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Mar 04
Improving the clinical management of complicated HIV cases in eThekwini

By: Lunga Memela (Communications Engagement Lead)

HST's Facility Team Leaders, Nurse Clinicians and Advanced Clinical Care Clinicians after deliberations at the inaugural Continuous Medical Education session held in February 2022 at HST's Durban Office.

Thursday 24 February 2022 marked the commencement of a new Continuous Medical Education (CME) programme that has been initiated by the Health Systems Trust (HST) for the organisation's Facility Team Leads based at Department of Health (DoH) and Municipal healthcare facilities in eThekwini District. The CME approach was initiated in response to requirements for treatment management of complex clinical cases among HIV-positive adults, adolescents, children, infants, pregnant women, and breastfeeding mothers.

The CME programme offers a monthly opportunity for healthcare practitioners from various facilities to join the industry's Advanced Clinical Care Clinicians in deliberating on and sharing best practices for management of unique cases whose unsuppressed viral load is negatively affecting health outcomes.

The ultimate goal of HIV antiretroviral therapy (ART) is suppression of a patient's viral load so that it becomes undetectable. UNAIDS confirms that: "With 20 years of evidence demonstrating that HIV treatment is highly effective in reducing the transmission of HIV, the evidence is now clear that people living with HIV with an undetectable viral load cannot transmit HIV sexually." This is the basis of the 'Undetectable = Untransmittable' (U=U) campaign, and is the key to epidemic control.

To accommodate the busy schedule of healthcare workers in the District, HST's CME programme enables them to attend face-to-face sessions during which unique cases are presented, or to participate in the robust discussions conducted through virtual platforms from their place of work.

This first CME engagement addressed two cases.

In reviewing the first case of a patient with renal failure, the group interrogated the cause and effects, and educated Clinicians on best practices, appropriate treatment, and identification of similar complex cases for referral.

The second case addressed drug resistance in children. Clinicians were taken through early identification of virological failure in paediatric cases, and how to analyse and interpret HIV drug resistance, leading to the formulation of an appropriate third-line drug regimen for the patient. Other aspects of this session addressed the need for psychosocial interventions to aid disclosure to children, and to support adolescents in improving their treatment adherence as they graduate from the paediatric programme. The CME session also covered the ways in which facilities can be made more child- and youth-friendly, and how this contributes to a better treatment environment.

There is hope!

HST is a District Support Partner to the Department of Health (DoH) in four districts in KwaZulu-Natal, and the new CME programme supports the DoH Consolidated Guidelines for the Management of HIV in Adults, Adolescents, Children and Infants and Prevention of Mother-to-Child Transmission.

Through the South African Sustainable Response to HIV/AIDS and TB (SA SURE) Project which is funded by the U.S Centers for Disease Control and Prevention (CDC) through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), HST's CME programme is encouraging healthcare practitioners to abide by these guidelines for improved and strengthened HIV case management.

From left: Dr Tinyiko Khosa (Advanced Clinical Care Clinician); Kubashini Nair (HST's eThekwini District Training Co-ordinator); and Dr Ganizani Mlawanda (Advanced Clinical Care Clinician).

HST's Advanced Clinical Care Clinician, Dr Tinyiko Khosa, said: "It's very important to remind patients about the goal of therapy." From her experience, it becomes easier to promote adherence to ART once a patient understands why they need to take treatment in the first place. "ART is good for viral load suppression, reducing morbidity and increasing life expectancy." Dr Khosa said that patients should be encouraged to adhere to ART. "I always say, 'it's treatment for life'… the same as eating food every day for sustenance."

HST's Advanced Clinical Care Clinician, Dr Ganizani Mlawanda, who chaired the first CME session, and HST's eThekwini District Training Co-ordinator, Kubashini (Kubi) Nair, expanded on Dr Khosa's comments.

"There are always updates in HIV clinical care," noted Nair, "so it is important for healthcare practitioners to come together, brush up their skills and share current knowledge. The CME programme is an opportunity for eThekwini healthcare workers to pause and reflect on what was done, what was done well, what can be improved." Passionate about her work on the ground, Nair said it is rewarding to see how someone can achieve viral suppression and thus look forward to a healthy future.

Chatsworth Township Centre's Facility Team Leader, Nokulunga Dlamini, expressed appreciation for the programme: "We are really grateful for this session. It is a reminder that we at the facilities are not alone; we have support!"

In addition to ART adherence promotion and supporting patients to take the correct medication in the proper manner, the take-home message to all healthcare practitioners on the day was: Act early! Investigate, consult, and refer, so that patients have the best chance of achieving an undetectable viral load.

Colleagues promoting the use of the National Consolidated Guidelines for the Management of HIV in Adults, Adolescents, Children and Infants and Prevention of Mother-to-Child Transmission.


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