April 28, 2003

Health Center Doctor Works
With Ugandan Physicians On AIDS
By Kristina Goodnough

here are few bright spots in the AIDS epidemic affecting Africa. But Dr. Kevin Dieckhaus was able to participate in one recently. He spent a month teaching AIDS medicine to physicians in Uganda, one of the few countries in Africa making progress in its battle against the virus.

Through the Academic Alliance for AIDS Care & Prevention in Africa and the Infectious Diseases Society of America, Dieckhaus and another physician from the University of Minnesota spent a month training a dozen African physicians about medical care for patients with AIDS, now the leading cause of death on the African continent.

The course provided a comprehensive curriculum, including basic science, clinical management, computer and Internet skills, laboratory testing, and the application of this knowledge in limited-resource settings.

"The education component is the first part of a project undertaken by the Academic Alliance that also includes building a large-scale state-of-the-art clinic, laboratory, and medical training center for HIV/AIDS in Kampala," says Dieckhaus, who specializes in infectious diseases and AIDS at the Health Center.

"We were there because sub-Saharan Africa is going to experience increased funding for AIDS medicines and services over the next few years," he says. "Physicians there need to be armed with the latest information on how to best use those limited resources."

Dieckhaus says his efforts to provide clinical care and convey knowledge about the complex treatment regimens needed to treat AIDS in a country where "even providing a glass of clean water often requires more infrastructure than is available" were overwhelming at times. "The concern is to make sure whatever help you provide is sustainable," he says. "Intermittent treatment for AIDS can make the virus resistant to treatment so you don't want to start people on treatment they cannot continue."

Although medication costs are considerably lower in Uganda than in this country, price remains a huge obstacle to treatment, Dieckhaus says. Even the least expensive medication costs $30 per month, he notes. With most Ugandans living on less than $1 per day, they must make a choice between medication and food.

Employers are beginning to help pay for medication, however. "So many of those who are ill are in their prime working years that companies are beginning to understand it makes good economic sense to care for them, so they can preserve their work force for a few more years," he says.

The training program took place at Makerere University and other clinical sites in Kampala. "The university has a 700-bed hospital that is full to overflowing, and 70 percent of all patients admitted are infected with HIV," says Dieckhaus.

About a dozen African physicians participate in each month-long training program provided by the Academic Alliance. To date, over 90 physicians have been trained.

"Selection into the program is highly competitive," says Dieckhaus. "Most physicians in Sub-Saharan Africa are general medical officers without specialty training and they are treating a population where one out of five to eight people is infected with HIV."

Unlike in other African countries, in Uganda there has been a steady decline in the prevalence of the disease since it peaked there in 1992. Still, of the 1.1 million people in Uganda living with HIV, only 9,000 are on antiretroviral regimens.

"It's a huge problem, but Uganda is starting to get some of the resources it needs to begin to deal with the problem," Dieckhaus says. "In that respect, the country is a model for the rest of Africa."