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Providing HAART in HIV Prevention Research Geneva 21June 2005

Providing HAART in HIV Prevention Research Geneva 21June 2005. Chrispin Kambili, MD International AIDS Vaccine Initiative Nairobi, Kenya. The Challenges. International research is carried out in a context of global inequity of access to adequate health care.

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Providing HAART in HIV Prevention Research Geneva 21June 2005

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  1. Providing HAART in HIV Prevention ResearchGeneva 21June 2005 Chrispin Kambili, MD International AIDS Vaccine Initiative Nairobi, Kenya

  2. The Challenges • International research is carried out in a context of global inequity of access to adequate health care. • Communities may see HIV prevention research as secondary: primary concern is care & treatment now • If the treatment & care concerns are not addressed, researchers may lose community support

  3. The Challenges • Treatment of HIV/AIDS must fundamentally be the responsibility of Governments, through their public health systems. • Almost all heavily affected countries in Africa can not afford to provide treatment on their own. • Even with the massive increase in funding for HIV/AIDS treatment and care, there still is work to be done--it’s not just the cost of drugs: there is need for infrastructure and (trained) personnel.  

  4. Price of 1st line drugs 140 to 300 USD/person/year

  5. Levels of responsibility • Provision of HAART to those infected during trial—An obligation of researchers/sponsors • Provision of HAART to “screen-outs”—Morally praiseworthy for researchers/sponsors to do so • The community—Integrate research activities into the overall HIV/AIDS agenda and create improvements to healthcare access that benefit whole community

  6. Providing HAART • Researchers lack expertise in provision of HAART • Need to proactively seek partners to provide care prior • Easier when research activities physically linked to other healthcare activities

  7. How to get things moving • Get governments involved in the process • Gov’t should take the lead is setting the agenda and establishing needs • Educate one another as to everyone’s roles! • Work with gov’t to identify stakeholders and potential partners

  8. Examples • HIV vaccine site in Kigali partners with its sister org to obtain funding from GFATM—now treating 122 people identified during vaccine research activities. • A vaccine site in a Nairobi slum has received funding to work with a City Council clinic to provide ART to research participants • The USMHRP in Kericho has secured PEPFAR money and is working with the District Hosp to provide ART to over 600 • This efforts are miniscule when one considers the need!

  9. Kilifi, Kenya: Mar 2005

  10. Screening to enroll into an HIV incidence study Tested HIV+ Percent Site 1 2005 192 10% Site 2 1405 160 11% Site 3 11800 1850 16% Site 4 1000 164 16% ~20% need treatment with ART now!

  11. Case for optimism: Changing Landscape • Continued global commitment • Greater potential for partnerships • Prices of drugs

  12. True partnership is hard work!

  13. Attributes of a Partnership • A shared objective • Although motivations and values differ • Shared risk-taking • Inherent in new ways of doing business • Shared decision making • In implementation at a minimum • Contributions from each participant • Will differ • Benefits to each participant • May differ

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