Director of The Center for Global Health Policy Christine Lubinski is blogging today from South Africa. She and other Center staff are touring South Africa and Zambia this week and hosting five congressional staff on visits to U.S. government funded programs to address HIV and TB.
Glenda Gray, a pediatrician who began her work in what may be the largest hospital in the world—the Chris Hani Baragwanath Hospital in Johannesburg—worked to evolve her practice and her mission as the HIV epidemic evolved. During the late ‘80s and early ‘90s, HIV infection dominated the hospital admissions. Dr. Gray quickly realized that the most effective way to reduce the number of pediatric infections was to intervene with the mothers.
This realization contributed to a reduction in perinatal HIV infection among the children served by the program, who primarily come from the slums of neighboring Soweto, from 20 to 5 percent. There are 1 million births annually in South Africa, and one-quarter of those births are by HIV positive women.
Today Gray’s program provides a range of services to some of the poorest citizens in the country, including early infant diagnosis of HIV infection, which requires a test that costs roughly $100 because of the complex technology. This technology is life saving because infants who are not diagnosed promptly have a high risk of dying before they reach two years of age. In Gray’s program, mothers can receive their own antiretroviral therapy (ART) at the same location where their children receive care.
Today, Gray’s program continues early diagnosis in infants, provides ART to adults and children , provides TB services to persons with HIV that do not currently qualify for HIV treatment, and a variety of clinical trials including critical testing of ARTs and topical microbicides aimed at preventing HIV acquisition. Program workers are poised to implement male circumcision and are working to explore neonatal circumcision. They are also seeking funding for a modified test and treat trial that would treat everyone identified proactively with a CD4 count below 350.
There are worries about the future among Gray and her staff. Today they provide ART treatment through funding from the President’s Emergency Plan for AIDS Relief (PEPFAR). Soon, they must begin a relatively rapid transition of their patients to government-run programs. They worry the public sector government programs are not prepared to offer the level and quality of care currently enjoyed by their patients. They worry, for example about the frequent drug stock-outs experienced by the public sector programs. Will their patients find their way to the government-funded clinics?
Too soon to tell, but Gray and her staff credit PEPFAR for saving a generation of young South Africans and hope that the United States will continue research and programmatic support to see their still young democracy through the worst pandemic in modern human history.