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Sometimes a child’s simple words can capture the heart of a complex issue. "I was made from my Mom and I am very happy.” This beautiful nursery rhyme was written by Gianni Rodari, a child in Africa born HIV-free and healthy from a mother that was HIV positive. The reason Gianni was born healthy and happy, along with 20,0001 other children and counting, is the Drug Resource Enhancement against AIDS and Malnutrition program, or DREAM.
Launched in February 2002, The DREAM program began in Mozambique and has expanded to ten African countries where treatment centers and molecular biology laboratories have been established. Some laboratories also specialize in the treatment of children. With the devastating effect of the HIV/AIDS epidemic across parts of Africa, the DREAM program is a clear example of the tremendous impact that molecular diagnostics can have in emerging markets.
Results That Save Lives
“When we first started, the idea of providing access to this kind of molecular diagnostic technology and patient monitoring programs in many of these rural African areas was thought to be crazy,” says Dr. Giovanni Guidotti, General Secretary of Foundation DREAM. “But the results speak for themselves. We’ve helped to significantly reduce mortality from HIV/AIDS in ten countries. And the results among HIV positive mothers are wonderful. We’ve succeeded in reducing the transmission of the disease from mother to child to less than two percent. And we think it’s realistic to get that to zero for a future generation of HIV/AIDS-free children.”
One of the major causes of maternal mortality in emerging markets is HIV infection, responsible for 20-50% of maternal deaths in countries with a high prevalence of infection. Every year in Africa, approximately 1.4 million pregnancies occur in HIV-infected women, and 30-40% of the children born to these women will become infected without intervention1.
The DREAM Program has targeted this group with outstanding success. Testing and treatment programs implemented by DREAM have resulted in:
• A reduction of mother-to-child transmission of HIV infection to below 2%
• A decrease of maternal mortality by 70%
• Maternal mortality rates significantly lower than the general population—only 1.2%
In addition to the result of targeting HIV-infected women, 1,500,00,000 people have been positively impacted by DREAM’s various health programs through the years.
The Role of Viral Load Testing
The fulcrum of the DREAM Program is the administration of antiretroviral drugs and continued nursing care to women during pregnancy, and in the period following the child’s birth. Proper sample collections, HIV viral load testing and CD4 cell counts conducted in molecular diagnostics labs play a significant part in the success of the treatment initially, as well as over time. The goal of providing ART is to suppress HIV to undetectable levels for life. Viral suppression reduces illness, death, the development of drug resistance and the spread of new infections. When HIV is undetectable, it means the virus isn’t replicating and people can live healthy, productive lives.
Viral load (VL) monitoring is the optimal tool to determine if treatment is working and has long been the standard of care for treatment monitoring in wealthy countries. HIV treatment, once started, must be taken for life. Routine treatment monitoring is necessary to ensure that a person’s ART regimen continues to be effective. If treatment stops working, people become sick and the risk of drug resistance and transmission is increased. The first sign that a patient is no longer under optimal treatment is a detectable viral load. So the best and earliest signal that a clinical intervention is needed is the viral load measurement.
As of May, 2013, the DREAM laboratories in African have performed 398,000 viral load tests and provided antiretroviral therapy to 90,700 patients, including 10,000 children. The results have been reduced complications of HIV disease, slower progression from HIV infection to AIDS, and the prolonging of life.
“We are able to accurately collect Dried Blood Spot (DBS) samples, even from very rural areas in Malawi, for example,” says Dr. Guidotti. “The 20 clinical laboratories running viral load testing have clearly helped to reduce mortality rates by a factor of more than ten times. Among HIV-positive mothers, the results in reduced transmission to their child are just incredible. This proves that access to this technology in Africa can help curve the HIV/AIDS epidemic.”
Real Challenges and Real People
For those looking to establish molecular diagnostics labs in emerging market countries, the experience and subsequent success of DREAM should be inspiring. But, as is usually the case in emerging markets, Dr. Guidotti faced funding obstacles when he and his team set out to build the first lab in Mozambique.
“When we approached potential donors, our main focus was to make the case that it was better to spend money in the beginning on proper lab technology, prevention, monitoring and patient care, rather than the additional millions that would be needed to care for HIV/AIDS infected patients without intervention,” says Dr. Guidotti. “We also had to convince them that viral load testing had great value, and that, with the right technology, it could be cost-effective. We also made the case that it was the right thing to do, to provide African patients access to the same level of care as Western society.”
“Finally, it was important for us to demonstrate that we can make a big difference and a better world, and to show the faces of the people and children that would be impacted. We spent a great deal of time writing and publishing testimonials and case studies, showing donors how their contribution could save real lives.”
One of those real and young lives is Gianni Rodari, who may have been infected by HIV had it not been for DREAM’s intervention. Fortunately, with the help of the DREAM program and the use of molecular diagnostics, he is HIV/AIDS-free. As his nursery rhyme portends, Gianni can now look forward to the promise of a healthy and “happy” life.