People suffering from HIV related illnesses, may attend a wide variety of services at different levels of the health care system in Tanzania. These services may range between a public or private multipurpose clinic or health centre, home based care program, antenatal clinic or PMTCT program, VCT site, TB or STI clinic, a general OPD unit or an inpatient ward. In order to provide effective and quality HIV/AIDS Care and Treatment, services need to be organized in a manner to ensure regular and standardized follow up. The establishment of a Care and Treatment Clinic (CTC) at health care facilities accredited for the provision of HIV care with HAART, will ensure that over time a cohort of people in need of HIV care can be registered, provided with care and treatment as well as followed up. Close collaboration needs to be ensured for essential related services such as DOTS for TB, reproductive health and family planning and home care services. There are certain core elements of care and treatment that need to be established at the care and treatment clinics. These include:
Basic education regarding the mechanism of HIV infection and disease progression.
Management of disease symptoms
Education about behaviour change to reduce transmission of HIV
Orientation to the care and treatment programme
Education and counselling on life-long disease management
Education and counselling about actions that may delay progression of disease and reduce co-morbidities by addressing nutrition, food safety and clean water
Routine clinical care and nutritional assistance to malnourished patients
Prophylaxis for OIs as indicated by these guidelines. (see chapter 10.3)
Assessing eligibility for ART (clinically and CD4 counts)
Recording and reporting according to the established system
Each of the patients that are seen at the CTC, will fall into one of three clinical categories with specific clinical goals of treatment as outlined below:
(i) Clinically asymptomatic stage (mildly immuno-suppressed): HIV+ individuals, whose CD4 cell counts are high and are asymptomatic, will come to the clinic for periodic monitoring. The goals of care for these patients are to delay progression by treating and/or preventing opportunistic infections and to enhance the likelihood of success of future treatment by improving adherence to medications and visits.
(ii) Symptomatic HIV (moderately immuno-suppressed): HIV+ Individuals who have significantly compromised immune systems but are not eligible for ART. These are at greater risk for progression to AIDS and will need close monitoring. The goals of care for these patients are to delay progression by treating opportunistic infections and to enhance the likelihood of success of future treatment by improving adherence to medications and visits.
AIDS (treatment-ready patients): These are patients who are eligible for ART as detailed in the criteria in later chapters. The goals of treatment and care for these patients are to reduce morbidity and mortality by aggressively suppressing viral load and treating opportunistic infections, and to maximize the benefits of treatment by encouraging consistent adherence to antiretroviral therapy.
Patients in any of the three categories are free to come to the CTC whenever their clinical situations deteriorate.