Pediatricians travel to Africa, treat children with AIDS

December 2005

U.S. pediatricians are reaching out to lend a helping hand to those living with HIV and AIDS in Africa, particularly young children who are most severely affected by the deadly virus.

Approximately 1.9 million African children are living with HIV, but because there are few pediatricians and family practitioners, it is estimated that only 1% of them receive treatment. And while sub-Saharan Africa bears the greatest burden of the world’s AIDS cases, it barely accounts for 1% of the world’s health care workforce.

This is why the Pediatric AIDS Corps aims to expand access of HIV/AIDS treatment and care by sending pediatricians to regions of the world devastated by the epidemic and lacking necessary health care workers to care for patients, said Mark W. Kline, MD, director of the Baylor International Pediatric AIDS Initiative.

“In far too many places across Africa and around the developing world, children are being denied access to care and treatment that we know can save their lives; treatment that has been available here in the United States since the mid 1990s,” he said during a press conference at the TIME Global Health Summit in New York. “We hope to treat about 80,000 children for HIV over the five years the program exists.”

The Corps also addresses a major barrier to HIV/AIDS treatment; namely, the dearth of pediatric professionals experienced in treating pediatric HIV, administering antiretrovirals and monitoring for adverse events, according to Kline.

This announcement follows the release of a study, published in The New England Journal of Medicine, that shows the United States is a major contributor to Africa’s “brain drain” — a term used to describe the shortage of medical professionals in the developing world, an area desperately needing them.

Lead researcher Fitzhugh Mullan, MD, professor of pediatrics at George Washington University Medical Center and chair of the Institute of Medicine’s Committee on the Options for Overseas Placement of U.S. Health Professionals, discussed the study and said the Corps is an important solution to this problem.

“Training enough domestic physicians to meet the public’s need in wealthy nations is important to mitigate the brain drain from poor countries. But this will take time,” he said. “The most important immediate-term strategy for combating HIV disease and the brain drain in Africa is the mobilization of more U.S. health professionals to work abroad.”

How it evolved

The Pediatric AIDS Corps was developed through the work of the Baylor International Pediatric AIDS Initiative, which was started by the efforts of Kline.

It is created by a unique partnership between a corporate foundation and an academic health care institution. The Bristol-Myers Squibb Foundation funds $22 million of the endeavor and the Baylor College of Medicine funds $10 million.

“The Pediatric AIDS Corps is an outstanding example of choosing a focused area where an organization can have an impact. It’s also an example of the strength of collaboration; it represents academia, industry and government working together to address a public health issue. I think this should be and will be a model for the future,” said Peter Traber, MD, president and chief executive officer of Baylor College of Medicine.

This partnership has led to the development of the Children’s Clinical Center of Excellence, the world’s largest pediatric HIV clinical treatment center, which opened its doors in Botswana in 2003.

John Damonti, president of the Bristol-Myers Squibb Foundation, believes the corps is a crucial step toward greatly reducing the devastation of global pediatric AIDS, and noted that the children’s clinics are integral to the program.

“We realize that the Corps is a short-term solution to treatment for children in Africa, but it is an important bridge until local capacity can be developed. So working with our partners at Baylor, we are creating not only a cadre of highly skilled children’s doctors who will ‘treat and train,’ but also a network of children’s clinics to provide the physical infrastructure so critical to the long-term successful treatment of children with HIV/AIDS and their families,” he said.

Lending a hand

Since announcement of the Pediatric AIDS Corps in June, the response from American health professionals has been dramatic. So far, the corps has recruited 31 physicians in just over three months, according to Kline. Most are young doctors just completing training in pediatrics, medicine/pediatrics, family practice or pediatric infectious diseases.

“I am especially pleased by the high caliber of the corps members. They are a rare group of community-minded physicians who are truly following their hearts. In the end, medicine is all about compassion, and this is compassion at its very best,” Kline said.

Kebba Jobarteh, MD, is one member of the first wave of physicians to participate with this new humanitarian team. Born in Kenya and raised in New York City, he immediately knew the Corps was something he wanted to be a part of. The Yale- and Harvard-educated physician recently returned from the Botswana-Baylor Children’s Clinical Center of Excellence, which has more than 1,400 children in treatment – the largest concentration of children with HIV in care in any center worldwide.

“The AIDS corps is an incredible opportunity to treat children infected with HIV in those nations most heavily affected by the pandemic. The joint mission of treating kids and training local health care workers to care for the children is that I have been working towards for all of these years.”

Corps member Laura Guderian, MD, of New York City, will be going to Botswana in July 2006. She trained in internal medicine at the Albert Einstein College of Medicine in New York City, and her initial encounter with the devastating effects of HIV was as an undergraduate volunteer for Community Hospice of Louisiana.

“During my three years providing respite care for hospice patients, I witnessed overwhelming tragedy and loss endured by individuals and families as a result of AIDS,” she said. “I saw in them incredible strength and courage in the face of suffering and death. The experience inspired me to devote my career to improving the lives of those living with HIV and AIDS.”

A complete list of physicians accepted to the Corps can be found at www.bayloraids.org.

How to get involved

Over the next five years, the program will recruit approximately 250 pediatricians and family practitioners to assist in the rapid scale-up of HIV/AIDS care and treatment.

“We need a coalition of the willing to bring more pediatricians to Africa to help treat and to train,” Damonti added at the conference. “We know that others share our beliefs that HIV/AIDS doesn’t have to be a death sentence to many of Africa’s children.”

The initiative is currently recruiting 50 board-eligible or board-certified pediatricians and family practitioners for placement in six countries in Africa where it has constructed or is constructing Children’s Clinical Centers of Excellence. These countries include Botswana, Burkina Faso, Lesotho, Malawi, Swaziland and Uganda, the countries hardest hit by the HIV/AIDS epidemic, according to Damonti.

The corps asks participants to commit to a minimum one-year assignment to a primary health care setting affiliated with the Children’s Clinical Centers of Excellence. Every participating health professional will remain linked to one of the centers for professional development and training, continuing education and professional consultation.

Participants will provide full-time primary and HIV/AIDS specialty care and treatment in collaboration with local health professionals. Corps members will also participate in training activities of the children’s centers to build local capacity for pediatric, family primary and HIV/AIDS specialty care and treatment.

Participants will receive an annual living stipend of $40,000, plus benefits, and provision for housing allowance. Student loan debt relief is also available on a sliding scale.

Interested applicants are urged to send a current curriculum vita, the names and contact information of three references and a narrative statement describing your short- and long-term career goals to Meg Ferris, PhD, MPH, at mferris@bcm.edu.

For more information:

• Mullan F. The metrics of the physician brain drain. N Engl J Med. 2005;353:1810-1818.
• For additional information about the Baylor International Pediatric AIDS Initiative and Pediatric AIDS Corps, visit www.bayloraids.org.