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There is hope for HIV/AIDS in Botswana
Di Caelers. 27 June 2003. Cape Argus. Republished courtesy of Independent Newspapers (Pty) Ltd.
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Last December doctors from Botswana, in partnership with Harvard University in the United States, were piloting treatment with antiretrovirals of people with HIV/AIDS from a tiny room at the Princess Marina Hospital in Gabarone.
Today, about 6 000 people across that country are receiving the treatment, and that same partnership of doctors is conducting pioneering HIV/AIDS research in resource-poor settings that promises answers that can be applied across the entire sub-continent, including South Africa.
Questions like resistance to antiretrovirals, a concern that has been expressed widely here in respect of a national treatment programme, are likely to be answered by a vitally important research project - and the first of its kind in the world - being conducted on 650 people in Gabarone.
Called Tshepo, which means 'hope' in Setswana, it is the first large-scale study of the use of antiretrovirals for the treatment of adults with HIV in Africa.
Planned to assess mutation rates for drug resistance of HIV (sub-type C which is the type of HIV found commonly in South Africa too), the study will also evaluate different strategies of how to best administer the drugs in this African setting.
The work is being made possible courtesy of the Botswana-Harvard HIV Reference Laboratory, a partnership that Peter Piot, director of UNAIDS, has called "a model for how to do collaborative public health research in Africa".
The state-of-the-art building, which opened in 2001 as a result of the joint efforts of the Botswana government, the Harvard AIDS Institute and funders Secure the Future, it is a fully outfitted research laboratory and training centre that has spawned multiple research projects that are both complete and ongoing.
To add to the expertise, the city also last week celebrated the official opening, also on the site of the Princess Marina Hospital in Gabarone, of a top-notch paediatric research facility that rivals anything similar in New York or London.
Built at a cost of $5.5 million, the Baylor-Botswana Children's Clinical Centre of Excellence is funded by Secure the Future, pharmaceutical company Bristol-Myers Squibb's $100m commitment to fighting HIV/AIDS in Botswana, South Africa and neighbouring countries. Secure the Future paid $6m for the building of the Reference Laboratory.
The Children's Clinical Centre is set to kick off with a three-year trial involving about 600 HIV-positive children in Botswana, examining "structured treatment interruption", or research into periods of "no drug" treatment for children on antiretrovirals, with a view to addressing toxicity and cost.
In the Tshepo trial, scientists will compare six different antiretroviral combinations, all standard ones used around the world, and two of which are being used in Botswana's national ARV programme.
The primary objectives of this study include: monitoring drug resistance; evaluating the safety, tolerability and effectiveness of these combinations; and, comparing two adherence strategies to determine the best long-term adherence strategy in this setting.
The first patients were enrolled in December and by May 1, according to study co-ordinator Dr Bill Wester, all were doing well. "We'll be monitoring the people involved in the study closely for 36 months," he said. Medication for that study is supplied by Bristol-Myers Squibb.
In Botswana, Health Minister Joy Phumaphi said an antiretroviral therapy programme was started in January. Currently six sites are up and running and another six will be added before the end of the year.
She said she welcomed partnerships of any kind to strengthen the country's battle against HIV/AIDS, describing them as part of a cloth being woven that would eventually be so strong that AIDS could finally be beaten.
Botswana has also rolled out its mother-to-child HIV-transmission prevention programme to the entire country, and the President Festus Mogae said the new Botswana-Baylor Children's Clinical Centre of Excellence would support the work in this field that is already being done in Botswana. He called the new centre "a monument to the common struggle against the scourge of AIDS".
"The battle calls for a multi-faceted approach which includes strong prevention, good clinical practice and sound research." Botswana, Mogae said, had suffered major setbacks with the gains the country had made being eroded by HIV/AIDS. But in the past two years figures had indicated the pandemic was plateauing. "But we mustn't be complacent," he warned.
Secure the Future senior medical director, Dr Sebastian Wanless, said the research centres were an indication of the top priority the Botswana government had accorded the fight against HIV/AIDS.
With thousands of HIV-positive people in Botswana already on antiretroviral treatment, he said the results from the new children's institute promised important data for the future treatment of HIV-positive children throughout the continent of Africa.
Professor Gabriel Anabwani, head of paediatrics at Princess Marina Hospital said the centre would enhance the training needs of southern African healthcare workers, and serve as a model for the care of HIV-infected children. |
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