Nav: Home

Study examines lessons learned at Africa's first public antiretroviral treatment clinic

March 10, 2005

A public clinic offering antiretroviral (ARV) treatment to people with HIV/AIDS, recently established in Botswana, has had its share of trials and errors. However, the obstacles it has encountered--and has largely overcome--can serve as valuable lessons for other developing countries trying to launch their own treatment programs, according to an article in the March 15 issue of Clinical Infectious Diseases, now available online.

According to World Health Organization estimates, only about 700,000 of the 6 million people with HIV/AIDS who need ARV treatment are getting it. Major efforts are underway to increase access to ARV treatment, but many countries are struggling with limited staff and infrastructure.

Botswana's high rates of HIV--more than a third of its adult population is infected--make it a prime candidate for publicly available ARV treatment. Africa's first public ARV clinic opened in Gaborone, Botswana's capital city, in January of 2002, and was immediately inundated with patients, some of whom had to wait four or five months to begin ARV treatment.

Physical space for consultation and counseling proved to be the first challenge. The facility's 4,000-patient capacity was quickly reached. To handle the influx, additional buildings were erected, and they now accommodate more than 11,000 patients being treated at the clinic.

Clinic staffing changes were also necessary. Initially, medical personnel were rotated in from inpatient hospital wards in order to gain outpatient care experience. However, to ensure consistent care for clinic patients, a core team of HIV specialists was eventually created to staff the clinic and train junior staff as HIV care providers. All ARV clinic staff members involved in patient care received ongoing training to get the most up-to-date information on HIV treatment.

The lack of medical personnel available to staff such a specialized clinic in an African nation has varying causes, depending on the country, according to Richard Marlink, MD, of the Harvard School of Public Health AIDS Initiative and lead author of the article. "In some places, this deficit is not because the experts don't exist, but rather that the system can't pay them or [doesn't] have positions for them," Dr. Marlink said. "In other places, the experts just don't exist in the numbers needed." Botswana has a peculiar combination of the two problems in that there are lots of nursing schools, but no medical schools. Many nurses are often forced to look for work outside Botswana due to a lack of positions that pay well, but physicians have to be contracted from other countries, said Dr. Marlink.

If the country's government institutionalizes the ARV clinic's practice of having specialists train junior staff in HIV treatment, it could help to ensure an ongoing source of expert care providers "so that it's an accepted specialty, as it were, for young nurses and doctors and counselors to enter into a specialized profession of HIV/AIDS care," Dr. Marlink added.

The Botswanan government's ongoing support of efforts to control the spread of HIV/AIDS has been a key to the creation of the ARV clinic. "From President [Ketumile] Masire to President [Festus] Mogae, the leadership on approaching the epidemic as a national epidemic has been unbelievable," Dr. Marlink said.

Most African medical centers deal solely with acute problems, such as medical emergencies, rather than chronic conditions. Therefore, the ARV clinic's successful establishment, as well as its treatment of thousands of HIV-infected people, is promising. "We're hoping that this will help create infrastructure that will help not only with HIV but with other chronic diseases that would normally be easily treated in the West," Dr. Marlink said.
-end-
Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Alexandria, Virginia, IDSA is a professional society representing more than 8,000 physicians and scientists who specialize in infectious diseases. Nested within the IDSA, the HIV Medicine Association (HIVMA) is the professional home for more than 2,700 physicians, scientists and other health care professionals dedicated to the field of HIV/AIDS. HIVMA promotes quality in HIV care and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice. For more information, visit www.idsociety.org.

Infectious Diseases Society of America

Related Hiv Articles:

Defective HIV proviruses reduce effective immune system response, interfere with HIV cure
A new study finds defective HIV proviruses, long thought to be harmless, produce viral proteins and distract the immune system from killing intact proviruses needed to reduce the HIV reservoir and cure HIV.
1 in 7 people living with HIV in the EU/EEA are not aware of their HIV status
Almost 30,000 newly diagnosed HIV infections were reported by the 31 European Union and European Economic Area (EU/EEA) countries in 2015, according to data published today by ECDC and the WHO Regional Office for Europe.
Smoking may shorten the lifespan of people living with HIV more than HIV itself
A new study led by researchers at Massachusetts General Hospital finds that cigarette smoking substantially reduces the lifespan of people living with HIV in the US, potentially even more than HIV itself.
For smokers with HIV, smoking may now be more harmful than HIV itself
HIV-positive individuals who smoke cigarettes may be more likely to die from smoking-related disease than the infection itself, according to a new study published in the Journal of Infectious Diseases.
Patients diagnosed late with HIV infection are more likely to transmit HIV to others
An estimated 1.2 million people live with HIV in the United States, with nearly 13 percent being unaware of their infection.
The Lancet HIV: New HIV infections stagnating at 2.5 million a year worldwide
A major new analysis from the Global Burden of Disease 2015 study, published today in The Lancet HIV journal, reveals that although deaths from HIV/AIDS have been steadily declining from a peak in 2005, 2.5 million people worldwide became newly infected with HIV in 2015, a number that hasn't changed substantially in the past 10 years.
NIH scientists discover that defective HIV DNA can encode HIV-related proteins
Investigators from the National Institutes of Health have discovered that cells from HIV-infected people whose virus is suppressed with treatment harbor defective HIV DNA that can nevertheless be transcribed into a template for producing HIV-related proteins.
Study examines risk of HIV transmission from condomless sex with virologically suppressed HIV infection
Among nearly 900 serodifferent (one partner is HIV-positive, one is HIV-negative) heterosexual and men who have sex with men couples in which the HIV-positive partner was using suppressive antiretroviral therapy and who reported condomless sex, during a median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission, according to a study appearing in the July 12 issue of JAMA, an HIV/AIDS theme issue.
HIV vaccine design should adapt as HIV virus mutates
Researchers from UAB, Emory and Microsoft demonstrate that HIV has evolved to be pre-adapted to the immune response, worsening clinical outcomes in newly infected patients.
Charlie Sheen's HIV disclosure may reinvigorate awareness, prevention of HIV
Actor Charlie Sheen's public disclosure in November 2015 that he has the human immunodeficiency virus (HIV) corresponded with the greatest number of HIV-related Google searches ever recorded in the United States, according to an article published online by JAMA Internal Medicine.

Related Hiv Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Moving Forward
When the life you've built slips out of your grasp, you're often told it's best to move on. But is that true? Instead of forgetting the past, TED speakers describe how we can move forward with it. Guests include writers Nora McInerny and Suleika Jaouad, and human rights advocate Lindy Lou Isonhood.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...