Corporate and Foundation Relations

HSPH'S LIFESAVING WORK IN BOTSWANA SUPPORTED BY BRISTOL-MYERS SQUIBB'S SECURE THE FUTURE INITIATIVE

L: Anti-retroviral drugs. R: Children in Botswana.
Photos by Richard Feldman.

In Botswana, more than one fourth of all adults are living with HIV/AIDS – among the highest rates in the world. More than 120,000 of the country’s children have been orphaned by the virus, according to UNAIDS/WHO estimates.

The Harvard School of Public Health AIDS Initiative (HAI) has been making an impact in Botswana since 1996. HAI received important early support for its work in the country from Bristol-Myers Squibb’s SECURE THE FUTURE initiative, the first and largest corporate commitment of its kind to fight HIV/AIDS in Africa.

A Grounbreaking Study
SECURE THE FUTURE funded the Adult Anti-Retroviral Treatment and Resistance Study or the “Tshepo” (meaning hope in Setswana) Study – one of the first large-scale research studies of anti-retroviral drug regimens to treat AIDS and HIV infection in Africa.

The study follows 650 adults infected with HIV-1C – the subtype predominant in southern Africa – for three years on anti-retroviral drug therapy. Patients have been randomized to one of six medication regimens and to one of two ways of receiving the drugs. One group visits the treatment clinic each month to see the doctor and pick up medications; the second augments monthly clinic visits with visits from a “treatment partner” who observes the patient taking his or her medication each day in their home or community. The study team monitors the types and rates of anti-retroviral drug resistance developing in this setting, and evaluates the safety, tolerability and effectiveness of the drug combinations and adherence strategies. What they learn can then be applied at treatment facilities throughout the region.

Those working with “SECURE
THE FUTURE understood that infrastructure had to be put in
place before anything else could
be done,” Richard Marlink said.

The funding from SECURE THE FUTURE came “at a time when people weren’t talking about disease treatment in Africa,” said Max Essex, Chairman, Harvard School of Public Health AIDS Initiative; Chairman, Department of Immunology and Infectious Diseases and John LaPorte Given Professor of Infectious Diseases in the Department of Immunology and Infectious Diseases. Bristol-Myers Squibb was “filling a niche in providing the type of funding that no one else was providing,” he said. Programs such as the Global Fund, UNAIDS, and U.S. government-funded PEPFAR provide treatment services, but are not doing research into which drugs are the most effective or what circumstances of administering the drug work best, Essex said.

The Tshepo Study is conducted at the Botswana-Harvard HIV Reference Laboratory. This state of the art facility located on the grounds of the country’s largest hospital received its initial funding from SECURE THE FUTURE, along with funds from the Government of Botswana and Harvard University.

The facility received funding to expand from the African Comprehensive HIV/AIDS Partnerships in Botswana, a public-private partnership involving the Government of Botswana, Merck & Co. Inc. and the Bill & Melinda Gates Foundation.

On the same campus as the Botswana-Harvard Reference Laboratory is the largest antiretroviral treatment clinic in the world. Approximately 4,000 patients are already receiving free treatment at this site.

"Although only half of the infected people in Botswana needing treatment today are able to be on treatment, this is a far larger proportion than in any other African settings, and more are being added to the treatment rosters each day,” said Richard Marlink, Executive Director of HAI, Principle Investigator for the Tshepo Study and a professor in the Department of Immunology and Infectious Diseases at HSPH.

Those working with “SECURE THE FUTURE understood that infrastructure had to be put in place before anything else could be done,” Marlink said. That involves more than buildings and staff, he said. The foundation provides training in medical ethics and record-keeping for staff at the site — a step critical for success in an African setting where this type of project has not been attempted before, Marlink said.

An added benefit to this project is that more people are willing to be tested now that they see that treatment is available, Marlink said. Before, in the face of discrimination and with little hope for treatment, many people in Botswana chose not to get tested. Now, attitudes are changing and more people are willing to disclose their HIV status, Marlink said. Several of the clinic’s patients have even gone on to participate in Botswana’s Miss Stigma Free beauty pageant.

"We at Bristol-Myers Squibb are very pleased with our partnership with HAI,” John McGoldrick, Executive Vice President and General Counsel at Bristol-Myers Squibb said. McGoldrick believes that the lab has already brought a great deal of value to the fight against HIV/AIDS and that there is the potential to learn much from the Tshepo Study.

“Partnering is the key to fighting the pandemic,” McGoldrick said. “HAI has been an excellent partner and we hope others will join in partnering with HAI to bring to bear the resources necessary to fight HIV/AIDS,” he said.

Bristol-Myers Squibb has supported additional HIV and AIDS initiatives at HAI, including research symposiums and an international art auction to benefit anti-AIDS initiatives in Africa, featuring prominent African artists. Other corporations which have supported HAI in Botswana include Merck & Co. Inc., Boehringer Ingelheim, and GlaxoSmithKline.

"Genetic Variation among African HIV's: Implications for Vaccines and Drugs."
Havard Public Health NOW, May 28, 2004