I thought I would take some time to write about some of the things I have been doing in terms of building some capacity here at the Baylor Children's Clinic. Each day I walk from my apartment to the clinic it is about a 15 minutes. I stay in the lobby of the clinic and shortly after I arrive there is a "morning prayer" with the patients which I try to participate. I usually meet with Mma Phoi to discuss mostly the drafts that I have sent her of various documents I have been writing. The primary project I have been working on is a "Adolescent Adherence Group". One of the major issues in any treatment for HIV is adhering to the medication regime, especially teens and children. If a patient forgets to take their meds on a regular bases or stops treatment, it may cause the HIV to "mutate" and become treatment resistant. In the medical community it is agreed that and adherence rate of of 95% is required to remain healthy. Lower the rate the more likely for opportunistic infection. Here one of the most opportunistic infections is TB. It is especially difficult for the teens and children because of the stage of development. We all know how teens do what they are told, never forget and do things on time. Frequently, they have to take meds in the morning and evening, (HAARTs), some times 4-8 pills at a time, one pill is so large it is shaped long and curved so it can be swallowed easier. Each day in the clinic children and teens come with a parent or even by themselves and they bring their meds; at check in they left over pills are counted and the compliance rate is low ( below 90%) the children have to see the nurse for adherence counselling. The children are weighed, measured and have a general check up; frequently blood work is done to determine viral load and C4 counts, if viral load is high or C4 low med changes are in order. The clinic patient population included toddlers. If a 95% adherence rate is maintain it is possible for the the viral load to be "undetectable" and the risk of infecting other is lowered especially when precautions or not taken.
The major reasons for non-adherence is "stigma" and discrimination, especially children/teens at school when then have to go to clinic or they get sick. This is also the reason for non-disclosure. Even in families where parent and child are taking meds frequently there is no "talking about it" in the house hold.
So the group I collaborated on designing is a psycho-educational group for both teens and caregivers to provide support, develop social networks thereby increasing adherence to meds and increasing health.
It is a 12 week group covering various topics related to social, mental well being and physical well being. It includes participation of caregivers in order to support the child in the home environment and some experimental/novel concepts like a "text tree" ( still in the process of development). The group is just waiting approval of senior management. So I now I am focused on developing Standard Operating Procedures for Psychological Therapy.
(I will post more pictures of Victoria falls soon!!)
