Pharmacy links with Zimbabwe

By ELLEN GOLDBAUM
Contributing Editor

Improving treatment of patients with HIV in Zimbabwe and potentially other developing nations by adapting approaches that have been successful in the U.S. is the goal of a new collaborative effort between UB and the University of Zimbabwe.

About 25 percent of Zimbabwe's adult population is infected with HIV, according to the United Nations.

A primary goal of the program is to equip pharmacists at the University of Zimbabwe—home to the nation's only medical school—with training and resources so that they can begin to conduct more clinical pharmacology trials of AIDS drugs. UB's online HIV Pharmacotherapy Network http://hiv.buffalo.edu also will be utilized to encourage the global dissemination of ideas on HIV pharmacotherapy, particularly as they pertain to developing nations.

With new training and expertise, the University of Zimbabwe will be better positioned to obtain funding from the World Health Organization to implement pharmacology-related protocols and enroll patients in its own clinical trials.

The collaboration grew out of the relationship between the Department of Pharmacy Practice in the School of Pharmacy and Pharmaceutical Sciences and its chair, Gene Morse, with Chiedza Maponga, a 1988 graduate of the school and a native of Zimbabwe.

"At the moment, Zimbabwe lacks the resources and expertise to do advanced clinical pharmacology and pharmacotherapeutic research on HIV, but an extensive number of AIDS cases are there," explained Maponga. "That is the patient population that is needed to conduct the studies and work on this problem."

Morse and Maponga stressed that the collaboration will be mutually beneficial because through the exchange of research and education, it will provide UB students and faculty with a critical international perspective on AIDS.

"AIDS is not just a national issue for the U.S., it's a global issue," said Maponga. "Even from a business perspective, drug companies right now are only concerned with the U.S. market, but there are fewer than 1 million people living with AIDS here, and about 28 million people with AIDS living in sub-Saharan Africa. It is shortsighted to ignore that huge market."

To foster the collaboration, Maponga, who was the first Zimbabwean to earn a doctorate of pharmacy and is now chair of the University of Zimbabwe's Department of Pharmacy, has been funded as a visiting professor at UB for two years by a National Institute for Allergy and Infectious Diseases grant. The grant to UB supports Maponga's work in the Department of Pharmacy Practice and its Laboratory for Antiviral Research, a Pharmacology Support Laboratory for the National Institutes of Health Adult AIDS Clinical Trials Group (AACTG) and a component of the AIDS Clinical Trials Unit based at the University of Rochester.

Morse has served as national chair of the Adult AIDS Clinical Trials Group Pharmacology Committee of the NIH and under his direction, the UB lab has developed methods to quantitatively and qualitatively analyze how antiretrovirals, the main components of AIDS treatment, are metabolized, and what their effects—both beneficial and undesirable—are on patients.

According to Morse, the Pharmacology Support Laboratory is an ideal environment for providing integrated training in HIV pharmacotherapy.

"We are one of a handful of places in the country that has an innovative HIV Adherence-Pharmacology Program integrated with a larger laboratory and clinical research initiative focused on AIDS pharmacology," said Morse, who also is associate dean of clinical education and research with the School of Pharmacy and Pharmaceutical Sciences. "There are very few places in the U.S. in which so many different kinds of pharmacological expertise are together in one place."

Morse said the Pharmacology Support Lab has evolved a focus on both research and education, including clinical practice and training in adherence so patients stick to their regimens, and state-of-the-art laboratory analysis to measure blood concentrations of AIDS drugs. In addition, through expanded efforts in pharmacometrics, UB pharmacy faculty members Alan Forrest, clinical professor, and Patrick Smith and Robert DiCenzo, both clinical assistant professors, are providing innovative approaches to interpreting pharmacology data.

While the affordability of AIDS drugs remains a key concern for African nations, Maponga said training in the U.S. has demonstrated to him that even an enormous donation of drugs would not by itself solve the problem in Zimbabwe.

"Here in the U.S., you don't think about the cost of drugs, but you do highlight the complexities of managing HIV and that is most important," he said.

"We cannot fool ourselves into thinking that just getting the drugs is the answer. In the whole AIDS equation, the cost of drugs contributes only about 5 percent."

The rest of the "equation," he continued, are the costs associated with caring for AIDS patients, patient management, prevention of other infections, caring for the sick at home, monitoring and treating drug resistance, and adherence and compliance with complex drug regimens.

These are in addition to the enormous social consequences to people with AIDS and their families, particularly children who have been orphaned by the disease.