Researchers creating model of HIV care for developing nations

December 21, 2009

(PhysOrg.com) -- Expanding Michigan State University's global health outreach, a team of researchers is working in the Dominican Republic to establish a model for HIV/AIDS care that can be exported to other resource-limited countries.

The team, led by Reza Nassiri, the director of MSU's Institute of International Health, is treating patients and educating doctors at the Santo Domingo / clinic.

"By focusing on clinical work and educational outreach, we have the opportunity to dramatically raise the standard of care in the Dominican Republic," said Nassiri, who has been researching HIV/AIDS for more than two decades and seeks to make MSU a global center for HIV education and clinical care. "We hope to replicate our work in the Dominican and create a new model that can be taken to other countries with limited health care resources."

That work includes expanding HIV/AIDS treatments and ensuring they are as effective as possible, said Peter Gulick, an associate professor of internal medicine in MSU's College of Osteopathic Medicine.

"The testing procedures in the Dominican Republic are actually quite good," Gulick said. "The problem is that drug treatments are based on outdated methods, and if medications are not being used properly many patients develop . You cannot begin treatment based solely on physical diagnosis."

For example, poor treatment methods lead directly to problems such as the inability to prevent mother-to-infant transmission. Also, diseases such as tuberculosis are rampant and cause many complications and fatalities among those afflicted with HIV/AIDS.

Tackling those issues and raising the standard of care from a clinical point of view involves establishing viral loads for HIV patients, measuring resistance to medications and working with Dominican physicians to guide more effective treatments, Gulick said.

Nassiri and his team selected the Dominican Republic for the initiative due to past medical relationships between Nassiri and the HIV clinic there as well as the fact HIV/AIDS has become the leading cause of death among teenagers and adults between 15 and 49 years of age.

Others involved in the partnership from MSU include Walid Khalife, director of the Molecular Diagnostic Laboratory at Lansing's Sparrow Hospital, and Linda Williams, a clinical nurse investigator in the College of Osteopathic Medicine. A team of four physicians from the HIV/AIDS clinic in Santo Domingo - led by director Ellen Koenig - are working closely with MSU physicians, and some have come to East Lansing for training.

"We need to build relationships to secure the expertise and financial backing we need," said Nassiri, whose team has been funded thus far by the College of Osteopathic Medicine and is seeking funds from the National Institutes of Health.

In addition, Gulick is negotiating with pharmaceutical firm Abbott Labs to donate HIV diagnostic kits to be used in areas of the Dominican Republic where HIV/AIDS prevalence is high. Nassiri said he is asking the partners there to develop a proposal as to how the kits can best be used. He also is seeking multidisciplinary collaborators from across campus in order to further strengthen the relationship between MSU and the clinic in Santo Domingo.

MSU will be sending its medical delegation back to the Dominican Republic in spring 2010. Also, Khalife soon will be hosting a physician from the Dominican team for training in HIV molecular diagnostics.

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