Medical Advocates for Social Justice
Conference Abstract
from the
4th International Workshop on the Clinical Pharmacology
of HIV Therapy

Cannes, France  March 27-29, 2003
 

 

Transitioning an Established Antiretroviral Adherence-Pharmacology Unit to Developing Countries.

C. Maponga, M Simoyi, L Esch, L. Catanzaro, RG Hewitt,
RC Reichman, GD Morse.

University of Zimbabwe (UZ), Harare, Zimbabwe, Chitungwiza City Health
Department, Chitungwiza, Zimbabwe, University at Buffalo (UB) School
of Pharmacy and Pharmaceutical Sciences, SUNY, Buffalo, New York, Erie
County Medical Center, University of Rochester Medical Center (URMC),
Rochester, NY, and Adult AIDS Clinical Trials Group (AACTG), DAIDS,
NIAID, Bethesda, Maryland.
 

  

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Background:
The global HIV epidemic demands that methods to facilitate the transfer of information from wealthy nations to poor nations are developed. To begin this process in the area of antiretroviral clinical pharmacology, the AACTG established a fellowship program between UB and the University of Zimbabwe.

Methods: 
A visiting fellow, from Zimbabwe, is developing a collaboration over a two-year period between the UB HIV Adherence-Pharmacology Unit in Buffalo, NY and Harare, Zimbabwe. The fellow employs sequential visits between Zimbabwe and the USA to facilitate learning within an already established program at UB and adapt them to fit the needs in Zimbabwe. The program includes: didactic training, clinical training in an HIV adherence/pharmacology unit,  laboratory methods training to measure antiretrovirals, the use of a web-based HIV ePharmacotherapy Network (www.hiv.buffalo.edu), and establishing a global editorial board to represent the varying needs of countries with regard to obtaining and utilizing antiretrovirals
ARVs.

Results:
A memorandum of understanding between the collaborating institutions was developed to define the specific areas of collaboration. The fellow has made two visits to Zimbabwe to implement the Adherence-Pharmacology Clinic in support of ongoing clinical research. Important areas of contrasting needs have been identified. For example, in the USA one research focus is on maximizing therapeutic outcomes in individual patients using resistance tests and therapeutic drug monitoring (TDM), while in Zimbabwe obtaining access to ARVs and prophylactic medications are paramount. Also, the issue of counterfeit antiretrovirals requires that drug testing be done on a routine basis to ensure that medications contain appropriate active ingredients.  Funding requests have been developed for a clinical pharmacology laboratory to purchase analytical equipment, computers and technical support.

Conclusion:
The use of an established Adherence-Pharmacology Unit in the USA that is familiar with drug procurement, medication adherence assessment, selection of antiretroviral regimens and methods for managing HIV-infected patients during chronic therapy has allowed for the rapid implementation of this initiative. Training approaches are being developed utilizing web-based training tutorials to complement visits between countries by applying "telepharmacology" approaches to optimize program development.
 
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