Tremendous benefits anticipated for Caribbean region

A MULTI-million U.S. dollar HIV/AIDS facility, soon to be opened in Bridgetown, Barbados, provides an excellent example of movement on the kind of regional cooperation alluded to in the 2001 Pan-Caribbean Partnership against HIV/AIDS. It also represents an approach towards the ‘improved monitoring of patients’ strongly advocated in the ‘Best Practices’ project tabled at the recent US-CARICOM HIV/AIDS meeting in Georgetown, Guyana.

The facility, `The Lady Mead Referral Unit’ built by the Barbados Government with co-financing by the World Bank, is a technologically advanced and sophisticated state-of-the-art Unit of diagnostic equipment, designed primarily for testing and monitoring HIV patients.

Two Guyanese media workers actively involved in disseminating HIV/AIDS information, were recently taken on a tour of the facility by Director of the Unit, Dr. Akin Abayomi, and Technologist Kelly Carmichael who plays a lead role in its operations. Dr. Abayomi, Haem Oncologist/Consultant Physician and Blood Specialist is also a Lecturer at the University of the West Indies.

According to Dr. Abayomi, at the Unit, patients infected with HIV will be monitored on the basis of two criterion:

** The viral load (the quantity of HIV virus in the body)

** The damage done to the immune system.

There is a direct inter relationship, he outlined, adding: “The more (your viral load), the more damage the immune system has sustained.”

The state-of-the-art equipment used in testing and monitoring persons with the HIV virus.
He said that depending on what is found in the two tests, then the clinicians will decide whether the virus has reached the critical level, and determine if the immune system is still good. In such a case, a newly diagnosed person will be seen every three months for example, and the tests repeated until the critical point is reached.

This means that there will be a decline of the immune system and rise in the virus load.

“It is at this point that we start treatment, and it should reverse the whole process, so the immune system recovers, and the virus load decreases, and that way, we can sustain the patient for several more years, rather that watch the patient go on a progressive decline, to the point of death,” he told the Chronicle.

“And the treatments are getting better, and we have access to a good selection of drugs; we have a lot of choices,” he affirmed, noting that a person with the virus can now live on treatment for as long as 10 years.

`You’ve got to do it properly’
Noting the seriousness of treating persons with HIV with the cocktail of drugs available, he stressed that nothing should be taken for granted.

He cleared the air on misconceptions by many who are of the opinion that as soon as they as diagnosed with the virus, they can safely access and treat themselves with drugs acquired privately without being monitored, once they have access to the money.

“If you are going to treat HIV, you have got to do it properly, otherwise you are going to run into problems with resistance,” Dr. Abayomi stressed.

He stated categorically: “Not every patient tested positive gets treated with the cocktail of drugs or the Highly Active Antiretroviral Therapy (HAART) - usually three drugs.

“We operate within certain international guidelines. We do not start treating until there is a certain amount of virus in the body and the immune system has suffered a certain amount of damage.”

“The reason for this,” he said, “is that we are not sure what the benefit is, to start treating the moment you are diagnosed.”

And this is for several reasons, he explained:

The viruses can develop resistance very quickly.

These drugs have their own side effects.

“So we feel it is best to leave the patients while they remain well, until a certain point before we start treatment and we are hopeful that virus burden in the body will decrease.

Outlining the implications for persons using the cocktails he said: “Someone on a cocktail of treatment could be taking up to 10 or 15 tablets per day, and those may cause stomach upset, disturbance of the liver, disturbance of the fat in the blood. They can also have problems with the heart; it can suppress the bone marrow; it can cause nervousness, loss of sleep. Loss of appetite, skin problems….

“So every drug has side effects, especially when you are taking a whole cocktail,” the Consultant noted.

And commenting on the use of Mother-to-Child Transmission (MTC) drugs being used for the last several months here in Guyana, he said: “There are different protocols, but it’s a tablet which is used, not once for all, but which the expectant mother keeps taking towards the end of the pregnancy.”

Dr. Abayomi, however, cautioned: “We also stop the mother from breast feeding the child, because the virus can go through the milk as well.” He added: “By giving the treatment in the last phase of the pregnancy, we reduce the risk of transmission by up to 60 - 70 per cent in some protocols, so that’s a significant benefit.”

The combination of HIV drugs (cocktails) has been in use for about the last six months under Government prescription in Barbados, and earlier this year, Guyana commenced manufacturing its own antiretroviral pharmaceuticals.

ARV refers to the ‘Antiretrovirals’, a family of different drugs, which reduce HIV growth and replication, or prevent HIV from being properly assembled.

Some of the drugs more commonly used in the Caribbean are AZT and Combivir. AZT (also known as Zidovudine (ZDV) is an antiretroviral drug, which inhibits HIV replication. It is used in the prevention of mother-to-child transmission of HIV. AZT+3TC (also known as Combivir) is a combination of two ARVs and administered in certain regimens to prevent mother-to-child transmission of HIV (e.g. PETRA).

But even though the drugs may now be available in the Caribbean, it is the first time such facility is being established to exclusively test and monitor the viral load on the person’s immune system and how their bodies are reacting to the drugs.

It is here that Barbados can be of immense help to other Caribbean countries in the Region’s concerted fight to stem the dreaded HIV/AIDS epidemic.

Said Dr. Abayomi: “We are looking to be of assistance to all the neighbouring countries in this geographical location of the Caribbean.”

Adding that patients would not necessarily have to travel to the Barbados Centre, he said: “The patients don’t actually have to come, we can provide the Laboratory facilities that they require in the country to help them manage the patients, so they would just need to send the blood samples and we would send back the results with our recommendations, and then the doctors in those countries will now know what drugs to use, and when to use them... That is crucial. If you are going to treat HIV you have to do it properly, otherwise you are going to run into problems…”

Indications are that other Caribbean countries are also interested in the technology. But since such a project is very costly, it is not likely, he said, that the World Bank would support every state to develop such facilities.

“What we would like to do, is to be of service to the Eastern Caribbean, so that we would act like a Referral Centre and offer the facility and investigations to our colleagues in all the other islands all the way down to Guyana…,” he said.

The doctor noted that it is a very expensive process to maintain such a facility, and pointed to the fact that there must be a building, fully computerised equipment, clinical staff: doctors, nurses, technologists, councillors, drugs and reagents as to fight against opportunistic infections.

“Fighting HIV is not going to be cheap on a confrontational approach, but it is going to be cheap in the long run if we are looking at the future,” he said.

Alluding to the developments in Sub-Sahara Africa and India, he said: “If you look at it in the long term, the cost benefits are there, because if we do not do something about it now, then ten years down the line, you are in trouble and would be spending much more.”

The Global AIDS Strategy Framework on HIV/AIDS points out: “Vigorous measures taken now to reduce the rate of HIV infections will pay substantial dividends in years to come in countries with high and law prevalence alike. The strategy stresses that prevention works, adding that large scale prevention programmes in virtually all settings have clearly demonstrated that the spread of HIV can be reduced, especially among young people.”

Keeping the virus under control
The Consultant disclosed that at the Lady Mead Centre, they will also be introducing some new therapies.

“The whole idea is to make society conscious about this HIV/AIDS problem, he commented.

Another benefit accruing from the facility he said, is that in the process of treating people, you reduce their risk of transmission.

“We are trying to break the transmission cycle as far as possible. So by treating the patient, we are making him less infective. At the same time, we are also counselling and educating them about safety to community, hoping that this whole effort is going to keep the virus under control.”

The facility, which is due to be declared open soon, is to be run initially by a five-man team of technical personnel headed by Dr. Abayomi. Three members of staff have just completed a period of training in Miami and two others are soon to proceed.

“By the end of June, we should be fully functional,” he stated.

Under the Expanded HIV Programme in Barbados, which seeks to incorporate the involvement of several Ministries and agencies, the programme is achieving considerable success. AIDS Programme Coordinator, Ms. Sade Leon-Slinger, is impressed with the impact the programme has been making in its efforts at educating and sensitising citizens, as well as getting persons to come forward voluntarily to be tested and counselled.

At a National Health Extravaganza held at Queens Park on Mothers Day, by 16:00 hours, some 170 persons had taken tests at the HIV/AIDS tent on the ground. One advantage is that confidentiality is assured. Those tested were given cards bearing a code number so as to preserve their anonymity and advised of a date to visit the clinic to uplift their results. Only code numbers were used.

At the recent US-CARICOM HIV/AIDS meeting in Guyana, Prime Minister of St. Kitts and Nevis, Dr. Denzil Douglas said it was important for Caribbean countries to stem the incidence of the disease here through the use of official health facilities with well staffed and equipped laboratories. He expressed concern about the widening gap between resources available and resources required, adding that: “The widening technological gap is creating inequalities in access to ‘quality’ care.”