There is still a need for general practitioner training. But if a patient living with HIV does not have enough money the general practitioner is going to give one or two antiretroviral medications anyway. One or two drugs are insufficient in this era of three drug regimens. The doctor who prescribed the most insufficient therapy in Rangoon a couple of years ago was a specialist!
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Medical association warns on ART misuse
Khin Myat
Myanmar Times
January 24 - 30, 2011
Boxes of ART medicine at a medical fair in Yangon.
OFFICIALS from the Myanmar Medical Association and other non-government organisations have backed calls for increased training for general practitioners who prescribe anti-retroviral treatment (ART) to HIV patients.
Association spokesperson Dr Myint Zaw said doctors needed to counsel patients on ART use when prescribing the treatment.
“It is really important for patients to receive counselling from a doctor who is knowledgeable about HIV/AIDS,” he said. “There’s no need to take ART simply because you have contracted HIV. Some people go 10 or 15 years without taking it.”
He said HIV patients and pharmacists also had a role to play in ensuring patients did not develop resistance to ART, which often occurs when medication is taken unnecessarily.
“Some patients want to keep their infection a secret and buy ART themselves without proper counselling,” he said, adding that pharmacists should not sell ART to patients without a prescription.
“ART needs to be taken for two times a day, 12 hours apart. If a patient misses a dose more than six times in a month, they can become resistant and [have to take] second-line [medication]. Adherence counselling between doctors and patients is important to avoid this scenario.”
Second-line ART is four times more expensive than first-line treatment, which costs about K25,000 a month, and also has more side effects.
At a workshop last month, an official from the United Nations Program on HIV/AIDS (UNAIDS) said many general practitioners provide ART despite having no formal training on ART management.
“There is a great need for training and monitoring performance of all service providers, not only [general practitioners],” said Dr Khin Zar Li Aye, a UNAIDS moni-toring and evaluation officer.
She recommended general practitioners take a free ART education course that the MMA has offered since 2005.
U Thiha Kyaing, chairperson of Myanmar Phoenix Group, which was established in 2005 by people living with HIV, said he had heard about cases in which doctors provided ART without proper counselling.
The practice is thought to be most common outside of Yangon, where both doctors and patients have less access to educational resources.
“It is very risky for HIV patients to take treatment without counselling. If a person contracts HIV, it is very important they see a doctor who has good knowledge about HIV and ART,” he said.
Phoenix member Ma Aye Mya Thida said her husband developed resistance to first-line ART because he took the treatment unnecessarily back in 2003, after falling ill and being admitted to a private medical clinic in Yangon.
“My father-in-law did not tell us the truth about what my husband was suffering from – he said it was tuberculosis. My husband took drugs prescribed by the doctors without counselling. Only later we found it was ART,” she said.
The lack of counselling and poor knowledge about HIV meant her husband quickly developed resistance to first-line treatment. “When we needed second-line ART, we had no money left,” said Ma Thida, who is also HIV-positive.
As a result of their experience, Ma Thida and her husband began offering over-the-phone counselling and support to HIV patients in December and receive on average two phone calls a day. “I think the service can be very beneficial,” she said. “When someone contacts me for counselling, I share my knowledge and give advice and encourage them.”
The idea has caught on with other people living with HIV, who see it as a way of preventing others from making the same mistakes.
“When you find out you have contracted HIV, the first person you want to see is someone who has been in the same situation,” said Ko Myo Min Oo, who is also a member of Phoenix. “We do this as a way of helping others, a kind of social work.”
Ma Thida and Ko Myo Min Oo can be contacted on 09-492-94225 and (01) 725-954 respectively.
http://www.mmtimes.com/2011/news/559/news55910.html
