Adherence – a major challenge to clinically managing HIV patients

Clinical Care Coordinator for HIV/AIDS, Dr. Maria Pereira has revealed that adherence to taking medication continues to pose a huge challenge to the holistic management and care of patients with HIV and AIDS in Antigua and Barbuda.
Dr. Pereira, who has been managing the national HIV and AIDS Care and Treatment programme since 2013, said that taking the medication as prescribed is crucial to ensuring that patients maintain better health.
“Sometimes the HIV medication can be taken once a day, sometimes it’s twice a day, but some persons go through a stage of being fed up of taking the medication. They get medication burn out, so they always need a lot of counselling and encouragement.”
She shared a number of issues that could lead to patients with HIV becoming tardy in taking their pills.
 “There could a situation where they don’t have privacy to hide their medication – they might stop taking it. If they come to the clinic and people are there that they know they might turn back, so they won’t get their medication. If they fall out with a staff member. They might decide they would stop taking the medication; they may get depressed, tired. All these factors can affect people taking their medication,” Dr. Pereira explained.
However, she spoke of a management strategy that has been employed to help persons cope with the routine that has to be done for life.
“We check to see how often they go to the pharmacy for the medication which is only filled at MSJMC Pharmacy and it’s given for a certain number of months.”
She continued, “If they haven’t come, we call them to find out what’s the problem and try and see how we can help and encourage them to continue with their medication, so we have that system in place.”
She said other strategies which are used to develop a culture of taking their medication; this includes getting a pill box to put out their medication for the week or setting the alarm on their phones.
Dr. Pereira said that the message of prevention and treatment has been touted for years but she questions whether people are doing what they are supposed to be doing.
“It’s one thing to have the information in your head, but it’s quite another thing to actually do it. What we have to continue to do is a lot of education, so we go to the schools. We start at the secondary
level and we really need the students to understand their risks and what they have to do to prevent this disease. We also get the churches involved and the AIDS Secretariat goes out to various activities and hosts various testing exercises.”
She said as carnival quickly approaches, the secretariat is getting ready to share even more information and condoms will be available for distribution.
According to the World Health Organisation (WHO), Antigua and Barbuda and other countries should be aiming for what is termed “90/90/90”.
 “Ninety percent of persons with HIV should know their status, 90 percent should be in care and treatment and 90 percent should have zero viral load.”
Patients with HIV who are virally suppressed would not normally pass on the virus to another person as undetectable – untransmittable. However, she urged everyone to always use a condom.
With regards to the WHO’s 90/90/90 Initiative, Dr. Pereira noted that although 70 percent of the population here in Antigua and Barbuda may know their status, the balance who don’t may be spreading the disease unknowingly.
About 1,200 people were diagnosed as HIV positive over the last 30 years, with about 300 now deceased.
“So we have about 900 and 300 of that number are in care and treatment and some are still in denial, afraid or have died, so there is still that gap we have to deal with.”
Once the person tests positive, according to the HIV and AIDS Clinical Care Coordinator, it’s now standard practice to begin treatment right away, no matter the CD4 count. This was not the case before as the CD4 count had to be below a certain level to commence treatment.
This latest practice has proven to extend the life span and helps to prevent many people from reaching AIDS stage.
There are four stages of HIV/ and AIDS. Stage One is when the person is diagnosed, and they might not have any symptoms. Stage Two is when the patient gets wart and respiratory tract infections and experience weight loss. In the third stage of the disease, serious infections will occur and stage 4 is full blown AIDS with cancers and other diseases setting in, causing the patient not to function in society. Nutritional support, she said, is also crucial in managing HIV.
Asked about the age range of people affected by the disease, she said it’s usually people between 15 and 40 who are most vulnerable, but it has been observed that
people 60 and over are now coming in who are HIV positive.
“It could be that they contracted it years ago and they are now coming in the late stage. This is a challenge because the immune system in this older group of persons is already older or compromised and if they don’t take their medication, they can have some serious difficulties. More men are coming in than females. Once the person has entered the programme, we keep a close eye on them. Also it could be that older men don’t like to use condoms for whatever reason so the risks increase or that the education was not known or adhered to.”
Dr. Pereira is pleading with people who are positive to access treatment with medication which is being provided by the Global Fund and the government of Antigua and Barbuda.
“Once persons take their medication, they can live a normal life; they can go to work and be productive in various aspects of life.”
She pointed out that although this is the 21st century, there is still a problem with stigma and discrimination regarding HIV positive people, but it is not as bad as years ago.  She said it now boils down to some HIV-infected people getting a nasty comment or a look, rather than being physically ridiculed as years gone by.
“I am appealing to persons to stop the stigma and discrimination; it’s not worth it. All of us are God’s children despite our preferences or lifestyles,” Dr. Pereira concluded.