Update on the Sandy Logie (HIV) Clinic

Sarah Rittman
medical student

May 2005

The Sandy Logie Clinic at Saint Francis’ Hospital, Katete, has been prescribing anti-retroviral drugs (ARVs) to HIV positive patients since 2002. Though sold at cost, the price of the drugs still proved too high for many patients, who would have benefited greatly from these drugs if they could afford them. However, in June 2004 the clinic secured funding for drugs supplied by The Global Fund. Through a system of means testing those patients who could not afford ARVs were exempt from paying. This represented a huge step forward for the clinic; but cost was still a barrier to some patients. Then, in November 2004, the hospital was awarded AIDS Relief drugs, allowing them to lower the cost to those who still had to pay for the drugs. However, from March 2005, all ARVs prescribed through the Sandy Logie Clinic were completely free. To date, the clinic has treated around 500 people with ARVs.

The benefits of anti-retroviral therapy, when the treatment plan is strictly adhered to, are difficult to overestimate. Doctors at the clinic report seeing numerous examples of the ‘Lazarus Effect’, whereby extremely ill patients improve to the extent that they can return to work and live relatively normal lives.

This was the case with one Lusaka businessman. He tested positive for HIV and his condition rapidly deteriorated, to the extent that he was admitted to the hospital as an in-patient, not responding to TB treatment. As he was the sole breadwinner of the family this left his wife and two small children with little to live on. He could not work, and therefore he could not afford ARVs. However, he was able to access them through the hospital and the change has been remarkable. He has now returned to work and can once again provide for his family, and live a normal family life.

A similar story has been repeated by many different patients, for example a nurse who was on her deathbed. Thanks to ARV treatment she is now back at work at a local hospital, allowing her to earn a living and to continue caring for other patients. Numerous teachers have been able to return to work after starting treatment. ARVs are enabling teachers, nurses, farmers, trades people and countless others to continue their jobs. This allows them to continue contributing to society and the economy; and live positively with their HIV status.

 However, there are still many challenges facing the Sandy Logie Clinic. Doctors are concerned about the continuing supply of affordable ARV drugs. Only recently India, a country that currently drugs for the Global Fund, stopped manufacturing generic drugs. The demand for ARVs across Sub-Saharan Africa in particular is incredibly high. The continuous supply of ARVs is crucial to stop resistance building up. If patients miss even one dose the virus can build up resistance, making it much less effective.

This presents a huge challenge to the understaffed clinical team at the Sandy Logie Clinic: each patient started on ARVs must be able to adhere strictly to their regime. This requires counselling and training and follow-up appointments every 2 weeks initially and when used to the treatment at least every three months. For many patients this means travelling large distances to the hospital, the cost of transport is very high so people often use bicycles or come by foot, sometimes traveling for most of the day to come to clinic appointments. The stigma of HIV persists and can make patients unwilling to disclose their status to friends and family. If patients do not have the support of family and friends it can make adherence to the demanding drug regime all the more difficult.

However, there is hope for the future. Dr Shelagh Parkinson, Executive Director of Saint Francis’ Hospital, predicts that as people see the beneficial effect of ARVs, they will be more willing to come for voluntary counselling and testing (VCT). ARVs represent a benefit of knowing your HIV status; though they cannot cure AIDS they can allow people to live a normal life. The clinic is also focusing on preventing mother to child transmission; thereby creating the possibility of a generation free from infection. Having enough clinical staff to do this is essential.