Establishment of GAIA Mission 2002 and “Rendez vous des Specialistes VIH/SIDA”
GAIA Vaccine Foundation has been working in Mali since 2002, when Dr. Annie De Groot first established collaborations with Malian HIV researchers. She soon recognized the lack of coordinated networking between HIV/AIDS NGOs, GOs and HIV care providers and misinformation about HIV/AIDS treatment among practitioners that might impair the ethical conduct of HIV vaccine trials in Mali. GAIA VF’s mission arose from the need to coordinate these HIV/AIDS endeavors. Therefore, GAIA VF developed plans for an annual HIV/AIDS conference and to set up clinical centers in the city where good HIV care would be modeled.
Mother to Child HIV Transmission Prevention, 2004
In 2004, GAIA VF established a clinic-based peer discussion group for women and a Mother-to-child HIV transmission prevention program (MTCP) in Sikoro, a resource-limited village within Bamako. More than 100 women per month are tested. This clinic is named Chez Rosalie after the Providence philanthropist Rosalie Fain who donated the seed funds for the clinic and committed to supporting the clinic for three years.
As of December 2005, the clinic had tested 990 women and identified more than 40 women who needed HIV treatment to prevent transmission to their babies. In Fall 2007, the numbers are higher: 2,700 women have been tested, and 80 HIV-seropositive women have been provided with HIV medications when delivering. These HIV-infected mothers (and their partners) now form the core of the HIV-infected clinic population at the Centre D’Espoir.
Knowledge, Attitudes, Practices, 2005
What does GAIA know about HIV prevention in Mali? GAIA VF has performed surveys about HIV knowledge at the FMPOS medical school (2004) and the markets (2005). To summarize, knowledge about the existence of HIV/AIDS is widespread (87% of 279 persons interviewed in the Bamako market places knew about HIV/AIDS) but the rate of condom use remains extremely low (14 % for females and 15% for males) and only a few respondents had been tested (less than 2.5%).
Very few individuals were aware of ARVs and their life-saving effects. Many knew about condoms but few had access to them. Even fewer had been HIV tested, despite having participated in high-risk behaviors. Misconceptions about HIV infection and PLWH/A were very common. Much remains to be done to improve the average Malian’s ability to reduce HIV risk.
Plans for the Next Two Years
The next year will be a critical phase in the development of the Centre D’Espoir. Not only will construction begin, but also we will be inspected by the national AIDS organization (CSLS) and the regional Department of Health (DRS) in December 2007. Our records and protocols will be audited, in preparation for approval as a “prescriptive center”. Following this evaluation, a decision will be made as to whether we can provide free, government supplied HIV medications and HIV tests at the Centre D’Espoir. We would be the first CSCOM-based clinic to have that right to provide direct care at the neighborhood level, in all of Mali.
In preparation for our government audit, we are hiring a consultant to evaluate our clinic charts and protocols in October, 2007. We expect the construction of the new clinic to be complete in November 2007. With a full-out effort by every member of the GAIA Mali staff, we expect to pass our evaluation and become a prescribing center in January 2008.
Additional Programs will be developed for Sikoro this year, including: (1) A pediatric program (for HIV seropositive children that will be run by the GAIA Mali Director, Karamoko Tounkara, who is a formally trained pediatrician; (2) A microfinance project for HIV seropositive women modeled on a successful program lead by Brown University graduate Jessica Beckerman; (3) A TB case finding program based on a successful program initiated in Kenya by Brown Professor Jane Carter.
Additional Programs will be developed for Sikoro this year, including: (1) A pediatric program (for HIV seropositive children that will be run by the GAIA Mali Director, Karamoko Tounkara, who is a formally trained pediatrician; (2) A microfinance project for HIV seropositive women modeled on a successful program lead by Brown University graduate Jessica Beckerman; (3) A TB case finding program based on a successful program initiated in Kenya by Brown Professor Jane Carter. We will also perform two evaluations: (1) an evaluation of the effectiveness of the Here Bolo peer education program, and (2) an evaluation of the clinical care – specifically, a survey of patients who are engaged in the clinic. Both surveys will be performed by medical students who are not clinic or GAIA Mali staff so as to have the most objective measures of our interventions.
How Will We Measure Success?
The final criteria for success of the Centre D’Espoir (in the long term) will be the recognition of the Centre D’Espoir clinic as a “model” for other clinics in Mali – for example, the establishment of a second “Hope Center” in another neighborhood in Mali, which would be modeled on the Hope Center in Sikoro.