U of A health researcher’s pilot project shows treatment on par with the best hospitals in east African nation.

Keith Gerein, The Edmonton Journal
Published: Sunday, January 13

When Arif Alibhai went to Uganda two years ago, he knew the job before him required both scholastic ability and a humanitarian touch.

The east African country had made substantial strides in combatting an AIDS epidemic, yet the progress was tragically uneven. Anti-retroviral drugs were available only at major urban hospitals, effectively denying treatment to patients in many rural areas.

The challenge offered to Alibhai, a University of Alberta health researcher, was to devise a system of dispensing medication in these remote districts.

The catch? Not only would any solution have to be low-cost and sustainable over the long term, it would also have to get around a critical shortage of doctors.

After tossing around a few ideas, Alibhai and his team came up with a plan: Instead of using health professionals to deliver drugs, the job could be done by unpaid community volunteers.

So far, the concept appears to be working.

Early results from a rural pilot project show treatment that is on par with the best Ugandan hospitals — a success story that could potentially serve as a model for drug programs in other AIDS-afflicted countries.

“The whole point was to look at the problem of how rural people access treatment,” said Alibhai, the senior project manager. “We asked ourselves, is it possible to move the treatment to where the people are?”

The site chosen for the pilot project was Kabarole, a predominately rural district on the western edge of Uganda where subsistence farming is the main activity.

A poor area, the prevalence of HIV among adults in Kabarole is 10 per cent, significantly higher than Uganda’s national rate of six per cent.

Such a disparity is a major concern, said Tom Rubaale, a member of the district health team. Since the disease kills people in their prime working years, it has a particularly devastating impact on poor families who depend on their strongest adults for income, he said.

That thin line between survival and starvation is one reason why rural AIDS patients in Kabarole often choose not to be treated. With anti-retroviral drugs offered only in the district capital, many people find it’s too far to go, said Joa Okech Ojony, a district health officer.

“It may take two days for people to make the trip, and they can’t afford that because it’s two days away from their livelihood,” he said. “Others are too frail to travel, and even if they weren’t, the costs of travel are prohibitive.”

The project team knew that bringing drugs into rural areas would solve only half the problem. The more critical conundrum was the lack of doctors. Without them, who would hand out the medication? Who would ensure patients took their pills twice a day on schedule? Who would keep watch for adverse effects?

In searching for answers, team members recalled a study done in Haiti on hard-to-reach patients and thought they could adapt the Caribbean program to sub-Saharan Africa.

“Anything we did had to be sustainable in the long term, meaning it had to be minimal cost,” said Alibhai, who joined Ojony and Rubaale in Edmonton recently at a global health conference. “We already knew that volunteerism is a big part of Ugandan culture, so calling on volunteers seemed to make sense.”

Working out of small rural health clinics — upgraded with funding from the Canadian Institutes of Health Research — community members were recruited and trained to take on many duties traditionally performed by health professionals.

The most important of these was to make weekly visits to patients to ensure they were taking their medication, and to check for any negative reactions.

After six months, the project has shown strong results. Ninety per cent of rural patients have had successful treatment outcomes, while the drug adherence rate has hovered near 99 per cent — achievements at least equal to the district hospital. Alibhai believes the program’s success is due, in part, to the personal touch patients receive from friends and neighbours assigned to check in on them. Volunteers can outperform doctors when it comes to offering social support, compassion and encouragement.

And success builds success. As people hear of positive results and see neighbours getting better, more patients sign up for the program. Women in particular are more likely to seek treatment when it is delivered in a community-based setting, said Walter Kipp, the U of A health scientist who supervised the project.

Researchers will continue to study the drug program over a two-year period. During that time, one of the biggest challenges will be to avoid complacency, both in keeping patients taking their drugs and keeping volunteers motivated to perform their duties, Kipp said.

Funding is another issue. More money is needed not only to keep the program going in Kabarole — where an estimated 16,000 people will need treatment in the next five years — but also to expand the project to other areas of Uganda and other countries afflicted with AIDS, Alibhai said.

“When you start working in global health,” he said, “you have to make a commitment to stay in it for the long term because the need is great.”

Source: http://www.canada.com/edmontonjournal/news/cityplus/

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