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Celebrate World AIDS Day with ICAP
In addition to various ICAP commemorations across the globe, two special events will take place on the Columbia University campus in New York City during this World AIDS Day.
On Wednesday, November 30, ICAP will host a screening of the film, We Were Here. Produced and directed by David Weissman, We Were Here is the first documentary to take a deep and reflective look back at the arrival and impact of AIDS in San Francisco. This film explores how the City's community was affected by, and how it responded to, the calamitous epidemic. Though a San Francisco-based story, We Were Here extends beyond San Francisco and beyond AIDS itself. It speaks to the capacity of individuals to rise to the occasion, and to the incredible power of a community coming together with love, compassion, and determination.
A special introduction to the film will be given by Wafaa El-Sadr, ICAP Director; David Hoos, ICAP Senior Implementation Director; Robert Gamboa, ICAP Harlem Community Outreach and Retention Specialist; and Amirah Sequeira, Columbia University Student Representative. This event is on November 30 from 7:00 to 9:00 pm in Miller Theater on the Columbia University Morningside Campus (116th and Broadway). Register here.
On Thursday, December 1, ICAP is a sponsor of the “30 In 30 Out: World AIDS Day Benefit Event” hosted by the Columbia Student Global AIDS Campaign. ICAP’s David Hoos will be speaking at the event, alongside Jeffrey Sachs, director of the Earth Institute; Laura Pinsky, founder and director of the Gay Health Advocacy Project; and Jesus Aguais, executive director of New York-based Aid for AIDS International. The event will also feature performances by the Steps Repertory Ensemble and the Daniel Gwirtzman Dance Company.
Visit the World AIDS Week Facebook page to learn more about events produced by the Columbia Student AIDS Campaign.
ICAP Joins US Government and Partners for Launch of Nursing Education Partnership Initiative
ICAP joined with representatives of the US Government and Ministries of Health from five African countries in Lilongwe, Malawi on November 17 for the launch of the Nursing Education Partnership Initiative—an initiative developed to address the critical shortage of nurses and midwives in sub-Saharan Africa by strengthening the quality and capacity of these health professionals.
ICAP’s Nurse Capacity Initiative (INCI), a multi-country program designed to enhance nursing education opportunities in sub-Saharan Africa, partnered with the Office of the U.S. Global AIDS Coordinator (OGAC) in the U.S. Department of State and the U.S. Department of Health and Human Services/Health Resources and Services Administration (HRSA) over a year ago to begin coordinating and implementing the Nursing Education Partnership Initiative (NEPI). A five-year project funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), NEPI supports the development of transformative nursing educational interventions with the goal of increasing the capacity of selected nursing schools, and the nurse educational system overall. Participating partner countries included Zambia, Malawi, Lesotho, Ethiopia, and the Democratic Republic of Congo (DRC).
Building on ICAP’s global health research, education, and programmatic experience in over 21 countries around the world, the ICAP Nurse Capacity Initiative (INCI) is leading the NEPI Coordinating Center, providing training, continuous quality improvement, and evaluation support for nursing education projects carried out in the five selected NEPI countries. The Coordinating Center also plays a pivotal role in planning the implementation of interventions and communications between Ministries of Health, nursing and midwifery schools, educators, professional council, and other stakeholders.
The three-day launch event in Malawi convened many of these key partners for discussions focused on developing teaching, learning, and assessment standards in the nursing clinic and classroom. The event also helped to enhance the INCI-NEPI network, enabling an exchange of best practices, challenges, and opportunities for the partnership.
“The launch event has been an opportunity to deepen our cross-country programs and present the strength and enormous potential of expanded nursing and midwifery leadership to the larger international forum. We are determined to support efforts to increasing the number of skilled nurses and midwives capable of leadership roles within the healthcare team,” said Jennifer Dohrn, project director of the ICAP Nurse Capacity Initiative.
Over the next year, the ICAP-led Coordinating Center will continue to develop sustainable educational interventions in partnership with Ministries of Health in each partner country.
“Nurses are the backbone of the health system,” said Wafaa El-Sadr, ICAP director, “They deserve our full attention and support.” Working toward the critical task of scaling up the quantity and quality of the nursing and midwifery workforce throughout the world, INCI-NEPI partnership will disseminate its findings and develop models for replicating nursing and midwifery education interventions in other countries.
Wafaa El-Sadr Argues for "Treatment as Prevention" in World Bank and USAID Debate
ICAP Director Wafaa El-Sadr was a panelist on the debate "Treatment as Prevention" hosted by The World Bank and USAID on November 10, 2011. The debate featured four expert panelists designated to argue for and against treatment as prevention. This debate built on discussions that emanated from the HPTN-052 study which demonstrated that early ART was associated with a 96 percent reduction in HIV transmission from an HIV-infected person to his or her sexual partner.
Moderated by Nancy Birdsall, president of the Center for Global Development, the debate put forth the following proposition: “Countries should spend a majority of what is likely to be a flat or even declining HIV prevention budget on 'treatment as prevention.’”
Arguing in favor of the proposition, El-Sadr proposed three main reasons for why at least 50 percent of prevention resources should be allocated to treatment for prevention: 1) evidence must inform prevention; 2) ART for prevention is effective, feasible, equitable, ethical, and a well-accepted disease control strategy; and 3) the use of ART for prevention has important spill over effects for the individual and the community.
“At 96 percent protection – as demonstrated in the HPTN 052 study—this to date is the highest level of protection we have ever been able to achieve with any of one prevention intervention. This is beyond our wildest dreams. And the most compelling evidence is that it actually can be done and should be done, and that we need to give this intervention the lion share of our prevention resources,” said El-Sadr.
Also speaking in favor of the proposition, Sten H. Vermund, director of the Vanderbilt Institute for Global Health, asked “Is there any prevention strategy even remotely likely to reduce risk as efficiently as a 96 percent reduction of risk?” Vermund explained that ART for prevention is a reality now. “We are in a position to put tens of thousands, hundreds of thousands, perhaps millions of people on therapy,” he said.
Stefano Bertozzi, director of the HIV and Tuberculosis Global Health Program at the Bill and Melinda Gates Foundation, and Myron Cohen, director of the Institute for Global Health and Infectious Diseases at UNC, argued against the proposition. Bertozzi critqued the premise of the proposition, noting that prevention and treatment funding must be based on country needs and not an arbitrary threshold of 50 percent as defined in the proposition. “The correct answer, the right proportion, the optimal way to reduce death and disease from HIV should be guided by the countries specific situation – both the epidemiology of the country and the current response of the country,” said Bertozzi.
Myron Cohen, who is also the principal investigator on the HPTN 052, noted that the benefits from prevention as treatment will primarily be regional due to the unique health challenges that each country faces, and therefore it does not make sense to shift prevention funds to treatment funds in every country. “More ART may be less important than the more sensible use of ART,” said Cohen. “The premise of this debate is very interesting, but premature. Before we spend most of our money on ART, let’s figure out the best way to use the treatment dollars.”
The debate and subsequent question and answer session are available online. View the debate.
Large Number of Patients Enrolled in HIV Care and Treatment in Mozambique, Yet Challenges Remain
A new study conducted by ICAP and published in JAIDS examines HIV care in Mozambique, finding that a substantial number of HIV-infected patients have been successfully enrolled in care and treatment programs, but that challenges remain in terms of retention of patients and initiation of treatment at earlier stages of HIV disease.
Mozambique had an estimated national HIV prevalence of 11.5% in 2009. Rapidly scaled up HIV care and treatment in the past years however has helped to increase initiation of antiretroviral treatment to an estimated 170,000 people in the country. Researchers at ICAP, in partnership with the Mozambique Ministry of Health, set out to evaluate the program and patient outcomes in 28 HIV care and treatment clinics supported by ICAP in 5 provinces in Mozambique. The study focused on describing characteristics of the clinic, patients, treatment initiation, and frequency of key outcomes such as patients who are loss to follow-up or death. The clinics analyzed represented 13% of all clinics providing ART in Mozambique at the end of December 2009.
Patient information routinely collected during each clinic visit between 2003 and 2009, as well as data about clinic and program characteristics were evaluated. Their analysis shows that large numbers of patients were successfully enrolled in HIV care and ART initiation—overall 154,188 patients were enrolled in HIV care at the 28 clinics during the six-year period and 55,014 (35.6%) were initiated on ART. The majority of adult patients enrolled in care and those who initiated ART were women (65.4% and 62.8%, respectively), which may reflect higher testing and referral rates for women in the country. Children were also enrolled and initiated on ART—10,164 (6.6%) and 3,745 (6.8%) respectively were children less than 15 years old.
The study also noted that among those that started ART, 27 % of adults and 21 % of children were lost to follow-up at 12 months with a 12-month mortality rate of 5% and 7% for adults and children, respectively. High rates of loss to follow-up and death were also observed among those that did not initiate ART.
While these findings are comparable to studies of similar populations in sub-Saharan Africa, they demonstrate both the remarkable success of the Mozambique efforts and the remaining challenges. Efforts are ongoing to enhance retention rates among all patients enrolled in care and treatment in the clinics. Read the full article.
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