February 2002 Insights
Health Issue #2
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Local solutions
The role of district hospitals
Antiretroviral
drugs (ARVs) are available for people with HIV/AIDS at certain specialist
centres in developing countries. In Thailand, generic drug production
is growing rapidly and prices have fallen by 80 percent over two years.
But most patients are poor and cannot get to specialist centres. For
wider access, district hospitals must play a role.
Médecins
Sans Frontières are conducting operational research in Thailand
with long-standing partners: the Thai Network of People living with
HIV/AIDS and the Bang Kruai and Ban Laem District Hospitals. 88 adults
and children have started three-drug ART treatment at these hospitals.
Most have advanced disease. In the first six months of treatment, nearly
all saw an improvement in their CD4 cell count.
Discussions revealed
that district hospital staff are keen to provide ARV in order to:
- improve services
for patients
- increase their
own knowledge and potential
- prevent new HIV
infections
- enhance their
hospital's reputation
- re-frame AIDS
as a 'normal' disease.
But will increased
availability of treatment encourage unsafe sex? Some centres in developing
countries refuse to treat patients thought to have high-risk behaviour.
Health workers here feel that they could advise patients on reducing
risky behaviour. If 'high-risk' patients are excluded from treatment,
this opportunity will be lost. Another concern of health workers is
the potential for conflict if drug supplies are limited.
Seven patients in
the study developed serious drug side-effects, requiring a change in
treatment. However, milder side-effects, such as nausea, diarrhoea,
headache and muscle pains, often improve within two to four weeks of
starting treatment. Adherence can be improved by educating patients
about side-effects and developing a plan to help them cope. Where possible,
this should include peer support from other people with HIV/AIDS.
The researchers
conclude that:
- District hospitals
can manage ARV treatment and most patients will benefit.
- Enrolment should
be based on medical rather than social or behavioural criteria.
- Alternative ARVs
must be supplied for patients who develop serious side-effects. Hospitals
need clear guidelines on dealing with these problems.
- Education and
peer support, particularly relating to side-effects, can help patients
adhere to treatment.
David Wilson
Médecins Sans Frontières in Thailand
311 Ladphrao 101
Wangtonglarng
Bangkok 10240
Thailand
T: +66 2375 6491
F: +66 2374 9835
msfbthai@ksc.th.com
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