Research program in Northern provinces aims to save lives by changing behavior
When Somchai’s health began to deteriorate in March of 2004, both he and his family suspected that HIV might be the culprit. He experienced fever, diarrhea, and a significant weight loss. His wife and mother had already begun to distance themselves from him, avoiding even casual contact, refusing even to share the same eating utensils for fear of contracting the dreaded AIDS virus.
A 38 year-old woodcarver in Hang Dong District near Chiang Mai, Somchai had already made up his mind. If his blood test came back positive for HIV, he would end his own life. The reputation of HIV/AIDS as a killer is firmly established within this rural community, and the high cost of medical treatment beyond the reach of Somchai’s 4,000 to 5,000 baht per month income.
When he went for his results, however, Somchai was met by a nurse counselor who provided not only the unfortunate news of his positive test results, but also reassuring information about the free availability of an HIV treatment regimen known as highly active antiretroviral therapy (HAART), capable of controlling what was once a routinely fatal progression of the disease.
This was followed by a counseling session directed towards his family, aimed at providing accurate and up-to-date information concerning the prognosis and care of people living with HIV/AIDS. Arrangements were also made for Somchai to meet with others in his community who are successfully living with the virus, a process known as “peer counseling.”
Somchai no longer contemplates suicide. His mother has developed into a community activist of sorts, educating the people of the village to the facts about HIV, a serious and life-threatening illness, but one that is capable of effective management. His family no longer fears infection by casual contact.
The main challenge facing Somchai now is to maintain very strict adherence to the treatment regimen. This requires him to take his antiretroviral (ARV) medications every 12 hours, with minimal variation or missed dosages.
Patients like Somchai, however, typically find the required level of adherence a major challenge. Less than 95% adherence to ARV treatment allows the virus to develop drug resistant strains. Unchecked by the antiretroviral treatment, the virus can once again begin to replicate, attacking and destroying the body’s protective immune system. A weakened immune system allows opportunistic infections to occur, placing the patient’s life at risk, and requiring treatment with other expensive drugs.
Adherence to a treatment regimen is, by its nature a psychological issue, since it requires changing patients’ attitudes and behavior. For this reason, Dr. Sombat Tapanya, a psychologist with previous research experience on issues of treatment adherence, provided a valuable psychological perspective. The outcome of this research is expected to demonstrate that both medical and psychological components are necessary in order to achieve maximal treatment effectiveness.
To assist him with strict adherence, Somchai was provided with an alarm watch, which signals him each time he must take his medications. He meets monthly with his assigned counselor who monitors his adherence to treatment, and tries to address social and economic issues that could adversely affect him and his family. He also participates regularly in peer counseling, in which he and other patients provide mutual support and encouragement to maintain adherence to ARV treatment and avoid infecting others.
Somchai is one of about 700 participants in a research project aimed at increasing treatment adherence among people living with HIV/AIDS. The project, jointly funded by the Population Council, an international nonprofit NGO, and the Thai Ministry of Public Health, is being carried out in 45 hospitals in Chiang Mai, Chiang Rai, Lampang and Lampoon provinces. The project utilizes four teams of workers; a clinical team, led by Tasana Leusaree, M.D., a counseling team, led by psychologist Sombat Tapanya, Ph.D. and Sangworn Sombatmai, peer intervention, led by Sureerat Treemakara, and an evaluation team, led by Suwat Chariyalertsak, M.D., Ph.D.
Armed with life saving medications, knowledge, and psychosocial support, Somchai and others living with HIV/AIDS in Northern Thailand are empowered to resume their lives, after receiving a diagnosis that formerly would have meant a death sentence.
This innovative program to increase adherence to ARV treatment is the first of its kind in Southeast Asia. Plans are now underway to make similar programs available in other areas of Thailand, as well as other countries in the region.
A 38 year-old woodcarver in Hang Dong District near Chiang Mai, Somchai had already made up his mind. If his blood test came back positive for HIV, he would end his own life. The reputation of HIV/AIDS as a killer is firmly established within this rural community, and the high cost of medical treatment beyond the reach of Somchai’s 4,000 to 5,000 baht per month income.
When he went for his results, however, Somchai was met by a nurse counselor who provided not only the unfortunate news of his positive test results, but also reassuring information about the free availability of an HIV treatment regimen known as highly active antiretroviral therapy (HAART), capable of controlling what was once a routinely fatal progression of the disease.
This was followed by a counseling session directed towards his family, aimed at providing accurate and up-to-date information concerning the prognosis and care of people living with HIV/AIDS. Arrangements were also made for Somchai to meet with others in his community who are successfully living with the virus, a process known as “peer counseling.”
Somchai no longer contemplates suicide. His mother has developed into a community activist of sorts, educating the people of the village to the facts about HIV, a serious and life-threatening illness, but one that is capable of effective management. His family no longer fears infection by casual contact.
The main challenge facing Somchai now is to maintain very strict adherence to the treatment regimen. This requires him to take his antiretroviral (ARV) medications every 12 hours, with minimal variation or missed dosages.
Patients like Somchai, however, typically find the required level of adherence a major challenge. Less than 95% adherence to ARV treatment allows the virus to develop drug resistant strains. Unchecked by the antiretroviral treatment, the virus can once again begin to replicate, attacking and destroying the body’s protective immune system. A weakened immune system allows opportunistic infections to occur, placing the patient’s life at risk, and requiring treatment with other expensive drugs.
Adherence to a treatment regimen is, by its nature a psychological issue, since it requires changing patients’ attitudes and behavior. For this reason, Dr. Sombat Tapanya, a psychologist with previous research experience on issues of treatment adherence, provided a valuable psychological perspective. The outcome of this research is expected to demonstrate that both medical and psychological components are necessary in order to achieve maximal treatment effectiveness.
To assist him with strict adherence, Somchai was provided with an alarm watch, which signals him each time he must take his medications. He meets monthly with his assigned counselor who monitors his adherence to treatment, and tries to address social and economic issues that could adversely affect him and his family. He also participates regularly in peer counseling, in which he and other patients provide mutual support and encouragement to maintain adherence to ARV treatment and avoid infecting others.
Somchai is one of about 700 participants in a research project aimed at increasing treatment adherence among people living with HIV/AIDS. The project, jointly funded by the Population Council, an international nonprofit NGO, and the Thai Ministry of Public Health, is being carried out in 45 hospitals in Chiang Mai, Chiang Rai, Lampang and Lampoon provinces. The project utilizes four teams of workers; a clinical team, led by Tasana Leusaree, M.D., a counseling team, led by psychologist Sombat Tapanya, Ph.D. and Sangworn Sombatmai, peer intervention, led by Sureerat Treemakara, and an evaluation team, led by Suwat Chariyalertsak, M.D., Ph.D.
Armed with life saving medications, knowledge, and psychosocial support, Somchai and others living with HIV/AIDS in Northern Thailand are empowered to resume their lives, after receiving a diagnosis that formerly would have meant a death sentence.
This innovative program to increase adherence to ARV treatment is the first of its kind in Southeast Asia. Plans are now underway to make similar programs available in other areas of Thailand, as well as other countries in the region.
posted by Michael | Saturday, May 14, 2005
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