antiretroviral therapy

{Photo credit: Reavis/MSH, Malawi}Photo credit: Reavis/MSH, Malawi

The World Health Organization (WHO) made waves at the International AIDS Society conference in Kuala Lumpur when it issued revised guidelines for HIV treatment. The new guidelines—WHO’s first major update since 2010—recommend an earlier start to treatment, from a CD4 threshold of 350 cells/mm3 to 500 cells/mm3. While most patients don’t show symptoms of disease at these higher CD4 counts (a measure of immune system strength), the new guidelines responded to evidence that an earlier start improves long-term clinical outcomes and that ARV treatment dramatically reduces patients’ likelihood of transmitting the virus to sexual partners.

Marie Madelaine Thomas receives antiretroviral therapy through an SDSH-supported clinic. Since August 2012, SDSH has provided ART to more than 3,665 individuals.

{Photo credit: MSH, South Africa.}Photo credit: MSH, South Africa.

The prospect that we may see the end of AIDS in our lifetime has never been greater. Over the last decade, the global HIV & AIDS community has achieved stunning successes, including a steady decrease in new HIV cases, a massive scale-up of antiretroviral therapy (ART), and proof that treatment is prevention. As we begin the XIX International AIDS Conference, we are also excited by new scientific advances in prevention and treatment, such as Option B+  for prevention of maternal-to-child transmission (PMTCT). As new possibilities develop, we must also build on the successes of the last decade. Only by "turning the tide together" through the simultaneous pursuit of new possibilities, leveraging of proven interventions for scale and sustainability, and strengthening of health systems overall, can we hope to reach our goal of ending the HIV & AIDS epidemic.

Jessica, David, and Matuet are members of the community, HIV-positive clients, and a key to HIV care and treatment at Masafu Hospital. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

I visited Masafu Hospital in eastern Uganda on a busy Tuesday morning. Tuesdays are antiretroviral therapy (ART) clinic days at this Ugandan facility. Patients come on their designated date for a checkup and to pick up their prescription refill. (Clients get a one month supply of medicines; ideally health workers see the HIV-positive clients once a month to check their health status.)

Three volunteer expert clients --- Jessica, David, and Matuet --- assist the trained health workers on clinic and non-clinic days.

On ART-clinic days, Jessica, David and Matuet organize files, greet patients, inform patients about side effects, educate on prevention methods, support CD4 collection, and communicate with relatives. On non-clinic days, the expert clients reach out to the communities to reduce stigma, inform people about the services available at health centers, and encourage others to know their status.

David explains that he chose to become an expert client because, “I have the challenge too; I want to help others understand HIV better.”

Matuet said, “Other community members don’t want to know their status. I had to stand up.”

Anna outside Kaginima Hospital, eastern Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

“I knew I wanted to be a nurse since I was 10. A woman used to come home to my village in her nurse uniform on the weekends and she was so smart and nice. It was my goal,” said Anna.

Anna finished nursing school and her formal training in 1998 and started working in 1999. In 2000, she began working at Kaginima Hospital in eastern Uganda, where she still works today.

Kaginima Hospital is an expanding facility and uniquely has a lot of space for patients and services. The facility has a surgical theater with two beds and is well stocked with medical supplies. As a private, nonprofit hospital, Kaginima does not receive any support from the Ugandan government. The hospital relies on support from USAID, international organizations, faith-based organizations, and local nongovernmental organizations. They also charge nominal fees for the services directly to patients.

Rabi giving a public awareness lecture on HIV in her locality. {Photo credit: MSH, Nigeria.}Photo credit: MSH, Nigeria.

Rabi gives a public awareness lecture on HIV. (Photo credit: MSH, Nigeria)

Forty-year old Rabi Suleiman lives in Koko Besse area in Kebbi state, Nigeria. She is married without children. Rabi, who now lives with her third husband, recalls that her ordeal with illness and social ostracism began in 2009. Rabi’s three marriages were the result of her inability to conceive, and a continuous search for a partner with whom she could successfully bear children. In the course of her marriages she contracted HIV.

Weakened by continuous infections and emaciated beyond recognition, Rabi recalls that she was abandoned, equated to animal status and locked up in a hut meant for cattle in her family home. Her meals were pushed to her through a door opening by relations who refused to look her in the face.

Today, Rabi has a new story to tell. With the assistance of the Prevention Organizational Systems AIDS Care and Treatment (ProACT) project outreach team, Rabi was enrolled with the USAID-supported ProACT antiretroviral therapy (ART) program in the General Hospital, Koko, late in 2009.

Chinaecherem Nwodo {Photo credit: MSH.}Photo credit: MSH.

Stigmatized, isolated, and conditioned to undertake hard labor, 14 year-old Chinaecherem Nwodo shows that one can overcome the most dire circumstances. Chinaecherem was despised and accused of witchcraft in her community, the Onu-Orie-Obuno-Akpugo village in Nkano West Local Government, Enugu State, Nigeria. Her abusive treatment by community members reflected the challenges facing some children in rural areas of Nigeria.

The community blamed her for her mother’s death and father’s insanity. She was barely two years old when her mother died, and she was abandoned to the care of her sixty-three year-old maternal grandmother. As a teenager, she was traumatized and suffered intense malnourishment. To this day she looks like a 6 year-old girl, though her health has improved.

Yambayoh Magaji (right), a student laboratory technician, works with Garkida General Hospital's HIV Laboratory Focal Person Dahiru Sabo. {Photo credit: MSH.}Photo credit: MSH.

The USAID-supported Prevention Organizational Systems AIDS Care and Treatment (ProACT) project provides HIV & AIDS services to five sites in Adamawa State, Nigeria.

The greatest challenge for ProACT Adamawa has been the fragile health system, particularly in terms of human resources for health (HRH), one of the six building blocks of the health system. The inadequate health workforce in the laboratory affects other components of the health systems, such as: 1) medicines, vaccines and technology, 2) information, 3) governance and leadership, 4) health financing, and 5) service delivery.

The situation in Adamawa was such that one or two laboratory staff members did all the work in the laboratory, including phlebotomy, chemistry, hematology, immunology, malaria and tuberculosis (TB) microscopy. On average, there was a patient/staff ratio of 40:1 on clinic days. This situation applied to all the sites with regard to health workforce in the laboratories.

Blog post updated Dec. 28, 2011.

Aynalem with community outreach worker, Woineshet, in Ethiopia. (MSH)

 

Twenty six year-old Aynalem Bekele has spent her entire life struggling to survive. Left in poverty after her father’s death, Aynalem and her mother baked injera (bread) and washed clothes to afford the rent on their small, dilapidated house in Hawassa, Ethiopia.

In late 2008, Aynalem’s health began to deteriorate leaving her bedridden, unable to work or care for her elderly mother, and struggling to survive yet again.

Yvonise is a good-natured 40-year-old woman with an easy smile. She is mother to four children: two boys and two girls. Her youngest, a little girl, is six years old.

Today, Yvonise sits patiently at the pharmacy of Hôpital Immaculée Conception de Port-de-Paix (HIC Port-de-Paix) in Haiti, waiting for Miss Sevrine, her caregiver, to provide her with a month’s supply of life-saving medicine.

Yvonise is one of 2,200 patients enrolled in the HIV/AIDS program at HIC Port-de-Paix. She was infected years ago with the AIDS virus, but her family does not know. Keeping her secret is a constant burden.

“I tell my kids that I have an infection for which I am being treated,” she said. This is how she justifies her monthly trips to the hospital.

Yvonise knows first hand how important it is for her to keep her appointments. “Since I’ve been coming to the clinic and taking my medication, I’ve been feeling more energetic,” she said, grinning from ear to ear.

Pages

Printer Friendly Version
Subscribe to RSS - antiretroviral therapy