By Eric Msikiti:
For 36-year-old Memory Nchawa of Phokera Village, Traditional Authority (T/A) Mbenje in Nsanje, it all started with a minor cough.
Thinking it was just that, a cough, the mother of three made a one-hour journey to the nearest health centre where she received medical help.
But the cough continued for three months until it culminated into a serious illness.
“I had pain in my stomach and, within weeks, the stomach and feet began to swell but, despite the severe coughing, diagnosis at Bangula Health Centre showed that I had no TB,” Nchawa said.
It was only after this illness that Nchawa was later taken to Queen Elizabeth Central Hospital (Qech) in Blantyre to where she was admitted for two weeks.
It was at Qech where Nchawa was diagnosed with tuberculosis (TB).
Further tests revealed that Nchawa had advanced HIV; a condition which medical experts say has been killing at least two people in the first 48 hours of being admitted to Nsanje District Hospital.
She is now on antiretroviral therapy (ART) and admitted to Nsanje District Hospital where initiatives to build capacity for health personnel in the fight against the condition are taking place.
Advanced HIV is caused by, among other things, low adherence to ART among people living with HIV.
TB and shortage of food are also some of the causes of the condition according to officials.
“Taking medication has never been a problem with me but, as a family, we have been facing critical shortage of food, especially now that I have been in hospital for some time,” Nchawa said.
Elsewhere in Nsanje, 19-year-old Simbazako Thove prepares for an X-ray at the district hospital.
Thove is living with HIV and TB and was forced to drop out of school due to financial problems after the death of her parents.
He now lives with his elder brother, a small-scale farmer.
Thove was tested HIV-positive last year and is currently on ART.
Unlike Nchawa, who says her condition is improving by the day, Thove says he is still experiencing pain despite continuously taking his medication.
“Most of the pain comes from the ribs. I always take my drugs but I am afraid there is no improvement,” Thove says.
Thove and Nchawa are some of at least 40 cases of advanced HIV that are recorded in Nsanje every month.
But Nsanje District Medical Officer Alphonsina Ndembera says recently the situation has improved as compared to how things were three months ago.
“The problem was that most people living with HIV would come late to seek medical help and, in most cases, the condition would have reached critical levels by the time the patients came for medical attention.
“But through various interventions, people now know which signs to look out for and report such cases the soonest to the hospital,” Ndembera says.
A charity organisation Médecins Sans Frontières (MSF) Belgium is sponsoring initiatives aimed at building the capacity of health personnel to deal with the situation.
Among other things, MSF Belgium has supported the rehabilitation of a female ward and a Rapid Assessment Unit at the facility as part of efforts to ensure patients with advanced HIV are well taken care of.
MSF Belgium’s Head of Mission to Malawi Ilse Casteels says the two facilities will help in the prompt diagnosis and treatment of advanced HIV.
“Although the District Health Management Team and healthcare workers here in Nsanje have made impressive progress to reach Malawi’s HIV targets, more still needs to be done to reach out to at least 21.7 percent of HIV patients who still don’t know their status.
“We also need to make sure that no person living with HIV interrupts their treatment and are lost,” Casteels says.
Poor nutrition and inconsistencies in taking medication among people living with HIV reportedly lead to advanced HIV.
Reports indicate that Malawi has made progress in reaching the UNAids 90:90:90 targets, meaning 90 percent of people living with HIV know their status, 90 percent of people diagnosed with HIV are initiated on ART and 90 percent of all people on ART are virally suppressed.
At the end of 2018, Malawi reached 91 percent, 83 percent and 90 percent with 810,245 people on treatment.
But, despite this progress, HIV remains the leading cause of death among adults in Malawi, with an estimated 17,000 deaths a year.
According to World Health Organisation, these advancements in decreasing the number of HIV-related deaths seemed to have stopped.
But a substantial number of patients are still at risk of developing advanced HIV.
MSF says a significant number of patients have also interrupted their treatment and are lost to follow up and that other patients are failing on treatment but only low proportion of them has been switched to second-line ARVs.
These patients, according to reports, are at high risk of developing advanced HIV.
As a solution, MSF has been offering support to Nsanje District Health Office.
The charity is working with Nsanje District Health Office on improving the circle of care for advanced HIV patients.
At community level, patients are sensitised to identify danger signs and go to the health centre while, at health centre level, patients are screened for advanced HIV and, if necessary, referred to a hospital.
A mentoring programme is currently being rolled out in pilot sites to improve the competences of the clinical staff.
“At hospital level, a rapid assessment unit is integrated into the emergency unit to promptly diagnose patients with advanced HIV and put them on treatment.
In the wards, medical staff is trained to improve the quality of care,” Casteels adds.
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