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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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PENN Medicine is a $2.2 billion enterprise dedicated to the related missions of medical education, biomedical research, and quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System (created in 1993 as the nation’s first integrated academic health system).

Penn’s School of Medicine is ranked #2 in the nation for receipt of NIH funds; and ranked #4 in the nation in U.S. News & World Report’s recent ranking of top research-oriented medical schools. Supporting 1400 full-time faculty and 700 students, Penn’s School of Medicine is recognized worldwide for its superior education and training of the next generation of physician/scientists and leaders of academic medicine.

Penn’s Health System consists of four hospitals (including its flagship Hospital of the University of Pennsylvania, consistently rated one of the nation’s “Honor Roll” hospitals by U.S. News & World Report); a faculty practice plan, a primary-care provider network, three multispecialty satellite facilities, and home healthcare and hospice.

Release available online at http://www.uphs.upenn.edu/news/News_Releases/nov03/botswana.htm