Responding to the HIV pandemic: the power of an academic medical partnership

Abstract

Partnerships between academic medical center (AMCs) in North America and the developing world are uniquely capable of fulfilling the tripartite needs of care, training, and research required to address health care crises in the developing world. Moreover, the institutional resources and credibility of AMCs can provide the foundation to build systems of care with long-term sustainability, even in resource-poor settings. The authors describe a partnership between Indiana University School of Medicine and Moi University and Moi Teaching and Referral Hospital in Kenya A s physicians and academicians, it is our privilege and our responsibility to provide services to our patients and their communities, to nurture and inspire our students and trainees, and to examine and understand the complexities of our world. The power of this tripartite academic mission is particularly evident in the collaborative response of some academic medical centers (AMCs) and large public hospitals to the health problems of uninsured populations in the United States. Over the last several decades, for example, the political and academic leaders of the city of Indianapolis leveraged the entrepreneurial and intellectual energy of the city’s academic community to respond meaningfully to the health needs of a broad swath of its most vulnerable population. A comprehensive care system was established in affiliation with the public hospital and a number of community-based health centers. 1 Those sites, in turn, became laboratories for Please see the end of this article for information about the authors. Correspondence should be addressed to Dr. Einterz, Wishard Hospital, OPW M200, 1001 W. 10th Street, Indianapolis, IN 46202; e-mail: (reinterz@iupui.edu). 812 that demonstrates the power of an academic medical partnership in its response to the HIV/AIDS pandemic in sub-Saharan Africa. Through the Academic Model for the Prevention and Treatment of HIV/AIDS, the partnership currently treats over 40,000 HIV-positive patients at 19 urban and rural sites in western Kenya, now enrolls nearly 2,000 new HIV positive patients every month, feeds up to 30,000 people weekly, enables economic security, fosters HIV prevention, tests more than 25,000 pregnant women annually for HIV, engages communities, and is developing a robust electronic information system. research and classrooms for training generations of health professionals dedicated to providing a single standard of care for all persons. Though much work needs to be done, we can look proudly at many such achievements of AMCs across the United States. Sub-Saharan Africa, in contrast, is facing an HIV/AIDS crisis— one of the most devastating pandemics in human history—and has yet to realize the power of its AMCs. The reasons for this oversight are many: inadequate collaboration and communication between the ministry of health and ministry of education in many countries, inadequately prepared managers and leaders, systems that are ill equipped and/ or inadequately structured to manage and deliver complex and comprehensive programs, and a pervasive, insidious feeling of fatalism. The failure of most African countries in the 1990s to control the HIV/AIDS pandemic is self-evident. And, even with the advent of the Global Fund and the President’s Emergency Plan for AIDS Relief in the current decade, the number of success stories in Africa is far too few. It is ironic that AMCs have failed to engage fully against the pandemic that is sweeping the African continent, The partnership evolved from a program of limited size and a focus on general internal medicine into one of the largest and most comprehensive HIV/AIDS- control systems in sub-Saharan Africa. The partnership’s rapid increase in scale, combined with the comprehensive and long-term approach to the region’s health care needs, provides a twinning model that can and should be replicated to address the shameful fact that millions are dying of preventable and treatable