HIV/AIDS Treatment and Care : Clinical protocols for the European ...

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90 HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION 3. Organization of services • The needs of patients and their families can be addressed by a team approach, including bereavement counselling if indicated. • Palliative care services can be provided as consultative services in hospitals at both inpatient units and outpatient clinics. • Palliative care services can also be provided in the community, in outpatient settings and as home-based care, coordinated with hospital services as needed. • Where available, palliative care specialists should be available to AIDS clinical services. In situations where such access is difficult, AIDS clinics should refer to other institutions where palliative care specialists and services are available. • AIDS care providers should also be familiar with basic principles of palliative care and be able to manage routine problems without needing to refer to palliative care specialists. • Nongovernmental organizations should be involved in delivering palliative care.
palliative care for people living with hiv II. General considerations for palliative home care of people living with HIV (PLHIV) Care of patients at home and in the community is an essential component of palliative care. Caregivers’ questions and concerns about safety and infection control can be readily addressed by references to simple and longstanding practices which decrease risk of contamination with HIV and other bloodborne pathogens. Standard infection control measures to prevent the transmission of HIV have been well established since the 1980s (7, 8). Precautions that should be taken when caring for someone with HIV/AIDS, whether it be in the hospital, clinic or at home, should be the same. These precautions are based on the principles of standard infection control and should be in place and respected at all times. These principles minimize the risk of contamination through infected blood or other body fluids by considering all such fluids as potentially infectious and applying simple and consistent techniques for handling and disposing of them. 1. Precautionary measures at home When palliative care is offered at home, the health care provider (doctor or nurse) should counsel the home care provider (family member, friend or other service provider) on the following points: • Family members and other caregivers can safely care for AIDS patients. There is an extremely low risk of HIV transmission to health care providers and household contacts if the following hygienic practices are respected. ° Wear latex gloves when in contact with blood and bodily fluids. ° Keep wounds covered (on both caregivers and PLHIV); if they become wet with blood or other body fluids, change dressings and dispose of properly. ° Clean up blood, faeces and urine with ordinary household bleach while wearing gloves. ° Keep clothing and sheets that are stained with blood, faeces or other body fluids separate from other household laundry. Use a piece of plastic or gloves to handle soiled items. ° Do not share toothbrushes, razors, needles or other skin-piercing instruments. ° Wash hands with soap and water after changing soiled bedsheets and clothing and after any contact with bodily fluids. • There is no risk from casual household contact (no gloves needed). • Cutlery and other food items, unsoiled clothing and linens, toilets, baths, showers, etc. can be cleaned with ordinary cleaning products. 2. Education on management of symptoms The attending doctor or nurse should provide clear instructions to home caregivers on the management of symptoms, including: • explanation of symptom management; • education in the most immediately necessary areas, teaching a few skills at a time; • demonstration of skills, such as how to safely give an injection; • verification of skills and knowledge by asking questions and requesting demonstrations; • encouraging the care provider to return if there are any questions or concerns; • ensuring that the caregivers know when and whom to call for help and how to provide back-up, especially in case of side-effects or drug interactions. 91
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HIV/AIDS TREATMENT AND CARE Clinica
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© World Health Organization 2007 A
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iv Acknowledgements The editors wou
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vi Marco Vitoria (WHO headquarters)
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viii CRP C-reactive protein CS caes
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x LFT liver function test LGE linea
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xii TDM therapeutic drug monitoring
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xiv Introduction HIV is a chronic i
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Annex 7. Glossary .................
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HIV/AIDS TREATMENT AND CARE CLINICA
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HIV/AIDS TREATMENT AND CARE CLINICA
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10 HIV/AIDS TREATMENT AND CARE CLIN
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1 HIV/AIDS TREATMENT AND CARE CLINI
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Contents I. Policy and principles .
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I. Policy and principles HIV/AIDS T
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HIV/AIDS TREATMENT AND CARE FOR INJ
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° bacterial pneumonia ° endocardi
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Social factors are: • homelessnes
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Table 3. Interactions between ARV d
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Other medications Use Rifampicin (R
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Table 5. Interactions of illicit dr
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ANNEX 1 ASI6 C © 2004 University o
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• Cardiovascular Hypertension Tac
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Contents I. Epidemiology and natura
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ManageMent of Hepatitis C and HiV C
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Annex 3. Alcohol screening question
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Table 16. a sample of the drug pipe
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3.2. Considerations regarding treat
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278 hiv/aids tReatment and caRe cLi
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I. Prevention strategies Prevention
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Prevention of HePatitis a, B, C and
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Prevention of HePatitis a, B, C and
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5. Contraceptive methods for women
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I. Policy issues Prevention of Hiv
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III. Initial evaluation Prevention
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Prevention of Hiv transmission from
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6. Fungal infections...............
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• Disseminated non-tuberculous my
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Annex 3. Rabies vaccines ..........
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442 hIv/aIds tReatment and caRe clI
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Contents I. Policy issues .........
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I. Policy issues post-exposure prop
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post-exposure prophylaxis for hiv i
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° condom use ° presence of STIs (
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Table 3. thre- drug arv regimens Pr
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VI. Suggested minimum data to be co
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History of antiretroviral treatment
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Test results: HBV: HCV: HIV: Post-t
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Infection control standard precauti
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The World Health Organization (WHO)
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