Page 21 - Nursing Matters June 2021 Vol 12

current issues

retention in care. NIMART has also been
2
shown to reduce patient waiting times, This short synopsis on the TLART programme demonstrates
offer more affordable healthcare and how vital the nurse’s role is within the multidisciplinary team when
improve health-related quality of life in addressing the complicated needs of treatment-experienced
patients.
2
HIV-positive patients.
As NIMART nurses are now managing
the majority of our country’s HIV positive
population, they are well positioned to on adherence, but still present with a viral 2. Improve patient adherence
identify patients that are struggling with load (VL) > 1000 copies/mL. In adults, and simplify the ART regimen
their ART, and those that may be failing these PI-based regimens are generally
second-line regimens. This is key to the the patient’s second-line regimen. In Patients who have a high VL while
identification of patients requiring TLART. children, however, the situation is more taking a PI-based regimen require extra
complicated as a PI-based regimen can attention to find out if they are struggling
Antiretroviral regimens be their first-line regimen. Patients who with adherence, whether it is patient,
fulfil the above criteria are eligible for provider, medicine or health system-
Medicine access in the South African a drug resistance test (DRT) through the related factors. It is important to address
public healthcare sector is guided by National Health Laboratory Services, psychosocial issues and involve social
the Standard Treatment Guidelines and if the drug resistance test indicates workers, counsellors, psychologists, and
(STGs) and Essential Medicines List that there is PI resistance, these patients psychiatrists when necessary. It may also
(EML). The PHC STGs and EML assist are then candidates for TLART. be beneficial to simplify the ART regimen
healthcare workers at PHC facilities to reduce the pill burden, side effects,
in selecting appropriate treatment Patients who have had tuberculosis (TB) drug interactions or make the regimen
regimens and includes medicines that treatment with a PI-based ART regimen once a day instead of twice a day. An
can be prescribed and dispensed by are also more likely to develop resistance expert or ART helpline can be contacted
nurses for various conditions. The latest to ART. This is why it is vital for nurses to assist with this (see Table 1).
edition, 2020, provides guidance for the to remember to double the dose of
initiation of patients on first- and second- lopinavir/ritonavir in adults on rifampicin, 3. Preparing the patient for a
3
line ART. As TLART involves complicated and to give ritonavir super-boosting to drug resistance test (DRT)
resistance mechanisms, specialist review children on rifampicin. If a nurse finds
of the patient and recommendation of a patient with a high VL on a PI-based In some cases, it is possible that the patient
an appropriate regimen on a case-by- regimen this should prompt them to check appears to be failing their ART because
case basis, is needed. This is performed whether the patient has been on TB they may not be taking their medicine
by a National TLART Expert Review treatment at the same time, and if the ART correctly, or not taking their medicine at

Committee. Nurses can manage the was managed correctly during this time. all. Doing a DRT is expensive and is only
patients and liase with the committee to If not, the nurse should call an expert beneficial to the patient if the patient is
provide TLART for their patients in PHC to discuss the case, as the patient may adherent to their treatment. It is therefore
facilities so that patients do not have to require resistance testing sooner. important that the patient is counselled
travel long distances to hospitals. before this test is done, and are advised to
Role of the nurse: to identify patients that take their treatment appropriately for at
What role can nurses play to support would be candidates for TLART. least one month before the DRT is taken.
patients who require TLART?
Table 1: ART Helplines
1. Identifying patients who are
failing second-line (protease Institution Contact Number
inhibitor-based) treatment National HIV & TB Care Worker Hotline: 0800 212 506 or
021 406 6782
The first step is to identify those patients KZN Paediatric Hotline 0800 006 603
that may be potential candidates for
TLART and to bring them to the attention The following can also be contacted via SMS/Please Call Me/WhatsApp:
of the medical doctor. These are patients National HIV & TB Care Worker Hotline: 071 840 1572
who have been on a protease inhibitor Right to Care Adult HIV Helpline 082 957 6698
(PI), such as lopinavir/ritonavir or
atazanavir/ritonavir, for more than two Right to Care Paediatric and Adolescent 082 352 6642
years and who have also been counselled HIV Helpline

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