MOZAMBIQUE: New model of care & rapid diagnostics give hope to advanced HIV patients
When Joao discovered he was coinfected with HIV and tuberculosis (TB), he started antiretroviral treatment at Jose Macamo hospital in the Mozambican capital, Maputo. When an MSF team started work there in March 2018, with the aim of providing simplified and patient-centred care to people with complicated and advanced forms of HIV and drug-resistant TB, Joao was one of their first patients.
In Mozambique, 2.2 million people are living with HIV, putting it in the world’s top ten countries with a high HIV burden. People with advanced HIV have a severely compromised immune system and a low number of infection-fighting cells – described as having a CD4 count of 200 or below. Advanced HIV is usually due to a resistance to treatment, a late HIV diagnosis and difficulties to adhere to treatment.
When patients first arrive at Jose Macamo hospital, their blood is tested so that staff can determine their medical needs. The first test is the CD4 count. If the result is 200 or below, the same sample of blood is then tested for meningitis and for tuberculosis – the two most common opportunistic infections linked to HIV. Results come back within an hour, allowing the patient to be put on treatment immediately.
“For the best chance of success and the lowest mortality risk, patients need to be enrolled on treatment as early as possible,” says Dr. Ana Gabriela Gutierrez Zamudio , MSF Project Medical Referent.
MSF’s aim, alongside the national health authorities in Jose Macamo hospital, is to provide screening, diagnosis and treatment to patients with advanced HIV in less than 48 hours. This speedy process is only available in one other place in the country, at MSF’s project in the coastal city of Beira.
Health staff at Jose Macamo hospital screen around 200 people each month. Eighty-four per cent of newly arrived patients have previously been diagnosed with HIV and 92 per cent have already been on antiretroviral treatment. Despite this, 58 per cent of patients arrive with advanced HIV, suggesting that either the dosage of the drugs was wrong or they were not taking the treatment correctly.
As well as receiving the correct medical treatment, patients also receive psychological support in the form of two counselling sessions – one upon arrival and one upon discharge – to help them stick to their treatment.
Fátima Macia is an MSF counsellor who provides patients with psychological support. “Working with these vulnerable people is not always easy,” she says. “Sometimes the stories they tell us are stories that we have already experienced in our own family, but we have to be strong or we will not be able to provide the necessary support. Patients tell us their life story and their difficulties and we, in turn, have to transmit security: we have to bolster them so that they feel strong enough to continue the treatment.”
Salgado Marques has advanced HIV, but thanks to the support of his family, he is sticking to his treatment and his health is improving. “I always had support from my family,” He says. “If it weren't for them, I don’t know what would have happened to me. Thanks to my family and the fact that I am following the treatment well, I feel better now.”
In the two years that MSF has been working alongside the Mozambican Ministry of Health at Jose Macamo hospital it has trained staff to provide fully comprehensive screening, diagnosis and treatment to people with advanced HIV and other conditions.
“This partnership between MSF and our hospital is extremely important,” says Dr Ermelinda Chamba of Jose Macamo hospital. “MSF has made available advanced kits that allow for rapid diagnosis and treatment, this means that today we can make a quicker diagnosis of HIV-related opportunistic infections and successfully treat patients for conditions such as crypto-meningitis and tuberculosis that we did not previously know they had.”
Now MSF has handed over its activities in full to the team at Jose Macamo hospital, but will continue to provide monthly supports of the necessary medical supplies to enable them to successfully provide patients with comprehensive care, treat opportunistic infections and reduce mortality.
.jpg "In Maputo, Mozambique, Jose Macamo hospital. Viral load monitoring has been used for years in Western countries, and is recommended by the World Health Organization as the gold standard of care for HIV. Contrary to the CD4 test that gives only an indirect indication of the disease’s progression, this technology calculates precisely how much virus is present in the patient’s body. It allows physicians to detect right away how well the ARV treatment is working, if the patient is not taking his drugs properly or has developed resistance to the first line of HIV drugs. Photographer: Sarah-Eve Hammond")
.jpg "In Maputo, Mozambique, Jose Macamo hospital. Viral load monitoring has been used for years in Western countries, and is recommended by the World Health Organization as the gold standard of care for HIV. Contrary to the CD4 test that gives only an indirect indication of the disease’s progression, this technology calculates precisely how much virus is present in the patient’s body. It allows physicians to detect right away how well the ARV treatment is working, if the patient is not taking his drugs properly or has developed resistance to the first line of HIV drugs.
A few months ago, when MSF – with support from UNITAID – introduced the machine in the hospital, 25 years old Ilidio was handpicked by his supervisor from the Mozambican Ministry of Health to be one of the three lab technicians trained to operate the machine, and he’s quite proud to show off his delicate handling of the state-of-the-art technology. “I had heard of it at school, and it was very exciting to go from theory to practice”, he says. Photographer: Sarah-Eve Hammond")