GLOBAL ENHANCING CARE INITIATIVE CONTINUES GROUNDBREAKING RESEARCH TO IMPROVE CARE FOR HIV AND AIDS IN THE DEVELOPING WORLD

First two years of five-year initiative produce positive results.

DURBAN, SOUTH AFRICA, July 9, 2000—In Durban today, representatives from HAI presented an update for the two-year anniversary of the Enhancing Care Initiative. Launched in 1998 at the 12th World AIDS Conference in Geneva, Switzerland, the Initiative has made remarkable progress in its quest to improve the quality of care provided to people living with HIV and AIDS around the world, especially those in resource-scarce countries.

The Initiative—the first of its kind—aims to solve problems related to HIV and AIDS care in individual countries through the development of AIDS Care Teams, whose members are local experts with experience addressing the epidemic in their countries. Each AIDS Care Team is composed of clinicians, people living with HIV, epidemiologists, health care delivery experts, human rights specialists, behavioral scientists, economists and political scientists from the region involved. Since its inception, the Initiative has established four regional AIDS Care Teams in resource-scarce areas around the world. Along with teams in Brazil and Senegal, the Initiative is now represented in Thailand and South Africa as well.

"The Enhancing Care Initiative recognizes the importance of local experts working together to improve care for people living with HIV and AIDS," says Richard Marlink, executive director of HAI. "People who live in the regions are most intimately acquainted with the particular challenges of providing care locally. The Initiative helps unleash that knowledge so it can be applied to concrete improvements in care."

The AIDS Care Framework
In order to help identify problems in the care for people living with HIV and AIDS, each team uses the AIDS Care Framework developed by the Enhancing Care Initiative. The framework—a tool that supports the assessment of HIV and AIDS care in a specific population or region—is composed of three main components—analysis, planning and evaluation. Using the framework, each of the teams has been able to define key elements of care and their corresponding relationships, assess the state of care, and identify any existing gaps in knowledge or efforts.

A thorough analysis is critical to each team’s research since it provides the foundation for the planning and evaluation components of the framework. Examining individual care, the analysis component covers nine areas of care: voluntary HIV testing and counseling; basic medical care services (including HIV/STD prevention); laboratory and diagnostic services; HIV and AIDS clinical management (including opportunistic infection prophylaxis); new therapies (including antiretrovirals); community-based care (including traditional and complementary therapies); social services; care education and information dissemination; and supportive care and care of the dying.

Upon completion of the analysis component, a team will move into the planning and evaluation components from which recommendations are made on how to provide the best care possible to each country’s HIV and AIDS patients.

South Africa: The Importance of Home- and Community-Based Care
The rapidly increasing number of AIDS cases has begun to severely strain the existing health care systems in the developing world. In places like KwaZulu–Natal, South Africa, there are more patients in need of hospitalization than there are available hospital beds. As this strain continues, the importance of quality care alternatives, including home and community-based care, becomes critical. Led by Dr. Vinodh Gathiram, professor, University of Natal, and Antonia Mtinjana, occupational health education coordinator, University of Natal, the team has developed a proposal for a home and hospice care network in KwaZulu–Natal and has identified the need within the province to improve the continuum of care, which exists between hospitals and the community.

Senegal: Understanding the Economic Impact of HIV and AIDS Care
As developing nations work to build the basic infrastructure necessary to improve overall living conditions, the economic impact of establishing and maintaining a sound healthcare infrastructure is substantial. In Senegal, the AIDS Care Team’s goal is to provide solid recommendations to its government on how best to improve HIV and AIDS care on a national level. Led by Dr. Souleymane Mboup, professor, University of Dakar, the team began its project with Phase I research in which an overall assessment of HIV and AIDS care throughout the country was conducted. Using data from Phase I, the team began to analyze factors that affect health care delivery, including the availability of basic medical care, laboratory diagnostic services, and basic treatment of opportunistic infections. In addition, the team is assessing the costs of sustaining the national antiretroviral pilot program.

Brazil: Closing the Gender Gap
Recognizing the inequities in the medical treatment of HIV-positive men and women living in Brazil, the Brazilian AIDS Care Team designed two studies to address this issue. For the last two years, the team, led by Dr. José Ricardo Ayres, associate professor, Department of Preventive Medicine, University of São Paulo Medical School, has researched the public health services offered to women in São Paulo and Santos living with HIV and the obstacles to the use of health services by HIV-positive pregnant women. The Brazilian AIDS Care Team, having surveyed more than 1,100 women living with HIV, will use the final data to influence the policies and programs that are available for women living with HIV in Brazil.

Thailand: Bridging the Knowledge Gap
As in many other regions in resource-scarce countries, AIDS is taking its toll in Thailand, where the northern region has been hardest hit by the epidemic. Preliminary research was conducted on the impact of AIDS but significant gaps in knowledge still exist.

Led by Wilawan Senaratana, dean of faculty of nursing, Chiang Mai University, the Thai team began its project with a situation analysis of HIV and AIDS care in Northern Thailand. The analysis provided a broad overview and was presented at a number of symposia, including a two-day satellite meeting held in conjunction with the 1999 Thai National Conference on HIV and AIDS. Having completed an analysis of both rural and urban factors that contribute to enhanced community-based care, the team has identified and begun to implement compassionate and sustainable community-based improvements to care in the northern region. There are also plans to record and disseminate success stories regarding HIV/AIDS care in Northern Thailand.

A five-year initiative of HAI, based at the Harvard School of Public Health, and initiated with a major commitment from the Merck Company Foundation, the Enhancing Care Initiative brings together the best possible local experts, creating AIDS Care Teams dedicated to solving unique regional issues. The overriding goal of the Care Teams is to improve care for people living with HIV and AIDS by making the most effective use of scarce resources and developing sustainable solutions that draw on local expertise.

The Merck Company Foundation is a U.S.-based private foundation that is qualified as a charitable organization under the U.S. Internal Revenue Code. Established in 1957 by Merck & Co. Inc., the Merck Company Foundation is funded entirely by the Merck Company and is Merck’s primary resource for the support of nonprofit organizations.