Sustainability of donor programs: evaluating and informing the transition of a large HIV prevention program in India to local ownership

Background

Sustainability is the holy grail of many development projects, yet there is limited evidence about strategies that effectively support transition of programs from donor funding to national governments. The first phase of Avahan, the India AIDS Initiative supported by the Bill and Melinda Gates Foundation (2003–2009), aimed to demonstrate an HIV/AIDS prevention program at scale, primarily targeted at high-risk groups. During the second phase (2009–2013), this large-scale program will be transitioned to its natural owners: the Government of India and local communities. This paper describes the evaluation design for the Avahan transition strategy.

Methods/Design

A detailed logic model for the transition was developed. The Avahan transition strategy focuses on three activities: (1) enhancing capacities among communities, non-governmental organizations (NGOs), and government entities, in line with India's national AIDS control strategy; (2) aligning technical and managerial aspects of Avahan programs with government norms and standards; and (3) promoting and sustaining commitment to services for most-at-risk populations. It is anticipated that programs will then transfer smoothly to government and community ownership, become institutionalized within the government system, and support a sustained HIV/AIDS response.The research design evaluates the implementation and effectiveness of (1) activities undertaken by the program; (2) intermediate effects including the process of institutionalization and the extent to which key Avahan organizational procedures and behaviors are integrated into government systems; and (3) overarching effects namely the impact of the transition process on the sustained delivery of HIV/AIDS prevention services to high-risk groups. Both qualitative and quantitative research approaches are employed so that the evaluation will both assess outcomes and explain why they have occurred.

Conclusions

It is unusual for donor-supported projects in low- and middle-income countries to carefully plan transition processes, and prospectively evaluate these. This evaluation is designed so as to both inform decision making throughout the transition process and answer larger questions about the transition and sustainability of donor programs.

Cross section and parity-violating spin asymmetries of W± boson production in polarized p + p collisions at sqrt[s] = 500 GeV

Large parity-violating longitudinal single-spin asymmetries A(L)(e+) = -0.86(-0.14) (+0.30) and A(L)(e-) = 0.88(-0.71) (+0.12) are observed for inclusive high transverse momentum electrons and positrons in polarized p+p collisions at a center-of-mass energy of sqrt[s] = 500 GeV with the PHENIX detector at RHIC. These e± come mainly from the decay of W± and Z0 bosons, and their asymmetries directly demonstrate parity violation in the couplings of the W± to the light quarks. The observed electron and positron yields were used to estimate W± boson production cross sections for the e± channels of σ(pp → W+ X) × BR(W+ → e+ ν(e)) = 144.1 ± 21.2(stat)(-10.3) (+3.4) (syst) ± 21.6(norm)  pb, and σ(pp → W- X) × BR(W- → e- ν[over ¯](e)) = 31.7 ± 12.1(stat)(-8.2) (+10.1) (syst) ± 4.8(norm)  pb.

Transport and metabolism of the antitumour drug candidate 2'-benzoyloxycinnamaldehyde in Caco-2 cells

The transport and metabolism of the antitumour drug candidate 2'-benzoyloxycinnamaldehyde (BCA) was characterized in Caco-2 cells. BCA disappeared rapidly from the donor side without being transported to the receiver side during its absorptive transport across Caco-2 cells. Its metabolites 2'-hydroxycinnamaldehyde (HCA) and o-coumaric acid (OCA) were formed in both the donor and the receiver sides. HCA, in a separate study, also disappeared rapidly from the donor side, mostly being converted to its oxidative metabolite OCA during its absorptive transport across Caco-2 cells. OCA was transported rapidly in the absorptive direction across Caco-2 cells with a P(app) of 25.4 +/- 1.0 x 10(-6) cm s(-1) (mean +/- standard deviation (SD), n = 3). OCA was fully recovered from both the donor and the receiver side throughout the time-course of this study. Formation of HCA from BCA was inhibited almost completely by bis(p-nitrophenyl)phosphate (BNPP), a selective inhibitor of carboxylesterases (CES), and phenylmethylsulfonyl fluoride (PMSF), a broad specificity inhibitor of esterases in Caco-2 cells, suggesting that this hydrolytic biotransformation was likely mediated predominantly by CES. Conversion of HCA to OCA was inhibited significantly by isovanillin, a selective inhibitor of aldehyde oxidase (AO). Inhibitors for xanthine oxidase (XO) and aldehyde dehydrogenase (ALDH), which are known to be involved in the oxidation of aldehydes to carboxylic acids, did not have a significant effect on the biotransformation of HCA to OCA in Caco-2 cells. In summary, the present work demonstrates that BCA is hydrolysed rapidly to HCA, followed by subsequent oxidation to OCA, in Caco-2 cells. The results provide a mechanistic understanding of the poor absorption and low bioavailability of BCA after oral administration.

Effects of green tea extract administration on the pharmacokinetics of clozapine in rats

The pharmacokinetic interaction between clozapine, an atypical antipsychotic with metabolic complications, including weight gain, and green tea consumption has not been evaluated, although green tea is responsible for beneficial effects, including weight reduction, and is widely consumed in the world. Commercial green tea extract (175 mg kg−1) or saline was administered orally for 4 days before the oral administration of clozapine (20 mg kg−1) to rats. Plasma concentrations of clozapine were measured up to 5 h after clozapine administration, and then hepatic CYP1A2 expression and activity were determined. There was no significant difference in the elimination half-life of clozapine between the green tea extract and saline groups. However, the time to reach peak concentration (Tmax) was significantly increased by green tea extract. The mean total area under the plasma concentration-time curve (AUC0-∞) and maximal peak plasma concentration (Cmax) of clozapine in the green tea extract group were significantly lower than those of controls. Green tea extract induced a ∼2-fold increase in hepatic CYP1A2 levels, while the activity increased slightly (by 10% of control). Because of this reduction in AUC and Tmax of clozapine by green tea extract pretreatment, we suggest that both the rate and amount of absorption of clozapine may be reduced by green tea extract, although the hepatic elimination phase may not be significantly altered. Therefore, the clinical implications of the effects of green tea on the bioavailability of clozapine in patients should be further evaluated.

Identification of noncollagenous sites encoding specific interactions and quaternary assembly of alpha 3 alpha 4 alpha 5(IV) collagen: implications for Alport gene therapy

Defective assembly of alpha 3 alpha 4 alpha 5(IV) collagen in the glomerular basement membrane causes Alport syndrome, a hereditary glomerulonephritis progressing to end-stage kidney failure. Assembly of collagen IV chains into heterotrimeric molecules and networks is driven by their noncollagenous (NC1) domains, but the sites encoding the specificity of these interactions are not known. To identify the sites directing quaternary assembly of alpha 3 alpha 4 alpha 5(IV) collagen, correctly folded NC1 chimeras were produced, and their interactions with other NC1 monomers were evaluated. All alpha1/alpha 5 chimeras containing alpha 5 NC1 residues 188-227 replicated the ability of alpha 5 NC1 to bind to alpha3NC1 and co-assemble into NC1 hexamers. Conversely, substitution of alpha 5 NC1 residues 188-227 by alpha1NC1 abolished these quaternary interactions. The amino-terminal 58 residues of alpha3NC1 encoded binding to alpha 5 NC1, but this interaction was not sufficient for hexamer co-assembly. Because alpha 5 NC1 residues 188-227 are necessary and sufficient for assembly into alpha 3 alpha 4 alpha 5 NC1 hexamers, whereas the immunodominant alloantigenic sites of alpha 5 NC1 do not encode specific quaternary interactions, the findings provide a basis for the rational design of less immunogenic alpha 5(IV) collagen constructs for the gene therapy of X-linked Alport patients.

Quantum-well states in Cu/Fe/Cu(111) coupled to the bulk band through the barrier

The quantum-well state (QWS) has been observed on the surface of Cu/Fe/Cu(111). The confinement of the states on the top Cu layers is due to the minority spin barrier of the Fe underlayer. This QWS coexists with the Shockley surface state, which is observed on a clean Cu(111) surface. The resonant behavior of this QWS versus photon energy results from the vertical transition to the unoccupied bulk band, which is possibly due to the coupling between the overlayer Cu and the substrate Cu(111).

Protective effect of oxidative stress in HaCaT keratinocytes expressing E7 oncogene

In a previous study, we established a stable cell line which constitutively expresses E7 in HaCaT human keratinocyte cell line and identified various relevant factors including oxygen modulators affected by the E7 oncogene. E7-expressing HaCaT cells (HaCaT/E7) appeared to be more resistant to H2O2-induced cell death. Here, we demonstrate how E7 oncogene would modulate oxidative stress-induced cell death. In addition, we verified the increased expression of catalase in the HaCaT/E7 by Western blot analysis. The results suggest that the E7 oncogene would induce higher resistance to ROS-induced cell injury in the E7-infected cells via the upregulation of catalase. To investigate these paradoxical effects of high concentrations of H2O2 (500 microM-1 mM), we examined their effects on receptor mediated apoptosis, cell death via the mitochondrial pathway and modulation of apoptosis related factors. Our results revealed that HaCaT keratinocytes infected with HPV 16 E7 oncogene modulated expressions of catalase, Bcl-xL, IL-18, Fas, Bad, and cytochrome c as well as NF-kappaB, resulting in the resistance to oxidative stress-induced cell death.

The alloantigenic sites of alpha3alpha4alpha5(IV) collagen: pathogenic X-linked alport alloantibodies target two accessible conformational epitopes in the alpha5NC1 domain

Anti-glomerular basement membrane (GBM) antibody nephritis is caused by an autoimmune or alloimmune reaction to the NC1 domains of alpha3alpha4alpha5(IV) collagen. Some patients with X-linked Alport syndrome (XLAS) develop post-transplant nephritis mediated by pathogenic anti-GBM alloantibodies to collagen IV chains present in the renal allograft but absent from the tissues of the patient. In this work, the epitopes targeted by alloantibodies from these patients were identified and characterized. All XLAS alloantibodies recognized conformational epitopes in the NC1 domain of alpha5(IV) collagen, which were mapped using chimeric alpha1/alpha5 NC1 domains expressed in mammalian cells. Allograft-eluted alloantibodies mainly targeted two conformational alloepitopes mapping to alpha5NC1 residues 1-45 and 114-168. These regions also encompassed the major epitopes of circulating XLAS alloantibodies, which in some patients additionally targeted alpha5NC1 residues 169-229. Both kidney-eluted and circulating alloantibodies to alpha5NC1 distinctively targeted epitopes accessible in the alpha3alpha4alpha5NC1 hexamers of human GBM, unlike anti-GBM autoantibodies, which targeted sequestered alpha3NC1 epitopes. The results identify two immunodominant alpha5NC1 epitopes as major alloantigenic sites of alpha3alpha4alpha5(IV) collagen specifically implicated in the pathogenesis of post-transplant nephritis in XLAS patients. The contrast between the accessibility of these alloepitopes and the crypticity of autoepitopes indicates that distinct molecular forms of antigen may initiate the immunopathogenic processes in the two forms of anti-GBM disease.

Study of decay mechanisms in B--->Lambdac+ppi- decays and observation of low-mass structure in the Lambdac+p system

Using a sample of 152 x 10(6) BB pairs accumulated with the Belle detector at the KEKB e+e- collider, we study the decay mechanism of three-body charmed decay B- --> Lambdac+ ppi-. The intermediate two-body decay B--->Sigmac (2455)0 p is observed for the first time with a branching fraction of (3.7 +/- 0.7 +/- 0.4 +/- 1.0) x 10(-5) and a statistical significance of 8.4sigma. We also observe a low-mass enhancement in the (Lambdac+p) system, which can be parametrized as a Breit-Wigner function with a mass of (3.35(-0.02)(+0.01) +/-0.02) GeV/c2 and a width of (0.07(-0.03)(+0.04) +/-0.04) GeV/c2. We measure its branching fraction to be (3.9(-0.7)(+0.8) +/- 0.4 +/- 1.0) x 10(-5) with a statistical significance of 6.2sigma. The errors are statistical, systematic, and that of the Lambdac+-->pK- pi+ decay branching fraction.

Loss of alpha3/alpha4(IV) collagen from the glomerular basement membrane induces a strain-dependent isoform switch to alpha5alpha6(IV) collagen associated with longer renal survival in Col4a3-/- Alport mice

Mutations in COL4A3/4/5 genes that affect the normal assembly of the alpha3/4/5(IV) collagen network in the glomerular basement membrane (GBM) cause Alport syndrome. Patients progress to renal failure at variable rates that are determined by the underlying mutation and putative modifier genes. Col4a3(-/-) mice, a model for autosomal recessive Alport syndrome, progress to renal failure significantly slower on the C57BL/6 than on the 129X1/Sv background. Reported here is a novel strain-specific alternative collagen IV isoform switch that is associated with the differential renal survival in Col4a3(-/-) Alport mice. The downregulation or the absence of alpha3/4(IV) collagen chains in the GBM of Lmx1b(-/-) and Col4a3(-/-) mice was found to induce ectopic deposition of alpha5/6(IV) collagen. The GBM deposition of alpha5/6(IV) collagen was abundant in C57BL/6 Col4a3(-/-) mice but almost undetectable in 129X1/Sv Col4a3(-/-) mice. This strain difference was due to overall low expression of alpha6(IV) chain and alpha5/6(IV) protomers in the tissues of 129X1/SvJ mice, a natural Col4a6 knockdown. In (129 x B6)F1 Col4a3(-/-) mice, the amount of alpha5/6(IV) collagen in the GBM was inherited in a mother-to-son manner, suggesting that it is controlled by one or more X-linked loci, possibly Col4a6 itself. Importantly, high levels of ectopic alpha5/6(IV) collagen in the GBM were associated with approximately 46% longer renal survival. These findings suggest that alpha5/6(IV) collagen, the biologic role of which has been hitherto unknown, may partially substitute for alpha3/4/5(IV) collagen. Therapeutically induced GBM deposition of alpha5/6(IV) collagen may provide a novel strategy for delaying renal failure in patients with autosomal recessive Alport syndrome.

Effect of feeding food waste-broiler litter and bakery by-product mixture to pigs

This study was conducted to evaluate the effects of feeding aerobically processed and vacuum-dried food waste-broiler litter and bakery by-product mixture to finishing pigs on performance, carcass characteristics, meat quality and taste panel test. A corn-soy diet (Control) was replaced with food waste mixture (FWM) at dietary levels of 25% (25% FWM) and 50% (50% FWM) on a dry matter (DM) basis. Diets were fed to a total of 45 pigs (mean body weight 69.4kg) during the eight wk of finishing period. After slaughtering, longissmus muscle at 24h postmortem was used for meat quality analysis. Restaurant food waste was high in protein (22.0%) and fat (23.9%). Supplementing a corn-soy diet with FWM increased (P<0.05) feed DM intake, did not alter (P>0.05) average daily gain, decreased (P<0.05) feed efficiency especially for 50% FWM treatment, and substantially reduced (P<0.05) feed cost, compared with feeding a corn-soy diet only. Feeding FWM up to 50% did not affect (P>0.05) carcass characteristics (carcass weight, dressing percentage, backfat thickness and carcass grade), meat fatty acid composition, meat quality (marbling score, pH, water holding capacity, drip loss, L*, a*, b* values, Warner-Bratzler shear force, cooking loss), and taste panel test (flavor, taste, tenderness, juiciness, and overall acceptance) compared with feeding a corn-soy diet. However, meat color was paler (P<0.05) for 50% FWM fed animals than a corn-soy diet fed animals. Meat color was the only limiting factor when FWM was fed to finishing pigs. In conclusion, aerobically processed and vacuum-dried food waste-broiler litter and bakery by-product mixture was similar to a corn-soy diet in feed value for finishing pigs.

Determination of /Vub/ from measurements of the inclusive charmless semileptonic partial rates of B mesons using full reconstruction tags

We present a measurement of the Cabibbo-Kobayashi-Maskawa matrix element /Vub/, based on 253 fb(-1) of data collected by the Belle detector at the KEKB e+ e- asymmetric collider. Events are tagged by fully reconstructing one of the B mesons, produced in pairs from Gamma(4S). The signal for b --> u semileptonic decay is distinguished from the b --> c background using the hadronic mass Mx, the leptonic invariant mass squared q2 and the variable P+ [triple bond] Ex - /px/. The results are obtained for events with p(l)* > or = 1 GeV/c, in three kinematic regions (1) Mx < 1.7 GeV/c2, (2) Mx < 1.7 GeV/c2 combined with q2 > 8 GeV2/c2, and by (3) P+ < 0.66 GeV/c. The matrix element /Vub/ is found to be (4.09 +/- 0.19 +/- 0.20(+0.14) -0.15 +/- 0.18) x 10(-3), where the errors are statistical, systematic including Monte Carlo modeling, theoretical, and from shape function parameter determination, respectively.

Measurements of B decays to two kaons

We report measurements of B meson decays to two kaons using 253 fb(-1) of data collected with the Belle detector at the KEKB energy-asymmetric e+ e- collider. We find evidence for signals in B+ --> K0 K+ and B0 --> K0 K0 with significances of 3.0sigma and 3.5sigma, respectively. (Charge-conjugate modes are included.) The corresponding branching fractions are measured to be [symbol: see text](B+ --> K0 K+) = (1.0 +/- 0.4 +/- 0.1) x 10(-6) and [symbol: see text](B0 --> K0 K0) = (0.8 +/- 0.3 +/- 0.1) x 10(-6). These decay modes are examples of hadronic bd transitions. No signal is observed in the decay B0 --> K+ K-, and we set an upper limit of 3.7 x 10(-7) at 90% confidence level.

Measurement of the wrong-sign decays D0 --> K+ pi- pi0 and D0 --> K+ pi- pi+ pi-, and search for CP violation

Using 281 fb-1 of data from the Belle experiment recorded at or near the (4S) resonance, we have measured the rates of the "wrong-sign" decays D0 --> K+ pi- pi0 and D0 --> K+ pi- pi+ pi- relative to those of the Cabibbo-favored decays D0 --> K- pi+ pi0 and D0 --> K- pi+ pi+ pi-. These wrong-sign decays proceed via a doubly Cabibbo-suppressed amplitude or via D0-D0 mixing; the latter has not yet been observed. We obtain R(WS)(K pi pi0) = [0.229 +/- 0.015(stat)(+0.013)(-0.009)(syst)]% and R(WS)(K3pi) = [0.320 +/- 0.018(stat)(+0.018)(0.013)(syst)]%. The CP asymmetries are measured to be -0.006 +/- 0.053 and -0.018 +/- 0.044 for the K+ pi- pi0 and K+ pi- pi+ pi- final states, respectively.

Measurements of the branching fraction and polarization in B+ --> rho+ K*0 decays

We present the results of a study of the charmless vector-vector decay B+ --> rho+ K*0, based on 253 fb(-1) of data collected with the Belle detector at the KEKB asymmetric-energy e+ e- collider. We obtain the branching fraction B(B+ --> rho+ K*0) = [8.9 +/- 1.7(stat) +/- 1.2(syst)] x 10(-6). We also perform a helicity analysis of the rho and K* vector mesons, and obtain the longitudinal polarization fraction f(L)(B+ --> rho+ K*0) = 0.43 +/- 0.11(stat)(-0.02)(+0.05) (syst).

Improved evidence for direct CP violation in B0-->pi+pi- decays and model-independent constraints on phi2

We present a new measurement of the time-dependent CP-violating parameters in B(0)--> pi(+)pi(-) decays with 275 x 10(6) BB pairs collected with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider operating at the Gamma(4S) resonance. We find 666 +/- 43 B(0) --> pi(+)pi(-) events and measure the CP-violating parameters: S(pipi) = -0.67 +/- 0.16(stat) +/- 0.06(syst) and A(pipi) = +0.56 +/- 0.12(stat) +/- 0.06(syst). We find evidence for large direct CP violation with a significance greater than 4 standard deviations for any S(pipi) value. Using isospin relations, we obtain 95.4% confidence intervals for the Cabibbo-Kobayashi-Maskawa quark-mixing matrix angle phi(2) of 0 degree < phiv(2) < 19 degrees and 71 degrees < phi(2) < 180 degrees.

Studies of CP violation in B-->J/PsiK* decays

CP violation in B-->J/PsiK* decays is studied using an angular analysis in a data sample of 253 fb(-1) recorded with the Belle detector at the KEKB e(+)e(-) collider. The flavor separated measurements of the decay amplitudes indicate no evidence for direct CP violation. T-odd CP violation is studied using the asymmetries in triple product correlations, and the results are consistent with the standard model null predictions. The time-dependent angular analysis gives the following values of CP-violating parameters: sin(2phi(1) = 0.24 +/- 0.31 +/- 0.05 and cos(2phi(1)=0.56 +/- 0.79 +/- 0.11.

Measurement of time-dependent CP-violating asymmetries in B0 --> K(s)0K(s)0K(s)0 decay

We present a measurement of CP-violation parameters in the B0 --> K(s)0K(s)0K(s)0 decay based on a sample of 275 x 10(6) BB pairs collected at the upsilon(4S) resonance with the Belle detector at the KEKB energy-asymmetric e+e- collider. One neutral B meson is fully reconstructed in the decay B0 --> K(s)0K(s)0K(s)0, and the flavor of the accompanying B meson is identified from its decay products. CP-violation parameters are obtained from the asymmetry in the distributions of the proper-time interval between the two B decays: S = +1.26 +/- 0.68(stat) +/- 0.20(syst) and [symbol: see text] = +0.54 +/- 0.34(stat) +/- 0.09(syst).

Observation of B+ --> plambdagamma

We report the first observation of the radiative hyperonic B decay B+ --> plambdagamma, using a 140 fb(-1) data sample recorded on upsilom(4S) resonance with the Belle detector at the KEKB asymmetric energy e+e- collider. The measured branching fraction is [symbol: see text](B+ --> plambdagamma) = (2.16(+0.58)(-0.53) +/- 0.20) x 10(-6). We examine its M(plambda) distribution and observe a peak near threshold. This feature is expected by the short-distance b --> sgamma transition. A search for B+ --> pepsilon0gamma yields no significant signal, and we set a 90% confidence-level upper limit on the branching fraction of [symbol: see textB+ --> pepsilon0gamma <4.6 x 10(-6).

Measurement of the D(s)+ lifetime

A high statistics measurement of the D(s)+ lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis of the two decay modes, D(s)+ --> phi(1020)pi+ and D(s)+ -->K*(892)0K+, used for the measurement. The measured lifetime is 507.4 +/- 5.5(stat) +/- 5.1(syst) fs using 8961 +/- 105 D(s)+ --> phi(1020)pi+ and 4680 +/- 90 D(s)+ --> K*(892)0K+ decays. This is a significant improvement over the present world average.