As my colleagues have mentioned,
our organization is seeking funds to implement pilot programs to initially treat
50 patients with HAART at each of our 6 clinics in Africa. We plan to limit the
number to 50 at each clinic so that we can learn to provide HAART effectively
and safely to our patients and collect good data regarding the outcomes of the
treatment. If we are going to continue to receive funding, we'll
need to demonstrate that we can successfully manage these programs
. If we
are successful, I'm optimistic that we will qualify for more funds to expand our
services and treat more patients.
At each clinic, we plan to treat patients with ARVs and
collect data regarding the outcomes of the treatment. There are many questions
about the use of ARVs in Africa that we can address in our study. For example,
there are two different types of HIV
, HIV-1 and HIV-2. HIV-1 is further divided into 2 groups that contain
several different sub-types. We do not yet know which anti-retroviral
drugs will be most effective against the sub-types carried by our patients. It
may be that the drugs that are effective against the strains of HIV prevalent in
the U.S. and Europe do not work as well for our patients in Africa. Our study
should help determine whether HIV sub-type affects the efficacy of different HAART
regimens
.
Dr. Dijiba mentioned that advanced tests that indicate the
state of a patient's immune system may not be available to us at every clinic.
Consequently, another question we will be able to address is "whether
the therapeutic outcome of HAART is different for patients who initiate this
therapy based on clinical signs and symptoms versus those who begin HAART based
on lab tests that measure CD4 cell counts and viral loads."
All treatment provided will be free, including the drugs.
I know Nurse Khosa will appreciate this even though some
may not. It is essential that patients take their ARVs every day as
prescribed. Failure to adhere to their dosing schedule can result in the virus
becoming resistant to the drugs they are using, meaning they will no longer
suppress the replication of the virus in a patient's body. And, if the resistant
virus is transmitted to another individual, those drugs will not work for him or
her either. Providing drugs free of charge and delivering them using DOT will
help ensure that drugs are used correctly. I agree with Dr. Dijiba's proposal to
seek additional funds to increase our ability to provide treatment for
opportunistic infections. Controlling these infections helps to slow the
progression of AIDS. There has been a lot of attention given to ARVs during
recent months. Dr. Dijiba is correct to remind us that they are not the only
form of treatment needed by patients with HIV/AIDS.
I feel we should begin by treating patients who are
no longer responding to treatment for opportunistic infections. They have the
greatest need. Lauren Martínez suggests that perhaps we should include 25 sex
workers in the program as a means of lowering infection rates in our service
area. At the present time, I would like to concentrate on treating the patients
who would have exhausted all treatment options besides HAART. I would like to
propose, however, that we train some of the sex workers to be community
health workers who will deliver the ARVs to patients on a daily basis. Because
we know that nutritional
status affects the progression of AIDS, one of the components of the HAART
study proposal is to provide food assistance to those being treated in the
program. If possible, the community health workers could also receive food
assistance to compensate them for their time spent performing this important
duty. Since hunger forces many women into prostitution, providing them with
another means of putting food on the table may help to lower infection rates.
AIDS is a complicated disease because there is no vaccine
on the market that prevents infection and no cure available for those who become
infected. We know how people can avoid HIV infection and we can tell them how to
do it, but the key is fostering conditions that actually give people a real
choice to avoid infection. Poverty, hunger, war, inequality, and lack of
education and medical care all compromise an individual's ability to avoid HIV
infection and receive care once infected. Medical science continues to seek a
cure for HIV/AIDS. Until a cure is found, our clinics can provide some answers
about slowing the spread of the disease and postponing death as the whole world
struggles with the broader implications and causes of AIDS in Africa and
throughout the world.
