title: Challenges facing HIV treatment in Guinea-Bissau: the benefits of international research collaborations.
abstract: OBJECTIVE
  The introduction of antiretroviral therapy (ART) for HIV infection in sub-Saharan Africa has improved the quality of life of millions of people and reduced mortality. However, substantial problems with the infrastructure for ART delivery remain.
  
  
  METHODS
  Clinicians and researchers at an HIV clinic in Guinea-Bissau identified problems with the delivery of ART by establishing a clinical database and by collaborating with international researchers.
  
  
  METHODS
  The Bissau HIV cohort study group was established in 2007 as a collaboration between local HIV physicians and international HIV researchers. Patients were recruited from the HIV clinic at the country's main hospital in the capital Bissau.
  
  
  RESULTS
  Between 2005 and 2013, 5514 HIV-positive patients were treated at the clinic. Working together, local health-care workers and international researchers identified the main problems affecting ART delivery: inadequate drug supply; loss of patients to follow-up; and inadequate laboratory services. Solutions to these problems were devised. The collaborations encouraged local physicians to start their own research projects to find possible solutions to problems at the clinic.
  
  
  CONCLUSIONS
  The HIV clinic in Bissau faced numerous obstacles in delivering ART at a sufficiently high quality and patients' lives were put in jeopardy. The effectiveness of ART could be enhanced by delivering it as part of an international research collaboration since such collaborations can help identify problems, find solutions and increase the capacity of the health-care system.
authors.affiliation: Projecto de Saúde de Bandim, INDEPTH Network, Apertado 861, 1004 Bissau Codex, Guinea-Bissau .
authors.forename: Sanne
authors.initials: S
authors.lastname: Jespersen
authors.affiliation: Projecto de Saúde de Bandim, INDEPTH Network, Apertado 861, 1004 Bissau Codex, Guinea-Bissau .
authors.forename: Bo Langhoff
authors.initials: BL
authors.lastname: Hønge
authors.affiliation: Projecto de Saúde de Bandim, INDEPTH Network, Apertado 861, 1004 Bissau Codex, Guinea-Bissau .
authors.forename: Inés
authors.initials: I
authors.lastname: Oliveira
authors.affiliation: National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau .
authors.forename: Candida
authors.initials: C
authors.lastname: Medina
authors.affiliation: National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau .
authors.forename: David
authors.initials: D
authors.lastname: da Silva Té
authors.affiliation: National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau .
authors.forename: Faustino Gomes
authors.initials: FG
authors.lastname: Correia
authors.affiliation: National Public Health Laboratory, Bissau, Guinea-Bissau .
authors.forename: Zacarias José
authors.initials: ZJ
authors.lastname: da Silva
authors.affiliation: Department of Clinical Immunology, Aarhus University Hospital, Denmark .
authors.forename: Christian
authors.initials: C
authors.lastname: Erikstrup
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark .
authors.forename: Lars
authors.initials: L
authors.lastname: Østergaard
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark .
authors.forename: Alex Lund
authors.initials: AL
authors.lastname: Laursen
authors.affiliation: GloHAU, Center for Global Health, Aarhus University, Denmark .
authors.forename: Christian
authors.initials: C
authors.lastname: Wejse
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000600:supply & distribution*; D015331:Cohort Studies; D003151:Community Health Centers; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006169:Guinea-Bissau; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D012106:Research
chemical_list: D044966:Anti-Retroviral Agents