In 2025, Integral Global (IG) has been supporting Aga Khan University Hospital (AKUH) on their hospital pilot project, “Development of Clinical Guidelines for Extreme Drug-Resistant (XDR) Typhoid Fever.” The project objective is to update clinical guidelines for typhoid case management to align with current evidence on the evolving resistance demands. The team is extracting and analyzing data from 2022 to 2025 to identify optimal treatment strategies, which will inform new clinical guidelines. In October, IG’s Typhoid Fever Implementation Specialist met with the project team from AKUH to track the project progress. Data extraction is ongoing. The next meeting between IG and AKUH is planned for January 2026 to assess the data analysis process.
Fast Rural Development Program (FRDP) Pilot Project in Hyderabad and Umerkot
In August 2025, IG’s Typhoid Fever Implementation Specialist conducted a site visit to review the implementation status of the FRDP pilot project. The infrastructure installed by the project included a solar well at the Ghulam Nabi Shah Health Facility and a deep water well in the Modakar village; which were found to be fully functional and greatly utilized by the community. Integration of the solar well with health facility water, sanitation, and hygiene (WASH) services has improved the patient care environment. Since the installation of the deep water well, the Modakar community members have established a Village Water User Committee for maintenance of the well and reported improved health outcomes, including fewer cases of diarrhea in children. Additionally, hygiene promotion activities are ongoing in targeted communities, focusing on handwashing, safe water storage, and latrine use. There has been positive coordination with local health authorities, which has enhanced project acceptance among the wider community.
Coordination of Extreme Drug-Resistant Typhoid Control Efforts in Sindh, Pakistan
IG provides technical support to CDC’s Division of Foodborne, Waterborne, and Environmental Diseases Branch for stakeholder engagement and program implementation for XDR typhoid in Pakistan’s Sindh province. IG’s Typhoid Fever Implementation Specialist is based in Karachi, Sindh, and coordinates routinely with the Integrated Disease Surveillance & Response Unit (IDSRU). Additionally, IG personnel participated in key stakeholder engagement and prioritization workshops for XDR activities in Sindh in October and November 2024 and are providing technical assistance to the IDSRU and stakeholders to implement key recommendations, draft policies, and standardization of surveillance and reporting measures.In 2025, IG supported the implementation of an XDR typhoid training module to the Field Epidemiology Training Program (FETP) in Sindh.