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International Association of Physicians in AIDS Care, January 2000 Journal
People around the world are benefiting from instantaneous access to far off libraries, universities, and other troves of data via the World Wide Web. Physicians are reinventing their profession, utilizing telemedicine to administer off-site diagnoses or accessing up-to-the-minute clinical guidelines before the guidelines even make it to the printing press. As with healthcare, inequities in access to this valuable medical information has spawned a world of haves and have nots. I-Med Exchange is an Internet-based, bidirectional educational program IAPAC is coordinating at medical sites in Botswana, Lesotho, Namibia, South Africa, and Swaziland. The program includes unlimited access to medical information services on the World Wide Web, e-mail capabilities, and the use of Web conferencing. The fundamental idea behind I-Med Exchange is to empower physicians, other healthcare professionals and, as important, patients to problem-solve by working together via information technology.
Despite the immensity of the global crisis in access to healthcare, several international nongovernmental organizations and pharmaceutical companies are advancing enterprises that promise to extend the benefits of medical and scientific progress to those for whom such progress has been unattainable. IAPAC plays a key role in two such global initiatives--the UNAIDS HIV Drug Access Initiative (which is introducing antiretroviral drugs into Chile, Côte d'Ivoire, Uganda, and Vietnam) and Secure the Future (a multimillion dollar initiative to advance medical education, expand AIDS drug access, and implement HIV prevention efforts in five southern African countries). IAPAC is providing independent evaluations of the context, framework, objectives, activities, impact and, ultimately, sustainability of these two model drug access and medical education initiatives. IAPAC's monitoring goals include recognizing objectives met, flagging potential deficiencies, recommending programmatic adjustments, and drawing more widely applicable lessons to guide decision-making around future model programs developed for an implemented in the developing world.
Spearheaded by Mark Kline, MD--an IAPAC member and prominent pediatric AIDS expert from Baylor College of Medicine in Houston, Texas, USA--the Romanian Pediatric AIDS Initiative is a collaborative effort partnering US-based healthcare professionals, their Romanian colleagues, and IAPAC. The initiative aims to bring state-of-the-art pediatric and specialty care to thousands of HIV-infected children in Constanta, Romania. The objective is to provide this care at a clinical center housed in an abandoned book warehouse donated by the Romanian government and refurbished by Baylor College of Medicine in collaboration with IAPAC. Additionally, this clinical center may eventually play a role in the education of Eastern European healthcare professionals. Clinical trials conducted in the center could answer research questions of worldwide importance regarding disease progression and therapeutic interventions, while allowing an opportunity for training Eastern European healthcare professionals in the latest research and clinical management practices.
The advent of combination therapy with protease inhibitors dramatically altered HIV clinical management, offering much needed hope of clinical benefit for tens of thousands of HIV-infected patients. Realizing the potential of the full AIDS drug armamentarium requires that HIV/AIDS-treating physicians achieve a core clinical competency that allows for the optimum use of available drugs and technologies. How is this core competency achieved? Through the years, there has been a recurring question in the medical community about whether HIV should have its own medical subspecialty to allow for the long overdue recognition of the special expertise required by HIV/AIDS-treating physicians to provide quality care for their patients living with HIV disease. As a professional association whose membership is primarily HIV/AIDS-treating physicians, IAPAC has launched an exploratory mission polling physicians about their interest in an HIV medical subspecialty. This exploratory phase of IAPAC's physician-led initiative will guide the association's activities and potential collaborations around this timely issue in 2000.
Since its launch in 1995, the Journal of the International Association of Physicians in AIDS Care (Journal) has evolved into a primary source of clinical and public policy information for physicians and other healthcare professionals. The IAPAC Journal is known for its comprehensive coverage and analysis of national, regional, and international medical and public policy conferences written by internationally renown journalists. In 2000, the Journal will undergo a transformation to achieve a balance between conference coverage and analysis, and the inclusion of peer-reviewed articles on clinical experience. Also this year, IAPAC will be accredited to afford continuing medical education (CME) credits through our monthly Journal.
Achieving more than 310,000 "hits" a month is no easy feat considering the alphabet soup of AIDS-specific and -related sites available on the World Wide Web. The IAPAC Web site (www.iapac.org) features articles from IAPAC's Journal; daily highlights of key presentations at international HIV/AIDS and related coinfectious diseases conferences; and original material commissioned exclusively for the IAPAC Web site. Special features include simultaneous uploads of full-text posters, featured abstracts, and important pharmaceutical news releases from major international medical conferences; drug monographs on the major drugs used in the clinical management of HIV/AIDS and other coinfectious diseases; abstracts of and commentaries on original research in peer-reviewed journals; and physician on-line forums hosted from important global conferences. IAPAC is planning extensive Web site-specific coverage of several conferences in 2000, including the 13th International AIDS Conference in Durban, South Africa.
To advance IAPAC's goal of expanding access by all HIV/AIDS-treating physicians globally to current guidelines for the clinical management of HIV disease, the association develops and distributes print copies of HIV/AIDS treatment guidelines as Journal Supplements. In 1999, IAPAC distributed more than 75,000 Journal Supplements of the regularly updated US Department of Health and Human Services (DHHS) HIV/AIDS treatment guidelines in both English and Spanish. The Journal Supplements feature these guidelines in standard Journal format that incorporates the tables and charts into the text rather than as addenda to the guidelines in the DHHS format. Revisions to the guidelines are highlighted in red, bold-face type. These guidelines are also featured on the IAPAC Web site in a user-friendly format. To supplement these guidelines, IAPAC developed colorful charts and posters with a brief summary of the guidelines and featuring photographs of each of the antiretroviral drugs. Thousands of these charts and posters have been distributed globally and were adapted for and are currently featured on the IAPAC Web site.
In an effort to educate our membership and key public policy decision-makers about pressing advocacy issues, IAPAC publishes THEMIS, a quarterly public policy education/advocacy primer. THEMIS is distributed to IAPAC's US membership; local, state, and federal officials; and select members of the media. Past issues have covered such topics as African Americans and AIDS and the controversy around pharmaceutical patent rights and access to HIV/AIDS drugs and technologies.
Because more than 94 percent of the HIV-infected global population lacks access to appropriate healthcare and life-sustaining drugs, IAPAC sponsors a series of international conferences focused on the global crisis in access to healthcare, including AIDS-specific and -related services, drugs, and technologies. The annual conference brings together international experts--physicians, economists, public health officials, nongovernmental organization leaders, patient advocates, and people with HIV/AIDS--to explore new ways to distribute existing health resources in ways that will benefit as many people as possible. Over three days, an audience of 250 to 300 delegates dissect resource allocation issues from perspectives that are not purely clinical. Debated are dilemmas of ethics, economics, human rights, and access to information that are inherent in a world where 16,000 people become HIV-infected each day. The Fourth International Conference on Healthcare Resource Allocation for HIV/AIDS and Other Life-Threatening Illnesses is scheduled to take place October 16-18, 2000, in Cairo, Egypt.
Establishing adequate levels of the most effective drug and/or drug cobinmations is key to effective management of HIV and other life-therqtening dcoinfectiouys diseases. IAPAC's new series of annual symposia on these rapidly expanding research and advances in diagnostic technologies are designed to provide clinicians and policymakers with the information needed to maximize the value of diagnostic technologies and the expanding armamentarium of therapeutic agents.
Responding to a need identified by our membership, IAPAC will hold its first annual meeting this year in Chicago, Illinois, USA. The IAPAC Annual Meeting 2000: On the Brink of a Century of Challenge, has been designed as an innovative forum to include symposia sponsored by the Pan American Health Organization and the Midwest AIDS Training & Education Center, as well as symposia sponsored by pharmaceutical manufacturers. This may serve as a new model for more effective use of increasingly limited funds available for HIV education. The IAPAC Annual Meeting 2000 will serve as a venue for discussion of clinical management and medical practice issues. Among the scheduled IAPAC clinical presentations are the long-term toxicities of antiretroviral therapy; emerging challenges in HIV/HCV coinfection; clinical concerns in the management of HIV-infected substance users; recreational and HIV drug interactions; the role of sexual counselling in the reduction of MDR-HIV; and challenges in designing clinical trials in the 21st century. IAPAC medical practice issues up for discussion include HIV subcapitations; managed care contract negotiations; the need for an HIV medical subspecialty; and the role of HIV state medical societies in the future of managed care.
Approved by the IAPAC Board of Trustees, December 29, 1999.
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ÆGIS is made possible through unrestricted grants from Roxane Laboratories, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeard in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.
Copyright © 2000 - International Association of Physicians in AIDS Care. All rights reserved. http://www.iapac.org
This information is designed to support, not replace, the relationship that exists between you and your doctor.