COL Nelson Michael, M'D', Ph'D' Walter Reed Army Institute of Research

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Linkage to HIV Care and Treatment via Clinical
Research--the USMHRP Approach

• COL Nelson Michael, M.D., Ph.D.Walter Reed Army
  Institute of Research
• U.S.Military HIV Research Program
• 20 June 2008
• Global Campaign for Microbicides

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Outline

• HIV and the military
• Background and approach
• Worldwide network
• Research studies
• Care and treatment

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HIV - A Worldwide Threat

• HIV disproportionately affects the most
  productive age strata of society in the
  developing world.
• This leads to destruction of individuals,
  families, communities and political institutions.
• The impact of HIV/AIDS adds to burdens of
  poverty, disease, and conflict to erode regional
  stability.
• HIV/AIDS is a threat to deployed US military,
  peacekeepers, and aid workers.

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HIV Threatens World Security
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HIV/AIDS is a US National Security Threat

• Goals
• Defuse regional conflicts
• Prevent enemies from using WMD
• Support global economic growth
• Reduce the toll of HIV/AIDS and other infectious
  diseases
• Transform the US military for the 21st century

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Background and Mission

• In 1986, USMHRP was initiated as a result of US
  Congressional directive
• Mission
• Develop a GLOBALLY effective HIV-1 vaccine
• Targeted HIV-1 genotype and epidemiologic
  surveillance to guide vaccine development
• Evaluation and implementation of disease
  prevention modalities through clinical research
  at the Military Treatment Facilities
• USMHRP support of the Presidents Emergency Plan
  for AIDS Relief

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USMHRP

• Walter Reed Army Institute of Research
• State of the art vaccine research and development
  facility in Rockville, MD
• Five international vaccine development sites
• Twenty international surveillance sites
• Seven military medical center treatment
  facilities (MTFs)

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USMHRP Worldwide Network

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Philosophy of USMHRP

• integrate prevention and care and treatment
  into all research program activities
• A credible prevention program must accompany any
  vaccine research study
• HIV care for vaccine participants is an
  international standard
• General standards of medical care must be
  adequate to
• provide parity compared to HIV care
• distinguish product related adverse events from
  disease
• In resource poor settings, medical benefits
  (including care for HIV) should be available to
  the community to avoid coercive inducement to
  volunteer
• Development of local capacity to execute and
  manage programs/services is critical to ensure
  sustainability

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Integrating Research and Prevention, Care and
Treatment
Research
Health Care Prevention Treatment
Community Family
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Sustainable Approach

• Maintain a low level of US technical staff
• Empower local leadership in determining course
  and approach to expansion.
• Expand clinic staff based on capacity of partner
  to absorb positions into annual budgets.

• Build upon existing systems and functional
  mechanisms.
• Develop ongoing training capacity as part of the
  partner portfolio.
• Strengthen logistic infrastructure and capacity
  of counterparts.

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Impact

• Trained over 2,200 individuals in ART and 1,300
  in palliative care.
• Improved HIV clinic, CT, ANC, lab, TB clinic and
  delivery ward infrastructure.
• Integrated HIV treatment and prevention into
  general medical education in the realms of
  internal medicine, pediatrics an.

• Improved lab and pharmacy services and capacity
  in stock management and forecasting.
• Enhanced patient data collection and usage.
• Stronger linkages between/among community
  programs and clinical services
• Kenya LWHC, Samoei, Kericho Youth Center
• Nigeria Barracks HIV/AIDS Committees, local NGOs
• Tanzania Networking of NGOs, womens barracks
  groups
• Uganda CAI, Kayunga Youth Center

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Capacity Developed
As of March 31st, 2008
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Current ART by Country (gt41K)
Total Number of Clients
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HISIS - HIV prevalence incidence
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The Way Forward

• Expand services to lower level facilities and
  address HR/task shifting.
• Continue to transition technical capacity to
  partners and move towards more of a management
  role.
• Improve local partners capacity to evaluate their
  own services focusing on improving quality.
• Expand upon PHE opportunities and research
  experience to work with partners to
• Evaluate best methods of service delivery and how
  to expand.
• Address aspects of long term treatment and
  treatment failure.

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Summary

• USMHRP is dedicated to the development of a
  globally effective HIV vaccine relying on
  discovery, NHP, and clinical trials.
• USMHRP executes clinical research in seamless
  integration with prevention, care, and treatment
  programs.
• USMHRP works in multilateral partnership with
  global HIV prevention and care stakeholders.