AIDS care in Guatemala
MSF works in Hospicio San Jose, Clinica Familiar Luis Angel Garcia at San Juan de Dios Hospital and Roosevelt Hospital, three Guatemalan centres which care for HIV/AIDS patients.
Hospicio San Jose
Since 1999, MSF has supported the Hospicio (Hospice) centre, run by the Guatemalan association Jospice International. Hospicio, originally set up for the terminally ill, has the capacity to receive 12 adults and 12 children. MSF's involvement has enabled Hospicio to change its functioning - it now provides monitoring and medical care for HIV/AIDS patients. The MSF team carries out consultations for hospitalised patients, outpatient services and home visits.
The team offers medical assistance for home visits, provides financial assistance for laboratory expenses and complementary tests, and maintains a network of doctors who do referrals and offer patients free consultations. MSF also supports Hospicio with ARV treatment for certain patients (this includes protocols, managing stocks, supplying medication).
Our activities in Hospicio
- Hospitalised patients: 3 consultations per week (91 persons from January to August 2001 for a stay of 12 days on average).
- Home visits: once a week, 5 to 10 patients per consultation. MSF also helps the home visit services (90 families followed).
- 90% of the triple-therapy medication is provided by foreign donations. The rest is supplied by local associations or purchased by Hospicio. MSF supplements this when needed.
- In October 2001, 25 children and 6 adults were receiving anti-retroviral treatment.
Clinica Familiar Luis Angel Garcia (San Juan de Dios Hospital)
In February 2001, MSF decided to launch a treatment programme for AIDS patients in another health service, Clinica Familiar (family clinic) Luis Angel Garcia. It provides specialised consultations for HIV patients and treatment for children with AIDS in San Juan de Dios hospital in Guatemala City.
Realising that a large number of the children treated by Clinica Familiar were orphans or had only one parent, MSF started offering triple-therapy to their parents. From the start of 2002, treatment will be offered on a wider scale to adults who consult Clinica Familiar.
Our activities in Clinica Familiar
- In collaboration with Clinica Familiar and San Juan de Dios hospital, MSF defined an ARV access plan for 80 adults; defined the priority beneficiaries; built up a pharmacy for six months of treatment for 80 adults, including an emergency supply for the treatment of children in case the stock ran out; and begun home visits.
- Inclusion criteria :
- - Medical criteria: symptomatic HIV patient, presenting a controlled opportunistic infection (except for tuberculosis, in which case we wait until the end of treatment), with a CD4 count below 200/mm3 and a viral load above 10,000 /ml.
- - Social criteria: parent of an HIV child monitored and treated by Clinica Familiar and not covered by the social security system (IGSS).
- Patients are monitored regularly during their treatment: clinical controls every two weeks for the first two months, then once a month; laboratory test once a month; CD4 and viral load calculated during the 8th week and thereafter every three and six months respectively.
- In October 2001, about 20 parents were accepted into the MSF programme, which will be expanded in early 2002 to 100 adults in consultation at the Clinica Familiar.
The two projects (Hospicio and Clinica Familiar) are closely linked. The non-hospitalised Hospicio patients consult at the Clinica Familiar, and the medical treatment provided by Hospicio allows for the hospitalisation of patients referred by Clinica Familiar who do not have access to San Jan de Dios hospital.
In February 2001, MSF started an AIDS programme in Roosevelt Hospital, where the ward for infectious diseases lacked drugs and resources to offer integral assistance for people living with HIV/AIDS. As well as supporting and supervising the hospital staff, MSF offers consultations, pre- and post-test counselling, ARV treatments, nutritional and psychological support, and group therapy for people under ARV treatment.
MSF also conducts home visits to follow-up patients on ARV treatment or for palliative care, and monitors hospitalised patients. MSF contributes to a laboratory within the Hospital, so that MSF's patients can have analyses made at a reduced price. MSF also offers patients some financial support for public transport to attend consultations.
- MSF's project will offer ARV treatment up to 70 people. At present, there are some 53 people receiving ARV treatment.
- MSF has also set up and manages a pharmacy within the infectious diseases ward.
- Inclusion criteria: symptomatic HIV patient, CD4 count below 200/mm3, adherence to previous prophylaxis treatment and little economic resources. Adults in charge of children are a priority.
- Before starting ARV treatment, patients undergo a thorough medical examination including X-rays, serology, viral charge, CD4, etc.
- Patients under ARV treatment are monitored regularly. During the first three months of treatment, they have clinical controls and analysis every 15 days and are visited at home. Thereafter, monitoring is done every three and six months.
In Coatepeque, Quetzaltenango Department, MSF works in an AIDS clinic, offering treatment for opportunistic infections to more than 200 people. Some of them are referred to Roosevelt Hospital for hospitalisation or ARV treatment.