The U.S. President's Emergency Plan for AIDS Relief - October 2009 Newsletter

Ambassador Eric Goosby, U.S. Global AIDS Coordinator, travelled to Uganda and Kenya earlier this month to speak with country officials and members of civil society about their epidemics and their partnerships with the U.S. Government in the fight against HIV/AIDS.

Ambassador Goosby met with Ugandan President H.E. Yoweri Museveni, and also toured several initiatives supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in the nation's capital, Kampala. These included the Infectious Diseases Institute, The AIDS Support Organization (TASO) and Meeting Point, a grassroots organization that provides care for people living with and affected by HIV/AIDS.

While in Uganda, Ambassador Goosby pledged continued support for Uganda's fight against HIV/ AIDS and expressed a desire to further strengthen the partnership between Uganda and the United States.

From fiscal year 2004-2009, the American people, through PEPFAR, provided over $1.2 billion to Uganda to support comprehensive HIV/AIDS prevention, treatment and care programs. Currently, PEPFAR supports antiretroviral treatment for 120,000 Ugandans.

During his visit to Uganda, Ambassador Goosby also stressed the importance of HIV prevention. “We should try different prevention approaches because people who have heard HIV/AIDS messages are the ones getting infected. …We need to keep drumming prevention messages, as long as AIDS exists, because behavior change needs continuity,” he said.

Ambassador Goosby also highlighted the need for new strategies and efforts to reduce stigma in order to ensure prevention messages are effective. “Infections are moving from younger people to 30-35 year-old women and men in their 40s. We need to respond by reviving prevention campaigns,” he said.

Following his trip to Uganda, Ambassador Goosby traveled to Kenya, where he met with government officials from the Ministry of Public Health and Sanitation, the Ministry of Medical Services, and the National AIDS Control Commission. They discussed the wealth of data made available by the recent USG-supported Kenya AIDS Indicator Survey (KAIS), and opportunities for PEPFAR technical support to strengthen the Kenyan Government's capacity to manage its response to HIV/AIDS.

At Kenyatta National Hospital, Ambassador Goosby met with senior clinicians to discuss ideas for enhancing medical education, and participated in a “grand rounds” discussion on the case of a patient who has been on treatment since before PEPFAR began and who is now receiving PEPFAR-supported antiretroviral treatment.

While in Kenya, Ambassador Goosby visited the Kangemi Health Center, which provides a wide range of health services to residents of an informal settlement. He also met with civil society members and health care providers to exchange ideas on possible new approaches to address Kenya's HIV/AIDS epidemic.

Through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. Government has helped to dramatically scale up counseling and testing in Vietnam by supporting free and confidential services at more than 130 sites.

Vietnam has long suffered from a shortage of trained personnel, aging equipment and inconsistent quality standards, which have hampered the ability to produce accurate HIV diagnostic test results.

In 2006, the U.S. Centers for Disease Control and Prevention began working with the Vietnamese National Institute of Hygiene and Epidemiology (NIHE) to develop an external quality assessment program that would identify laboratories with a high rate of testing errors.

The U.S. Department of Defense, working with its counterpart in Vietnam, supported similar training at the Military Institute of Hygiene and Epidemiology.

Through these programs, staff from both institutes were sent to Thai government testing facilities in Bangkok for training. They returned with panels of serum that allowed them to conduct an assessment of HIV testing in Vietnamese laboratories. These serum panels were sent to more than 100 provincial and regional laboratories to be tested and the results were compared among all laboratory participants from the program.

While laboratories use different techniques and test kits, if a sample is positive, it should test positive independent of the methods used.

The initial results identified several laboratories with problems. To address problematic areas, NIHE developed its own external quality assessment plan and response. Laboratories that performed poorly were offered training to improve their skills. As a result, over the past three years, participating laboratories demonstrated vast improvements, a remarkable turnaround in such a short period of time.

PEPFAR will now look for ways to expand this successful program to other laboratories, including those at military sites that offer HIV testing.

“Although this program is newly established,” says Dr. Nguyen Thanh Long, Director of the Vietnam Administration for HIV/AIDS Control, “it has gained remarkable results and has been a significant component in assuring the quality of HIV testing services in Vietnam.”

Dr. Long believes that this model should be expanded and applied to all clinical tests, not just those related to HIV, so that more patients can benefit from quality testing.

Five years ago, Joan Ndunge Musyoka's parents found out they were HIV-positive. Shortly after their diagnosis, they enrolled in a community-based project supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) that provides care for people living with and affected by HIV/AIDS in Kenya.

Joan's father lost his battle with HIV/AIDS in 2004, forcing her mother to become the sole provider for the family. At first, her mother took this in stride, but soon the worries and stress that came with their situation drove her into depression. Joan was left with the difficult responsibility of caring for herself and her siblings.

As a result of this hardship and financial instability, Joan struggled to finish her secondary education. Although she enrolled in Form Three (11th grade) three times, she could never afford to finish a full term. But Joan refused to give up. She took on odd jobs and saved the pay that she did not use to take care of her siblings for tuition. Still, Joan struggled to complete school.

In 2008, community health workers suggested Joan apply for a PEPFAR-supported scholarship program for orphans and vulnerable children. While hesitant, Joan filled out the application.

But this skepticism would soon be erased. When Joan traveled the 230 kilometers to Makutano High School for her fourth term in Form Three, she was greeted with good news. She was told by the school's Headmaster that the scholarship program had paid her school fees for the entire year. Tears of joy flooded Joan's face upon hearing this news.

“I am grateful to be a glimmer of hope for my family and I'm determined to excel and lead my family out of poverty,” said Joan.

“This milestone exemplifies the dedication, caring, and hard work of all who strive to better the lives of those infected with or affected by HIV/AIDS,” said HHS Secretary Kathleen Sebelius.

In fiscal year 2008 alone, PEPFAR provided nearly $1.6 billion in support of treatment programs, including antiretroviral drugs and services.

Since the program's inception, the U.S. Government, through PEPFAR, has worked to increase the availability of safe, effective, low-cost, and generic ARVs in the developing world through an expedited “tentative approval” process conducted by HHS/FDA. Through this process, ARVs from anywhere in the world, produced by any manufacturer, can be rapidly reviewed to assess quality standards and subsequently cleared for purchase under PEPFAR.

The expedited tentative approval process is employed for PEPFAR-procured drugs used abroad that cannot be approved for marketing in the United States due to existing patents and marketing exclusivity.

Through this approval process, PEPFAR can ensure that the drugs purchased for use abroad meet all of HHS/FDA's manufacturing quality, clinical safety, and efficacy requirements. Additionally, tentatively approved drugs are added to the World Health Organization's prequalification list of generic ARVs.

PEPFAR is proud of this milestone and looks forwards to continuing procurement of safe, effective drugs that are of high quality and consistent with international law.

“PEPFAR is committed to supporting partner countries to build and maintain sustainable procurement and supply chain systems,” said Ambassador Eric Goosby, U.S. Global AIDS Coordinator.