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Vital Signs

$2 million grant will aid in the fight against AIDS in Africa

The DARDAR Health Project at DMS has been fighting AIDS in Tanzania—one patient, one scientist, and one student at a time. The project began in 2000 as an ambitious but singlefocus study of tuberculosis (TB) in AIDS patients. Now it encompasses a health clinic in Dar es Salaam, an elective for DMS students, a fellowship underwritten by the National Institutes of Health's Fogarty International Center, and studies related to HIV, TB, and hepatitis C. Next on the horizon is the establishment of a pediatric program in Dar es Salaam, thanks to a $2-million grant from the Foundation for the Treatment of Children with AIDS (FTCA).

"The new grant actually provides money for a number of different projects," explains Dr. Fordham von Reyn, principal investigator for DARDAR. "The most important of these is a comprehensive HIV-care program for HIV-positive children of the mothers in our DARDAR study. We have done a survey of approximately 1,200 women in the study and have estimated that they have about 100 HIV-positive children, none of whom are in treatment."

Antiviral: "Many of the women in the study have already lost children to AIDS," continues von Reyn. "A major part of this grant will be to build a facility, hire . . . staff, provide the purchase of the expensive antiviral drugs for HIV, and then begin a treatment program."

The grant will also fund a study aimed at keeping pregnant women with HIV and TB from transmitting TB to their babies. (There are already programs to prevent mother-to-child HIV transmission.) Von Reyn and his colleagues in Dar es Salaam have found that about 15% of people with HIV in Tanzania also have previously unrecognized active TB; they suspect that a similar percentage of HIV-positive pregnant women have undiagnosed TB. "There is very little known about how to diagnose that," von Reyn explains, "the best way to treat it, and the best way to manage their newborns."

Endowment: A new DMS faculty endowment—named in honor of John L. Steffens, a 1963 Dartmouth College alumnus and a major supporter of FTCA—is also being funded by the grant. The position will be filled by an infectious-disease specialist who will serve as director of the new pediatric program.

Investing in the future is an important component of DARDAR, which provides learning opportunities for students from DMS and Muhimbili University College of Health Sciences. This past fall, Cara Mathews, DMS '05, became the first student to do DARDAR's six-week elective. The experience affected her deeply. "It is part of me, a part of every day, and a part of my future," says Mathews.

She divided her time in Tanzania between seeing patients at the DARDAR clinic and participating in rounds at the Muhimbili University-affiliated hospital in Dar es Salaam. "I got to see the patients when they were ill, and that was a great experience for me because the diseases are so different than what we would see here," recalls Mathews. While she was fascinated by the cases of malaria, which is uncommon in the U.S., the Tanzanian students were intrigued by the one patient who had had a heart attack—a condition Mathews had seen any number of times but the Tanzanians had not. "I had kind of thought, 'Okay, we'll treat him, and let's move on.' [But] we just stayed there and stayed there and talked about him."

Encounter: Students who go to Dar es Salaam will "encounter both infectious diseases and other diseases . . . that they would never encounter in their careers here," says Dr. Richard Waddell, a research assistant professor of medicine at DMS and one of the directors of DARDAR.

"You also get to see how these diseases are dealt with in a resource-poor setting," says Dr. Lisa Adams. Adams is a member of the DMS faculty and oversees the Fogarty Fellowship part of DARDAR. It allows graduate students and postdoctoral fellows from Muhimbili University to study at DMS and Boston University in one of several areas related to HIV and TB—vaccine research, mucosal immunology, behavioral change, and treatment research.

The name DARDAR is based on the first syllables of Dartmouth and Dar es Salaam; in addition, "dada" means "sister" in Kiswahili, one of the local languages. That way of describing the relationship between Dartmouth and Muhimbili University has become ever more apt in the years since the program's founding. Not only strong working relationships but friendships, too, have arisen from the collaboration, according to Dr. Kisali Pallangyo, the principal of Muhimbili University College of Health Sciences.

Infected: Although HIV statistics in Tanzania remain daunting—as many as 3.3 million of the country's 36 million residents are infected—DARDAR "holds great promise for growing and serving a community that has been severely affected by the AIDS epidemic," according to Dr. Gary Noel, a 1977 Dartmouth College graduate and one of the founders of FTCA.

Pallangyo agrees. "The future of this collaboration is very promising," he says.

Jennifer Durgin

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