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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
close this folderCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
View the document2.1 Overview
View the document2.2 Serostatus Determination
View the document2.3 Scope of Care and Treatment
Open this folder and view contents2.4 Care and Treatment for those on Antiretroviral Therapy (ART)
Open this folder and view contents2.5 Linkages
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

2.3 Scope of Care and Treatment

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.

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