Nothing to be done

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• Nothing to be done
• (Samuel Beckett)

M Saag, NEJM 1994 (330) 706-7
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Mortality rate per 100 patient yearsProportion
of the cohort prescribed HAART each quartile
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We have failed to translate our scientific
progress into action where it is most needed in
the communities of the poorest regions of the
world.
Nelson Mandela, Paris, 2003
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Maslow Hierarchy of Needs
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Reasons for Treating

• Economic
• Social stability
• National security
• Humanitarian

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The Impact of HIV/AIDS on Industries
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Reasons for treating

• Economic
• Social stability
• National security
• Humanitarian

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• Re-imagine

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• The Director-General of the WHO, Dr Lee Jong-Wook
  we need to change the way we think and act
  and that business as usual will not work as
  business as usual means watching thousands of
  people die everyday

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CARE
Cohort programme to evaluate Access to
anti- Retroviral therapy and Education

• PE PK substudies

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Study sites

• Dakar, Senegal

• Nairobi, Kenya

• Abidjan, Côte dIvoire

• Kampala, Uganda

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Percentage of patients with virologic success
(pVL lt 400 c/ml) over time (OT)
100.0
90.0
80.0
70.0
60.0
of patients
50.0
40.0
Abidjan
30.0
Dakar
20.0
Kampala
Nairobi
10.0
0.0
0
12
24
36
48
60
72
84
96
Week
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Mean CD4 cell count over time
500
450
400
350
Mean CD4 cell count (10e6/L)
300
250
200
150
100
0
12
24
36
48
60
72
84
96
Week
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Paradigm Shift

• Deny
• Threaten
• Embrace

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Challenges
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Funding

• Countries
• Philanthropists
• Research Agencies

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Challenges
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ID training institute, Makerere

• Start up Funding Pfizer

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Challenges
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The Mystery of Capital(Why Capitalism Triumphs
in the West and Fails Everywhere Else)

• Hernando De Soto, 2000

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Obstacles to Legality

• Small garment workshop in Lima, Peru
• Legally!
• Team of 4 one person enterprise
• 6 hours a day
• 289 days
• Cost - 1,231
• 31 months X minimum monthly wage

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Obstacles to Legality
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Uganda

• Population 28 million
• Age 15 - 45 2.8-6.6
• To Treat 114,000
• 3 x 5 Target gt 60,000

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Issues

• Election
• Global Fund
• European Aid

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ARV-ACT Drug Interactions
ARV
ACT
CYP 450
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Harmonisation

• Donor Agencies

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Challenges
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The Village of 100 People

• 80 living in substandard housing
• 70 unable to read
• 50 suffering from malnutrition
• 1 would have a college education
• 1 would own a computer

P. Harter K. Wilber A. Robbins
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Styles of Verbal Communication
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Time HorizonsPast, Present and Future
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Nelfinavir plasma concentration profiles
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Stockholm Challenge and Ethiopia
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Uganda Coverage

• uganda coverage

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Clinical History

• 30 year old man
• HIV and TB co-infected
• CD4 5
• Rx ERHZ plus Triomune 30

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Clinical History

• Headache, weight loss, loss of balance
• Ddx ?

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Clinical History

• Dx Hunger and Dehydration
• Rx ? Free analgesia for headache
• Caution Avoid acetaminophen/paracetemol
• Rx Ibuprofen take with food.

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Clinical History

• Dx Hunger and Dehydration
• Rx ? Free analgesia for headache
• Caution Avoid acetaminophen/paracetemol
• Rx Ibuprofen take with food.

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Maslow Hierarchy of Needs
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Unprecedented Opportunity

• HIV, TB and Malaria
• NID
• Poverty Reduction

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Paradigm Shift

• Deny
• Threaten
• Embrace