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Staff level hurts AIDS fight

Page 2 of 2 -- Many places, even entire countries, are still not ready to start programs. In the small West African nation of Guinea-Bissau, a shipment last month of Brazilian-made antiretroviral drugs arrived at the airport -- and there it sits, because the country does not have trained health workers to oversee distribution.

"That is incredibly striking," Dr. Mark Dybul, deputy chief of the President's Emergency Plan for AIDS Relief, or PEPFAR, said of the Guinea-Bissau situation. "It shows how important capacity is."

Around Africa, "drug-distribution systems are a massive, massive problem," Dybul said by telephone from Washington. "It's not just the supply chain, it's capacity overall. We're going from doubling, or tripling, the number of people on therapy, and the production capacity isn't there."

But Dybul also was forced to confront some bad news this month when he learned that manufacturers of two branded drugs currently purchased by the US program would soon have trouble meeting orders because of the increased demand. Officials from Bristol Myers Squibb, which produces stavudine, and Merck, which makes efavirenz, suggested to the US grantees that they either not take on new patients or they begin using stocks on shelves, according to three program directors who talked with the pharmaceutical representatives. The president's AIDS plan currently encourages program directors to keep a backlog of six months of drugs in case of shortages.

Several heads of US-funded AIDS programs said the projected drug shortages raise long-term concerns about whether pharmaceutical companies or generic manufacturers have the capacity to keep up with rising future demands.

Still, the biggest long-term problem for AIDS treatment programs is the lack of trained health workers, specialists said.

"There's nowhere where we're not facing some form of human resource problem, even in South Africa," said Jim Yong Kim, director of HIV/AIDS programs at the World Health Organization in Geneva. South Africa, which fell far short of its treatment targets last year, is acknowledged as having Africa's strongest health system.

Kim, who helped craft WHO's initiative of treating 3 million people in the developing world by the end of 2005, said donors will have to find ways to increase the salaries of health workers in poor countries to prevent more from leaving their jobs. One important step was the British development agency's decision to give nearly $200 million to the government of Malawi with the express purpose of increasing health workers' pay.

Almost no one believes the 3-million goal will be reached because of the capacity problems ahead; Kim, in a meeting of AIDS researchers in Boston on Tuesday, acknowledged the difficulties.

For AIDS specialists, the treatment of adults won't be the only stress on health systems' capacities.

Also ahead will be pressure for pediatric care of children with HIV, more HIV testing centers, and the expansion of programs preventing the transmission of HIV from mother to child.

"All of this means not only do you have to train the health workers, but you have to pay them," said Zeitz of the Global AIDS Alliance. "There are a ton of vibrant people who would love to get trained as community health workers. It would help the unemployment problem in many countries."

John Donnelly can be reached at donnelly@globe.com. 

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