Day 6 CTC at Ilula

 

We met a well-appearing middle-aged woman in the CTC (HIV Care and Treatment Clinic) at Ilula today that has been on HIV antiretroviral (ARV) drug therapy for 15 years.  When asked her age, she replied that she did not know!  She had not been able to attend school when she was young so was not actually aware of her date or year of birth.  Ponder that simple thought for a moment—if you actually did not know how old you were—would that be a good thing or a bad thing?  What must it feel like to not be aware of your age—is that the definition of being able to act as young as you feel?

We were here at Ilula 20 years ago in January of 2006 when the HIV program first started.  Now, 20 years later, the CTC remains robust, and even despite USAID withdrawl from support, patients have access to free ARVs.  There are now more than 2800 patients currently on ARVs at the Ilula CTC.  The clinic provides rather comprehensive care including nutrition counseling, hypertension screening, routine TB screening, gender-based-violence screening, contraception and cervical cancer screening.  Now, 20 years later, we rarely, if ever see cases of advanced HIV, such as  PCP pneumonia, cryptococcal meningitis or disseminated herpes zoster on the inpatient ward.

In 2016, the late Paul Farmer’s group, Partners in Health, reported a 53% 10-year survival of the first cohort of patients (910) that were initiated on ARVs in Haiti in 2006 (Pierre et al, New Engl J Med 2016;374:397). The argument at the time was whether complicated HIV care could safely be delivered in a very resource constrained health care system. This prompted us to look at our 10-year follow up data in 2016.   Of an initial 763 patients started on ARVs in 2006, 45% were alive in 2016. 

Now we are at the 20-year anniversary of the initiation of the HIV CTC at Ilula. Of the original cohort, 233 have moved out of the catchment area and thus not available for follow up.  Of the remaining 520 patients, 24% are still alive and receiving therapy.  I cannot find data from programs in similar resource constrained settings to compare.  Although this seems like a low number, it obviously is a meaningful outcome for those patients who are still alive and able to receive active treatment! And, hopefully, these patients are also able to act as young as they feel

 

Randy Hurley