What We Do
MSF has been working in Bihar since 2007. Our activities have seen a gradual transition to focus on people living with advanced HIV and life threatening opportunistic infections at Guru Gobind Singh Hospital in Patna. This focus has been driven by a lack of access to care for this extremely vulnerable population, by stigma from healthcare providers and by a lack of specialist tests and drugs.
Patients with advanced HIV have an extremely high mortality rate, with complex treatment needs covering nutrition, infection, mental health and psychosocial support.
MSF has been working in collaboration with the government to reduce the mortality and morbidity in this group of patients through increasing access to holistic care for those presenting with life-threatening opportunistic infections.
People living with HIV are diagnosed with advanced HIV if they have a CD4 count of less than 200 cells/mm3 or if they have certain opportunistic infections of WHO stage 3 or 4 in adult and adolescent ar all children younger than 5 years old.
People with advanced HIV may have high levels of mortality when they have life-threatening opportunistic infections like kala azar or tuberculosis.
Based on our research, 10 to 15 per cent of people living with advanced HIV need specialised management.
Since 2019, we have developed and introduced several parallel synergistic approaches to demonstrate a model of care that could be replicated across other sites or whose specific components could be used to generate knowledge to improve approaches to treatment for this patient group at the national level.
Our areas of current focus include proactive antimicrobial resistance stewardship to better guide the rational use of antimicrobials. The project’s other components – including palliative care, nutrition, intensive mental health support and advocacy – make it significant for demonstrating a model of care for advanced HIV in low-resource settings. MSF is working with state and national level AIDS control programme leadership to contribute knowledge and experience. As part of this, the project conducted two workshops during 2020 with the Ministry of Health to train five external medical doctors and four ART counsellors. Also in 2021, a workshop was conducted with the ART Nodal doctors to bridge the gap between ART centres and Districts Hospitals.
The COVID-19 pandemic had a substantial impact on access to care for advanced HIV patients, with a 50 per cent reduction in the number of patients seen in the hospital over the year, reflecting in part the precarious situation in which this cohort of patients’ lives; the impact of this on overall mortality and morbidity remains to be seen. The team worked hard to maintain access to patients and continue delivering lifesaving services, managing eight patients with advanced HIV and COVID-19 infection, of whom the majority survived.