In the business world, people talk about “Return on Investment” or “ROI”. What’s that mean? Well, usually that it means – what’s the reward for the funds we invest. At GAIA Vaccine Foundation, our ROI can be measured in smiles, in healthy babies who do not have HIV infection, in lives saved. What’s that ROI? Priceless. And unlike many not-for-profits, GAIA donor dollars go directly to programs. GAIA VF supporters have satisfaction of knowing that lives can be dramatically improved, and the knowledge that – during the greatest pandemic in human history, GAIA VF is leading the way.

How so? We understood the importance of improving access to treatment and invested in building the Hope Center Clinic in 2008 to make HIV treatment accessible. The clinic brings HIV medications right to patients in their neighborhood. We predicted that improving access would reduce HIV transmission, and we were right! In fact, one of the key discoveries in HIV/AIDS in recent years has been that “Treatment is Prevention”. In May 2011, a study involving 1,763 HIV-sero-discordant couples (one partner was HIV positive, the other was not) was stopped before its original closing date because an interim analysis showed a 96% reduction in the HIV transmission rate (See Cohen M.S. et al. N Engl J Med. 2011).

Based on the published data, our success at HCC and the global trend to make HIV treatment available as a means of prevention, our next step is to petition the Malian government to provide Treatment as Prevention at our HCC and follow the impact on the community. In the absence of a vaccine, if providing access to medication can lead to eradication of AIDS, we’re ready to spring into action.

What does the new finding that treating HIV can prevent HIV transmission and the call for Universal Access mean for the rest of the world? It means that the gap between the number of people needing to be treated and the funds available to make that treatment accessible just got wider. Recent reports show a 7% decrease in philanthropic donations for AIDS, from 2009. GAIA Vaccine Foundation’s achievements have proved that each donor’s support is critical to further our mission and improve access to HIV care. In this special World AIDS Day 2011 update, we are pleased to report that the support that we generously received from all our donors allowed us to go above and beyond the objectives that were set for our program.

Through donations and grants, GAIA VF created one of the first clinics in West Africa to distribute village-level HIV care. In January 2011, the Hope Center Clinic was awarded a “Ciwara” (highest honor) by the local Department of Health. As the next International AIDS Conference is taking place in Washington DC in 2012 we will be highlighting our success in oral and poster session. We just completed an evaluation of our Mother to Child HIV transmission prevention program (started in 2005) and data from the past 30 months of our universal access intervention in Sikoro have been analyzed. We are happy to share the results with you.

Assessing our PMTCT Program
In 2010 and again in 2011, volunteers from all over the world traveled to Mali to work on a major evaluation of our program. Our volunteers included Christina Gomez-Mira (U. Texas), Natasha Rybak (Brown U.), Emily Kossow (Wesleyan), Tonhu Hoang (Concord Academy), and Nick Platt (American University of Paris) worked on assessing the adult HIV care with Ali Bicki (U. Miami) while Danielle Poole (Brown MPH program) and Shahla Yekta, Ph.D. (URI) worked on the HPV vaccine studies.

Our efforts are yielding positive results. Mother to child transmission (MTCT) is near zero – only one mother transmitted the virus to her child. The mothers report that they are very satisfied with the care that they are provided at HCC’s “Chez Rosalie” (the MTCT prevention program). In 2011 a second study was conducted and a questionnaire related to both mother and children was submitted. This process allowed us to link the mothers enrolled in the PMTCT program to their newborn and previous children and identify risk factors for transmission.

PMTCT in numbers (2005-2011)
10,150   pregnant women in prenatal care
9,060     pregnant women tested for HIV
198        pregnant women diagnosed with HIV
156        newborns in care
129        babies fed with formula

Evaluating our HIV care Program
We recently evaluated the efficacy of HIV treatment with “tri-therapy” in terms of AIDS-related infections, changes in weight, and CD4 counts over a 30 month study period. More than 60% of the patients increased their weight and CD4 counts and the percentage of patients with opportunistic infections was significantly reduced.

2011 Hope Center Clinic Achievements
200     HIV-infected adults and children in care
20       newborns tested by PCR for HIV
37       children in care
86       new HIV+ patients on treatment
830     patients received nutrition support
62%    improved their viral load while under ARV
61%   of patients had opportunistic infection (OI) at beginning of therapy; <17% had OI after 7-15 months

HPV vaccine Project – Preparing for Trials
Danielle Poole (with help from Kate Tracy, University of Maryland) carried out a study to evaluate whether women (and men) in Mali are ready to accept vaccination with HPV vaccine, the newly approved vaccine that prevents cervical cancer in women and anal warts in men.

This study is supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The KAP and WTP studies will enable GAIA VF to collect information and data necessary for introducing the Gardasil vaccine in Mali; a clinical study is anticipated for next year. This project helps GAIA filed personnel develop the necessary experience, protocols, put an infrastructure in place, and also enables us to train medical personnel. The goal is to lay the groundwork for all vaccine studies to come.

December 1st is World AIDS Day: Honor the Day with a donation!
This year the UNAIDS objectives are: “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” Help us stop HIV/AIDS!

Thirty years after the first report about HIV, what can each of us say that we have done to stop AIDS?

As you are a supporter of the GAIA Vaccine Foundation you know the answer – quite a lot!

Research on the GAIA HIV vaccine continues in parallel with the National Institutes of Health-supported collaboration extending from Providence (URI, EpiVax) to the University of Bamako and the laboratory of Dr. Ousmane Koita. To demonstrate that HIV prevention is linked to HIV care, we developed a model program of HIV access to care, prevention, and mother-to-child HIV transmission prevention (MTCTP) in a clinic in Sikoro, an underprivileged suburb of Bamako.

Our short term and long term objectives may initially appear to be very different, but in fact, we are pursuing a steady path toward a single unified goal – a globally accessible, globally relevant HIV vaccine.
We have a consistent record of progress in the battle against HIV and AIDS and we are now entering a capacity building phase at our Hope Center Clinic, where we are beginning to create the infrastructure for vaccine trials.

In 2010, GAIA was able to provide cutting-edge HIV care and prevention at the front line of the HIV epidemic

•    We promote HIV prevention through peer education – our peer educators include a football coach, a university student, and a young mother, each of whom promotes HIV testing in their spare time.
•    We link government resources with the community, distributing free HIV care medication provided by the national HIV programs to patients enrolled at the clinic.
•    We provide cutting-edge HIV care at the front line of the battle against AIDS, setting an example for the rest of West Africa.

Access to care and impact on patient wellness
Since the launch of our ARV access program in 2009, hundreds of patients have enrolled. Other than the few deaths observed for patients who were already in the highly advanced clinical stages of disease when they arrived at our clinic, we have seen steady improvement in patient status as measured by CD4 T cell counts, weight, and adherence to therapy. As a result of donor support, we have also been able to increase our testing capacity. Our peer educators made more than 4,000 contacts within the community. Fifty percent of new patients were eligible to start HIV medication, of whom about half were pregnant women. Those who are HIV-seropositive, but not yet clinically eligible for ARV treatment, are being followed. We have had an almost 100% rate of adherence to therapy – all of the patients followed for longer than 11 months are adherent to treatment - and only a few patients have failed to follow up. To strengthen adherence to treatment, we hired a case manager and now provide education and psychological support sessions within the Hope Center Clinic.
Due to improved adherence to treatment, the patients’ health statuses have greatly improved. Significantly, our physicians have reported that patients have fewer opportunistic infections while on treatment. No deaths have been observed among those patients followed in the clinic who have been treated for at least four months. This is an incredibly important achievement:  not only does it reinforce the belief that therapy can make a difference, but it also motivates our professional staff and our patients to engage in HIV care.

Successful prevention of MTC HIV transmission
Since February 2005, more than 7,000 women have received prenatal care from GAIA’s Chez Rosalie clinic, with an average of 128 women per month. Women who test positive are offered PMTCT services, and ARV and other necessary treatments are made available to their children. The percentage of women who accepted PMTCT grew from 35% in 2005 to 100% since 2010. To date, nearly 100 HIV-positive mothers have given birth in the Chez Rosalie clinic. All of the children born of mothers treated at the Chez Rosalie clinic (entirely supported by GAIA) are HIV-negative! That is a remarkable success.

Award winning clinical care at Hope Clinic!
Our Hope Clinic won a “Ciwara” Award from the local government in January 2011!

New programs for 2011
We are conducting a clinical study in preparation for testing an HPV vaccine. This project will build capacity for eventual HIV vaccine trials by providing training to our collaborators. If funding is approved, a small HPV vaccine trial will take place next year.

Continuing programs in 2011
HIV care, nutritional support, and MTCTP (Chez Rosalie) will be ongoing. The number of patients continues to expand. Donor support is sincerely appreciated for our award-winning program!

Thank you for supporting our work. Each donation helps us stop HIV in its tracks!

We have 135 people in care in the clinic right now, and another 5 to 10 come in each month for treatment. Acceptance of HIV treatment has been very good and patient satisfaction with care is excellent.

We’ve been assessing people at different time points - at entry, at 6 months, at 1 year. On average, tree months after starting treatment the T cell counts of our patients increases by 100 – a sign of treatment success. Increased T-cell counts also means that our patients are less susceptible to opportunistic infections and are more able to participate in the activities of daily life, contributing to the wellbeing of their families.

As for HIV education and TB outreach - both programs (Here Bolo for HIV and TB Bolo for tuberculosis) are going strong. All 12 peer educators are still with us and we're planning to assess our education program to see if there is improvement. We do believe we have had an impact… we'll see when we do the study!!!

Thank you for supporting our programs in Mali!

Spreading the word on World AIDS Day

Our work in the community on WAD

Good news from West Africa! Your favorite HIV prevention organization has successfully completed its second year of improving access to HIV care. With your support, GAIA has improved access to care for more than 45,000 Malians at the GAIA community-based clinic, the Hope Center Clinic in Sikoro, Mali.
Slowly but steadily, GAIA VF is building a state of the art program for HIV-positive patients in this resource-poor setting. The goal of this program is to reduce HIV transmission in one area of the world, to demonstrate the impact of community-based HIV care, and to prepare for an HIV vaccine trial in the same community.

Access to HIV treatment   
Since its inception, the program has enrolled over one hundred patients, and the results so far are encouraging: our patients have steadily been regaining weight, and their CD4 T cell counts are climbing. The patients also understand the importance of taking their medications – our pharmacist reports that adherence has climbed to near 100%.
This high rate of adherence is due to GAIA VF’s investment in peer support sessions at the clinic. The investment is certainly paying off: as a result of improved adherence, AIDS-related infections have become less common, and the general well-being of our patients continues to improve. No deaths have been observed among those patients followed in the clinic who have been treated for at least 4 months! Even the most skeptical members of the community are beginning to see the importance of HIV testing, access to care, and treatment.

HIV testing and follow up
The door to improved survival with HIV is early diagnosis. In 2010, GAIA VF increased the clinic’s HIV testing capacity. Our peer educators made 3,000 contacts within the community and more than 1,500 were tested for HIV. 81% were screened through our Prevention for Mother to Child Transmission (PMTCT) and 19% via Voluntary Counseling and Testing (VCT). 50% of the new patients were eligible for initiation of therapy, and received HIV medication. Half of these patients are pregnant women. Those that are HIV-seropositive but not yet clinically eligible for HIV treatment are being followed. We recently hired a case manager to improve patient follow up and monitor adherence.
 
Clinic Improvements
With donor support, we’re building a new maternity ward at the clinic. We’re also making technical improvements:  we purchased an air conditioner and replaced the refrigerator in the pharmacy, and we pay for Internet access. We also organized training for our staff to strengthen their skills.
 
HIV-TB Prevention program
Two Brown University students (Lauren Pischel and Julie Caplow) invested time and energy on our TB Bolo program in 2009. As a result of their enthusiasm and hard work, GAIA VF decided to invest in improving tuberculosis prevention and screening by making the tools available at the Hope Center Clinic for the rapid detection of TB. As a result, our TB case detection rate is rising and, as TB transmission is reduced, our HIV patients will be less likely to be co-infected with TB.

How can you help support our work in 2011?

Our plans for 2011 include -

Free HIV testing for all who wish to have it
GAIA VF will continue to expand HIV testing and increase the number of patients on HIV treatment. This is a lifesaving intervention, and it also reduces HIV transmission in the community. Like the Mother-to-Child-Transmission (MTCT) prevention program, it’s the ‘vaccine we have now’. With your support we plan to increase screening/testing by 25% and the number of patients under ARV treatment by 100%.

Encouraging fathers to participate
Of all our programs, the mother-to-child-transmission prevention program enrolls the most HIV infected patients. We plan to use this “window” into the family to reach their contacts. In 2011, we’ll work to improve our connections to men by reaching out to new fathers and conducting a comprehensive follow-up program. Increasing the number of post-natal consultations, strengthening the HIV counseling and support services for mothers and fathers, encouraging mothers to bring the baby’s father to the pre- and post-natal sessions, and training more nurse-midwives will allow us to enroll more patients through the post-natal “window” of access to the family.

Raising awareness, reducing stigma
In pursuit of our goal to involve fathers and young men in HIV testing, we’ll launch an awareness campaign targeting men, so as to decrease the stigma of HIV infection and encourage men of all ages to get tested and treated for HIV.

Community outreach
Our award-winning “Here Bolo” program will continue this year (and it has now been adopted in Haiti!). Our peer educators will tailor their communications to specific groups in Sikoro (women, elders, youth, orphans, men/fathers), making sure that everyone knows that free, complete HIV care is available in their community.

Nutritional support for patients
Nutritional support is a key aspect of our care for the AIDS patients. In addition to providing a weekly meal, this program reduces stigma and improves communication, adherence to treatment, and the effectiveness of medications.

A bright new space for children with HIV
GAIA VF has plans to recruit a pediatric HIV specialist to provide care to children born with HIV in the community. We would like to challenge our donors to contribute to this effort to build a space for our pediatric HIV patients. We hope to create a warm, happy setting for their care.

World AIDS Day 2010: Honor the day with a donation!

This year the GAIA Vaccine Foundation is moving its annual WAD event to Mali! Can’t go? Stay tuned: we have a big event coming up in the Spring in Providence! Check in on line and stay in touch!

Make a contribution to GAIA in honor of World AIDS Day! Help us stop HIV in its tracks!

GAIA by the numbers in 2010:

12,824 condoms distributed
1,890 HIV tests performed
More than 100 patients receiving HIV treatment
38 at-risk newborns currently being followed
2 new programs: HPV and TB prevention

When originally planning for the trip to West Africa I was at first a bit apprehensive of site visits in French. I've only studied the language for a year and I feared I might not be able to understand the organization's work or get a good sense of their impact if the visit was entirely in French.

Meeting with GAIA Foundation however quickly put these fears aside. Understanding the amazing work of GAIA does not require nuisance or subtlety. Their work is clear, direct and entails the truly praiseworthy work of literally saving lives on a daily basis. Over a number days in Bamako, Mali I had the opportunity to learn about this work both on "official" and "unofficial" site visits with the organization.

Though the "official" site visit occurred on July 12th, I would say the unofficial portion of the visit began when Lorraine and I moved into the GAIA guesthouse and were greeted by two enthusiastic and passionate GAIA volunteers, Tonyu and Emily. I don't think GAIA could have found two better representatives or endorsements than these two. Not only did they spend long nights explaining the difficult situation of health in Mali, but they also detailed the innovate approach GAIA has undertaken and gave us an introduction the inspiring doctor we would meet the following day, the local director of GAIA Dr. Tounkara. He would not disappoint. We learned that the organization works in the Sinkoro area, a part of Bamako that has been traditionally undeserved by health services with approximately 1 doctor per 40,000 patients. Devastating diseases such as HIV/AIDS and Tuberculosis has had a profound effect on the community and continue to disrupt the lives of many throughout the area.

As for the "official" site visit Dr. Tounkara, or as many call him "Kara", walked us through the Hope Clinic, greeting staff and patients alike along the way. He explained how GAIA is working in conjunction with the Malian government to make the clinic into a model that can be replicated throughout the country. The clinic takes a holistic approach to health, but has been greatly aided by GAIA's support in fighting HIV/AIDS and Tubrcolosis through both treatment and outreach.

Sitting down with the head of the Hope clinic, we learned how GAIA has additionally been instrumental in stepping in where the Malian government funds leave off. GAIA has been able to raise funds for advanced medical equipment and facilities, when the government of Mali is unable to provide the funding. What is truly unique is the way GAIA does not direct the improvements but responds to the needs of the community and its leaders.

Donating money can sometimes be a tricky business and it can be difficult to understand the impact of your donation. Furthermore, development models have proven complicated with ambiguous results. These doubts are not necessary with GAIA. Their impact is so clear that even a French beginner can understand them. GAIA's projects transform lives and represent a glimpse at the future of health in Mali.

...and if you're still not convinced they also speak English.

Andrew is traveling in the field visiting numerous GlobalGiving projects. Follow his and his fellow traveler's adventures at www.itfwa.wordpress.com.

Tested 1,840 patients for HIV; identified 100 cases Started 33 new patients on HIV medications Screened 540 pregnant women by ultrasound Prevented HIV transmission to 12 newborns PMTCT Program: 1,440 pregnant women received councelling, 1,438 were tested – out of which 25 tested HIV+. 30 babies (under 18 mo) are being followed. Extended staff in Mali: GAIA hired an HIV pharmacist for ARV treatments. Student training: Kotou Sangare, a student at the Laboratory of Applied Molecular Biology (affiliated with the University of Bamako) travelled to Providence last summer and trained with a local laboratory team to do research on the GAIA HIV vaccine. World AIDS Day/Week in Bamako: Tounkara Karamoko (our Director) organized many events within the community in order to raise HIV awareness. Maternity renovation (on going): With 1,200 mothers giving birth every year the maternity needed an extra room for deliveries. The ASACO (Sikoro’s health infrastructure) is raising money to build this addition. GAIA VF is also participating in funding We plan on continuing the PMTCT evaluation, to increase amount of patients treated with ARV by 100%, acquiring medical supplies for the addition, beds, mattresses and a birthing table.

GAIA would like to thank you for your contributions and support and making it possible for us to open this clinic and expand its health care and awareness.

Dear GAIA Supporters!

GAIA’s Hope Center Clinic, the clinic that you helped build on the front line of AIDS in the village of Sikoro, Bamako, Mali, is not only the first village-level HIV clinic to offer free HIV care in Mali but it has become a model to replicate! As a direct result of our work, 16 other village-based centers of care will be opening in Mali in 2010. Our clinic has become a model for the “decentralization” of HIV care for the rest of West Africa. Because of our work, West African doctors and policy makers are expanding their efforts to offer more HIV treatment at the village level. Our commitment to improving HIV care, and access to it, is changing the course of the HIV/AIDS epidemic in West Africa. Treatment is one of the best means of preventing AIDS transmission now, while the world waits for a successful HIV vaccine to be developed.

Activities 2009 (January – September 2009)

• January 2009: Muralist Eduardo Piñeda painted a mural on the Hope Center Clinic wall. Mr Piñeda and his daughter, Teresa, donated this work. A video is being produced by the filmmaker Dan Viens to document the process of working with the community. • February 2009: Approval of the Hope Center to be the first “infirmary” style clinic to distribute free HIV medication in West Africa. HIV specialist and HIV Pharmacist working on site at Hope Center Clinic • March – April 2009: Delivery of an ultrasound machine to our clinic in Mali – to assist pregnant moms with planning their deliveries and reduce the risk of childbirth. KAP/ Vaccine willingness to participate studies in village and presentation at IAS, Keystone meetings • June 2009: Implementation of TB BOLO, our TB education and outreach Program. • July – October 2009: Kotou Sangare trained in HIV vaccine research techniques will re-establish basic research protocol (HIV ELISpot assays, validation of GAIA Vaccine) lead by Dr. Ousmane Koita

Ongoing Activities

• HIV testing and access to care at the Hope Center Clinic in Sikoro, Bamako, Mali – one of the first certified HIV care clinics at the village level in Mali • MTCTP at Chez Rosalie – HIV Prevention Program operating since 2005, in Hope Center maternity that receives more than 120 pregnant moms/month • HIV education and outreach: Here Bolo – peer education program – since 2007 • TB education and outreach: TB Bolo - initiated October 2008 • Nutrition for HIV-seropositive patients at Hope Center Clinic continues – weekly Friday meals • Peer support group – with HIV seropositive peer discussion facilitator • HIV vaccine research ongoing

By the numbers - In 2009, GAIA has already

• Distributed 8,135 condoms • Taught 5,214 people about HIV • Consulted with 1,123 patients about their risk of acquiring HIV and STIs • Tested 1,505 patients for HIV and sexually transmitted disease • Provided 560 boxes of artificial milk to HIV sero-positive moms • Welcomed 27 HIV-free newborns to Chez Rosalie

Our commitment to improving care, and access to it, is changing the course of the HIV/AIDS epidemic in West Africa.

Thank you for your visionary support of our work!

Dear Donors!

With your help the GAIA Vaccine Foundation has established itself as a reputable organization for providing HIV/AIDS education, prevention, and treatment programs both in Rhode Island and West Africa.

While we work hard on that HIV vaccine, we have some important news to share. Our Hope Center Clinic is now the first village-level HIV clinic to offer free HIV care in Mali. There are no others like it. Indeed, our clinic has become a model for the “decentralization” of HIV care for the rest of West Africa. With our programs now in place, we are on track to serve almost five times as many patients over last year! And perhaps more important, our clinic is a model for others. Because of our work, West African doctors and policy makers are expanding their efforts to offer more HIV treatment at the village level. Treatment is one of the best means of preventing AIDS transmission now, while we wait for the vaccine to be developed.

As we look both to the near and distant future, there is still so much to be done. In the short term we will measure our success in terms of the number of patients followed by the Hope Center Clinic and will determine whether providing easy access to free HIV care has an impact on viral load, CD4 T cell count, and survival. In the long term, we will measure success by whether we are able to expand the number of people who have access to HIV counseling, testing, and treatment in the other 780 such village-based clinics Mali.

As Dr. Aliou Sylla, director of Mali’s national AIDS program, said at the opening of the Hope Center Clinic, GAIA has set an example for other to follow—we delivered on our promises. It is only with your support that we can continue to deliver on those promises. It is important to remember that our work in Mali is not simply a charity effort: our commitment to improving care, and access to it, is changing the course of the HIV/AIDS epidemic in West Africa. We thank you for your visionary support of our work and hope that you will continue to sustain this important, life saving effort!

Very truly yours,

Annie

Julie and Lauren launched TB prevention program

Peer Educators - summer 2009