IN 2002, efforts to intensify HIV treatment in Guyana were made possible with the introduction of antiretrovirals (ART) as a key factor to be used by health care providers in delivering care to patients living with HIV.
This was followed by additional developments to ensure the best care is provided to patients with the introduction of guidelines for standardized management of adults and children with HIV infections and the introduction of immunological testing through CD4.
This effort was further expanded yesterday with the launch and institutionalisation of the HIV Drug Resistance (HIVDR) Monitoring programme which makes it part of the health system. Guyana is the first in the Caribbean and Latin America to introduce such an initiative and is a collaborative effort between the Health Ministry and the Pan American Health Organisation/ World Health Organisation (PAHO/WHO).
Health Minister, Dr. Leslie Ramsammy, in his presentation illustrated that as the first country in the Caribbean and Latin America to institutionalize the drug resistance programme, it is hoped that other countries will follow.
“This is a step forward that demonstrates how comprehensive Guyana’s diagnostic and treatment programme is. It underlines the fact that we are not willing to stand still but constantly assess and expand the programme so that it remains a world class programme,” he said.
He explained that one of the challenges faced by scientists, physicians and persons living with HIV is the availability of medication to treat HIV resistance. It is imperative for Guyana to develop a system of vigilance as it relates to the use of medication.
Thus far, this has resulted in more than 80 percent of the persons who should be on ARV receiving treatment.
Due to rising cost, medications must be preserved since there are not many new medicines being developed, this is critical so as to prevent the return of the day when HIV will become a deadly extra judicial death sentence.
Guyana must now learn from the experiences from developed and developing countries that have older treatment programmes and have demonstrated that HIV will become resistant to the medications being used.
However the pace at which that resistance develops depends on several factors including strict adherence. In this case, health workers must ensure that HIV patients are not missing their medication since this contributes to resistance.
Director of the National AIDS Programme Secretariat, Dr. Shanti Singh defined HIV drug resistance as a mutation of the genetic structure of HIV which inhibits the ability of the antiretroviral drugs or a combination of the drugs to block reproduction of the virus.
Resistance to antiretroviral is developed due to poor adherence to medication, insufficient drug level in the body, viral replication in the presence of the drug, resistant virus and poor potency of the drug.
“The HIV drug resistance as outlined by WHO includes the development of a national HIV DR working group and a detailed national HIV DR strategy, this was developed in 2006 through the office of the chief medical officer with the working group being established shortly after,” Dr. Singh said.
Additionally, as part of the programme, early warning indicators have been identified and agreed on as a part of the overall HIVDR monitoring.
Processing of the specimens will be conducted at a WHO accredited laboratory in Puerto Rico which will indicate the virus’s mutations and patterns. The selected site for the programme is the National Care and Treatment Centre. That site was recommended by the WHO in recognition that site has to initiate at least 100 new persons per year on antiretroviral therapy.
“The launch of the programme comes at an opportune time since World Health Day was celebrated on April 7 under the theme “Combat anti-microbial: No actions today, No cure tomorrow,” stated PAHO/WHO Representative, Dr. Beverly Barnett.
On that day the WHO unveiled a six-point policy package for all countries to consider in combating anti-microbial resistance. One of the points deals with strengthening surveillance and laboratory capacity.
“Guyana is in the fore front of compliance with both the WHO recommendations and one of the principles of the Caribbean pharmaceutical policy,” she added.
She further emphasised that “over the years, Government has sought to scale up its response to HIV in collaboration with partners with many achievements including a decline in deaths due to HIV infections and transmission from mother to child.”
The results of the programme will contribute valuable information to the Health Ministry’s HIV and care treatment programme for evidence based decision making to effectively support first line ART and practices associated with HIVDR prevention, inform future treatment guidelines and possible addition of new regiments and support on-going discussions and evidence based decisions on the drug resistant strains of HIV in the Caribbean. (GINA)