Project #2754

HIV and TB care at the village level in Mali

by GAIA Vaccine Foundation

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!

Peer Educators in Sikoro
Peer Educators in Sikoro

We have 135 people in care in the clinic right now, and another 5 to 10 come in each month for treatment. Acceptance of HIV treatment has been very good and patient satisfaction with care is excellent.

We’ve been assessing people at different time points - at entry, at 6 months, at 1 year. On average, tree months after starting treatment the T cell counts of our patients increases by 100 – a sign of treatment success. Increased T-cell counts also means that our patients are less susceptible to opportunistic infections and are more able to participate in the activities of daily life, contributing to the wellbeing of their families.

As for HIV education and TB outreach - both programs (Here Bolo for HIV and TB Bolo for tuberculosis) are going strong. All 12 peer educators are still with us and we're planning to assess our education program to see if there is improvement. We do believe we have had an impact… we'll see when we do the study!!!

Thank you for supporting our programs in Mali!

Spreading the word on World AIDS Day
Spreading the word on World AIDS Day
Our work in the community on WAD
Our work in the community on WAD
Nurse at Hope Center Clinic - June 2010
Nurse at Hope Center Clinic - June 2010

Good news from West Africa! Your favorite HIV prevention organization has successfully completed its second year of improving access to HIV care. With your support, GAIA has improved access to care for more than 45,000 Malians at the GAIA community-based clinic, the Hope Center Clinic in Sikoro, Mali.
Slowly but steadily, GAIA VF is building a state of the art program for HIV-positive patients in this resource-poor setting. The goal of this program is to reduce HIV transmission in one area of the world, to demonstrate the impact of community-based HIV care, and to prepare for an HIV vaccine trial in the same community.

Access to HIV treatment   
Since its inception, the program has enrolled over one hundred patients, and the results so far are encouraging: our patients have steadily been regaining weight, and their CD4 T cell counts are climbing. The patients also understand the importance of taking their medications – our pharmacist reports that adherence has climbed to near 100%.
This high rate of adherence is due to GAIA VF’s investment in peer support sessions at the clinic. The investment is certainly paying off: as a result of improved adherence, AIDS-related infections have become less common, and the general well-being of our patients continues to improve. No deaths have been observed among those patients followed in the clinic who have been treated for at least 4 months! Even the most skeptical members of the community are beginning to see the importance of HIV testing, access to care, and treatment.

HIV testing and follow up
The door to improved survival with HIV is early diagnosis. In 2010, GAIA VF increased the clinic’s HIV testing capacity. Our peer educators made 3,000 contacts within the community and more than 1,500 were tested for HIV. 81% were screened through our Prevention for Mother to Child Transmission (PMTCT) and 19% via Voluntary Counseling and Testing (VCT). 50% of the new patients were eligible for initiation of therapy, and received HIV medication. Half of these patients are pregnant women. Those that are HIV-seropositive but not yet clinically eligible for HIV treatment are being followed. We recently hired a case manager to improve patient follow up and monitor adherence.
Clinic Improvements
With donor support, we’re building a new maternity ward at the clinic. We’re also making technical improvements:  we purchased an air conditioner and replaced the refrigerator in the pharmacy, and we pay for Internet access. We also organized training for our staff to strengthen their skills.
HIV-TB Prevention program
Two Brown University students (Lauren Pischel and Julie Caplow) invested time and energy on our TB Bolo program in 2009. As a result of their enthusiasm and hard work, GAIA VF decided to invest in improving tuberculosis prevention and screening by making the tools available at the Hope Center Clinic for the rapid detection of TB. As a result, our TB case detection rate is rising and, as TB transmission is reduced, our HIV patients will be less likely to be co-infected with TB.

How can you help support our work in 2011?

Our plans for 2011 include -

Free HIV testing for all who wish to have it
GAIA VF will continue to expand HIV testing and increase the number of patients on HIV treatment. This is a lifesaving intervention, and it also reduces HIV transmission in the community. Like the Mother-to-Child-Transmission (MTCT) prevention program, it’s the ‘vaccine we have now’. With your support we plan to increase screening/testing by 25% and the number of patients under ARV treatment by 100%.

Encouraging fathers to participate
Of all our programs, the mother-to-child-transmission prevention program enrolls the most HIV infected patients. We plan to use this “window” into the family to reach their contacts. In 2011, we’ll work to improve our connections to men by reaching out to new fathers and conducting a comprehensive follow-up program. Increasing the number of post-natal consultations, strengthening the HIV counseling and support services for mothers and fathers, encouraging mothers to bring the baby’s father to the pre- and post-natal sessions, and training more nurse-midwives will allow us to enroll more patients through the post-natal “window” of access to the family.

Raising awareness, reducing stigma
In pursuit of our goal to involve fathers and young men in HIV testing, we’ll launch an awareness campaign targeting men, so as to decrease the stigma of HIV infection and encourage men of all ages to get tested and treated for HIV.

Community outreach
Our award-winning “Here Bolo” program will continue this year (and it has now been adopted in Haiti!). Our peer educators will tailor their communications to specific groups in Sikoro (women, elders, youth, orphans, men/fathers), making sure that everyone knows that free, complete HIV care is available in their community.

Nutritional support for patients
Nutritional support is a key aspect of our care for the AIDS patients. In addition to providing a weekly meal, this program reduces stigma and improves communication, adherence to treatment, and the effectiveness of medications.

A bright new space for children with HIV
GAIA VF has plans to recruit a pediatric HIV specialist to provide care to children born with HIV in the community. We would like to challenge our donors to contribute to this effort to build a space for our pediatric HIV patients. We hope to create a warm, happy setting for their care.

World AIDS Day 2010: Honor the day with a donation!

This year the GAIA Vaccine Foundation is moving its annual WAD event to Mali! Can’t go? Stay tuned: we have a big event coming up in the Spring in Providence! Check in on line and stay in touch!

Make a contribution to GAIA in honor of World AIDS Day! Help us stop HIV in its tracks!

GAIA by the numbers in 2010:

12,824 condoms distributed
1,890 HIV tests performed
More than 100 patients receiving HIV treatment
38 at-risk newborns currently being followed
2 new programs: HPV and TB prevention

The staff of GAIA
The staff of GAIA

When originally planning for the trip to West Africa I was at first a bit apprehensive of site visits in French. I've only studied the language for a year and I feared I might not be able to understand the organization's work or get a good sense of their impact if the visit was entirely in French.

Meeting with GAIA Foundation however quickly put these fears aside. Understanding the amazing work of GAIA does not require nuisance or subtlety. Their work is clear, direct and entails the truly praiseworthy work of literally saving lives on a daily basis. Over a number days in Bamako, Mali I had the opportunity to learn about this work both on "official" and "unofficial" site visits with the organization.

Though the "official" site visit occurred on July 12th, I would say the unofficial portion of the visit began when Lorraine and I moved into the GAIA guesthouse and were greeted by two enthusiastic and passionate GAIA volunteers, Tonyu and Emily. I don't think GAIA could have found two better representatives or endorsements than these two. Not only did they spend long nights explaining the difficult situation of health in Mali, but they also detailed the innovate approach GAIA has undertaken and gave us an introduction the inspiring doctor we would meet the following day, the local director of GAIA Dr. Tounkara. He would not disappoint. We learned that the organization works in the Sinkoro area, a part of Bamako that has been traditionally undeserved by health services with approximately 1 doctor per 40,000 patients. Devastating diseases such as HIV/AIDS and Tuberculosis has had a profound effect on the community and continue to disrupt the lives of many throughout the area.

As for the "official" site visit Dr. Tounkara, or as many call him "Kara", walked us through the Hope Clinic, greeting staff and patients alike along the way. He explained how GAIA is working in conjunction with the Malian government to make the clinic into a model that can be replicated throughout the country. The clinic takes a holistic approach to health, but has been greatly aided by GAIA's support in fighting HIV/AIDS and Tubrcolosis through both treatment and outreach.

Sitting down with the head of the Hope clinic, we learned how GAIA has additionally been instrumental in stepping in where the Malian government funds leave off. GAIA has been able to raise funds for advanced medical equipment and facilities, when the government of Mali is unable to provide the funding. What is truly unique is the way GAIA does not direct the improvements but responds to the needs of the community and its leaders.

Donating money can sometimes be a tricky business and it can be difficult to understand the impact of your donation. Furthermore, development models have proven complicated with ambiguous results. These doubts are not necessary with GAIA. Their impact is so clear that even a French beginner can understand them. GAIA's projects transform lives and represent a glimpse at the future of health in Mali.

...and if you're still not convinced they also speak English.

Andrew is traveling in the field visiting numerous GlobalGiving projects. Follow his and his fellow traveler's adventures at

Tested 1,840 patients for HIV; identified 100 cases Started 33 new patients on HIV medications Screened 540 pregnant women by ultrasound Prevented HIV transmission to 12 newborns PMTCT Program: 1,440 pregnant women received councelling, 1,438 were tested – out of which 25 tested HIV+. 30 babies (under 18 mo) are being followed. Extended staff in Mali: GAIA hired an HIV pharmacist for ARV treatments. Student training: Kotou Sangare, a student at the Laboratory of Applied Molecular Biology (affiliated with the University of Bamako) travelled to Providence last summer and trained with a local laboratory team to do research on the GAIA HIV vaccine. World AIDS Day/Week in Bamako: Tounkara Karamoko (our Director) organized many events within the community in order to raise HIV awareness. Maternity renovation (on going): With 1,200 mothers giving birth every year the maternity needed an extra room for deliveries. The ASACO (Sikoro’s health infrastructure) is raising money to build this addition. GAIA VF is also participating in funding We plan on continuing the PMTCT evaluation, to increase amount of patients treated with ARV by 100%, acquiring medical supplies for the addition, beds, mattresses and a birthing table.

GAIA would like to thank you for your contributions and support and making it possible for us to open this clinic and expand its health care and awareness.


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Organization Information

GAIA Vaccine Foundation

Location: Providence, RI - USA
Website: http:/​/​
Project Leader:
GAIA Vaccine Foundation
Providence, RI United States

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