ARV Treatment outcomes in North Costal Andhra

[Guest guest]

FACTORS DETERMINING THE PERSISTENCE OF THE VIRUS IN PATIENTS ON

HAART – RESOURCE LIMITED COUNTRY SETTING-A PILOT STUDY.

Dr. Phanender.Ketha, M.D. Nodal Officer for control of AIDS,

Project implementation plan, Phase II, National AIDS Control

Organisation, India., Pulmonologist, Civil Assistant Surgeon,

Government E.S.I. Hospital, Visakhapatnam –5, Andhra Pradesh

(India). E-mail: <drkphane@...>

Background: Due to various social factors, the HAART which is

provided to the patients under the social security schemes, shows

failure.

The factors noted are: At the patient's end, the patient in fear of

the social ostracism, changes the place of residence,get absconded

from the duty or goes on unauthorized absence leading to failure to

contribute money to the social security schemes, illiteracy &

ignorance leading to improper dose and dosage, family withdrawal,

poor health education facilities, social & interfamilial problems

with the spouse, social stigma due to a poor understanding by the

society about the means of transmission of HIV , patient's

inability to access the officers at the work to sort out certain

issues regarding the documentation and the eligibility for medical

benefit.

At the healthcare setting, inadequate contribution of the patient to

the social security scheme makes them ineligible for the medical

benefits, patients come alone to the hospital with great difficulty

without an attendant leading to difficulties in attending the

emergencies, improper provision of the documents required for

obtaining the medical benefit, etc.

A clinical study of the treatment outcomes of Highly Active Anti-

Retroviral Therapy in North Costal Andhra among thirty patients, HIV

infected with low CD4 counts who are on Anti-retroviral therapy for a

period of 1 ½ year, was done.

Material and Methods: Initially screened with rapid test(tridot)

followed by by western blot testing,CD4 counts (flow cytometry)

evaluation and Viral Load estimations (RT PCR), HAART started

appropriately and monitered periodically, evaluated for the results.

Results: Overall results are that there is no mortality, there are

two cases of clinical failure and considering the immunological

failure in whom viral load was done (only 1/3 of the total patients).

66.6% were showing minimal viremia, 33.3% of cases showed viremia

more than 20,000. Viral load done in 9 cases only, out of them 6

patients have viremia less than 20,000, one out of the 6 patients has

undetectable viremia, 3 patients have viremia below 10,000, 2

patients have viremia in between 10,000 and 20,000.

Conclusion: We conclude with guidelines for best practices as well as

recommendations for future research.

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[Guest guest]

Dear Forum,

The observations around treatment failure and potential for drug resistance

are well noted in the report by the good doctor from NACO.

The same degree of failure and resistance impacted on TB patients for many

of the same reasons not the least of which can be economic or unreasonably

complex benefit claiming procedures. Hospitals can be creative because the

repetitiveness of the claiming process whilst mystifying to the individual

will be quite transparent to hospital allied health staff.

Without losing sight of the main objective and that is a decline in

mortality and better prevention we need to work harder at ensuring patients

understand how the medicine works so that they can appreciate the need for

good adherence regimes. Using D.O.T. principles we can be very creative in

helping in this process. Care and Support volunteers can help overcome the

stigma associated with living with the disease and these need to be

cultivated in communities where higher prevalence exists without identifying

individuals.

Dosit boxes can carry medicines required for a week at a time and as well as

serving as a reminder for taking the medicine they also double as an

adherence monitoring device. How many doses did you miss this week? A very

wrong question of course because it infers poor performance and judgement.

Eventually family members can help in the monitoring and D.O.T. processes as

can the use of SMS messaging when personal attendance is restricted.

What we need is creativity to succeed not resignation to failure.

Congratulations for the picture of the results gained from good adherence

practices. Should failure become apparent due to medicine quality this

monitoring will immediately make the problem apparent and regular random

sampling should ensure counterfeit medicine can be readily detected.

Geoffrey

E-mail:<gheaviside@...>