Page 34 - Nursing Matters June 2021 Vol 12

require TB prophylaxis. 34. All newly diagnosed HIV positive patients should initiate
19. Pregnancy does not preclude screening for cervical ART on the same day unless there are medical reasons
cancer, and it can be performed up to 20 weeks to defer.
gestation. 35. Before initiating ART, screen for TB and cryptococcal
20. Link pregnant women back to care post-delivery meningitis (CM) symptoms. Patients with TB or CM
to ensure treatment adherence. Additional support symptoms should defer same-day ART initiation and be
includes referral to a community health worker, or referred to a clinic for additional tests.
support group such as a postnatal club. 36. To reduce the risk of COVID-19 transmission, strengthen
21. At discharge post-delivery, provide women with 2 facility-level Infection Control Practices; including
months of ART. physical distancing, washing/sanitising hands and
22. A tuberculin skin test (TST) is not required prior to the correct use of masks and other personal protective
equipment (PPE).
starting TPT. DTG increases metformin levels, therefore
the maximum metformin dose in patients on DTG should 37. Support ART adherence and ensure missed appointment
be 500mg 12-hourly. lists are actively managed in facilities to bring patients
back to care.
23. If a patient is on rifampicin, DTG needs to be given
12-hourly rather than daily. If a patient is on a TLD fixed 38. If you have any concerns about the stock levels of
dose combination, add DTG 50mg 12 hours To this. TEE or TLD, please contact your district pharmacist
24. Adult patients who are not yet on ART when TB treatment immediately.
is initiated should initiate on efavirenz (EFV) containing 39. If a couple encounters difficulty in achieving pregnancy,
regimen. it is important to involve both partners and refer them
25. Switch a stable pregnant woman on ART from EFV to for infertility interventions.
DTG if her VL is <50 copies/mL and she is no longer in 40. Rilpivirine should not be used as the third agent in first-
the first 6 weeks of pregnancy. line regimens when the VL is >100,000 copies/mL.
26. Patients switched to TLD do not need to return for review 41. Pregnant women with a CD4 <350 cells/uL and without
after 1 month, unless they are a new patient. Those who contraindications should be given TB preventative
switched from TEE to TLD and have been decanted to therapy (TPT) for 12 months.
an external ART pick-up site, can stay decanted. 42. TB preventative therapy (TPT)should be deferred in
27. Patients with persistent low-grade viraemia (VL 50-999 pregnant women with a CD4 >350 cells/uL until 6
copies/mL) should be discussed with a HIV expert weeks post-delivery.
before switching from TEE to TLD. 43. The code C#PMTCT should be on the lab form of
28. There is no longer a need for the SAHPRA Risk every viral load request in a pregnant or breastfeeding
Acknowledgment Form to be completed before woman, to ensure electronic gatekeeping rules do not
switching patients from TEE to TLD. lead to sample rejection.
29. To reduce the risk of COVID-19 transmission, introduce 44. DTG and TAF use may be associated with weight gain.
outdoor clinic service points and community- based Counsel and manage patients appropriately, especially
distribution points for ARVs. pregnant women in order to reduce pregnancy
associated adverse outcomes.
30. To reduce the the risk of COVID-19 transmission,
patients in community-based adherence clubs or 45. In recurrent treatment defaulters, consider re-initiating
support groups should be seen individually for support ART with a DTG or PI-based regimen, provided there
and ART distribution, rather than in groups. are no contraindications.
31. To reduce the risk of COVID-19 transmission, implement 46. Avoid resistance tests before 2 years on ART in patients
2 monthly dispensing for all ART and TB patients across who are not virally suppressed on a DTG- or PI-based
all facilities. regimen.
32. To reduce the risk of COVID-19 transmission, accelerate 47. The dose of lopinavir/ritonavir (LPV/r) must be doubled
decanting of patients to external ART pick-up points if the patient is on rifampicin-based TB treatment.
based on the revised eligibility criteria. 48. Neither atazanavir nor darunavir can be prescribed if
33. Fast-track people living with HIV (PLHIV) with the patient is on rifampicin-based TB treatment.
comorbidities and a higher risk for severe COVID-19
patients as well as those presenting to facilities with
symptoms.

Abbreviations: ART – antiretroviral therapy; ARV – antiretroviral; CD4 – cluster of differentiation 4; IPT – isoniazid preventive therapy;
PrEP – pre-exposure prophylaxis; TB – tuberculosis; U=U – undetectable = untransmissible; UTT – universal test and treat; VL – viral load.

HIV Nursing Matters | June 2021 | page 32