Richard Waddell and Lisa Adams discussed how members of the Dartmouth community and others are helping to improve global health on Tuesday to a packed crowd in the Rockefeller Center. The pair, who are both involved with the Section of Infectious Disease and International Health at Dartmouth Medical School, focused on the collaborative efforts of DARDAR, an ongoing project that tests the efficacy of a vaccine to stop the spread of tuberculosis in people who have HIV/AIDS.
Before Adams launched into the lecture, she displayed a picture of a woman who lives in the outskirts of Dar es Salaam, Tanzania. Adams explained that this woman lives in a very poor district of the city and lost her husband, presumably to AIDS. She also lost two of her six children to AIDS, including her 30-year-old daughter.
The 60-year-old grandmother takes care of her deceased daughter's six-year-old son. Like any grandmother who is parenting, she is worried about her grandson -- about paying his school fees and about drainage from his ear that has continued for years and may affect his hearing.
When Adams began the epidemiology portion of the lecture, she asked the audience to remember this story and the faces that are behind the statistical numbers she discussed. In 2004, there were about 40 million people living with HIV and just over three million deaths in that year, she said. Additionally, there are about nine million new cases of TB and about two million deaths from it each year.
"If you were to line up the world's population in a single file line, every third person would be infected with the tuberculosis bacteria," Adams said.
Adams said that besides illness and death, HIV/AIDS and TB have other negative effects. With adults, both diseases result in the inability to work efficiently, which causes a diminished agricultural and industrial productivity. Children sometimes drop out of school to tend to infected family members or because they have the virus themselves.
"There are about 14 million orphans worldwide, which is equivalent to every child under the age of five in the United States," Adams said.
In addition, both TB and HIV/AIDS are a cause of and caused by poverty. Some of the economic effects at the household level can be measured by the fact that an adult with TB loses on average three to four months from work, or about 20 to 30 percent of their annual income.
"And you can also imagine a situation in which terminal AIDS can just deplete a household income," Adams said. "Obviously, at the household level these effects are quite drastic."
About 25.8 million of the 40 million individuals living with HIV/AIDS are living in sub-Saharan Africa and southern Africa. These countries have been the hardest hit and are carrying the largest burden, Adams said.
In Tanzania, Dartmouth has collaborated with the Muhimbili University College of Health Sciences to form DARDAR, which is an acronym for Dartmouth Medical School and the city of Dar es Salaam.
According to Waddell, the integrated program of combining care for TB and HIV/AIDS has made a "quantum leap" forward since its start in November 2004.
"The two sister organizations are pulling together to offer this clinical trial, DARDAR. It is a randomized profile of a vaccine and we will see if it prevents the transmission of TB in people who are HIV/AIDS positive," Waddell said.
The clinic has completed its recruitment for the study and has enrolled almost 2,000 HIV positive people. Over a 12 month period, 990 people have received the placebo five times and another 990 have received the vaccine five times. All the subjects are given routine care for HIV.
"After seven years, at the end of the study, which will roughly be in the middle of 2008, we will break the code and then analyze the data to see if it was in fact effective," Waddell said.
Dartmouth's Global Health Initiative has created many opportunities for the entire community to get involved with battling international health issues.
"You've have heard a lot of facts and you've heard a lot of numbers. Sometimes these numbers are beyond our ability to grasp. We hear about figures like $50 trillion and 30 million people. How do we cope with it?" Waddell said. "It is only when we see real people like the lecture has shown ... and hear the real stories, that we begin to better understand the human condition."
