Out of Africa: Advancing HIV prevention and care
While health care providers in the U.S. have made remarkable strides in extending the lives of those infected with HIV , many countries around the world still lag decades behind in their diagnostic and treatment capabilities, a disparity with tragic, yet preventable consequences.
For more than 20 years, Ellen G. Chadwick, MD, has been a driving force in ensuring advanced treatments for children and adolescents with HIV. She has served as co-director of the Pediatric, Adolescent and Maternal HIV Infection Program at Children's Memorial since 1986, as well as co-principal investigator for the Pediatric AIDS Clinical Trials Center funded by grants from the National Institutes of Health and the National Institute of Allergy and Infectious Diseases. Now she is sharing her years of experience and expertise with health care providers in Africa, where the HIV crisis is most dire.
In the fall of 2005, Chadwick traveled to Kenya and South Africa as part of the International Center for AIDS Treatment and Prevention's initiative called “MTCT-Plus,” (Mother to Child Transmission). The program, spanning 14 African nations, offers free HIV testing and treatment to pregnant women to prevent the transmission of the virus from mother to baby. The “Plus” component is the treatment extended to members of a woman's household, such as her spouse, children and in-laws, if they, too, are infected.
Chadwick trained health care providers in Soweto, South Africa at Chris Hani Baragwanath Hospital, the largest hospital in the world, where approximately 20 to 30 babies were born every day to HIV-infected mothers. She also spent time in the largest HIV clinic in Kisumu, Kenya, training physicians, nurses and pharmacists while treating young patients, many of whom had never received medication and were gravely ill.
“It is so rewarding to see how quickly children with HIV feel better after starting antiretroviral (anti-HIV) therapy,” says Chadwick. “To see the children's smiles and the hope and relief on their mothers' faces was tremendously gratifying.”
In the spring of 2006, she returned to Africa to train physicians in Ethiopia, where few providers had any experience in treating, or even diagnosing HIV in children. “We went there expecting to teach them how to manage the disease, but soon realized that we needed to start at the beginning and help them identify those who needed to be tested,” says Chadwick.
Chadwick says that in Ethiopia, physicians are so overwhelmed with providing general medical care that the thought of adding the whole spectrum of HIV care was daunting. Many expressed fear about the ramifications of making an HIV diagnosis, from the need to test and treat other members of the person's household, to serious social implications, such as an HIV-positive woman being shunned or victimized by domestic violence. Chadwick and her team focused on identifying and training local individuals who could continue to educate others in HIV prevention and treatment and work to uphold the new systems put into place.
“There is still a huge amount of work that needs to be done,” she says. Despite the many challenges, Chadwick feels a great sense of hope about the potential for progress in Africa.
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