A N N U A L

R E P O R T

2 0 1 7

To eliminate cervical cancer globally through early

prevention and treament

To live in a world where no woman dies of cervical cancer,

a preventable disease

+45,000women

screened

+4,000women treated

+2,500trained

healthcareproviders

+30published

papers

OUR MISSION OUR VISION

R E S E A R C H

I M P L E M E N T A T I O N

C L I N I C A L A C T I V I T Y

A D V O C A C Y A N D P O L I C Y

A N N U A L R E P O R T 2 0 1 7 | 2

Millions of women at high risk for cervical cancer around the world have never been screened, for reasons beyond their control. We at Basic Health International are proud to be innovators in the field of cervical cancer prevention, dedicated to developing novel approaches to screening and treatment. Our research and implementation programs are revolutionizing cervical cancer prevention tools.

In 2017, we finished our landmark screen-and-treat CAPE program in partnership with the Ministry of Health of El Salvador, having screened over 25,000 women and treated over 2,000 women with cryotherapy. We also completed an HPV self-sampling study that reached over 2,000 women in an effort to extend screening coverage to women who are reluctant to undergo clinician-based screening. By endorsing self-sampling screening as an option for this high-risk population, this study has the potential to impact policy.

In other exciting news, BHI has begun training healthcare providers from El Salvador’s Ministry of Health to launch a national cervical cancer prevention initiative based on the CAPE paradigm. This will be the first public program of its kind in the world! We are incredibly honored to be part of this amazing moment in the global fight against cervical cancer.

We are also engaged in several NIH-funded clinical trials that will transform secondary prevention of cervical cancer. The development of screening and treatment technologies customized for limited-resource settings has been a priority for BHI. We have been testing the adapted Cryopen and WiSAP thermal ablation device in research studies in El Salvador, Haiti, Colombia, and Peru, and believe these devices can be global game changers in treatment of cervical pre-cancer. A new clinical trial funded by the NIH and the Gateway for Cancer Research will be initiated this summer in Mexico with the goal of establishing best clinical practices for thermal ablation.

MIRIAM CREMER MD MPH

PRESIDENT AND FOUNDER

A M ESSAG E F RO M M I R I A M`Looking to the future, we are excited to have outstanding partners supporting and facilitating our research and implementation projects. We are humbled to collaborate with and receive support from The Rising Tide Foundation, Gateway for Cancer Research, the National Cancer Institute/NIH, the Pan-American Health Organization, the CDC Foundation, the Platt Family Foundation, PATH, Rice University, MD Anderson Cancer Center, and the Cleveland Clinic, among others.

We have begun conversations with partners in China, India, and Antigua & Barbuda to fulfill a long-awaited goal of expanding our work in other regions of the world. BHI will welcome new leadership to manage this expansion. Dr. Rachel Masch has served as Executive Director since 2015, balancing this role with her ongoing clinical practice. We are so grateful for Dr. Masch’s service and glad that she will remain a central part of our team in the role of Chief Medical Officer. We are also thrilled to announce that Dr. Mauricio Maza will become the new Executive Director. Dr. Maza has been an integral member of BHI since 2004 and is a globally recognized public health expert and advocate. BHI will undoubtedly continue to flourish under his leadership.

Cervical cancer continues to kill thousands of women in the poorest regions of the world every year. This is unacceptable—resources exist to prevent these tragic deaths. By bringing vaccines and diagnostic and treatment tools to underserved regions, BHI can save the lives of women and prevent the suffering of entire families. Our work is made possible by the generosity of our donors and funding agencies, and the hard work of our staff and collaborators. We are so appreciative of your continued support.

Drs. Maza and Alfaro, and Dra Andrea Chacon from the MOH of El Salvador, travel to Peru, as part of a delegation with Pink Ribbon Red Ribbon, PAHO and PATH to present results from CAPE project to the Minister of Health of Peru, Dr. Garcia Funegra, and MOH officials

Drs. Cremer and Maza give oral presentations of projects at the IPV Conference in Capetown, South Africa and conduct a site visit to research clinical sites

F E B R U A R Y

Drs. Maza, Alfaro and Masch collaborate with the CDC Foundation in moderating a workshop for using the Improving Data for Decision-making in Global Cervical Cancer Programmes (IDCCP) toolkits for patient monitoring and evaluation, as well as the facility - based surveys in Washington D.C.

J A N U A R Y

Drs. Cremer and Maza join the technical advisory panel at the Global Good conference in Seattle, WashingtonM A R C H

2 0 1 7 B H I N O T A B L E

E V E N T S

Dr. Maza is a speaker at the First Congress of Colposcopy and Pathology of the lower genital tract of Peru

Drs. Cremer, Maza, Alfaro, Soler and Felix, attend the Affordable Cancer Technologies (ACT) Program (UH2/UH3) Principal Investigators Meeting, in Washington, DC.

Dr. Maza participates as a consultant at a WHO meeting in Geneva, Switzerland, for prequalification requirements for IVD’s used for the detection of HPV in cervical cancer screening

M A Y

Drs. Cremer, Maza, Masch, and Alfaro lead workshops and present data on self-sampling studies, UH 2 and data from phase three of CAPE in Orlando, Florida

In addition, Dr. Cremer participates in an expert panel of cervical cancer specialists in Latin America

Dr. Maza participates in NCI’s Symposium on Global Cancer Research, in Washington, D.C. Dr. Maza is an invited speaker at the CUGH Conference in Washington, D.C.

Dr. Masch participates at the Haiti sans Cervical Cancer first annual symposium in Port-au-Prince, Haiti

A P R I L

Dr. Maza is invited by the Global Coalition Against Cervical Cancer to share the experience of El Salvador with the Ministry of Health of Nicaragua

Dr. Alfaro receives a grant from the World Health Organization, to attend the summer school of the International Agency for Research of Cancer, in Lyon, France

J U N E

2 0 1 7 B H I N O T A B L E

E V E N T S

A N N U A L R E P O R T 2 0 1 7 | 5

Drs. Cremer, Alfaro and Soler launch UH3 study in Bogota, Colombia

Dr. Maza is an invited speaker at The Third ICGEB Workshop on Human Papillomavirus and Associated Malignancies: Biology, Prevention and Therapy in São Paulo, Brazil

S E P T E M B E R

Dr. Masch launches the self-sampling project in HaitiDr. Cremer launches UH3 in El Salvador

J U L Y

Dr. Maza attends the “Cancer Screening in 5 Continents” meeting at the PAHO Organization offices to help plan how to implement the analysis of cancer screening programs in the Americas in Washington D.C.

Dr. Cremer visits the Ninewells Hospital in Dundee, Scotland to share experiences with thermoablation practices

Dr. Cremer meets in Munich, Germany with Stephan Hilgers of WISAP® Medical Technology, the engineer of a novel thermoablation device adapted for the treatment of cervical pre cancer in low-resource settings

O C T O B E R

2 0 1 7 B H I N O T A B L E

E V E N T S

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Drs. Cremer, Maza, and Alfaro, hold a meeting and a workshop for continuing medical education in colposcopy for salvadorean physicians, with the support of MD Anderson and the Cleveland Clinic

Drs. Cremer, Masch, and Alfaro visit hospitals in the United Kingdom to observe thermoablation practices for BHI's upcoming research

D E C E M B E R

BHI hosts its first annual Cycle for Cervical Cancer benefit, held at SoulCycle in New York City raising around $10,000

The CDC joins BHI to present the latest version of the toolkit for program monitoring and facility-based surveys to officials from the Ministry of Health (MOH) of El Salvador. Afterwards, the three institutions hold a national symposium: “Unidos contra el cancer”

BHI, Universidad Matias Delgado and Instituto del Cancer participate in a training workshop held by MD Anderson on RedCap, an application for online surveys and databases

N O V E M B E R

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E V E N T S

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CAPE: Cervical Cancer Prevention in El Salvador

I M P L E M E N T A T I O N

A N D O U T R E A C H

CAMBIAR FOTO

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Women who live in low-resource settings often have to wait weeks between cervical cancer screening, obtaining results, and scheduling treatment. Since many are lost to follow-up, they are at high risk of developing cervical cancer.

As a solution to high lost to follow-up, BHI in partnership with the Ministry of Health began a cervical cancer screen-and-treat program designed to introduce HPV DNA-based screening into the public sector. This program is called cervical cancer prevention in El Salvador (CAPE). CareHPV, the only low-cost screening test that is commercially available was used for screening. El Salvador was one of the first countries to receive a donation of careHPV from QiagenCares, so that all of the CareHPV tests used in this project were provided free of charge.

Through PATH, BHI was awarded a Bill and Melinda Gates Foundation grant, which enabled the training of more than 700 health promoters, 500 nurses and physicians, and administrative personnel on the key components of the cervical cancer program. BHI helped to establish 14 clinics in the Paracentral region, where women with a positive HPV result can receive visual assessment for treatment (VAT) and subsequent cryotherapy, if eligible.

We will begin a five year follow-up on the women who were screened and treated when the project began in 2012. This crucial data will help inform further programs and keep us moving in the direction of eliminating this disease. We will take on this new endeavor with the support of the MD Anderson Cancer Center.

At the conclusion of the CAPE project in 2017, more than 28,000 women were screened with a low-cost HPV test and over 2,500 women who were HPV positive received treatment.

The Salvadoran Ministry of Health (MOH) has secured one million dollars in funding to scale up this model in the public health system in 2018. BHI will continue to act as technical advisors in this countrywide initiative. The Salvadoran Ministry of Health is leading the way to adopting innovative approaches to cervical cancer screening.

I M P L E M E N T A T I O N

A N D O U T R E A C H

Self - SamplingEl Salvador

Haiti Screen andTreat program

CAMBIAR FOTO

A N N U A L R E P O R T 2 0 1 7 | 9

A total of 1,867 women performed self-sampling and over 90% of women with abnormal results received and adequate treatment.

With the support of the Rising Tide Foundation, BHI’s self-sampling research project ended in December, 2017. A total of 1,867 women performed self-sampling and over 90% of women with abnormal results received adequate treatment. This project helps to confirm that this innovative, community-based method of screening for cervical cancer offers a viable alternative to the vulnerable population of women who would not otherwise have access to care.

Over 10,000 women have been screened through VIA and have been treated with conventional and CryoPen® cryotherapy.

BHI is proud to be one of the founding members of Haiti sans Cervical Cancer (HsCC), a consortium of NGOs, government officials and local organizations working in Haiti on cervical cancer prevention. The goals of HsCC are to establish a national cervix registry, institute national protocols for cervical cancer screening and treatment, create a national vaccination program, and design and implement a national program for palliative care.

The LMIC-adapted Cryopen® is a treatment device especially designed for use in low-resource settings.

LMIC - ADAPTED CRYOPEN®

I N N O V A T I V E R E S E A R C H

The WiSAP LMIC- adapted Thermoablation device uses heat instead of cold to treat cervical precancer.

Thermoablation

The Rising Tide Foundation, The Gateway for Cancer Research, and The Foundation for Wom-en’s Wellness are supplementing the NIH grants by about $1.5 million dollars. These awards will allow us to expand our NIH-funded research to access more patients. Findings from these studies will be presented to the World Health Organization to influence the recommendations of future guide-lines in the treatment of cervical pre-cancer.

THE GOOD NEWS DO NOT END

HERE

A N N U A L R E P O R T 2 0 1 7 | 1 0

BHI and the Cleveland Clinic have been working on this since 2015 and in May, we presented our preliminary results at the NCI’s headquarters. We also conducted hands-own workshops to demonstrate the use of both devices and have received an overwhelmingly positive response from medical providers around the world. Sponsored by the National Cancer Institute Affordable Cancer Technologies Program (NCI ACT), additional research will test the effectiveness and safety of both portable treatments. The CryoPen and the Thermoablation. Both have the potential to revolutionize the field of cervical cancer prevention by making treatment available in even the most remote locations. A randomized control trial enrollment is underway to test the efficacy of CryoPen® cryotherapy and the Wisap® LMIC adapted thermoablator in El Salvador and Colombia. In 2018 we will start to enroll patients in an additional site in Peru. Cleveland Clinica and BHI were able to secure funds from the Rising Tide Foundation to include thermoablation in the evaluation of these technologies.

BHI is also subcontracted by the Cleveland Clinic in an R01 grant from the NIH (a medical-industry partnership grant) to test different protocolos of applications with the LMIC-adapted thermoablator. Supplement funding to expand the trial was awarded by the Gateway for Cancer Research. Work on the prototype of this device is currently ongoing and we will start enrollment of patients in Mexico in mid-2018.

I N N O V A T I V E R E S E A R C H

HRME: High Resolution Micro Endoscopy

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The HRME imaging system is intended to be a low-cost, innovative technique that allows real-time, point-of-care detection of high-grade precancerous cervical lesions without a biopsy being performed. To date, we have enrolled more than 900 women in this project.

BHI conducted one of the first studies testing the acceptability of HPV tests as a cervical cancer screening method among transgender men in a LMIC. In partnership with the non profit organization Generación Hombres Trans of San Salvador, we offered HPV self-collected tests and comprehensive physical exams to transgender men. Most of them accepted the HPV self-collection. We hope that the use of HPV self-sampling tests in transgender men is a viable method that can significantly improve the participation and acceptance of cervical cancer screening in a LMIC setting. HPV testing may reduce the number of unsatisfactory results generated when using Papanicolaou screening in transgender men. We will be presenting the results of this project at the ASCCP Conference in April 2018.

Cervical Cancer Screening in Transgender Men

A D V O C A C Y A N D

G L O B A L I M P A C T

Basic Health International has been a technical collaborator for the Pan-American Health Organization / World Health Organization, helping with the content of cervical cancer guidelines, manuals and reports. These materials give the evidence many countries around the world need to change their own policies and guidelines on cervical cancer prevention and treatment.

In 2018 the Inter-sectoral and Inter-institutional Committee for Cancer Control in El Salvador will launch an advoca-cy plan to increase the MOH budget for cervical cancer prevention programs. An awareness campaign will be developed to address the social and cultural barriers that prevent women from getting screened for cervical cancer.

At the close of 2017, BHI has screened approximately 45,000 patients in screening and treatment programs in El Salvador and Haiti.

BHI, along with the CDC and the Salvadoran Ministry of Health, held a monitoring and evaluation training in El Salvador to scale-up screening and treatment efforts into the Central, Occidental and Oriental regions of the country.

Dr. Miriam Cremer, the President and Founder of BHI continues to enroll patient in a grant from the National Cancer Institute (NCI) through the Cleveland Clinic Women's Health Institute to perform a trial comparing innovative cervical precancer treatments in El Salvador, Peru and Colombia.

Drs. Miriam Cremer, Rachel Masch, and Karla Alfaro had the opportunity to visit hospitals in the United Kingdom to observe thermoablation for BHI's upcoming research.�

Cleveland Clinic was granted funding from The Gateway for Cancer Research and the Rising Tide Foundation to partner with BHI on ongoing NIH-funded studies. In addition, BHI has also received funding for this project from the Foundation for Women's Wellness.

BHI participated in the �rst annual symposium of Haiti sans Cervical Cancer in Port-au-Prince, Haiti

BHI was asked to assist in an international workshop hosted by PAHO/World Health Organization. Ministry of health delegates from 6 different countries in the Latin-American region attended. During the workshop, tools developed for improving cervical cancer programs were disseminated to the participants. Since El Salvador has successfully used these tools, the CDC replicated this workshop and presented it to stakeholders in El Salvador

In conjunction with the testing of HRME, Rice university is also developing a very low-cost (~$2 US) HPV test, and has asked BHI to help them evaluate it as part of their NHI grant on which we are sub-contracted.

A N N U A L R E P O R T 2 0 1 7 | 1 2

2 0 1 7 H I G H L I G H T S

F I N A N C I A L S

At the close of 2017, BHI has screened approximately 45,000 patients in screening and treatment programs in El Salvador and Haiti.

BHI, along with the CDC and the Salvadoran Ministry of Health, held a monitoring and evaluation training in El Salvador to scale-up screening and treatment efforts into the Central, Occidental and Oriental regions of the country.

Dr. Miriam Cremer, the President and Founder of BHI continues to enroll patient in a grant from the National Cancer Institute (NCI) through the Cleveland Clinic Women's Health Institute to perform a trial comparing innovative cervical precancer treatments in El Salvador, Peru and Colombia.

Drs. Miriam Cremer, Rachel Masch, and Karla Alfaro had the opportunity to visit hospitals in the United Kingdom to observe thermoablation for BHI's upcoming research.�

Cleveland Clinic was granted funding from The Gateway for Cancer Research and the Rising Tide Foundation to partner with BHI on ongoing NIH-funded studies. In addition, BHI has also received funding for this project from the Foundation for Women's Wellness.

BHI participated in the �rst annual symposium of Haiti sans Cervical Cancer in Port-au-Prince, Haiti

BHI was asked to assist in an international workshop hosted by PAHO/World Health Organization. Ministry of health delegates from 6 different countries in the Latin-American region attended. During the workshop, tools developed for improving cervical cancer programs were disseminated to the participants. Since El Salvador has successfully used these tools, the CDC replicated this workshop and presented it to stakeholders in El Salvador

In conjunction with the testing of HRME, Rice university is also developing a very low-cost (~$2 US) HPV test, and has asked BHI to help them evaluate it as part of their NHI grant on which we are sub-contracted.

39%

37%

7%

3% 14 %

ADMINISTRATION

DEVELOPMENT

PROJECTS

RESEARCH

PATIENT CARE*

I N C O M E 2 0 1 6 2 0 1 7

$ 1,906,548

$ 251,908

$ 73,356

$ 14,570

$ 2,246,384

$ 1,739,220

$ 300,564

$ 74,928

$ 17,785

$ 2,132,497

Non-Government Grants

Government Grants

Direct Public Support

Other Income

TOTAL INCOME (*UNAUDITED)

E X P E N S E S

2 0 1 7 E X P E N S E S

2 0 1 6 2 0 1 7

$ 342,060

$ 102,834

$ 763,236

$ 690,474

$ 49,629 $ 56,795

$ 1,948,233

$ 286,295

$ 147,353

$ 780,790

$ 814,059

$ 2,085,292

Administration

Development

Projects

Research

Patient Care

TOTAL EXPENSES (*UNAUDITED)

A N N U A L R E P O R T 2 0 1 7 | 1 4

*BHI HAS A GLOBAL PUBLIC HEALTH MISSION, HOWEVER WE OCCASIONALLY PROVIDE INDIVIDUAL PATIENT CARE.

Liz Lange Dr. Amy Woolever

A D V I S O R Y B O A R D

Einhorn Family Charitable Trust The Platt Family Foundation

F O U N D A T I O N S

Deepa Desai and Sumit Raipal Perdomo Family

William and Anne BaretzMiriam Cremer and Ian NixonCatherine D'Amato Miriam HessLiz Lange and David ShapiroLeva Family FoundationRobert LewisWendy LiberanteLaura Schiller Catherine PlattReach MDRoxane Reardon and Brian Bolster Laura Schiller Amy Woolever and Daniel Krainin

Leslie BoydJoseph and Susan BrowdyKerry Reinertsen and Emmanuel CrabbeSheldon CremerEsther FeinHelen GroftRachel MaschJennifer Mendel Eric ShermanJulie ShihLaClaire and Robert StewartLivia Wan

Ilana Addis Christina ArnettJoseph and Denise AugelloCheryl BassLauren BatailleNeha BhardwajSylvie BlausteinAnne BorkowfKeri-Anne Browne Regge Bulman and Monica SuuaAdam CifuAllison CowettAlexis Cramer Men-Jean and Giuseppe Del PrioreMax El Tawil

Caryl Hirsch and Jay FeingoldJuan and Betsy FelixTracey FlumWilliam and Helen GroftEdward GrubachCorita GrudzenDevi Gupta & Anthony Webb Dawn HarbatkinEthel HessRachel HessHeidi JacheAdam Jacobs Rachel Jones Ronald and Magdala JosephDavid KieferJane Kim and Stephen ReschJaime KnopmanMelissa KnorrShawn KonaryChristina KwonRona LardouxDiana LardyHermione LautureAnne LedermanCindy LeibovitchVeronica LernerCarol LoweSloan Maasikas Susanna MacSarah MallongaRichard MarkJason MaschMegan McCarrenMcCarthy Family Amy NovattJane NovattLoraine O'NeillKatherine O'haraPaulina and Don Ospina Sarah PachtmanLisa PerrieraConor Platt and Sara Mahoney Charles and Margaret Platt Tom Randall and Katrina ArmstrongChuck RobertsZoe RodriguezLinda Ronis and Jon Kass

Alvin and Nancy RoselinHumberto RossiJennifer RothenbergSusan RubinCarol Russell Jac Schiener Rebecca Schundler Lana SelitskyChris and Elizabeth SpeedElana StoryElizabeth ToroM. Jean Uy-Kroh Linda Weber Penny and Kevin WhiteJill Whyte Sandy WolofskyMichael YakerAnthony and Carole YatesNikki Zite

Kathryn ArabaszElizabeth ArztJori BelkinEmilie BenderSonya Borrero Dianne B. BraunPaul and Christine CremerGillian DeanDana Dorfman GrubinAntonette DulayM. Elizabeth FinoRachel Friedman Harris FriessJulia Gage Jillian GaraiJulia GolubMyrna GrossmanCarol HenaoHannah HenningsBen and Molly HowardStacie A. Jhaveri Elizabeth Jones Linda KassDalia KlausnerLauren KouffmanRebecca and Arthur LebowitzGillian LizarsEmily Loeb and Lee Hammons

I N D I V I D U A L D O N O R S

Sarah NicholsKenichi and Mary OhsakaBridgette PayneRebecca PodolskyLisa SampsonMalcolm ShorttMatthew SiedhoffMark SmithArianna Strome Jody Walter Arielle WatlingtonRosemary WeinRoxanne White

Jessica AtrioKatherine BellKatherine Bergman Lynn BorziJordan BrennerKimberley BullardPaula CastanoMiriam CharryMarilyn ChernickRebecca DonnGena DormineyEmily FeinerDavid Marra FrancisLindsay GimErica GrahamKristin HalvorsenElizabeth JanisMikail KoromaPaige KozlowskiRafael Licea Kiley MurphyHoward and Elaine Myers Raya O'Neal Lauren OffringaAlexandra RauJenna SalsedoKate SangervasiWilliam ShapiroDr. Morton and Noami SoiferLara Tãrle Kate VaugheyJuliana WhiteRapp-Yanowitz Family

Miriam HessWendy LiberanteRicardo Perdomo

Melissa Rendler Dr. Laura Schiller

Joseph PlattDeppea DesaiDr. Juan Carlos Félix

B O A R D O F D I R E C T O R S

The Bristol Myers Sqiibb Foundation Leva Family Foundation

The Boston Foundation The Merck Foundation

Amgen Foundation Amazon Smile

Many thanks to our 2017 individual and foundation support.Your generous contributions make our work possible

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N E W Y O R K | P I T T S B U R G H

S A N S A L V A D O R , E L S A L V A D O R