A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

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A Guide to Primary Care of People with HIV/AIDS Chapter 2: Approach to the Patient 2 • Inform patients whose positive HIV or AIDS status must be reported to the State health department, tell them if partner notification is required, and explain what they should expect regarding efforts that must be made by the patient, provider, or health department to notify sex partners or individuals who may have been exposed to HIV through their needle sharing. Assure them that the patient’s name is always kept confidential, and is never given to potentially exposed individuals by the Health Department. • Carefully assess patients’ risk-taking behaviors, educate them regarding HIV transmission, and perform STD screening (see question on STD screening in this chapter). • Provide counseling to encourage safer sexual practices (see section on Risk Assessment and Counseling below) and make referrals to drug rehabilitation or needle exchange centers (see Chapter 13: Management of Substance Abuse). The recently released Federal guidelines on prevention for persons living with HIV, which contain recommendations for providers, are listed in the Suggested Resources below. (See also Chapter 4: Prevention of HIV in the Clinical Care Setting.) PATIENT EDUCATION What does patient education involve? The provider should assess the patient’s understanding of HIV disease and begin patient education at the initial evaluation. To make sound decisions regarding treatment, the patient must understand certain medical information, including: • The critical role of the patient in his or her own care • Natural history of HIV disease and consequences of immune system destruction • How HIV is transmitted • The meaning of the viral load and CD4 count • The beneficial impact of antiretroviral drugs • Early signs and symptoms of opportunistic illnesses • The role of prophylactic agents What should patients understand before beginning antiretroviral therapy? Before initiating antiretroviral therapy, patients must be fully aware of: • The importance of adhering completely to the treatment regimen • The possibility of drug resistance and loss of treatment options • The proper timing of pills and coordinating pill-taking with meals • Possible side effects and long-term drug toxicities • The option to stop treatment at any time In addition, patients should express a commitment to adhere to treatment before providers initiate any form of treatment. (For more on adherence, see Chapter 7: Adherence.) How should providers incorporate patient education into care? Patient education is so important that entire clinic visits are often devoted to a discussion of key concepts. Providers should use easily understood language and confirm the patient’s understanding of medical terms and concepts. During these discussions, it is helpful for providers to be flexible, acknowledging that uncertainties exist regarding optimal medical management of HIV disease. Because patient education is time-consuming, many HIV specialty clinics utilize staff other than the primary care provider, such as nurses and nurse practitioners who specialize in HIV clinical care, physician’s assistants, pharmacists, and trained peer educators. This interdisciplinary team approach can supplement the limited time primary care providers often have with patients. What information resources are available for patients? Clinics can provide patient education materials and make referrals to social workers, nutritionists, pharmacists, and financial advisers who serve as first-line sources of information about medical issues and social services available in the community. At the regional level, community-based HIV/AIDS organizations and county and State public health departments offer information about medical care and facilitate access to legal aid, financial assistance, low-income housing, support groups, and other social services. At the national level, many organizations provide comprehensive information about HIV/AIDS. Table 2-1 lists recommended resources to which providers can refer patients for information and support. 8 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau
A Guide to Primary Care of People with HIV/AIDS Chapter 2: Approach to the Patient Table 2-1. Information Resources for Patients Internet Sites Agency Topics Web address (accessed 4/04) AIDS Education Global Information System Daily briefing; key topics; basics; fact sheets http://www.aegis.com 2 AIDS Gateway to the Internet Fact sheets; conferences; news; community http://www.aids.org AIDS Info Resource for federally and privately funded clinical trials http://www.aidsinfo.nih.gov/ AIDSmeds.com Extensive treatment information http://www.aidsmeds.com American Association of Family Practice Health topics http://familydoctor.org Centers for Disease Control and Prevention Health topics; traveler’s health http://www.cdc.gov Guides for Living Database of social service organizations http://www.guides4living.com HIV InSite Comprehensive site for providers and patients http://hivinsite.ucsf.edu/ Johns Hopkins AIDS Service Comprehensive site for providers and patients; expert Q & A; resources http://www.hopkins-aids.edu/ New Mexico AIDS Info Fact sheets; internet bookmarks http://www.aidsinfonet.org Project Inform Fact sheets; outreach and education; publications http://www.projectinform.org San Francisco AIDS Foundation AIDS 101; treatment; prevention http://www.sfaf.org The Body Comprehensive AIDS and HIV information resource http://www.thebody.com The Well Project Resource for HIV positive women http://www.thewellproject.com Phone Numbers Agency Topics Phone number(s) AIDS Clinical Trials Information Service Clinical trials information 1-800-874-2572 CDC National AIDS Hotline General AIDS information, local resources for HIV testing and services English 1-800-342-2437 (24/7) Spanish 1-800-344-7432 (8 am - 2 am EST) TTY 1-800-243-7889 Guides for Living National resource directory 1-303-702-1254 Social Security Benefits How to apply for social security benefits 1-800-772-1213 Project Inform Treatment information 1-800-822-7422 AIDS Treatment Information Service Treatment information 1-800-448-0440 Direct Access Alternative Information Resources Alternative Treatments 1-888-951-5433 NYC: 1-212-725-6994 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau 9
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