For most of the past four years, Dr. John Bartlett, associate director of research at the Duke Global Health Institute, has been living in Tanzania. There, he has worked with physicians and researchers from Duke and Kilimanjaro Christian Medical Centre to conduct research on AIDS and other widespread disease in the country, as well as help build clinics, improve medical infrastructure and train local medical personnel.
Despite frequent power and water outages, Bartlett told The Chronicle's Jessica Lichter that his only regret about the venture is never becoming fluent in Kiswahili.
The Chronicle: What did your group's work in Tanzania entail?
Dr. John Bartlett: Our work in Tanzania involved collaborating with colleagues at KCMC to develop all of the elements of clinical research. All of those elements include training staff members in Tanzania, developing a laboratory that could support robust clinical research and then once the infrastructure is in place, beginning to recruit patients into clinical trials.
TC: What implications do you think your team's work has for Tanzania and for other developing nations?
JB: I would point to two specific examples of our research that helped to inform policy in Tanzania.
The first was a study that looked at access to voluntary counsel and testing for HIV infection. We found that when testing was made absolutely free for patients, almost four times as many people got tested as when there was a co-payment [of one dollar]. Because of the increase in volume of the people to be tested, the new infections that would be diagnosed and the preventive and treatment measures that would be undertaken, we showed that free testing was highly cost effective. As a result of that, the Ministry of Health of Tanzania made [these] services completely free.
A second area where we were able to learn something that was important for policy development was in the area of payment for antiretroviral drugs. We were able to look at adherence to medications, virologic failure and at resistance to the drugs in a population of people who were coming to KCMC.... We identified two factors that predicted difficulty in taking the medications as prescribed.
One of those factors was having to pay for your medicines. The second factor that was really important was disclosure to another person. If a patient had disclosed to a family member or friend about their HIV infection, they did better in taking their medications and had a lower rate of virologic failure. So as a consequence of these findings and of international aid, the Ministry of Health of Tanzania made medications free to all patients and now virtually all treatment programs have a requirement that an individual patient disclose to someone about their HIV status so that they receive that social support in taking medications.
TC: Was the local population welcoming towards your work?
JB: The local population has been profoundly affected by HIV/AIDS. Every family has had family members die. Virtually all of my colleagues had orphans from other family members that they had brought into their homes. So, in their personal lives, everyone was touched by HIV/AIDS. As a consequence, they wanted to see improved understanding about the disease, improved access to treatments and prevention.
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