Working with adolescents living with HIV

252 Pages·2015·24.86 MB·English

Working with
adolescents
living with HIV
A handbook for healthcare providers
TERMS OF USE
The informaton contained in this publicaton may be freely distributed and reproduced, as long as it is
used for non-commercial purposes and the source is acknowledged.
SUGGESTED CITATION
Fick C, Fairlie L, Moultrie H, Woollet N, Pahad K, Thomson K, Pleaner M. Working with adolescents
living with HIV: A handbook for healthcare providers. Johannesburg: Wits RHI and Southern African
HIV Clinicians Society, 2015.
©Wits RHI and the Southern African HIV Clinicians Society 2015
DISCLAIMER
This resource was made possible with support from The U.S. President’s Emergency Plan for AIDS
Relief (PEPFAR) through the U.S. Agency for Internatonal Development (USAID). The contents are the
responsibility of Wits RHI and the Southern Africa HIV Clinicians Society and do not necessarily refect
the opinion of PEPFAR, USAID or the U.S. Government.
Although every efort was made to ensure that all informaton in this document is accurate and up to
date, the authors accept no liability for the consequences of inaccurate or misleading data.
CONTACT DETAILS
Wits RHI Southern African HIV Clinicians Society
Hillbrow Health Precinct 112 Algernon Road
22 Esselen Street Norwood 2192
Hillbrow 2001 Johannesburg, South Africa
Johannesburg, South Africa Tel: [phone]
Tel: [phone] Email:
Working with
adolescents
living with HIV
A handbook for healthcare providers
Wits RHI and the Southern African HIV Clinicians Society
ACKNOWLEDGEMENTS
ACKNOWLEDGEMENTS
Authors
Dr Candice Fick (Wits RHI)
Dr Lee Fairlie (Wits RHI)
Dr Harry Moultrie (Wits RHI)
Nataly Woollet (Wits RHI)
Shenaaz Pahad (Wits RHI)
Kirsten Thomson (Wits RHI)
Melanie Pleaner (Wits RHI)
Editor/handbook coordinator
Melanie Pleaner (Wits RHI)
Acknowledgement is extended to the following, listed in alphabetcal order:
Contributors
Dr Kirsty Donald (Red Cross War Memorial Children’s Hospital/University of Cape Town)
Shamagonam James (Wits RHI)
Dr Rene Nassen (Western Cape Department of Health and Stellenbosch University)
Shanaaz Randeria (Wits RHI)
Expert reviewers
Dr Andrew Black (Wits RHI)
Juliet Houghton (CHIVA South Africa, on behalf of Southern African HIV Clinicians Society)
Dr Leon Levin (Right to Care, on behalf of Southern African HIV Clinicians Society)
Dr Laurie Schowalter (Southern African HIV Clinicians Society)
Dr Marnie Vujovic (Right to Care, on behalf of Southern African HIV Clinicians Society)
Thanks to the following for commissioning, management and support in the development of the handbook:
Dr Sinead Delany-Moretlwe, Director of Research (Wits RHI)
Lauren Jankelowitz, CEO (Southern African HIV Clinicians Society)
Karen Kelley, Director, Health Programmes (Wits RHI)
Phinah Kodisang, Programme Manager, Adolescent Innovatons Project (Wits RHI)
Dr Memory Muturiki, Technical Head, Adolescent Innovatons Project (Wits RHI)
Dr Laurie Schowalter, Technical Adviser, Policy and Implementaton (Southern African HIV Clinicians Society)
The following for their ideas and support:
Aloysia Makau (Wits RHI)
Linda Mazibuko (Wits RHI)
Monica Nkwanyana (Wits RHI)
Nombulelo Shezi (Wits RHI)
Dr Nosisa Sipambo (Chris Hani Baragwanath Academic Hospital/University of the Witwatersrand)
Nokuphumelela Zwane (Wits RHI)
Design and layout: Jessica Finkelstein Design
1
C O N T E N T S
Contents
IL TS FO ,S EX OB IF S ERUG DNA S ELBA T 3
VERBA IIT A SNO DNA SMYNO RC A 6
I N T R O D U C T I O N 9
A P R T A: lC inical am nageem nt o f adolescents living with HIV 51
CITES NO :1 NA ICUDOITRTN NO O T WIKRO GN WIHT STNECS ELODA 71
.1 dA olescentrf- iendl y services 91
.2 dA olescents living with HIV: who are the ?y 52
3. Development and maturaton of adolescents living with HIV 28
CITES NO :2 IT A T LUSNO C ,NO INERCS GN DNA HIKA T- Y RO T S GN 93
4. The consultaton 41
5. Clinical management: history-taking, screening and examinaton 46
CITES NO :3 ITNO C MUN FO :ERAC HC T DNA T RA 5
6. HIV counsel5li7ng, testng and linkages to care
7. Preparing fo6r4 ART: the inital asesment
8. ART initato7n3
.9 oF low pu- and 7 om nitoring o f clients on TRA
10. Adverse ev8e1nts and drug reactons to ARVs
1. Managing 8v5irological failure and changing treatment regimens
CITES NO :4 TNEMEGANAM FO INUTROPO IT S C ICITEFN SNO DNA HTO RE
HIV DETALER- IDNOC IT SNO 39
.21 ebu T rclu osis 59
.31 rC tpy ococal dise101ase
14. Other op1o0rt4unistc infectons
15. HIV-asociated 107 conditons (non-infectous)
CITES NO :5 31 LAUXES DNA CUDOITRPER V E HTLAE
16. Sexual and reproductve health 115
.71 rP egnanc y and adolescents living with HIV 921
18. Preventon for adolescents 231
Working with adolescents living with HIV: A handbook for healthcare providers 1
C O N T E N T S
Contents contnued
TRA P :B aM nageem nt o f the sp cy hosocial welleb ing
and em ntal health o f adolescents living with HIV 731
ICUDOITRTN NO O T T RA P B 931
CIT ES NO :6 HC Y SP ICOSO LA WIEBLE GN 141
19. Psychosocial support and communicaton 341
.02 dA herence 741
.12 iD sclosru e 941
22. Transiton 651
.32 opuS rt grospu of r adolescents 951
CITES NO :7 LA TNEM HHT LA E 161
.42 eM ntal health and HIV in adolescence 361
25. Management of common mental health conditons in adolescents living with HIV 071
26. Neurocognitve efects of HIV 184
R E F E R E N C E S
Part A: Clinical management of adolescents living with HIV 189
Part B: Management of the psychosocial wellbeing and mental health of adolescents living with HIV 302
A P P E N D I C E S 512
Appendix 1: (a) Tanner staging (b) Growth charts 712
Appendix 2: Five “As” for consultatons with adolescents 12
Appendix 3: ARV drug dosing chart for children and adolescents 2
Appendix 4: Managing acute adverse ARV reactons and grading toxicity 42
Appendix 5: TB regimens with dosages for uncomplicated and complicated TB 92
Appendix 6: TB preventon 032
Appendix 7: Distress protocol for managing adolescent rape victms 32
Appendix 8: Medical and legal protocol for adolescent rape victms 632
Appendix 9: Psychosocial assessment tool 732
Appendix 10: Tips for health workers on identfying possible mental ilness 142
Appendix 11: Distress protocol and screening tools for managing suicide ideaton in adolescents 242
Appendix 12: Distress protocol and screening tools for managing substance and alcohol abuse
in adolescents 542
2 Working with adolescents living with HIV: A handbook for healthcare providers 3
L I S T O F B OX E S , FI G U R E S A N D A BT L E S
LI S T O F B OX E S , FI G U R E S A N D A B T L E S
S EX OB
A P R T A: C LI NI C A L M A N A G E M E N T
Box 1: Key components of youth-friendly services 2
Box 2: Practcal ideas to make services youth-friendly 32
Box 3: Tips for consultng adolescents living with HIV 24
Box 4: HEADSSS approach to adolescent screening 48
Box 5: Checklist for examinatons 15
Box 6: Guidelines for gynaecological examinaton 25
Box 7: HCT and adolescents: the ‘fve Cs’ 75
Box 8: Assessing an adolescent’s maturity 58
Box 9: Checklist for pre-test counselling 95
Box 10: Screening and tests post-HIV diagnosis 26
Box 11: Checklist for processes and procedures for the inital ART visit 56
Box 12: Eligibility criteria of ART for adolescents 56
Box 13: Clients requiring fast-track ART initaton (as per DOH guidelines) 57
Box 14: Managing the client in need of a third line regimen 89
Box 15: Screening for TB 59
Box 16: Management of immune reconsttuton infammatory reacton (IRIS) for clients with TB 98
Box 17: Dosage of INH prophylaxis 9
Box 18: Recommended dosage of fuconazole prophylaxis 301
Box 19: Issues to discuss in relaton to SRH wellbeing 118
Box 20: Sexual health issues to explore 91
Box 21: Key issues to consider when managing SRH issues in adolescents living with HIV 021
Box 22: Recommended contraceptve methods for adolescents 121
Box 23: Signs and symptoms of STIs 421
Box 24: Interventons to manage sexual assault 721
Box 25: Combinaton HIV preventon 431
A P R T B: M A N A G E M E N T O F THE P S CYHO S O CI A L WE L L B EI N G A N D M E AN L T HEAT LH
Box 26: Notes on stgma 41
Box 27: Possible signs and symptoms of depression 171
Box 28: Screening questons for depression 171
Box 29: Diferences between grief/bereavement and depression 271
Box 30: Possible signs and symptoms of anxiety 371
Box 31: Screening questons for anxiety 471
Box 32: Possible signs and symptoms of trauma 571
Box 33: Screening questons for trauma 761
Box 34: Possible signs and symptoms of alcohol and substance disorders 178
Box 35: Screening questons for alcohol and substance abuse 178
Box 36: Diagnostc criteria for ADHD 180
Box 37: Screening questons for neurocognitve disorders 185
Box 38: ARVs and CNS penetraton efectveness (CPE) 187
Working with adolescents living with HIV: A handbook for healthcare providers 3
L I S T O F B OX E S , F I G U R E S AN D AT B L E S
L I S T O F B OX E S , F I G U R E S AN D AT B L E S contnued
SERUGIF
AP R T A : C L I N I CAL MANAG E M E N T
Figure 1: Partcipants in the care team 34
Figure 2: The HCT process 95
Figure 3: Testng algorithm for HCT 06
Figure 4: Objectves of the inital visit 46
Figure 5: Key elements of ART initaton 37
Figure 6: Algorithm for diagnosis and management of second line treatment failure 88
Figure 7: Diagnostc algorithm, TB Xpert 69
Figure 8: Algorithm for cryptococcal screening and prophylaxis 301
Figure 9: Factors associated with CLD in HIV-infected children and adolescents 108
AP R T B : MANAG E M E N T O F T H E P S CY H O S O C IAL W E L L B E I N G AN D M EAN T L H EAT LH
Figure 10: Mental health problems: cause and efect of HIV 461
Figure 11: Interacton between psychosocial, physical development and mental health 761
AT SELB
AP R T A : C L I N I CAL MANAG E M E N T
Table 1: Similarites and diferences between perinatally and non-perinatally infected adolescents 52
Table 2: Summary of adolescent development 03
Table 3: Guidelines for history-taking 74
Table 4: Key elements of the examinaton 05
Table 5: Gynaecological examinaton process in adolescents: what to do, what to look for 35
Table 6: Genital examinaton process in adolescent males: what to do, what to look for 45
Table 7: Suggested monitoring for adolescents who do not yet qualify for ART 68
Table 8: First line regimens for adolescents 96
Table 9: Suggested investgatons for adolescents initatng ART 07
Table 10: CPT dosage for children and adolescents 27
Table 11: Clinical review checklist for initaton 47
Table 12: Guidelines for monitoring adolescents on ART 78
Table 13: Guidelines for monitoring viral load for frst line regimens 97
Table 14: Optons for second line regimens 87
Table 15: TST recommendatons for adolescents ≥15 years of age 01
Table 16: WHO MEC classifcaton categories (per individual conditon) 121
Table 17: Consideratons for contracepton for adolescents living with HIV (ALHIV) 321
4 oW rkin g iw th adolescents livin g iw th : V I H A handbook for healthcare providers 5
L I S T O F B OX E S , FI G U R E S A N D A BT L E S
LI S T O F B OX E S , FI G U R E S A N D A B T L E S contnued
aP rt :B aM nageem nt o f the sp cy hosocial welleb ing and em ntal health
Table 19: Age- and development-specifc disclosure 251
Table 20: Selected risk and protectve factors for mental health of adolescents 168
Table 21: Summary of substance use, potental harm/side efects and impact in relaton to HIV and ART 971
Working with adolescents living with HIV: A handbook for healthcare providers 5
A B B R EVITIA O N S A N D A C R O N Y M S
Abbreviations and acronyms
ABC Abacavir ELISA Enzyme-linked immunosorbent assay
ADHD Atenton defcit hyperactvity disorder EUA Examinaton under anaesthesia
AFASS Accessible, Feasible, Afordable, Sustainable, Safe FBC Full blood count
AFB Acid-fast bacilli FDC Fixed-dose combinaton
AIDS Acquired immunodefciency syndrome CTF Emtricitabine (Emtriva)
AIN Acute intersttal nephrits FNA Fine needle aspiraton
ALHIV Adolescents living with HIV GAD Generalised anxiety disorder
ALT Alanine transaim nase GBV Gender-based violence
ANC Antenatal care GFR Glomerular fltraton rate
ART Antretroviral treatment/therapy GP General practtoner
ARV Antretroviral GUS Genital ulcer syndrome
ASCUS Atypical squamous cells of undetermined HAART Highly actve antretroviral treatment/therapy
signifcance
HAD HIV-associated dementa
ATV/r Atazanavir/ritonavir
HAND HIV-associated neurocognitve disorder
AZT Azidothymidine/zidovudine
Hb Haemoglobin
BAL Balanits/balanoposthits
HBV Hepatts B virus
BMD Bone mineral density
HCT HIV counselling and testng
BMI Body mass index
HDL High-density lipoprotein
cART Combinaton antretroviral therapy
HIV Human immunodefciency virus
CD4 Cluster of diferentaton antgen 4
HIVAN HIV-associated nephropathy
CET Cervical excitaton tenderness
HIVE HIV encephalopathy
CICT Client-initated counselling and testng
HIVICK HIV immune complex kidney disease
CLD Chronic lung disease
HPV Human papillomavirus
CMV Cytomegalovirus
HSIL High grade squamous intraepithelial lesion
CNS Central nervous system
HSRC Human Sciences Research Council
COC Combined oral contraceptve
HSV-2 Herpes simplex virus type 2
CPE CNS penetraton efectveness
IEC Informaton, educaton and communicaton
CPT Cotrimoxazole preventon therapy/prophylaxis
IMAI Integrated Management of Adolescent and Adult
CrAg Cryptococcal antgen Illness (WHO)
CSG Child Support Grant INH Isoniazid
C T scan Computerised tomography scan IPT Isoniazid preventve therapy
CTOP Choice on Terminaton of Pregnancy Act 92 of 1996 IRIS Immune reconsttuton infammatory syndrome
Cu IUD Copper intrauterine device IUCD Intrauterine contraceptve device
CVD Cardiovascular disease IUD Intrauterine device
dT4 Stavudine, Zerit IVIG Intravenous immunoglobulin
ddl Didanosine (Videx EC, Videx) LA Lipoatrophy
DMPA Depot medroxyprogesterone acetate (Depo-Provera) LAP Lower abdominal pain
DNA Deoxyribonucleic acid LARC Long-actng reversible contracepton
DOH Natonal Department of Health LD Lipodystrophy
DOT Directly observed therapy LDL Low-density lipoprotein
EBV Epstein-Barr virus LIP Lymphoid intersttal pneumonits
EFV Efavirenz (Sustva, Stocrin, Efavir) LNG-IUS Levonorgestrel intrauterine system
6 Working with adolescents living with HIV: A handbook for healthcare providers 7