Our work is hardly done  pg. 2

Yet technology was not enough. When the researchers examined what had gone wrong, they found gaps at every step along the “prevention cascade.”

In some cases, pregnant women weren’t offered nevirapine during their clinic visit. Or they forgot to take the drug when they went into labor. Or they gave their pill to a sick relative.

By attending to each step, the researchers have managed to increase nevirapine coverage to 60 percent. “Still, 40 percent of women are falling through the cracks,” Vermund says. “So our work is hardly done.”

With support from several U.S. and international aid agencies, and especially the $20 million in grants received in 2004 from the President’s Emergency Plan for AIDS Relief (PEPFAR), the Zambian program has been able to dramatically extend its reach.

Stringer and Isaac Zulu, M.D., of the University Teaching Hospital in Lusaka, are the co-principal investigators for the grants.

“PEPFAR has transformed our operation in Zambia,” Vermund says. “We have got over 17,000 persons on ART (anti-retroviral therapy) in the past two years, and we have over 30,000 people in care. That was done because we got the money.”

In 2006 Vermund turned his attention to Mozambique which, like its South African neighbors, has a numbingly high rate of AIDS.

The Vanderbilt-led effort, which has just garnered a PEPFAR grant, will initiate ART and HIV care in six small towns in rural Zambezia Province. Team members in 2006 included:

Maria de Fatima Lima, Ph.D., Dean, and Christine Minja-Trupin, Ph.D., School of Graduate Studies and Research, Meharry Medical College, Nashville;

J. Gary Linn, Ph.D., professor of Nursing in the Center for Health Research, Tennessee State University, Nashville;

Paula Schuman, M.D., MPH, director of the HIV/AIDS Center at Virginia Commonwealth University, Richmond;

Mauro Schechter, M.D., Ph.D., professor and director of AIDS Programs at the Universidade Federal do Rio de Janeiro; and Adele Schwartz Benzaken, M.D., of the Alfredo da Matta Foundation in Manaus, Brazil.

Brazil shares Mozambique’s national language—Portuguese.

The program won’t just be about AIDS. “You cannot provide HIV care without broad-based upgrading of the primary health system,” Vermund says. “HIV care settings with excellent laboratories don’t make sense if the adjacent clinic is bereft of water, sanitation, electricity…

“So we’re going be in there with HIV and TB (tuberculosis) and STDs and primary health care and vaccinations and upgrading of maternity services and chronic care services for kids.”

PEPFAR won’t pay for that kind of infrastructure development. Nor does it cover research to determine the most cost-effective way to provide AIDS care and treatment.

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