Guyana has launched and implemented an HIV Drug Resistance (HIVDR) Mon-itoring programme in the local health care system, in collaboration with PAHO/ WHO.
According to a Government Information Agency (GINA) press release Guyana is the first nation in the Caribbean to implement the programme. Minister of Health Dr Leslie Ramsammy said, “This is a step forward that demonstrates how comprehensive Guyana’s diagnostic and treatment programme is. It underlines the fact that we are not willing to stand still but constantly assess and expand the programme so that it remains a world class programme.” The minister also said he hopes other countries will emulate Guyana’s lead.
In 2002, efforts to intensify HIV treatment in Guyana were made possible with the introduction of antiretrovirals (ARTs) into HIV patients’ medical care. “This was followed by additional developments to ensure the best care is provided to patients with the introduction of guidelines for standardized management of adults and children with HIV infections and the introduction of immunological testing through CD4,” the release said. This effort was further expanded with the implementation of the HIV DR programme into the health care system.
Ramsammy explained that one of the challenges faced by scientists, physicians and persons living with HIV is the availability of medication to treat HIV resistance. Therefore, it is imperative that Guyana develops a system of vigilance regarding the use of the medication. So far this has resulted in more than 80% of persons who should be using the ARV treatment using it.
In addition, due to rising costs, medications must be preserved since there are not many new medicines being developed and this is critical to preventing the return of the day when HIV will become a deadly extra judicial death sentence. “Guyana must now learn from the experiences from developed and developing countries that have older treatment programmes and have demonstrated that HIV will become resistant to the medications being used, however the pace at which that resistance develops depends on several factors including strict adherence,” the release said. In this case health workers must ensure that HIV patients take their medications faithfully, as missing doses contributes to resistance.
Director, National AIDS Programme Secretariat, Dr Shanti Singh defined HIV drug resistance as a mutation of the genetic structure of HIV which inhibits the ability of the antiretroviral drugs or a combination of the drugs to block reproduction of the virus. She noted that resistance to antiretroviral drugs occurs after poor adherence to medication, when there are insufficient drug levels in the body, a viral replication in the presence of the drug, resistant virus and poor potency of the drug.
“The HIV drug resistance (programme) as outlined by WHO [World Health Organisation] includes the development of a national HIV DR working group and a detailed national HIV DR strategy, this was developed in 2006 through the office of the chief medical officer with the working group being established shortly after,” she said. Under the programme, early warning indicators have also been identified and agreed as part of the overall HIVDR monitoring.
Specimens will be processed at a WHO accredited laboratory in Puerto Rico which will indicate the virus’s mutations and patterns. The selected site for the programme is the National Care and Treatment Centre which the WHO recommended in recognition that the site has to initiate at least 100 new persons per year on antiretroviral therapy.
