AIDS is an abbreviation of Acquired Immune Deficiency Syndrome.
Acquired is something you get, Immune is the resistance against infections, Deficiency is a lack of something (in this context a lack of protection) and a Syndrome is a collection of signs and symptoms.
AIDS is a condition characterised by illness.
A person with HIV looks healthy and strong while a person with AIDS is sick.
A person can live with HIV and take a long time before developing AIDS.
A person with HIV can not be recognised unless s/he is subjected to an HIV antibody test.
TASO provides services to three categories of clients; People Living with HIV/AIDS (PLWHA), Community Based and Non-Governmental Organisations (CBOs and NGOs) and the general public.
To PLWHA: Counselling services to individuals and their families. Medical support to individuals and their families. Social support through provision of school fees for needy children, training in IGA management skills and provision of opportunity for fellowship.
To Communities, CBOs and NGOs: Capacity building, to enable them to provide TASO-like services to people living with AIDS in the communities. Capacity building is done through training of counsellors for CBOs and NGOs and by helping the CBO leadership to improve their management skills through training in project planning and management.
To the General Public: Benefits from TASO AIDS education and mobilization done through information, education and communication strategies, such as drama, film shows, radio programmes and poster presentations, among others.
Does TASO provide ARV's and what medical treatment does TASO provide?
At the moment, TASO does not have the resources to provide ARV's to its clients. However, those clients who can buy their own ARV's can benefit from the technical knowledge of the TASO Medical Officers. TASO is also actively involved in lobbying for price reductions in order to make ARV's available to its clients. When that objective is achieved, TASO will definitely start providing ARV therapy to its clients. For the moment, TASO continues to treat the various opportunistic infections afflicting its clients using the ordinary drugs in the market but administered skillfully. It is also involved in a number of trials on availability of ARV’s in resource limited settings.
PLWHA do not really pay for the services they receive from TASO. They only make a token contribution of USH. 500/= per visit to a TASO centre. With this contribution they receive counselling and medical treatment. TASO caters for clients' transport to and from the centre and also pays for laboratory investigations that may have to be done outside the centre.
NGOs and CBOs are expected to make contributions to costs incurred by TASO for training their personnel. Their contribution varies depending on the NGO capacity. In kind, contributions like training venues, feeding trainees, providing stationery, transport etc, are encouraged. TASO supports communities free of any charge, however they are expected to provide volunteers for the community AIDS programme. These volunteers are trained by TASO as AIDS Care Workers and Parish AIDS Committees.
This is a course for building the skills of persons who intend to take up HIV/AIDS counselling in hospitals, non government organisations (NGOs), community based organisations (CBOs) and any other established organisations.
What are the requirements for the counsellors' course?
A degree/diploma in Education, Social Sciences, Social Work or Social Administration; a diploma/certificate in nursing, midwifery or any health related field; profound experience in AIDS work with a minimum of Uganda Certificate of Education or equivalent. It is also necessary to have a place for practicing counselling skills learnt, preferably an established hospital/NGO/counselling centre/institution which is accessible by TASO Training Centre.
The survival of TASO clients varies greatly depending on the individuals and other factors. Currently TASO has some clients who were registered as early as 1988 but are still doing very well. For more information contact mail@tasouganda.org. If you would like a question answered please send an email to the address: mail@tasouganda.org/training@tasouganda.org
ANTIRETROVIRAL THERAPY (ART)
Introduction
Antiretroviral therapy (ART) has altered the nature of AIDS disease, transforming an almost uniformly fatal illness into a chronic and apparently stable condition. How effective treatment can be made available to the great majority of people with HIV/AIDS is an urgent issue of global significance. But even where such treatment is available, its use is complicated by a number of factors, including side effects, drug-drug interactions and the selection of drug-resistant virus.
TASO’s ART Programme brief
TASO was established in 1987 to offer hope and improve the quality of life of people living with HIV/AIDS in Uganda. TASO is acknowledged as the pioneer organisation in provision of care and support services to its clients. Today, TASO has over 80,000 registered members among whom about 30,000 are active.
The increased global initiatives for wider access to ARV's, TASO’s long standing track record for advocating for access of these drugs to those who are in need of them and TASO's comparative advantage in care and support, resulted into a 5 year ART programme. This programme is based on the National ART Policy treatment guidelines and the WHO 3x5guidelines. The plan to be implemented over the next 5 year period of 2004-2008 seeks to provide ART to 10,000 TASO clients starting with 3,000 clients in its first year of implementation.
As such it becomes increasingly important for all TASO’s stakeholders to be familiar with what ART is all about.
What is ART?
Antiretroviral therapy is a treatment consisting of a regiment of drugs, which work against HIV by slowing down the reproduction of HIV in the body, reducing the viral load and repairing damage to the immune system. These drugs are often referred to as antiretrovirals, anti-HIV drugs or HIV antiviral drugs. However, these drugs have to be used in combination if they are to work effectively. This is known as Combination Therapy.
Human Immuno-deficiency Virus (HIV) is a virus, like any other virus, which produces new copies of itself when it enters the body. With these new copies HIV can go on and infect other previously healthy cells. It is easy for HIV to spread quickly through the billions of cells in the body. If it is not stopped from reproducing itself, it reduces one’s immune response to infection and deteriorates to AIDS. However, antiretrovirals (ARV's) can slow this process.
The treatment to slow the process of replication consists of a drug regiment that has to be taken everyday for the rest of someone’s life once started. Although it is not a cure, if taken correctly, these drug combinations can considerably improve the quality of life of a person living with HIV/AIDS. Thus, the person suffers fewer sicknesses, is likely to feel well again and is able to resume work as well as live longer.
(ART is not a cure for HIV/AIDS)
Why Combination Therapy?
For antiretroviral treatment to be effective for a long time, more than one antiretroviral drug must be taken at a time. The term Highly Active Antiretroviral Therapy (HAART) is used to describe a combination of two or more anti-HIV drugs.
It is advised to use a minimum of two antiretroviral drugs. If one drug is taken on its own, it has been found that over a period of time the drug stops working. HIV reacts to the drug in the person’s body and changes so that the drug no longer affects the virus. The virus then starts to reproduce itself the same way as before. This is when the virus becomes resistant to the drug. The HAART delays the progress of the disease and prolongs survival to maintain quality of life.
Goals of ART
· Maximum and lasting control of viral reproduction (replication)
· Restore and/or protect the immune function
· Reduce HIV-related illness and death
· Improve the quality of life
· Limit the likelihood of viral resistance to preserve life for future treatment options
Benefits of ART
· Protection and/or restoration of the immune function
· Improvement of overall health and prolongation of life
· Control over virus multiplication
· Possible decrease in risk of viral transmission to others
Principles of ART
§ Not to start soon (when CD4 count is close to normal) or too late (when the immune system is irreversibly damaged)
§ Efficacy of the chosen drug regimens
§ Freedom from serious adverse effects
§ Ease of administration
§ On going support of the patient to maintain adherence
The Risks of ART
· Known and as yet unknown side effects such as long-term drug toxicities, including potentially fatal toxicity.
· The potential to develop HIV drug resistance to those drugs currently available and possibly to those not yet available. This may limit future treatment options.
· Problems with other drugs.
(Source: Guidelines for use of ARV medications: Treatment and prophylaxis for adults, pregnant women, adolescents and children, Feb. 2002)
Things you should know before starting ART
One needs to understand two important concepts: “Adherence’’ and “Drug Resistance”
Adherence
This means taking your medication the way it is supposed to be taken. Anti-HIV drugs may need to be taken at specific times of the day, with or without certain kinds of food. It is likely that you won’t be taking these drugs for just a week or two but, rather, for many years.
Drug Resistance
When an anti-HIV therapy is failing or is not taken properly, the virus begins to mutate. Then the drugs become even less effective, until finally they stop working altogether. This process is known as Drug Resistance. It is important to minimize drug resistance because resistance to one drug may also produce resistance to other drugs that you have never taken. This is known as Cross Resistance.
Importance of Adherence to your Treatment Regiment
· One of the most important things to think about before beginning treatment for HIV is your ability to take the treatment properly. This is called Treatment Adherence.
· As far as it is known, anti-HIV medicine has to be taken for life. Not taking the drug properly can lead to Drug Resistance, which can lead to treatment failure.
· It is important to know that different drugs have different rules. Some drugs may be taken only once a day, while other drugs must be taken two or three times a day.
· Some drugs must be taken on an empty stomach, while others must be taken with a high fatty meal.
· Because you will probably be taking several different medications, each drug will have different rules. It is important to know which drug goes with each rule.
What you need to know to ensure good adherence
· How many pills of each different medicine are you supposed to take at a time?
· How many times a day are you supposed to take each medicine and when do you take them?
· What are the food requirements for each different medicine?
· What should you do if you forget a dose?
Techniques for Adherence
· Agree to a regiment that you understand fully.
· Recruit family members, friends, peers and community support to remind you regularly. Try to find people you are always with.
· Use memory aids such as pill boxes.
· Plan ahead by keeping extra medication in key places and obtain refills in enough time before the last doze.
· Avoid alcoholism.
Planning a drug regiment that works with your schedule will help to improve your adherence. Anti-HIV drugs can keep HIV infected people alive longer and can help them to have an active life. Treatment, therefore, is a very important option and people living with the virus should consider starting treatment before HIV has a chance to do serious damage to their immune system.
When will I start treatment?
There is no right or wrong answer, it all depends on the individual and the advice of your doctor. However it could also largely depend on two main factors: Your physical health and your mental readiness to start therapy and stick with it.
In terms of physical health, your viral load count, T-cell count and how you feel will each play a major role in figuring out when to start. Along with these medical issues, the decision to start treatment will also depend on your willingness to take your medication every day and to follow the strict instructions provided by your doctor.
Switching Regiments
Although there is a degree of reluctance to switch patients from one antiretroviral regiment to another, under certain criteria a switch is essential to safeguard the clinical promise of antiretroviral therapy. The criterion for switching regiments primarily revolves around treatment failure and drug toxicity. Other considerations relate to occurrence of active tuberculosis or pregnancy.
In treatment failure an entirely new regiment will need to be used. In the case of toxicity, either an entire new regiment can be prescribed or, when the toxicity is related to an identifiable drug in the regiment, the offending drug may be replaced with another that does not have the same side effects.
Antiretroviral Therapy and Tuberculosis
Clients ready for ART may have active tuberculosis and clients already receiving ART may develop tuberculosis. The clinical management of co-infection with HIV and TB is complicated by drug interactions between antiretroviral agents and anti-tuberculosis agents, some of which magnify the toxicity of TB treatment. It is therefore important to understand these complications and to coordinate the introduction of antiretroviral therapy with established tuberculosis programmes to avoid diminishing treatment success.
Antiretroviral Therapy and Opportunistic Infections
Prompt initiation of antiretroviral therapy should be considered when opportunistic infections occur for which treatment is suboptimal or unavailable. This is because improvement of the immune system may enhance the patient’s recovery. ART is an effective approach to stemming the incidences of opportunistic infection, although it should not replace the use of antimicrobial prophylaxis. It is, however, important to note that there may be a transient worsening of some opportunistic infections two to three weeks after the initiation of antiretroviral therapy. This is referred to as Immune Reconstitution Syndrome. It is characterized by fever, lymphadenopathy, worsening pulmonary lesions and expanding CNS lesions. In general, antiretroviral therapy should not be interrupted due to Immune Reconstitution Syndrome.
Women of Child Bearing Potential or Who Are Pregnant
Women receiving antiretroviral therapy should have effective and appropriate contraceptive methods available to them in order to reduce the likelihood of unintended pregnancy. It is important to note that some antiretroviral drugs can lower blood concentration of oral contraceptives and additional or alternative contraception needs to be used to avoid pregnancy in women receiving these drugs.
1.Source: www.aidsmeds.com
2. Global AIDS learning and evaluation network; Introduction to antiretroviral therapies. Module no, 8 Chicago: IAPAC, 2002
3.National Antiretroviral treatment and care guidelines for Adults and Children Kampala: MOH, 2003
