Physical Health Mali Project #4874

Nutrition and peer support for HIV+ patients

by GAIA Vaccine Foundation

Nutrition and peer support for HIV+ patients

Project Report | Nov 28, 2011
2011 World AIDS Day Update

By Mali Rochas | Executive Director

Preparing food for the patients

In the business world, people talk about “Return on Investment” or “ROI”. What’s that mean? Well, usually hat it means – what’s the reward for the funds we invest. At GAIA Vaccine Foundation, our ROI can be measured in smiles, in healthy babies who do not have HIV infection, in lives saved. What’s that ROI? Priceless. And unlike many not-for-profits, GAIA donor dollars go directly to programs. GAIA VF supporters have satisfaction of knowing that lives can be dramatically improved, and the knowledge that – during the greatest pandemic in human history, GAIA VF is leading the way.

How so? We understood the importance of improving access to treatment and invested in building the Hope Center Clinic in 2008 to make HIV treatment accessible. The clinic brings HIV medications right to patients in their neighborhood. We predicted that improving access would reduce HIV transmission, and we were right! In fact, one of the key discoveries in HIV/AIDS in recent years has been that “Treatment is Prevention”. In May 2011, a study involving 1,763 HIV-sero-discordant couples (one partner was HIV positive, the other was not) was stopped before its original closing date because an interim analysis showed a 96% reduction in the HIV transmission rate (See Cohen M.S. et al. N Engl J Med. 2011).

Based on the published data, our success at HCC and the global trend to make HIV treatment available as a means of prevention, our next step is to petition the Malian government to provide Treatment as Prevention at our HCC and follow the impact on the community. In the absence of a vaccine, if providing access to medication can lead to eradication of AIDS, we’re ready to spring into action.

What does the new finding that treating HIV can prevent HIV transmission and the call for Universal Access mean for the rest of the world? It means that the gap between the number of people needing to be treated and the funds available to make that treatment accessible just got wider. Recent reports show a 7% decrease in philanthropic donations for AIDS, from 2009. GAIA Vaccine Foundation’s achievements have proved that each donor’s support is critical to further our mission and improve access to HIV care. In this special World AIDS Day 2011 update, we are pleased to report that the support that we generously received from all our donors allowed us to go above and beyond the objectives that were set for our program.

Through donations and grants, GAIA VF created one of the first clinics in West Africa to distribute village-level HIV care. In January 2011, the Hope Center Clinic was awarded a “Ciwara” (highest honor) by the local Department of Health. As the next International AIDS Conference is taking place in Washington DC in 2012 we will be highlighting our success in oral and poster session. We just completed an evaluation of our Mother to Child HIV transmission prevention program (started in 2005) and data from the past 30 months of our universal access intervention in Sikoro have been analyzed. We are happy to share the results with you.

Assessing our PMTCT Program
In 2010 and again in 2011, volunteers from all over the world traveled to Mali to work on a major evaluation of our program. Our volunteers included Christina Gomez-Mira (U. Texas), Natasha Rybak (Brown U.), Emily Kossow (Wesleyan), Tonhu Hoang (Concord Academy), and Nick Platt (American University of Paris) worked on assessing the adult HIV care with Ali Bicki (U. Miami) while Danielle Poole (Brown MPH program) and Shahla Yekta, Ph.D. (URI) worked on the HPV vaccine studies.

Our efforts are yielding positive results. Mother to child transmission (MTCT) is near zero – only one mother transmitted the virus to her child. The mothers report that they are very satisfied with the care that they are provided at HCC’s “Chez Rosalie” (the MTCT prevention program). In 2011 a second study was conducted and a questionnaire related to both mother and children was submitted. This process allowed us to link the mothers enrolled in the PMTCT program to their newborn and previous children and identify risk factors for transmission.

PMTCT in numbers (2005-2011)
10,150   pregnant women in prenatal care
9,060     pregnant women tested for HIV
198        pregnant women diagnosed with HIV
156        newborns in care
129        babies fed with formula

Evaluating our HIV care Program
We recently evaluated the efficacy of HIV treatment with “tri-therapy” in terms of AIDS-related infections, changes in weight, and CD4 counts over a 30 month study period. More than 60% of the patients increased their weight and CD4 counts and the percentage of patients with opportunistic infections was significantly reduced.

2011 Hope Center Clinic Achievements
200     HIV-infected adults and children in care
20       newborns tested by PCR for HIV
37       children in care
86       new HIV+ patients on treatment
830     patients received nutrition support
62%    improved their viral load while under ARV
61%   of patients had opportunistic infection (OI) at beginning of therapy; <17% had OI after 7-15 months

HPV vaccine Project – Preparing for Trials
Danielle Poole (with help from Kate Tracy, University of Maryland) carried out a study to evaluate whether women (and men) in Mali are ready to accept vaccination with HPV vaccine, the newly approved vaccine that prevents cervical cancer in women and anal warts in men.

This study is supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The KAP and WTP studies will enable GAIA VF to collect information and data necessary for introducing the Gardasil vaccine in Mali; a clinical study is anticipated for next year. This project helps GAIA filed personnel develop the necessary experience, protocols, put an infrastructure in place, and also enables us to train medical personnel. The goal is to lay the groundwork for all vaccine studies to come.

December 1st is World AIDS Day: Honor the Day with a donation!
This year the UNAIDS objectives are: “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” Help us stop HIV/AIDS!

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Jul 18, 2011
Summer Update

By Dr Anne De Groot | Founder and Scientific Director

Thirty years after the first report about HIV, what can each of us say that we have done to stop AIDS?

As you are a supporter of the GAIA Vaccine Foundation you know the answer – quite a lot!

Research on the GAIA HIV vaccine continues in parallel with the National Institutes of Health-supported collaboration extending from Providence (URI, EpiVax) to the University of Bamako and the laboratory of Dr. Ousmane Koita. To demonstrate that HIV prevention is linked to HIV care, we developed a model program of HIV access to care, prevention, and mother-to-child HIV transmission prevention (MTCTP) in a clinic in Sikoro, an underprivileged suburb of Bamako.

Our short term and long term objectives may initially appear to be very different, but in fact, we are pursuing a steady path toward a single unified goal – a globally accessible, globally relevant HIV vaccine.
We have a consistent record of progress in the battle against HIV and AIDS and we are now entering a capacity building phase at our Hope Center Clinic, where we are beginning to create the infrastructure for vaccine trials.

In 2010, GAIA was able to provide cutting-edge HIV care and prevention at the front line of the HIV epidemic

•   We promote HIV prevention through peer education – our peer educators include a football coach, a university student, and a young mother, each of whom promotes HIV testing in their spare time.
•   We link government resources with the community, distributing free HIV care medication provided by the national HIV programs to patients enrolled at the clinic.
•   We provide cutting-edge HIV care at the front line of the battle against AIDS, setting an example for the rest of West Africa.

Access to care and impact on patient wellness
Since the launch of our ARV access program in 2009, hundreds of patients have enrolled. Other than the few deaths observed for patients who were already in the highly advanced clinical stages of disease when they arrived at our clinic, we have seen steady improvement in patient status as measured by CD4 T cell counts, weight, and adherence to therapy. As a result of donor support, we have also been able to increase our testing capacity. Our peer educators made more than 4,000 contacts within the community. Fifty percent of new patients were eligible to start HIV medication, of whom about half were pregnant women. Those who are HIV-seropositive, but not yet clinically eligible for ARV treatment, are being followed. We have had an almost 100% rate of adherence to therapy – all of the patients followed for longer than 11 months are adherent to treatment - and only a few patients have failed to follow up. To strengthen adherence to treatment, we hired a case manager and now provide education and psychological support sessions within the Hope Center Clinic.
Due to improved adherence to treatment, the patients’ health statuses have greatly improved. Significantly, our physicians have reported that patients have fewer opportunistic infections while on treatment. No deaths have been observed among those patients followed in the clinic who have been treated for at least four months. This is an incredibly important achievement: not only does it reinforce the belief that therapy can make a difference, but it also motivates our professional staff and our patients to engage in HIV care.

Successful prevention of MTC HIV transmission
Since February 2005, more than 7,000 women have received prenatal care from GAIA’s Chez Rosalie clinic, with an average of 128 women per month. Women who test positive are offered PMTCT services, and ARV and other necessary treatments are made available to their children. The percentage of women who accepted PMTCT grew from 35% in 2005 to 100% since 2010. To date, nearly 100 HIV-positive mothers have given birth in the Chez Rosalie clinic. All of the children born of mothers treated at the Chez Rosalie clinic (entirely supported by GAIA) are HIV-negative! That is a remarkable success.

Award winning clinical care at Hope Clinic!
Our Hope Clinic won a “Ciwara” Award from the local government in January 2011!

New programs for 2011
We are conducting a clinical study in preparation for testing an HPV vaccine. This project will build capacity for eventual HIV vaccine trials by providing training to our collaborators. If funding is approved, a small HPV vaccine trial will take place next year.

Continuing programs in 2011
HIV care, nutritional support, and MTCTP (Chez Rosalie) will be ongoing. The number of patients continues to expand. Donor support is sincerely appreciated for our award-winning program!

Thank you for supporting our work. Each donation helps us stop HIV in its tracks!

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Jun 13, 2011
Food and adherence to treatment

By Mali Rochas | Executive Director

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