Dr. Ditangco, My New Doctor

She was referred to me by my doctor friend. We deserve to have the best doctor for my case because we always want educated decisions when it comes to the ARV's. We don't want doctors panicking and then make me switch fast to another medicine without even thinking that the side effects are worse for my current condition.

We met Dr. Ditangco in the hospital. She has no clinic there but she was a consultant on deck. She happened to be free at that time so she was able to meet us. I was formally introduced by my doctor friend then she talked to me alone first without Tag. Then she came out and explained that there is nothing to worry about the ALT. We were just panicking, she claimed, when in fact she has lots of patients who have high ALT's without symptoms like me. She said report fast if I see and feel any symptoms ..that's it. I asked her if she can take me in and she said yes. Yehey! One of the best HIV experts in the country is my doctor. I asked a lot of questions which she answered with confidence.

She then enrolled me to the RITM program, since she is the head of the HIV hub there. She just asked for my HIV test result and she filled out everything for me. She gave me my code name too. She made me the prescription for my meds for a 2 month supply which I have to get next week. She told me too that she will bring my meds every time I have consultations with her in her clinic so I don't have to go to RITM. That was nice of her. We felt relieved.

She told me that treatment of HIV/AIDS is comparable to treatment of diabetes now. As long as I have confidence with the medicines and I take them regularly without skipping them, I will be fine. She realistically said that it will take time, but she wants my viral load to be undetectable hopefully by 1 year. Nice, I whispered to myself. At last we have a goal to beat.

I am confident that everything will be fine from now on. Tag asked me what my plans are. I told him I want to go back to work. He said rest for 2 more months, start on January and I agreed. He likes me to take care of myself and him while I'm not working. We both agreed that since I moved to another hub, we should be grateful to all our doctors who helped us get through the process. We will visit my previous hub and Drs T and R in the hospital for all their help.

I found this article about Dr. Ditangco: First Line Forever

"First-line Forever"

IN THE PHILIPPINES, STOPPING DRUG RESISTANCE BEFORE IT STARTS

July 2010 - Approximately 950 people are on antiretroviral therapy (ART) in the Philippines, and Dr. Rossana Ditangco knows them all.

As head of the AIDS Research Group at the Research Institute for Tropical Medicine (RITM) near Manila, she may not have met them all in person but she has become familiar with key details of their lives: where and when they get their medications, what kind of support they receive from their healthcare providers, and how their immune systems are responding to treatment. This knowledge comes from an ambitious new program—inspired in part by RITM's participation in the TREAT Asia Studies to Evaluate Resistance (TASER)—to enhance treatment adherence and monitor the emergence of drug resistance in the Philippines.

Preventing drug resistance, which can lead to failure of first-line treatment, is particularly important in countries like the Philippines where access to second-line drugs is limited due to cost. Dr. Ditangco began planning the resistance monitoring program several years ago when first-line ART became more widely available in the Philippines. "Thanks to my constant interaction with other clinicians and researchers in the region, I knew that drug resistance was one of the major challenges of scaling up treatment," she explained.

Staff at RITM’s AIDS Research Group (from left): Cresset Manucat, Elizabeth Navo, Laila Grace Marquez, Rosa Lyn Bantique, Ana Inocencio, and Dr. Rossana Ditangco.

Drug resistance is not widespread in the Philippines, which is how Dr. Ditangco and her colleagues want to keep it. "Our motto is First-line Forever," she says. Among the small population of patients who are experiencing treatment failure as a result of resistance, most have been living with HIV for many years and began taking ART before the country had a systematic treatment and counseling program.

Dr. Ditangco and her colleagues spent more than two years developing the monitoring program, aided by the technical assistance they received through TASER. The program she has designed includes training for healthcare workers on treatment guidelines and adherence counseling, a physician guidebook, informational materials for patients, and standardized enrollment forms and adherence evaluation forms. It also includes a standard operating procedure for patient enrollment, monitoring, and laboratory testing, which includes regular CD4 and viral load testing, as well as resistance testing.

"TASER enabled me to bring the technology into the country, and then transfer the technology to the national program," she said. "I've also been able to interact with top scientists in the area, which is very important. In developing countries like the Philippines, we would not have access to this technology and knowledge without joining a regional group like TREAT Asia."

In addition to her role as a researcher, Dr. Ditangco is still a practicing physician, caring for patients at RITM who are enrolled in TASER and the TREAT Asia HIV Observational Database (TAHOD). "Working in the field helps me see firsthand what is going on," she explained. "Patients now are very educated when it comes to treatment. But they are still dealing with personal issues that interfere with adherence, and that's very difficult to contend with. We have to do a lot of counseling."

According to Dr. Ditangco, RITM acts as the "central nervous system" of the national treatment program, overseeing a network of treatment hubs—government hospitals that provide ART. For the monitoring program, Dr. Ditangco established a database into which HIV/AIDS clinicians across the country enter all their patients' information, and then transfer the data to RITM for analysis.

Following the first data transfer this spring, most participating clinicians are enthusiastic about the program. "They are all in agreement that we cannot allow drug resistance to develop because we may not be able to provide second-line treatment to everyone," said Dr. Ditangco.