Over the past decade many of the major challenges in the area of health in Barbados have been related to the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS).
After the first two cases of AIDS were reported in 1982, successive Governments have implemented a number of programmes and policies to manage the transmission of the virus, and treat the disease.?? However, during the early 1980s and 1990s, these measures were focused mainly on the provision of treatment to prevent and manage opportunistic infections.??
In response to the need for a more definitive treatment for HIV, the National AIDS programme was expanded and the Ladymeade Reference Unit (LRU) opened its doors 10 years ago on June 26, 2002.
According to Senior Medical Officer of Health (Chronic Diseases) at the Ministry of Health, Dr. Anton Best, the expansion of the national programme and the birth of the LRU was a welcome addition to the efforts to treat HIV.?? "A key part of the expansion was the establishment of a clinic for more definitive management of persons living with HIV. Up until that point HIV was managed at the Counselling Clinic at the Respitory Unit at the QEH, but that clinic was bursting at the seams…a whole lot more needed to be done…
"The LRU, as part of the national AIDS programme, set out to provide anti-retroviral therapy as the means by which you reduce the illness due to HIV and reduce the mortality associated with it," he explained.
The senior health official added that a third benefit realised by the establishment of the LRU was the reduced incidence of HIV in the body so that the number of persons becoming newly infected with the virus had declined in Barbados.?? "This has been happening for about three years now because of anti-retroviral therapy.?? When you put a person with HIV on anti-retroviral therapy it renders them highly unlikely to pass on the virus to anybody else," Dr. Best clarified.
The LRU offers a range of services.?? There is a laboratory which offers CD4 and viral load testing, as well as a monitoring aspect which involves the work of specially trained staff to conduct assessments. "We have community nurses that can go out into the community to reach people, to do contact tracing. We also have social workers who can do case management…we are managing a whole lot more than just a disease – [there are] persons with adverse psycho-social circumstances associated with the disease itself and other factors related to the disease.
"We don’t only manage persons with HIV but persons who have been exposed to HIV whether through occupational exposure or non-occupational exposure…So, for a health worker who gets a needle-stick injury there is something called post-exposure prophylaxis…During this process you are counselled and then tested and given a short course of antiretroviral therapy…Non-occupational exposure [can occur] where persons are assaulted sexually, and through a system with the police force, persons are referred to the LRU to undergo post-exposure prophylaxis management which involves testing and treatment and follow-up care," Dr. Best pointed out.
In addition to testing for CD4 cells and viral loads associated with HIV and AIDS, the high tech equipment in the LRU lab has also had the additional benefit of being able to test for other kinds of diseases. According to Dr. Best, molecular or definitive testing had been done to determine the specific strains that people may have of influenza, as well as testing for cancers, chlamydia and gonorrhea.??
"We can do other tests including HIV drug resistant testing, molecular diagnostic testing for tuberculosis and testing for the Human Papilloma Virus, which is the virus that causes cervical cancer.?? So, because of the investment in HIV there has been a tremendous benefit for the wider health sector of Barbados," he stated.
So, what are the future plans for the LRU? It is envisaged that some of the services would be effectively decentralised in an effort to allow physicians to coordinate the total care of persons with HIV, resulting in less persons having to attend the Unit for treatment.
"Ten years later we know we need to decentralise, we need to integrate our services into primary care so the doctor that refers a person newly diagnosed with HIV should be able to competently manage a person living with HIV in terms of assessment… [and] send samples to be tested for CD4s and viral loads…We want to get to a stage where people with HIV can comfortably go to their polyclinics and be managed, [and] continue to see private doctors.
"In essence, what we want the LRU to become is truly that – a reference unit – [where] only difficult cases are referred to us for management, for example, people who are not adhering to their therapy, [or] cases in which there is what we call co-infection…people with HIV who have other diseases like hepatitis B or C and tuberculosis," the Senior Medical Officer of Health noted.
??As part of the LRU’s 10th Anniversary celebrations the Unit hosted a client appreciation week where a series of activities including dance, karaoke and massage therapy were organised for LRU clients. There was also a public lecture on June 26 and a gala event entitled Journey to the Living, which was held on June 28 at the Frank Collymore Hall.