A Day in the Life...

Instead of another adventure story or Saturday trip, I thought I’d share a little about the work I’ve been doing in Moshi. My days are spent at the Kilimanjaro Christian Medical Centre, one of 4 regional referral hospitals in Tanzania and the home of the Duke-KCMC collaboration. There are lots of studies going on in the Duke group – at least 12 – and all the major funders of HIV research are represented, from CHAVI (the international consortium working on an HIV vaccine) to the Elizabeth Glaser Pediatric AIDS Foundation and the NIH.

I’m working on two studies in particular, one in children and one in adults. In the pediatrics study we are trying to develop affordable predictors for when a child’s antiretroviral medications stop working and the virus begins to take over again. In the US, this so-called virologic failure is determined by a complicated (and expensive!) method that measures the number of virus particles in the bloodstream. Technology and resources are not to the point of being able to use that method widely in Africa, however. Virologic failure is a major problem here, because the longer patients are in failure, the more likely they will develop resistance and fail the only second line regimen currently available in Tanzania. Through this study we are hoping to find a combination of affordable lab tests that could be used to predict when patients begin to fail their regimens.

The second study I’m working on is called Coping, Health, and Treatment in Tanzania (CHAT) and is examining a lot of psychosocial factors that go into HIV care and prognosis. It’s a long-term study that will run over the next 5 years and involves multiple sites in addition to KCMC.

These days I spend most of my time in the KCMC family care clinic, where HIV+ parents and children come monthly for their HIV primary care. I help guide the patients and their families through the rather tedious process of being enrolled in the study, making sure they have met with the office staff, nurses, social worker, doctor, and lab technician. Afterwards I review the charts for past lab results and other necessary information. Now that I have finished Swahili School and my language skills are improving, I am hopeful that I will be begin to take an even more active role with the children and their parents during the enrollment process.

In the spring I will spend more time at the other sites for CHAT, including the mobile voluntary counseling and testing units that offer HIV testing in rural villages surrounding Moshi. I will also have the opportunity to help enroll patients in CHAT at Mawenzi Hospital, the public hospital in Moshi that lacks many of the resources found at KCMC.

Through these two studies I have been exposed to all aspects of HIV care, from the initial diagnosis to routine follow-up and end of life treatment. I have learned a lot about how the illness affects families here, both medically and socially. There is still significant stigma associated with HIV, but seeing the grace with which these families handle their situations has been inspiring.