Investing social capital
Keys to conducting research abroad … and at home
Haitian AIDS researcher Jean William Pape, M.D., and David Holtgrave, Ph.D., an expert on HIV prevention programs in the United States, share their views about what it takes to conduct AIDS research in resource-poor countries, and what we can learn from these experiences.
Holtgrave chairs the Department of Health, Behavior and Society, in the Johns Hopkins Bloomberg School of Public Health. He formerly directed the Division of HIV/AIDS Prevention, Intervention Research and Support at the U.S. Centers for Disease Control and Prevention (CDC), and was vice-chair of Behavioral Sciences and Health Education at Emory University’s Rollins School of Public Health.
They spoke with Lens editor Bill Snyder in 2006.
Dr. Pape, I’d first like to discuss the paper, “Anti-retroviral therapy in 1,000 patients with AIDS in Haiti,” published in 2005 in the New England Journal of Medicine. What were some of the logistical, economic and social barriers to conducting this research?
The major difficulties that we encountered were mostly related to adherence. It is very difficult to have anybody stay on medication for a long time; it’s even more difficult for people who are very poor or cannot afford the costs of transportation and could not afford to eat on a daily basis.
This is why we developed a team approach involving the psychologist or social worker, the nurse, the pharmacist, the physician—actually the physician was the least important—as well as people living with AIDS on HAART (highly active anti-retroviral therapy) who also worked with us.
We also had a very sophisticated data management system to keep track of patients’ visits. This system informs immediately the staff about those who missed an appointment. Since patients do not have telephone at home we had to train field workers to visit them at their home, report on their status and give them another appointment. We also had to provide nutritional support and provide as well free transportation to and from the clinic… With this package the adherence issues were mostly resolved.
In addition, this study was conducted at a very difficult time. President Aristide was sent into exile and there was a lot of disruption of the social matrix of this country. There was a lot social unrest. There was a lot of political violence. And we had to develop contingency plans.
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