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HIV & ADHERENCE

HIV & ADHERENCE. Mr. A. Ndlovukazi (ART Nurse – Good Shepherd Mission Hospital) 21/11/11. Objectives. To be able to: Differentiate between ARVs and HAART List primary goals HAART Explain how HAART works Identify and manage minor side effects at home Explain the importance of adherence.

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HIV & ADHERENCE

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  1. HIV & ADHERENCE Mr. A. Ndlovukazi (ART Nurse – Good Shepherd Mission Hospital) 21/11/11

  2. Objectives To be able to: • Differentiate between ARVs and HAART • List primary goals HAART • Explain how HAART works • Identify and manage minor side effects at home • Explain the importance of adherence

  3. Let us recap on life cycle of HIV...

  4. HAART • Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. • When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Anti-Retroviral Therapy (HAART).

  5. GOALS The primary goal of HAART is to Decrease HIV-related morbidity and mortality and thereby; a) the patient should experience fewer HIV-related illnesses with an improvement in quality of life. b) restore the patient’s immune function as indicated by a rise in CD4+ count c) reduce viral load to undetectable levels (<400 copies/ml) and remain undetectable on HAART for as long as possible – only available for selected patients in Swaziland

  6. How do ARVs work? • ARV drugs are of different classes and they work in different stages of the HIV life cycle, thus preventing the virus from replicating itself and maturing which then leads to decrease in the amount of the virus in the body – viral load. • The body will continue making up its own antibodies including the CD4, thus the immunity is strengthened, i.e. CD4 count will increase and the body will be able to fight infections.

  7. MOST IMPORTANT!!! ARVs: • do not make antibodies (CD4) • do not cure the HI Virus • do nottreat other opportunistic infections. • do not prevent HIV transmission from one person to another • HAART is a lifelong treatment or until cure is discovered.

  8. How are they taken? • Combination of at least 3 drugs (TRIPLE THERAPY) must be given. (mono-therapy or dual-therapy are not acceptable). • Mostly taken twice a day, same time everyday (e.g. 7am, 7pm) • Some may be taken once a day.

  9. Requirement for starting HAART. • Documented HIV positive test result • Medical eligibility (i.e. clinical staging) and/or immunological eligibility (CD4) – to be determined by a trained nurse or medical officer. • Any opportunistic infection has been treated or stabilized, particularly TB • Patient is ready for ARV Therapy • Supportive clinical team prepared for chronic care

  10. Readiness for ART… • Acceptance of HIV status. • Knowledge of how HIV affects the body and the understanding the role of ARVs. • Demonstrate good adherence and compliance prior to ART initiation e.g. keeping appointment dates, co-trimoxazole prophylaxis, etc • Prepared to take treatment for life. • Social support structures and disclosure may also be considered.

  11. ART ELIGIBILITY CRITERIA CD4+ count <350cells/ml irrespective of WHO clinical stage i.e. whether sick or not. OR WHO clinical stage III and IV disease irrespective of Cd4+ count. OR Co-infection: HIV/TB and HIV/HBV AND Patient expresses willingness and readiness to take ART adherently.

  12. Side Effects Definition: • Usually bad unintended results of medicine in the body. It may be minor to life threatening. • They can be managed at home if minor or at clinic/hospital if worse

  13. Adherence Definition: • the act of continuing to obey a rule, law, agreement etc. - acceptance of an active role in one’s own health care

  14. Why Adherence? • Cornerstone for successful HIV therapy • It is also a major contributor of treatment failure

  15. Important aspects of Adherence • Time • Choose your time well • Have reliable reminders (e.g. Alarm clock, cell phone) • Treatment supporter • Encouraging, reminding • Early treatment of illnesses • Safe sex • Prevents infecting partner/re-infecting self

  16. Of importance... • Family planning – to prevent unplanned pregnancies • Regular exercise and enough rest – to stay healthy • Balanced diet – for strong immunity • Be relaxed & cheerful • Avoid alcohol & drugs • Avoid traditional medicines and over-the-counter drugs • Always carry your medication wherever you go • When sick, notify your Doctor/Nurse of your status and the treatment you are taking

  17. Questions?

  18. Thank you! Ngiyabonga!

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