis. With community-based screening, testing, and diagnosis, these catastrophic costs can be mostly eliminated.

Following initiation on treatment, ongoing treatment can be monitored by family members, trained patient supporters living in the same geographic area, or through distant support mechanisms such as video directly observed therapy (vDOT). All these mechanisms maintain the patients’ treatment at the community level, further eliminating catastrophic costs associated with DR-TB treatment.

Breaking the Transmission Chain

The main goal of TB control is to break the infection transmission chain. Point-of-care screening, testing, and diagnosis of drug-sensitive and DR-TB in high burden settings is an effective intervention for finding and treating all people with TB and preventing them from infecting others. Ultraportable AI-driven X-ray coupled with a molecular diagnostic test makes this goal achievable.

The award recognizes companies with overall outstanding achievement in stability, contingency, disaster, or recovery operations.

“Despite very real, often very dangerous working and living conditions, our team in Mali continues to deliver the goals and objectives identified by USAID that are necessary to improve the health and wellbeing of thousands of Malian villagers,” said Earl Gast, URC president. “I am honored to represent them and our people around the world working under similar threats to personal and professional security.”

Keneya Nieta directly supports USAID’s countering violent extremism (CVE)/preventing violent extremism (PVE) strategy by connecting vulnerable communities to critical services – specifically, to health care. Working in 4,000 villages across the regions of Mopti, Segou, and Sikasso, URC is improving community health in close partnership with community health platforms, reaching more than 7 million people with critical health care in 2023. This was achieved without loss of life.

Working at the community-level has not been easy, with more than 140 villages targeted by Keneya Nieta considered non-secure or at higher risk due to the presence of hostile armed groups. Local leaders have been threatened and community members displaced, and military operations are ongoing in many villages.

Despite these challenges, URC continues to make progress. Local financial management and health planning improved with increasing awareness about village solidarity funds, resulting in nearly $700,000 in funds raised. These funds cover 90% of operating villages and have supported 26,343 pregnant women and 207,907 children to access essential care services to date. More than 357,500 people were reached through family planning (FP) outreach, resulting in over 40,000 new users of FP services.

URC was the only international development company that received the Vanguard Award this year.

In URC’s nearly 60-year history implementing global health and development projects, it has successfully initiated, maintained, and adapted operations in fragile and conflict settings to ensure delivery of quality health care for all, including marginalized populations.

“ISOA would like to congratulate URC for its ISOA Global Impact Vanguard Award,” said Howie Lind, president and executive director of ISOA. “This project demonstrates how URC has successfully initiated, maintained and adapted operations in fragile conflict settings to ensure delivery of quality health care.”

The Ministry of Health Guidelines for the Prevention and Treatment of HIV and AIDS in Uganda (2022) recommend cervical cancer screening for WLHIV using human papillomavirus (HPV) testing. If HPV testing is not available, screening with visual inspection with acetic acid (VIA) or Pap smear is recommended.

The PEPFAR-funded Department of Defense HIV/AIDS Prevention Program Uganda (DoD Uganda URC Project) supported the successful accreditation of 12 military health facilities to provide cervical cancer screening and treatment services.

Aida Nambuusi, a registered midwife at the Uganda National Defense Force (UPDF)’s 2^nd Division Mbarara Military Hospital, is among the 52 healthcare workers trained by URC to provide cervical cancer screening services to WLHIV.

Prior to her training, Aida shared, “I used to feel incompetent, but the training opened my eyes. I gained confidence to carry out these services and provide quality screening to mothers.”

Through URC’s comprehensive training initiatives, Aida’s insecurities were transformed into confidence. The social and behavior change communications materials introduced in the training quickly became her guide, offering detailed procedures that not only kept her updated on the latest cervical cancer screening guidelines but also improved her skills in practice.

Thanks to tools and job aids for cervical cancer screening, Aida now confidently and accurately manages data, ensuring efficient follow-ups and timely screenings for her patients.

Community Outreach Engages Local Communities to Improve Screening Uptake

URC supports community outreach in Uganda making it easier for women to access screening services, and continuous health education efforts have shifted attitudes towards cervical cancer screening. Public speakers on local radios and engagement with Village Health Teams (VHTs) empower community engagement in cervical cancer screening campaigns.

“Women living with HIV now turn up willingly because they understand the importance of screening for their health,” Aida shared.

“When I was screened for cancer, I was told I don’t have cancer and was informed to return after some years. The procedure was not painful at all, and I encourage other women to take up the service,” Babirye, a beneficiary at 2^nd Division, Mbarara mentioned.

“It’s good to know your status and the procedure for screening was not painful. It was quick and the procedure did not take long,” Beatrice said about her experience.

Since URC supported this cervical cancer initiative, Aida has noticed positive changes in her community, with more WLHIV seeking screening. From October 2020 to October 2023, the 31 URC-supported UPDF health facilities have screened 7,325 WLHIV – 72% of the 10,188 WLHIV who received care from those facilities in that time period. A total of 862 women had abnormal results, with 96.3% of these women receiving treatment for precancerous lesions per national guidelines. The remaining 3.7% of these women were diagnosed with cervical cancer and referred to oncology services for further management.

URC continues to work to improve uptake of cervical cancer screening by WLHIV, and the results achieved to date are promising. UPDF, with URC’s support, is achieving comprehensive screening and appropriate cervical cancer treatment for all WLHIV in the project’s target areas.

Dennis Carroll

Chief Scientist

Avian Influenza is back, and the world largely is yawning, but we should be alarmed. This highly pathogenic avian influenza H5N1 virus was first reported in Hong Kong in 1997. As an avian virus, it is highly transmittable among poultry and lethal: it kills 100% of the poultry infected. As an immediate threat to humans, however, it is very limited as it lacks the genetic coding that would enable efficient human infections, but on the occasions that humans have been infected it has proven to be extraordinarily lethal, killing more than 50% of those infected.

By comparison, the SARS-COV2 virus (COVID-19) killed less than 0.1% of those it infected. As an influenza virus, H5N1 belongs to the family of viruses that have caused some of the most devastating pandemics in history, most notoriously being the 1918 pandemic that killed an estimated 50-100 million people worldwide.

The scientific community understands that only a handful of mutations are required in the H5N1 virus to transform it into a more infectious agent, like the seasonal flu, which moves easily from person to person. Allowing the virus to spread uncontrolled through poultry, with the occasional human infections, was a recipe for equally uncontrolled mutations elevating the risk of the H5N1 becoming a truly pandemic virus unparalleled in human history.

Swift Coordination Made the Difference in 2005

In 2005, the H5N1 virus began spreading rapidly from Asia, across the Middle East, and into Europe and Africa, killing hundreds of millions of poultry and dramatically raising worldwide concerns. The global response was equally dramatic and swift. A global coalition, with significant leadership from the U.S., quickly deployed resources and personnel to bring the spread of the virus under control. USAID and the program that I ran at the time, the Emerging Threats Program, played a significant role in building systems and capacities in more than 50 countries to bring this threat under control.

By 2007, the number of countries infected with this virus had dropped from a high of more than 65 countries to fewer than seven, mostly in Asia. Widespread use of enhanced biosecurity measures on farms and the availability of a highly effective H5N1 poultry vaccine dramatically reduced the global threat from this virus. The Emerging Threats program continued to support efforts to control the virus in the few countries where it continued to circulate. The program also monitored for any changes in its epidemiology or genetic profile that could signal a renewed threat. The world breathed a collective sigh of relief.

With All Eyes on COVID-19, H5N1 Spreads

Fast forward to 2020. With much attention focused on SARS COV2 (the COVID-19 virus), the H5N1 virus once again began spreading uncontrollably. In 2022 a strain of H5N1 caused an outbreak in farmed mink in Spain, and in 2023 farms in Finland reported infections in mink, foxes, raccoon dogs, and their crossbreeds. On both occasions the outbreaks signaled that the virus was not only spreading but had evolved to infect mammal populations. In the summer of 2022 outbreaks among harbor and gray seals in eastern Quebec and on the coast of Maine signaled the virus for the first time has spread into North America. Brazil reported their first H5N1 outbreaks in 2023, indicating the virus was now widely distributed on virtually every continent.

The sense of urgency and global solidarity that had characterized the response in 2005 was absent. On March 25 of this year the H5N1 saga took on an even more alarming twist – a multistate outbreak of H5N1 bird flu was reported in dairy cows and on April 1 the U.S. Centers for Disease Control and Prevention (CDC) confirmed the first H5N1 human infection in a person with exposure to dairy cows. Since then, H5N1 infections of dairy cows have been confirmed at more than 80 farms in nine states (as of June 5) with four confirmed human cases.

We Don’t Know What We Don’t Know about H5N1

This, unfortunately, is likely the tip of the iceberg. The domestic surveillance for H5N1 being mounted by CDC and the U.S. Department of Agriculture (USDA) is fragmented and largely based on voluntary reporting. There has been only scant monitoring for genetic changes in the virus that could signal greater risk to humans. And the sharing of viral sequences collected from cows is moving at an alarmingly slow pace. We don’t know how widely distributed this virus is among U.S. dairy herds and dairy workers.

Even more alarmingly, there appears to be no significant monitoring of farm pigs, either domestically or internationally, for possible infections by H5N1. This is of particular concern because pigs, unlike cows, are also host to the very influenzas that infect us every flu season. Were the H5N1 virus to infect a pig that is co-infected with a seasonal flu (i.e. H1N1 or H3N2) that has the genetic profile that enable high transmissibility among humans, there is a very real possibility that through the exchange of genetic material between the different viruses – a common phenomenon known as “gene swapping” – the H5N1 virus could acquire the very profile that would make it a highly infectious threat to humans. Were this to happen the COVID-19 pandemic would look like a garden party.

If there’s one lesson we should have learned from the COVID-19 pandemic, it’s the importance of timely and comprehensive surveillance and the essential requirement for global coordination. The global spread of the H5N1 virus and its steady march to diversify its host species signals the real possibility that sooner than later the virus will acquire the necessary mutation to wreak havoc among human populations. As has been repeated many times, a threat anywhere is a threat everywhere. In 2005, it was the combination of surveillance and coordination that enabled the successful control of the virus. It was the absence of these two features which led to the devastation of COVID-19.

Work Together or Risk the Consequences

The fragmentation of global politics and the lack of urgency are only elevating the risks of H5N1 emerging as the next and far more deadly pandemic virus. The U.S. urgently needs to overhaul its domestic monitoring of the virus by CDC and USDA to ensure a timely and transparent monitoring across all livestock and high-risk human populations, as well as the real time sharing of genetic data

And, as the U.S. did in 2005, it needs to galvanize a global effort to bring this threat under control, with leadership from USAID. We’ve seen the success when coordinated action is taken and the consequences when it is not. The world must stop yawning, it’s time to wake up and act. The next pandemic may not be as forgiving as the last.

Eckhard Kleinau

Director, Research and Evaluation

A recent randomized controlled trial (RCT) led by Dr. Eckhard Kleinau, Director, Research and Evaluation, URC, evaluated the effectiveness of the chatbot Vitalk in improving the mental wellbeing of health workers in Malawi during the COVID-19 pandemic. The study involving 1,584 participants from various healthcare facilities revealed significant improvements in mental health outcomes for those using the chatbot.

Study Overview

The trial compared Vitalk, an interactive chatbot, with passive internet resources in reducing symptoms of depression, anxiety, burnout, and loneliness while enhancing resilience. Participants were randomly assigned to either the treatment group using Vitalk or the control group accessing internet resources.

Mental Health Crisis Among Health Workers

The pandemic has exacerbated mental health issues among healthcare professionals worldwide. In Malawi, limited mental health services led to acute problems for accessing treatment, with only 0.02 psychologists and 0.01 psychiatrists per 100,000 people. This study highlights the urgent need for innovative mental health interventions in low-resource settings.

Key Findings

Results showed that Vitalk significantly improved mental health and resilience outcomes compared to the control group. Key findings include:

• Depression: Participants using Vitalk reported a significant reduction in depression symptoms.
• Anxiety: The chatbot also reduced anxiety levels.
• Burnout: There was a trend toward reducing burnout, though not statistically significant.
• Resilience: Users of the chatbot exhibited greater improvements in resilience and resilience-building activities.

Participant Engagement

Engagement with the Vitalk app was high, with participants interacting with the chatbot an average of 92 times over the study period. In contrast, the control group accessed the provided web resources infrequently. The high engagement levels with Vitalk highlight the potential of digital interventions to maintain user interest and deliver consistent mental health support.

Conclusion

This trial demonstrates that interactive chatbots like Vitalk can effectively improve the mental wellbeing of health workers, especially in low-resource settings. Significant reductions in depression, anxiety, and burnout, along with enhanced resilience, suggest that digital interventions could be crucial in addressing the mental health crisis among healthcare professionals exacerbated by the COVID-19 pandemic.

Renovations Expand Space for Quality HIV Service Provision 

To improve clinic infrastructure of UEDF HIV clinics, the DoD Eswatini URC Project, PEPFAR DoD, and UEDF identified four priority clinics with rudimentary infrastructure and inadequate space to provide comprehensive HIV/AIDS services: the UEDF clinics at Nkoyoyo, Garrison, Mlindazwe, and Gcina Barracks.  

The project worked alongside UEDF both on the redesign and renovation of the clinics.  

At Nkoyoyo, Garrison, and Mlindazwe barracks, the project brought in prefabricated buildings known as “park homes” – each containing 15-rooms to expand the clinics’ available space. The project also remodeled the two-room structure at Gcina and expanded it to seven rooms.  

Clinic Resource Expansion and Accreditation 

Prior to the accreditation and handover of the newly renovated and remodeled clinics, the project ensured the clinics had trained personnel to support the increased service capacity. This included HIV testing service counselors, nurses, psychologists, military paramedics, and peer educators. The project also ensured the clinics had functioning electricity and potable water, sanitary facilities, along with the necessary equipment, supplies, and commodities.  

Once these essential resources were in place, the project supported the UEDF to obtain Ministry of Health accreditation of the sites to provide HIV/TB comprehensive care. 

Engaging the Community for HIV Service Uptake 

A comprehensive effort to support the renovations in partnership with UEDF – coupled with community mobilization activities – contributed to the remarkable increase in uptake of services by UEDF service members, their families, and surrounding communities. 

Improved Client Satisfaction and Care Quality 

The larger clinic structures now have sufficient space for private counseling and exam rooms, basic laboratory services, and pharmacy services. The infrastructure improvements allowed for the expansion of HIV/AIDS services, improved quality of services, and increased human resources at each site, benefiting the military personnel, their families, and the communities around them. 

The implemented customer feedback program has placed suggestion boxes at each site. To date, more than 90% of the feedback shows a high level of client satisfaction. The clients mainly cite excellent healthcare services from clinic staff as the standout feature.   

As one client at the Garrison clinic shared, “I was not comfortable coming to this clinic because there was no privacy. But now, I’m happy that I can receive care in a private, clean, and decent space, and the nurses are very friendly.” 

Investing in Health Workers’ Wellbeing for Sustainable, Quality Services 

In 2023, URC renovated the old structure which provided staff accommodations at the Phocweni Clinic. The building posed a health risk due to the presence of asbestos and lacked adequate space to house the increased number of health workers at the clinic.  

The renovation was a collaborative effort. The UEDF Combat Unit led the renovations. The Microprojects Unit of the Ministry of Economic Planning provided a structural and renovation engineer for technical support. The PEPFAR DoD Program Manager and URC provided procurement of materials, management oversight, and technical support throughout the renovation project.  

In April 2024, Caitlin Piper, U.S. Chargé d’affaires and DHAPP Branch Chief, Dr. Michael Grillo, officially handed over the newly renovated and expanded staff housing building to the UEDF and the Eswatini government. The renovated housing, which increased the quality and quantity of available accommodations, offers the opportunity for more health officers to reside within a short distance of their workplace, increasing their ability to serve clients in urgent and emergency situations and improving the overall quality of the client experience.

The impact of the CBDR program under Karen’s stewardship has been profound. In 2023 alone, her efforts led to over 300 people enrolling in the program, with a remarkable completion rate of over 90%. Her dedication not only brings healing to individuals and families but also strengthens the entire community’s health system. Karen was honored with the Health Service Achiever award for her exceptional service and affirming her pivotal role in Alangalang’s recognition for outstanding anti-drug abuse efforts. Behind every thank you message from grateful families lies Karen’s unwavering commitment to fostering recovery and resilience. Her story is a beacon of hope and a testament to the power of dedicated health service professionals in changing lives.

URC was honored with the Bell Seal at the Gold level for exceeding workplace standards that promote positive worker mental health and wellbeing, an acknowledgment of the company’s commitment to embracing and advancing best practices to promote mental health in all work environments.

The certification process includes a rigorous evaluation of policies and practices in four areas: workplace culture, benefits, compliance, and wellness. URC excelled in compliance by securing a score of 100 percent and culture by securing a score of 97 percent.

“This award recognizes the value we place on our employees’ wellbeing and the successful efforts we’ve made to enact those values,” said Robin Goebel, URC Vice President of Human Resources. “It’s a great day when we can humbly demonstrate our respect for our staff and how deeply we care for them.”

Bell Seal recipients represent over 28 industries – from health care and the public sector to financial services and manufacturing – and organizational sizes, from three to more than 1 million workers, in 35 states.

The Bell Seal is both a celebration and a call to action. It challenges employers to meaningfully improve the lives of employees, elevating mental health as a key component of organizational strategy.

“A recognition at any level – Bronze, Silver, Gold, or Platinum – means your organization is doing an excellent job of aligning your wellness investments with topline industry best practices,” said Schroeder Stribling, president and CEO, Mental Health America.