RVD-R patients at UTH

This morning we were introduced to the team of pharmacists who work in the HIV clinic dispensing antiretroviral therapy. All antiretroviral medications are FREE to the people of Zambia! Three months after the patient is started on treatment and once the patient is stable they begin coming to the clinic where we were located. A patient first sees the doctor to assess their current condition and completes labs for monitoring their CD4 count, viral load, renal function, liver function and blood counts. After seeing the doctor they come to the pharmacy area to pick their prescriptions and receive counseling. The room has seating to see three patients at a time which while very efficient, limits the privacy for the patients. They have a drug dispensing database that they use to track refills dispensed which was one of the first times we have seen technology used! The first line regimen in Zambia is tenofovir/emtricitabine/efavirenz (Atripla). If the patient is not improving on the first line regimen they often switch out efavirenz for nevirapine or emtricitabine for lamivudine. Also if the patient is experiencing renal dysfunction they will switch tenofovor (TDF) for another agent like abacavir. We will will return to this clinic on Thursday afternoon to see patients who have failed the first and second line therapies and who are now on third line therapy. There are so many opportunities for Kristin and I to learn!

The clinic pharmacist also explained HIV prophlyaxis following a potential exposure. One patient that we encountered was a young woman who was a victim of sexual assault. The pharmacist explained to me that in Zambia a woman is considered to be at fault for sexual assault which often delays women from coming to the hospital to receive appropriate treatment. Women who experience sexual assault are educated and encouraged to come to the hospital as soon as possible, especially within 72 hours. Women will receive HIV prophylaxis with (tenofovir/emtricitabine) Truvada and lopinavir/ritonavir (Aluvia) or atazanvir/ritonavir. In addition women are offered an emergency contraceptive and antibiotics.

In addition, when Kristin and I were on OB/GYN ward rounds last week we were caring for many patients who were HIV positive. In order to try to maintain their privacy during patient presentations on ward rounds, we referred to their positive HIV status as "RVD-R", which stands for retroviral disease reactive. We are practicing becoming accustomed to this term to protect the sensitivity of this diagnosis, which much of the population views negatively.