HIV/AIDS

1. The clinic is supervised every three months by the District Communicable Disease Control Co-ordinator and the Senior Infection Control Nurse of the district hospital.

2. Every three months those clinics performing RPR and Rapid HIV tests have a visit by a laboratory technologist for quality control.

3. At least one professional nurse will attend an HIV/AIDS/STD/TB workshop or other continuing education event on HIV/AIDS each year.

1.1 HIV/AIDS Strategic Plan for South Africa 2000-2005
1.2 Summary results of the last (e.g. 1998) National HIV Serological Survey on women attending public health services in South Africa.
1.3 Management of Occupational Exposure to Human Immunodeficiency Virus (HIV).
1.4 Paediatric HIV/AIDS Guidelines.
1.5 HIV/AIDS Clinical Care Guidelines for Adults. Primary AIDS Care, latest edition.
1.6 Epidemiological Notes - National or Provincial relating to HIV/AIDS.
1.7 Strategies to reduce Mother to Child Transmission of HIV and other infections during Pregnancy and Childbirth.
1.8 HIV/AIDS Guidelines for home based care.
1.9 Policy guidelines and recommendations for feeding of infants of HIV positive mothers.
1.10 AIDS pamphlets in the local language.
1.11 Illustrated booklets e.g. Soul City – AIDS in our community
1.12 Posters on HIV/AIDS/STD in the local languages and preferably depicting local culture settings.

2.1 Remote clinics have laboratory equipment for RPR and Rapid HIV.

3.1 Gloves and protective aprons and goggles
3.2 Condoms - male and dildo (female condoms if policy)
3.3 Post exposure prophylaxis of occupationally acquired HIV exposure e.g. needle stick injuries with HIV positive blood in accordance with the recommendations of the Essential Drug List.

Knowledge and attitudes

4.1 Staff know the contents of the guidelines on Management of Occupational Exposure to Human Immunodeficiency Virus.
4.2 Staff relate to patients in a non-discriminatory and non-judgemental manner and maintain strict confidentiality about patient’s HIV status.
4.3 Staff are familiar with regulations and mechanisms to deal with confidentiality in notifying patients with AIDS disease or AIDS deaths.
4.4 Staff provide warm, compassionate, counselling on a continuous basis and which is sensitive to culture, language and social circumstances of patients.
4.5 Staff are aware of the effects of factors such as unprotected sexual intercourse, multiple sexual partners, poverty, migrant labour, women’s socio-economic conditions, lack of education, the high incidence of STD, lack of recreational facilities, violence and rape, drugs and alcohol, discrimination, lack of relevant knowledge in relation to HIV transmission in the clinics catchment area.
4.6 Staff are aware of the social consequences (orphans, loss of work, family, disruptions, youths schooling and careers) of AIDS.
4.7 Staff seek to reduce fear and stigma of HIV/AIDS.
4.8 Staff provide youth friendly services that help promoting improved health seeking behaviour and adopting safer sex practices

Skills

4.9 Staff are able to

4.9.1 Take a good history including a sexual history, after establishing a trusting relationship.
4.9.2 Undertake a physical examination according to guidelines checklist in good lighting and in privacy.
4.9.3 Do pre and post test counselling after informed consent and take laboratory specimens for HIV (two separate blood specimens), and RPR.
4.9.4 Perform, after training, rapid HIV and RPR tests in those remote clinics where this has been set up.
4.9.5 Continue counselling at suitable times when more time can be allocated.
4.9.6 Promote optimal health and safer sexual practices (wellness management to include mental attitude, nutrition, healthy lifestyle, vitamins, no drugs or alcohol, avoidance of re-infection with HIV and STD by practising safer sex, early treatment if infectious including TB).
4.9.7 Assess the prognosis of HIV to AIDS by recognising and diagnosing the common opportunistic infections.
4.9.8 Diagnose acute pneumonia and start on cotrimoxazole or other antibiotic while arranging referral for admission.
4.9.9 Refer to Tuberculosis and HIV/AIDS clinical guidelines and initiate directly observed tuberculosis treatment after obtaining positive sputum results or send for x-ray when in doubt and also send sputum for culture, while starting INH prophylaxis 300mg daily
4.9.10 Offer periodic check-ups, including weight, to all HIV cases.
4.9.11 Discuss voluntary HIV testing with patients with STD or TB, and get consent forms signed.
4.9.12 Counsel cases of rape and offer HIV test after informed consent and pre- and post test counselling.
4.9.13 Use universal precautions.
4.9.14 Use policy guidelines and recommendations for feeding infants of HIV positive mothers and assess mothers’ circumstances and counsel appropriately and abide with mothers’ rights to choose after informed counselling.
4.9.15 Know all community structures in the clinic catchment area that can assist HIV positive mothers and infants and be able to differentiate between slow and rapid progressors.
4.9.16 Provide education, counselling and supportive care for child and child carer (including treatment of intercurrent illness, advise about feeding, Road to Health chart, immunisation, Vitamin A) and facilitate access to social services.
4.9.17 Collaborates with traditional healers on HIV/AIDS
4.10 All clinic staff (professional and cleaning/laundry) are immunised against Hepatitis B.

5.1 Refer cases of Herpes zoster, oesophageal candidiasis and severe continued diarrhoea (after trial of symptomatic treatment).
5.2 Refer suspected TB cases with negative sputum for further investigation

6.1 All education vigorously addresses ignorance, fear and prejudice regarding patients with HIV/AIDS attending clinics.
6.2 Increase acceptance and use of condoms among the youth and other sexually active populations

7.1 Patient’s records are kept according to protocol with emphasis on confidentiality.

8.1 The clinic has a working relationship with Community Health Committees, political leaders, ward councillors, NGOs and CBOs in the catchment area of the clinic.
8.2 Clinics keep track of HIV positive patients in their catchment areas while keeping information confidential.
8.3 Staff help in meeting needs of the individual and family - preventing problems, assisting in care and knowing when and where to seek assistance.
8.4 Staff inform and train family and community groups in home-based care.
8.5 Staff seek to de-stigmatise HIV disease in community through education.
8.6 Staff assist in integrating home based care services from industry, traditional organisations, church, NGO, welfare, and provide guidelines to community health committees on situation analysis and needs assessment in the community.
8.7 Staff work with traditional healers on improved advocacy of HIV/AIDS and STDs.
8.8 Staff provide simple home kits if possible.
8.9 Staff undertake home visits to supervise care and provide support.

9.1 Staff collaborate with other departments like education and other sectors.
9.2 Staff collaborate with Community Health Committees, political leaders, ward councillors, NGOs and CBOs in the catchment area of the clinic.
9.3 Staff collaborate with traditional healers in the clinic catchment area