Certification Programs

Applying South African National Guidelines on Antiretroviral Therapy

1-1 The Initial Assessment of the HIV-Infected Patient

  • Authors: Ashraf Grimwood, MBChB, MPH; Joel E. Gallant, MD, MPH

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: Although HIV prevalence has stabilised at approximately 12% in South Africa,&nbs... (more)

    Abstract: Although HIV prevalence has stabilised at approximately 12% in South Africa, the absolute number of persons living with HIV/AIDS continues to increase by approximately 100,000 each year, presenting healthcare providers with ongoing challenges in implementing universal HIV testing and linking infected patients to appropriate care and support systems. In this chapter, Ashraf Grimwood, MBChB, MPH, and Joel E. Gallant, MD, MPH, review key issues related to HIV testing and diagnosis, the initial clinical and laboratory evaluation of HIV-infected patients, prophylaxis for opportunistic infections, vaccinations, record keeping and patient follow-up, and referral for specialised care with an emphasis on national and international guideline recommendations. (less)

1-2 The South African Antiretroviral Armamentarium

  • Authors: Ian M. Sanne, MBBCH, FCP(SA); Brian Gazzard, MA, MD, FRCP

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: In the course of the 30 years since the identification of HIV infection, more th... (more)

    Abstract: In the course of the 30 years since the identification of HIV infection, more than 20 HIV-targeted drugs have been developed that are effective in reducing viral load and improving CD4+ cell count and clinical outcomes in persons infected with HIV. It is critical that healthcare providers treating patients with HIV infection have a thorough understanding of these agents and knowledge of national guideline recommendations on how and when they should be used. This chapter will provide a comprehensive overview of the various classes of antiretroviral drugs used for the treatment of HIV as well as detailed descriptions of individual agents, including recommendations for their usage in South Africa, key adverse events and monitoring guidelines, and important drug–drug interactions and resistance mutations associated with each agent. Drugs that may be available to South African healthcare providers in the near future are also reviewed. (less)

1-3 Starting Adult Patients on Antiretroviral Therapy in South Africa

  • Authors: David Spencer, MD; Joel E. Gallant, MD, MPH

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: September 12, 2017

  • Abstract:

    The overriding concept in starting antiretroviral therapy is that patients must ...

    (more)

    Abstract:

    The overriding concept in starting antiretroviral therapy is that patients must be ready, willing, and committed to embark upon a lifetime of regular medication. The critical “start date,” once it is chosen, becomes central to the patient’s antiretroviral therapy programme. This chapter, authored by David Spencer, MD, and Joel E. Gallant, MD, MPH, addresses the choice of the start date, the preparation of the patient before this date, and monitoring of the patient in the initial 6 months of the antiretroviral therapy programme.

    (less)

1-4 Laboratory Assays in the Management of Antiretroviral Therapy

  • Author: Ian M. Sanne, MBBCH, FCP(SA); Lesley Erica Scott, BSc Hons, MSc, PhD; Wendy Susan Stevens, MD

    Editor in Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract:

    For persons living with HIV, the repertoire of tests employed for disease diagno...

    (more)

    Abstract:

    For persons living with HIV, the repertoire of tests employed for disease diagnosis and monitoring depends on the age group of the individual (adult, adolescent, child, or infant), sex, whether pregnant or not, the presence of concomitant tuberculosis or hepatitis B and the type of facility at which the individual receives healthcare. The literature on evidence-based diagnostics in the HIV treatment setting is poor, with few randomised clinical trials contributing to available data and guiding recommendations on optimal monitoring practices.

    Prevailing treatment guidelines in South Africa dictate the test repertoire for each patient. These include various assays conducted at different time points in treatment or initiating treatment for the first time, comprising but not restricted to the following: HIV diagnostic tests, CD4+ cell count, chemistry assays (toxicity testing), haematology (full blood count or haemoglobin), HIV viral load testing, and where possible, HIV drug genotypic resistance testing. In addition, other screening tests may be incorporated including for tuberculosis, cryptococcal meningitis, syphilis, and/or hepatitis B. The repertoire of recommended tests may change based on availability of testing platforms, skill of staff, introduction of new tests, changes in treatment guidelines, and affordability.

    In this chapter, Ian M. Sanne, MBBCH, FCP(SA); Lesley Erica Scott, BSc Hons, MSc, PhD; and Wendy Susan Stevens, MBBch, MMed (Haem), FCPath (Haem), outline the repertoire of laboratory tests that are recommended in South Africa and describe the National Health Laboratory Services that provide standardised service to the healthcare sites across South Africa.

    (less)

1-5 Treatment Failure, HIV Resistance, and Later Regimens

  • Authors: David Spencer, MD; Mark Nelson, MA, MBBS, FRCP

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: Antiretroviral resistance and suboptimal adherence to antiretroviral therapy (AR... (more)

    Abstract: Antiretroviral resistance and suboptimal adherence to antiretroviral therapy (ART) contribute to ART failure. Best outcomes are achieved when resistance is diagnosed as soon as possible, the response to resistance is swift, and adequate time and resources are devoted to issues of adherence. Levels of primary antiretroviral resistance vary in Africa, and the proportion of those who have any resistance mutation has risen during the past decade. Available data suggest that approximately 80% of patients in sub-Saharan Africa remain on first-line ART after 1 year, with ART failure occurring in a relatively small percentage and loss to care accounting for the majority of the attrition. Second-line ART fails in as many as 25% of patients, with most failures occurring within 6 months. Adherence has been shown to be the key to effective ART. Patients who have undergone adherence counselling after virologic failure have been able to regain virologic suppression using the same “failing” regimen in 40% to 50% of cases of first-line failure and in three quarters of those experiencing second-line failure. Resistance and adherence lie at the heart of the success of our response to this epidemic. (less)

1-6 Long-term Complications of HIV and ART

  • Authors: Sipho Dlamini, MBChB, FCP(SA), Cert ID(SA); Eefje Jong, MD, PhD

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: As survival improves with effective antiretroviral therapy (ART), healthcare wor... (more)

    Abstract: As survival improves with effective antiretroviral therapy (ART), healthcare workers and people living with HIV (PLHIV) will increasingly be confronted with long-term complications of HIV disease and ART. These complications include metabolic derangements such as lipodystrophy, dyslipidaemia, obesity, and diabetes; hypertension and other cardiovascular diseases; non-AIDS–related cancers; renal dysfunction; and chronic lung diseases. Factors implicated in the pathogenesis of long-term complications areresidual immune dysfunction associated with HIV infection, persistent viral coinfections, ART adverse effects, and comorbidities that accelerate these complications. As programmes for care and treatment for PLHIV expand, primary care physicians need to be aware of these noncommunicable diseases and integrate screening and therapy into general HIV management. (less)

1-7 Antiretroviral Treatment of HIV-Positive Women of Childbearing Potential

  • Authors: Louise Kuhn, PhD

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract:

    The HIV epidemic in South Africa remains the largest in the world, with an estim...

    (more)

    Abstract:

    The HIV epidemic in South Africa remains the largest in the world, with an estimated 6.8 million South Africans living with HIV in 2014; among these are 3 million women at least 15 years of age. Sex disparity in HIV infection is pronounced in young adults 15-24 years of age with prevalence in young women being more than 3 times that of men in the same age group.



    In 2010, 30.2% of South African women accessing antenatal care were HIV positive. Programmes to prevent mother-to-child HIV transmission in South Africa have the capacity to dramatically decrease rates of vertical transmission of HIV infection. In 2013, the South African guidelines were updated to recommend that all pregnant or breast-feeding women should receive antiretroviral therapy, which is anticipated to further reduce rates of vertical transmission. In addition, continued testing of HIV-uninfected pregnant women during their pregnancies may uncover new infections with high risk of vertical transmission. An important addition to the PMTCT program is testing at birth and early initiation of ART for HIV-exposed infants who test positive. This will be detailed in a later section.



    Clinicians should remain current with new recommendations to provide best care of their patients.

    (less)

1-8 Antiretroviral Treatment of HIV-Positive Children

  • Authors: Louise Kuhn, PhD

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract:

    Despite advances in the prevention of mother-to-child transmission (PMTCT) of HI...

    (more)

    Abstract:

    Despite advances in the prevention of mother-to-child transmission (PMTCT) of HIV in South Africa since the early years of the epidemic, approximately 10,000 new cases of paediatric HIV infection still occur every year. The greatest risk factor for MTCT is lack or late start of antiretroviral therapy with most transmissions occurring in utero, during labour, or through postpartum breast-feeding. Currently, an estimated 3% of HIV-exposed infants are HIV positive 6 weeks after birth. Paediatric HIV care includes not only PMTCT but also addressing the special needs of both newly HIV-infected infants and young children and continuing to care for older children who were born before the availability of effective PMTCT. Although providing effective antiretroviral therapy for pregnant women contributes significantly to reducing transmission rates, the use of prophylactic nevirapine and zidovudine to the infant also continues to play an important part in prevention. Both the World Health Organisation and the South Africa National Department of Health have included in their treatment guidelines recommendations regarding HIV testing in infants and children, the initiation of antiretroviral therapy (including special liquid and other formulations of antiretroviral agents), childhood immunisations, and the appropriate screening and management of opportunistic infections and other conditions that commonly occur in HIV-infected infants and children. The greatest challenges to managing paediatric HIV disease include: low access to care, family-related issues, limited antiretroviral therapy selection, nevirapine resistance, developmental problems, and adherence barriers.

    (less)

1-9 Antiretroviral Management in Primary Care: The Evolving Roles of Nurses and Doctors

  • Authors: Nathan Ford, PhD, FRCP; Victor Fredlund, MB BS (LOND); Dirk Hagemeister, BA, DipHIVMan, MPH, EMMB, FAfAllgMed Dr.med.

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: The combined HIV/AIDS and tuberculosis epidemics have placed a substantial strai... (more)

    Abstract: The combined HIV/AIDS and tuberculosis epidemics have placed a substantial strain on the South African healthcare system, with massive shortfalls in the human resources required to effectively treat and manage these diseases. A critical feature of South Africa’s response to this healthcare crisis has been to expand nonspecialist and community involvement in planning and delivering antiretroviral therapy by decentralising routine HIV care to local primary-care clinics and by task shifting routine antiretroviral therapy initiation and management to professional nurses. As a result of these changes, the role of the physician in HIV management is evolving, particularly as it becomes a chronic, manageable disease in patients who are treated promptly. This chapter will review challenges associated with universal antiretroviral therapy access, models of HIV care in South Africa and other resource-limited settings, the process of decentralising HIV care to local community-based primary-care facilities, nurse initiation and management of antiretroviral therapy, and the role of physicians in the era of nurse-initiated and managed antiretroviral therapy. (less)

1-10 Management of the HIV-Infected Patient With Advanced Disease

  • Authors: Eefje Jong, MD, PhD; Henry Sunpath, MBBS, MFamMed, DipHIVMan, MPH

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: September 10, 2017

  • Abstract: Although many HIV-infected South African patients can initiate and continue anti... (more)

    Abstract: Although many HIV-infected South African patients can initiate and continue antiretroviral therapy (ART) at primary care–level facilities in their home communities, a significant number of patients require up-referral to district-level or other healthcare facilities due to a variety of circumstances. Reasons that patients may require up-referral include late presentation to HIV care, complex or challenging opportunistic infections or other serious disease, virologic failure, patterns of erratic adherence to ART, comorbid conditions (eg, kidney or liver disease), issues surrounding immune reconstitution inflammatory syndrome, or serious adverse effects due to ART or treatment for other conditions. Primary care facilities often are not capable of managing patients experiencing any of these conditions, and primary care staff must be familiar with both the array of circumstances that may be cause for referral and the appropriate procedures to be followed to ensure that referred patients access the secondary- or tertiary-level care to which they are referred. Moreover, healthcare practitioners at all levels need to be familiar with the procedures required when patients have completed care for a complex condition and are subsequently down-referred to primary care facilities for follow-up care, continuing management of ART, or other reasons. (less)

Management of TB in HIV-Coinfected Patients

2-1 Overview of Tuberculosis and Synergies With HIV Infection

  • Authors: Gavin J. Churchyard, MBBCh, MMed, FCP, PhD; Christopher J. Hoffmann, MD, MPH, MS

    Editor In Chief: Richard E. Chaisson, MD

  • Last Reviewed: July 8, 2016

  • Abstract: In southern Africa, especially South Africa, the HIV and tuberculosis (TB) epide... (more)

    Abstract: In southern Africa, especially South Africa, the HIV and tuberculosis (TB) epidemics are meshed tightly together, with the TB epidemic threatening the progress that has been made in expanding HIV care. In southern Africa, TB disease is the leading cause of death for persons living with HIV. Controlling the TB epidemic will require practitioners to develop improved skills in suspecting, diagnosing, and treating TB in HIV-infected individuals and improvements in the health system to engage and retain individuals with HIV or TB in care. In persons living with HIV, TB infection can present atypically—eg, absence of usual symptoms like cough, fever, night sweats, and weight loss, lack of cavitation or typical radiographic findings, extrapulmonary disease—and can progress rapidly, frequently resulting in death. Successful control of the TB epidemic must provide integrated diagnosis, treatment, and prevention, involving social support and case management in addition to expert clinical care. Housing, work conditions, and economic issues also play critical roles in both continuing and controlling the linked epidemics. The successful mid-20th–century efforts to roll back the TB epidemics in the United States and Europe can provide vital lessons for southern Africa. Such enhanced efforts can enable South Africa to meet the goals of its strategic plan on HIV, sexually transmitted infections, and TB. (less)

2-2 Preventing Tuberculosis in Persons Living With HIV

  • Authors: Neal Martinson, MBBCh, DCH, MFGP, MPH; Martie van der Walt, PhD, MBA

    Editor In Chief: Richard E. Chaisson, MD

  • Last Reviewed: July 8, 2016

  • Abstract:

    Tuberculosis prevention is a national strategic initiative in South Africa and i...

    (more)

    Abstract:

    Tuberculosis prevention is a national strategic initiative in South Africa and is especially critical given the high prevalence among HIV-infected individuals. In this module, Neil Martinson, MBBCh, DCH, MFGP, MPH; and Martie van der Walt, PhD, MBA, provide a practical update for physicians on prevention of tuberculosis in persons living with HIV. Identifying and treating both active and latent tuberculosis as promptly as possible prevents tuberculosis transmission in high-priority target populations such as HIV-infected patients. Understanding the “Three I’s” for tuberculosis prevention, which include intensified and active tuberculosis case-finding paired with high-quality antituberculosis treatment, isoniazid preventive therapy, and infection control in healthcare facilities and congregate settings, is essential to further this goal. Since the introduction of the Three I’s, a number of authorities have emphasized the fourth ‘I’: initiation of antiretroviral therapy. This module explains the rationale for various case-finding approaches, preventive therapy with isoniazid, and the role of antiretroviral therapy in prevention, as well as key issues for transmission control in South Africa—occupational, behavioural, social, and structural interventions—through examining elements of the South Africa National Strategic Plan.

    (less)

2-3 Diagnosing Tuberculosis in Persons Living With HIV in South Africa

  • Authors: Colleen Hanrahan, PhD; Mark Nicol, MD; Wendy Susan Stevens, MD

    Editor in Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract:

    South Africa is one of the top 10 countries worldwide in tuberculosis (TB) incid...

    (more)

    Abstract:

    South Africa is one of the top 10 countries worldwide in tuberculosis (TB) incidence.[ref: WHO Global TB 2015] Complicating this pandemic is the emergence of drug-resistant Mycobacterium tuberculosis strains and the high HIV/TB coinfection rate among South African patients. After discussing the clinical presentation of TB among HIV-infected patients and the challenges associated with the diagnosis of TB in sub-Saharan Africa, the authors explore the current diagnostic tools for TB (including smear microscopy, culture, nucleic acid amplification technology, and phenotypic and genotypic drug susceptibility testing). Also reviewed is the TB diagnostic algorithm applied in South Africa and the diagnostic process for treatment monitoring.

    (less)

2-4 Treatment of Tuberculosis in HIV-Infected Adults

  • Authors: Jean B. Nachega, MD, PhD, MPH, DTM&H

    Editors In Chief: Richard E. Chaisson, MD; Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: Many individuals in South Africa are living with both tuberculosis and HIV. The ... (more)

    Abstract: Many individuals in South Africa are living with both tuberculosis and HIV. The concomitant treatment of these 2 conditions poses specific clinical challenges. In this chapter, Jean B. Nachega, MD, PhD, MPH, DTM&H, provides clinicians with a practical update on tuberculosis treatment in HIV-infected adults. Diagnosis, prevention, treatment, and management of adverse effects are also addressed. (less)

2-5 Treatment of Multidrug-Resistant Tuberculosis and Extensively Drug–Resistant Tuberculosis

  • Authors: Francesca Conradie, MBBCh; Richard E. Chaisson, MD

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: The emergence of multidrug-resistant tuberculosis (MDR-TB) has occurred largely ... (more)

    Abstract: The emergence of multidrug-resistant tuberculosis (MDR-TB) has occurred largely through human error in disease diagnosis and management and in patient adherence to prescribed treatments. Standardised short-course therapy is not sufficient to manage MDR-TB, and there has been an increase in prevalence of number of mutations that confer resistance to other drugs in that regimen. Culture-based drug susceptibility testing of patient specimens has been the gold standard of diagnosing MDR-TB, but several molecular-diagnosis assays that can make accurate, rapid diagnoses have become available in recent years. In addition to the drugs in the short-course regimen, other antituberculosis agents include aminoglycosides, polypeptides, fluoroquinolones, thioamides, salicylates, and terizidone. Several new classes of antituberculosis agents with novel mechanisms of action may soon be available in South Africa. The South African Department of Health has published a detailed set of guidelines for the diagnosis and treatment of MDR-TB, case findings, and management of adverse effects. These guidelines include not only the clinical management of the disease, but also the organisation and management of the public health efforts that must be practiced to control the epidemic. Novel agents and regimens that are currently in clinical trials will lead to future treatments that are shorter and that do not include injectable drugs. (less)

Nursing Care of HIV-Infected Patients

3-1 Basics of HIV Disease

  • Author: Talitha Crowley, MCur, PGDip Primary Health Care, PGDip Nursing Ed, BCur

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: HIV primarily infects CD4+ cells of the human immune system, eventually causing ... (more)

    Abstract: HIV primarily infects CD4+ cells of the human immune system, eventually causing deterioration of the immune system and susceptibility to a range of opportunistic infections, neoplasms, and other disorders. Clinicians with a basic understanding of why HIV presents such great challenges may be better prepared to educate people living with HIV about the disease. Understanding the pathogenesis and epidemiology of HIV can provide clinicians and their patients with tools to encourage active participation in screening, prevention, and treatment of this disease. HIV is transmitted primarily through exchange of blood and/or genital fluids and to newborn infants from HIV-infected mothers in utero or during breast-feeding. After transmission, HIV undergoes various stages of infection including an acute phase with the potential for influenzalike symptoms and high infectivity, seroconversion after which detection and diagnosis is more likely, and asymptomatic chronic HIV. An HIV-infected person’s innate immune responses can control the virus for many years in the asymptomatic state, although it does gradual damage to the immune system. However, patients will eventually progress to symptomatic HIV/AIDS. Currently, a range of different types of medications are available that can disrupt HIV replication at various points in its life cycle, leading to improved clinical outcomes and reduced mortality. Understanding the barriers to diagnosis and patient care as well as the potential targets for optimal treatment selection may lead to a more comprehensive treatment plan for patients infected with HIV. (less)

3-2 Integrating HIV Care Within Primary Healthcare Services

  • Authors: Elizabeth Mokoka, RN, PhD; Debra M. Winters, APRN-BC, AACRN

    Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract:

    This chapter outlines services that are normally provided in primary healthcare ...

    (more)

    Abstract:

    This chapter outlines services that are normally provided in primary healthcare facilities and how HIV care can be integrated into each of the services as a way to increase care and treatment and improve healthcare delivery through a unified approach. Together, HIV and tuberculosis disease contribute significantly to the burden of disease faced by South Africans. Therefore, the South African government has undertaken an extensive effort to address HIV and tuberculosis in an integrated manner. The importance of integrating counselling and testing (both provider- and patient-initiated) is also highlighted. Key to successful integration is the introduction of task sharing, training, mentoring, patient-centred care, and community involvement and support. A well-organised service will ensure seamless patient flow with strict infection control measures, sound data management principles, and monitoring and evaluation.

    (less)

3-3 Essentials of Nursing Management in Facilities With ART Services

  • Authors: Winnifred Moleko, MED (PHC), PDM (HIV), AHM; Sheena Jacob, MSN, MPH

    Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA); Stacie Stender, MSN, MSc ID, FNP

  • Last Reviewed: July 8, 2016

  • Abstract:

    HIV care in South Africa is provided across multiple levels and various types of...

    (more)

    Abstract:

    HIV care in South Africa is provided across multiple levels and various types of facilities. The South Africa National Department of Health has developed National Core Standards for Health Establishments to guide healthcare systems in providing effective healthcare delivery in South Africa, including for HIV and related services. The National Core Standards also provide national benchmarks of quality to assist  healthcare providers and facility managers identify gaps and improve HIV programmes at healthcare facilities. Across all levels of care, nurses are fundamental in provision of services to HIV-infected individuals.

    (less)

3-4 Nursing Care of Children Exposed to or Infected With HIV: Focus on Antiretroviral Therapy

  • Authors: Talitha Crowley, MCur, PGDip Primary Health Care, PGDip Nursing Ed, BCur; Susan Strasser, MPH, MSN, PhD

    Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA); Stacie Stender, MSN, MSc ID, FNP

  • Last Reviewed: July 8, 2016

  • Abstract:

    Adequate support for HIV-exposed children and early initiation of antiretroviral...

    (more)

    Abstract:

    Adequate support for HIV-exposed children and early initiation of antiretroviral therapy (ART) in HIV-infected children are essential to decrease child mortality in South Africa. Nurses play a key role both in identifying children who need treatment and in managing those children on lifesaving ART. This chapter discusses antiretroviral prophylaxis, criteria for initiating ART in children, guidelines for administering ART regimens, psychosocial support, appropriate follow-up care, and referrals of complicated cases.

    (less)

3-5 Nursing Care of Antiretroviral Therapy in Women of Childbearing Potential

  • Authors: Talitha Crowley, MCur, PGDip Primary Health Care, PGDip Nursing Ed, BCur

    Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA); Stacie Stender, MSN, MSc ID, FNP

  • Last Reviewed: July 8, 2016

  • Abstract: Preventing mother-to-child transmission of HIV is a national health imperative i... (more)

    Abstract: Preventing mother-to-child transmission of HIV is a national health imperative in South Africa. In this chapter Talitha Crowley, MCur, PGD Primary Health Care, PGD Nursing Ed, and Suzanne Jed, MSN, FNP-BC, discuss prevention of mother-to-child transmission of HIV and management of antiretroviral therapy during pregnancy, delivery, and postpartum. The chapter covers diagnosis, prevention, and treatment of mothers and infants infected with or exposed to HIV, as well as information on infant feeding. (less)

3-6 Initiation and Follow-up of Adults Receiving ART

  • Authors: Suzanne Jed, MSN, FNP-BC; Talitha Crowley, MCur, PGDip Primary Health Care, PGDip Nursing Ed, BCur

    Editor In Chief: Stacie Stender, MSN, MSc ID, FNP

  • Last Reviewed: September 10, 2017

  • Abstract: Nurses in primary HIV care in South Africa play a crucial role in identifying pa... (more)

    Abstract: Nurses in primary HIV care in South Africa play a crucial role in identifying patients eligible for antiretroviral therapy (ART), initiating therapy, and managing patients on ART. In this chapter, Suzanne Jed, MSN, FNP-BC, and Talitha Crowley, MCur, PGD Primary Health Care, PGD Nursing Ed, provide an update on current ART management guidelines for nurses. The chapter covers initiation, follow-up, patient readiness and adherence, management of adverse effects, and special situations. (less)

3-7 Adherence and Retention in HIV Care

  • Authors: Catherine Orrell, MBChB, MSc, MMed (Clin Pharmacol); Carmen J. Portillo, RN, PhD, FAAN

    Editor In Chief: Stacie Stender, MSN, MSc ID, FNP

  • Last Reviewed: July 8, 2016

  • Abstract: Linkage to and adherence in care are essential components of successful HIV trea... (more)

    Abstract: Linkage to and adherence in care are essential components of successful HIV treatment. In this module, Catherine Orrell, MBChB, MSc, MMED (Clin Pharmacol), and Carmen J. Portillo, RN, PhD, FAAN, review common barriers to suboptimal adherence and provide proven approaches to monitor adherence to avoid HIV resistance and strategies to optimize treatment, from entry into care through retention in care for the long term. (less)

3-8 Identifying and Managing Adverse Effects of Antiretroviral Drugs

  • Authors: Jantjie Taljaard, MD, DTM&H; Julia Bereda-Thakhathi, MACUR, PHC Specialist

    Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA); Stacie Stender, MSN, MSc ID, FNP

  • Last Reviewed: July 8, 2016

  • Abstract: Antiretroviral therapy may cause adverse effects that require prompt diagnosis a... (more)

    Abstract: Antiretroviral therapy may cause adverse effects that require prompt diagnosis and appropriate management by healthcare providers. Nurses must be able to anticipate and prevent adverse effects when possible, reassure patients that certain adverse effects will wane over time, manage minor adverse effects, and refer patients for more serious adverse effects, when necessary. In this chapter, Jantjie Taljaard, MD, DTM&H, discusses for the nursing audience the risk factors for adverse effects in patients beginning antiretroviral therapy, how to prepare patients for the adverse effects they may experience on antiretroviral therapy, and how to manage these adverse effects or refer cases, when necessary. (less)

3-9 Palliative Care

  • Authors: Julia Downing, PhD, RGN; Liz Gwyther, MB ChB, FCFP, MSc Pall Med

    Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA); Stacie Stender, MSN, MSc ID, FNP

  • Last Reviewed: July 8, 2016

  • Abstract: Palliative care involves the provision of measures to alleviate suffering and im... (more)

    Abstract: Palliative care involves the provision of measures to alleviate suffering and improve quality of life for individuals who have chronic or progressive, life-threatening diseases. Although palliative care includes compassionate end-of-life care for patients with terminal illness, it is not limited to the end stages of life and should be provided across the full continuum of care of the illness. For example, in the setting of HIV infection, support of antiretroviral therapy and treatment for opportunistic infections constitute critical components of palliative care. When resources are available, optimal delivery of palliative care should be within the context of a multidisciplinary team that includes many different types of healthcare and service providers. However, nurses generally make up the core of this team and play a particularly vital role in resource-limited settings. This chapter reviews critical strategies and skills that nurses need to provide the best palliative care possible within their treatment settings. Key topics addressed include: a comprehensive description of the goals and elements of palliative care; the essential role of nurses in provision of palliative care; the impact of illness on suffering; effective and respectful communication skills; caregiver attitude; pain assessment and management; symptom management; specific features of palliative care for children; helping the bereaved cope with grief and loss; ethical issues in palliative care; and how palliative care service delivery is relevant to caregivers of people living with HIV. (less)

3-10 Nursing Diagnosis and Management of Tuberculosis in HIV-Infected Patients

  • Authors: Dr. Kerrigan McCarthy; Stacie Stender, MSN, MSc ID, FNP

    Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA)

  • Last Reviewed: July 8, 2016

  • Abstract: Tuberculosis is endemic among South Africans and in particular among those with ... (more)

    Abstract: Tuberculosis is endemic among South Africans and in particular among those with HIV infection. In this module, Kerrigan McCarthy and Stacie Stender, MSN, MSc ID, FNP, provide a practical update on tuberculosis prevention and treatment for nurses. The chapter covers diagnosis, prevention, treatment, and management of adverse effects. (less)