Princess Marina Hospital

Botswana Adopts Radical Approach to HIV

GABORONE, Botswana (AP) -- When Botswana first offered free AIDS treatment, health authorities in one of the world's most infected countries braced for a rush of patients. It did not happen. It turned out that most people were so afraid of the deadly disease, and the frequent social ostracism, that they did not want to know if they were infected.

The missing medics in Botswana's Aids battle

Eighteen months ago Botswana became the first African country to offer antiretroviral drugs to everyone for free. A huge amount of cash has been dedicated to the cause, but money cannot buy the workers so desperately needed. For example at Princess Marina Hospital in Gaborone people start queuing outside the gates by 5 a.m. The hospital's waiting rooms and corridors are filled to bursting point until the doors close again at the end of the day. Staff admit they cannot treat anyone else. This hospital is dispatching drugs and advice to more than 6,000 people, making it the largest treatment centre for HIV or Aids in the world. Many have presumed that money - or the lack of it - has been the main obstacle to distributing the drugs that are so desperately needed. But here the crunch has come because of a lack of workers. The problem is about to get worse as the drugs distribution programme is rolled out to new areas of the country. At the moment, Achap - a partnership between pharmaceutical giant Merck, the Bill and Melinda Gates Foundation and the Botswana government - has six treatment centres but it desperately needs to better serve rural communities. The skills shortage is much wider than healthcare workers. We need people who can manage the centres, do the finances and put forward budget proposals, says Achap's Brad Ryder. There is another, sadder reason why the problem is becoming more acute. Hospital superintendent Howard Moffat confirms that many health workers have been living in denial when faced with the virus they spend their days treating - and some are being lost to AIDS. The government is desperately negotiating with China and Cuba to get more doctors, but existing staff are simultaneously being lured away by agencies in the West. In 2002, Botswana lost 120 of its nurses to the UK. The net result is that, despite the huge amount of money being dedicated to the cause, progress is happening more slowly than had been expected. 35% of Botswana's 1.8m people are living with HIV. More than 90% do not know their status 9,000 are on treatment 14,500 are enrolled for treatment. We thought that by offering drugs for free we would achieve more. No doubt we are saving lives, but it's not the percentage we wanted, says Ibou Thior, project director at the Harvard Aids Institute in Gaborone. Stigma is still rampant. The foreign minister says he has been instructed to highlight the fight against AIDS at every public speech. And president Festus Mogae - who regularly warns that his people face extinction - himself publicly took an HIV test and declared his status (negative). Despite this enormous effort, 90% or more of the population have still not dared to take the test. There are ongoing discussions about the ethics of routinely testing for HIV. However, the real need is to combat the fear and convince people they can have a meaningful life while living with HIV. Dr Moffat at the Princess Marina hospital says that people delay confronting the truth to such an extent that some are brought in when it's already too late. Each day, a handful of patients will be brought into the Marina's waiting room on stretchers. Those who have waited so long are a significant drain on resources. Up to 10 healthy patients could be given drugs and counselling during the time needed to cope with one patient in intensive care. As the battle goes on, the international donor community and other African countries are watching closely to assess Botswana's success. Dr Howard Moffat is optimistic that the battle will eventually be won. The race to train more staff is already underway, with a medical school under construction in Gaborone and almost 1,000 health care workers having been trained at the Harvard AIDS Institute. But he is also conscious of the implications for the rest of Africa if Botswana - with all the money it has in relation to a relatively small population - cannot find a way to manage the virus. The government - one of the richest in Africa thanks to huge diamond resources - has set aside $70m a year to tackle the disease, while it has also won an unprecedented level of support from the private sector. (Source: BBC News 21 Nov.2003)

Botswana: Vaccine trials open officially

The first trial of an experimental AIDS vaccine in Southern Africa began this week in Botswana with the enrollment and injection of the first two volunteers at the Princess Marina hospital in the capital, Gaborone. The research is a joint initiative by the Ministry of Health and the Botswana-Harvard AIDS Institute Partnership (BHP), established in 1996 by the Botswana Government and the Harvard AIDS Institute. Phase 1 of the trials, currently being conducted, is open to individuals between the ages of 21 and 40, who are in general good health, HIV negative, available for 18 months, not pregnant and intending to remain so during the course of testing. BHP hope approximately 14 HIV-negative volunteers, from an initial group of 30 Batswana participating so far, will be enrolled. Potential volunteers continue to be screened. The experimental vaccine is composed of a non-infectious component of HIV's genetic material. During the study, side effects will be examined to determine the vaccine's safety at three different dosages, and the body's immune response. The vaccine was developed by Epimmune, a company based in San Diego, California. The BHP HIV Reference Laboratory is an ultramodern research facility that is also helping to build Botswana’s professional capacity by training the nation's future researchers and technicians. BHP is designed to identify opportunities for collaborative research, as well as pursue education activities in the fight against HIV/AIDS. The government of Botswana deserves recognition for the creation of the BHP laboratory and the capacity it has built with trained staff, state-of-the-art equipment and Botswana-specific research, noted Dr Max Essex, BHP Chairman. Botswana stands ready to conduct not only this study, but other important HIV research. It is important to stress that the road to a successful vaccine is long, and that this phase 1 trial is a first step for Botswana on that road. (Source: PLUSNEWS 8 July, 2003).

Where hope for AIDS springs

Last December doctors from Botswana, in partnership with Harvard University in the United States, were piloting treatment with antiretrovirals of people with HIV/AIDS from a tiny room at the Princess Marina Hospital in Gabarone. Today, about 6 000 people across that country are receiving the treatment, and that same partnership of doctors is conducting pioneering AIDS research in resource-poor settings that promises answers that can be applied across the entire sub-continent, including South Africa. Questions like resistance to antiretrovirals, a concern that has been expressed widely here in respect of a national treatment programme, are likely to be answered by a vitally important research project - and the first of its kind in the world - being conducted on 650 people in Gabarone. Called Tshepo, which means hope in Setswana, it is the first large-scale study of the use of antiretrovirals for the treatment of adults with HIV in Africa. Planned to assess mutation rates for drug resistance of HIV (sub-type C which is the type of HIV found commonly in South Africa too), the study will also evaluate different strategies of how to best administer the drugs in this African setting. In the Tshepo trial, scientists will compare six different antiretroviral combinations, all standard ones used around the world, and two of which are being used in Botswana's national ARV programme. The Children's Clinical Centre is set to kick off with a three-year trial involving about 600 HIV-positive children in Botswana, examining structured treatment interruption, or research into periods of no drug treatment for children on antiretrovirals, with a view to addressing toxicity and cost. Botswana has also rolled out its mother-to-child HIV-transmission prevention programme to the entire country, and the President Festus Mogae said the new Botswana-Baylor Children's Clinical Centre of Excellence would support the work in this field that is already being done in Botswana. The battle calls for a multi-faceted approach which includes strong prevention, good clinical practice and sound research. Botswana, Mogae said, had suffered major setbacks with the gains the country had made being eroded by HIV/AIDS. But in the past two years figures had indicated the pandemic was plateauing. But we mustn't be complacent, he warned. (Source: Di Caelers: The Cape Argus, 27 June 2003)