African public health project treating AIDS

“In 2004, Botswana, in Africa, had the lowest life expectancy in the world at 38 years old due to the high prevalence of AIDS and lack of treatment,” Robert Murphy, professor of medicine at Northwestern University Chicago and director of Global Health, told 60 La Crosse community members on April 16 at UW-La Crosse’s Graff Main Hall during his presentation, “Scaling up HIV/AIDS Treatment in Africa 2010.”

By 2008, Botswana’s life expectancy increased to 54 years old thanks to the work Murphy has been doing with the President’s Emergency Plan for AIDS Relief (PEPFAR) starting in 2000. 

“PEPFAR is the largest public health project in the history of the earth,” Murphy said, working on creating drugs to treat AIDS symptoms, creating health programs to diagnose HIV in asymptomatic patients, and educating new health care leaders all in Sub-Sahara Africa.

Ninety percent of HIV infections occur outside the developed world, Murphy said.  Yet in Africa, 20-40 percent of AIDS patients have access to drug therapy to treat symptoms.  According to a study done by the World Health Organization, this statistic is up from 2005, where 10 percent of patients had access to drug therapy. 

Currently, there is no cure for HIV/AIDS.  However, antiretroviral (ARV) therapy has successfully been reducing AIDS symptoms to help patients live a normal life since 1987, Murphy said.  However, ARV therapy is only effective when treatment is started early, before symptoms begin to occur.  In Africa, a person will have HIV for about seven years before any indication of the disease is prevalent, Murphy said. 

PEPFAR is a $15 billion initiative that has helped diagnose HIV/AIDS patients, and distribute ARV therapy treatments, but not without its challenges, Murphy said.       “The amount of HIV infections being diagnosed still outpaces those taking ARV’s 2.5 to one,” Murphy said.  Other challenges include starting patients on treatment early enough to be effective, as 10-15 percent of patients on ARV still experience early mortality.  Africa’s weak health care systems and shortage of workers result in limited number of patients being seen, Murphy said. 

Murphy’s part in PEPFAR includes working with 100,000 HIV/AIDS adult patients and 5,000 children in Nigeria, Tanzania, and Botswana. 

The program begins with patients signing an informed consent so health data can be used unanimously in epidemiology studies.  Patients receive CBTX coverage, which includes treatment to help prevent opportunistic diseases and malaria, tuberculosis screening coverage, lab data and HIV/AIDS testing, Murphy said. 

Testing to confirm the presence of HIV/AIDS includes a CD4 and viral load test. A CD4 test counts the number of lymphocytes in a patient blood that AIDS targets to destroy.  As AIDS progresses, more CD4 cells are destroyed and the body loses immunity, resulting in an inability to fight common diseases that can lead to death.  A lymphocyte count of less than 350 cells/millimeters cubed in the blood indicates the need to start treatment for HIV/AIDS with ARV therapy. 

A viral load test includes a polymerase chain reaction test to measure viral particles in the blood per millimeter, Murphy said.