Help, we do not have a CD4 count machine
Jan 02, 2007
Dear Doctor, <br>I am a clinical officer working in one of the upcountry clinics. We have been encouraging people to come for voluntary counselling and testing at our centre and the response has been good.
Dear Doctor,
I am a clinical officer working in one of the upcountry clinics. We have been encouraging people to come for voluntary counselling and testing at our centre and the response has been good. However, we are faced with a problem: We do not have access to a CD4 count machine and therefore, cannot advise our patients whether they are due for Antiretroviral Therapy (ART) or not. What can we do? Our patients are getting frustrated and others are even being discouraged from coming for VCT? Please, advise.
Jude
Dear Jude,
Thanks for encouraging people to come for VCT because most Ugandans (over 75%) do not know their HIV sero-status. Of the estimated 200,000 Ugandans who need ARVs, only about 80,000 are getting them. As you rightly noted, this discourages others from going for VCT.
It would be good if we could do CD4 counts for all patients before initiating ART. It also makes for easy monitoring. Unfortunately, this is not possible though the situation has improved and several centres nation-wide can now do the tests. It is recommended that all patients with a positive HIV test be staged using the World Health Organisation (WHO) staging which depends on clinical assessment using symptoms and opportunistic infections one has had. The method puts all patients with HIV in four stages and those in stages three and four should be put on ARVs.
However, it must be stressed that initiating ART using WHO staging should be encouraged only where CD4 count machines are inaccessible.
The use of this method is likely to leave out people who are immune-suppressed, with very low CD4 counts, but do not have the symptoms used as criteria for WHO staging. Such people will be put in HIV stages one or two, when their CD4 count is low and they need to be on ART. Health care givers should ensure that they access these services through networking if they cannot afford them at their centres.
Remember, HIV/AIDS care is not all about ARVs. Many people are doing well by being counselled and helped to live positively with the disease while using the basic care package. for people with HIV. This includes: septrin prophylaxis, provision of safe water plus improved hygiene, good nutrition and provision of insecticide treated mosquito nets. I have seen people’s CD4 counts go up by only being on the basic care package. You can do a lot for people with HIV/AIDS without using ARVs. This period should also be used to counsel and prepare patients for ART because it has been found that people who adhere to septrin and keeping appointments tend to adhere on ARVs which as you know should not be stopped once initiated.
Send your question on HIV to Health Editor,
The New Vision,
P. O. Box 9815, Kampala
or health&beauty@newvision.co.ug
I am a clinical officer working in one of the upcountry clinics. We have been encouraging people to come for voluntary counselling and testing at our centre and the response has been good. However, we are faced with a problem: We do not have access to a CD4 count machine and therefore, cannot advise our patients whether they are due for Antiretroviral Therapy (ART) or not. What can we do? Our patients are getting frustrated and others are even being discouraged from coming for VCT? Please, advise.
Jude
Dear Jude,
Thanks for encouraging people to come for VCT because most Ugandans (over 75%) do not know their HIV sero-status. Of the estimated 200,000 Ugandans who need ARVs, only about 80,000 are getting them. As you rightly noted, this discourages others from going for VCT.
It would be good if we could do CD4 counts for all patients before initiating ART. It also makes for easy monitoring. Unfortunately, this is not possible though the situation has improved and several centres nation-wide can now do the tests. It is recommended that all patients with a positive HIV test be staged using the World Health Organisation (WHO) staging which depends on clinical assessment using symptoms and opportunistic infections one has had. The method puts all patients with HIV in four stages and those in stages three and four should be put on ARVs.
However, it must be stressed that initiating ART using WHO staging should be encouraged only where CD4 count machines are inaccessible.
The use of this method is likely to leave out people who are immune-suppressed, with very low CD4 counts, but do not have the symptoms used as criteria for WHO staging. Such people will be put in HIV stages one or two, when their CD4 count is low and they need to be on ART. Health care givers should ensure that they access these services through networking if they cannot afford them at their centres.
Remember, HIV/AIDS care is not all about ARVs. Many people are doing well by being counselled and helped to live positively with the disease while using the basic care package. for people with HIV. This includes: septrin prophylaxis, provision of safe water plus improved hygiene, good nutrition and provision of insecticide treated mosquito nets. I have seen people’s CD4 counts go up by only being on the basic care package. You can do a lot for people with HIV/AIDS without using ARVs. This period should also be used to counsel and prepare patients for ART because it has been found that people who adhere to septrin and keeping appointments tend to adhere on ARVs which as you know should not be stopped once initiated.
Send your question on HIV to Health Editor,
The New Vision,
P. O. Box 9815, Kampala
or health&beauty@newvision.co.ug