A D Harries

International Union Against Tuberculosis and Lung Disease (The Union), Lutetia Parisorum, Île-de-France, France

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Publications (435)2024.92 Total impact

  • Public Health Action. 03/2014;
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    ABSTRACT: In the Somali Regional State, Ethiopia, where most of the population are pastoralists, conventional TB treatment strategies based on directly observed treatment (DOT) at health facilities are not adapted to the mobile pastoralist lifestyle and treatment adherence is poor. From a rural district, we report on treatment outcomes of a modified self-administered treatment (SAT) strategy for pastoralists with TB. A descriptive cohort study was carried out between May 2010 and March 2012. The modified DOT strategy comprised a shorter intensive phase at the health facility (2 weeks for new patients, 8 weeks in the event of re-treatment), followed by self-administered TB treatment. A total of 390 patients started TB treatment. The overall treatment success rate was 81.2% (317/390); the rates of death, loss-to-follow up and treatment failure were 6.7% (26/390), 9.2% (36/390) and 0.3% (1/390) respectively. A considerable proportion (10/26, 38%) of deaths occurred during the first month of treatment. In a pastoralist setting, a modified SAT strategy resulted in good treatment outcomes. If the global plan to eliminate TB by 2050 is to become a reality, it will be necessary to adapt TB services to client needs to ensure that all TB patients (including pastoralists) have access to TB treatment.
    International Health 03/2014; · 1.01 Impact Factor
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    ABSTRACT: We assessed the HIV-positive yield of offering provider-initiated HIV testing and counselling (PITC) for TB and the costs, in Madagascar, which has a low HIV prevalence and a high TB burden. A cross-sectional study of routinely collected records from January 2010 to June 2011. A total of 37 596 TB patients were registered in 205 TB centres. HIV testing was available in 95 (46%) of centres where 7524 (40%) of those offered testing accepted it. Only 35 (0.5%) individuals were found HIV positive. Initial costs were about US$1.4 million and annual recurrent costs about US$0.1 million. There are concerns of cost investment for countrywide introduction of PITC in a low HIV prevalence setting.
    Transactions of the Royal Society of Tropical Medicine and Hygiene 01/2014; · 1.82 Impact Factor
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    ABSTRACT: Rifampicin and protease inhibitors are difficult to use concomitantly in patients with HIV-associated tuberculosis because of drug-drug interactions. Rifabutin has been proposed as an alternative rifamycin, but there is concern that the current recommended dose is suboptimal. The principal aim of this study was to compare bioavailability of two doses of rifabutin (150 mg three times per week and 150 mg daily) in patients with HIV-associated tuberculosis who initiated lopinavir/ritonavir-based antiretroviral therapy in Vietnam. Concentrations of lopinavir/ritonavir were also measured. This was a randomized, open-label, multi-dose, two-arm, cross-over trial, conducted in Vietnamese adults with HIV-associated tuberculosis in Ho Chi Minh City (Clinical trial registry number NCT00651066). Rifabutin pharmacokinetics were evaluated before and after the introduction of lopinavir/ritonavir -based antiretroviral therapy using patient randomization lists. Serial rifabutin and 25-O-desacetyl rifabutin concentrations were measured during a dose interval after 2 weeks of rifabutin 300 mg daily, after 3 weeks of rifabutin 150 mg daily with lopinavir/ritonavir and after 3 weeks of rifabutin 150 mg three times per week with lopinavir/ritonavir. Sixteen and seventeen patients were respectively randomized to the two arms, and pharmacokinetic analysis carried out in 12 and 13 respectively. Rifabutin 150 mg daily with lopinavir/ritonavir was associated with a 32% mean increase in rifabutin average steady state concentration compared with rifabutin 300 mg alone. In contrast, the rifabutin average steady state concentration decreased by 44% when rifabutin was given at 150 mg three times per week with lopinavir/ritonavir. With both dosing regimens, 2 - 5 fold increases of the 25-O-desacetyl- rifabutin metabolite were observed when rifabutin was given with lopinavir/ritonavir compared with rifabutin alone. The different doses of rifabutin had no significant effect on lopinavir/ritonavir plasma concentrations. Based on these findings, rifabutin 150 mg daily may be preferred when co-administered with lopinavir/ritonavir in patients with HIV-associated tuberculosis. ClinicalTrials.gov NCT00651066.
    PLoS ONE 01/2014; 9(1):e84866. · 3.73 Impact Factor
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    ABSTRACT: In a primary healthcare clinic in Jordan to determine: (i) treatment outcomes stratified by baseline characteristics of all patients with diabetes mellitus (DM) ever registered as of June 2012 and (ii) in those who failed to attend the clinic in the quarter (April-June 2012), the number who repeatedly did not attend in subsequent quarters up to 1 year later, again stratified by baseline characteristics. A retrospective cohort study with treatment outcome data collected and analysed using e-health and the cohort analysis approach in UNRWA Nuzha Primary Health Care Clinic for Palestine refugees, Amman, Jordan. As of June 2012, there were 2974 patients with DM ever registered, of whom 2246 (76%) attended the clinic, 279 (9%) did not attend, 81 (3%) died, 67 (2%) were transferred out and 301 (10%) were lost to follow-up. A higher proportion of males and patients with undetermined or poor disease control failed to attend the clinic compared with those who attended the clinic. Of the 279 patients who did not attend the clinic in quarter 2, 2012, 144 (52%) were never seen for four consecutive quarters and were therefore defined as lost to follow-up. There were a few differences between patients who were lost to follow-up and those who re-attended at another visit that included some variation in age and fewer disease-related complications amongst those who were lost to follow-up. This study endorses the value of e-health and cohort analysis for monitoring and managing patients with DM. Just over half of patients who fail to attend a scheduled quarterly appointment are declared lost to follow-up 1 year later, and systems need to be set up to identify and contact such patients so that those who are late for their appointments can be brought back to care and those who might have died or silently transferred out can be correctly recorded.
    Tropical Medicine & International Health 01/2014; · 2.94 Impact Factor
  • Tropical Medicine & International Health 01/2014; 19(1). · 2.94 Impact Factor
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    ABSTRACT: Atypical environmental conditions with drought followed by heavy rainfall and flooding in arid areas in sub-Saharan Africa can lead to explosive epidemics of malaria, which might be prevented through timely vector-control interventions. Wajir County in Northeast Kenya is classified as having seasonal malaria transmission. The aim of this study was to describe in Wajir town the environmental conditions, the scope and timing of vector-control interventions and the associated resulting burden of malaria at two time periods (1996-1998 and 2005-2007). This is a cross-sectional descriptive and ecological study using data collected for routine program monitoring and evaluation. In both time periods, there were atypical environmental conditions with drought and malnutrition followed by massive monthly rainfall resulting in flooding and animal/human Rift Valley Fever. In 1998, this was associated with a large and explosive malaria epidemic (weekly incidence rates peaking at 54/1,000 population/week) with vector-control interventions starting over six months after the massive rainfall and when the malaria epidemic was abating. In 2007, vector-control interventions started sooner within about three months after the massive rainfall and no malaria epidemic was recorded with weekly malaria incidence rates never exceeding 0.5 per 1,000 population per week. Did timely vector-control interventions in Wajir town prevent a malaria epidemic? In 2007, the neighboring county of Garissa experienced similar climatic events as Wajir, but vector-control interventions started six months after the heavy un-seasonal rainfall and large scale flooding resulted in a malaria epidemic with monthly incidence rates peaking at 40/1,000 population. In conclusion, this study suggests that atypical environmental conditions can herald a malaria outbreak in certain settings. In turn, this should alert responsible stakeholders about the need to act rapidly and preemptively with appropriate and wide-scale vector-control interventions to mitigate the risk.
    PLoS ONE 01/2014; 9(4):e92386. · 3.73 Impact Factor
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    ABSTRACT: The aim of this study was to use E-Health to report on 12-month, 24-month and 36-month outcomes and late-stage complications of a cohort of Palestine refugees with diabetes mellitus (DM) registered in the second quarter of 2010 in a primary healthcare clinic in Amman, Jordan. Retrospective cohort study with treatment outcomes censored at 12-month time points using E-Health in UNRWA's Nuzha Primary Health Care Clinic. Of 119 newly registered DM patients, 61% were female, 90% were aged ≥40 years, 92% had type 2 DM with 73% of those having hypertension and one-third of patients were newly diagnosed. In the first 3 years of follow-up, the proportion of clinic attendees decreased from 72% to 64% and then to 61%; the proportion lost to-follow-up increased from 9% to 19% and then to 29%. At the three time points of follow-up, 71-78% had blood glucose ≤180 mg/dl; 63-74% had cholesterol <200 mg/dl; and about 90% had blood pressure <140/90 mmHg. Obesity remained constant at 50%. The proportion of patients with late-stage complications increased from 1% at baseline to 7% at 1 year, 14% at 2 years and 15% at 3 years. Nuzha PHC Clinic was able to monitor a cohort of DM patients for 3 years using E-Health and the principles of cohort analysis. This further endorses the use of cohort analysis for managing patients with DM and other non-communicable diseases.
    Tropical Medicine & International Health 12/2013; · 2.94 Impact Factor
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    ABSTRACT: SETTING: Six primary health care clinics in Jordan, serving Palestine refugees diagnosed with diabetes mellitus (DM). OBJECTIVES: To report on the number and characteristics of new DM patients registered in the second quarter of 2013 and of all DM patients ever registered by 30 June 2013, with treatment outcomes and cumulative burden of late-stage complications. DESIGN: A descriptive cohort study using routine data collected through e-Health. RESULTS: Of the 288 new patients in Q2 2013 and 12 548 patients ever registered with DM by 30 June 2013, smoking, physical inactivity and obesity were recorded in 19%, 50% and 47%, respectively. In Q2 2013, 9740 (78%) patients attended a clinic, with >99% having undergone disease control measures: of these, 72% had postprandial blood glucose ≤ 180 mg/dl, 71% had blood cholesterol < 200 mg/dl, 82% had blood pressure < 140/90 and 40% had body mass index < 30 kg/m2. Late-stage complications were present in 1130 (11.6%) patients who attended a clinic, with cardiovascular disease and stroke being the most common. Several differences in outcomes were found between males and females. CONCLUSION: There is a high burden of disease due to DM at primary health care clinics in Jordan. Cohort analysis using e-Health is a vital way to assess management and follow-up.
    Public Health Action. 12/2013; 3(4):259-264.
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    ABSTRACT: In Benin, patients with smear-negative pulmonary TB (SNPTB) are of low priority in the National Tuberculosis Programme (NTP) and little is known about their profile or treatment outcomes. A retrospective cohort study was carried out to determine characteristics and treatment outcomes in all adults registered with SNPTB in 2009. Findings were compared with patients with new smear-positive pulmonary tuberculosis (PTB) diagnosed in the same period. Of 3140 patients with PTB, 273 (8.7%) had SNPTB, with higher rates in northern and southwestern regions. SNPTB was associated with female gender, older age and HIV-positive status (p<0.01). Patients with SNPTB had a higher proportion of unsuccessful treatment outcomes compared with smear-positive PTB owing to death and loss to follow-up (LFU) (p<0.01). The region with the capital city had the highest rate of LFU. Differences in unsuccessful outcomes between SNPTB and smear-positive PTB were more apparent in persons who were HIV-negative, and among HIV-positives not on antiretroviral treatment. In Benin, treatment outcomes of SNPTB patients were inferior to those with smear-positive PTB, with LFU being a major problem. The Benin NTP needs to better address the problem of patients with SNPTB in terms of monitoring and reporting, treatment management including that associated with HIV care, and reducing LFU.
    Transactions of the Royal Society of Tropical Medicine and Hygiene 11/2013; · 1.82 Impact Factor
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    ABSTRACT: The global burden of diabetes mellitus (DM) is immense, with numbers expected to rise to over 550 million by 2030. Countries in Asia, such as India and China, will bear the brunt of this unfolding epidemic. Persons with DM have a significantly increased risk of developing active tuberculosis (TB) that is two to three times higher than in persons without DM. This article reviews the epidemiology and interactions of these two diseases, discusses how the World Health Organization and International Union Against Tuberculosis and Lung Disease developed and launched the Collaborative Framework for the care and control of TB and DM, and examines three important challenges for care. These relate to 1) bi-directional screening of the two diseases, 2) treatment of patients with dual disease, and 3) prevention of TB in persons with DM. For each area, the gaps in knowledge and the priority research areas are highlighted. Undiagnosed, inadequately treated and poorly controlled DM appears to be a much greater threat to TB prevention and control than previously realised, and the problem needs to be addressed. Prevention of DM through attention to unhealthy diets, sedentary lifestyles and childhood and adult obesity must be included in broad non-communicable disease prevention strategies. This collaborative framework provides a template for action, and the recommendations now need to be implemented and evaluated in the field to lay down a firm foundation for the scaling up of interventions that work and are effective in tackling this dual burden of disease.
    Public Health Action. 11/2013; 3(S):S3–S9.
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    ABSTRACT: Setting: Seventeen peripheral health institutions (PHI) in Kolar district (population: 0.5 million), South India. Objective: To assess the feasibility and results of screening patients with tuberculosis (TB) for diabetes mellitus (DM) at peripheral level. Design: From January to September 2012, all TB patients were assessed for DM. Those with unknown DM status were screened for the disease (free of charge) by trained laboratory technicians at each PHI, using a glucometer supplied by the national programme on a capillary blood sample. Those with fasting blood glucose (FBG) ⩾ 126 mg/dl (⩾7 mM) were diagnosed as DM-positive. Results: Of 362 TB patients, 358 (99%) were assessed for DM and 62 (17.1%) had the diseases—53 (14.6%) had a previous history of DM and 9 (2.9%) were newly diagnosed. All new DM patients were enrolled into DM care. Higher DM prevalence was found among TB patients aged ⩾40 years, smokers and those with smear-positive pulmonary TB. To detect a new case of DM, the number needed to screen (NNS) among TB patients was 40. Conclusion: Screening of TB patients for DM was feasible and effective in a peripheral setting. The availability of trained laboratory technicians and free services at e very PHI made the intervention feasible. The study has contributed towards a national policy decision in this regard.
    Public Health Action. 11/2013; 3(S):S34–S37.
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    ABSTRACT: In 2011, Malawi initiated an ambitious program for the prevention of maternal to child transmission (PMTCT) of HIV, called 'Option B+,' which employs a universal test and life-long treatment strategy for all pregnant women. Priority setting should take place in defining a national research agenda for evaluating Option B + rollout in Malawi. In April 2011, a three-day workshop took place for all major stakeholders in PMTCT aiming to provide an update on current PMTCT operational research in Malawi, find consensus on key questions not yet being addressed, identify opportunities for collaboration, and develop multi-partner research proposals. Overall, 24 participants attended the workshop including representatives from the Ministry of Health, the National AIDS Commission and 12 multilateral, non-governmental organizations and academic partners.Three interrelated clusters emerged as priorities for research: i) pregnancy intentions and family planning needs; ii) evaluation of models of care; and iii) determinants of uptake, adherence, and retention of women for Option B+. In addition, two cross-cutting themes arose: partner involvement in PMTCT services and cost-effectiveness as a guide to priority setting.Within each cluster a coordinator was designated and a proposed plan for research and potential collaborators were discussed. The results of the workshop were presented to the national technical working groups and the National AIDS Commission. Several large-scale, collaborative proposals have been developed and funded to address the research areas defined. Option B + represents a significant change in PMTCT policy in Malawi and the process for evaluation of the Malawi PMTCT strategy is outlined. This workshop contributed to defining and coordinating the national agenda for research priorities.
    Health Research Policy and Systems 10/2013; 11(1):40. · 1.38 Impact Factor
  • Anil Kapur, Anthony D Harries
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    ABSTRACT: The need to stem the rising tide of non-communicable diseases (NCDs) including diabetes has been recognised at the highest levels through the UN political declaration. Diabetes care services are largely unavailable in the primary care setting in most developing countries and where available the services are unstructured, with poor record keeping, stock outs and frequent disruption in supplies. With no systematic monitoring of care and programme implementation, treatment outcomes are poor and are consequently associated with a high economic burden. Systematic evaluation of programmes through cohort monitoring has been shown to be effective in large-scale interventions for two chronic infectious diseases-tuberculosis and HIV/AIDS. Can the same simple tool of cohort monitoring be applied to improve diabetes care delivery in the developing world? Pilot projects show it is possible, but scale up and expansion would require investment in information technology. In a scenario where systems for NCD are just beginning to be set up, it makes sense to learn from and build further on the initial pilot programmes.
    Diabetes research and clinical practice 09/2013; · 2.74 Impact Factor
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    ABSTRACT: There is a high burden of both diabetes (DM) and tuberculosis (TB) in China. We evaluated the association between DM and the pattern of disease, 2-month sputum smear conversion and treatment outcomes of patients with TB in Guangzhou, China. All patients registered with TB from September 2011 to June 2012 were screened for DM and assessed for treatment outcomes in relation to presence or absence of DM and quality of DM control using patient registers, treatment cards and electronic record systems. There were 1589 patients with TB of whom 189 (12%) had DM. Among those with DM, there was a significantly higher proportion of men, persons aged 35 years and older and persons with smear-positive pulmonary tuberculosis (PTB) (P < 0.01). In patients with DM and new smear-positive PTB, there was a higher proportion who had positive sputum smears at 2 months (21.7% vs. 5.6%, RR 3.85, 95%CI 2.24-6.63), who were lost-to-follow-up (5.2% vs. 1.7%, RR 3.23, 95%CI 1.08-9.63) and who failed treatment (10.3% vs. 2.3%, RR 4.46, 95%CI 1.96-10.18) compared with patients who had no DM. There was no significant association between these adverse outcomes and DM control as measured by 2 and 6-month fasting blood glucose. Diabetes mellitus in new smear-positive patients with PTB was associated with failure to sputum smear convert at 2 months and adverse treatment outcomes of loss-to-follow-up and failure. Further research is needed to understand the reasons for these findings and to determine whether the current length of treatment of 6 months is adequate.
    Tropical Medicine & International Health 09/2013; · 2.94 Impact Factor
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    ABSTRACT: Ethics approval of research studies is essential for the protection and rights of study subjects, whether this is for prospective research or record reviews. This article shares a painful lesson learned from a field experience where the appropriate steps for obtaining ethics approval were not followed by a young researcher. This researcher had embarked on an operational research project, but had omitted to seek ethics approval from a local ethics committee. Young researchers, particularly from low- and middle income countries, need to learn about the importance and value of ethics.
    Public Health Action. 09/2013; 3(3):253-254.
  • Anthony D Harries, Rony Zachariah, Dermot Maher
    Tropical Medicine & International Health 09/2013; 18(9):1154-6. · 2.94 Impact Factor
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    ABSTRACT: For several years, BRAC (previously known as the Bangladesh Rural Advancement Committee) has been assisting with national TB control efforts in Bangladesh and has especially focused on training of community healthcare personnel. This study attempts to determine whether there is any association between a community-based TB training programme in peri-urban Dhaka and TB case finding within the same catchment area. This was a cross-sectional retrospective study using laboratory sputum registers and annual BRAC training reports. Between 2005 and 2010, there were 536 training activities for community healthcare providers with 9037 people trained. Numbers of patients attending laboratories with suspected TB increased from 8211 in 2004 (before training) to 10 961 in 2005 (start of training) with the proportion diagnosed with smear-positive TB increasing from 7.1% to 11.2%. Thereafter, the numbers with suspected and diagnosed TB remained similar up to 2010. The most important sources of referral of patients for investigation were community health volunteers and self-referring patients accounting for 58% of all patients. In this operational research study in peri-urban Dhaka, there was an initial increase in TB case finding with numbers then reaching a plateau despite continued training activities. Further prospective evaluation is required to understand these phenomena.
    International Health 09/2013; 5(3):223-7. · 1.01 Impact Factor
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    ABSTRACT: In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000--2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges. Descriptive study using routine programme data. Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31--51 days).The main operational challenges included: i) early case finding and recruitment for conservative management, ii) national capacity building in obstetric fistula surgical repair, and iii) assessing the psychosocial impact of this model. In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.
    BMC Pregnancy and Childbirth 08/2013; 13(1):164. · 2.52 Impact Factor
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    ABSTRACT: Zimbabwe's target to achieve Universal Access to treatment for HIV and AIDS, was severely affected by a decade long economic recession that threatened to reverse all the country's social and economic indicators. Despite these challenges, by September 2010, 282,916 adults and children (47.7% of those in need of treatment) were on treatment at 509 sites countrywide since national scale up started. ART services are predominantly offered through the public sector, with the private sector being an untapped potential resource for ART services for the future. Challenges of skilled and adequately trained human resources have hindered progress towards service availability. Providing access to children in particular has been constrained by lack of clinical mentorship for health workers, weak systems for support supervision, and inadequate HIV diagnostic services especially for children under 18 months and challenges with follow up of the HIV-exposed infants. Though the country has not met its target of Universal Access by 2010, significant progress has been made with over a 30-fold increase in service availability.
    The Central African journal of medicine 07/2013; 56(1-4):12-4.

Publication Stats

5k Citations
2,024.92 Total Impact Points


  • 2008–2014
    • International Union Against Tuberculosis and Lung Disease (The Union)
      Lutetia Parisorum, Île-de-France, France
    • Malawi Centers of Disease Control and Prevention
      Lilongwe, Central Region, Malawi
  • 2013
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      • Tropical and Infectious Disease Unit
      Liverpool, England, United Kingdom
    • Epicentre MSF
      Lutetia Parisorum, Île-de-France, France
    • United Nations Relief and Works Agency for Palestine Refugees
      Majdal, Southern District, Jordan
    • Ministry of Health and Child Welfare, Zimbabwe
      Salisbury, Harare Province, Zimbabwe
  • 2005–2013
    • Doctors Without Borders
      Lutetia Parisorum, Île-de-France, France
    • London School of Hygiene and Tropical Medicine
      • Department of Clinical Research
      Londinium, England, United Kingdom
  • 2012
    • All India Institute of Medical Sciences
      New Dilli, NCT, India
  • 2006–2012
    • Médecins Sans Frontières
      Bruxelles, Brussels Capital Region, Belgium
    • American University Washington D.C.
      Washington, Washington, D.C., United States
  • 2011
    • Management Sciences for Health
      Medford, Massachusetts, United States
    • Addis Ababa University
      Ādīs Ābeba, Ādīs Ābeba, Ethiopia
    • International AIDS Society
      Genève, Geneva, Switzerland
  • 1999–2011
    • Ministry of Health, Malawi
      Lilongwe, Central Region, Malawi
  • 2010
    • Uganda Virus Research Institute
      Entebbe, Central Region, Uganda
    • University of Cape Town
      • Faculty of Health Sciences
      Cape Town, Province of the Western Cape, South Africa
    • Stellenbosch University
      • Department of Paediatrics and Child Health
      Stellenbosch, Province of the Western Cape, South Africa
  • 2009–2010
    • Research Institute of Tuberculosis
      Edo, Tōkyō, Japan
  • 2007–2008
    • Centers for Disease Control and Prevention
      Atlanta, Michigan, United States
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • Mission Hospital
      Asheville, North Carolina, United States
  • 2004
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2003
    • University of Amsterdam
      • Faculty of Medicine AMC
      Amsterdam, North Holland, Netherlands
  • 2002
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • Academic Medical Center
      Amsterdam, North Holland, Netherlands
    • James Cook University
      • Anton Breinl Centre for Public Health & Tropical Medicine
      Townsville, Queensland, Australia
  • 1991–2002
    • Liverpool School of Tropical Medicine
      Liverpool, England, United Kingdom
  • 2001
    • Maastricht University
      • Department of Health Promotion
      Maastricht, Provincie Limburg, Netherlands
  • 2000
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
  • 1995–1999
    • University of Malawi
      • College of Medicine
      Zomba, Southern Region, Malawi
  • 1993–1998
    • The Queen Elizabeth Central Hospital in Blantyre
      Kapeni, Southern Region, Malawi
  • 1994
    • Blantyre International University
      Kapeni, Southern Region, Malawi