T. Ramavarman

THIRUVANANTHAPURAM: A strategy evolved through a dedicated teamwork of doctors, nurses and other sections at Government Medical College, Thrissur, for treating people infected by the HIV virus has become a model for the management of AIDS patients across the country.

A key feature of this `Thrissur Model of HIV Care' is that it integrates HIV care into the existing mainstream health care system in a multi-speciality hospital, without any additional infrastructure expenditure.

The only supplementary cost is that of the Anti-Retroviral Therapy (ART) which has now become the most-accepted treatment regime for the HIV-infected across the world.

And the success rate of this `model' launched in the medical college a couple of years ago is quite remarkable. The team involved could achieve almost 100 per cent success in preventing the transmission of the infection from parents to the offspring.

The children of nearly all the HIV-positive mothers who had their delivery at the medical college were found to be free from the infection after the stipulated 18 months of post-natal period.

The mortality rate among the in-patients who were in the advanced stage of the disease could be brought down to less than 15 per cent. The hospital now had 2,000 registered HIV patients and out of them 700 were on the ART.


The team could achieve more than 95 per cent adherence to the ART regime - a significant achievement considering that dropout rate in this system is very high across the world and is one of the causes of the persisting high mortality levels of AIDS.

Pointing out that stigma has been a major factor in the deprivation of effective healthcare regimes for the HIV-infected, coordinator of the project and senior lecturer in the dermatology department of the college

Ajit Kumar told The Hindu here that revealing of the status of such patients was fraught with several dangers.

"The patients might lose their job, family and house. There are chances that they are even denied care at the healthcare setting. Even at the Thrissur medical college there were instances of the people living with HIV/AIDS being discriminated against, in some departments in the early days. Even the doctors treating HIV cases were sometimes stigmatised."

Changing situation

He said the situation had changed drastically now. In the medical college, HIV was no longer seen as an exotic disease to be managed by certain specialists alone. The approach had been that it was just another disease that any doctor could attend to.

"Here HIV is seen as a problem with many specialised issues, each needing focussed attention. It is considered a sub-specialty of the department of general medicine. This department takes the lead role in the management of the patient and draws up the involvement of a variety of specialists from many fields, whenever needed."

All HIV-specific issues are addressed at an outpatient clinic managed by a trained doctor and counsellor. In-patient care is provided at the respective specialties without any discrimination.

For example, the HIV-infected pregnant mothers are given the required medicines during the entire period of pregnancy, in collaboration with the specialists in the gynaecology department. It is ensured that all such deliveries are caesareans.

The surgery department conducts all the surgeries including the caesarean section. The paediatric department provides the support for the management of the children of the HIV-infected. Counselling of the patients, family members and the healthcare workers (HCWs) forms an important component of the `model'. Prophylaxis against opportunistic infection, treatment of co-morbidity and referral services are also part of the regime.


Dr. Ajit Kumar said along with stigma inadequate training of HCWs was a major impediment in ensuring quality HIV care in the healthcare system. But at Thrissur Medical College, all the HCWs were being given regular training in not only HIV care but also in all related issues like prophylaxis, waste management, human rights and legal issues associated with HIV care, as well as in personal protection of the HCWs.

According to sources, lack of a CD4 machine in the college forces the patients to go to Thiruvananthapuram or Ernakulam for CD4 count tests. Only those patients with a CD4 count of less than 200/ c mm or those who have some other indication for the ART are started on the treatment. The constant support received from the National AIDS Control Programme, Kerala State AIDS Control Society, Revised National TB Control Program, self-help groups, NGOs and other tertiary care centres was a major factor for the bright outcome of the programme, along with the committed involvement of the college administration and staff.