Looking Over the Long-Term


Next week in clinic, I will see Tony. Tony is 12-years-old, and he has been receiving antiretroviral medicines through the AMPATH clinic at the Moi Teaching and Referral Hospital in Eldoret, Kenya for five years. He comes in once a month, and my clinic team makes sure that they schedule him to see me whenever I am in Kenya. When Tony was enrolled into our care system as a seven-year-old, he looked like he was about four - tiny and frail and sick. He has grown some since then, but he still only weighs 35 pounds, and you might mistake him for a seven-year-old still.

Tony's immune system improved some on his HIV medicines, but he went through a year or two after his parents both died where he was bouncing around from one aunty's house to another. Some did a good job in giving him his medicines, and others had little time or attention for this child with extra needs. Tony's 18-year-old brother looks after him now, bringing him to clinic and reporting diligently on how he tries to make sure Tony takes the medicines every morning and every night.

Unfortunately, Tony's virus has become resistant to the HIV medicines that he started on when he was seven. The virus is multiplying in his blood, and Tony's weakened immune system shows how badly it is under attack. When I saw him in February, he had a painful yeast infection all the way down his esophagus. I had to switch him over to our second-line combination of HIV medicines. "We do not have a third option," I explained. "This is our last chance to keep the virus sleeping."

The other tricky thing that I have done over the past few months with Tony is to tell him that he has HIV. He knew that something was very wrong, and he feared that HIV was the cause of his many sicknesses, but no one had ever spoken the words to him. With the change in his medicines, he needed to know what this disease was and how important it is for him to keep taking these medicines.

Tony's story points to some of the major challenges we face with sustaining effective care for a disease like HIV in a resource-limited setting. Over the long-term, we need to support adherence to therapy, provide appropriate medicines, offer families culturally sensitive support to tell their children about this terrible disease in the appropriate way and at the appropriate time, and train up clinicians who can provide good care for even the complicated patients like Tony. Plenty of work to do over the long-term...

Posted at 22:41


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