The fourth issue of the Medical Education Marathon on the role of primary care in HIV response

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In Ukraine, approximately one in 165 people are living with HIV. Many people are unaware of their HIV status because society is not well-informed about the virus’s spread, prevention, and treatment. Today, the HIV epidemic in Ukraine can be overcome by mass testing of the population. If everyone knows ones’ HIV status, it will be the slightest chance of getting or transmitting the virus to someone. Hence, on World AIDS Day, during the fourth issue of the Medical Education Marathon, we reflected on the following:

  • how primary care has become a part of a support for people living with HIV;  what is the role of primary health care, what opportunities are available, and what challenges it is working with,
  • a vision of the role of primary health care in HIV prevention, response to new commitments,
  • transfer of supporting people living with HIV to primary health care facilities, positive changes,
  • what is the support of people living with HIV now, what is the difference between the support at the primary health care level and in specialized institutions (HIV centres), the role of nurses in support of people living with HIV,
  • peer groups as an opportunity to share experiences with doctors who support HIV patients.

The family doctor is significant for patients’ first contact with the health care system. In a sense, family doctors are health gatekeepers who diagnose, prevent, and treat. For people living with HIV, the role of family doctors is essential. Therefore, their dialogue can be based on trust.

In Ukraine, the relationship between family doctors and patients living with HIV has begun to develop due to health care reform. “Unfortunately, despite our country’s significant successes in the fight against the HIV/AIDS epidemic, according to the WHO, Ukraine remains a country at high risk of HIV infection among Central European and Asian countries. Today, the Healthcare Guarantee Programme has outlined a clear list of medical services and medicines that the state guarantees to each patient according to his clinical needs. The goal of the National Health Service of Ukraine (NHSU) is to diagnose, detect infection and prescribe antiretroviral drugs as soon as possible,” said Ruslana Dutchuk, chief specialist of the Clinical and Scientific Expertise Department of the Universal Medical Services Coverage Strategy Department, (NHSU).

 

“For me, the topic of HIV is very close. I have been working for people living with HIV for about three years. As a general practitioner, it is important for me that people who come for medical care must be completely honest with me. So, I understand what treatment they need, what referrals, what screening questionnaires need to be conducted, what additional preventive measures are needed for this person,” said Dmytro Skirgiko, a family doctor of the All-Ukrainian network for people living with HIV, 100% life. Family physicians do not deal with different diseases in their daily work but with individual patients. And for every doctor, a patient is a person who needs help. “We need to understand that when a person learns about one’s HIV-positive status, it is difficult for them. And who but a general practitioner can be the first to provide psychological assistance, refer to a specialist or psychologist, refer to the various social services,” Dmytro added.

The role of the family doctor is valuable in the diagnosis of HIV infection. A timely diagnosis is an important step that helps a person with HIV live a full life. “I am 100% in favor that the diagnosis should be made by family doctors who know the family better and the environment in which the family lives. They are the ones who can help and motivate family members to retake the test,” said Iryna Raus, an infectious disease doctor, and pediatrician at the Kyiv City Center for AIDS Prevention and Control.

“Testing should be offered to everyone, not based on symptoms, but as part of routine care for their health. Once a year — must-have. If this is constantly repeated to patients, sooner or later, there will be a positive effect. If every family doctor starts telling his patients that they need to be tested, that they can live with HIV, and urges people to be treated if something goes wrong, then the stigma will disappear,” said Valeriia Rachynska, a person living with HIV and a member of the NGO 100% Life.

To build a relationship of trust and respect between a person living with HIV and a family doctor, it is necessary to train doctors and nurses to be aware of this topic. Intolerance is often caused by a lack of knowledge about HIV. Today, there are many online courses for health professionals on the website of the National Health Service of Ukraine and the Center for Public Health. They help to understand the topic better. “I have been working as a nurse for many years and have repeatedly faced situations where there is discrimination against people living with HIV. It infuriates me. I am very tolerant of all people. I perceive every patient as equal,” said Anna Asanova, a nurse at the 7th outpatient clinic, Center of PHC # 1 of Dniprovskyi district.

Today, attention must be paid to the treatment and diagnosis of patients and the cultivation of an empathic attitude toward people living with HIV among doctors. “It’s very cool that the National Health Service of Ukraine and the Center for Public Health are initiating the creation of courses not only on hard skills. We are now talking about soft skills, which become an advantage in financial moments and communication with the patient,” said Daryna Dmytriievska, a family doctor and consultant for the Ukrainian-Swiss project “Development of Medical Education.”

Thank you for joining our discussion of this important topic. You can view other issues of the medical education marathon at this link → http://mededu.tilda.ws/marathon. By the way, the team of Tviy simeynyi likar has prepared posters calling to find out your HIV status and QR code, which can be used to find the nearest testing point in your city → https://bit.ly/3Ea3c44