HIV TREATMENT, CARE & SUPPORT =
HIV no longer a Death Sentence
| Current HIV and AIDS Treatment Centres in Trinidad & Tobago - Adults |
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| Medical Research Foundation #7 Queens Park East. Port of Spain Tel: 1 (868) 623 5843, 625 8512, 627 9923 |
| Ward 04 - San Fernando General Hospital Ward 02 - Drop-in Centre Hours: 8:00 am - 12:00 noon |
| Caribbean Medical Centre - CMC AIDS Counselling Centre #5 Queens Park East. Port of Spain Tel: 1 (868) 625 1643 |
| Tobago Health Promotion Clinic Calder Hall Road Scarborough . Tobago Tel: 660 7872 Hours: 9:00 am - 2:00 pm |
| Current HIV and AIDS Treatment Centres in Trinidad & Tobago - Children |
| Cyril Ross Nursery #7 El Dorado Road. Tunapuna Tel: 1 (868) 662 8975 |
| Scarborough Regional Hospital, Tobago Tel: 1 (686) 639 2551 - 6 Ref: Dr. Gillian Wheeler |
| Eric Williams Medical Science Complex Paediatric / Children’s Hospital Tel: 1 (868) 645 2640. Ext: 3717 |
| Counselling, Care and Support Services for persons living with HIV and AIDS, in Trinidad & Tobago. |
| Caribbean Medical Centre - CMC AIDS Counselling Centre #5 Queens Park East. Port of Spain Tel: 1 (868) 625 1643 |
| South AIDS Support #25 Victoria West, Paradise Pasture San Fernando (next to PSA) Tel: 1 (868) 625 AIDS (2437) |
| Community Action Resource - CARe # 25 Norfolk St. Belmont . Port of Spain Tel: 1 (868) 624 0632 |
| Tobago AIDS Society Room 14 Fairfield Complex, Bacolet Street Scarborough. Tobago Tel: 1 (868) 635 1024. |
| Cyril Ross Nursery - Children and Families #7 El Dorado Road. Tunapuna Tel: 1 (868) 662 8975 |
| Tobago Oasis Foundation 1st Floor Phillips Plaza Burnett Street, Scarborough. Tobago Tel: 1 (868) 635 1088 / 1089 |
| Family First Foundation - Children, Families and Youth at-risk 170 Calder Hall Road Tel: 1 (868) 639 2286, 631 2273 (I CARE) |
| The National AIDS Hotline Tel: 1 (868) 625 2437 |
The HIV and AIDS pandemic is the greatest scourge to mankind and has already killed more people than previous wars and plagues put together. It is no longer just a public health problem but a socio-economic one which if not controlled will lead to a significant loss of live in every community and country throughout the planet. Like many governments, ours in Trinidad & Tobago decided to mount an action plan to stem the onslaught of the disease for which the T&T National Strategic Plan was developed in 2002; launched in 2003 for a period of five years; and managed under the National AIDS Coordination Committee to oversee its following priority areas:
- Prevention and Education etc.
- Care Treatment and Support
- Research and Surveillance
- Advocacy and Legislation
- Monitoring and Evaluation
Since 2003 much work has being done in areas 1 and 2 and as my interest is mainly Priority 2, which I will discusses what we have being doing in this area.
The Ward 02 at the San Fernando General Hospital is the focal point of HIV/ AIDS treatment and care, with the South West Regional Health Authority (SWRHA). Its origins stemmed as the former infectious disease ward when common infectious diseases such as Diphtheria and Mumps were prevalent. With the decrease of these diseases and the rise and increase of HIV and AIDS, Dr. Adoo a Nigerian doctor felt the need of admitting patients with AIDS, so that they could get tender loving care and die with dignity. It is a pity that he died before the advent, availability and public access of Antiretrovirals (ARVs) in Trinidad & Tobago. WARD 02 is referred to as the Dr. Adoo Ward in commemoration and carrying forward of the great work he started.
Today, Ward 02 is dedicated to the Treatment, Care and Support for persons living with HIV and AIDS. Our main source of patient / client referrals stem from Sexually Transmitted Infection (STI) clinics situated at Ward 17, Couva Health Facility , Princes Town Health Facility, Point Fortin Health Centre, Siparia Health Centre and Rio Claro Health Centre which are also called Voluntary, Counselling and Testing (VCT) centres.
Ward 02 also serves as a VCT centre as we do not turn away any person who walks-in and requests for a HIV test. Such persons are served at our out-patient clinic, which is open from Monday to Friday between 8:00 am - 12:00 noon. When an individual first attends our clinic a private and confidential history is taken and a physical examination done with the following essential investigations:
- Chest X ray.
- Mantoux test - to rule out Tuberculosis which is more prevalent with HIV rising infections and if positive would necessitate referral to the chest clinic for expert treatment.
- Routine blood testing - which will help us to make an initial assessment of the individual for one of two main categories according to the World Health Organisation (WHO) classification as follows:
1. HIV/ AIDS asymptomatic
This refers to persons who show no signs or symptoms indicating any AIDS related opportunistic infections and would not be put on treatment (ARVs) until we do a CD4 count and Viral Load test which are conducted once a week at our centre. Asymptomatic persons are only put on ARVs if their CD4 count is below 200 cells. Otherwise they are counselled with no Antiretroviral Treatment (ART) until it becomes necessary. Patient CD4 and Viral loads are usually done once in six months unless their condition warrants earlier testing. Currently, out of our 500 patients about 10 are not on ART.
2. HIV/AIDS symptomatic
Symptomatic patients have lost weight with diarrhoea, chronic cough and oral thrush that we will immediately start on ART, without waiting for a CD4 count. Our standard first line treatment is Combivir (AZT/3TC) and Stocrin. We are conforming for the triple therapy as we have had good results with these drugs and only change them because of reported side effects. They all cause nausea and vomiting at times and occasionally skin rashes. 3TC is the least troublesome but AZT can cause severe Anaemia, so low that patients have to have blood transfusions. In these cases AZT is stopped and never to be repeated. It is usually substituted by Stavudine (D4T) which can cause pain in the peripheral limbs which is called peripheral neuropathy, and also will be under consideration for a change if the pain is unbearable. Because of our small armamentarium of ARV's (8 drugs) we are restricted in our combination and would have to change for other type of ARV's, a protease inhibitor, namely Crixivan or Kaletra.. Stocrin's main side effect is sleeplessness due to nightmares and heaviness of the head, and we usually replace it with Nevirpine. It is also important to know that anyone on psychiatric medications or having a pregnancy should avoid Stocrin. Nevirpine has to be used with care because it can cause a skin rash and liver toxicity. Crixivan & Kaletra can cause kidney stone formation and hyperlipidaemia and the onset of Diabetes. Together with AZT this drug can cause Lypodistrophy and has to be taken with a fat free diet.
Because of the virus's uncanny ability to mutate and change into resistance forms there is difficulty in treatment management which necessitates, 95% of adherence for the drug regime or else resistance will develop against the drugs and we would have to use different combinations for which we are sorely limited. Of great help will be resistance testing which is not done in Trinidad but in developed countries in which at the very first visit where it is done the best ART combination could be identified and started.
Counselling by the Ward 02 staff is an on-going process which helps us to assist our patients with the psychosocial aspect of the disease. Support is also provided by South AIDS Support (SAS), a Non-governmental Organisation (NGO) based in San Fernando that provides a drop-in centre for persons living with HIV and AIDS (PLWHAs). The ward is also involved with South AIDS Support's voluntary, counselling and testing programs (VCT), conducted at special HIV/AIDS annual public events such World AIDS Day and Candlelight Memorial celebrations.
At our in-patient at Ward 02, the 5 beds we possess are usually filled with the referrals from the general medical wards where these patients have being admitted through the emergency department and found out to be HIV/ AIDS positive. Apart from full blown AIDS, patients who come in late for treatment are usually from transferrals mainly due to opportunistic infections such as Toxoplasmosis (PCP).
Another source of HIV positive patient referral to our clinic is through the Preventing Mother to Child Transmission programme (PMTCT), where HIV positive mothers are sent us in early pregnancy for monitoring of CD4 and Viral loads and if necessary for treatment. We have been successful in our PMTCT program for the past three years in not having any HIV positive newborn infants (neonates). However we do get children who are HIV positive who were born before the program started or because their mothers defaulted from the program. We have about 20 children in our clinic where they are seen in conjunction with the paediatrician. Other sources of the potential patients are through the post exposure prophylaxes program (PEP); and sexual assault cases for which the Ward 02 doctors are on call for 24 hours. Thus far, we have had no positive cases through this program.
With all of these progressive developments and access to ART in Trinidad, there are still many barriers and challenges ahead of us in providing a comprehensive National HIV/AIDS Treatment, Care and Support Programme. To bring back our reader to reality and the dire state of affairs I wish to state - we estimate about 25,000 plus patients in north Trinidad and only 3,000 are being reached and under treatment; and in south Trinidad we have only 500 patients on treatment with estimates of about 6,000 plus likely to be HIV positive. Unfortunately, although during the past decades we have come to know the cause of the disease, the way the virus is spread (modes of the transmission) and best prevention methods - we have not being able to stem the onslaught of the pandemic through fear, superstition and myths, ignorance and most importantly stigma and discrimination. Twenty five years ago there were only half a million known cases throughout our planet. Now there are over 50 million infected cases, 25 million deaths and 75,000 orphans due to death of both parents due to AIDS. Our biggest challenges ahead are getting people to come forward and get HIV tested; providing treatment to those in need; and teaching everyone to change their attitude about sex and sexual behaviours.
Dr. R. Mohammed
Ward 02. San Fernando General Hospital
Specifically written for FRee FORUM. All rights reserved.
MSMNPA Research. November 2006.
