The initiative is
1. Meeting the new vision of the United nation, 90/90/90 foe hiv
2. Reaching all hiv patients and provide the best treatment possible
3. Decreasing stigma about hiv
HIV care committee started on Jan-2012, under care of Dr. Jameela Al-Salman (chairperson of the medical Department).
The committee consists of eight members:
(Chief of HIV Care Committee),
(Consultant of the pathology / Microbiology SMC medical lab),
(Public health consultant-Head of communicable diseases group),
(Head medical Technologist),
(Staff Nurse/HIV Coordinator).
This committee worked to provide helps to the HIV patients, reduce the mortality, and follow up with the patients their treatment and investigations.
The importance of the committee is to solve patients’ problems, ease their treatment, and reduce the cost of their treatment.
Purpose of the committee:
Encourage other members from another department to cooperate and work together for easy and faster treatment.
Reduce stigma for HIV patient.
IN 2012, a multidisciplinary team was established for HIV management involving major stakeholders: public health, infectious diseases, pharmacists, nursing and virologists. The team established a system which capture each step of patients care to improve its quality. It was established by under a higher authority in the secondary care. This team meets regularly, where we started with putting an action plans to form an integrated system to provide the best care for these patients.
The main objectives of this team were the followings:
1. To structure a program which optimize the patient journey.
2. To capture all the positive Bahraini patients and to improve their compliance
3. To introduce up to date new HIV medications
4. To implement the international guidelines for HIV management
5. To create and follow quality indicators that can measure the progress of the team work.
We started collecting the basic data which involved the followings:
1. First form: The demographic information about the patients, their risk factors, their progress and response to treatment and their follow up, their prevention protocol.
2. The second form include the serial of their blood tests specifically, HIV viral load, CD4 count and the genotyping.
3. Third form: Lists form the pharmacy where we assigned one pharmacist to look after these patients, where we get an updated list of the patients with their medications and if they missed taking them to call them urgently to ensure compliance.
We assigned a Nurse coordinator for the HIV service and who overlooks the whole process of data collection, entering and providing patient support services
These data were entered in a soft copy excel sheets to analysis the data. The data were followed up closely and discussed in regular meetings.
Over the same period we introduced new and updated HIV medications to increase the response rate to HIV medications. At the same time they were a lot of educational services provided to the staff. We are in the process of publishing patient educational materials.
A software database was established to include all patients: to record their visits, labs results, clinical progress, medications regimen and their appointments to flag missed ones.
Objective of the committee:
a) Improve the quality of patients care.
b) Provide social base and social support.
c) Provide the best care to the HIV patients.
d) Provide the medication as patient needs.
e) Provide the needed lab test.
f) Provide routine visit to the patients in the clinic.
g) Access to health care system
h) Decrease stigma about hiv among health care workers and community
In general we were able to :
1. identify all patients who are currently living with HIV in the country and improve the data base and all the statistics
2. we created a data base for all patients with all the blood work including viral load, CD4 count and their treatment and the response to treatment and the risk factors
3. increase the rate of HIV patients accessing health care system and maintained on treatment
4. worked on decreasing HIV stigma through extensive workshops and educational session for all health care workers
5. providing the best treatment
6. we smoothed the service we are providing for all HIV patients as it was very fragmented between primary care, public health , secondary care , laboratory , and pharmacy
7. increased the compliance by calling the HIV patients
8. decreased the rate of in patients and mortality of HIV patients
9. in addition to the workshops , a yearly symposium is being done for the update in the care of HIV to include all health care workers
The program structure was reviewed regularly to optimize our services.
We have a great success over the last three years where we started with uncontrolled 40 patients on medications. Now, most of patients 90/94 on treatments have good results. The reminder is being tracked to start their treatment. Up to this date: we are following, 115 patients 98 of them are on regular medications.
In regard to the viral load, up to this date, 30.out of 125 patients were undetectable (30%), and now after two years 49 patients out of 115 (42.6%).
Achievements of the HIV care committee:
Stigma training trainer Workshop.
Trained around 300 staffs.
Provide the medicine, and replace some medication which is not effective.
To follow the blood tests and provide the best medical management for the patients and adjust the medication.
Involve the public health
Collect all the information about the patients’ medicine, CD4%, CD4 count and genotype it is make easy to follow patients’ care.
Provide a team work system for the best care of the patients
Side effect of the medicine is less.
No repetition to the expensive blood test, as was happening in the past as it is monitored and regulated by the coordinator.
Improvement in the patients lab result. As at least half of the patients are controlled with undetectable viral load with the new system.
Reduce the rate of mortality.
Decrease the number of inpatient
Increase the average of HIV patients’ age.
A complete and regular Meeting and minutes.
Brochures with information about the medications (under print).
Increase the quality of the HIV care in Bahrain to be a unique model for the countries
This is a statistic of HIV patients according their age and gender:
GENDER NO TOTAL
FEMALE 21 90
AVERAGE NO TOTAL
11_20 2 90
Figure (4) shows statistics according the lab test:
CD4 COUNT <200 23 TARGET NOT DETECTED 23
CD4 COUNT 200-300 19 V.LOAD <75 9
CD4 COUNT >350 50 HIGH LEVEL 44
NOT DONE 2 NOT DONE 18
TOTAL NO. OF PATIENTS 94 TOTAL NO. OF PATIENTS 94