SYDNEY, Australia, July 23 /Xinhua-PRNewswire/ -- Today Bristol-Myers Squibb announced a new approach to expand its SECURE THE FUTURE(R) program in the developing world through replicating its most successful HIV treatment support programs in partnership with governments, community groups and other funders. The initiative will provide a practical, step-by-step guide and the expertise of SECURE THE FUTURE staff to create effective HIV treatment support programs based on methods proven successful even in the poorest, most remote areas of Africa. The program is already being replicated in Mali, Namibia, South Africa and Swaziland.
The aim is to enable others to take advantage of the lessons learned by SECURE THE FUTURE from eight years of work fighting HIV/AIDS in some of the most resource constrained areas of Africa. The experiences of a five-site demonstration project coordinated by SECURE THE FUTURE in partnership with governments, district hospitals and civil society in Botswana, Lesotho, Namibia, Swaziland and South Africa are documented in the manual.
Higher CD4 counts, better adherence to drug regimens, reduced hospital bed occupancy, reduced in-hospital AIDS-related deaths and better quality of life are all documented outcomes of the treatment support program. Closely monitored and rigorously evaluated, the program paired medical care and treatment with a variety of community support programs including home-based care, targeted and broad-based community mobilization and education, psychosocial supports, nutritional resources, income generating projects and buddy programs.
"With community support, a patient is more likely to seek testing and treatment, will be better prepared to begin and adhere to antiretroviral therapy, is less likely to default on treatment and is more likely to have a better clinical outcome," said Phangisile Mtshali, director of the Bristol-Myers Squibb Foundation, who oversaw implementation of the SECURE THE FUTURE program in southern Africa through 2006. The program, launched by Bristol-Myers Squibb in 1999, has grown to a $150 million commitment in 12 African countries with special emphasis on community treatment support programs, care for children and building infrastructure.
At the International AIDS Society conference in Sydney, SECURE THE FUTURE representatives offered a public health tool entitled SECURE THE FUTURE Manual: Seven Steps to Involve the Community in HIV/AIDS Treatment Support Programs (First Edition). The guide shows how to establish antiretroviral treatment programs that integrate community supports to assure that the patient receives assistance at home and in the community as well as at the clinic. It provides field-tested tools to help communities adapt and implement the model of care and monitor and evaluate its impact on the patient. The manual includes full case studies from communities that implemented the model.
"This manual is a practical, how-to guide to integrate efforts of clinicians and community workers. It shows how each can add value to the other’s work, sharing information about clients’ progress and needs through case management tools," said Patricia Doykos Duquette, director of the Bristol-Myers Squibb Foundation and co-author of the manual. "For example, home-based care workers can be alerted when a patient fails to appear for a scheduled clinic visit. When a clinic nutritionist identifies a malnourished patient, the community partnering program can provide food parcels so important to successful treatment." The manual is available online at www.bms.com/foundation or by sending an email request to patricia.duquette@bms.com.
Bristol-Myers Squibb and SECURE THE FUTURE staffs are available to consult with governments and community groups on replication of the model. They will provide technical support to groups seeking to develop their own programs.
Since 2003, SECURE THE FUTURE has operated five community-based treatment support sites. By April 2007, the sites had enrolled more than 17,000 patients, with over 8,000 on antiretroviral treatment. The model places equal emphasis on supporting the needs of patients receiving antiretroviral treatment and patients whose disease has not yet progressed to warrant treatment.
A rigorously conducted evaluation of the five sites by Family Health International showed that HIV-positive patients who received integrated medical care and broad-based community support achieved and sustained improved clinical outcomes. For instance, at the sites, community mobilization led to a rapid uptake of clinical services, an improved community response to HIV/AIDS, a reduction in stigma surrounding the disease and better adherence with treatment.
Zengani Chirwa, M.D., chief medical officer for Mapilelo, the SECURE THE FUTURE funded community-based treatment support center in Caprivi, Namibia, said, "The provision of support programs by community groups greatly enhances clinical treatment outcomes. For example, the SECURE THE FUTURE demonstration centers recorded higher CD4 counts in patients who received medical treatment and community supports. Monitoring shows that those who were receiving community supports recorded a CD4 count after 12 months averaging 326 compared to 268 for those who did not receive the supports. That measurement is a very important indicator of a person’s health status, with higher counts indicating a greater ability to fight infection."
At both the Caprivi and Bobonong centers, Chirwa noted that the hospital bed occupancy rate was reduced by 50 percent with the combination community supports to medical care.
Governments and community groups are already spearheading efforts to replicate the SECURE THE FUTURE centers. The first replication program was created by SECURE THE FUTURE in the Koulikoro region of Mali at the request of local experts in partnership with the national government in 2005. To date, over 5,000 people have been tested, with 374 HIV-positive patients enrolled in the program and 214 receiving antiretroviral treatment. The Koulikoro Reference Health Center offers community outreach and education, food programs and home-based care through local non-governmental organizations (NGOs), community-based organizations and association of People Living with HIV/AIDS.
In Namibia, the Mapilelo Project, in partnership with the national government and local community-based organizations, opened a new center this April in Kavango, Nankudu, Namibia. The Nankudu District Hospital and four primary health clinics offer medical treatment and community support to approximately 900 patients.
In Bambisana in the Eastern Cape Province of South Africa, the Bambisanani NGO began partnering with the local district hospital in February to provide community support, including home-based care and food security to 1,400 HIV-positive patients on antiretroviral medicines. With SECURE THE FUTURE funding, Bambisanani has also opened two centers to assist 50 orphans and vulnerable children in the district, because of the escalating number of children negatively impacted by the disease.
In Swaziland, the national government, in partnership with SECURE THE FUTURE, is replicating the PORECO model of Prevention-of-Mother-to-Child Transmission Program Plus that has been validated in Mbabane. The replication project, in the Northern Hhohho region, will serve up to 3,000 pregnant women, their newborn children and their partners by providing community support and intensive patient tracking throughout pregnancy, delivery and postnatal care. The continuum of care continues after the child’s birth with pediatric care for the newborn facilitated by the Pediatric AIDS Corps doctors, a program funded through the SECURE THE FUTURE and Baylor College of Medicine collaboration.
The SECURE THE FUTURE manual was co-authored by Sebastian Wanless, M.D., medical director of SECURE THE FUTURE, Duquette and Mtshali, the project managers who implemented the programs, along with assistance of the Bristol-Myers Squibb Foundation staff, and I-TECH, the International Training and Education Center on HIV. I-TECH is a joint project of the University of Washington and the University of California San Francisco. I-TECH was established in 2002 as part of the President’s Emergency Plan for AIDS Relief (PEPFAR) by the Health Resources and Services Administration in collaboration with the U.S. Centers for Disease Control and Prevention and USAID.
Bristol-Myers Squibb is a global pharmaceutical and healthcare products company whose mission is to extend and enhance human life. Visit Bristol-Myers Squibb at http://www.bms.com .
