1. Managing patient infected with HIV in a Government health Clinic – Six years experience Dr. Norsiah Ali PMC MD(USM),MMed (UM) Family Medicine Specialist, Tampin Health Clinic, Tampin, N. Sembilan,Malaysia @ Fellowship Community Addiction Medicine Department of General Practice Monash University, Victoria

2. TAMPIN HEALTH CLINIC Location, Population coverage, Daily attendances, Staff, Activities…

3. Introduction HIV infection has caused a lot of sufferings and thousands has died. HIV infection has caused a lot of sufferings and thousands has died. In Malaysia, it has spread tremendously to both urban and rural populations since it was first identified and mainly related to drug addiction. In Malaysia, it has spread tremendously to both urban and rural populations since it was first identified and mainly related to drug addiction. The pool for drug addiction in Malaysia is mainly in some pockets in urban areas and villages particularly FELDA areas. The pool for drug addiction in Malaysia is mainly in some pockets in urban areas and villages particularly FELDA areas. Currently the majority of clinics providing treatment to HIV infected patients are located in urban area. Therefore there is a need to provide care accessible to patient. Currently the majority of clinics providing treatment to HIV infected patients are located in urban area. Therefore there is a need to provide care accessible to patient.

4. FELDA (Federal Land Development Authority) 308 areas 308 areas 500 families per area 500 families per area Settlers are mainly from poor socioeconomic and low education status Settlers are mainly from poor socioeconomic and low education status

5. History of HIV service in Tampin Health Clinic First started in 2001 after FMS attended a course conducted by the AIDS Division Ministry of Health. First started in 2001 after FMS attended a course conducted by the AIDS Division Ministry of Health. Integrate with other illnesses Integrate with other illnesses 1 st case: 52 yrs old man 1 st case: 52 yrs old man Initial years: Counseling sessions, Symptomatic Rx, prophylaxis against PCP….many died. Initial years: Counseling sessions, Symptomatic Rx, prophylaxis against PCP….many died. 2004: 6 patients referred for HAART ( 3 KL Hosp, 3 Seremban Hosp) 2004: 6 patients referred for HAART ( 3 KL Hosp, 3 Seremban Hosp) April 2005 : FMS attached to ID Clinic GHKL for 2 weeks April 2005 : FMS attached to ID Clinic GHKL for 2 weeks July 2005 : HAART initiated in Tampin Health Clinic July 2005 : HAART initiated in Tampin Health Clinic

6. Clinic session

7. Registed patients Year New registration Cumulative number 200144 2002711 2003516 20041127 20052148 20064997 30 th March 2007 21118

8. How patients are captured ( N=118 )

9. Health Forum in FELDA area

10. Collaboration with other agencies….National Drug Agency, Police Dept, Drug Rehab Centre, Community Leaders etc.

11. Sociodemography a. Gender: Male – 109 (92.4%) Female – 9 (7.6%) b. Ethnic group Malay- 98 ( 83 %) Chinese – 6 ( 5 %) Indian – 14 (12%)

12. Age distribution

13. Risk factors & Stage when first came to clinic

14. Co-infections & ADI (N=118)

15. Outcome after 6/12 on ARV (N=32) IndicatorPercentage Subjective feeling of general well being 100% Weight gain 80% Increment in CD4 vs baseline 100% Viral load < 50 copies at 6 mth 100% ( out of 15 ) Comply to Rx and F/up 100% (Out of 28: 2 transfer out, 2 passed away)

16. an interactive session with infected patients

17. Difficulties To ensure patient comply to treatment and f/up. To ensure patient comply to treatment and f/up. Need to regularly keep track with patients attendance and serial counseling. Need to regularly keep track with patients attendance and serial counseling. Lack of manpower Lack of manpower Delay in getting lab result (Hep C, CD 4 ) Delay in getting lab result (Hep C, CD 4 ) Not many can afford Hep C treatment Not many can afford Hep C treatment Relapse to drug addiction – Methadone Relapse to drug addiction – Methadone Involve with police case Involve with police case

18. Conclusion HIV Clinic can be conducted in a primary care clinic HIV Clinic can be conducted in a primary care clinic Need to have good liaison with ID physician Need to have good liaison with ID physician Collaboration with other agencies and community Collaboration with other agencies and community Dedicated and motivated staff Dedicated and motivated staff Good support services ( laboratory, counseling sessions etc ) Good support services ( laboratory, counseling sessions etc ) Careful selection of patients for HAART Careful selection of patients for HAART