Transcript Managing patient infected with HIV in a Government health

Managing patient infected with HIV in a
Government health Clinic – Six years
experience
Dr. Norsiah Ali PMC
MD(USM),MMed (UM)
Family Medicine Specialist,
Tampin Health Clinic, Tampin, N. Sembilan,Malaysia
@ Fellowship Community Addiction Medicine
Department of General Practice
Monash University, Victoria
TAMPIN HEALTH CLINIC
Location, Population coverage, Daily attendances, Staff, Activities…
Introduction
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HIV infection has caused a lot of sufferings and
thousands has died.
In Malaysia, it has spread tremendously to
both urban and rural populations since it was
first identified and mainly related to drug
addiction.
The pool for drug addiction in Malaysia is
mainly in some pockets in urban areas and
villages particularly FELDA areas.
Currently the majority of clinics providing
treatment to HIV infected patients are located
in urban area. Therefore there is a need to
provide care accessible to patient.
FELDA (Federal Land
Development Authority)
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308 areas
500 families per area
Settlers are mainly
from poor
socioeconomic and
low education status
History of HIV service
in Tampin Health Clinic
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First started in 2001 after FMS attended a course
conducted by the AIDS Division Ministry of Health.
Integrate with other illnesses
1st case: 52 yrs old man
Initial years: Counseling sessions, Symptomatic Rx,
prophylaxis against PCP….many died.
2004: 6 patients referred for HAART ( 3 KL Hosp, 3
Seremban Hosp)
April 2005 : FMS attached to ID Clinic GHKL for 2
weeks
July 2005 : HAART initiated in Tampin Health Clinic
Clinic session
Registed patients
Year
New registration
Cumulative number
2001
4
4
2002
7
11
2003
5
16
2004
11
27
2005
21
48
2006
49
97
30th
March
2007
21
118
How patients are
captured ( N=118 )
90
80.6
80
Percentage
70
60
50
40
30
16.1
20
10
3.2
0
walk in
P.Serenti
Source of referal
Tampin Hosp
Health Forum in FELDA
area
Collaboration with other agencies….National
Drug Agency, Police Dept, Drug Rehab Centre,
Community Leaders etc.
Sociodemography
a.
Gender:
Male – 109 (92.4%)
Female – 9 (7.6%)
b. Ethnic group
Malay- 98 ( 83 %)
Chinese – 6 ( 5 %)
Indian – 14 (12%)
Age distribution
40
37.1
35
Percentage
30
25
21
20
12.9
15
10
5
6.5
1.6
1.6
0-9
10_20
0
20-29
30-39
Age ( yrs )
40-49
50-59
Risk factors & Stage when first came to clinic
22%
1%
40%
60%
77%
IVDU Heterosex Vertical
Asymptomatic
AIDS
Co-infections & ADI (N=118)
80
70.3
70
Percentage
Percentage
60
50
40
30
20
12.7
10
2.5
0
18
16
14
12
10
16.9
12
8
6
4
2
0
2.5
TB
Hep C
Hep B
Co-infections
11
PCP
CMV
Syphillis
ADIs
3.3
Cancer
Oral
candidiasis
Outcome after 6/12 on ARV (N=32)
Indicator
Percentage
Subjective feeling of general
well being
100%
Weight gain
80%
Increment in CD4 vs
baseline
100%
Viral load < 50 copies at 6
mth
Comply to Rx and F/up
100% ( out of 15 )
100% (Out of 28: 2 transfer
out, 2 passed away)
an interactive session with
infected patients
Difficulties
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To ensure patient comply to treatment and
f/up.
Need to regularly keep track with patient’s
attendance and serial counseling.
Lack of manpower
Delay in getting lab result (Hep C, CD 4 )
Not many can afford Hep C treatment
Relapse to drug addiction – Methadone
Involve with police case
Conclusion
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HIV Clinic can be conducted in a primary
care clinic
Need to have good liaison with ID physician
Collaboration with other agencies and
community
Dedicated and motivated staff
Good support services ( laboratory,
counseling sessions etc )
Careful selection of patients for HAART