2012 is GAIA Vaccine Foundation’s 10th anniversary! 10 years ago, we first set out to establish collaborations with Malian HIV researchers. GAIA VF was subsequently established to coordinate networking among HIV/AIDS governmental organizations, non-governmental organizations, and HIV care providers, as well as to tackle the problem of misinformation about HIV/AIDS treatment among clinicians and patients that could impair the ethical conduct of HIV vaccine trials in Mali.
With your help, we have been able to support the treatment of HIV seropositive women and their families at the Hope Center Clinic and at “Chez Rosalie”, our successful mother-to-child HIV transmission prevention (MTCTP) program, since 2005! We have established strong local and regional partnerships in Mali, performed vaccine readiness research, and implemented a comprehensive HIV care program in anticipation of performing HIV vaccine trials.
With approval from the Malian Ministry of Health, GAIA VF has addressed the issue of access to care by setting up a model village-based HIV care and treatment clinic. The Hope Center Clinic now features HIV case management, outreach to identify new patients, referral to care, and promotion of medication adherence. GAIA VF also partners with local organizations to improve access to specialty HIV care at the clinic.
Our goal is to leverage innovative HIV management techniques, expand HIV treatment, and increase HIV knowledge in order to improve access and adherence to care, a model that could be implemented to expand village-level HIV care throughout West Africa.
Coup d’Etat in Mali
Unfortunately, 2012 was also the setting for a military coup, which took place in Mali in March. While there is ongoing civil unrest in the northern part of the country, our onsite director Dr. Karamoko Tounkara reports that all is calm in Mali’s capital of Bamako. Our patients and staff are safe, as are GAIA VF’s collaborating scientists.
In spite of this unrest, we are still providing access to HIV testing, care, and prevention, as well as food for HIV-infected patients, at our clinic in Sikoro. While we have had to reduce the scope of our programs to cut costs, the current political crisis has had no other impact on our activities at the Hope Center Clinic.
Although circumstances have been hard, enrollment in the MTCTP program has been steady over the past months.Voluntary HIV testing requests have skyrocketed in the past year, increasing from 226 in 2011 to 412 in 2012!This reflects not only GAIA VF’s resilience in keeping its programs open when other programs were forced to close due to the current political turmoil, but also an awareness and appreciation for the services provided by our clinic. We believe that continuing to operate our programs will instill hope in the citizens of Mali to sustain them through these difficult times.
Our Malian collaborators are continuing the fight against AIDS, and we need to bolster their optimism that peace and prosperity will be restored. More than ever, GAIA VF, our staff, and our patients need our, and your, support.
HIV Care Program
Since the launch of our antiretroviral (ARV) access program in 2009, more than 200 patients have enrolled in care at the clinic. In the past 2 years, GAIA VF was able to reduce the cost to patients of HIV screening and provide supplies and material for HIV screening activities. We reinforced our staff to levels appropriate for management of persons living with HIV/AIDS and hired a full-time pharmacist (full-time) trained in the management of care for HIV-positive patients, as required by the government of Mali.
2011-2012 Hope Center Clinic Achievements
438 Voluntary HIV test requests
221 HIV-infected adults and children in care
42 HIV-infected children in care
118 New HIV-positive patients on treatment
1040 Meals distributed to our patients
Hope is a Vaccine Award Dinner
Dr. Myron Cohen and Dr. Julio Montaner were awarded the 2012 International Hope is a Vaccine award for their ardent support of the “Treatment as Prevention” approach to ending AIDS, in the absence of an effective vaccine. The National Hope is a Vaccine award was given to Jon Cohen (correspondent with Science) for covering HIV/AIDS from every angle, and the Local Hope is a Vaccine award winner was Dr. Paul Loberti for his unfailingly devoted advocacy of HIV prevention as a means of addressing the HIV epidemic. Our 2012 awardees attended the World AIDS Conference in Washington DC and gathered for a friendly award dinner together with Congressman David Cicilline.
Treatment as prevention: “The new vaccine for AIDS?”
The GAIA Vaccine Foundation held a satellite session at the AIDS Vaccine Conference in Boston in September 2012. Guest speaker (and 2012 Hope is a Vaccine Award winner!) Dr. Myron Cohen discussed the potential for implementation of the “Treatment as Prevention” (TasP) approach to ending AIDS, in the absence of an effective vaccine. Dr. Zoumana Koty, our Malian HIV specialist, was the recipient of both a scholarship and a travel grant, enabling him to attend the conference and present his work on improving clinical outcomes for HIV-positive patients at the Hope Center Clinic in Mali.
December 1st is World AIDS Day!
Your support for GAIA could not be more important than it is right now – we cannot continue without your help. Help us preserve our HIV care, treatment, and education programs in Mali! Please stand strong with GAIA VF and make a donation today.
In the business world, people talk about “Return on Investment” or “ROI”. What’s that mean? Well, usually hat it means – what’s the reward for the funds we invest. At GAIA Vaccine Foundation, our ROI can be measured in smiles, in healthy babies who do not have HIV infection, in lives saved. What’s that ROI? Priceless. And unlike many not-for-profits, GAIA donor dollars go directly to programs. GAIA VF supporters have satisfaction of knowing that lives can be dramatically improved, and the knowledge that – during the greatest pandemic in human history, GAIA VF is leading the way. How so? We understood the importance of improving access to treatment and invested in building the Hope Center Clinic in 2008 to make HIV treatment accessible. The clinic brings HIV medications right to patients in their neighborhood. We predicted that improving access would reduce HIV transmission, and we were right! In fact, one of the key discoveries in HIV/AIDS in recent years has been that “Treatment is Prevention”. In May 2011, a study involving 1,763 HIV-sero-discordant couples (one partner was HIV positive, the other was not) was stopped before its original closing date because an interim analysis showed a 96% reduction in the HIV transmission rate (See Cohen M.S. et al. N Engl J Med. 2011). Based on the published data, our success at HCC and the global trend to make HIV treatment available as a means of prevention, our next step is to petition the Malian government to provide Treatment as Prevention at our HCC and follow the impact on the community. In the absence of a vaccine, if providing access to medication can lead to eradication of AIDS, we’re ready to spring into action. What does the new finding that treating HIV can prevent HIV transmission and the call for Universal Access mean for the rest of the world? It means that the gap between the number of people needing to be treated and the funds available to make that treatment accessible just got wider. Recent reports show a 7% decrease in philanthropic donations for AIDS, from 2009. GAIA Vaccine Foundation’s achievements have proved that each donor’s support is critical to further our mission and improve access to HIV care. In this special World AIDS Day 2011 update, we are pleased to report that the support that we generously received from all our donors allowed us to go above and beyond the objectives that were set for our program. Through donations and grants, GAIA VF created one of the first clinics in West Africa to distribute village-level HIV care. In January 2011, the Hope Center Clinic was awarded a “Ciwara” (highest honor) by the local Department of Health. As the next International AIDS Conference is taking place in Washington DC in 2012 we will be highlighting our success in oral and poster session. We just completed an evaluation of our Mother to Child HIV transmission prevention program (started in 2005) and data from the past 30 months of our universal access intervention in Sikoro have been analyzed. We are happy to share the results with you. Assessing our PMTCT Program In 2010 and again in 2011, volunteers from all over the world traveled to Mali to work on a major evaluation of our program. Our volunteers included Christina Gomez-Mira (U. Texas), Natasha Rybak (Brown U.), Emily Kossow (Wesleyan), Tonhu Hoang (Concord Academy), and Nick Platt (American University of Paris) worked on assessing the adult HIV care with Ali Bicki (U. Miami) while Danielle Poole (Brown MPH program) and Shahla Yekta, Ph.D. (URI) worked on the HPV vaccine studies. Our efforts are yielding positive results. Mother to child transmission (MTCT) is near zero – only one mother transmitted the virus to her child. The mothers report that they are very satisfied with the care that they are provided at HCC’s “Chez Rosalie” (the MTCT prevention program). In 2011 a second study was conducted and a questionnaire related to both mother and children was submitted. This process allowed us to link the mothers enrolled in the PMTCT program to their newborn and previous children and identify risk factors for transmission. PMTCT in numbers (2005-2011) 10,150 pregnant women in prenatal care 9,060 pregnant women tested for HIV 198 pregnant women diagnosed with HIV 156 newborns in care 129 babies fed with formula Evaluating our HIV care Program We recently evaluated the efficacy of HIV treatment with “tri-therapy” in terms of AIDS-related infections, changes in weight, and CD4 counts over a 30 month study period. More than 60% of the patients increased their weight and CD4 counts and the percentage of patients with opportunistic infections was significantly reduced. 2011 Hope Center Clinic Achievements 200 HIV-infected adults and children in care 20 newborns tested by PCR for HIV 37 children in care 86 new HIV+ patients on treatment 830 patients received nutrition support 62% improved their viral load while under ARV 61% of patients had opportunistic infection (OI) at beginning of therapy; <17% had OI after 7-15 months HPV vaccine Project – Preparing for Trials Danielle Poole (with help from Kate Tracy, University of Maryland) carried out a study to evaluate whether women (and men) in Mali are ready to accept vaccination with HPV vaccine, the newly approved vaccine that prevents cervical cancer in women and anal warts in men. This study is supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The KAP and WTP studies will enable GAIA VF to collect information and data necessary for introducing the Gardasil vaccine in Mali; a clinical study is anticipated for next year. This project helps GAIA filed personnel develop the necessary experience, protocols, put an infrastructure in place, and also enables us to train medical personnel. The goal is to lay the groundwork for all vaccine studies to come. December 1st is World AIDS Day: Honor the Day with a donation! This year the UNAIDS objectives are: “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” Help us stop HIV/AIDS!
Thirty years after the first report about HIV, what can each of us say that we have done to stop AIDS?As you are a supporter of the GAIA Vaccine Foundation you know the answer – quite a lot!Research on the GAIA HIV vaccine continues in parallel with the National Institutes of Health-supported collaboration extending from Providence (URI, EpiVax) to the University of Bamako and the laboratory of Dr. Ousmane Koita. To demonstrate that HIV prevention is linked to HIV care, we developed a model program of HIV access to care, prevention, and mother-to-child HIV transmission prevention (MTCTP) in a clinic in Sikoro, an underprivileged suburb of Bamako.Our short term and long term objectives may initially appear to be very different, but in fact, we are pursuing a steady path toward a single unified goal – a globally accessible, globally relevant HIV vaccine. We have a consistent record of progress in the battle against HIV and AIDS and we are now entering a capacity building phase at our Hope Center Clinic, where we are beginning to create the infrastructure for vaccine trials.
In 2010, GAIA was able to provide cutting-edge HIV care and prevention at the front line of the HIV epidemic• We promote HIV prevention through peer education – our peer educators include a football coach, a university student, and a young mother, each of whom promotes HIV testing in their spare time.• We link government resources with the community, distributing free HIV care medication provided by the national HIV programs to patients enrolled at the clinic.• We provide cutting-edge HIV care at the front line of the battle against AIDS, setting an example for the rest of West Africa.Access to care and impact on patient wellnessSince the launch of our ARV access program in 2009, hundreds of patients have enrolled. Other than the few deaths observed for patients who were already in the highly advanced clinical stages of disease when they arrived at our clinic, we have seen steady improvement in patient status as measured by CD4 T cell counts, weight, and adherence to therapy. As a result of donor support, we have also been able to increase our testing capacity. Our peer educators made more than 4,000 contacts within the community. Fifty percent of new patients were eligible to start HIV medication, of whom about half were pregnant women. Those who are HIV-seropositive, but not yet clinically eligible for ARV treatment, are being followed. We have had an almost 100% rate of adherence to therapy – all of the patients followed for longer than 11 months are adherent to treatment - and only a few patients have failed to follow up. To strengthen adherence to treatment, we hired a case manager and now provide education and psychological support sessions within the Hope Center Clinic.Due to improved adherence to treatment, the patients’ health statuses have greatly improved. Significantly, our physicians have reported that patients have fewer opportunistic infections while on treatment. No deaths have been observed among those patients followed in the clinic who have been treated for at least four months. This is an incredibly important achievement: not only does it reinforce the belief that therapy can make a difference, but it also motivates our professional staff and our patients to engage in HIV care.
Successful prevention of MTC HIV transmissionSince February 2005, more than 7,000 women have received prenatal care from GAIA’s Chez Rosalie clinic, with an average of 128 women per month. Women who test positive are offered PMTCT services, and ARV and other necessary treatments are made available to their children. The percentage of women who accepted PMTCT grew from 35% in 2005 to 100% since 2010. To date, nearly 100 HIV-positive mothers have given birth in the Chez Rosalie clinic. All of the children born of mothers treated at the Chez Rosalie clinic (entirely supported by GAIA) are HIV-negative! That is a remarkable success.
Award winning clinical care at Hope Clinic! Our Hope Clinic won a “Ciwara” Award from the local government in January 2011!
New programs for 2011We are conducting a clinical study in preparation for testing an HPV vaccine. This project will build capacity for eventual HIV vaccine trials by providing training to our collaborators. If funding is approved, a small HPV vaccine trial will take place next year.
Continuing programs in 2011HIV care, nutritional support, and MTCTP (Chez Rosalie) will be ongoing. The number of patients continues to expand. Donor support is sincerely appreciated for our award-winning program! Thank you for supporting our work. Each donation helps us stop HIV in its tracks!
GAIA HIV Vaccine research is ongoing. Peptides that would be included in the future vaccine were synthesized for testing in Mali this year, and Lauren Levitz and Kotou Sangare carried out ELISpot (T cell) assays in the laboratory of Ousmane Koita, Ph.D., the main GAIA Vaccine Collaborator in Mali. Although this is not yet a clinical trial, the research is required before the GAIA vaccine is developed, to confirm that the peptide epitopes will be recognized by people who are affected by HIV in Mali. The results of this study were excellent - all of the peptides were confirmed, meaning that they are now validated for inclusion in the GAIA Vaccine. A paper on the research is forthcoming, and these data will be used to find additional funding for the vaccine development program. In the meantime, the staff of GAIA in Mali is being trained for future vaccine trials: preparation for an HPV (cervical cancer) vaccine study is underway. For more information, visit the home website at http://www.GAIAvaccine.org. In the next year, we plan to validate additional epitopes that would be included in the final vaccine product. Support for the ongoing research is critically important, as this is the only not-for-profit HIV vaccine under development. As the mission of the GAIA Vaccine Foundation is to develop a globally relevant, universally available vaccine, the GAIA Vaccine will be licensed to developing world countries for their use without any 'intellectual property" restrictions.
In conducting HIV vaccine research in Bamako, like with any other task, there are fast days and there are slow days. On the fast days, we work madly to process blood samples, to overcome shortages in equipment, and to knock down the various logistical obstacles that obstruct advanced HIV vaccine research in the fourth least-developed country in the world. On slow days, we volunteer at the local health clinic, where Lauren works with the midwives in the maternity ward and John performs tests in the clinic’s humble diagnostic lab. One of the most common diagnostic procedures is providing HIV tests to pregnant women. It is staggeringly easy to prevent transmission from mother to child, and doing so is the kind of high-yield intervention that many clinics, ours included, focus their resources on. Our clinic in particular has become a model that the Malian Ministry of Health is looking to bring to scale. Though he doesn’t remember what the woman looked like or how she dressed, the first HIV test that John administered is fixed in both of our minds. In the clinic’s lab, John took the woman’s finger, carefully swabbed it with alcohol, removed a lancet from the package, and jabbed her finger. John touched the blood to the test strip, added a quivering drop of chaser, and sat down to watch. There are no suspense-building string quartets in real life; the flies don’t stop buzzing nor do the chairs stop creaking as the little red line moves its way up the test strip as far as it will go before it digs in, resolutely in the wrong placeOn the other side of the clinic, Lauren sat in a small exam room, observing prenatal consultations. As women came in and were asked a barrage of questions in Bambara, the midwives translated their responses into French for Lauren’s benefit. Each visit seemed exactly like the last, except for one. Though it was impossible to hear what the midwives were saying to the patient behind the flowered exam curtain, the woman’s heart-wrenching sobs filled the small space. No translation was offered, but none was needed. This was the same patient John had just tested, a woman whose life had been changed with a simple finger prick.That brings us to the other lab, the so-called “real lab” with centrifuges and sterile hoods and incubators. With blood donated by patients like this woman, we are testing, piece by piece, components that may one day be included in an HIV vaccine. Previous vaccines have failed, and few dozen other groups are currently grappling, as we are, with the complexities of this task. Because every virus is different and each person’s immune system is different, a vaccine based on tests done in Providence may not bear fruit in Mali. We need to confirm, in Mali and in the US, that the vaccine we develop will work wherever it is needed. Our work in the lab involves taking HIV-positive blood, exposing blood cells to viral components we think will be reactive, and asking questions, the answers to which may spare millions from the anguish of the woman we saw that first morning at the clinic. The problems have been daunting, and we are still reaching for the optimistic targets we set in September.Even if we do not finish by the time we leave, we will have made progress. We are training the researchers in Bamako to do this work, so that the people who speak the scientific language of the laboratory also speak the vernacular of the clinic and the village it serves. So that the people whose business it is to take blood and make it speak are the same people that can provide support and shelter to the HIV-positive people who provided it.
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