Study confirms value of volunteer-based HIV treatment in Uganda

(Edmonton) Walter Kipp always knew his hypothesis would bear fruit. Now he has the hard data to prove that using a volunteer team to deliver antiretroviral drugs to HIV patients in rural Uganda works as well as, or even better than, hospital delivery.

Four years into his research project in the small town of Rwimi, near Fort Portal in Western Uganda, and having monitored the treatment of 400 patients both at home and in the district hospital, the U of A public health scientist and his team can claim victory. The next stage, aided with $280,000 from the Canadian Institutes of Health Research, will be to hand the program over to local health services.

“We were worried about the access of life-saving antiretroviral therapies for HIV patients, because they cannot afford to go to the urban hospitals where the treatment is available,” said Kipp. “Transport costs have shown in the literature to be the biggest barrier to treatment.

“So we decided on community-based intervention and hypothesized that this therapy, which is a bit more complicated than giving an Aspirin pill, should nonetheless be possible with the help of a health-care facility to provide to people in their homes.”

A team of volunteers would be given a two-day training session, after which they would administer and monitor the drugs to HIV patients. If problems arose, the volunteers would help get patients either to a local referral centre or to the nearest hospital.

“The district government is really happy about it, and they want to expand it to the whole district, but they have to see how it goes at the local level first,” said Kipp. Similar programs have been shown to work in other parts of Africa.

Kipp’s team will now conduct more training seminars, set up some rules and guidelines and then let the Ugandans run the treatment program themselves. “Hopefully in three years we’ll see that the local authorities can do it, because there is a difference between research programs and local services.”

Kipp estimates his treatment program may have helped prevent 800 to 1,000 children from becoming orphaned, a significant result given the high number of child-headed households created by the AIDS scourge throughout Africa. And one of his most profound satisfactions, he adds, has been witnessing the hope the program has brought to the region.

“When you see the poverty there, you can’t find the words. People are completely paralyzed.” But as something like this takes on success, he says, “you cannot believe how much ability comes out of people, and they didn’t even know it. People develop talents they had no idea they had.

“It has been quite a personal thing for me, to recognize how much talent we have in this group. You know, you could cry about it. It’s a kind of overall concept of development, which primary health care in the strong sense really means.”

After his team hands over the pilot project to local authorities, says Kipp, they will likely continue, and perhaps even scale up, their research.

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