November 6, 2003
Penn Program in Botswana provides comprehensive HIV-program
at epicenter of AIDS epidemic Division of Infectious
Diseases, University of Pennsylvania Medical Center,
establishes clinical, educational and research program
in Africa
Nearly 40 percent of all adults in the Republic of Botswana,
Africa, are infected with HIV--possibly making it home
to the world’s highest prevalence of the virus,
and the best possible location to develop a global model
for fighting HIV infection and AIDS. The most recent
addition to Botswana’s arsenal in its war against
HIV infection – the Penn Program in Botswana
– will be discussed by officials from Botswana,
Penn Medical Center, and the African Comprehensive HIV/AIDS
Partnership (ACHAP) at a symposium on November 13, 2003.
The Penn-Botswana HIV Symposium is being held from 4:00-6:30
p.m. in the Austrian Auditorium of the Clinical Research
Building located on the Medical Center’s campus.
What sets the Penn Program in Botswana apart is the
scale with which it will expand upon existing Penn clinical
research initiatives to include educational and clinical
care components, the scope of which have never before
been developed in Botswana. Although other academic
medical centers have programs based in Botswana, none
support three distinct and integrated components of
education, clinical and research programs that focus
on the adult patient.
“HIV is a global issue,” said Harvey
M. Friedman, M.D., Professor of Medicine, Chief
of the Division of Infectious Diseases and Director
of the Penn Program in Botswana, “As physicians,
researchers and educators, we are already doing everything
that we know how to do here in Philadelphia, and we
provide the best possible care we can to our patients.
We must take a global prospective if we want to truly
tackle the problem of HIV infection and work to solve
the
problem at its epicenter. In Botswana, we are dealing
with almost half of the adult population infected with
HIV and are focused on investigating effective protocols,
providing treatment and care, and training our future
caregivers,” Friedman said.
Since July of 2001, the Infectious Diseases Division
of Penn has had faculty, fellows and residents working
in Botswana. The expanded program in Botswana represents
collaboration between the Division of Infectious Diseases,
Penn’s School of Medicine, and the Government
of Botswana. It is funded by the Department of Medicine,
Penn’s School of Medicine and the African Comprehensive
HIV/AIDS Partnership (ACHAP).
ACHAP is a public-private partnership between the Government
of Botswana, the Bill & Melinda Gates Foundation,
and the Merck Company Foundation. Additional funding,
in the form of a developmental grant from Penn’s
Center for AIDS Research (CFAR), has helped underwrite
Penn’s research in antiretroviral outcomes in
Botswana. In addition, the National Institutes of Health
(NIH) is currently reviewing an application from the
Penn Program in Botswana to establish an international
core research facility. If granted, it will provide
the needed infrastructure to support all of the Botswana-based
clinical research protocols.
Currently, the Penn Program in Botswana provides initiatives
that reflect the tri-fold mission of the University
of Pennsylvania Medical Center. These initiatives include:
Education
- The University of Pennsylvania School of Medicine
now offers a six-week elective in International Medicine
that provides third- and fourth-year medical students,
residents and fellows the opportunity to gain credit
with the Penn Program in Botswana. [At the symposium
on Thursday, medical students Richard Vidal, Hema
Magge and Sanam Roder will discuss their experience
with the Penn Program in Botswana at 6:10 p.m.]
- A Penn faculty physician is on staff full-time
at the Princess Marina Hospital, located in Botswana’s
capital city Gaborone, who will help train the residents
and students on rotation as well as hospital-based
staff and physicians.
- Penn’s Infectious Diseases Division has established
one- and two-month “observerships” for
its Botswanian counterparts to travel to Philadelphia
and observe patient care at the Hospital of the University
of Pennsylvania (HUP).
Clinical Care
- Since September of last year, Dan Baxter, M.D.,
Clinical Assistant Professor of Medicine, University
of Pennsylvania School of Medicine, has been on staff
full-time working with the Ministry of Health in Botswana.
He is helping to train local providers on how to use
antiretroviral medications within the outpatient setting,
where the majority of care is provided.
- In January of 2004, Jason Kessler, M.D., Instructor
in Medicine, University of Pennsylvania School of
Medicine, will join Dr. Baxter. Kessler will help
establish Penn’s in-patient program at the Princess
Marina Hospital. Penn’s physicians, residents
and fellows will support the current staff in providing
clinical care to the hospital’s 150 inpatients
on the general medical ward.
Research
- Last month, Angelina Ulzen-Chelan, M.D., joined
the Penn faculty and is based in Botswana as the Program’s
full-time research coordinator.
- Clinical research protocols currently underway
in Botswana include research to:
- Develop a model of cost-effective HIV care;
Establish simple, cost-effective predictors to determine
positive and negative outcomes of antiretroviral medications;
- Upgrade the hospital’s diagnostic capabilities
to determine and treat the microbial causes of meningitis
within the inpatient population; and,
- Determine how best to treat patients with tuberculosis
(TB) & HIV co-infection. According to Dr. Friedman,
nearly 80 percent of African patients with HIV are
also co-infected with TB. Penn’s study will
try to determine how best to treat two superimposed
epidemics, with their own treatment protocols and
medications, without adversely affecting patients.
“We are pleased by the early successes of the
Penn Program in Botswana,” said Friedman. “We
are optimistic that this valuable program will continue
to grow and meet the needs of the people of Botswana
and the Penn community. As the Penn Program in Botswana
expands, we are reaching out to other schools at Penn
to encourage broad participation and representation,”
said Friedman.
Although there are many components to the program that
Friedman finds exciting, it is the medical students’
exposure to international medicine that is particularly
rewarding in his role as an educator. “This exposure,
at such a pivotal time in a medical student’s
career, is so important,” said Dr. Friedman. “For
some students, what they experience will become the
focus of their career. For others, it may be just a
piece of what they do, but each one will come back richer
for the experience. They will see how medicine is practiced
in another part of the world and will learn just how
lucky we are in this part of the world. They will also
become excited about all that they can do and how much
they can accomplish,” he concluded.
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