With Little Donor Assistance, Cameroon Struggles to Treat HIV

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When Carole McArthur, MD, Ph.D., started her HIV work in Cameroon in the late 1990s, she was shocked at scarcity of diagnostics, despite strong indications that HIV infection was widespread. Without access to tests, she realized there was no way to understand the scope of the epidemic. 

Dr. McArthur, a professor of oral biology and pathology at the University of Missouri-Kansas City, returned to the U.S. and approached Abbott Laboratories, which agreed to donate its HIV screening tests to aid her efforts in Cameroon; in return, she would help the company evaluate its diagnostic tests and distribute them to many hospitals and clinics in Cameroon.

“It was a win-win because my corporate benefactors got important information regarding their diagnostic system, unobtainable in the US, and we were able to provide resources to hospitals,” said Dr. McArthur, who has also done research on the genetics of HIV.

She began to travel to Cameroon several times a year, eventually helping a Cameroonian physician, Dr. Paul Achu, establish the Mezam Polyclinic HIV/AIDS Center, which also has a hospital and research lab, in the North West Province City of Bamenda. “We obtained extensive scientific information regarding HIV of value to the US and at the same time, we were able to show the Cameroonian government just how big a problem HIV was … I was able to test up to 20,000 people a year,” she said. “It was a horrendously huge problem.”

Dr. McArthur could not obtain a similar partner to help provide HIV treatment, however, so patients who tested positive for HIV were unable to get access to antiretroviral drugs.  As in other parts of the developing world, ARVs were simply not available in Cameroon in the late 1990s. Dr. McArthur said some drugs obtained in the US were provided for pregnant HIV positive women to prevent transmission to their newborns, but she remained in the painfully desperate position of not being able to provide therapy for all patients. 

“We were able to treat the opportunistic infections with antibiotics in some cases, but could not obtain assistance from the many sources we explored to address the basic problem,” she said. “Thousands of people died because we just had no drugs.”

Dr. McArthur and other HIV experts say that Cameroon has not gotten nearly enough assistance from US global AIDS programs such as the President’s Emergency Plan for AIDS Relief (PEPFAR). USAID has directed some aid to Cameroon for HIV/AIDS programs, allocating about $600,000 for such efforts in the West African country in 2007.

“This is a country where you don’t see many donor partners,” said Dr. John Nkengasong, chief of the International Laboratory Branch at the Centers for Disease Control and Prevention’s Global AIDS Program. He noted that Cameroon faces this dearth of international funding despite having a disease burden that is similar to Uganda, Tanzania and other African countries that receive significant outside assistance for HIV/AIDS and other global health problems.

According to a UNAIDS/World Health Organization country profile, HIV prevalence in Cameroon was 5.1 percent in 2007. Approximately 540,000 people in Cameroon were HIV positive in 2007, the UNAIDS/WHO profile shows, and there were 39,000 AIDS-related deaths. Only about 25 percent of those eligible for ARVs were getting the necessary treatment.

 

Dr. Nkengasong said that Cameroon has only been able to start HIV-positive patients on ARVs in the last five years, thanks to grants from the Global Fund for AIDS, Tuberculosis and Malaria.

“Cameroon has created many treatment centers,” said Dr. Nkengasong, who visited his native Cameroon in May. “And as I speak they have 60,000 HIV patients on treatment, which is a truly remarkable achievement.”

Dr. Nkengasong and Dr. McArthur both said they would like to see PEPFAR’s reach expanded to include Cameroon. If PEPFAR could invest “just $5 million or $10 million, it could go a long way in Cameroon,” Dr. Nkengasong said. “You could have a big presence with a small investment.”

Although there has been some HIV treatment scale-up, Dr. McArthur has been unable to maintain funding for the Mezam Polyclinic’s HIV testing and research efforts. When Abbott sold its diagnostic business, which included its HIV screening tests, in 2005, Dr. McArthur could not find a new public or private sector partner.

As a result, she has ramped down her work on HIV genetics and retooled her Cameroon project to focus on tuberculosis, a major cause of mortality in HIV patients. WHO reports there were 36,000 new TB cases in Cameroon in 2007; 15,000 of those were among people who also have HIV.

Dr. McArthur recently entered into a new collaboration with TREK Diagnostic Systems, a microbiology company in Cleveland, which has agreed to provide its expertise and TB drug resistance technology for her work in Cameroon. A myriad of other small corporate contracts have enabled Dr. McArthur to continue providing free TB diagnosis, but her long-term dream—to establish a research center for emerging diseases—remains out of reach for now.

Dr. McArthur said the clinic she supports currently identifies approximately 600 confirmed TB cases per year and she hopes to double this over the coming two years. Her clinic is one of the few in Cameroon to offer more sophisticated TB tests that can distinguish between drug-susceptible and drug-resistant TB. The clinic’s staff works in collaboration with the Cameroonian government to connect TB infected patients with medication, which is provided through a number of organizations, including WHO.

According to WHO, TB treatment in all of Cameroon is implemented in accordance with Directly Observed Treatment, Short course, the strategy used to ensure patients complete their full regimen of medication. But Dr. McArthur expressed concern about the extent of the DOTS follow-up and worries about the emergence of drug-resistant TB in the country.

She is currently writing a grant application, hoping to secure funding from National Institutes of Health for infrastructure and capacity building in Cameroon; if she’s successful, that could make a world of difference.

“Instead of having two nurses, we’ll have ten,” she said. “And then we’ll be able to send a guy on a motorbike to follow up on patients to check that they take their TB drugs.We will also obtain more information on TB of value to TB patients in the US.”

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