COMPETITION FOR GRANTS TO BUILD AFRICAN CAPACITY FOR HIV/AIDS PREVENTION TRIALS

Table of Contents

• Introduction
• GHRI-CHVI Partnership Program to Strengthen HIV/AIDS Clinical Trial Capacity and Networks in low-and-middle-income countries
  • Program Design and Objectives
• Capacity Building Grants Competition - the focus of this Call:
  • Key Focal Areas
  • Value and Duration
• Selection Process and Milestones
  • Merit Review and Review Committee
  • Confidentiality Policy
• Eligibility and Merit Review Criteria
  • Eligibility Criteria
  • Review Criteria
• Application Process
  • Letter of Intent (LOI) Requirements
  • Submitting the LOI
• Contacts for Further Information
• APPENDIX 1: GHRI and GHRI Partners
• APPENDIX 2: Allowable Costs/Budget Guidelines
• References

Introduction

The Canadian HIV Vaccine Initiative¹ (CHVI) represents a collaborative Canadian contribution to the Global HIV Vaccine Enterprise that is dedicated to accelerating worldwide efforts towards the development of safe, effective, affordable, and globally accessible HIV vaccines. The CHVI is guided by the following four principles: strategic coordination and integration; multi-sectoral collaboration and engagement; promotion of human rights and global access; and accountability and transparency. These principles are critical to the successful achievement of the CHVI's overall goal of coordinating domestic and international HIV vaccine efforts to support the Global HIV Vaccine Enterprise. CHVI builds on the Government of Canada’s long-term commitment to a comprehensive approach to fighting HIV/AIDS domestically and globally, including the development of new HIV prevention technologies.

Specific goals of the CHVI are to:

1. Strengthen HIV vaccine discovery and social research capacity;
2. Strengthen clinical trial capacity and networks, particularly in Low and Middle Income Countries (low-and-middle-income countries);
3. Increase global pilot scale manufacturing capacity for HIV vaccine clinical trial lots;
4. Address policy and regulatory approaches for HIV vaccines, particularly in low-and-middle-income countries;
5. Promote the community and social aspects of HIV vaccine research and delivery; and
6. Ensure horizontal collaboration within the CHVI and with domestic and international collaborators.

GHRI-CHVI Partnership Program to Strengthen HIV/AIDS Clinical Trial Capacity and Networks in low-and-middle-income countries

The Global Health Research Initiative² (GHRI) is managing a new program to strengthen clinical trial capacity and networks in low-and-middle-income countries. This program builds on a CAD $3 million program launched by GHRI in 2006 to provide HIV/AIDS Prevention Trials Capacity Building Grants to three low-and-middle-income country-Canadian teams. The new program will foster synergies and complementarities with other CHVI components noted above, and other global efforts³ to build capacity for HIV/AIDS prevention trials.

Program Design and Objectives

The program incorporates conclusions and program ideas emerging from the international consultation conducted by the CHVI on February 10-12, 2008.⁴

Geographic Focus: Given the heavy burden of the HIV/AIDS epidemic in Africa, and the opportunity to capitalize on the partnerships and infrastructure of the first round of HIV/AIDS prevention trials capacity building grants, this new program will continue to maintain focus on developing African capacity in this domain.

Objectives: The program objectives are: 1) to create sustainable African capacity and leadership to conduct future HIV/AIDS prevention trials with special focus on innovations in HIV/AIDS prevention technologies, particularly HIV vaccines, and 2) to advance the collaboration and networking of African, Canadian and international researchers and institutions in global HIV/AIDS prevention trials efforts.

Building Sustainable Capacity: This program is designed to create sustainable research capacity for HIV/AIDS prevention trials. This program also emphasizes the need to extend the concept of capacity beyond the traditional technical and scientific skills to include research management, leadership, administration, and community and policy engagement (see description in Table 1, page 6).

Flexibility for Innovation: The new program encourages innovative and creative approaches to building sustainable capacity for HIV/AIDS prevention trials and offers synergy and networking grants to supplement work funded through the first round of competition.

Linkages and Networking

Mechanisms for ongoing communication, learning and sharing (e.g. of data and platforms) are integral to both the GHRI and the CHVI. Teams funded through a GHRI capacity building grant are expected to gather at official meetings and symposia to discuss and share their progress and challenges. Some of these meetings will also include awardees supported by the CHVI (e.g. social research team grants program). These meetings will not only include the sharing of data but also the identified challenges and lessons learned from the teams. Co-PIs and their respective teams in low-and-middle-income countries and Canada are also expected to communicate with one another on a regular basis.

Capacity Building Grants Competition - the focus of this Call:

Grants will be selected through a two-phase open competition: letters of intent (LOI) and invited full-scale applications that build on new or established partnerships to develop sustainable African capacity and leadership to conduct future HIV/AIDS prevention trials.

Key Focal Areas

Strengthening research capacity is a multi-dimensional challenge. [1, 2] The process involves multi-level action, through a combination of strategies, in order to strengthen different types of skills. The literature suggests that in order to strengthen research capacity, one must act at the individual, institutional, national research system and political and economic levels (enabling environment). [3] The capacity building strategies may include graduate and post-graduate training, using a “learning by doing” approach, north-south and south-south institutional partnerships or the development of centres or networks of excellence. [4] While there has been a focus on the development of technical research skills, there is a growing recognition that we also needs to enhance skills related to other key dimensions of a research process: research management, knowledge translation and research leadership (individual and institutional), among others.

Table 1 outlines a menu of potential strategies drawn from the CHVI consultation held in February 2008.⁵ It is provided as a reference for applicants to consider in determining their particular strategy or niche and it is expected that applicants will provide a strong rationale and a clear statement of the 'value added' of their proposal to the current landscape of related activities.

 

 

Value and Duration

Successful teams at the LOI stage are eligible to receive Development Grants of up to a maximum of CAD$ 20,000 to develop a full-scale application.

Full-scale applications will be assessed by an international merit review panel and successful teams will receive Capacity Building Grants of up to CAD$ 1.4 million per grant profiled over a maximum of four years. Although CAD $1.4 million is the maximum budget allowable per grant under this competition, in many instances a smaller budget may be deemed more appropriate. The appropriateness of the budget for the proposed project will play a significant role in the merit review and selection processes.

Grants will be monitored periodically during the course of their funding to facilitate their successful completion and to contribute to a better understanding of how to fund, organize, and undertake programs of work designed to build research capacity.

Before funds are released, each application must have undergone an ethical review and received approval from their institution or an ad hoc ethics review committee in accordance with national and international guidelines such as the Tri-Council Policy Statement on the Ethical Conduct for Research Involving Human Subjects or the CIOMS (Council for International Organizations of Medical Sciences), 1991 guidelines for ethical review of epidemiological studies.

Selection Process and Milestones

The selection process will consist of an initial eligibility screening followed by a full technical review by an international Review Committee. Eligibility and review criteria are outlined in Section 5.0 below.

Letters of Intent (LOIs) will first be screened for eligibility and relevance. This will be followed by a merit review by an international Review Committee for a full discussion, ranking, and final decision. In addition to project scores, due consideration will be given to the extent to which LOIs will meet the objectives of the Capacity Building Grants. Successful LOI applicants will be invited to submit full-scale applications, which will be peer-reviewed and adjudicated through a similar process.

Milestone	Timeline
Deadline for receipt of LOIs	September 4 2009
Review of LOIs and Development Grants approved	October 9 2009
Deadline for full-scale proposals for Capacity Building Grants	January 22 2010
Review and approval of full-scale applications and Capacity Building Grants	March 5 2010

 

Merit Review and Review Committee

Merit Review is an enhanced form of traditional peer review. It considers the traditional scientific excellence criteria and also potential impact, which assesses the collective experience of the team, the appropriateness of decision-maker partners and institutions involved and dissemination and communication plans. Therefore, merit review panels are made up of peers drawn from both the research and decision-maker communities who can comprehensively evaluate the grant applications. Where appropriate to the objectives of the competition, educators and communication experts may also participate.

Review committees also consider the overall profile of themes and jurisdictions of the top-ranked applications in assessing potential impact of the program as a whole and in providing feedback to GHRI regarding final funding decisions.

An international Review Committee (with strong participation from Africa) composed of scientific, academic and sectoral (health, education, etc.) experts, stakeholders, and decision-makers will assess the scientific excellence and potential impact of all LOIs and full-scale applications. Relevant staff from the CHVI Secretariat will be invited as observers in order to assess synergy and complementarity between the LOIs and the other CHVI components but they will not grade the LOIs and therefore will not take part in the discussions of the review committee related to the ranking of the LOIs.

GHRI will make every effort to ensure that its decisions are fair and objective. Each Review Committee member will sign a Conflict of Interest form. Should a conflict of interest situation arise, the Review Committee member is required to notify GHRI immediately. Subsequently, GHRI will take action as necessary to meet its commitment to fairness and objectivity.

Confidentiality Policy

Under the GHRI agreement, relevant departments and officials/representatives from CIDA, CIHR, Health Canada, IDRC and PHAC have access to all information related to applications submitted under this program, including the merit review ratings. Applications that are not approved for this competition may be shared with other agencies for funding consideration. Applications are otherwise considered confidential until they are approved for funding, at which point the abstracts, objectives, names of applicants and their institutions, and budgets remain in the public domain.

Eligibility and Merit Review Criteria

A two-stage review process will be undertaken: (i) Screening against Eligibility Criteria; and (ii) review against Review Criteria.

Eligibility Criteria

All LOIs will be screened for eligibility according to the eligibility criteria outlined below. A team whose LOI does not meet the eligibility requirements will be provided with an explanation of the decision within three months after the application deadline.

Only those LOIs that meet ALL of the eligibility criteria will be considered for full merit review by the international Review Committee.

Team Composition and Partnerships

• Teams must include at least one African institution and at least one Canadian institution.
• The majority of the grant funds must be administered by one or by up to three African institutions.
• Canadian researchers are eligible as co-principal applicants or as co-applicants, with a clear rationale about how their involvement contributes to building sustainable African research capacity for HIV/AIDS prevention trials.
• Researchers that are not affiliated with an institution in Africa or Canada are eligible as co-applicants, with a clear rationale about how their involvement contributes to building sustainable African research capacity for HIV/AIDS prevention trials.
• Established or new teams must demonstrate that they have already developed at least an informal relationship with the intent to work together in the future. The grant is not for forging new relationships.
• The team must have a track record in conducting HIV/AIDS prevention trials and/or experience building 'platforms' for prevention trials with both generic and disease-specific training components
• Teams must demonstrate language fluency for the regions where activities will take place.
  

 

Proposed Activities

Proposed activities must focus predominantly on strengthening or building sustainable capacity to undertake HIV/AIDS prevention trials in Africa by African researchers and African institutions. Prevention trial grants are not eligible for funding.⁶

Review Criteria

All LOIs must justify the proposed approaches to sustainable capacity strengthening and demonstrate how this work will contribute to strengthening individual and institutional leadership capacity to undertake, disseminate and use research for HIV/AIDS prevention, and by African researchers and African institutions.

Each application will be assessed according to the following review criteria.

Capacity building - Reviewers will assess the rationale and proposed approach to building or strengthening African capacity to conduct, and use results of, prevention trials in Africa, including:

• Overview of current capacity and leadership, capacity building initiatives and gaps and justification for the planned focus and strategy;
• The spectrum of disciplinary approaches and competencies required to conduct and lead prevention trials, share and apply results at multiple levels (individual, team, network, institutional and community, see Table 1) and the breadth of involvement of these perspectives in defining the proposed approach.
• Scope of capacity building, training, and mentoring approaches beyond conventional on-site academic training to consider career paths involving multiple actors in prevention trials research and their use.
• Consideration of gender, socio-economic, ethnicity or ability-based equity issues and their differential impacts.

Team composition and partners - Note: This competition is not appropriate for teams forging new relationships. Reviewers will assess the mix of experience, skills and networks of the proposed team members and partners in relation to the proposed program of work to build sustainable African capacity to conduct, and use results of, prevention trials in Africa, including:

• Preference will be given to proposals led by researchers affiliated with an African Institution.
• The mix of interdisciplinary training, experience and linguistic fluency appropriate for the proposed approaches for training and developing the technical, scientific, leadership, management and policy and community engagement skills of researchers, institutions and communities in Africa.
• The track record of team members in conducting HIV/AIDS prevention trials and/or experience building 'platforms' for prevention trials with both generic and disease-specific training components.
• Experience of the team and institution working with other partners to achieve collaborative outcomes, including structures for governance, resolution of conflicts, communications and consideration of ethics.
• The current infrastructure and organizational capacity of the institutional partner(s) to support the proposed program of work and to administer large multi-site grants (in human and financial terms); and/or the partnership/strategy to strengthen this over the life of the grant.
• Africa-based partners should include a mix of institutions with well-established research activities, and/ or promising institutions that are either developing or renewing their research potential.
• All teams must demonstrate the organizational capacity to administer grants of this nature (in human and financial terms).

 

Budget - Reviewers will assess the appropriateness and justification of the proposed budget and costs, including:

• personnel;
• consultants;
• evaluation;
• equipment;
• travel;
• training; and
• indirect project costs.

Please refer to the detailed guidelines provided in Appendix II.

Potential impact - Reviewers will assess the potential of the proposed team, partnership and program of work to build sustainable African capacity and leadership to conduct, and use results of, prevention trials in Africa, including.

• Relevance of the proposed program of work to the country(ies) involved and description of how it will help build sustained capacity for African researchers and institutions in the proposed country(ies).
• “Value-added” of the program of work to existing initiatives and/or its potential influence on other prevention trials or related research collaborations.
• Innovative nature of the program of work, partnership and/or uniqueness of its contribution to regional capacity.
• Level of commitment of sponsoring institutions and partners to a sustained program of capacity building, research and its application in the proposed domain (e.g., in-kind resources, staff time, funds, link with strategic plans, etc.).
• Extent or nature of relevant community or organizational involvement in the development of the proposal.
• Communications and evaluation plans to promote ongoing learning, sharing of lessons learned and outlines potential indicators to assess process and results.
• Potential to evolve over time to create the foundation for further capacity building, research and its application.

Application Process

Letter of Intent (LOI) Requirements

The LOI should be typewritten in Times New Roman 12 point font and each page must be numbered and include the name of the principal applicant(s). The LOI may be written in English or French.

Cover Pages

The LOI must have cover pages that include the following:

• A brief project title;
• Primary location(s) where project activities will occur;
• Name(s), institutional affiliations and respective countries of residence of principal applicant(s) and team members and their contact details (i.e. mailing address, telephone, fax and email address);
• Name and location of organization/institution that will administer the project funds plus documentation verifying that it is a legal entity;
• Co-sponsors (if applicable); and
• Total amount of funding requested for the first year, period of support requested (up to a maximum of four years) and the full amount requested for the period of support (in Canadian dollars (in local currency).

The LOI must be signed by the principal applicant(s) and the designated official(s) of the organization(s) that will administer the funds.

Signatures must be provided to confirm that team members and the administering agency have agreed to their role and/or commitment to the proposed research. Faxed signatures of the team members are acceptable.

Content

1. A clear and concise abstract of the proposed program of work, suitable for public dissemination (300 words maximum)
2. Summary of proposal: Summary of the proposed program of work clearly articulating (in 5 pages maximum):
   1. Statement of current capacity and needs;
   2. Objectives;
   3. Relevance of proposed activities;
   4. Summary of the approaches and expected outcomes;
   5. Brief discussion on gender, ethics and Knowledge Transfer Exchange (KTE);
   6. Overview of Monitoring, Evaluation, and Learning approaches (with some indication of proposed indicators); and
   7. Communication Plan.
3. Team: Description of the team (as defined in Section 5.1 of this Call) clearly outlining each investigator/community/partner member’s role, relevant experience, and planned contribution to the team (2 pages maximum).
4. Budget:
   Up to CA $20,000 is available to all successful LOI applicants for development of full-scale applications. Please include a separate budget for this component that may include: communications, meetings with local stakeholders and international partners, travel, background analysis and literature review. All successful LOI applicants will receive free access to several on-line scientific databases and journals during the three-month period necessary to develop the full application.
   Capacity-Building Grant
   1. total amount requested for the first year, period of support requested and the full amount requested for the period of support in Canadian dollars;
   2. a summary budget for the first year including a brief description and justification of the main budget expenditures;
   3. a summary of contributions by each source (including financial and “in kind”) for the first year.

 

Attachments

• Abbreviated curriculum vitae for each of the principal applicant(s) should be appended (4 pages maximum).
• Institutional Profile Questionnaire (available at : http://archive.idrc.ca/admin/Forms/Inst _profile_e.pdf )

Submitting the LOI

Send one original hardcopy of your completed application and supporting documentation by courier or mail to the address below. In addition, send an electronic copy to [rgeneau@idrc.ca] with the following subject heading: “CHVI grant LOI - last name of one principal investigator/applicant” (e.g. “CHVI grant LOI-Bishop”).

Senior Program Officer

Competition for Clinical Trial Capacity Building Grants - a Component of the
Canadian HIV Vaccine Initiative (CHVI)
International Development Research Centre
PO Box 8500, Ottawa, Canada
K1G 3H9

Contacts for Further Information

For general questions about the initiative, please visit:
http://www.ghri.ca
http://www.chvi-icvv.gc.ca/index-eng.html

Questions regarding submission requirements/how to apply, grant administration, the review process and thematic areas will be coordinated through:

Senior Program Officer
Global Health Research Initiative
Tel: +1-613-236-6163 ext 2618
Fax: +1-613-563-0815
Email: [rgeneau@idrc.ca]

 

APPENDIX 1: GHRI and GHRI Partners

Global Health Research Initiative (GHRI)

The GHRI was officially launched in September 2001 with the signing of a memorandum of understanding among Health Canada, the Canadian International Development Agency (CIDA), the Canadian Institutes of Health Research (CIHR) and the International Development Research Centre (IDRC) to collaborate on global health research in Canada and to help reduce the 10/90 gap worldwide. The Public Health Agency of Canada (PHAC) joined GHRI in 2008. The partnership aims to strengthen and build capacity for global health research in Canada and developing countries, and to strengthen the effectiveness of overseas development assistance.

Global Health Research Initiative Partners:

CIHR is the major federal agency responsible for funding health research in Canada. As set out by Parliament, the objective of CIHR is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system. The Institutes of CIHR bring together researchers who approach health challenges from different disciplinary perspectives, drawing on the combined strengths of these approaches. The four pillars of CIHR include biomedical, clinical science, health systems and services, and the social, cultural and environmental influences on the health of populations. (www.cihr.ca)

CIDA’s aim is to reduce poverty, promote human rights, and support sustainable development in developing countries. The measure of success of Canada's official development assistance program lies in its contribution to the achievement of the Millennium Development Goals and Canada's broader international policy objectives. Building on lessons learned and best practices in health and HIV/AIDS programming over many decades, CIDA will continue to collaborate with key Canadian, international, and developing-country partners in an effort to build country capacity. CIDA will strive to support policies, initiatives, and relevant research that: prevent and control high-burden, communicable, poverty-linked diseases; combat HIV/AIDS; improve infant and child health; improve sexual and reproductive health and reduce maternal mortality; improve food security and nutrition; and strengthen health systems.
(www.cida.ca)

Health Canada has as its mandate to help the people of Canada maintain and improve their health. Health Canada recognizes the importance of health issues in a global environment and works actively to ensure that Canada and the Canadian public are protected from external health threats, benefit from and contribute to the advancement of health in the global context. Health Canada represents Canada in the World Health Organization, the Pan American Health Organization and other international health fora. (www.hc-sc.gc.ca)

In 1970, IDRC was created by an Act of Parliament, with the mandate of supporting the creation and utilization of research for development. IDRC’s primary mission is to support research by Southern researchers (i.e. researchers resident in low and middle-income countries), addressing development priorities identified by the South. The ultimate beneficiaries of the research supported by IDRC should be communities in the countries of the South, particularly marginalized or disadvantaged groups. Within IDRC (www.idrc.ca), the following programs are directly participating in this Call: Governance, Equity and Health (www.idrc.ca/geh); Ecosystems Approaches to Human Health (www.idrc.ca/ecohealth); Research for International Tobacco Control (www.idrc.ca/ritc); and Innovation, Policy and Science (www.idrc.ca/IPS).

Strengthening its ability to protect the health and safety of Canadians, the Government of Canada has delivered on its commitment to establish a new Public Health Agency of Canada and appoint a Chief Public Health Officer. The creation of the PHAC marks the beginning of a new approach to federal leadership and collaboration with provinces and territories on efforts to renew the public health system in Canada and support a sustainable health care system. Focused on more effective efforts to prevent chronic diseases, like cancer and heart disease, prevent injuries and respond to public health emergencies and infectious disease outbreaks, PHAC works closely with provinces and territories to keep Canadians healthy and help reduce pressures on the health care system (www.phac-aspc.gc.ca).

 

APPENDIX 2: Allowable Costs/Budget Guidelines

Personnel

Includes all remuneration, allowances, and benefits paid to staff and advisors hired for a specific project. Project advisors are people hired for long periods (more than 1 year) and paid on a regular basis. The payment of replacement salaries (to release academics from teaching commitments) or of core salaries (i.e., of existing staff) must be justified in the context of research capacity building. As a general rule, IDRC does not pay salary supplements, i.e., honorarium for full-time employees in addition to their regular salaries or higher salaries than the institution would normally pay. Depending on their role, graduate students may be supported here or under the Research Expenses or Training category. In the case of Canadian investigators, salary support is limited to 0.5 FTE for principal applicants or co- principal applicants based in Canadian institutions

Consultants

Consultants provide expert professional advice and usually work on a fee-for-service basis. Compared with project advisors (see Salaries), consultants are contracted for shorter periods to work on specific assignments. Payments to consultants include all expenses related to the services of a consultant for a specific activity within the project.

Evaluation

Includes the systematic assessment of a project, program, policy, or strategic issue to assess either progress toward achieving objectives or the quality and effects of IDRC-funded activities. Evaluation may occur during an activity or after its completion. Evaluation costs can include: consultant fees; travel expenses; and dissemination of the evaluation findings. In projects where evaluation is the primary objective, costs may also include: research expenses; training; and salaries and benefits for personnel directly involved in the evaluation.

Equipment

Includes equipment that has a useful life of more than 1 year and costs more than CAD 1,000 per item. Costs may include the basic purchase price, related Canadian sales taxes (net of government rebates), freight costs, and other costs associated with purchasing the equipment. IDRC does not pay foreign taxes, import duties, or equipment insurance after delivery. The recipient institution is responsible for all subsequent insurance coverage, and IDRC does not assume responsibility for any losses after delivery.

International travel

Includes all costs related to international travel incurred by project staff. Allowable costs include ground transportation, accommodation, meals, airfare, departure taxes, and other related expenses. Daily costs cannot exceed IDRC per diem rates (see http://www.idrc.ca/admin/perdiems/consultant.htm).

Includes a trainee’s registration and tuition fees; living and other allowances; research and training expenses; and travel costs during the trainee’s participation in degree or diploma programs, short courses, student field work, postdoctoral training, or other scholarly activities. The training budget should be reported in four sub-categories based on the type of training being supported: PhD - study leading to a PhD degree; Masters - study leading to a Masters’ degree; Short Course - study leading to a diploma or certificate; or Other - all other scholarly activities (e.g., field work or postdoctoral study). Training for project staff that relates to the implementation of research activities should be shown under Research Expenses.

Project Expenses

Includes services and materials required to carry out the project activities. Costs include remuneration of persons who gather data and information or provide casual labour, maintenance and operation of project vehicles, consumable goods and non-capital equipment, computer services, training for project staff for implementation of project activities, in-country travel, reference materials, rent paid for land or premises used for a research activity, and translation of project-related documents. (Note: IDRC provides free access to many electronic databases for all of our partners.)

Indirect Project Costs

Includes administrative costs not directly related to the research. Costs may include clerical, accounting, or secretarial help, general office expenses, office rental and utility charges, non capital office furnishings, communications costs, and photocopying. IDRC expects the recipient to absorb the indirect or administrative costs of a project as part of its local contribution. In exceptional cases, IDRC will consider a contribution towards indirect costs. The maximum contribution is 10% of all recipient-administered costs, excluding capital equipment. The only time a recipient is allowed to claim a percentage on capital equipment is when the recipient administers the procurement, shipping, and delivery on behalf of one or more recipients in the same project.

References

1. Nchinda TC: Research capacity strengthening in the South. Soc Sci Med 2002, 54(11):1699-1711.
2. Commission for research partnerships with developing countries: Enhancing research capacity in developing and transition countries. Berne: KFPE; 2001.
3. Ijsselmuiden, Carel: Human resources for health research. 2007(104):22-27.
4. Lansang MA, Dennis R: Building capacity in health research in the developing world. Bull World Health Organ 2004, 82(10):764-770.

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