Module 5: Management Of Employees With HIV/AIDS At Primary Level - Anti-Retroviral Therapy

PERCEPTIONS ABOUT HAART:

ART: Antiretroviral therapy
HAART: Highly active antiretroviral therapy
ARV: Antiretroviral medications.

There are many misperceptions about anti-retroviral therapy, BUT

• Trials have shown they work - there is decreased morbidity and mortality.
• They do have side effects and careful monitoring is required.
• People in poor settings can adhere to HAART.
• It is not complex for the health services and ways have been found at primary care level to prepare, support and monitor patients.
• The costs of ARVs have come down.

When to provide HAART:

Our criteria are:

• On clinical and biological grounds.
• At stage 3 or 4.
• When the CD4 < 200 cells/µl.
• Patient MUST be ready and prepared.
• Service MUST have continuous supply of drugs and be able to provide monitoring and support close to patient’s home or work place.

Over 95% of tablets must be taken to maintain reasonable chance of viral suppression. It is difficult to find predictors of adherence but patients can be well prepared and supported.

Choice of regimen:

The following needs to be taken into account:

• Cost - in private sector R500 per month.
• Side effects - some have more side effects.
• Monitoring is required - some require more monitoring that involve laboratory costs.
• New fixed dose combinations (FDCs) - single tablet containing all three drugs (not registered in South Africa yet).