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Report From the President: JHACI: A Low-Cost, High-Impact Intervention

August 2002

Jose M. Zuniga

The April 2002 IAPAC Monthly featured an update on development of the Global AIDS Learning & Evaluation Network (GALEN), a program of the International Association of Physicians in AIDS Care (IAPAC) designed to train, evaluate, and certify as "HIV care specialists" physicians in resource-limited settings within developing world countries. Since publication of that update, GALEN has been received with almost universal support and encouragement -- most recently last month at the XIV International AIDS Conference in Barcelona. Yet, more than this, recent events in the global community have opened the opportunity for GALEN to soon be injected into a comprehensive pilot program that will bring together a combination of funding, medical education, and drug access for select clinics in desperately underserved rural, developing world settings.

At a press conference held July 10, 2002, at the XIV International AIDS Conference's media center, IAPAC announced that GALEN would act as the keystone of an inter-organizational pilot program to provide comprehensive support to four rural HIV care clinics. The Joint HIV/AIDS Care Initiative (JHACI) pairs IAPAC with the Albert Einstein College of Medicine Institute of Global HIV Medicine in New York; the Royal Free Centre for HIV Medicine in London; the Thai Red Cross AIDS Research Centre in Bangkok; and the University of Ottawa in Canada. The Pan American Health Organization (PAHO), which is the Regional Office in the Americas for the World Health Organization (WHO), is a facilitating partner.

Through this multisectoral partnership, JHACI will assist in its pilot phase a clinic in each of four select countries -- Haiti, Jamaica, South Africa, and Thailand. JHACI will provide a sum of funding to these clinics to cover basic operating expenses, and will also deliver HIV medical education through GALEN and bidirectional physician exchanges, while brokering the appropriate introduction of donated HIV-related and -specific medications and technologies as per the "Building Blocks" framework for HIV/AIDS comprehensive care co-authored in June 2000 by PAHO, IAPAC, and UNAIDS.

JHACI comes first and foremost as a response to the desperate need to increase the capacity of overburdened and under-resourced rural clinics in developing world settings. JHACI represents the collective desire of its partner institutions to address the very serious concerns now raised by funding and drug access schemes such as the UNAIDS/WHO Accelerating Access Initiative and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) that will make available advanced antiretroviral therapies into settings that may not be able to provide for their ethical and appropriate administration.

JHACI is a project rooted in a commitment to action. It stresses that more than simply drugs and money, those providing care to persons living with HIV/AIDS in limited-resource settings require an adequate health system infrastructure through which to operate, and the clinical management knowledge needed to effectively treat HIV disease and a host of related opportunistic infections and co-infectious diseases. Not only is this capacity important to ensure ethical treatment, but it is a critical measure required to ensure patient adherence to therapy regimens, to prevent mass biological resistance to drug options, and to limit secondary health complications which may occur through drug toxicity.

Overall, the objectives of the pilot phase of JHACI will be to enhance the quality of care provided to HIV-infected men, women, and children at the JHACI-assisted clinics; to enhance the capacity of Haitian, Jamaican, South African, and Thai medical staff at these clinics to offer care and support to HIV-infected patients; and, ultimately, to prepare the ground for these clinics to become Centers of Excellence within their respective national borders. An important goal of this pilot phase is to learn valuable lessons leading to JHACI's expansion beyond the initial four clinics and the initial four countries.

Through both the aforementioned provisions and IAPAC-led monitoring and evaluation of progress and impact, JHACI will offer an opportunity to achieve significant reductions in HIV-specific and HIV-related morbidity and mortality. Moreover, JHACI signals an important consensus by IAPAC and our partners that there exist significant opportunities to provide low-cost, high-impact interventions in redress of the HIV/AIDS pandemic, but that these cannot exist unless there is commitment to multisectoral, inter-institutional cooperation.

Toward our ultimate implementation of JHACI, I applaud and thank IAPAC's partners for their visionary commitment. IAPAC offers the strength and experience of its 12,000-plus members in these ongoing endeavors, all of which provide every reason to expect not that the pilot stage of JHACI will be guided toward ethical and clinical success, but that JHACI will be introduced globally within the foreseeable future.

What Will JHACI Offer?

Financial Support

JHACI will provide each clinic with an as yet undetermined amount of funding to cover annual operating costs (average: US$20,000/year).

Medical Education

JHACI partners will utilize IAPAC's GALEN curriculum to certify "HIV care specialists" at the JHACI-assisted clinics. In addition, JHACI will arrange for continuing medical education (e.g., I-Med Exchange, on-site clinical symposia, journals, clinical management guides and tools). IAPAC member physicians will conduct onsite education of healthcare professionals.

Medical Exchange

JHACI partners, with assistance from IAPAC, will coordinate bi-directional exchanges of physicians and allied health professionals. Selected healthcare professionals will have the opportunity to obtain short-term training at the Albert Einstein College of Medicine Institute of Global HIV Medicine, Royal Free Centre for HIV Medicine, Thai Red Cross AIDS Research Center, or University of Ottawa. IAPAC physician members (as well as promising residents and post-doctoral fellows) will have the opportunity to receive short-term training at the JHACI-assisted clinics, thereby promoting bi-directional knowledge sharing and sustained future collaborative activities.

Drug Donations

JHACI partners will negotiate donations of and price discounts for HIV and diagnostic technologies, to include antiretroviral drugs.

José M. Zuniga is President of the International Association of Physicians in AIDS Care and Editor-in-Chief of the IAPAC Monthly.

Back to the August 2002 issue of IAPAC Monthly.

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This article was provided by International Association of Physicians in AIDS Care. It is a part of the publication IAPAC Monthly.
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