Managing patient infected with HIV Managing patient infected with HIV in a Government health Clinic – Six in a Government health Clinic – Six

years experienceyears experience

Dr. Norsiah Ali PMCDr. Norsiah Ali PMCMD(USM),MMed (UM)MD(USM),MMed (UM)

Family Medicine Specialist,Family Medicine Specialist,Tampin Health Clinic, Tampin, N. Sembilan,MalaysiaTampin Health Clinic, Tampin, N. Sembilan,Malaysia

@ Fellowship Community Addiction Medicine@ Fellowship Community Addiction MedicineDepartment of General PracticeDepartment of General Practice

Monash University, VictoriaMonash University, Victoria

TAMPIN HEALTH CLINICTAMPIN HEALTH CLINIC

Location, Population coverage, Daily attendances, Staff, Activities…

IntroductionIntroduction HIV infection has caused a lot of HIV infection has caused a lot of

sufferings and thousands has died.sufferings and thousands has died. In Malaysia, it has spread tremendously In Malaysia, it has spread tremendously

to both urban and rural populations since to both urban and rural populations since it was first identified and mainly related it was first identified and mainly related to drug addiction.to drug addiction.

The pool for drug addiction in Malaysia is The pool for drug addiction in Malaysia is mainly in some pockets in urban areas mainly in some pockets in urban areas and villages particularly FELDA areas.and villages particularly FELDA areas.

Currently the majority of clinics providing Currently the majority of clinics providing treatment to HIV infected patients are treatment to HIV infected patients are located in urban area. Therefore there is located in urban area. Therefore there is a need to provide care accessible to a need to provide care accessible to patient. patient.

FELDA (Federal Land FELDA (Federal Land Development Authority)Development Authority)

308 areas 308 areas 500 families per 500 families per

areaarea Settlers are Settlers are

mainly from poor mainly from poor socioeconomic socioeconomic and low education and low education statusstatus

History of HIV serviceHistory of HIV servicein Tampin Health Clinicin Tampin Health Clinic First started in 2001 after FMS attended a First started in 2001 after FMS attended a

course conducted by the AIDS Division Ministry course conducted by the AIDS Division Ministry of Health.of Health.

Integrate with other illnessesIntegrate with other illnesses 11stst case: 52 yrs old man case: 52 yrs old man Initial years: Counseling sessions, Symptomatic Initial years: Counseling sessions, Symptomatic

Rx, prophylaxis against PCP….many died.Rx, prophylaxis against PCP….many died. 2004: 6 patients referred for HAART ( 3 KL Hosp, 2004: 6 patients referred for HAART ( 3 KL Hosp,

3 Seremban Hosp)3 Seremban Hosp) April 2005 : FMS attached to ID Clinic GHKL for 2 April 2005 : FMS attached to ID Clinic GHKL for 2

weeksweeks July 2005 : HAART initiated in Tampin Health July 2005 : HAART initiated in Tampin Health

ClinicClinic

Clinic sessionClinic session

Registed patientsRegisted patients YearYear New registrationNew registration Cumulative Cumulative

numbernumber

20012001 44 44

20022002 77 1111

20032003 55 1616

20042004 1111 2727

20052005 2121 4848

20062006 4949 97973030thth

March March 20072007

2121 118118

How patients are How patients are captured ( N=118 )captured ( N=118 )

80.6

16.1

3.2

0

10

20

30

40

50

60

70

80

90

walk in P.Serenti Tampin Hosp

Source of referal

Per

cent

age

Health Forum in FELDA Health Forum in FELDA areaarea

Collaboration with other Collaboration with other agencies….National Drug Agency, Police agencies….National Drug Agency, Police Dept, Drug Rehab Centre, Community Dept, Drug Rehab Centre, Community Leaders etc.Leaders etc.

SociodemographySociodemography

a.a. Gender:Gender:

Male – 109 (92.4%)Male – 109 (92.4%)

Female – 9 (7.6%)Female – 9 (7.6%)

b. Ethnic groupb. Ethnic group

Malay- 98 ( 83 %)Malay- 98 ( 83 %)

Chinese – 6 ( 5 %)Chinese – 6 ( 5 %)

Indian – 14 (12%)Indian – 14 (12%)

Age distributionAge distribution

1.6 1.6

21

37.1

12.9

6.5

0

5

10

15

20

25

30

35

40

0-9 10_20 20-29 30-39 40-49 50-59

Age ( yrs )

Per

cen

tag

e

Risk factors & Stage when first came to Risk factors & Stage when first came to clinicclinic

77%

22%1%

IVDU Heterosex Vertical

60%

40%

Asymptomatic

AIDS

Co-infections & ADI (N=118)Co-infections & ADI (N=118)

1211

2.53.3

16.9

0

2

4

6

8

10

12

14

16

18

TB PCP CMV Cancer Oralcandidiasis

ADIs

Perc

entag

e

70.3

12.7

2.5

0

10

20

30

40

50

60

70

80

Hep C Hep B Syphillis

Co-infections

Perce

ntage

Outcome after 6/12 on ARV Outcome after 6/12 on ARV (N=32)(N=32)

IndicatorIndicator PercentagePercentageSubjective feeling of Subjective feeling of general well beinggeneral well being

100%100%

Weight gainWeight gain 80%80%

Increment in CD4 vs Increment in CD4 vs baselinebaseline

100%100%

Viral load < 50 copies at Viral load < 50 copies at 6 mth6 mth

100% ( out of 15 )100% ( out of 15 )

Comply to Rx and F/upComply to Rx and F/up 100% (Out of 28: 2 100% (Out of 28: 2 transfer out, 2 passed transfer out, 2 passed

away)away)

an interactive session with an interactive session with infected patientsinfected patients

DifficultiesDifficulties

To ensure patient comply to treatment To ensure patient comply to treatment and f/up. and f/up.

Need to regularly keep track with Need to regularly keep track with patient’s attendance and serial patient’s attendance and serial counseling.counseling.

Lack of manpowerLack of manpower Delay in getting lab result (Hep C, CD 4 )Delay in getting lab result (Hep C, CD 4 ) Not many can afford Hep C treatmentNot many can afford Hep C treatment Relapse to drug addiction – MethadoneRelapse to drug addiction – Methadone Involve with police caseInvolve with police case

ConclusionConclusion

HIV Clinic can be conducted in a primary HIV Clinic can be conducted in a primary care cliniccare clinic

Need to have good liaison with ID Need to have good liaison with ID physicianphysician

Collaboration with other agencies and Collaboration with other agencies and communitycommunity

Dedicated and motivated staffDedicated and motivated staff Good support services ( laboratory, Good support services ( laboratory,

counseling sessions etc )counseling sessions etc ) Careful selection of patients for HAARTCareful selection of patients for HAART