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Working with adolescents living with HIV PDF

252 Pages·2015·24.86 MB·English
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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: +27 11 728 7365 Tel: +27 11 358 5500 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

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