TREATMENT LITERACY TRAINING - PowerPoint Presentation

Slide1

TREATMENT LITERACY TRAINING

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My Personal Path to Treatment

Treatment

Literacy

Slide3

My Personal Path

In this activity: You will illustrate on a flip chart, your personal HIV history from when you were diagnosed to now, and reflect on critical steps in your journey.As an example of how to illustrate your path, let’s do a journey chart for, say, weight loss together….

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WEIGHT LOSS

WOKE UP(realised I was overweight)DOCTOR(visited the doctor to talk about weight loss options)DIET (went on a diet and cut out late night snacks/desserts)

GYM

(joined the gym but did not go regularly-

still no weight loss)

GYM PARTNER

(found a gym partner and started going regularly)

DIET

(went on a more serious diet and cut out peanuts and wheat products)

WEIGHT LOSS ACHIEVED

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Now It’s Your Turn!

Individually, on flip chart paper:Draw a diagram that outlines your personal HIV history from when you were diagnosed until nowHang your diagram on the wall in such a way so that you can add to it. As the workshop progresses use Post-it notes to add: Opportunities for peer support (Yellow) Issues or problems that need to be addressed (Pink)Things that went well and might be “good practice” (Green)Other issues or things that you would like to note (Blue)

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What is Treatment Literacy?

Treatment literacy is an information and communication process :where persons know their HIV statushow to access treatmenthow HIV workshow the medication worksthe importance of taking it

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What is Treatment Literacy?

offer support and ideas for adhering to treatment and helping others to do so.It is not only important for healthcare workers and people living with HIV, but for everyone including other public and private organizations, family, friends and the wider society.

Slide8

Importance of Treatment Literacy

Increase in HIV Voluntary Testing and CounsellingHelp PLHIV and others understand why Antiretroviral Therapy (ART) is needed, what it can and cannot doStarting treatment and staying in care can lead to improved health outcomesPeople living with HIV (PLHIV) know the name of the medication their taking, its side effects, nutrition and positive livingPromotes better adhrence to antiretroviral (ARV)Promotes safe sex and consistent condom use

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Importance of Treatment Literacy (Cont’d)

Prevent opportunitistic infections and sexual transmitted infectionsLeads to viral suppressionReduce HIV transmissionReduce HIV-related deaths

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Disease progression

Treatment

Literacy

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What is HIV?

HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding

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HIV in the Body: Adult Natural

HistoryPerson gets infected with HIV and it multiplies very rapidly – “acute Infection”Most people will have mild flu-like symptoms two to six weeks after being infectedSome have no symptoms or don’t recall anyThe risk of transmitting the virus at this stage is very highThe virus quietly and slowly multiplies – “clinical latency”

No signs/symptoms

Latent period for two to more than 10 years

The immune system is still strong

The virus damages certain organs and the general immune system following rapid replication of the virus

– ”advanced HIV” or “Acquired Immune Deficiency Syndrome (AIDS)”

Some signs/symptoms, due to weakening immune system

Opportunistic Infections (OIs) and/or cancers are able to survive and dominate the very weak immune

system

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HIV and the Immune System

The immune system in the body tries to protect it from foreign agents like germs and cancer cells.There are many type of cells and substances involved in the immune system. T-lymphocytes (T cells) are one type of white blood cell in the immune system.HIV attacks the T cells that have a special receptor (molecule) called CD4, so these lymphocytes often are called CD4 cells. (HIV has the key to unlock and enter the CD4 door of the T cell)

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Acute HIV (Primary Stage)

Most people infected by HIV develop a flu-like illness within a two weeks to two months after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include:FeverHeadacheMuscle aches and joint painRashSore throat and painful mouth soresSwollen lymph glands, mainly on the neck

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Chronic HIV (Latent Stage)

In some people, persistent swelling of lymph nodes occurs during this stage. Otherwise, there are no specific signs and symptoms. HIV remains in the body and in infected white blood cells.This stage of HIV infection generally lasts around 10 years if you're not receiving antiretroviral therapy. But sometimes, even with this treatment, it lasts for decades. Some people develop more severe disease much sooner

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Progression to AIDS (Advanced HIV Stage)

Acquired Immunodeficiency Syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the Human Immunodeficiency Virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease.

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Progression to AIDS (Advanced HIV Stage)

When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers — diseases that wouldn't usually trouble a person with a healthy immune system.

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HIV and its Effect on CD4 Cells

A person gets infected with HIV and it multiplies very rapidly – “acute infection”CD4 is usually high, well above 500 cells/mlViral load (VL) is just starting to climbThe virus quietly and slowly multiplies –”clinical latency”CD4 is usually above 200–499 per ml and VL is at a steady level

The virus damages certain organs and the general immune system, following rapid replication of the virus –”Advanced HIV” or “AIDS”

CD4 is below 200 cells/ml

VL

above 100,000 cop/ml

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HIV and AIDS

As HIV damages the CD4 cells, the immune system becomes weaker.A person can start getting infections when the immune system cannot effectively fight them off; untreated opportunistic infections (OIs) can eventually lead to death due to immunodeficiency. When the immune system gets to an extremely deteriorated state—at a certain point in the most advances stages—this deficiency in the immune system is called advanced HIV, or Acquired Immune Deficiency Syndrome (AIDS). The World Health Organization defines AIDS as the occurrence of any of more than 20 OIs or HIV-related cancers.Source: World Health Organization. 2016. “HIV/AIDS.” Available at: http://www.who.int/features/qa/71/en/.

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An

Example of an Advanced HIV ConditionPruritic Papular Eruption (PPE)Itchy, diffuse rash Occurs mostly on the arms and legs, but trunk and face involved in 50% of casesDoes not appear on the palms of hands or soles of feet

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Common AIDS-defining Conditions

Candidiasis (gullet or airway disease) Fungal infection caused by yeasts belonging to the genus Candida Candida is a normal growth in the body. With lower immunity, overgrowth of candida can cause symptoms to developCandida that develops in the mouth or throat is called “thrush”

or

oropharyngeal candidiasis

Candida

that develops in the vagina is commonly referred to as “yeast infection”

If it progresses to the throat, lungs, or esophagus, is an AIDS-defining

condition

Pneumocystis

carinii

pneumonia

(

PCP

)

(lung

)

In people with healthy immune systems, it does not cause any

problems

In people with HIV, it can multiply quickly in the lungs, causing

pneumonia

PCP is now treated prophylactically (prevented) with an antibiotic, such as

Bactrim

Recurrent pneumonia

(

2

or more

episodes per year)

Condition where fluid builds up in the lungs and can cause coughing and/or shortness of breath.

Two or (usually) more separate episodes usually with fever, leukocytosis (high white blood cell count), and purulent (pus) sputum

production

These episodes are separated by an interval of at least one month without symptoms or clearing of the chest visible by

radiograph

Cervical cancer

(invasive/has

spread past the neck

of womb

)

Caused by some strains of human papillomavirus (HPV)

Develops at the neck of the womb

Women with HIV infection have a higher risk of developing cervical cancer

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Common AIDS-defining Conditions 2

Toxoplasmosis (commonly affects the brain)A parasite that infects the brain and sometimes the heart and lungsCommon ways this diseases is transmitted include via cat feces and soil HIV wasting syndrome

(

weight loss,

diarrhoea

)

A loss of 10% or more of body weight with no explanation other than HIV

infection

Herpes

simplex

V

iruses that cause small sores that are usually small red bumps or fluid-filled blisters that break and then crust over

and can be

itchy

and/or

painful

C

hronic ulcers (more

than one

month), lips, genitals, pulmonary or esophageal disease and other part of the body,

including hands

M. Tuberculosis

(TB

)

Caused by the bacterium

Mycobacterium tuberculosis

This

bacteria usually attacks the lungs, but TB bacteria can attack any part of the body, such as the kidney, spine, and

brain

Cytomegalovirus (CMV) disease

(

eyes, gut, etc.)

Member of the herpes family

50% of time no symptoms or causes mild flu-like symptoms

In someone who is immune deficient, it can infect almost any organ system and cause serious disease

If it infects the liver, it can cause hepatitis; in the lungs it can cause pneumonia; and in the eyes it can lead to retinitis, or loss of

sight

It is spread readily through semen, urine, or saliva, so it is common as

a sexually transmitted infection.

Cryptococcosis

(brain – meningitis, skin, etc.)

The

most common fungal infection of the central nervous system

It may present as a space-occupying lesion, meningitis (inflammation of tissue covering the brain),

or meningoencephalitis

(inflammation of the membranes of the brain and the adjoining cerebral tissue)

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Less Common AIDS-defining Conditions

Coccidioidomycosis Fungal infection of lungs and other organsFungus lives in soilPeople get it by breathing in microscopic fungal spores from the air/dustLymphoma

A cancer of a part of the immune system called the lymph

system including

lymph nodes

There are many types of lymphoma, including Hodgkin’s

and n

on-Hodgkin’s lymphomas

Cryptosporidiosis

“Crypto

”

P

arasitic infection of

gut

Can cause severe diarrhea that can last for months resulting in dehydration and malnutrition, and even death due to fluid

loss

Often found in farm animals

Mycobacterial

disease

Mycobacteria are a type of germ

There are many different kinds of mycobacterial

diseases

The most common one causes tuberculosis

Another one causes leprosy

Others cause infections that are called atypical mycobacterial infections. They are not "typical" because they do

not cause tuberculosis,

b

ut they can still harm people

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Less Common AIDS-defining Conditions 2

HIV-related encephalopathy (brain)“AIDS Dementia Complex” (ADC)Marked by a decline in mental processes, including symptoms such as a decline in thinking or “cognitive” functions, such as memory, reasoning, judgment, concentration, and problem solvingPotentially causes changes in personality and behavior, speech problems, and movement

Salmonella

(blood

and gut

)

A bacteria that often causes diarrhea, fever, and abdominal pain

In

severe cases, the infection can spread from the intestines to the bloodstream and then to other body sites

Can be fatal unless

the person is treated promptly with

antibiotics

Isosporiasis

(gut)

Caused

by a parasite that

infects the lining of the small intestine

Can cause severe

diarrhea

and the inability to absorb nutrients

Spread by feces

and f

ood or water contaminated with animal feces that

carry this parasite

Progressive multifocal leukoencephalopathy

(PML

)

A

viral infection

causing a

disease of the white matter of the brain

Is harmless except among those with lowered immune defenses for

whom PML has a

mortality rate of

30-50%

in the first few months following diagnosis

Kaposi’s sarcoma

(KS)

(skin, internal organs)

Cancer

of the connective tissues that support blood vessels

Presents with visible pink to purple to brown lesions under the skin, depending on the skin color

Can be very painful

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Examples of Conditions* for Diagnosis of AIDS

Esophageal Candidiasis (extensive thrush)White plaques on roof of mouth extending into esophagus (gullet) ShinglesExtensive, blistering rash, often with severe burning pain, tingling, or extensive sensitivity*These conditions do not occur only in people living with HIV

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Factors that Improve Survival

Consistently taking antiretroviral therapy with goal of undetectable viral load.Staying in HIV care.Closely adhering to your health provider’s recommendations.Eating nutritious foods.Taking care of themselves: Exercise, rest, no cigarette smoking, no illicit drugs, safer sex, and emotional health.Patient’s genetic make-up.When all done together life expectancy for people living with HIV has been shown to be almost the same as HIV-negative individuals.

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Moving to Test and Treat and Stay

As of December 2016, the Government of Jamaica adopted the “Test and Treat” strategy.This means that people living with HIV that are diagnosed, are prepared and are offered antiretroviral treatment (ART). Studies done across the world have now clearly demonstrated that ART is the best treatment for HIV.ART reduces HIV-related OIs and cancers, deaths, and conditions not traditionally considered to be associated with HIV, such as non-HIV related cancers, cardiovascular disease, kidney failure, and liver failure.

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Client-centered approach that simplifies and adapts sets of services to address the specific requirements of various groups of people living with HIV while reducing unnecessary burdens on the health system.

Adapted from: World Health Organization. 2016. “Differentiated Care for HIV: A Decision Framework for Antiretroviral Therapy.” Available at: http://www.differentiatedcare.org/. 28Adopting Differentiated Care for HIV

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Customised Care Packages:People presenting well

with higher CD4 counts/virally suppressedPeople with advanced diseasePeople who are unstable on treatment and need careful monitoringPeople who are stable on ARTOther variables: chronological and developmental age, missed appointments, loss to follow-up, adherence, logistics, stigma and discriminationDifferentiated Care: Characterised by 4 delivery components:Location of service deliveryProvider of the servicesType of services deliveredFrequency of the serviceWHO HIV Treatment and Care: What’s New in Service Delivery Nov. 2015Differentiated Care for HIV: Delivery of Specific Care Packages Based on Care Needs

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The client should be linked to HIV care in order to receive a customized package of care to meet their HIV service needs.

Assessments to determine individuals readiness to start ART should be started immediately upon entry to HIV care.ART should be initiated as soon as a person is ready to commit to treatment regardless of the availability of baseline laboratory tests.A thorough clinical evaluation must be performed on all newly-diagnosed HIV infected patients.Client should be screened for risk to lost to follow-up.At Initial HIV Diagnosis 1

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Upon diagnosis the client should be promptly linked to HIV care and treatment where the following set of services is offered

:Co-morbidity screening treatment and prevention:Co-trimoxazole (PCP-pneumocystis Carinii pneumonia) INH prophylaxis (to prevent TB) Laboratory baseline valuesAdherence supportPsychological and social supportClinical management of patients presenting with advanced HIVSource: Adapted from WHO Guidelines, 2015, Available at: http://www.who.int/hiv/pub/guidelines/en/.At Initial HIV Diagnosis 2

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Education and CounsellingART-readiness assessmentPositive Health, Dignity, and Prevention first tier package:

HIV BasicsTreatment literacyDisclosure supportPrevention counselling Stigma reductionCommunity support and linkagesAt Initial HIV Diagnosis 3

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At Initial HIV Diagnosis 4

Thorough clinical evaluation must be performedComprehensive history and physical examination allow for:Accurate assessment of WHO clinical stageScreening for active TB disease Diagnosis and management of other opportunistic infections and co-morbiditiesWHO Clinical StageClassification

of

HIV-associated Clinical

D

isease

1

Asymptomatic

2

Mild

3

Advanced

4

Severe

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ART Monitoring Clinical

assessment Laboratory testing Continuous adherence monitoring Adherence and retention support Disclosure support Peer support

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Viral Load

Viral Load: A viral load count is a lab test that measures the number of HIV particles in a milliliter of blood. These viral particles are called "copies." A viral load test helps provide information about the progression of the virus in the patient’s blood and how well antiretroviral therapy is controlling the virus.The goal of ART is to move the viral load down (i.e., to undetectable levels).Undetectable Viral Load/Viral Suppression: In general, your viral load is declared "undetectable" if it is under 20 to 75 copies in a sample of your blood (sometimes generalised as under 50 copies/ml). The exact number depends on the lab that analyses your test. When undetectable the chance of passing the virus onto another person is almost zero.

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Viral Loads

Source: Department of Health & Human Services, USA. 2016. “Undetectable Viral Load.” Available at: https://aidsinfo.nih.gov/education-materials/glossary/876/undetectable-viral-load.

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Viral Load Monitoring

Laboratory monitoring is not a prerequisite for the initiation or continuation of ART.Viral load monitoring is the preferred lab test for monitoring the success of ART.Viral load should be measured every 6 to 12 months after ART initiation and annually thereafter.CD4 monitoring continues to play an important role in monitoring HIV patients to asses their need for co-trimoxizole prophylaxis and the risk of OIs. CD4 monitoring is now de-emphasised in favor of viral load monitoring for monitoring the success of ART because of viral load’s greater accuracy in identifying treatment failure.

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WeightComplete blood count (CBC)HIV viral load

CD4 cell countSTI screeningTB screeningUrine testInitial and Regular Checks That Should be DoneBlood chemistry (liver function tests, kidney function tests, blood glucose, lipids)Hepatitis BHTLV I/II (Human T lymphotropic virus and retroviruses)Pap smear

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Key Points

Some people do not have signs of HIV and may not be aware of their HIV status.A blood test is the best way to know HIV status.A thorough physical assessment of all body systems may uncover signs of OIs, indicating that the person has AIDS.A blood test (CD4, viral load, and others) to check the immune status is required, even if there are no signs of HIV.Some people may need OI prophylaxis to prevent illnesses and further damage to their immune system. Consistent use of ART maximises supressed viral load, stops HIV progression and can prevent mother-to-child transmission and sexual transmission of the virus.39

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ART & ARV

Treatment

Literacy

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ARV VS ART

ARV (Anti-retroviral) is a drug that is used to prevent HIV from multiplying such as Tenofovir, Lamivudine and TenofovirART (Anti-retroviral Therapy/Treatment) is the use of HIV medicines (ARV) to treat HIV infection, suppress the virus and stop the progression of the HIV virus

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Goals of Anti

retroviral Therapy (ART)Suppress the virus Restore the immune system Treat the complicating illnessesMinimize the risk of resistance and toxicityImprove the quality of life and clinical outcomeTREAT THE WHOLE PERSON, not just the diseases they have

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Goals of Anti

retroviral Therapy (ART) (continued)Decrease chance of transmission to another person when someone has an undetectable viral load – treatment as preventionPrevent HIV transmission in HIV-negative people who are at high risk of being exposed to HIV (pre-exposure prophylaxis, or PrEP)Prevent HIV transmission in HIV-negative people who have been exposed to HIV (post-exposure prophylaxis, or PEP)

Slide44

Successful ART Requires Regular Visits

You need regular visits to see providers for your care as needed, before and after starting ART.You should see not only the nurse and doctor, but also most or all of the following: Multidisciplinary team:Nutritionist, adherence counselor, social worker, pharmacist, laboratory worker, contact investigator and/or mental health provider, dental provider, family planning counselor, obstetrician/ gynecologists, etc.

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Care Visits also Include Lab Tests …

CD4 test: The test that gives an idea of how well the immune system is (the higher the better).After first CD4, a repeat is done at three months and then once every six months, or at least once per year.Viral load (VL) test: The test that measures the number of HIV “copies” in your blood. If you are taking your ART as prescribed, it can tell how well it is working to control the virus (the lower the VL the better).It is done six months after starting ART, then every six months or at least once per year. Other screening (e.g., for tuberculosis, cervical cancer for women, and tests to check organs like liver, kidney, heart, lungs).

Slide46

Viral Load

CD4+ Cells

Time after infection

Antiretroviral

Therapy

This graph shows the effect of ART on HIV progression. The time to fall in immune status varies for individuals, hence, it is denoted by //.

How ART can Improve the Course of HIV in the Body

Slide47

Decrease the amount of HIV in the blood

(typically until viral load is less than 50 copies)Preserve immune system (so CD4 count increases)Long and healthy life (check other systems: liver, kidney function, etc.)Goals of Antiretroviral Therapy

Slide48

Moving to Test and TreatAs of December 2016 the Government of Jamaica adopted the “Test and Treat” strategy.

This means that antiretroviral treatment is offered to every person living with HIV in Jamaica as soon as they know their status.Studies done across the world have now clearly demonstrated that ART is the best treatment for HIV.ART reduces HIV-related opportunistic infections and cancers, deaths as well as conditions not traditionally considered to be associated with HIV, such as non-HIV-related cancers, cardiovascular disease, kidney failure, and liver failure.

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The decision to initiate ART for a given patient depends on your “readiness” to start.Your

provider will assess all aspects related to adherence (e.g., potential challenges and opportunities) and work with you to develop a simple adherence plan before starting ART. What might some of these barriers be? What are facilitators for succeeding?Consider: HIV knowledge, cultural and religious beliefs, literacy level, depression or other psychiatric illness, substance abuse, denial, disclosure issues, age, degree of illness, previous experience with healthcare system. Refer to other modules on disclosure, stigma, etc.Ready or Not?

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What are Some Concerns about Taking Pills?

50

What if I vomit up the pills?

What if I miss a dose?

What if I have side effects?

Tablets every day for the rest of my life..?

How many pills do I have to take?

How can I take these without friends & family knowing

Who and what are some resources and supports to help me succeed?

Slide51

Column ATenofovir + Lamivudine

Zidovudine + LamivudineFirst-line ART in JamaicaColumn BEfavirenzNevirapine

Slide52

Second-line TherapyRefers to the usual list of combinations of ARVs recommended for use when the first-line therapy fails.

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Recommended Second-line Regimen

Option Protease inhibitorsPreferred

Atazanavir + Ritonavir

Alternative

Lopinavir + Ritonavir

Switch

the NRTI backbone (i.e., if it was Tenofovir/Lamivudine, or switch to Zidovudine/Lamivudine, and vice versa).

AND

Replace

the NNRTI (Efavirenz or Nevirapine) with a protease Inhibitor.

Slide54

ART and Food Restrictions

ANTIRETROVIRAL FOOD RESTRICTIONSLamivudine 3TCWith or without food

Zidovudine AZT

With or without food

Abacavir

With or without food

Tenofovir TDF

With or without food

Efavirenz

With or without food; avoid fatty foods

Nevirapine

With or without food

Lopinavir/Ritonavir

With or without food

Darunavir

Take

with food

Atazanavir

Take with food

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Has anyone experienced side effects from their drug regimen?

Side Effects

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Side effects

ARVRash

Nevirapine, Efavirenz

Drowsiness, strange dreams

Efavirenz

Nausea

Zidovudine,

Tenofovir

, Lamivudine,

Lopinavir

, Ritonavir

Diarrhoea

Lopinavir, Ritonavir

Some effect on the liver

Nevirapine, Efavirenz,

Atazanavir

Metabolic effect: blood sugar or lipids

Most, but especially

Lopinavir

, Ritonavir,

Efavirenz

, and

Nevirapine

Affects kidney

Tenofovir

Common

S

ide

E

ffects of Some ARVs

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What is Adherence ?

Adherence:Engaged and accurate participation in your plan of care—sticking to the plan.It implies understanding, consent, and partnership.It includes both adherence to care and adherence to treatment.

Slide58

What is ART Adherence ?

Your ability to take all medications as prescribed:The right drugsStored under the right conditionThe right dosageThe right timeIn the right way58

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Adherence Process

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Adherence to ARVs and More…2

Benefits of Adherence:The goal of ART is to move the viral load down, ideally to undetectable levels. In general, your viral load will be declared "undetectable" if it is under 50 copies in a sample of your blood (although the exact number depends on the test and lab). Having an Undetectable Viral Load:Allows the immune system to recover and become stronger.Puts you at very low risk of becoming ill because of HIV. Reduces your risk of developing some other serious illnesses.The risk of HIV becoming resistant to the anti-HIV drugs you are taking is very small.Reduces the risk of passing on HIV to someone else.-

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Adherence to ARVs and More…

Keep multidisciplinary care appointments Regular lab monitoring (e.g., CD4, viral load)Self-acceptance and dealing with disclosure issuesSeek medical attention or support earlyIn case of default, go back to provider as soon as possiblePositive Health, Dignity, and PreventionSafer sex practices and sexual healthHealthy lifestyle activitiesScreening testsFamily planningPrevention of mother-to-child transmission

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WHY IS ADHERENCE CHALLENGING FOR SOME?

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ChallengeDosing frequency (some meds are taken 2 or 3 times daily)

Side effects Medication access/storageToo many pillsPossible Solutions to ChallengesSolutionTry pill boxes, carrying an extra dose at all times, setting the alarm on a watch, etc.Seek help to manage side effectsStore securely—most can be kept out of the fridgeSpeak with your medical provider

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ChallengeForgot to take pills in the morning, but still in window of time.Pills not with them?

Tired of taking pills? Systems related (cost/care/access/ stockouts, stigma)?Others? What Can You do to Overcome These Challenges? SolutionSet alarm on phone, take after brushing teeth, etc.Always have a few in a small pill box in your bag or at work/schoolPeer support, counselling, etc.Remember how good you felt when you heard your viral load was less than 40 copies

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Consequences of Non-adherence

Less suppression of HIV replication (so viral load goes up) Destruction of immune system (CD4 goes down)Disease progression Intermittent treatment for HIV and AIDS does not work.Preventing complications and preserving good health is more effective than trying to treat complications when they arise.Maintenance and/or restoration of immune defenses requires ongoing monitoring and treatment.Adherence decreases the chance of developing drug resistance.

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Drug resistanceRisk of transmission Limited future treatment optionsHigh cost for the individual and country

Increased risk of transmission Not accessing treatment can lead to worsening health and deathConsequences of Non-adherence(cont’d)

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Development of Drug Resistance

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Treatment Failure

Treatment failure is one or any combination of:Clinical failureImmunologic failureVirologic failure Factors that contribute to treatment failure:Drug resistanceDrug toxicityPoor treatment adherence

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Viral Load

CD4+ Cells

Time after infection

Antiretroviral

Therapy

Treatment Failure

Clinical Course of HIV Infection

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SummaryAdherence is integral.

Adherence can be difficult, but does not have to be difficult.Adherence must be supported.No HIV and AIDS treatment program should begin without assessment, counselling, information, and support on adherence.The benefits of adherence far outweigh the risks!

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The most effective regimen for you (and others) is the one you will take, and take regularly, so you and your provider/peer must explore ways to achieve this.

Slide72

90-90-90 Treatment Target toward the end of the AIDS Epidemic

By 2020, 90% of all people living with HIV will know their HIV status.By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.Source: Joint United Nations Programme on HIV/AIDS. n.d. “90-90-90 Treatment for All.” Available at: http://www.unaids.org/en/resources/909090.

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NHP Response to the Challenge

“…to strengthen the retention and linkage process by outlining the roles and responsibilities of treatment site staff, including those involved in outreach testing and laboratory services”Source: National HIV/STI Programme (NHP). 2014. Jamaica Country Progress Report/GARP 2014. Kingston: NHP.

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Key Take-away Messages

Antiretroviral therapy (ART) is a combination of ARVs used for treatment.Treatment does include, but is not limited to, pills, social support, and a focus on holistic health that compliments and supports adherence.The “best fit” first-line medication is established following discussion and understanding about side effect profile, lifestyle, other medications, etc.Test and Start is key. Once you are diagnosed, you can begin treatment immediately. Adherence to ART (ARVs and care) is very important to its success.Virally suppressed people will help prevent the spread of HIV—part of the prevention solution with DIGNITY!

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Ecological Model

Treatment

Literacy

Slide76

The Multidisciplinary

Adherence Team76Adherence SupportPharmacistSocial worker/counsellorNursePhysician

Treatment

supporter/

family/friends

Slide77

Role of the Multi-disciplinary Team

Conducting comprehensive assessments of the PLHIV’s psychological and social needsCommunicate regularly with the clients to ensure that they adhere to ARTEducate them of their Sexual and Reproductive Health RightsEnsure that people living with HIV adhere to their medication and take it properlyPLHIV get the correct medication or appropriate substitute, in the case of the pharmacistPractice safe sex and consistent condom use.

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Role of the Multi-disciplinary Team

Do regular checks for opportunistic infections such as liver and kidney function tests and pap smearEducate PLHIV of the importance of ART and retaining in careEncourage PLHIV to practice proper nutrition and hygiene. Promote self-care and peer supportProvide counselling and assess PLHIV mental health

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Case 1

Desmond was very happy that he finally got a job as a groundsman at a business office in town. It was near his home and the employer seemed nice ... but ... oh no, he will only have a day off on Sundays, so how will he fill the prescription for his ARV and attend his clinic appointment next month? He doesn’t want to ask for a day off, as he just started two days ago. What can he do? Which member from the multidisciplinary team he can speak with?

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Case 2

Jasmine was advised by her doctor that her CD4 was 300 and she should start ARV. She likes the fact that it would only be one tablet at night but is thinking of postponing the start of treatment until next year. She wants to complete the last year of her course, which she takes after work three nights per week. She just can’t afford to be drowsy, as she has to stay up late to study! What can she do? Which member from the multidisciplinary team she can speak with?

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Questions?