How HIV/AIDS treatment can best be combined with community-based care in some of the poorest areas of sub-Saharan Africa

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A West African community has joined the network of community-based treatment support programs that form Bristol-Myers Squibb's real world field test of how HIV/AIDS treatment can best be combined with community-based care in some of the poorest and most remote areas of sub-Saharan Africa.

The new program is based in the resource-constrained Koulikoro District of Mali. The six model treatment sites are reporting this week on site readiness activities, enrollment and early clinical outcomes at the World AIDS Conference being held in Bangkok, Thailand.

The Mali program joins five others funded by the company's groundbreaking $115 million SECURE THE FUTURE® HIV/AIDS initiative. They are located in six of the nine countries in southern and West Africa in which SECURE THE FUTURE operates. In late 2003, the company provided $30 million in grants to fund these six innovative approaches to effectively delivering treatment and support for HIV/AIDS patients and their families. The program is expected to directly benefit more than 5,000 patients who will receive antiretroviral therapy and many thousands more in the long term, as its successful aspects are replicated.

"Bristol-Myers Squibb's SECURE THE FUTURE program has been working with its African partners for five years to determine the most effective ways to combat the HIV/AIDS pandemic. These new treatment sites, including the one we are now announcing for Mali, will use the knowledge and experience gained during that time to offer a spectrum of care to patients and their communities, while allowing us to carefully monitor and evaluate the successes and challenges of the programs," said Peter R. Dolan, chairman and chief executive officer. "Our goal is to develop programs that can be replicated elsewhere, often in resource-limited settings, to create a broader impact and greater success in fighting the pandemic."

The other five treatment sites are in Mbabane, Swaziland; Uthukela District, KwaZulu-Natal, South Africa; Maseru, Lesotho; the Caprivi Region of Namibia; and Bobonong, Botswana. In addition, a separate grant to South Africa's National Association of People Living With HIV/AIDS will help build institutional capacity, mobilize communities and provide treatment literacy among its membership.

While most of the sites have only just become operational, data are already being collected. The sites already have already reached about 20,000 people through community mobilization activities, screened 821 patients and enrolled and begun treating or providing care for 494 people. Some 327 patients are undergoing screening procedures and will be enrolled in the program in the next few months. The sites have also enlisted more than 1300 volunteers in community-based support efforts. In Lesotho, for example, program organizers have been flooded with patients, mostly the very sick, straining available resources. In Swaziland, a prevention of mother to child transmission plus program, coupled with a variety of community support mechanisms, has enrolled 66 women in treatment, and all, except for one woman, have responded to therapy after three to six months. And of the 22 babies born to these mothers, only two have tested HIV positive.

According to Sebastian Wanless, M.D., who directs the medical care and research portion of the effort, "The initiative is already on track to enroll at least 1,000 patients by the end of 2004 in treatment or support programs of the approximately 5,000 expected to participate in the initial three-year program."

The programs at the six sites are the culmination of some 170 other programs supported to date through SECURE THE FUTURE, the company's $115 million pioneering commitment to address HIV/AIDS in sub-Saharan Africa. The initiative provides community education and outreach as well as medical research and care. Each site guarantees free Highly Active Antiretroviral Therapy (HAART) treatment for eligible patients and/or PMTCT "plus" programs (prevention of mother to child transmission programs that provide nevirapine treatments to stop HIV transmission to newborns, "plus" ARV treatments for infected mothers and their partners). The sites will also offer a large number of training, home-based care, income-generation, prevention, education, counseling and nutritional support projects in combination with and supporting medical treatment at the community level. Government health workers as well as volunteers from local NGOs and other organizations are participating fully.

"Probably the biggest hurdle to overcome has been recruiting and training personnel, including health care workers, project managers and community volunteers," said Phangisile Mtshali, director of SECURE THE FUTURE, Southern Africa. Nevertheless, train-the-trainer programs have been completed at all the sites and "buddies" are being trained for assignment to patients receiving HIV medications to help them stay on treatment. As additional volunteers are enlisted, home-based care programs are growing. A large number of NGOs, along with faith-based organizations and community-based groups, are also already involved in most sites. For example, in Namibia, a special NGO village has been constructed to encourage coordination, communication and interaction among the many participating voluntary organizations. More than 100 volunteers are already at work there.

"Since its inception," said Bristol-Myers Squibb Foundation President John Damonti, "SECURE THE FUTURE has adapted to the changing realities on the ground of the HIV/AIDS pandemic. When the program was first initiated in 1999, few drugs were available in Africa. Now that availability has grown, these treatment programs represent a further evolution of our effort, helping us prepare a blueprint for effectively providing drugs by ensuring community support programs that can accompany treatment. We will seek to determine what works and what needs to be done differently as treatment requirements move into the vast rural areas of sub-Saharan Africa."

Bristol-Myers Squibb is a global pharmaceutical and related health care products company whose mission is to extend and enhance human life.

Visit our SECURE THE FUTURE website at www.securethefuture.com

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