Behind the Alphabet Soup: Addressing Swaziland’s Number One Killer

Loxley_at_work

by Loxley Denzil Christopher Bennett II, Columbia College Senior majoring in neuroscience & behavior

I have to warn you, there are a lot of acronyms in this post. I could probably string together a sentence composed of three-letter acronyms to describe it.  So here we go: Link4Health (L4H) is a combination strategy to approaching HIV treatment here in Swaziland. It’s a two-arm program, which means that people will be randomly assigned to one of two different treatments based on which hospital facility she or he chooses. This NIH-funded study is designed and implemented by ICAP to evaluate two models of HIV treatment in Swaziland – the nation’s current standard of care and an experimental Combination Intervention Strategy (CIS).  Both arms provide quality care with Tenofovir Disoproxil Fumarate (TDF) based Highly Active Anti-Retroviral Therapy (HAART), but CIS has modifications: faster initiation of antiretroviral therapy and financial incentives. Hopefully these changes can increase linkage to and retention in anti retroviral therapy.

This study is so important because Swaziland has the highest prevalence of HIV in the world, and AIDS is the nation’s leading cause of death.  If HIV-infected individuals can be tested, begin antiretroviral therapy, and stay in care with strict adherence to an antiretroviral regimen, then they can maintain a low or even undetectable viral load. This means they can live full lives without progression to AIDS, and not transmit HIV to others.  Unfortunately, this process isn’t always followed.

From the United States to Uganda, remarkably few people infected with HIV make it through the treatment process before social, economic, or political barriers cause them to drop out. This reality is unfortunate, because 78-87 percent of people who stick to their antiretroviral therapy achieve an undetectable viral load. The goal is to find ways to keep people engaged in their HIV treatment and give them a chance of living healthy, happy lives, while also reducing the likelihood of infecting others with HIV.

My task will be to look at the patients engaged in rapid antiretroviral therapy initiation who have abnormal kidney function, which can sometimes result from Tenofovir Disoproxil Fumarate.

In Swaziland’s standard of care, healthcare professionals take many lab tests before initiating patients on these therapies. But providers don’t always get those lab results, so I’m also designing qualitative studies to explore the attitudes of healthcare providers, and to gauge patients’ understanding of the advantages and disadvantages of rapid antiretroviral initiation.

So far, I’ve already been working on these projects for a few weeks now, and have experienced many ups and downs. I’ll keep you posted on how things develop throughout my time in Swaziland.

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