AMPATH: Restoring lives not just immune systems

November 26, 2007

INDIANAPOLIS - The HIV/AIDS epidemic in Sub-Saharan Africa is decimating populations, depressing economies, deepening poverty and destabilizing traditional social orders. Various programs to prevent and treat HIV/AIDS have been developed, but few have demonstrated the capacity to make an on-going difference to a large number of affected individuals, their families and their communities.

A study published in the December issue of the Journal of General Internal Medicine reports on why AMPATH, a program which broadly defines health care, is successful in fighting AIDS and improving lives.

AMPATH, which stands for the Academic Model for the Prevention and Treatment of HIV/AIDS, was initiated in 2001 and grew out of a long-standing partnership between the Indiana University School of Medicine, Moi University and Moi Teaching and Referral Hospital, both in Eldoret, Kenya.

The first AMPATH patient was enrolled 6 years ago; today AMPATH serves an estimated 52,000 HIV-positive people in western Kenya.

"If we think that we can succeed in treating people with HIV/AIDS without attending to all their needs, we are mistaken," said Thomas Inui, M.D., M.S., principal investigator of the JGIM study. "The story of AMPATH is the story of attention to health and to restoring lives, not just immune systems." Dr. Inui is president and CEO of the Regenstrief Institute, Inc., Sam Regenstrief Professor of Health Services Research and associate dean for health care research at the Indiana University School of Medicine.

AMPATH takes a comprehensive approach to HIV/AIDS, attending to medical care, nutritional sufficiency and economic security. It assisting patients and their families by providing education, preventive services, treatment, dietary assistance, and by helping them grow food and hold jobs. Once individuals with HIV/AIDS are able to again earn a living and become vital members of their community once again, even the stigma associated with HIV/AIDS disappears.

Today AMPATH has expanded to include a consortium of U.S. medical schools led by the IU School of Medicine. Patient enrollment is rising by 2000 per month. AMPATH's high-production farms and demonstration farms provide food assistance to up to 30,000 people every month.

For the JGIM study, Dr. Inui and colleagues conducted oral interviews with individuals involved in AMPATH -- Kenyan physicians, clinical officers (similar to physicians' assistants in the U.S.), nurses, nutritionists, pharmacists and others working within facilities operated by the Kenya Ministry of Health. The interviews demonstrate how these individuals go beyond humane and compassion treatment.

Initially, health personnel were aware that families frequently walked for hours or even days, sometimes pushing a wheelbarrow as a means to transport a loved one, to a clinic. It was apparent that unless the doctors and healthcare workers could ensure continued nourishment to the patients and means for the families to survive economically, there would be no return to health. From this need grew educational and vocational programs for patients and their families and the farms to provide both crops and training and ultimately health (half the patients are on anti-retroviral drugs) and income security.
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In addition to Dr. Inui, co-authors of the JGIM study, which was funded by the Purpleville Foundation of Ontario, Canada, are Winston M. Nyandiko, M.D., and Sylvester N. Kimaiyo, M.D., of Moi University School of Medicine, Tadeo Muriuki, B.S., of AMPATH, Richard M. Frankel, Ph.D., Joseph J. Mamlin, M.D., Robert M. Einterz, M.D., and John E. Sidle, M.D., of the Indiana University School of Medicine. Dr. Frankel is also affiliated with the Richard Roudebush VA Medical Center in Indianapolis.

On Nov. 19, the U.S. Agency for International Development announced $60 million in new support for AMPATH, see http://medicine.indiana.edu/news_releases/viewRelease.php4?art=777&print=true

To learn more about AMPATH go to http://medicine.iupui.edu/kenya/hiv.aids.html

Indiana University

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