dc.description.abstract |
No one questions the gravity of the HIV/AIDS crisis that now
faces sub-Saharan Africa, though many have raised questions
about Africa’s ability to mount a meaningful response. Even
the most casual glance at most of Africa’s health-care infra-
structure, budgets and human resources would offer little
confidence that the complex issues surrounding modern
antiretroviral therapy can be managed effectively for such a
large population of patients. Existing medical facilities are not
prepared to support the care needs of large numbers of
ambulatory patients, especially when the demands for
training and research are superimposed.
In the past, the high cost of antiretrovirals (ARVs) made treat-
ment of impoverished HIV-infected patients beyond reach.
HIV programmes understandably targeted prevention and
palliative care strategies. However, the continuing decline in
the cost of antiretroviral drugs combined with ethical
concerns about pursuing prevention alone make it clear that
treatment is coming to Africa. Nevertheless, if the promise of
treatment is to be achieved, cost-effective systems of care must
emerge that are capable of ensuring unparalleled levels of
patient adherence. Poorly administered ARVs will have no
effect on the course of HIV infection, and will only result in
a reservoir of drug-resistant strains of HIV. Therefore, demon-
strations of models of comprehensive HIV care that have
proven effective in countries like Kenya are of the highest
priority.
The epidemiological facts of Kenya alone illustrate the con-
flict between the burden of HIV/AIDS and the immediate
need for a response: Kenya has an estimated 2.5 million
people, about 15% of the adult population, with HIV, which
ranks it the fourth most-affected country in the world (behind
India, Nigeria and South Africa).
(1)
HIV/AIDS has been
responsible for Kenyans losing 18 years in life expectancy,
from 65 to its current value of 47 years;
(2)
and there are
estimates that it claims approximately 700 young lives daily.
The transmission of the HIV virus from the mother to her
infant (MTCT) is an enormous problem; antenatal HIV
infection rates range from 8% to 25% in western Kenya.
Currently, about 400 000 HIV-positive people in Kenya
urgently need treatment with ARVs.
Moi University Faculty of Health Sciences (MUFHS),
located in western Kenya, includes the country's second med-
ical school. The faculty fosters community-based education
and service at a number of urban and rural health centres and
at Moi Teaching and Referral Hospital (MTRH), a large
urban hospital located in Eldoret. Along with their United
States collaborating medical schools, Indiana University
School of Medicine and Brown Medical School, MUFHS has
established an Academic Model of Prevention and Treatment
of HIV/AIDS (AMPATH) that provides community out-
reach and health education, prevention of mother-to-child
transmission of HIV (PMTCT), and treatment of HIV-
infected individuals at established clinics at Moi Teaching and
Referral Hospital and the affiliated Mosoriot Rural Health
Centre (MRHC). The Academic Model of Prevention and
Treatment of HIV/AIDS may well be a model of care that can
be replicated in countries faced with a similar devastating situation. |
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