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JANUARY / FEBRUARY 2003

FEATURES

First WHARF program in India gives training in AIDS care, prevention


A participant in the WHARF training program speaks during a group discussion.

The incidence of HIV and AIDS is on the rise in Asia, and the CIA estimates that India will have the largest population of infected people by 2010. This narrow window of opportunity to curb the epidemic is making prevention efforts even more critical. At the same time, India is the leading producer of generic antiretroviral medications; antiretroviral triple-therapy, while still out of reach for most people, is now available in a single pill for less than a dollar a day, and can be purchased over the counter. On one hand this is good news, but it raises concerns that infected people will follow incomplete regimens, leading to higher rates of resistance.

HMI, in conjunction with Wockhardt, Ltd., of Mumbai, India, is leading a series of free educational programs on HIV/AIDS that they hope will target a key population: health care providers. By training primary care physicians and other frontline providers in HIV/AIDS treatment and prevention, they hope to help build the capacity of medical providers to diagnose and treat HIV-related conditions and educate patients about the disease.

The initiative has been spearheaded by Dr. Harvey Makadon, Harvard Medical School associate professor of medicine at Beth Israel Deaconess Medical Center and director of health systems at HMI, and funded in part by a grant from the Horace Goldsmith Foundation. Wockhardt, a pharmaceutical company that has been working with HMI to develop its hospital network in Mumbai, agreed to join HMI in forming a nongovernmental organization called WHARF (Wockhardt-Harvard Medical International HIV/AIDS Education Foundation) to develop educational programs that would make an impact on HIV/AIDS in their region. WHARF has been working with dozens of organizations in Mumbai, including hospitals and governmental agencies.

Dr. Raymond Powrie receives a welcome gift at the Sion Hospital symposium.

The first program was held Dec. 4-7, and kicked off with a symposium at Sion Hospital, a municipal hospital that serves as a magnet for HIV education in Mumbai. A second symposium was held Dec. 7 at Nair Hospital; both featured talks on primary care for people living with HIV/AIDS and mother-to-child transmission of the infection.

The training program, which took place Dec. 5-6, featured presentations on a host of topics related to the science and epidemiology of HIV-related disease, counseling and testing, and the basics of antiretroviral therapy. “We’ve learned that talking about care is very linked to talking about prevention,” Makadon said. Even if health care providers are not in the position to offer therapies, they should feel comfortable discussing with patients the causes of infection and means of prevention, and counseling patients who have HIV-related conditions. “Hopefully we can make this a topic discussed more freely,” said Makadon.

Sessions were led by 12 faculty members from Mumbai and four from the U.S: Dr. John Fuller, assistant director of the Adult Clinical AIDS Program at Boston Medical Center; Dr. Howard Libman, director of HIV medical services at Healthcare Associates, Beth Israel Deaconess Medical Center; Dr. Raymond O. Powrie, director of the Fellowship Program in Obstetric Medicine, Women & Infants Hospital in Providence, Rhode Island; and Makadon. Powrie said the program “was an important opportunity to exchange ideas and gain such an understanding of what it means to confront HIV for providers [in India], where even getting gloves to practice universal precautions can be a struggle."

The 42 participants—16 physicians, 13 nurses, and 13 counselors—worked together in case discussions and role-playing to explore critical issues in caring for people with HIV/ AIDS, prevention counseling, and HIV testing. Dr. Hema Jerajani, professor and chief of dermatology at Sion Hospital and one of the participants, said the session was “a wonderful program that got a multidisciplinary group to learn and work together…to improve care of people with HIV in Mumbai.”

Participants interact in a session of the WHARF training program.

“This seminar got me thinking,” said one workshop participant. “We keep complaining about our lack of resources, lack of facilities. What we really need to ask ourselves is are we using our ‘meager resources,’ as it were, to the fullest?”

The training program aims to maximize its value and scope through a faculty development or “train the trainer” approach. Over the next three months, these participants will receive mentorship and resources so that they can fulfill a commitment to train at least five colleagues using materials they receive. In February, a follow-up session during a visit to India by Harvard Medical School dean Joseph Martin will allow them to report back on their progress, after which they will receive a certificate from HMI.

WHARF is currently working with the Mumbai District AIDS Control Society (MDACS) to plan further work in implementing guidelines and targeting high-risk communities; it will also hold a second faculty development session this spring. HMI is also working to develop a similar program in China, in conjunction with the New England Journal of Medicine and the China Medical Tribune, scheduled to start in April 2003.