Internships

Josephine Yolisa Nalule ’10

“Increasing access to antiretroviral drugs (ARVs) has been a hard-fought battle made possible by unprecedented alliances among AIDS activists, governments, philanthropic and international agencies, and the pharmaceutical industry. Many public- and private-sector treatment initiatives are being launched worldwide, raising a whole new set of national and global healthcare policy challenges regarding adequate drug delivery, sustainable treatment access, and the integration of treatment with prevention. Broader questions arise as well: How can international institutions hold donors and partners accountable in the long term? In what ways can national governments stay involved (or increase their involvement) in ARV rollout?  How does the variability of care infrastructure and treatment adherence affect drug resistance? And what effects do all of these issues have on the experience of living with HIV/AIDS and poverty on the ground?” (Joao Biehl)

“I specifically picked the topic of drug resistance to first line treatments and the access (or lack thereof) to patent protected treatment in Uganda. I had originally planned on looking into initiatives being taken to deal with drug resistance and also the distributions of ARVs in Uganda. However, on reaching  Kampala, Uganda, with reading literature and talking to various health professionals, I changed my topic and started to focus on the issues surrounding treatment failure and decision making process of when to switch a patient from 1st to 2nd and line treatment. Faced with varying thresholds of measurement, definitions of treatment failure, limited switching options and issues of cost effectiveness, it was enlightening to learn how different treatment centers are dealing with this in an effort to provide the most efficient health care to those who need it.  So I went around Kampala, the capital city, talking to different organizations including church organized AIDS programs, some government owned treatment centers, hospitals, NGOs etc talking to varying health professionals ranging from nurses, treatment dispensers to some administrators, trying to get understand what was happening with this issue of drug switching.”

“From the different answers from different centers, the question of effectiveness/success of the Ugandan ART in absence of efficient monitoring strategies is raised. How best can this success be monitored? If patients are switched too late how will this affect the clinical success of 2nd line? Is a set of national guidelines and thresholds needed for health professionals to follow in order to have early detections? If so, how will the thresholds be determined, given the limited switching options available in resource limited settings? Given that a lot of these issues come up as a result of lack of switching options, the question lingers about whether it should be acceptable that resource limited settings should settle for just 2 regimens yet there exist 3rd and 4th line regimens in the Western world that have just been made available/accessible to this side of the world. It was a very amazing project that i would like to continue to do even this upcoming year.”