A day in the life of Diego M. Cecchini

IAS member and Physician at Cosme Argerich Public Hospital, and Helios Salud Private Centre, Buenos Aires

 In the morning, I work at the Cosme Argerich Hospital in Buenos Aires city, located on the outer edge of the Buenos Aires province. Both the city and the province have a high prevalence of HIV infection compared to the rest of Argentina.

The hospital belongs to Buenos Aires city public health system and provides free assistance to resource limited populations who lack access to Health Maintenance Organizations. It is a tertiary referral centre and has one of the most important Obstetric and Neonatology Units within the city. It also has a significant number of HIV-positive patients --over 900-- under follow up, which includes a high number of pregnant women.

Mother-to-child transmission is the main cause of pediatric HIV-infection in Argentina. HIV perinatal transmission has remained stable at around 6% - in Buenos Aires city over the last few years, despite the availability of resources for antenatal, intrapartum and postpartum management of the mother and the newborn, including provision of free ARVs to HIV-positive pregnant women, formula feeding and the availability of laboratory testing for intrapartum HIV diagnosis.

One of my responsibilities in the public hospital is to assist all HIV-positive pregnant women, as part of the institution’s Working Group in the Prevention of Mother-to-Child Transmission (PMTCT). This working group has been successful in achieving an overall perinatal transmission of less than 2% in the last few years. The working group consists of Claudia Rodriguez, MD, a general coordinator; Marina Martinez, MD, a neonatologist; Rafael Giesolauro, MD, an obstetrician; and Debora Lema, a social assistant. We also work in partnership with the primary public health care centers of the surrounding areas.

My day begins in the early hours of the morning in the public hospital, where I assist outpatients living with HIV and other infections. I see both patients with fixed appointments and also those who just drop in. After that I do a full round in the Obstetric Unit, in order to provide and supervise the infectologic care of both HIV-negative and HIV-positive pregnant women, with a focus on the latter. I provide antepartum and pospartum care to these women, which involves defining postpartum continuation of ARVs, the best prophylaxis for the newborn, and much more.

On Mondays we do a full interdisciplinary round which includes all HIV-positive pregnant women, including any newborn babies, under follow-up to individualize the best strategy for each mother-child binomium. In this context, several challenges must be faced: lack of adherence to ARVs; late diagnosis during pregnancy, or even intrapartum; infection by drug resistant HIV in pregnancy; management of heavily ARV exposed patients, including those perinataly infected women that are now pregnant; and surveillance of maternal and neonatal drug toxicity. In such complex scenery, an interdisciplinary approach is mandatory to obtain good results.

On Wednesdays we do an interdisciplinary round which includes all HIV-positive patients admitted to the hospital as either inpatients or outpatients, in order to discuss the best clinical and psychosocial approach for each individual patient. Patients are seen as many times as necessary, there is no limit on the number of appointments granted to each woman.

In the afternoon, I work in Helios Salud, a reference private institution for HIV in Argentina. Helios Salud was conceived to provide a comprehensive approach for people living with HIV: an interdisciplinary view converging medical, nutritional, social and psychological knowledge to provide the best standard of care for HIV-positive patients. Helios Salud, under the medical supervision of the Medical Director, Dr. Isabel Cassetti, is currently following over 2,000 HIV-positive patients in a routine care basis. Most of them attend the clinic monthly.

Helios Salud, in partnership with Fundación Helios Salud, provides treatment, prevention campaigns and medical training in HIV-infection with a national influence. For that reason it has a specialized medical team and different areas of focus -- medical, mental health, nutrition, self-support groups -- to achieve this goal. The system used in this center is unique, as it provides counseling, testing, diagnosis, comprehensive care, treatment and prevention in one place. Strategies to achieve this comprehensive care include: frequent medical follow-up run by infectious diseases specialists; psychological support; social work; support by an adherence team; medication dispensed by a pharmacist; and peer support groups.

My work as part of the medical team is to provide assistance to patients. I also work in the development of medical aspects of an Electronic Medical record tailored to facilitate the follow up of HIV-positive patients and provide statistics on aspects such as opportunistic diseases, cardiovascular events, immune reconstitution system, toxicity of antiretroviral drugs and development of drug resistance, in order to support investigators’ initiative studies.

My routine work is intense to say the least, however my major motivation is to make a difference in people’s lives by providing the best health care possible.