Baylor pediatric HIV/AIDS program impacting access to care, treatment in Africa

By Glenna Picton

World AIDS was Dec. 1, and that gave Dr. Mark Kline, chair of pediatrics at Baylor College of Medicine and physician-in-chief at Texas Children's Hospital, the opportunity to reflect on the remarkable progress and impact of the program he developed to provide access to HIV/AIDS care, treatment and training resources in Africa.

The Baylor International Pediatric AIDS Initiative, led by Kline, established its first African children's HIV/AIDS care center in Botswana in 2002. At the time, there was not a single child in treatment in the country hardest hit by HIV/AIDS worldwide. Almost nine years later, the program has expanded to a broad network of clinics and satellite centers that blanket southern and east Africa and treat approximately 90,000 children.

Access to treatment

In the mid 1990s, the pediatric HIV/AIDS epidemic peaked in the United States, mostly because more pregnant women and children gained access to care and treatment. But that was not the case for the developing world, Kline said.

"Initially, there were so many questions about how children and families in these poor countries would benefit from treatment," said Kline. "Would children/families adhere to treatment? Would treatment be as effective? Could it be more toxic?"

Kline and his team believed children and adults in developing countries could benefit in the same way that children and families in the United States had from treatment with highly-active antiretroviral medications.

Pilot program in Romania

With support from the Abbott Fund, in 2001 BIPAI was able to establish a children's center in Romania, an area of Europe that accounted for most of its pediatric HIV/AIDS cases.

Over a four-month period, about 430 seriously ill or dying children were begun safely on antiretroviral treatment and began regaining their health.

"At the time, it was the largest number of children treated for HIV/AIDS anywhere in the world," said Kline. "This helped us document that children residing in poor countries could benefit from the same therapy we were giving to American children."

On to Africa

It was clear to the BIPAI team that there was a great need for similar programs in Africa. After the success of the Romanian clinic, the BIPAI team set their sights on Botswana, the epicenter of Africa's hardest hit region, with a 39 percent rate of HIV/AIDS among adults.

Funding from the Bristol-Myers Squibb Foundation enabled the BIPAI team to renovate two old store rooms to establish an HIV/AIDS care clinic and offer antiretroviral treatment.

"Pretty soon after that, we had 200 children in treatment," said Kline. "Now, we have approximately 4,000 children in treatment in the Baylor center in Botswana and it is one of the largest pediatric HIV/AIDS centers in the world."

As major new sources of funding became available, including the U.S. President's Emergency Plan for AIDS Relief or PEPFAR in 2003, BIPAI was able to grow on this initial impact.

Expansion of the network

Over the course of the decade, the BIPAI program has extended to establish clinics, and satellite centers, across southeastern Africa in Uganda, Tanzania, Malawi, Swaziland and Lesotho.

No matter how remote the area, children and their families have access to care. "We continue to work to establish satellite centers operated in conjunction with the main referral clinical centers," said Kline. "They are designed to provide local support and care for people with HIV/AIDS, wherever they live."

BIPAI set up programs that brought U.S. trained pediatricians and family physicians to care for children and their families, and work with local health care workers, governments and groups to set up training programs.

Kline says that programs to prevent mother-to-child transmission have dramatically reduced the number of infants born with HIV in many African settings, just as they have here in the U.S.

"We have resources in place that these communities didn't have in place before," said Kline. "Now, we are able to give medications to prevent transmission of HIV from the mother to child."

Continued growth

BIPAI will continue to grow in the future with a focus on expansion of global health programs and other diseases that play a role in global mortality rates.

Next year, BIPAI will open new clinics in Tanzania. They also hope to open one in Kenya in the future.

"The growth and expansion of this program has been made possible by many, many different people and groups, including our dedicated American and local faculty and staff, African partner governments, the United States government and major philanthropic groups such as the Bristol-Myers Squibb Foundation and the Abbott Fund," said Kline.

For more information on BIPAI, visit www.bayloraids.org.