Suspension of Disbelief

Posts Tagged ‘cd4 count

PhilHealth benefit package for people with HIV under review

leave a comment »

VERA Files | 01 December 2015

***

 

PhilHealth HIV - ARV Bottles

ARV Bottles

As the country commemorates World AIDS Day today (December 1), the Philippine Health Insurance Corp. (PhilHealth) is set to begin a formal review of its benefit package for people living with HIV (human immunodeficiency virus), or PLHIVs.

“We are currently reviewing the Outpatient HIV/AIDS Treatment (OHAT) Package, the implementation of it in treatment hubs, and the current rates, and if patients have questions, we can discuss it with them.  PhilHealth is going to conduct a formal review of benefits, this year up to next year, to address these issues,” Dr. Mary Antoinette Remonte, Medical Specialist II and Millennium Development Goals Benefit Products Team Head of PhilHealth, said.

PLHIVs in the country, who are members of PhilHealth, are entitled to several benefits under the OHAT Package. Every year, a member is entitled to P30,000, or P7,500 every quarter, worth of treatment, care and support (TCS) services from his chosen PhilHealth accredited treatment hub.

Also included in the OHAT Package are the following: drugs and medicines; laboratory examinations based on the specific treatment guideline, including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), test for monitoring antiretroviral (ARV) drug toxicity; and professional fees of providers.

Hospitalization coverage from PhilHealth ranges from P11,000-20,000, depending on the case. Any amount that will exceed the allotted budget will be charged to the patient.

DOH National Epidemiology Center

DOH National Epidemiology Center

However, PhilHealth has received  reports from several PLHIVs that the TCS services they get from their treatment hubs are different compared to other TCS providers.

“It has come to our attention that some treatment hubs charge for some laboratory tests, even after the release of the OHAT Package circular. Also, according to the guidelines set by the DOH (Department of Health), viral load testing is also covered by the OHAT Package,” Dr. Remonte said.

In the case of Paolo (not his real name), a person living with HIV  (PLHIV) from Manila who is receiving HIV TCS at San Lazaro Hospital, he was made to pay for the viral load test even if he is a PhilHealth member.

Sadly, if you are a PHLIV who had been charged for a particular TCS service, that is supposedly covered by the OHAT Package, “you cannot be reimbursed for what you spent, because the reimbursement goes directly to the facility. This is why it is important for a facility to properly maximize the reimbursement claims so they can help the patients,” Dr. Remonte added.

But the practice in other treatment hubs, like in the Research Institute for Tropical Medicine (RITM), is different. PLHIVs are able to receive free baseline laboratory tests and CD4 count.

“The OHAT Package does not cover baseline tests yet, but due to good financial management, we can provide them for free to new patients. And once they start their treatment, they would be eligible for OHAT,” Dr. Rosanna Ditangco, research chief head at RITM-ARG, explained.

For patients who are already starting their antiretroviral therapy, “we provide free CD4 and CBC tests. Yearly, during their anniversary, we provide free CD4, CBC, blood chemistry – depending on what ARV they are taking, and viral load. And if the doctor suspects treatment failure, a free viral load test will be done anytime plus HIV drug resistance testing,” Dr. Ditangco added.

That has been the system of RITM ever since PhilHealth released their OHAT Package circular.

“The HIV treatment regimen is standard for all treatment hubs, but the cost of laboratories are not the same. The practice is also different on how they utilize the PhilHealth reimbursement and this is because of administrative problems in the treatment hubs,” Dr. Remonte explained.

She also reminded PLHIVs to check if their treatment hubs were filing claims and if they find out that there were lapses, they could write a complaint, anonymously if they are worried about confidentiality.

For PLHIVs who want to avail of the benefits of the OHAT Package, they should be PhilHealth members with three to six months contributions; submit a waiver allowing PhilHealth to look in to their records; and provide a copy of their HIV confirmatory result and treatment regimen.

There are currently 22 accredited hospitals all over the country that are designated treatment hubs for PLHIVs. There are also several satellite clinics that provide TCS services for HIV management.

Like other agencies and institutions, PhilHealth is increasing its efforts to help manage the detrimental effects of HIV.

The Philippines is one of the countries where the prevalence of HIV has been increasing.

On the other hand, statistics from other countries show that HIV is already decreasing, or at zero growth.

As of August this year, there were already more than 5,000 reported HIV cases in the Philippines, according to the DOH. This number is 17% higher compared to the same period last year.

.

.

(VERA Files is put out by veteran journalists taking a deeper look at current issues. Vera is Latin for “true.”

***

Advertisements

Having HIV as an ongoing personal battle

leave a comment »

Outrage Magazine | 21 July 2015

***

 

This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”. More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

Positive-life

When Paolo – who was diagnosed to be HIV positive in 2007 – started taking antiretroviral (ARV) medicines, his life changed permanently. But even with the life-saving ARVs, he continues to have doubts if his status is, as many continue to believe, a punishment for his bad deeds, or maybe even a death sentence. After all, there was a point in his life when – knowing how difficult having HIV could be, he still irresponsibly knowingly engage in risky practices that may have infected his partners (i.e. spreading “the gift”). Not surprisingly, Paolo still experiences chronic depression.

Only last month, he faced another battle. His attending physician conveyed her concern toward his declining CD4 count. Because of this, Paolo may have to be shifted to the second line of ARVs.

“It was late last year when my doctor at San Lazaro Hospital told me that I should watch out for my declining CD4 count. She said that it might be a sign of too much stress or a problem with my ARV combination,” Paolo said.

When he went to the hospital last April to get his ARV supply, he was only given meds for one month (versus the usual 3 1/2 months’ supplies). It was also then when he was told that they have to wait for his latest CD4 count before they can give him more supplies.

The following month, Paolo had his CD4 count tested. True to form, yet still shocking Paolo, the decline continued. “My CD4 count was in a downward trend: 388 in May 2015, 426 in November 2014, 454 in May 2014, 470 in November 2013, and 533 in May 2013.”

Paolo’s CD4 count was 582 in December 2008, when he had his baseline tests; with the number immediately falling to 327 in June 2011.

There have been fluctuations (e.g. from 327 in June 2011 to 368 in March 2012), but Paolo’s attending physician said that ever since the last increase, “the numbers continued to go down, and it may be a sign of drug resistance or treatment failure.”

He was immediately asked to have a viral load test to check the number of HIV copies in his blood. His doctor also gave him a heads up on what he should expect if the result was high.

“The test costs P6,000. Even if I’m an old PhilHealth member and I’m able to avail free CD4 count tests and ARV medications, under the OHAT package, I was still asked to pay that amount. When this happens to you, complaining is the last thing on your mind. For me, I just want to know the result,” Paolo said.

He was told to return after three weeks for the result.

“It was probably the longest three weeks of my life. A lot things started running in my head: What if it’s high, would I be able to take the side effects of the level 2 medications? What if it’s low and my CD4 count continues to decline, what will happen to me?” Paolo asked. “During that three weeks, I had sleepless nights. I couldn’t even disclose it to the 16-year-old guy I was seeing. I was really afraid. I had no one to run to. I don’t want to die yet.”

Paolo was also reluctant to reach out to support groups.

“It’s not them who can and will help you because they don’t really know what you’re feeling, HIV is a personal thing. Support groups are not really supportive enough. Yes, you will have someone to talk to, but at the end of the day, it’s not them, not your friends, not even your family, who can help you get over what you’re feeling. Just yourself,” Paolo said.

But Paolo’s life did not stop while he waited for the test ascertaining his viral load.

“I started to see things from a different perspective. I’m able to appreciate and value even the smallest and simplest things. I know that it may be temporary because of the situation I was in, but it gave me a reason to smile and be thankful,” Paolo said.

He told Red, a friend his who is also HIV-positive, about his situation. Paolo reconciled with him after a long time.

“I know I was going to explode if I didn’t tell anyone about my situation. I felt a bit relieved after I told him what I was going through,” he said.

After then, both at work and at home, Paolo became more relaxed. He also started joining different LGBT- and HIV-related events. He even participated in the 21st Metro Manila Pride March last June, where he marched for the first time.

Paolo wanted to much to be optimistic. “There are so many better things that one can do, regardless if you’re a PLHIV or not,” he said.

And then the third week came. Paolo went back to San Lazaro Hospital to get his test result.

“The anxiety of waiting for the folded and stapled paper to be handed to you was really exhausting. The lady who was assisting the clients in the laboratory was moving very slowly. And when she finally handed the paper to me, I was able to breathe normally,” he recalled.

His result indicated 84 copies/mL.

“I was told by my doctor to rest more often and that I should also lessen stressful activities,” Paolo said.

His ARV medications stayed the same, and he was already given three months’ worth of supplies.

His CD4 count will be checked again after six months. And his doctor, provided that he continues to improve his lifestyle, remains optimistic that everything will be okay.

“I know I’m not the perfect role model. But based on what I’ve gone through, being a PLHIV is one difficult challenge. It’s not as simple as some doctors or support groups say. No one can and will help you, but yourself,” Paolo said. “It’s not easy to accept your situation, but instead of being too negative, why not do something about it?”

Paolo recommends self-sufficiency in facing being HIV positive.

“You can always live your life to the fullest, just don’t forget to look out for yourself. It may sound selfish, but at the end of the day, you are responsible for your own welfare,” Paolo ended.

*NAMES WERE CHANGED AS REQUESTED BY THE MAIN INTERVIEWEE TO PROTECT THE PRIVACY OF THE PEOPLE INVOLVED

.

.

(Outrage Magazine remains the only publication for the lesbian, gay, bisexual and transgender (LGBT) community in the Philippines.)

***

%d bloggers like this: