Lothian and Zambia join forces to tackle HIV/AIDS
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《英国医生杂志》
Lothian Health Board, in Edinburgh has set up a three year partnership with doctors from Zambia to try to tackle the HIV/AIDS pandemic. The partnership, which is partially funded by Lothian Health Board from an endowment, will be run by a part time coordinator and a multidisciplinary steering group.
It will facilitate trips to and from Zambia by Zambian and Lothian clinicians, community support planners, academics, and public health and IT personnel to support those living with HIV and AIDS in Zambia and in Lothian, and to share lessons on prevention, adherence, and voluntary counselling and testing in the two areas.
Clinicians from Lothian will visit two particular sites in Zambia where the country抯 antiretroviral therapy programme is being rolled out. They will support their Zambian colleagues in training trainers to deliver antiretroviral therapy.
The joint initiative follows an initial visit by members of the Lothian team to Zambia and a return visit from four senior Zambian doctors to Edinburgh at the beginning of May 2004 to exchange information and support in tackling the HIV/AIDS pandemic.
Lothian has one of the highest prevalences of HIV/AIDS in the United Kingdom outside London, mainly because it has had a high prevalence of drug users in the early years. During the Zambian doctors?visit, Brian Cavanagh, chairman of Lothian NHS, described how, in the late 1980s, Edinburgh adopted a multisectoral approach to the problem, which has helped to contain the epidemic.
Sixteen per cent of the Zambian population of 10 million are infected with HIV (rising to 22% in the capital, Lusaka), although rates in young people are beginning to fall.
Lothian is discussing with Dr Ben Chirwa, the director general of Zambia抯 Central Board of Health, how it can help in providing the expertise required for administering antiretroviral therapy, improving drug adherence in the community, and supporting disease monitoring and data management.
In return, Zambia is reviewing Scotland抯 knowledge of monitoring HIV/AIDS in different settings.
Peter Piot, the executive director of UNAIDS last year noted that "the treatment gap between developed and developing countries is a global public health emergency." Dr Liya Mutale of Zambia抯 National AIDS Council, who was a member of the group that visited Edinburgh earlier this month, echoed his words as she explained how within 18 months, Zambia hopes to increase the uptake of antiretroviral therapy from the current level of 3000 patients to 10 000. Initially, uptake of therapy was slow owing to the barrier of "cost sharing" (patients pay 20% of drug costs—about $8 (?.50; �6.70) a month), stigma, and lack of information at community level.
The authorities hope to scale up treatment by increasing the number of testing and counselling centres—33 new centres will be opened in the next month; developing guidelines to prevent mother to child transmission methods (which includes spouses); and rolling out the antiretroviral therapy programme to every province.
The Global Fund has donated $192m (?07m; �160m) to Zambia over the next five years, but a huge gap remains in both funding and work force capacity to achieve WHO抯 "3 by 5" target (three million people taking antiretroviral therapy by 2005). To achieve this target, 100 000 patients would need to be treated in Zambia in the next year (a target 10 times higher than that set by the Zambian health authorities themselves), and an extra $560m will be needed to accomplish that.
Dr Elijah Sinyinza, the acting director of Public Health Research of the Central Board of Health, who took part in the visit, described the challenges his country faces: a lack of human resources, slow population behaviour change, and an HIV programme requiring immense coordination. Only 10% of Zambians currently know their HIV status.
Dr Jabbin Mulwanda, director of Ndola Hospital, the country抯 second largest teaching hospital and one of the two hospitals responsible for the roll-out of the antiretroviral therapy programme to provincial hospitals, believes that one of the spin-offs from widely available antiretroviral therapy will be a reduction of the stigma surrounding AIDS and an upgrading of laboratories and skills that will ultimately strengthen the whole health system. Dr Joseph Banda of the Zambian AIDS and tuberculosis programme, ZAMBART, highlighted the huge problem of tuberculosis, which has increased fivefold since the start of the epidemic, and 80% of sputum positive patients are also with HIV.
He said that by promoting testing, not only will the uptake of antiretroviral therapy increase but also antituberculosis therapy.
So far, adherence to antiretroviral therapy has been very good, said Dr Mulwanda, because people who were sick are beginning to feel better as they take the drugs, but he fears it might not remain as good when they are feeling better but still have to take drugs daily, at significant cost to themselves and their families.(Melrose Dorothy Logie)
It will facilitate trips to and from Zambia by Zambian and Lothian clinicians, community support planners, academics, and public health and IT personnel to support those living with HIV and AIDS in Zambia and in Lothian, and to share lessons on prevention, adherence, and voluntary counselling and testing in the two areas.
Clinicians from Lothian will visit two particular sites in Zambia where the country抯 antiretroviral therapy programme is being rolled out. They will support their Zambian colleagues in training trainers to deliver antiretroviral therapy.
The joint initiative follows an initial visit by members of the Lothian team to Zambia and a return visit from four senior Zambian doctors to Edinburgh at the beginning of May 2004 to exchange information and support in tackling the HIV/AIDS pandemic.
Lothian has one of the highest prevalences of HIV/AIDS in the United Kingdom outside London, mainly because it has had a high prevalence of drug users in the early years. During the Zambian doctors?visit, Brian Cavanagh, chairman of Lothian NHS, described how, in the late 1980s, Edinburgh adopted a multisectoral approach to the problem, which has helped to contain the epidemic.
Sixteen per cent of the Zambian population of 10 million are infected with HIV (rising to 22% in the capital, Lusaka), although rates in young people are beginning to fall.
Lothian is discussing with Dr Ben Chirwa, the director general of Zambia抯 Central Board of Health, how it can help in providing the expertise required for administering antiretroviral therapy, improving drug adherence in the community, and supporting disease monitoring and data management.
In return, Zambia is reviewing Scotland抯 knowledge of monitoring HIV/AIDS in different settings.
Peter Piot, the executive director of UNAIDS last year noted that "the treatment gap between developed and developing countries is a global public health emergency." Dr Liya Mutale of Zambia抯 National AIDS Council, who was a member of the group that visited Edinburgh earlier this month, echoed his words as she explained how within 18 months, Zambia hopes to increase the uptake of antiretroviral therapy from the current level of 3000 patients to 10 000. Initially, uptake of therapy was slow owing to the barrier of "cost sharing" (patients pay 20% of drug costs—about $8 (?.50; �6.70) a month), stigma, and lack of information at community level.
The authorities hope to scale up treatment by increasing the number of testing and counselling centres—33 new centres will be opened in the next month; developing guidelines to prevent mother to child transmission methods (which includes spouses); and rolling out the antiretroviral therapy programme to every province.
The Global Fund has donated $192m (?07m; �160m) to Zambia over the next five years, but a huge gap remains in both funding and work force capacity to achieve WHO抯 "3 by 5" target (three million people taking antiretroviral therapy by 2005). To achieve this target, 100 000 patients would need to be treated in Zambia in the next year (a target 10 times higher than that set by the Zambian health authorities themselves), and an extra $560m will be needed to accomplish that.
Dr Elijah Sinyinza, the acting director of Public Health Research of the Central Board of Health, who took part in the visit, described the challenges his country faces: a lack of human resources, slow population behaviour change, and an HIV programme requiring immense coordination. Only 10% of Zambians currently know their HIV status.
Dr Jabbin Mulwanda, director of Ndola Hospital, the country抯 second largest teaching hospital and one of the two hospitals responsible for the roll-out of the antiretroviral therapy programme to provincial hospitals, believes that one of the spin-offs from widely available antiretroviral therapy will be a reduction of the stigma surrounding AIDS and an upgrading of laboratories and skills that will ultimately strengthen the whole health system. Dr Joseph Banda of the Zambian AIDS and tuberculosis programme, ZAMBART, highlighted the huge problem of tuberculosis, which has increased fivefold since the start of the epidemic, and 80% of sputum positive patients are also with HIV.
He said that by promoting testing, not only will the uptake of antiretroviral therapy increase but also antituberculosis therapy.
So far, adherence to antiretroviral therapy has been very good, said Dr Mulwanda, because people who were sick are beginning to feel better as they take the drugs, but he fears it might not remain as good when they are feeling better but still have to take drugs daily, at significant cost to themselves and their families.(Melrose Dorothy Logie)