2023-04-26 09:22:06
When talking about AIDS work, there are 3 numbers that the world pays attention to and is regarded as a goal that must be achieved, which is “95-95-95”.
The “first 95” refers to the rate of people who know they have the virus, the second “95” refers to the rate of people who know they have the virus and go on treatment, and “95”. Finally” is the rate of infected people who have been treated and can be suppressed.
in part of Thailand It is considered to be doing well in the “last 95” because it can cause infected infected people to be able to suppress the infection up to 97.3%. However, for the “first 95”, it is still about 94% and the “second 95” is still able to do 91%.
In summary, there are 2 things that Thailand needs to do better, which are to “test more” and “start taking more antiretroviral drugs”.
Dr. Rattapon Triamwichanon qualified person The National Health Security Office (NHSO) gives estimates of new HIV infections each year at 5,000-6,000, but believes the real number is much higher.
while in the part of those who have been diagnosed with the infection Still, there are still a number of patients who “loss follow up” or disappear from the care system.
Dr. Rattapol stated that the cause of the Loss follow up may be patients who still “can’t get over it” and want to go back for another examination at other hospitals. for sure or may be in the range “Asymptomatic”, therefore not receiving treatment, etc.
however “Same day ART” policy Or starting antiretroviral drugs within 24 hours after being diagnosed with HIV will help “close the weaknesses” in this regard because when detecting and making a decision to receive antiretroviral drugs early. From the research, it was found that when the drug was given quickly This allows the patient to remain in the treatment regimen for a long time.
Additional information from Chakraphat Boonruang, M.D. medical researcher The Institute for HIV Research and Innovation (IHRI) states that the majority of HIV treatment practices in Thailand are “Rapid ART Initiation”, which means starting antiretroviral drugs within 7 days after knowing the results of a blood test. infect
For this approach, there is still a problem of those infected with Loss from the treatment system, because for 7 days the patient has to leave work twice, the first time to hear the blood test results and the second time to start antiviral drugs. In some occupations, it is inconvenient to leave work for 2 days in 1 week, causing obstacles and causing patients to drop out of the system.
This is therefore the cause.“Same day ART” policy To start administering antiretroviral drugs to patients within 24 hours, which will reduce the number of Loss follow up.
Dr. Chakraphat said that this policy has been going on for many years. But due to the lack of a push to implement the policy, Same day ART did not actually serve. And many hospitals are still in Rapid ART Initiation.
“How good is Same day ART? From the data of an anonymous clinic since 2018, compared between infected people who come to receive normal services Compared to those following the Same day ART policy, those who entered the Same day ART were almost four times more likely to initiate antiretroviral therapy than the Rapid ART Initiation,” said the researcher.
Moreover, he states that Same day ART also puts infected people into a “U=U” state (infected people who are so well on antiretroviral drugs that the virus is no longer detectable in their blood). will not infect others) 2.2 times faster and more
At the same time, IHRI also views that Same day ART can provide services in hospitals. It should be able to be organized by the community, thus becomingModel “Community based same day ART” In the year 2019-2020, conducted in the form of research When a patient comes for a blood test I drew more blood. To detect things that are necessary to start antiretroviral drugs, such as finding CD4 values, liver values, kidney values, etc.
In community based organizations that have a CD4 detector, it takes about 2 hours to wait for the results. and start giving antiviral drugs within that day
“According to the research, 399 volunteers participated in the project. By the end of the program, 95% were able to start antiretroviral therapy within 24 hours. No loss follow up and can be referred to receive services at all hospitals according to their rights, “said Dr. Chakraphat.
However, when the research results were good Therefore, community-based same day ART has been expanded in many areas, for example, in October 2022, service began in Hat Yai. Under the cooperation of Hat Yai Hospital and the Rainbow Sky Association. Then in February 2023, the same day ART Pattaya service was started under the operation of Bang Lamung Hospital in collaboration with the Service Staff Friends Foundation (SWING), Pattaya branch.
Similarly, in Bangkok (Bangkok), Same day ART services are organized by Ratchaphiphat Hospital. in conjunction with the Rainbow Sky Association and Bang Rak Hospital in collaboration with IHRI and Friends of Service Workers Foundation
“This innovation may not be well known in Thailand. But it is very popular in the Philippines and Vietnam. To apply this model Therefore, in Thailand, which is the origin of this innovation. can be used at all Any area that is not ready starts with Same day ART in the hospital first. Any area that is ready can do community based same day ART as well,” Dr. Chakraphat gave guidelines.
side Thanakorn Aroongamwong, M.D. general practitioner Bang Lamung Hospital One of the hospitals that operate Same day ART said that one of the problems in caring for people with HIV is “starting medication” because patients often have to take time off from work to get services. which sometimes cannot take a day off This causes loss follow up problems quite often, therefore, it is believed that Same Day ART may be the answer.
He stated that at the same time, it was fortunate that Bang Lamung Hospital executives realized the importance of disease prevention. and to cooperate with private foundations in various fields Therefore, there is a coordination with the SWING Foundation, which has a medical technology clinic, SWING Pattaya, in joint operations. Its main objective is to reduce opportunistic infections. reduce the death rate Including reducing the transmission of infection to others enabling the patient to lead a normal life
“Our preparations started in November 2022. There were discussions with relevant agencies such as Bang Lamung Hospital, Pattaya Rak Center. Office of Disease Prevention and Control 6, Chonburi, AIDS Division and NHSO, including various private sector networks Agreed to jointly organize this service. Then, Jan. 2023, began to set up a community-based same day ART approach, laying out management, monitoring, and evaluation procedures. personnel training and mutual understanding with all relevant sectors,” Dr. Thanakorn recalled.
Since starting the service in February 2023, until now, there are 4 patients receiving Community Based same day ART care.
Dr. Thanakorn explained that the operation in this manner The private sector network is important and can help relieve the burden of the hospital quite a lot. Because of Same day ART’s main target audience, doctors or healthcare professionals sometimes talk in detail. Or inviting the start of antiretroviral drugs is not as good as private foundations. Which has a relationship or easier access to the target group
Therefore, he views that the private sector can help in many matters. Both mental and emotional readiness assessments, and when patients have problems with travel or migration, SWING Foundation will help coordinate. And when the drug is started, it also helps to monitor the medication in the early stages. Or those who have problems with expenses may have another fund to support.
In the process of initiating antiretroviral drugs The hospital has designed two categories: 1. Community Based same day ART, starting medication at the SWING Foundation service unit on Monday and Thursday, and 2. Starting medication at the hospital on Tuesday, Wednesday, and Friday when the patient walks in. There will be a blood test. If the result is negative, they will enter the PrEP program, but if they get a positive result, they will assess their eligibility to enter Same day ART. If they have direct access, they will enter the service process. But if the rights do not match, it will be recommended to go for the service according to the rights.
“In the blood test, HIV testing will also be performed. Various sexually transmitted diseases will also be tested. While waiting for the blood results, preparations will be made. Physical examination for comorbidities or contraindications for starting the drug In the meantime, SWING staff will send information to Bang Lamung Hospital via LINE. When the bleeding results will report CD4, if it exceeds 200, the doctor will consider it via video call and talk to the patient.
“Then, once the doctor has assessed, the medication can be started. I will be able to start the antiviral drug right away. And after taking the medicine, the SWING Foundation will call to ask about the symptoms on the 2nd, 15th and 20th day. Then, after taking the medicine for 1 month, they will have to come to the hospital to check the side effects of the medicine, “said Dr. Thanakorn.
this medical practitioner Continue to tell about the overall operation in the past. which the personnel team feels that the patient can “faster drug start” compared to conventional procedures It takes about 4-5 hours to finish, no need to wait long, reducing congestion in the hospital.
The plan after this The results will be expanded by presenting operations in various forums, such as meetings of the Provincial Public Health Office (SorPhor.) to invite other hospitals. Turn to provide more Same day ART services or the SWING Foundation may expand the service as a Community Based same day ART in other areas. so that patients have access to more medicines as well
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