December 10, 2012
By Aubrey Bittel
|Sarah Kessler, Ph.D., MPH|
Few global health issues are more urgent or devastating than the toll of HIV and AIDS in Africa. Sub-Saharan Africa has 10 percent of the world's population but is home to 70 percent of people living with HIV and AIDS. And according to the UNAIDS Report on the Global AIDS Epidemic, 72 percent of those who died from AIDS and its complications in 2010 lived in Africa.
Sarah Kessler, Ph.D., MPH, an assistant professor in KU Medical Center's Department of Family Medicine's research division, is committed to helping slow the spread of HIV, particularly in Africa, by decreasing the number of infants born with the disease.
Kessler, who has spent time researching HIV in the United States, Kenya, and Uganda, says that understanding the culture is key to helping any community combat the disease. For example, in some Kenyan and Ugandan communities all women are expected to bear children at some point.
"That's part of their culture," Dr. Kessler says. "It's unheard of for a woman to choose not to have children, and that mindset often doesn't change if the woman or her husband is HIV positive."
Kessler, who recently received a grant to provide Ugandans with safer childbearing techniques, advises men and women how they can reduce the risk of spreading the virus to their babies.
"It's possible to significantly reduce the risk of the child contracting the virus with treatment. If the medication is taken regularly, there's less than a 1 percent chance that HIV-positive parents will have an HIV-positive baby."
If an infant does test positive for the disease, he or she is not necessarily doomed to a short and painful life. The mortality rate of HIV-positive infants decreases by 76 percent when they begin treatment by 12 weeks of age. Problems begin when obstacles arise between children and treatment, and this is where Kessler sees potential for improvement. She is currently working with Brad Gautney, president of Global Health Innovations and founder of the HIV Infant Tracking System, (HITSystem) to improve communication between laboratories, health care providers and patients. Currently piloted in four hospitals in Kenya, the HITSystem moves patients' medical records from volumes of manually entered information to an online infrastructure.
"The current system for many hospitals is a very large notebook," Kessler explains. "Pages will be missing, there are stains, it's all hand-written, and it's very difficult to read it."
The HITSystem allows health care providers to enter a patient's history directly into the online database. Vital information such as whether the mother took antiretroviral drugs during pregnancy is now available not only to the health care providers, but also to the lab technicians who will be testing the child's blood samples for the disease. Currently, these samples and the test results are physically transported from the health care provider to the laboratory and back, and it is common for them to be misplaced in transit. With the HITSystem, lab workers enter results electronically, and providers immediately see them. Mothers concerned about their babies' HIV status no longer need to worry that they will not receive results. The providers have them as soon as they are entered. Additionally, the HITSystem includes an alert if information is not entered when necessary.
"We allow the laboratory 10 days with a sample," Kessler says. "If we don't get that result posted, they get an alert and know they need to resolve that."
Another aspect of the HITSystem in the Kenyan pilot study is direct communication with the child's family. Kessler and her colleagues have found that maintaining contact with the mother improves the chances they will return for follow-up care. The most effective form of communication usually depends on economic conditions. In the country's urban areas, where two of the pilot's studies are located, 97 percent of the mothers involved in the study have access to cell phones. In those areas, texting has proved an effective tool to alert mothers of upcoming test results or medical appointments. In the other two hospitals, which are located in more rural areas, only 63 percent of the patients reported having access to cell phones. In those areas it has been necessary for health care officials to make trips to different communities to deliver medical information. Luckily, the HITSystem also makes it easier to track patients' locations, enabling officials to successfully reach more people.
Kessler has recently helped submit an National Institutes of Health research project grant to expand the HITSystem to Malawi, one of the African countries most affected by HIV/AIDS. It is also a much more agriculturally focused and rural country. Cell phones are extremely uncommon. This poses an even bigger challenge, but Kessler is excited about the challenge.
"Malawi is where this program could have a really big impact,"she says. "There are so many HIV-positive babies that are not getting linked to care.."
You can learn more about the HITSSystem, or make a charitable donation by visiting http://globalhealthinnovations.org/.