Dispatch from Namibia

Katutura State Hospital, Windhoek, Namibia

17 June 2009

WINDHOEK, Namibia—In his last mission as Director of the WHO HIV/AIDS Department, Dr Kevin De Cock visited the Katutura State Hospital in Windhoek, Namibia, where he praised efforts by national authorities and health-care providers to expand antiretroviral treatment (ART) to those in need.

“Here’s a very large public hospital which five or six years ago, undoubtedly, would have been filled with patients with advanced HIV disease,” said Dr De Cock, who travelled to Windhoek for the 2009 HIV/AIDS Implementers’ Meeting. “There would have been no empty beds, and we would have seen a lot of extremely wasted patients,” he said.

Thanks to ART scale-up, most of those seeking HIV treatment at the Katutura facility are now managed as outpatients. Further, the majority of HIV-positive in-patients looked well, noted Dr De Cock, as he toured the hospital wards, showing the “benefits of timely access to antiretroviral therapy.”

Namibia has one of the highest HIV prevalence rates in the world, with an estimated 15.3% of the adult population affected. At the end of 2007, some 52,000 people in Namibia were receiving ART, according to the latest available figures.

The ART programme at Katutura hospital was launched in 2003 at the dawn of the “3 by 5 initiative,” a global effort spearheaded by WHO and partners that sought to put three million people on ART by the year 2005. Though that target was only reached in 2007, “3 by 5” is widely credited with galvanizing the unprecedented expansion of ART in low-and middle-income countries.

“When we first started in 2003, there were no doctors who were trained in ART management,” said Dr Refanus Kooper, a Namibian physician who heads the hospital’s ART clinic. “We began training doctors using WHO guidelines, then standardizing and adapting them to our country settings.”

About 5000 HIV-positive adults and 1100 children are now receiving regular ART at the clinic, and an additional 80 to 120 patients are newly enrolled each month. Many patients learn their HIV status at free HIV testing sites in the Katutura vicinity.

While the majority of patients at Katutura hospital are responding well to ART, some have experienced adverse reactions. Dr De Cock met one such patient in his visit to the clinic, a 55-year old mother of ten children who was suffering from several medical complications, including extrapulmonary tuberculosis and liver damage. Doctors said the complications were likely attributable to nevirapine, an antiretroviral drug. The patient’s condition illustrates another side of treatment scale-up, said Dr De Cock: “ART is simple, but isn’t always that simple.”

The extent of HIV drug resistance in resource-limited countries has not been systematically assessed. Together with national health authorities and partners, WHO is developing Namibia's first HIV drug resistance assessment, based on the WHO 2008 global strategy. Katutura hospital has been chosen as a pilot site for this initiative.

Audio clips
Dr Kevin De Cock

Leticia's condition and provider-initiated testing and counselling. (MP3)

"ART is simple, but it isn't always that simple". (MP3)

The relevance of WHO's work. (MP3)