Comprehensive HIV Management in India : A CME Program

[Guest guest]

Comprehensive HIV Management in India : A CME Program

Proposals are invited from the medical associations, hospitals and NGOs for

organising the Continued Medical Education programs on HIV/AIDS in different

parts of India. While hosting the event shall be the responsibility of the

proposing organization/hospital/NGO, the responsibility of the faculty, their

travel and resource material will be the joint responsibility of Peoples Health

Organisation (India) and Unison Medicare & Research Centre, Mumbai. Priority

will be given to those geographic areas that have not yet been covered by such

training programs. Certificate of participation will be given to all the

attendees. There are no fees. Basic background material will be provided to all

the participants. Participants will need to meet the cost of travel to the venue

of CME.

The CME is designed to bring the knowledge and commitment into action in

managing HIV positive patients in resource poor settings like India. The

epidemic in India is rapidly becoming generalized and severe. India has an

estimated 10-12 million people living with HIV/AIDS though the official NACO

estimates are very low ~ 4 million.

Though antiretroviral therapy (ART) has produced a dramatic impact on morbidity

and mortality among people living with HIV infection (PLWHA) in industrialised

countries, the situation in resource-poor settings is grim as only about 10% of

the people with HIV infections know about their status and may be only 10% of

those who know the status have access to HIV care and ART. It is now well

established that the prognosis of the patient depends on the knowledge and

experience of the physician managing HIV disease.

Though these drugs are available at a cheaper price in India, issues such as

when to initiate, choice of regime, quality of counseling and drug adherence

restrict the access to ART. It is not only cost of drugs and their availability;

it is also the patient follow-up protocol and the requisite investigations at

stake.

Adherence to western criteria of requiring three monthly CD4/CD8 count and

Plasma Viral Load tests will surely make us bankrupt besides leaving several

PLWHAs as well as caregivers disillusioned. However appropriate handling of

PLWHA in care-settings, by indigenously modifying monitoring guidelines, drug

combinations and follow-up criteria can increase the affordability range and

help improve the survival of our patients.

The Trainer Organisations:

PHO: After initiating HIV awareness campaign for the first time in India in

1985, People's Health Oreganisation (India) {formerly Indian Health

Organisation}, still remains to be on the forefront of the crusade against

HIV/AIDS. Two-decade old PHO has been among the few organisations responsible

for bringing India on the AIDS control map of the world. Apart from innovative

strategies to create AIDS awareness in India and large coverage of population,

PHO has been championing the cause of fighting against discrimination and human

rights violations of PLWHA. PHO's major strength has been in the targeted

intervention among sex workers, transport workers, students and other at-risk

people and in executing one of the largest and longest running project on

prevention of mother to child HIV transmission (PMTCT). PHO concepts and

projects are internationally acclaimed as the Best Practices; which are

responsible for bringing innumerable admirers and well wishers.

UNISON MEDICARE: Initiated in 1995 on the lines of the Whitman Clinic in

Washington DC and KIS in Munich, Unison Medicare & Research Centre, Mumbai, is

one of the country's few truly comprehensive HIV care clinics. The clinic was

described as the model of care in the resource-poor settings at the XII

International AIDS Conference in Geneva in 1998 and currently manages 3600

HIV/AIDS patients. Even by managing patients at low cost, the HIV mortality has

decreased significantly thanks to availability of Generic ARVs at almost 5 to

10% of the cost of patented ARVs, proper patient selection and comprehensive

holistic management. To decide the management and follow-up schedules, HIV

patients are classified according to socio-economic class and a specially

devised simple classification system.

The HIV Management has been classified into four steps: Supportive; Symptomatic

treatment; Treatment of Opportunistic Infections and ART. Even those patients,

who cannot afford ART, can be managed with the first three steps that increase

life span and improve quality of life substantially. An expensive test like

Plasma Viral Load is dispensed with for most. Intervals between follow-up tests

have been widened. For those, who cannot even afford CD4/CD8, their

near-accurate immunological status is assessed by inexpensive proxy tests like-

Montoux Test, Serum Proteins, Sedimentation rate and Absolute Lymphocyte count.

Mumbai, popularly termed as the AIDS capital of India- both in the problem and

its management, has at least one thing to rejoice - the skills of managing

HIV/AIDS patients and replicating the Mumbai Model of HIV Care is one of the

motto behind this exercise.

Facilitation Experience:

Skills Building workshop- " Building the foundation for advocacy and social

mobilization in resource poor settings " at 14th International AIDS Conference,

Barcelona: 9th July 2002

Workshops arranged for General Practitioner on Management of HIV/AIDS at 11

locations- Amritsar, Ludhiana, Jallandhar, Chandigarh, Faridkot (all in Punjab

state), Kathua (J & K), Jodhpur (Rajasthan), Lucknow (UP), Bhavnagar (Gujarat),

Latur, Jalgaon, Amravati, Nagpur, Pachora and Mumbai (Maharashtra). Collaborated

with 26 workshops on HIV management in India during 2000-2002.

Objectives:

1. To share the knowledge & commitment to improve the quality of life of people

living with HIV/AIDS in India

2. To improve the HIV management skills of private medical practitioners

utilising local resource

Methodology: CMEs will be conducted in a manner; which would enable the

caregivers to understand the limitations in resource poor settings and use more

skills and limited sophisticated tests. HIV experts will deliver lectures on

specific topic of management of HIV infection with special emphasis on

resource-limited settings. Video clippings will be shown to understand the

complexities of HIV-related issues in India; which may then be utilized in

proper patient-selection. The importance of basic inexpensive diagnostic tests

vis-à-vis tests like plasma viral load; CD4/CD8 and their role in staging of the

disease progression would form backbone of the workshop. The specific charts,

treatment algorithms and management protocols will be discussed from the point

of view of local adaptations. The approaches on: when to initiate ART, drug

combinations to use, STI (Structured Treatment Interruptions) etc. would be

discussed. There will be scope for chat with experts, and guidance on setting-up

the HIV Care centre.

Target Audience: Target audience will be persons who are engaged in or going to

enter the field of management of HIV/AIDS patients. We are mainly seeking

involvement of General Medical Practitioners (Family Physicians), General

Physicians, OBGYs, Paediatricians, Neurologists, TB/Chest Physicians.

Maximum number of participants per CME: 100 participants

CME Duration: Ideally 4 to 6 hours

Total CMEs during one year: 40 to 50

Fighting back: " The Third World can't wait for a miracle from developed

countries. AIDS is not only a health issue but a societal & development issue.

To care is a duty. To prevent is a responsibility. Prevention and care are the

twin engines that should drive our effort for the containment of AIDS. "

Late Professor V. Ramalingaswami, India, 1991 VII Intl. AIDS Conf., Florence

Please apply to:

Dr.I.S.Gilada,

Consultant in HIV/AIDS and

Secretary General, PHO

Peoples Health Organisation (India)

Municipal School Bldg., J.J.Hospital Compound, Mumbai-400008

Tel.3719020; 3061616; Fax: 3864433; e-mail: ihoaids@...

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PROFORMA FOR REQUISITION FOR THE CME PROGRAM/WORKSHOP

1.Name of Institute/Organisation

2. Complete Address

Phone Number(s) Fax No.: E-Mail:

3. Director/Chairman/ Secretary/Chief Functionary:

4. What is the most important reason behind your interest in hosting CME?

5. When and Where? (please justify)

6. Estimated audience (break-up, if possible):

7. Duration of program: 2 Hrs./ 4 Hrs./ 6 Hrs./Full day

8. Details of other/local speaker(s)/resource person(s) (if any)

Name of speaker Organisation Topic

Duration

9. Type of audio-visual aid required for your program:

Data Projector/ OHP/ Video system/ Slide Projector/Exhibition

10. What other material and help you except from PHO-UNISON?

Date :

Name (in Block letters):

Designation:

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