Thursday, 13 September 2007
Experts from Nigeria, Tanzania, and Botswana shared successes and challenges of Harvard-PEPFAR program in Africa
Abuja, Nigeria--In Nigeria three million people currently live with HIV/AIDS. Of these three million, 305 new infections occurred only last year.
This rapidly growing number of HIV infections in Nigeria motivated the APIN Plus-Nigeria program (Harvard-PEPFAR), an initiative started in 2003 to address AIDS prevention and intervention methods in Nigeria, to continually develop its technology and improve Nigeria’s HIV labs and pharmacies.
According to Ernest Ekong, National Clinical Coordinator for APIN Plus-Nigeria, the program uses data management to develop treatment response graphs to monitor biological failures in patients who are not responding well to their ARV treatments. When this occurs, doctors start resistance testing with patients and change the patients’ drugs accordingly to improve their biological response to ARV treatments.
‘The ability to graph biological failures is an important tool for medical staff to address adherence issues for patients,’ said Ekong. ‘It makes a huge difference in the lives and health of people living with HIV/AIDS.’
Since 2003, APIN has operated on 17 sites across the country—11 of which are research facilities, and six of which are primary health facilities. After their steady progress in data management and treatment response, the APIN Plus-Nigeria program plans to continually use data to give HIV/AIDS patients the quality care they deserve in Nigeria.
Tanzanian and US Governments support Harvard-PEPFAR’s expansion of renovated medical sites
In the past two months Tanzania’s Harvard-PEPFAR program received visits from three government figureheads to inaugurate the grand opening of its two renovated medical clinics in Amana and Mwana, Tanzania.
The Tanzanian president, the Tanzanian Minister of Health, and the U.S. Secretary for Human Health Services visited the sites to mark an important commitment between government officials and civil services to expand medical centers and build better infrastructures for people living with HIV/AIDS in Tanzania.
On September 5, 2007, the number of AIDS patients enrolled in the Tanzanian Harvard-PEPFAR program was 30, 915. With two new medical clinics available to provide space for patients, Dr. Guerino Chalamilla of Harvard-PEPFAR said that patients’ quality of life and drug adherence are the next big focus.
Patient tracking, a process in which four to six nurses at each medical site document patients’ phone numbers and physical addresses after their first visit, allows nurses to follow up with patients that have missed visits, provided abnormal lab results, or failed to pick up their ARV treatments.
Patient tracking encourages constant communication between nurses and patients and pushes patients to adhere to their ARV treatments—a very important aspect of living healthily with HIV/AIDS. Formal adherence is a crucial aspect of Tanzania’s program according to Chalamilla, as patients’ adherence rates are checked through self reporting and rate counters checked by pill counting.
‘If patients are taking less than 95 per cent of their pills, then medical staff must provide counseling to address the barriers to effective ARV treatment,’ said Chalamilla.
Critical attention to patient care marks Tanzania’s program as one committed to continually serving people living with HIV/AIDS. Since the late 1980s, the Harvard School of Public Health has worked in Tanzania to develop an internationally recognized clinical and vaccine based research program and a research study on the role of micronutrients in reproductive health and HIV/AIDS.
Harvard-PEPFAR program takes key step towards master training and patient care
In Botswana’s Harvard-PEPFAR program, people are often said to be valued more than numbers. Though this seems a positive statement, it raises imminent challenges for providing endless needs assessments for patients and staff members and to ensure complete satisfaction with PEPFAR treatment.
But Botswana is taking on the challenges with gust. Nurses now implement exit interviews, in which patients are asked questions about how satisfied they were with their visit, how long they had to wait for medical attention, and if they were seen by a nutritionist before they left the medical clinic. The administrators and staff also measure the success and impact of their program by carrying out quality of life studies for every patient.
‘Our program is quite simple,’ said Dr. Tendani Gaolathe of the Harvard-PEPFAR program in Botswana. ‘Our mandate is for training staff to care for patients, and we try to be very people focused, always.’
As for overcoming challenges, there is always more to be done. Space is always a major concern at Botswana clinics, and according to Gaolathe, limited manpower and expensive equipment servicing has caused some issues in the past.
“But we are learning our lessons,” said Gaolathe, such as making sure to establish service contracts for every piece of equipment they buy so as to avoid paying expensive repair fees in the future. And though the Botswana program is scheduled to officially end in February 2009, Gaolathe is confident that they will obtain another PEPFAR grant and continue to increase the level of patient care and staff treatment in Botswana.
*Reported by Amanda Hale