Projecting The Future Of The Hiv Aids Epidemic In Tijuana Mexico

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Projecting the Future of the HIV/AIDS Epidemic in Tijuana, Mexico

Author : Esmeralda Iñiguez-Stevens
Publisher :
ISBN 13 :
Total Pages : 218 pages
Book Rating : 4.:/5 (67 download)

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Book Synopsis Projecting the Future of the HIV/AIDS Epidemic in Tijuana, Mexico by : Esmeralda Iñiguez-Stevens

Download or read book Projecting the Future of the HIV/AIDS Epidemic in Tijuana, Mexico written by Esmeralda Iñiguez-Stevens and published by . This book was released on 2009 with total page 218 pages. Available in PDF, EPUB and Kindle. Book excerpt: Referred to as an "Epidemic Without Borders," the escalating HIV/AIDS epidemic in the U.S./Mexico border region is in urgent need of attention. Although the epidemic is currently concentrated there is potential for it to advance to a generalized level. Recent studies have estimated that 1 in 125 adults aged 15-49 in Tijuana is HIV-infected, with sub-groups most affected being men who have sex with men (MSM), injection drug users (IDUs), and female sex workers (FSWs). Given this there is urgent need to targeted HIV prevention initiatives for these populations. As a result we proposed the following: 1) estimate the total number of men and women aged 15-49 years infected with HIV in 2006; 2) project the new number of HIV infected adults ages 15-49 among non-IDU/FSWs over the next 30 years; 3) evaluate the potential impact of increasing condom use between non-IDU/FSWs and their client on the HIV epidemic curve over a period of 30 years. We calculated HIV prevalence estimates among men and women aged 15-49 in Tijuana, Mexico for 2006, overall and by risk groups (MSM, IDUs, FSWs, pregnant women, low risk men and women). General demographic data such as total population size, gender ratio, and age distribution were obtained from the 2005 Mexican census. To obtain the most updated estimates of HIV prevalence, a review of published literature and available data from community-based studies was conducted. Results of this modeling project allowed us to develop a range of possible estimates for the number of HIV infected individuals, both overall and for each of the at-risk sub-groups. A mathematical model to predict the course of the HIV epidemic over a 30-year period (2006-2036) among FSWs who are not injection drug users (non-IDU/FSWs) was developed. More specifically a deterministic compartmental mathematical model was constructed based on biological (i.e., probability of HIV transmission per sexual act, prevalence of sexually transmitted infections), behavioral (i.e., number of unprotected sexual encounters), and demographic (i.e. population age distribution and population sizes) parameters. Data for the model were derived from community-based studies, literature searches, population census, and communication with Mexican public health officials. A second deterministic compartmentalized model was developed to assess the impact of decreasing unprotected sex among non-IDU/FSWs on the prevalence and incidence of HIV/AIDS. More specifically decreases of 5%, 10%, 20%, 50% and 75% in unprotected sex were modeled. Data on baseline levels of unprotected sex among non-IDU/FSWs was taken from a community-based study. Sensitivity analysis for both deterministic models consisted of developing low- and high-growth scenarios for each of the modeled estimates. The estimated overall prevalence of HIV in Tijuana Mexico among adults ages 15-49, is 0.54% (N = 4,347) (Range: 0.22% (N = 1,750) - 0.86% ( N = 6,944). This means that as many as 1 in every 116 male and female adults between the ages of 15-49 could potentially be infected with HIV. However, HIV prevalence is most concentrated among sub-groups of the population such as men who have sex with men (MSM), female sex workers who are injection drug users (FSW-IDUs), female-IDUs, non-IDU/FSWs and male-IDUs. Results of the deterministic mathematical model show that accumulative HIV incidence will continue to rise over the 30-year modeled period (2006-2036). According to the low- and high-growth scenarios the HIV epidemic will become sustained at approximately 19% by the year 2036. A greater reduction in future HIV prevalence was observed when unprotected sex was decreased by greater than 50% among non-IDU/FSWs. The model also predicted that the greater the reductions in unprotected sex, the lower the level at which the epidemic would become a sustained epidemic

Projecting the Future of the HIV/AIDS Epidemic in Tijuana, Mexico

Author : Esmeralda Iñiguez-Stevens
Publisher :
ISBN 13 :
Total Pages : 109 pages
Book Rating : 4.:/5 (495 download)

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Book Synopsis Projecting the Future of the HIV/AIDS Epidemic in Tijuana, Mexico by : Esmeralda Iñiguez-Stevens

Download or read book Projecting the Future of the HIV/AIDS Epidemic in Tijuana, Mexico written by Esmeralda Iñiguez-Stevens and published by . This book was released on 2009 with total page 109 pages. Available in PDF, EPUB and Kindle. Book excerpt: Referred to as an "Epidemic Without Borders," the escalating HIV/AIDS epidemic in the U.S./Mexico border region is in urgent need of attention. Although the epidemic is currently concentrated there is potential for it to advance to a generalized level. Recent studies have estimated that 1 in 125 adults aged 15-49 in Tijuana is HIV-infected, with sub-groups most affected being men who have sex with men (MSM), injection drug users (IDUs), and female sex workers (FSWs). Given this there is urgent need to targeted HIV prevention initiatives for these populations. As a result we proposed the following: 1) estimate the total number of men and women aged 15-49 years infected with HIV in 2006; 2) project the new number of HIV infected adults ages 15-49 among non-IDU/FSWs over the next 30 years; 3) evaluate the potential impact of increasing condom use between non-IDU/FSWs and their client on the HIV epidemic curve over a period of 30 years. We calculated HIV prevalence estimates among men and women aged 15-49 in Tijuana, Mexico for 2006, overall and by risk groups (MSM, IDUs, FSWs, pregnant women, low risk men and women). General demographic data such as total population size, gender ratio, and age distribution were obtained from the 2005 Mexican census. To obtain the most updated estimates of HIV prevalence, a review of published literature and available data from community-based studies was conducted. Results of this modeling project allowed us to develop a range of possible estimates for the number of HIV infected individuals, both overall and for each of the at-risk sub-groups. A mathematical model to predict the course of the HIV epidemic over a 30-year period (2006-2036) among FSWs who are not injection drug users (non-IDU/FSWs) was developed. More specifically a deterministic compartmental mathematical model was constructed based on biological (i.e., probability of HIV transmission per sexual act, prevalence of sexually transmitted infections), behavioral (i.e., number of unprotected sexual encounters), and demographic (i.e. population age distribution and population sizes) parameters. Data for the model were derived from community-based studies, literature searches, population census, and communication with Mexican public health officials. A second deterministic compartmentalized model was developed to assess the impact of decreasing unprotected sex among non-IDU/FSWs on the prevalence and incidence of HIV/AIDS. More specifically decreases of 5%, 10%, 20%, 50% and 75% in unprotected sex were modeled. Data on baseline levels of unprotected sex among non-IDU/FSWs was taken from a community-based study. Sensitivity analysis for both deterministic models consisted of developing low- and high-growth scenarios for each of the modeled estimates. The estimated overall prevalence of HIV in Tijuana Mexico among adults ages 15-49, is 0.54% (N = 4,347) (Range: 0.22% (N = 1,750) - 0.86% (N = 6,944). This means that as many as 1 in every 116 male and female adults between the ages of 15-49 could potentially be infected with HIV. However, HIV prevalence is most concentrated among sub-groups of the population such as men who have sex with men (MSM), female sex workers who are injection drug users (FSW-IDUs), female-IDUs, non-IDU/FSWs and male-IDUs. Results of the deterministic mathematical model show that accumulative HIV incidence will continue to rise over the 30-year modeled period (2006-2036). According to the low- and high-growth scenarios the HIV epidemic will become sustained at approximately 19% by the year 2036. A greater reduction in future HIV prevalence was observed when unprotected sex was decreased by greater than 50% among non-IDU/FSWs. The model also predicted that the greater the reductions in unprotected sex, the lower the level at which the epidemic would become a sustained epidemic.

Tomorrow is a Long Time

Author : Jon Cohen
Publisher :
ISBN 13 : 9781942084082
Total Pages : 0 pages
Book Rating : 4.0/5 (84 download)

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Book Synopsis Tomorrow is a Long Time by : Jon Cohen

Download or read book Tomorrow is a Long Time written by Jon Cohen and published by . This book was released on 2015 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Tomorrow Is a Long Time shows the distance that separates aspiration from reality in the quest to end AIDS.

Environmental Change and Security Project Report

Author :
Publisher :
ISBN 13 :
Total Pages : 330 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Environmental Change and Security Project Report by :

Download or read book Environmental Change and Security Project Report written by and published by . This book was released on 2002 with total page 330 pages. Available in PDF, EPUB and Kindle. Book excerpt:

The Global HIV Epidemics among Sex Workers

Author : Deanna Kerrigan
Publisher : World Bank Publications
ISBN 13 : 0821397753
Total Pages : 344 pages
Book Rating : 4.8/5 (213 download)

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Book Synopsis The Global HIV Epidemics among Sex Workers by : Deanna Kerrigan

Download or read book The Global HIV Epidemics among Sex Workers written by Deanna Kerrigan and published by World Bank Publications. This book was released on 2012-12-01 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: A global economic analysis of HIV infection amongst sex workers, finding that evidence based and rights affirming interventions are not implemented to the level that their efficacy warrants, and that doing so at scale would be cost effective and deliver significant returns on investment.

Disease Control Priorities, Third Edition (Volume 6)

Author : King K. Holmes
Publisher : World Bank Publications
ISBN 13 : 1464805253
Total Pages : 1027 pages
Book Rating : 4.4/5 (648 download)

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Book Synopsis Disease Control Priorities, Third Edition (Volume 6) by : King K. Holmes

Download or read book Disease Control Priorities, Third Edition (Volume 6) written by King K. Holmes and published by World Bank Publications. This book was released on 2017-11-06 with total page 1027 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

The Perfect Predator

Author : Steffanie Strathdee
Publisher : Hachette Books
ISBN 13 : 0316418072
Total Pages : 346 pages
Book Rating : 4.3/5 (164 download)

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Book Synopsis The Perfect Predator by : Steffanie Strathdee

Download or read book The Perfect Predator written by Steffanie Strathdee and published by Hachette Books. This book was released on 2019-02-26 with total page 346 pages. Available in PDF, EPUB and Kindle. Book excerpt: An electrifying memoir of one woman's extraordinary effort to save her husband's life-and the discovery of a forgotten cure that has the potential to save millions more. "A memoir that reads like a thriller." -New York Times Book Review "A fascinating and terrifying peek into the devastating outcomes of antibiotic misuse-and what happens when standard health care falls short." -Scientific American Epidemiologist Steffanie Strathdee and her husband, psychologist Tom Patterson, were vacationing in Egypt when Tom came down with a stomach bug. What at first seemed like a case of food poisoning quickly turned critical, and by the time Tom had been transferred via emergency medevac to the world-class medical center at UC San Diego, where both he and Steffanie worked, blood work revealed why modern medicine was failing: Tom was fighting one of the most dangerous, antibiotic-resistant bacteria in the world. Frantic, Steffanie combed through research old and new and came across phage therapy: the idea that the right virus, aka "the perfect predator," can kill even the most lethal bacteria. Phage treatment had fallen out of favor almost 100 years ago, after antibiotic use went mainstream. Now, with time running out, Steffanie appealed to phage researchers all over the world for help. She found allies at the FDA, researchers from Texas A&M, and a clandestine Navy biomedical center -- and together they resurrected a forgotten cure. A nail-biting medical mystery, The Perfect Predator is a story of love and survival against all odds, and the (re)discovery of a powerful new weapon in the global superbug crisis.

City of Omens

Author : Dan Werb
Publisher : Bloomsbury Publishing USA
ISBN 13 : 1635573009
Total Pages : 311 pages
Book Rating : 4.6/5 (355 download)

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Book Synopsis City of Omens by : Dan Werb

Download or read book City of Omens written by Dan Werb and published by Bloomsbury Publishing USA. This book was released on 2019-06-04 with total page 311 pages. Available in PDF, EPUB and Kindle. Book excerpt: For decades, American hungers sustained Tijuana. In this scientific detective story, a public health expert reveals what happens when a border city's lifeline is brutally severed. Despite its reputation as a carnival of vice, Tijuana was, until recently, no more or less violent than neighboring San Diego, its sister city across the border wall. But then something changed. Over the past ten years, Mexico's third-largest city became one of the world's most dangerous. Tijuana's murder rate skyrocketed and produced a staggering number of female victims. Hundreds of women are now found dead in the city each year, or bound and mutilated along the highway that lines the Baja coast. When Dan Werb began to study these murders in 2013, rather than viewing them in isolation, he discovered that they could only be understood as one symptom among many. Environmental toxins, drug overdoses, HIV transmission: all were killing women at overwhelming rates. As an epidemiologist, trained to track epidemics by mining data, Werb sensed the presence of a deeper contagion targeting Tijuana's women. Not a virus, but some awful wrong buried in the city's social order, cutting down its most vulnerable inhabitants from multiple directions. Werb's search for the ultimate causes of Tijuana's femicide casts new light on immigration, human trafficking, addiction, and the true cost of American empire-building. It leads Werb all the way from factory slums to drug dens to the corridors of police corruption, as he follows a thread that ultimately leads to a surprising turn back over the border, looking northward. “City of Omens is a compelling and disturbing tour of a border world that outsiders rarely see - and simultaneously, a clear guide to a field of public health that offers an essential framework for understanding how both ideas and diseases can spread.” -- MAIA SZALAVITZ, author of Unbroken Brain “Dan Werb combines his expertise as a trained epidemiologist with his keen discernment as an investigative journalist to depict what happens when poverty, human desperation, and unfathomable greed at the highest levels of a society mix with imperial ambition and a criminally ill-conceived policy towards drug use. It is a riveting and heartbreaking story, told with eloquence and compassion.” -- GABOR MATÉ, MD, bestselling author of In the Realm of Hungry Ghosts: Close Encounters with Addiction “City of Omens is an urgent and needed account of a desperate problem. The perils that Mexico's women face haunt the conscience of a nation.” -- ALFREDO CORCHADO, author of Homelands and Midnight in Mexico

The Global HIV Epidemics among People Who Inject Drugs

Author : Arin Dutta
Publisher : World Bank Publications
ISBN 13 : 082139777X
Total Pages : 138 pages
Book Rating : 4.8/5 (213 download)

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Book Synopsis The Global HIV Epidemics among People Who Inject Drugs by : Arin Dutta

Download or read book The Global HIV Epidemics among People Who Inject Drugs written by Arin Dutta and published by World Bank Publications. This book was released on 2012-12-01 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: A global economic analysis of HIV infection amongst people who inject drugs, finding that harm reduction interventions are not implemented to the level that their efficacy warrants, and that doing so at scale would be both cost effective and responsive to a human rights imperative.

Handbook of Attitudes, Volume 2: Applications

Author : Dolores Albarracin
Publisher : Routledge
ISBN 13 : 1351712349
Total Pages : 610 pages
Book Rating : 4.3/5 (517 download)

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Book Synopsis Handbook of Attitudes, Volume 2: Applications by : Dolores Albarracin

Download or read book Handbook of Attitudes, Volume 2: Applications written by Dolores Albarracin and published by Routledge. This book was released on 2018-10-10 with total page 610 pages. Available in PDF, EPUB and Kindle. Book excerpt: Attitudes are evaluations of people, places, things, and ideas. They help us to navigate through a complex world. They provide guidance for decisions about which products to buy, how to travel to work, or where to go on vacation. They color our perceptions of others. Carefully crafted interventions can change attitudes and behavior. Yet attitudes, beliefs, and behavior are often formed and changed in casual social exchanges. The mere perception that other people—say, rich people— favor something may be sufficient to make another person favor it. People’s own actions also influence their attitudes, such that they adjust to be more supportive of the actions. People’s belief systems even change to align with and support their preferences, which at its extreme is a form of denial for which people lack awareness. These two volumes of The Handbook of Attitudes provide authoritative, critical surveys of theory and research about attitudes, beliefs, persuasion, and behavior from key authors in these areas. This second volume covers applications to measurement, behavior prediction, and interventions in the areas of cancer, HIV, substance use, diet, and exercise, as well as in politics, intergroup relations, aggression, migrations, advertising, accounting, education, and the environment.

Integrating Responses at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
ISBN 13 : 0309477948
Total Pages : 175 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Integrating Responses at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics by : National Academies of Sciences, Engineering, and Medicine

Download or read book Integrating Responses at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-09-27 with total page 175 pages. Available in PDF, EPUB and Kindle. Book excerpt: According to the Centers for Disease Control and Prevention (CDC), 115 Americans die each day from an opioid overdose, which averages one death every 12.5 minutes. Between 1999 and 2016, the number of drug overdoses catapulted by 300 percent, with injection drug use increasing by 93 percent between 2004 and 2014 and opioid-related hospital admissions increasing by 58 percent over the past decade. And an inexorable sequela of the opioid epidemic is the spread of infectious diseases. To address these infectious disease consequences of the opioid crisis, a public workshop titled Integrating Infectious Disease Considerations with Response to the Opioid Epidemic was convened on March 12 and 13, 2018, by the National Academies of Sciences, Engineering, and Medicine. Participants discussed strategies to prevent and treat infections in people who inject drugs, especially ways to work efficiently though the existing public health and medical systems. This publication summarizes the presentations and discussions from the workshop.

Emergent Public Health Issues in the US-Mexico Border Region

Author : Cecilia Ballesteros Rosales
Publisher : Frontiers Media SA
ISBN 13 : 2889450473
Total Pages : 118 pages
Book Rating : 4.8/5 (894 download)

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Book Synopsis Emergent Public Health Issues in the US-Mexico Border Region by : Cecilia Ballesteros Rosales

Download or read book Emergent Public Health Issues in the US-Mexico Border Region written by Cecilia Ballesteros Rosales and published by Frontiers Media SA. This book was released on 2017-02-16 with total page 118 pages. Available in PDF, EPUB and Kindle. Book excerpt: US-Mexico border region area has unique social, demographic and policy forces at work that shape the health of its residents as well as serves as a microcosm of migration health challenges facing an increasingly mobile and globalized world. This region reflects the largest migratory flow between any two nations in the world. Data from the Pew Research Center shows over the last 25 years there has never been lower than 140,000 annual immigrants from Mexico to the United States (with peaks over 700,000). This migratory route is extremely hazardous due to natural (e.g., arid and hot desert regions) and human made barriers as well as border enforcement practices tied to socio-political and geopolitical pressures. Also, reflecting the national interdependency of public health and human services needs, during the most recent five year period surveyed the migratory flow between the US and Mexico has equaled that of the flow of Mexico to the US--both around 1.4 million persons. Of particular public health concern, within the US-Mexico region of both nations there is among the highest disparities in income, education, infrastructure and access to health care--factors within the World Health Organization’s conceptualization of the Social Determinants of Health, and among the highest rates of chronic disease. For instance obesity and diabetes rates in this region are among the highest of those monitored in the world, with adult population estimates of the former over 40% and estimates in some population sub-groups for the latter over 20%. The publications reflected in this Research Topic, all reviewed from experts in the field, addressed many of the public health issues in the US Mexico Border Health Commission’s Healthy Border 2020 objectives. Those objectives-- broad public health goals used to guide a diverse range of government, research and community-based stakeholders--include Non Communicable Diseases (including adult and childhood obesity-related ones; cancer), Infectious Diseases (e.g., tuberculosis; HIV; emerging diseases--particularly mosquito borne illnesses), Maternal and Child Health, Mental Health Disorders, and Motor Vehicle Accidents. Other relevant public health issues affecting this region, for example environmental health, binational health services coordination (e.g., immunization), the impact of migration throughout the Americas and globally in this region, health issues related to the physical climate, access to quality health care, discrimination/mistreatment and well-being, acculturative/immigration stress, violence, substance use/abuse, oral health, respiratory disease, and well-being from a social determinants of health framework, are critical areas addressed in these publications or for future research. Each of these Research Topic publications presented applied solutions (e.g., new programs, technology or infrastructure) and/or public health policy recommendations relevant to each public health challenge addressed.

BLK.

Author : Alan Bell (Editor)
Publisher :
ISBN 13 :
Total Pages : 544 pages
Book Rating : 4.:/5 (321 download)

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Book Synopsis BLK. by : Alan Bell (Editor)

Download or read book BLK. written by Alan Bell (Editor) and published by . This book was released on 1990 with total page 544 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Global AIDS Monitoring 2019

Author : United Nations Publications
Publisher : UN
ISBN 13 : 9789292530884
Total Pages : 202 pages
Book Rating : 4.5/5 (38 download)

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Book Synopsis Global AIDS Monitoring 2019 by : United Nations Publications

Download or read book Global AIDS Monitoring 2019 written by United Nations Publications and published by UN. This book was released on 2019-04-17 with total page 202 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this document is to provide guidance to national AIDS programmes and partners on the use of indicators to measure and report on the country response. The 2016 United Nations Political Declaration on Ending AIDS, adopted at the United Nations General Assembly High-Level Meeting on AIDS in June 2016, mandated UNAIDS to support countries in reporting on the commitments in the Political Declaration. The Political Declaration on Ending AIDS built on three previous political declarations: the 2001 Declaration of Commitment on HIV/AIDS, the 2006 Political Declaration on HIV/AIDS and the 2011 Political Declaration on HIV and AIDS.

An Epidemic of Absence

Author : Moises Velasquez-Manoff
Publisher : Simon and Schuster
ISBN 13 : 1439199396
Total Pages : 416 pages
Book Rating : 4.4/5 (391 download)

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Book Synopsis An Epidemic of Absence by : Moises Velasquez-Manoff

Download or read book An Epidemic of Absence written by Moises Velasquez-Manoff and published by Simon and Schuster. This book was released on 2013-09-17 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt: A controversial, revisionist approach to autoimmune and allergic disorders considers the perspective that the human immune system has been disabled by twentieth-century hygiene and medical practices.

Health at the United States-Mexico Border and Fostering Binational Collaboration

Author : Kaaren Mary Halderman
Publisher :
ISBN 13 :
Total Pages : 192 pages
Book Rating : 4.:/5 (34 download)

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Book Synopsis Health at the United States-Mexico Border and Fostering Binational Collaboration by : Kaaren Mary Halderman

Download or read book Health at the United States-Mexico Border and Fostering Binational Collaboration written by Kaaren Mary Halderman and published by . This book was released on 1999 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309170397
Total Pages : 214 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System by : Institute of Medicine

Download or read book Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System written by Institute of Medicine and published by National Academies Press. This book was released on 2001-10-30 with total page 214 pages. Available in PDF, EPUB and Kindle. Book excerpt: Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review describes the capacity, quality, and effectiveness of the international and domestic facilities and programs that are a part of a DoD system to monitor and address emerging infectious diseases globally. The committee concludes that the goals of the system are in U.S. military, U.S. civilian, and global public health interests and that substantial progress has been made toward achieving system goals.