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Bench to bedside research in the developing world:
Expanding laboratory capacity in rural Haiti
from the Partners
AIDS Research Center
The worst HIV epidemic in North America is in Haiti, where over 5% of the
population is presently infected. Partners in Health (PIH), a non-governmental
organization led by Harvard Medical School physicians Paul Farmer and Jim
Kim and affiliated with the Brigham and Women's Hospital and the Partners
AIDS Research Center, has been actively involved in building treatment
capacity over the past 20 years in one of the poorest areas of rural Haiti.
As the HIV epidemic expanded, their local health gains began to be eroded,
prompting Paul Farmer to institute HIV treatment based on serologic and
clinical criteria alone. This program was initiated in 1998 as the first
clear attempt to treat HIV infection in resource-poor settings.
A patient education forum on HIV/AIDS was held in rural Haiti on August
29, 2002, sponsored by Partners in Health. |
Although tremendous benefits in terms of clinical improvement were realized,
basic laboratory values were not available since the clinic is a three
hour jeep ride from the nearest advanced laboratory facilities, which are
in the capital city. There are presently over 250 persons- approximately
12% of all HIV-positive patients followed by the Haiti team- being successfully
treated with highly active antiretroviral therapy (HAART) in this region
that lacks running water and electricity. The impressive accomplishments
of this program were highlighted during a recent conference for patients
at the treatment center in Cange, Haiti, convened in the local church,
that was also attended by representatives of the Partners AIDS Research
Center.
Investigators at the Partners AIDS Research Center are now working with
PIH to greatly expand supportive laboratory facilities in Cange, which
will greatly benefit clinical care and promote translational research efforts.
Until now, critical samples from Haiti have been brought to MGH for CD4
cell counts and viral load testing. Although cumbersome and costly, there
have been no other options to get these vital data. However, at a recent
visit of PARC scientists to the PIH site in Cange, Haiti, a plan was devised
to try to bring CD4 cell counting capacity on site at the hospital there.
The plan was devised by Drs. Farmer and Walker, and is dependent upon successful
training of a Haitian technician in Boston as well as the acquisition of
a flow cytometer for Haiti.
Discussions in Cange, Haiti lead to the plan to install CD4 cell counting
on site in rural Haiti. |
The institution of CD4 cell counts on site in rural Haiti is made possible
by the fact that there is a generator at the hospital so that electrical
current can be supplied. However, there are other obstacles that also need
to be overcome. Funds for this machine are presently being sought through
philanthropic sources, which is the only option available. A Haitian technician
will need to be trained, and to this end Tania Louis-Jean has come to Boston
from Cange and is currently receiving training in flow cytometry from Fred
Preffer and the clinical cytometry laboratory at MGH.
Amy Kelliher from the MGH Clinical Cytometry Laboratory with Deogratias
Niyizonkiza and Tania Louis-Jean following the first flow cytometry training
session at MGH. |
The other obstacle to implementing CD4 cell counts in rural Haiti is that
the sophisticated flow cytometer will be unlikely to survive the rough
land route to Cange. Drs. Farmer and Walker met with the First Lady of
Haiti, Mildred Aristide, to discuss other options. Mrs. Aristide, who serves
as Chair of Haiti's National AIDS Commission, has pledged assistance in
the use of the Presidential helicopter for transport of the flow cytometer
once the funds are procured to purchase the machine.
Paul Farmer and Bruce Walker meeting with the First Lady Mildred Aristide
in Cange, Haiti. Ms. Aristide pledged the use of the Presidential helicopter
to transport the flow cytometer to Cange.
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These collaborations in Haiti expand ongoing efforts of the Partners AIDS
Research Center to bring enhanced care to persons who are living in resource-poor
settings. They also represent another example of efforts to transfer critical
technologies to improve health care globally. Through these collaborations
between Partners in Health and the Partners AIDS Research Center, bench
to bedside research is leading to direct gains in the lives of persons
living with HIV/AIDS.
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