Twelve children among patients on anti-retrovirals at GUM Clinic
Persons should access treatment at onset of symptoms - Dr Ali
Stabroek News
February 3, 2004

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Some 180 people living with HIV/AIDS are currently receiving anti-retroviral treatment at Georgetown Public Hospital Corporation and along with these are six children under 12, including a baby.

Director of the Genito-Urinary Medicine (GUM) Clinic, Dr Michael Ali, said the clinic has been administering treatment to children infected with the virus for a while. He said that as they developed confidence in the treatment, the number of children being placed on it has increased. Children receive the same treatment as adults but it has to be dissolved in liquid. The same criterion used to determine dosage for adults, bodyweight etc, is used for children.

Since the clinic began the treatment programme in 2001 some 37 persons have died. The clinic only administers treatment to those persons who develop signs and symptoms of becoming ill from the virus.

"I wouldn't be too worried about those who just started treatment and they died because they could have been so sick that there was little that could have been done for them. They would have started the treatment too lateā€¦ [when] they are already sick from other complications; that continues to happen," Dr Ali said in a recent interview with Stabroek News.

As a result he encourages those HIV positive persons who are just beginning to develop symptoms to go for treatment early.

"Let's say they start losing weight. They notice rashes on their skins, things like that, diarrhoea, chronic diarrhoea, persistent diarrhoea, persistent coughs, they should come in. And even if they don't see symptoms we would be able to determine it. Sometimes they don't even know they have something. And sometimes they come and the problem they have is so far gone it is quite obvious, they should have come in earlier and we would have checked them..." Dr Ali said.

He added that persons presenting themselves late at the clinic for treatment is a growing problem as it is an indication that persons are not sensitised about the treatment programme or do not go because of the stigma attached to the disease.

Ali said that the patients who die late into their treatment are the ones they have to worry about. "...because we need to determine whether they develop resistance to the drugs and we have to keep that [the resistance to the drug] high because we have patients who could have accessed drug before and they could have been using them improperly. We have patients who have resistant strains of the virus. We have people who are coming back from other countries who are coming back for treatment and they could have resistant strains too..."

He said Guyanese with the virus return from Suriname, Barbados, Trinidad, St Vincent, St Lucia and the US and all go for treatment.

Another reason for persons dying late in the treatment, Dr Ali said, could be as a result of a complication of the treatment. He disclosed that because they are limited in terms of expertise and in terms of their lab work, coupled with the fact that they are not performing post mortem examinations on those who died, means they cannot determine what the persons died from.

"So we can't really determine that this patient died because of this complication of the treatment. Sometimes the person died from a totally unrelated cause to HIV/AIDS."

Their work will get easier when they start CD4 and viral load testing, as from these tests they would be able to determine if a person is resistant to the drug. He said while plans are afoot for the tests to be start, he cannot say when this will happen although he is hoping that it will be within a few months.

Questioned about the record-keeping, Dr Ali said they have records but the record would not have suited the purpose of someone who would have wanted to track the patients and determine their progress by looking for specific signs and symptoms.

"We took care of that by developing a continuous sheet for HIV patients, so those who start developing symptoms we [record] that by ticking what signs and symptoms you have and as time goes by, look at those disappear...

"But I wouldn't say the record-keeping is poor. We have records. I have seen records in Canada and know what record-keeping is like in this country and I think we have very good record-keeping and it is even better than others I know of."

He explained that at the clinic they have all the HIV patients' notes in their charts adding that each patient's chart contains their demographic data and the number of years they have been visiting the clinic among other information.

Their charts are kept in the records area. In terms of electronic data, Dr Ali disclosed that for every patient who visits the clinic, the pertinent information would be entered into a database. This was being done for a few years but Dr Ali said they have improved it to make it more accurate and more reflective of what is happening.

There is also a second database of all the patients on anti-retroviral treatment, but this is not used to follow patients and look at their progress it is simply for reference.

According to Dr Ali the nurses also do their own record keeping.

Everyday there are around two or three persons being put on treatment at the clinic, but Dr Ali actually described this as slow adding that he prefers it this way as if the clinic is flooded it will create more problems for them.

The clinic continues to educate the patients on the drug cocktail they are using and encourage them to adhere to the regulations.

According to Dr Ali treatment is available for patients in Regions Ten, Six, Five and Three and the different hospitals.

The doctors in those regions would have under gone training on how to administer the drug to the patients.

Dr Ali said the number of persons on treatment in the different regions is not quite big because of the stigma. He said patients still travel from those areas to access treatment at the Georgetown clinic.

Guyana started to administer treatment to HIV/AIDS patients in 2002 when the New Guyana Pharmaceutical Company commenced the manufacturing of the drugs.