Page 24 - ONLINE – Nursing Matters October 2020_Vol 11

clinical guidance
clinical update

Clinical tips

WHEN WE CONNECT

THINGS GET MUCH BETTER QUICKLY –

ACCESSING HIV CARE IN PHARMACIES

Our vision is to increase HIV prevention, testing, treatment, and
care options in pharmacies. Pharmacists, Nurses and GPs have
come together to reinforce your support network – there is no
question you cannot ask them.
1. Family planning and HIV services should always be 12. A TST is not required prior to starting TPT.
provided together. Therefore, at every family planning 13. DTG increases metformin levels therefore maximum
visit, offer HIV testing services. metformin dose should be 500 mg 12-hourly. If the
2. Counselling on the risks and benefits is essential when patient is on rifampicin, then double the DTG dose to
7.7 million South Africans are living with HIV and every day another 657 are infected. Each year 71,000 people die from initiating DTG in women wanting to conceive now or in 50 mg 12-hourly. If the patient is on TLD FDC, then add
DTG 50 mg 12-hourly after the TLD dose.
the near future.
complications linked to HIV – this may be your mother, sister, boyfriend, or best friend. The good thing is that 90% of 3. Initiating DTG in pregnant women in the first 6 weeks 14. Adult clients who are not yet on ART when TB treatment is
people living with HIV know their status, 62% have gotten on treatment, and 54% have undetectable viral loads. If we may carry a small risk of neural tube defects. Counsel the initiated should start on EFV-containing regimen.
connect, we can improve these numbers by making services available in more locations with longer opening hours. patient; allow her to make an informed choice. 15. Switch a stable pregnant woman on ART from EFV to DTG
4. The benefits of cotrimomazole outweigh the risks in if her VL is <50 copies/mL and she is no longer in the first
The Southern African HIV Clinicians Society (SAHCS) is leading EPIC - Expanding PrEP/ART Innovation Consortium to pregnancy in patients with CD4 counts <200 cells/µL, or 6 weeks of pregnancy.
expand HIV care at pharmacies. SAHCS has been supporting and strengthening the HIV knowledge and capacity of its with WHO clinical stage II, III or IV disease. 16. If you have any concerns about HIV-positive persons who
10 000+ members since 1998. 5. TB prevention, diagnosis and treatment in women must are COVID-19 symptomatic, please follow the COVID-19
receive greater emphasis if maternal and child outcome guidelines.
are to be improved. 17. Initiate all newly diagnosed HIV-positive patients on TLD
EPIC aims to increase access to HIV services by working with independent retail pharmacies. Everyone can come in for 6. Do an appropriate HIV test at 6 weeks post cessation of and switch those already on TEE (if eligible)
confidential support for HIV testing, emergency contraception, family planning, or sexual health questions. Pharmacies breastfeeding, even if breastfeeding continues for longer 18. Prioritise a switch from TEE to TLD; prescribe multi-month
are open late and on weekends, waiting times are often shorter than at clinics or hospitals, and all HIV services can be than 18 months. ART and decant eligible clients to external pick-up sites to
found under one roof. 7. Universal HIV testing is recommended at 18 months of limit facility visits.
age for all infants regardless of HIV exposure, except 19. Eligible patients must be switched from TEE to TLD as
The EPIC Consortium developed PIMART – the first ever course for Pharmacy-Initiated Management of Anti-retroviral those on ART. soon as possible. This is the best treatment for HIV-positive
Treatment. Pharmacists who complete the course will be permitted to start patients on ART, including PEP and PrEP 8. Pregnant adolescents are at a higher risk for poor patients and will help manage current ART stocks.
(pre- and post-exposure prophylaxis). Anyone with more complicated conditions or concerns will be referred to the adherence and poor viral suppression and require more 20. Clients switched to TLD do not need to return after 1 month
intensive support.
EPIC HIV Expert GP referral network. These are GPs with years of experience supporting HIV care. 9. Ensure that any woman diagnosed with TB is adherent to (unless new client). Those decanted on TEE who switched
to TLD can stay decanted.
TB treatment and aware that their newborn may require 21. There is no longer a need for the SAHPRA Risk
Working together, using our networks, sharing the latest information, and supporting each other TB prophylaxis. Acknowledgment Form to be completed before switching
helps us clearly see that we are here 4 Each Other. 10. Known HIV-positive women who are not currently on ART but clients from TEE to TLD.
are ART-exposed should initiate a DTG-containing regimen. 22. Clinicians must review the risks and benefits of TLD and
11. Pregnancy does not preclude screening for cervical TEE with all clients and document their decision in their
cancer, and it can be performed up to 20 weeks. medical file.
EXPANDING ACCESS TO PrEP AND ARVs
INNOVATION CONSORTIUM
PIMART 3 TC A RT C O VID-1 9 DTG EFV FDC
3TC – lamivudine; ART – antiretroviral therapy; COVID-19 – coronavirus disease of 2019; DTG – dolutegravir; EFV - efavirenz; FDC – fixed-dose combination;
PHARMACY INITIATED MANAGEMENT
OF ANTI-RETROVIRAL THERAPY
TEE
TB
TDF
PRA
S
AH
F FTC – emtricitabine; SAHPRA – South African Health Products Regulatory Authority; TB – tuberculosis; TDF –tenofovir disoproxil fumarate; TEE – TDF/FTC/EFV;
TC
HIV Nursing Matters | October 2020 | page 23
HIV Nursing Matters | October 2020 | page 22 TLD –TDF/3TC/DTG; TPT – tuberculosis preventive therapy; TST – tuberculin skin test; WHO – World Health Organization.
TLD
WH
T
TS
T
O
TP