1st International AIDS Society Conference on HIV Pathogenesis and Treatment Buenos Aires, Argentina - July 8-11, 2001

[ABSTRACT:] Since its recognition in 1981, HIV/AIDS has become a major public health issue, particularly in the developing world. Data from the United Nations Program on AIDS (UNAIDS) and the World Health Organization (WHO)estimated that 5.3 million new HIV infections worldwide occurred in 2000. Of these, an estimated 3.8 million (~72%) occurred in sub-Saharan Africa. At the end of the year 2000, an estimated 36.1 million people, worldwide, are living with HIV or AIDS, of whom 25.3 million (~70%) live in sub-Saharan Africa. Since the beginning of the epidemic, the total number of AIDS deaths, worldwide, is 21.8 million, of which over 17 million (~78%) occurred in sub-Saharan Africa. In Botswana, the HIV/AIDS statistics are alarming:

• National median HIV prevalence among 15-49 years old has increased from 18% in 1992 to 36% in 2000.

• In Gaborone, the capital city of Botswana, the median HIV prevalence is 44% among 15-49 years old.

• National median HIV prevalence among 15-19 years old increased from 16.4% in 1992 to 26.7% in 2000.

• Between 1998 and 2010, life expectancy will decrease from 64 to 42 years; infant mortality will increase from 41 to 65 per 1000 due to AIDS.

A public/private partnership is feasible in Botswana given the level of need demonstrated by the burden of HIV disease in Botswana, the country's political will and ability to commit the resources to sustain the project beyond the five-year pilot phase, accessibility of patients to healthcare facilities, and care capacities of the existing medical infrastructure. Increasingly large numbers of organizations, industries and governments are taking part in the fight against HIV/AIDS. However, the enormity of the problem requires even greater commitments within heavily affected countries. Furthermore, for optimal effectiveness these efforts need to be well coordinated and organized. Therefore, any concerted effort needs to be based on firm public/private partnerships, must have strong leadership, and requires the necessary resources and the focus to deliver tangible results in a short time frame. Finally, the effort needs to address all components of care - not just individual elements - in order to make meaningful progress in altering the devastating course of HIV/AIDS in Africa. In keeping with this premise and as part of the global effort to address the HIV/AIDS crisis, the Republic of Botswana and the Bill & Melinda Gates Foundation and Merck & Co. Inc. established a partnership, ACHAP, to implement a comprehensive program that spans the continuum of care from home to the hospital. The African Comprehensive HIV/AIDS Partnership is a joint effort of the Republic of Botswana, the Bill & Melinda Gates Foundation, Merck & Co. Inc. and The Merck Company Foundation to advance significantly HIV/AIDS prevention, healthcare access, patient management and treatment of HIV in Botswana. ACHAP seeks to develop and maintain a partnership that brings together the best of the public/private sector to demonstrate the ability to significantly advance HIV management and treatment through a tightly defined initiative in Botswana. While significant resources and expertise will come from various global partners, the project seeks to develop leadership and commitment within the country so that the project can be sustained after the pilot phase. This is critical to the project's success. Overall goals for the program include:

• Reduce HIV-infection and transmission

• Improve accessibility to comprehensive HIV care and support across a continuum from home to hospital

• Improve access to prophylaxis and treatment of opportunistic infections (OI) and highly active anti-retroviral therapy (HAART) in the public sector for all people living with HIV/AIDS (PLWHA), eligible for treatment according to national standards

• Strengthen sustainable improvements of health care systems and mitigate the impact of the epidemic

• Create a comprehensive model of care that ensures access to training, education, testing and monitoring facilities, basic medical care, treatment for opportunistic infections and antiretroviral therapy for pregnant women, children and adults with HIV/AIDS.

• Demonstrate the viability of the program in various settings throughout Botswana by significantly advancing the diagnosis and management of care for people with HIV/AIDS.

• Work with the government of Botswana, Gates, Boehringer Ingelheim, Unilever and other global partners and agencies to guarantee long-term sustainability of the project; work with individuals, institutions and non-governmental agencies to determine support, opportunities and long-term solutions.

The ACHAP is focused on improving the prevention of HIV infection along with significantly increasing the rates of diagnosis and treatment of HIV/AIDS. Initially, the ACHAP will seek to enable, through the provision of key resources, a level of care consistent with the capabilities of the local medical infrastructure available to manage and treat people with HIV/AIDS. As the program advances, it is expected that the level of care being provided would improve in step with infrastructure improvements, to include management and treatment for TB and opportunistic infections and ultimately, antiretrovirals. Since the public announcement of the program, the principals of this unique endeavor have established the governance of the project, finalized the internal and external management structure and initiated multidisciplinary teams in the Republic of Botswana. In conjunction with the National AIDS Coordinating Agency in Botswana, a thorough nationwide needs assessment is currently being conducted. This evaluation will allow the development of a detailed plan that will specify goals, identify the necessary partners, establish benchmarks and specific objectives for measuring the success, funding requirements and resources needed to complete the project as well as ensure that it can be sustained past the initial five-year commitment. Additionally, various short-term priorities have been identified pending the completion of the needs assessment. These priorities will enhance existing programs (initiated by other institutions and donor organizations) as well as target the implementation of new programs including:

• assessment of laboratories and increasing the capacity of laboratories nationwide at various levels of care (CDC/ACHAP),

• assessment and development of a training program for health careworkers in HIV/AIDS (ACHAP/Harvard AIDS Institute),

• assessment of medical stores, and enhancing distribution and infrastructure (ACHAP/McKinsey),

• embark on a massive condom distribution program nationwide (ACHAP/Population Services International),

• improve the effectiveness of voluntary testing and counseling programs and referral to care nationwide (BOTUSA CDC),

• review and facilitate the scaling up of mother-to-child-transmission programs nationwide (Botswana/ACHAP), vii) review of procedures for post-exposure prophylaxis for health care workers and rape victims (Botswana/ACHAP),

• establish small grants to scale up community based HIV/AIDS initiatives (ACHAP),

• support a distance learning program to educate teachers about HIV/AIDS (UNDP/UN Foundations/ACHAP/Botswana).

All activities are being conducted in close collaboration with the National Coordinating AIDS Agency, Ministry of Health in Botswana and other key stakeholders.

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