Saturday 24 January 2009

An informed community is a strong community

There's no doubt that the anti-HIV drugs that have been available in Indonesia for several years now have made an immense difference in our community. It used to be that six months or a year after we held any meeting, at least one third of the participants had died. Continuity was almost impossible, because the faces were always changing.

Now it's very different. In some cases, meetings have become 'same old, same old', almost no new faces, just the 'old guard', who are indeed growing older - and broader round the waist!

But how long will this last? There are a number of red flags. Perhaps the greatest threat will be caused by the high prevalence of viral hepatitis co-infection among those with HIV in Indonesia - I'll return to this some other time.

The other red flag should be more controllable: poor adherence to antiretroviral therapy (ART) and high dropout rates - at the last official report, over 10%. I'm frequently told that adherence is being monitored and is high, but I see few signs of effective monitoring, but more signs that adherence is beginning to drop. Why?

Of course, there are many reasons. But among them are lack of information and inadequate community involvement. With these two points in mind, we place considerable emphasis on what we call 'treatment educator training.' This is carried out mainly by the community for members of peer support groups. I've just carried out such training in Jogjakarta, with 15 participants from five groups. In this basic three to four day course, we talk about how HIV replicates, how ART inhibits this replication, why resistance to the drugs occurs, and how this can be prevented by adherence of more than 95%. We also discuss our role in informing our community and helping those on treatment to achieve, and more important, to sustain this high rate of adherence.

It is accepted here that doctors have at most five to ten minutes per patient. Clearly this offers no time to address adherence, let alone to assess its level. In any case, this task is probably best carried out by the peers, who are themselves on therapy. So ensuring that this community are informed is crucial...

Babé

No comments: