Who | dispatch from the field

17 June 2009
Dispatch from the field
Katutura State Hospital, Windhoek, Namibia

WINDHOEK, Namibia—In his last mission asDirector of the WHO HIV/AIDS Department, DrKevin De Cock visited the Katutura State Hospitalin Windhoek, Namibia, where he praised effortsby national authorities and health-care providersto expand antiretroviral treatment (ART) to thosein need.
“Here’s a very large public hospital which five orsix years ago, undoubtedly, would have been filled with patients with advanced HIV disease,” said Dr De Cock, who travelled to Windhoek for the 2009HIV/AIDS Implementers’ Meeting. “There would have been no empty beds, and we would have seen a lot of extremely wasted patients,” he said.
Interview with Dr Refanus Kooper, Chief, ART Thanks to ART scale-up, most of those seeking HIV treatment at the Katutura facility are nowmanaged as outpatients. Further, the majority ofHIV-positive in-patients looked well, noted Dr DeCock, as he toured the hospital wards, showing the“benefits of timely access to antiretroviral therapy.” Namibia has one of the highest HIV prevalence rates in the world, with an estimated 15.3% of the adultpopulation affected. At the end of 2007, some 52,000 people in Namibia were receiving ART, according to thelatest available figures.
The ART programme at Katutura hospital was launched in 2003 at the dawn of the “3 by 5 initiative,” a globaleffort spearheaded by WHO and partners that sought to put three million people on ART by the year 2005.
Though that target was only reached in 2007, “3 by 5” is widely credited with galvanizing the unprecedentedexpansion of ART in low-and middle-income countries.
“When we first started in 2003, there were no doctors who were trained in ART management,” said Dr RefanusKooper, a Namibian physician who heads the hospital’s ART clinic. “We began training doctors using WHOguidelines, then standardizing and adapting them to our country settings.” About 5000 HIV-positive adults and 1100 children are now receiving regular ART at the clinic, and an additional80 to 120 patients are newly enrolled each month. Many patients learn their HIV status at free HIV testing sitesin the Katutura vicinity.
While the majority of patients at Katutura hospital are responding well to ART, some have experienced adversereactions. Dr De Cock met one such patient in his visit to the clinic, a 55-year old mother of ten children whowas suffering from several medical complications, including extrapulmonary tuberculosis and liver damage.
Doctors said the complications were likely attributable to nevirapine, an antiretroviral drug. The patient’scondition illustrates another side of treatment scale-up, said Dr De Cock: “ART is simple, but isn’t always thatsimple.” The extent of HIV drug resistance in resource-limited countries has not been systematically assessed. Togetherwith national health authorities and partners, WHO is developing Namibia's first HIV drug resistanceassessment, based on the WHO 2008 global strategy. Katutura hospital has been chosen as a pilot site for thisinitiative.
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