Download HIV/AIDS Care in the Dominican Republic

HIV/AIDS Care in the Dominican Republic
Andrew Wilbur, MSII
Global Health Pathway
Instituto Dominicano de Estudios Virológicos (IDEV)
• HIV/AIDS clinic and research center in Santo Domingo, Dominican Republic
• Clinic team includes doctors, nurses, pharmacists, lab technicians, administrators,
a social worker, and a psychologist, among others
• Treats HIV-positive patients through the Dominican Republic’s national program
• Advances pharmaceutical research through enrollment in stage 2 and 3 clinical
trials of novel antiretroviral agents
Objectives
• Build Spanish language skills
• 488,334 (7.9%) MA residents speak Spanish at home (2012, census.gov)
• Experience Dominican culture
• 103,292 (1.6%) Dominican Americans in MA (2010, census.gov)
• Understand social and cultural views that affect HIV transmission and care
• Improve medical interviewing and physical examination skills
• Observe opportunistic infections characteristic of HIV infection and AIDS
• Understand how HIV infection is diagnosed and treated in the Dominican Republic
• Understand the availability and selection of antiretroviral regimens at IDEV and
compare/contrast with clinics in the United States
Clinical/Research Experiences at IDEV
“Physician as a Person”
• Attended morning meetings with IDEV physicians
• Session topics included emerging infectious diseases, current HIV clinical
knowledge, NEJM case studies, and safety information for research drugs
• Observed and assisted in medical interviews, physical exams, and vital signs
• Observed 10 different physicians conduct interviews in 3 languages
(Spanish, English, and Kreyol)
• Observed various opportunistic infections via physical exam and imaging
• Pneumocystis jirovecii pneumonia (PCP), Toxoplasma gondii encephalitis,
reactivation TB, Herpes zoster, oral candidiasis
• Completed an introductory lecture series on HIV biology, pathology, epidemiology,
and therapy with Dr. Carlos Adón, sub-director of IDEV
• Participated in community outreach activities in several local barrios
• Administered questionnaires to drug users to understand the risk factors
for HIV transmission within these communities
• Provided counseling about reducing one’s risk of infection
• Enrolled participants in free HIV rapid tests
• Assisted in a study that sought to identify clinical differences between HIV+ and
HIV- patients with Chikungunya virus infections
• Identified patients who had fallen ill with suspected Chikungunya virus
infection within the previous 2 weeks
• Guided patients through informed consent process and questionnaire
• Collaborated with laboratory team to obtain patients’ blood samples for
CHIKV IgM test
• Santo Domingo
• Made many new friends from IDEV and local medical schools (Universidad
Nacional Pedro Henríquez Ureña (UNPHU) and Universidad Iberoamericana
(UNIBE))
• Enjoyed Dominican food, music, and television during my homestay
• Danced merengue, bachata, and salsa in the Zona Colonial
• Went running along the seaside Malecón
• Explored the caves of Tres Ojos
• Navigated the city’s transportation system, including guaguas, carros
públicos, and a new subway system
• Samaná Peninsula
• Enjoyed the beaches and restaurants of las Terrenas and las Galeras
• Went horseback riding to Salto del Limón, a waterfall and swimming hole
• Isla Saona
• Saw dolphins and giant star fish, swam in the piscina natural, enjoyed
fresh fish at a beachside restaurant
Conclusions and Next Steps
• The IDEV family provided me with support and guidance for the entirety of my
experience in the Dominican Republic.
• I learned how a clinic is run, and how clinical trials are conducted.
• I plan on familiarizing myself with HIV/AIDS care in the US to compare/contrast
and to build on my current knowledge.
Acknowledgements
Additional Medical Experiences
• Visited hospitalized patients at the Centro Medico Dominico-Cubano, where they
received care for life-threatening, AIDS-related opportunistic infections
• Participated in rounds at Robert Reed Cabral Children's’ Hospital
• Visited specialized dengue unit
• Observed case of neonatal Chikungunya virus infection
• Attended Dr. Carlos Adón’s lecture on the role of evidence-based medicine in HIV
care at Hospital Padre Billini
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Dr. Ellen Koenig – Director, IDEV
Dr. Carlos Adón – Sub-Director, IDEV
Sr. Aldo Erazo – Head of International Affairs, UNPHU
Dr. José J. Asilis-Záiter – Dean of Faculty of Health Sciences, UNPHU
Dr. Douglas Golenbock – Chief of Infectious Disease & Immunology, UMMS
Rosa Ramírez & Jennifer Piña – my loving homestay family
All of my wonderful teachers, mentors, and friends at IDEV
• Please direct questions and comments to Andrew Wilbur:
• [email protected], 617-959-1157
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