Care, Treatment and Support for PLWHAs

Presentation Objectives By the end of this session you should be able to: describe the principles and elements of comprehensive care, treatment and support for PLWHAs; describe the management chronic disease; describe the role of ARVs and related therapies.

Principles of Care, Treatment and Support Prevention strategies must be integrated into care, treatment and support strategies. There should be a comprehensive range of services provided using a multi-disciplinary approach. Care, treatment and support must be provided through all stages of HIV (from infected to terminally ill and bereavement). PLHA must be involved in the design, planning, and implementation of activities. Local partners must be involved to ensure a network for effective care and support. Strategies for care, treatment and support must address stigma, discrimination, and denial.

Elements of Comprehensive Care, Treatment and Support Human Rights and Legal Support Involve PLHA Will-writing Community sensitization Socioeconomic Support Micro-credit Nutritional support Orphan support PEOPLE AND FAMILIES AFFECTED BY HIV and AIDS Medical &Nursing Care OI treatment and ARV Preventive therapy Palliative care Traditional therapy Psychosocial Support VCT Spiritual support Follow-up counseling

Elements of Comprehensive Care, Treatment and Support Providing HIV/AIDS care to people living with HIV and AIDS, and to their families requires a broad range of services that includes not only medical care and pharmaceuticals, but also supportive services to assure adequate nutrition; psychological, social, and daily living support; and prevention messages wherever the opportunity arises. Comprehensive HIV care includes the following components: medical needs, such as treatment information and treatment; psychological needs, such as emotional support; socioeconomic needs, such as welfare provisions, help in the household, and orphan support; human rights and legal needs, including access to care and protection against violence and discrimination.

Continuum of Care The types of services that PLHA need change as their illness progresses. Providing comprehensive care across a continuum—from home and community to institutional services — will ensure that the specific needs of clients and their families are met. A continuum of care is built around a network of resources and services that provide care and support to the ill person and the family caregiver. The goal is an affordable, comprehensive range of services in various settings, including the home, community projects, clinics, and hospitals. Effective referral systems have been developed to ensure that people living with and affected by HIV can benefit from the variety of services at the community and institutional levels throughout the course of infection and disease.

Medical and Nursing Care Counseling and testing for screening and diagnostic purposes Prophylaxis of opportunistic infections Management of HIV-related illnesses, including opportunistic infections TB control STI management Management of HIV disease with HAART Palliative care Access to HIV-related drugs, including drugs for opportunistic infections, antiretrovirals and traditional therapies Interventions to reduce parent-to-child transmission of HIV Clinical HIV/AIDS care for mothers and infants

Care for the Caregivers Caring for anyone with a serious chronic illness is a physical and emotional challenge for even the most dedicated caregivers. This is particularly true for nurses, counselors, volunteers, and caregivers in the home who provide the bulk of care for PLHA. Caregivers also need support to help them do their jobs well, avoid burnout and remain free of infection. Regular social events, better recognition, incentives, peer support, access to post-exposure prophylaxis, and additional training opportunities are some of the ways to address caregivers’ support needs.

Management of a Chronic Disease Chronic disease management is essential, especially once life-prolonging treatment for HIV/AIDS is available, creating a demand for long-term care. Principles of chronic disease management for HIV/AIDS care are as follows: the patient and health providers work as a team to foster the patient’s self-management skills, the health care provider’s application of technical knowledge and skills, and assistance from social services. This demands a steady relationship between patient and heath care team members.

Management of a Chronic Disease Continuing care involves regularly scheduled visits with clinical and support staff, on a predetermined schedule, to: monitor disease status and treatment effect, including labs; provide ready response to emerging health and socioeconomic issues; while at the same time maintaining up-to-date, easily retrievable documentation. Support for care team members is essential to provide quality of care and avoid frustration and burnout. Currently, available treatment is life-long. It is to be expected that motivation to maintain wellness and adhere to treatment will fluctuate during the course of the disease. Prevention must be part of care and treatment.

Antiretroviral Therapy ARV’s are not appropriate for everyone with HIV infection. They can help those who have moderate or severe symptoms of HIV infection or AIDS. ARV drugs inhibit important enzymes that are needed for HIV to replicate or multiply. ARV’s are not a cure for HIV infection.

Antiretroviral Therapy ARV’s can: restore immune function or slow the decline of immune function; prolong life and improve the quality of life; improve symptoms of HIV infection; decrease risk of illness and hospitalization; improve health and strength.

Antiretroviral Therapy They may need to be taken for the remainder of a person’s life. At least 3 drugs must be taken together to be effective. Most of the regimens have complicated schedules. Some side effects may impair the quality of life. If resistance develops the drugs no longer work effectively.

Antiretroviral Therapy ARV’s may be used to prevent HIV infection in PMTCT and after exposure to needle injuries or rape, also called Post Exposure Prophylaxsis (PEP). Neverapine given to the mother at the beginning of labour and given to the infant by 3 days of age reduces the risk of HIV transmission by nearly half. ARV’s may also prevent HIV infection after rape if given within 72 hours.

Special Issues in Managing Women and Children with HIV HIV presentation is the same in both sexes, but the disease has greater implications on a woman’s reproductive health her ability to cope with pregnancy and the possibility of transmission of the virus to her unborn and newborn child. During the asymptomatic phase of HIV, most women are unaware of their infection until the disease is diagnosed in their infants. This may cause conflict within the family; relatives think she brought in the infection. Special issues in managing women with HIV include: pregnancy and delivery; reproductive and gynecological problems including STDs; breastfeeding.

Special Issues in Managing Women and Children with HIV HIV may be transmitted to the infant during pregnancy, at the time of delivery, and through breast feeding; most transmission is thought to take place during delivery. For a mother known to be HIV-infected pre-natally, the additional risk of transmitting HIV to her infant through breast feeding has been estimated at 14 percent. For mothers who acquire HIV post-natally, the risk is as high as 29 percent. Many studies indicate that the risk of breast milk transmission is higher in the first few month of life, with a subsequent tapering off of risk.

Special Issues in Managing Women and Children with HIV However, the risk persists as long as the infant is breast fed. HIV transmission is also higher if the mother has mastitis. Current WHO/UNAIDS/UNICEF guidelines recommend that women with HIV infection be fully informed of both risks and benefits of breast feeding and be supported in their decision about feeding practices. Taking all factors into account, it is important to promote and support exclusive breast feeding for the first six months of life because the serostatus of most mothers is unknown and the benefits to infants outweigh the risks, regardless of the mother’s HIV status.

Special Issues in Managing Women and Children with HIV One of the biggest challenges is to identify HIV infected children early and give them proper care and support to them and their families. Seventy five percent of children living with HIV/AIDS present with symptoms in the first or second year of life. Between 40- 80 percent of HIV-infected children die before two years of age. Most children living with HIV/AIDS die of common childhood illnesses rather than AIDS.