Nutrition and peer support for HIV+ patients


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 awards 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.

As you know, a military coup took place in March 2012, and there is ongoing civil unrest in Bamako. The US embassy remains open, but Peace Corps volunteers have been withdrawn. Accordingly, we have reduced our own presence in Bamako to the minimum; however, we remain committed to continuing support of access to HIV care at the village level, which – in this time of unrest – remains a significant, if not more critical need.

We compiled the results of our work over the past four months in order to measure the impact of the political crisis on our activities at the Hope Center Clinic. Our monthly reports show that in spite of the difficult circumstances:

1) 150 pregnant women on average are still getting tested monthly. Enrollment in the PMTCT program has been steady over the past four months.

2) 30 families are still receiving nutritional support every week. Enrollment has been steady over the past four months.

3) 40 babies are currently being followed.

4) 55 patients on average are coming for voluntary HIV testing every month. Enrollment has skyrocketed in the past four months, increasing from 47 in January 2012 to 83 in April 2012. This increase in voluntary testing shows that our reputable management techniques and efforts to provide free high quality HIV care are reliable.

Our onsite director, Dr. Tounkara Karamoko, also said that significantly more HIV tests have been requested recently by people living in surrounding communities due to the closures of medical infrastructure and clinics in the past weeks.

Despite ongoing unrest in Mali, we remain committed to supporting humanitarian aid and preserving the program that has been one of the most successful interventions in Mali, over the last 10 years. We believe that it is critically important, at this juncture, to sustain hope. We must encourage our Malian colleagues to continue to fight against AIDS, and buttress their optimism that peace and prosperity will be restored.

Thank you!

Imagine this: You are on your way to have lunch with the women of Sikoro. The walk from the modestly furnished house that GAIA rents to Sikoro will take you about 45minutes. The heat will have you drenched within minutes -no matter the time of the day- and you will have to share the road with cars, motorcycles, donkeys, cows, goats and people, as there are no sidewalks. Along the way, you will wave at the children and their mothers, who walk -often long distances- with an infant on their back, a basket on their head, a bucket in one hand, an older child’s hand in the other. You will reply to the many hellos thrown on your way by passersby and people sitting on the sides of the road, and forget the physical discomfort ever more with every smile, exquisite and contagious, belonging to some of the poorest people on the planet.

Soon, you too will fall in love with them, as did I. You will fall in love with the children who want you to touch their little hands and remember them forever by taking their photographs; with the ladies braiding each other’s hair in the afternoon heat, calling out that they love you and kissing your hands. You will fall in love with the men, sitting in the shade of a rare tree, listening to the radio, inviting you for a cup of tea. So for a moment, you will forget about their torn, dirty clothes, their bare feet and their scars. It’s as if they have everything in the world.

When you finally reach the Centre de Santé Communautaire de Sikoro - the clinic that offers basic health care services to the community - you will be greeted by fruit vendors sitting outside the clinic’s walls, selling the few seasonal fruits available. It’s Friday, and the women have will have already started cooking. This is a weekly culinary activity, funded through GAIA, by HIV positive women for HIV positive women and their children. A group of more than 20 women and children will be sitting in a corner of the clinic’s courtyard, taking turns stirring the food in a large pot over a pile of wood on fire. The children will be playing or in their mothers’ arms, some asleep despite the heat and the noise. They will immediately signal for you to join them and make space on the crammed benches.

Preparing food for the patients
Preparing food for the patients

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 wellness
Since 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 transmission
Since 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 2011
We 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 2011
HIV 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!

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Project Leader

Anne De Groot

Founder and Scientific Director
Providence, RI United States

Where is this project located?

Mali   Health
Map of Nutrition and peer support for HIV+ patients