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

A Guide to Primary Care of People with HIV/AIDS
Chapter 4: Prevention of HIV in the Clinical Care Setting
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for enhanced counseling. More frequent screening
for STDs is appropriate with evidence or suspicion of
high-risk sexual behavior (eg, sex with a new partner,
sexual activity without consistent and correct condom
use); however, there are no data to guide the precise
frequency. More frequent screening might also be
appropriate in asymptomatic men who have sex with
men (MSM) and younger women because of a higher
STD prevalence among these demographic groups.
The local prevalence of these infections might guide
frequency of screening. Laboratory screening for drug
abuse is addressed in Chapter 13.
Table 4-2. Screening for Sexually
Transmitted Diseases
STD
Syphilis
Gonorrhea
Chlamydia
Trichomonas
Herpes simplex virus
Recommended test
Non-treponemal serologic test
(RPR, VDRL)
Nucleic acid amplification test
(first-catch urine or urethral [male]/
cervical [female] specimen) or
culture (urethral [male]/cervical
[female] specimen)
Nucleic acid amplification test
(first-catch urine or urethral [male]/
cervical [female] specimen)
Wet mount or culture
(vaginal secretion)
Type-specific HSV-2
antibody testing
What behavioral assessment and counseling
interventions should the provider implement?
Specific suggestions for assessment and counseling
are presented in Table 4-3 and in Chapter 2. Each
clinic must decide which aspects of HIV prevention
assessment and counseling are best done by the
primary provider, by other clinical providers with whom
the patient interacts, or some combination of both.
Brief interventions by physicians have been found to
be effective with other conditions, including smoking
cessation, improving dietary behavior, and reduction of
alcohol consumption. Thus, while data are limited on
the topic of HIV prevention, physicians should provide
such counseling until studies suggest alternate and
improved approaches.
How can clinic staff other than the primary
medical provider enhance HIV prevention
practice?
In most medium-sized and larger clinics, staff
members other than the primary medical provider
are responsible for referral, contact notification, and
quality improvement, which can all be used to enhance
prevention practice, as discussed below. In addition,
specific structural interventions (eg, arranging client
flow to ensure interaction with clinic staff who conduct
prevention counseling, use of video, written handouts
or other educational media, and distribution of
condoms) can strengthen the role of other clinic staff in
prevention activities.
What role does referral to community
resources play in HIV prevention?
Some complex patient issues and conditions fall
beyond the scope of a primary care clinic and must
be addressed before risky behavior can be reduced or
eliminated. These include drug abuse, mental health
issues, domestic violence, and assistance with needs
such as housing, food, and employment. Each clinic
should have established relationships with community
resources to address these issues, and staff members
should have thorough knowledge of the available
services as well as mechanisms in place to ensure that
patients can access the services. Finally, followup should
be done to be certain that the referrals are utilized
and are effective for each patient. It is unlikely that
persons at highest risk for transmitting HIV to others
can effectively reduce such behavior without access to a
comprehensive array of services and supports.
What are key elements of contact notification?
Contact notification is an effective way to identify
additional HIV-infected persons through HIV counseling
and testing, bring them into care, and provide support
to help them avoid transmitting HIV to others. Health
departments traditionally conduct contact notification;
in some States providers are required by law to report
to the health department known sexual or drugequipment-sharing
contacts of persons infected with
HIV. The standard method is to inform the patient’s
contacts that they have been placed at risk and need
HIV testing without identifying the source.
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U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau