Communicable Diseases Part 3
Topic outline
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Introduction to HIV/AIDS
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The HIV epidemic
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HIV and the immune response to infection
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What is HIV?
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The human immune system
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Lymphocytes and the immune response to infection
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Lymph nodes
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How does HIV disable the immune system?
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HIV infects the CD4 lymphocytes
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How does HIV damage our immune system?
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The progression from HIV infection to AIDS
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The natural course of HIV infection
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Clinical staging of HIV disease and AIDS
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Modes of transmission of HIV
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Transmission through sexual relations
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Transmission through blood contact
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Transmission from mother to child
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Myths about HIV transmission
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Opportunistic Infections and WHO HIV Clinical Staging
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What are opportunistic infections?
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Why are opportunistic infections common in PLHIV?
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WHO HIV clinical stages in adults and adolescents
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Common opportunistic clinical manifestations in people with HIV
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Persistent generalised lymphadenopathy (PGL)
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Skin problems
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Mouth, throat and oesophagus problems
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Pulmonary tuberculosis (PTB)
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HIV wasting syndrome
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Opportunistic infections and provider-initiated counselling and testing
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Prevention of opportunistic infections
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Criteria for starting cotrimoxazole prophylaxis by adult PLHIV
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Duration of cotrimoxazole prophylaxis for adult PLHIV
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Side-effects of cotrimoxazole prophylaxis
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Monitoring cotrimoxazole prophylaxis
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Introduction to Antiretroviral Therapy
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The difference between treatment and cure in HIV/AIDS
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The benefits of ART
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Antiretroviral drugs (ARVs) and antiretroviral therapy (ART)
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Groups of ARV drugs
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Why is the combination of three antiretroviral drugs necessary?
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How are antiretroviral drugs combined?
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ARV side-effects and how to manage them
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Adherence to HIV Care and Treatment
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What is adherence?
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What is non-adherence?
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The goal of adherence to ART
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Why is drug resistance important for ART?
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Why do people fail to take ARV drugs correctly?
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What personal, family or community factors influence adherence?
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How can healthcare providers affect patient adherence?
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What other factors negatively affect adherence to ART?
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Encouraging good adherence in patients on ART
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What should you do before a patient starts ART?
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What should you do after a patient starts ART?
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Provider-Initiated HIV Testing and Counselling
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The benefits of HIV testing
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The barriers to HIV testing
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Modes of delivering HIV counselling and testing
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The five steps in PITC
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Step 1:How to recommend HIV testing
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Pre-test information and education on HIV/AIDS
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How to assure confidentiality
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How to obtain informed consent
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Step 3:Obtaining a specimen for HIV testing
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Step 4:How to perform a rapid HIV test
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Performing an HIV test using the KHB rapid test kit
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Performing an HIV test using the STAT-PAK rapid test kit
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Performing an HIV test using the Uni-gold rapid test kit
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Step 5:Delivering an HIV test result, post-test counselling, and referral for treatment
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Delivering the result and post-test counselling when the result is HIV-positive
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Delivering the result and post-test counselling for HIV-negative people
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Prevention of HIV Infection, and Community Mobilisation
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General principles for preventing HIV infection
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Strategies for preventing sexual transmission of HIV
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Strategies to prevent HIV transmission from contaminated blood
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Community mobilisation for HIV prevention
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What is community mobilisation?
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Basic steps for community mobilisation
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Community mobilisation strategies for HIV
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Respecting cultural values in community mobilisation
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Principles of community mobilisation to address HIV/AIDS
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Community mobilisation activities for preventing HIV/AIDS
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Universal Precautions, Infection Prevention and Post-Exposure Prophylaxis for Health Workers
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Universal precautions
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Why are universal precautions needed?
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The safe injection of patients
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Preparing to give an injection
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Avoiding needle-stick injuries
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Recapping used needles
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Post-exposure prophylaxis (PEP)
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Immediate actions after occupational exposure to HIV
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Referral after rape for post-exposure HIV prophylaxis
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Prevention of Mother-to-Child Transmission of HIV
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Transmission of HIV from mother to child
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HIV testing and counselling for PMTCT
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Approaches to HIV testing in antenatal care settings
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Opt-in approach to HIV testing
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Opt-out approach to HIV testing
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Preferred ANC testing approach
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Steps in the HIV testing process
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General considerations
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Single-dose Nevirapine, and other ARV options for PMTCT
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Breastfeeding options for PMTCT
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Four interventions for PMTCT in the community
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HIV in Children
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Critical issues in HIV infection and progression to AIDS in children
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Minimising risk of infection in children
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Early diagnosis of HIV
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Differences in the management of children and adults with HIV
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Providing care for HIV-exposed infants and HIV-infected children
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Nutritional and psychosocial support for children with HIV
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Nutritional needs of HIV-infected children
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Providing psychosocial support to children infected with HIV
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Positive Living and Prevention of HIV Transmission for PLHIV
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What is positive living?
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PLHIV and prevention of HIV transmission
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Re-infection with HIV
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Strategies to minimise HIV transmission
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PLHIV should be informed about their health
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PLHIV should take medication as prescribed
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PLHIV should work as their energy allows, and avoid stress
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PLHIV should maintain good nutrition
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PLHIV should avoid getting infections
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PLHIV should get regular exercise and rest
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PLHIV should seek regular medical care
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Providing Palliative Care for People Living with HIV
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Palliative care and its significance in chronic illness
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Symptom management, including pain management
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Management of pain in PLHIV
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How to manage other common symptoms of HIV/AIDS
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Psychosocial and spiritual support
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Support for the patient
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Support for the caregivers
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Home-based care
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Support for oral hygiene
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Preventing bedsores in bedridden patients
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Moving a bedridden patient
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Hygienic care of the body
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Preventing stiff joints and muscles
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End-of-life care
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Preparing for death
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A checklist for end-of-life care
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Recognising signs of death
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Bereavement counselling
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Prevention and Control of Sexually Transmitted Infections
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Introduction to sexually transmitted infections (STIs)
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Transmission of STIs
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Risk factors for STIs
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Epidemiology of STIs
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Presentation of common STIs
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STIs caused by bacteria
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STIs caused by viruses
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STI caused by a protozoan
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STI caused by a fungus
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Syndromic management of STIs
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Classification of patients into syndromes
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Treatment and management of STI syndromes
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Common complications of STIs
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STIs and HIV
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The link between STIs and HIV/AIDS
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Which STIs facilitate the transmission of HIV?
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Key issues regarding STIs and HIV infection