The Doris Duke Charitable Foundation recently awarded two grants to Case Western Reserve University for Operations Research on AIDS Care and Treatment in Africa. Among 10 awards made, the foundation awarded two to Ajay K. Sethi, assistant professor and Christopher C. Whalen, professor, both in the Department of Epidemiology and Biostatistics in the School of Medicine. Each project tackles important problems regarding two sister epidemics in Uganda: HIV/AIDS and tuberculosis (TB).
Sethi and his colleagues are working with the Joint Clinical Research Centre, whose national TREAT program provides health care and antiretroviral therapy to HIV-infected individuals in Uganda. "In Uganda, there are no community-based pharmacies and patients have to return to the district hospital to pick up their medication refills. In rural areas, some patients have to travel long distances every month and that distance can prevent them from picking up their medications on time and taking them as prescribed," said Sethi.
To address this problem, his team will create and integrate a mobile pharmacy into three district hospitals in rural Southwestern Uganda. The hope is that delivering the medications to facilities closer to where patients reside will improve adherence and reduce the risk of development of resistance to the drugs.
Sethi added, "The patients will decide with their doctor whether the mobile pharmacy is right for them. We will deliver medications two consecutive months to patients 'prescribed' the mobile pharmacy. On the third, they will come back to the district hospital to receive their routine HIV care and a refill for our delivery service." A careful evaluation will be carried out by the team to determine if the intervention works, is satisfying to patients and providers and is sustainable in rural settings.
In urban Kampala, Whalen and his colleagues will employ active case finding methods in the community to identify individuals with both HIV and TB.
"Most African TB control programs rely on passive case finding methods for detecting tuberculosis. In the setting of an HIV epidemic, passive case finding may not suffice," said Whalen. "HIV changes TB from a treatable and curable infection to a disease with high mortality." Early diagnosis of individuals with HIV and TB is imperative for it can reduce mortality and prevent further spread of these diseases to other people. "Our study will compare two new ways of actively detecting TB in the community, identifying HIV infection and referring patients to clinics and medical centers where they can receive proper treatment for their infections," he said.
These projects continue to strengthen the longstanding Uganda-Case Western Reserve University Collaboration. Since 1988, the collaboration has been committed to address the public health priorities of Uganda, to build research capacity and to train the next generation of scientists in the country.
Evidence for the latter is demonstrated by the fact that four of the collaborators on the two Doris Duke Charitable Foundation studies received their graduate degrees from Case Western Reserve University. Francis Bajunirwe (GRS '07, epidemiology and biostatistics), David Kaawa-Mafigiri (GRS '07, anthropology), Juliet Sekandi (GRS '06, epidemiology and biostatistics) and Henry Luzze (GRS '05, epidemiology and biostatistics) were supported by the AIDS International Training and Research Program and International Clinical, Operational and Health Services Research and Training Award training grants funded by the Fogarty International Center, National Institutes of Health.
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