Our work is hardly done

Bill Snyder
Published: July, 2006

In late 2001, a team of U.S. and Zambian investigators launched an ambitious program to prevent HIV-positive women from infecting their babies.

Within two years, HIV counseling and testing was being provided in public delivery clinics throughout the Zambian capital, Lusaka.

Thousands of HIV-infected pregnant women were given tablets of nevirapine, a drug that can dramatically reduce mother-to-child transmission of the virus when taken by the woman during delivery, and when given soon after birth to the baby.

Yet when the researchers examined the results of their labors, they had an unfortunate surprise: only 30 percent of the women had actually taken their pills.

A gravel maker and his wife use hammers to crush stone near Lusaka, the Zambian capital.
Photo courtesy of Sten Vermund, M.D., Ph.D.
“We were horrified,” says Sten Vermund, M.D., Ph.D., who now directs the Institute for Global Health at Vanderbilt University School of Medicine. “It’s not so easy to implement this in some of the world’s poorest countries, even with the advantage of free drugs and relatively simple interventions.”

At the time, Vermund was chair of Epidemiology and director of the John J. Sparkman Center for International Public Health Education at the University of Alabama at Birmingham (UAB).

A former chief of the AIDS Vaccine Trials and Epidemiology Branch at the National Institute of Allergy and Infectious Diseases, he had studied the spread and treatment of HIV and other sexually transmitted diseases (STDs) all over the world.

In 2000, Vermund and fellow UAB faculty member Jeffrey Stringer, M.D., helped found—with UAB support—the Centre for Infectious Disease Research in Zambia (CIDRZ) to facilitate AIDS research in collaboration with Zambian public health officials led by Moses Sinkala, M.D.

The effort was supported by a training grant from the Fogarty International Center of the National Institutes of Health and by research funding from the Elizabeth Glaser Pediatric AIDS Foundation.

CIDRZ also had recently received a $4 million grant from the Bill & Melinda Gates Foundation to set up a paperless reference system in the clinics. “It was fundamentally an effort to jump from the 19th Century to the 21st Century—just skip the 20th Century,” Vermund explains.

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