Care and Treatment Clinic (CTC)
PST 06102
:
Counselling and Guidance
Session
10
: Care and treatment Clinic (CTC)
1
Learning tasks
By the end of this session students are expected to be able to:
Explain
Concept of care and treatment Clinic (CTC)
Identify
core elements of HIV preventions, treatment and support at CTC
Explain
organization of care and treatment services
2
Introduction to Care and Treatment Clinic (CTC)
Is
a National Plan which was launched in 2004 for
Tanzania mainland
, with the aim of providing quality care, Education, Counseling and guidance
and treatment
for all people living with HIV/AIDS (
PLHIV).
CTC
have been set up, in both public and private hospitals, and in referral hospitals down
to health
centers and dispensaries, throughout Tanzania.
Standard
Operating Procedures (SOP) for Care and Treatment Clinics (CTC) in hospitals
have been
developed based upon various National Guidelines, the SOP outline the procedures in
a standardized
manner on how to operate the set down objectives of the programme.
3
CTC is
an integral part of the delivery of care and treatment made to ensure that
effective monitoring
and evaluation of the stated programme takes place in one roof, Data collected
from CTC
, as well as data from other sources of the programme like Inpatient, are made useful
to inform
about progress in delivering the services to Patient Living with HIV (PLHIV), and on
the impact
these services have on the lives of patients that access them.
Core
goals for management of HIV in CTC are
;
maximal
suppression of viral replication
and
promotion
of immune reconstitution through combination antiretroviral therapy and
promoting long-term
adherence, avoiding drug interactions, minimizing toxic effects, simplifying
treatment regimens
, decreasing drug costs, managing comorbid conditions, and preventing transmission
of HIV
by achieving undetectable viral
load
WHO
promotes a comprehensive approach to the management of people living with HIV that addresses the individual‘s full range of
health related
needs, many of which may change during his or her lifetime.
4
What are the core elements of HIV prevention, treatment and support at CTC?
5
Core Elements of HIV Prevention, Treatment and Support at CTC
The core elements of HIV prevention, treatment and support that need to be available within
CTC services
at any level include
This
includes
the following
:
Education
about behavioral risks and condom use for infected people
Orientation
on care and treatment services available in hospital and district
Education
and regular counselling on life-long disease management, and in particular
on treatment
adherence
Education
and counselling on actions that may delay progression of disease and reduce comorbidities; for example, addressing nutrition, food safety, clean water and use of
insecticide treated
bed-nets
6
Early identification and management of co-morbidities such as TB
Prophylaxis
for OIs and cancers including
Cotrimoxazole
, TB preventive therapy and
cervical screening
Assessing
eligibility for ART i.e. clinical staging, social eligibility and CD4 counts
Effective
referrals to essential hospital services such as antenatal clinics for MTCT,
family planning
advice before and while on ART, STI or other specialized clinics
Recording
and reporting according to the established electronic and paper based system
Registration
and appointment systems for effective treatment continuation and
preventing missed
appointments
Referral
to community services such as HBC, social welfare and legal support
7
Prophylaxis for OIs and cancers including
Co-
trimoxazole
, TB preventive therapy and
cervical screening
Assessing
eligibility for ART i.e. clinical staging, social eligibility and CD4 counts
Effective
referrals to essential hospital services such as antenatal clinics for MTCT,
family planning
advice before and while on ART, STI or other specialized clinics
Recording
and reporting according to the established electronic and paper based system
Registration
and appointment systems for effective treatment continuation and
preventing missed
appointments
Referral
to community services such as HBC, social welfare and legal
support
In order to provide effective and quality HIV and AIDS Care and Treatment, service delivery needs to be organized in a manner to ensure efficiency, user friendliness, and regular, standardized follow up. Quality Improvement (QI) initiatives are a helpful tool in this regard
8
Organization of Care and Treatment Services
The organization of care and treatment services at (CTC) is, patient visit plan,
adherence management
and life style counseling, medical record system and reporting
1. Patient
visit plan
At
the initial clinic visit, a triage nurse will assess patient‘s needs, register basic
information on
reliable patient demographics and contact information, issue relevant forms such
as CTC1
, CTC2 and the TB screening tool, weigh the patient, and direct her/him to
relevant sites
.
o Patients who are recommended for and agree to initiate therapy will meet
with pharmaceutical
personnel for counseling and guidance on ARVs and other
related medicines
; they will discuss adherence, medication dosages and adverse
reaction management
.
o Patients will be scheduled for a follow-up appointment in two weeks, then monthly for
the first
six months, depending on assessment by the clinician and pharmaceutical personnel
on the
status of a patient on ART
o When patient is clinically stable, with good adherence for at least the first six months
or more
to ART regimen, and no history of drug toxicity or recurrent OI, s/he may be given
an appointment
of two months hence or more, as agreed between the clinician,
pharmaceutical personnel
and the patient.
o All patients are advised to come into the CTC immediately before their
condition deteriorates
prior to their next scheduled visit.
9
2.
Adherence
Management and Lifestyle Counselling;
Adherence
to preventive therapies, TB treatment and ARVs are important factors in
ensuring better
health outcomes.
Patients
in long term therapy or prophylaxis, including ARV treatment, are
strongly encouraged
a family
member, friend, colleague, or community member) to support the patient
in complying
to prescribed medication.
Patients
also receive counseling and guidance on HIV/AIDS transmission risk
reduction, nutritional
and family planning advice, and adverse event management.
Psychosocial
needs such as social or legal support, disclosure of HIV status, mental
health, referrals
to HBC services and facilitation for joining PLHIV (People Living with
AIDS) support
groups will also be addressed during the counselling and guidance session.
In addition
, the patient will be screened for TB and other OIs for early identification,
treatment or
prophylaxis.
10
3. Medical
Records System
The
Patient Identification Card (CTC1), the Patient Record Form (CTC2), the
Registers (pre-ART
and ART), the Reporting Forms (for Cross-sectional and Cohort analysis), and
the referral
form have been designed for the purpose of patient identification, patient
monitoring and
programme monitoring
.
In
addition, an appointment book to facilitate scheduling and follow-up on lost patients
is included
in the patient monitoring system.
4. Reporting
Reporting
at the CTC should be done as follows using the appropriate reporting forms
and tools
:
Quarterly
Reports:
Programme
Monitoring
11
Key Point
Core goals for management of HIV in CTC are; maximal suppression of viral replication
and promotion
of immune reconstitution through combination antiretroviral therapy and
promoting long-term
adherence, avoiding drug interactions, minimizing toxic effects, simplifying
treatment regimens
, decreasing drug costs, managing comorbid conditions, and preventing transmission
of HIV
by achieving undetectable viral load
Patients
in long term therapy or prophylaxis, including ARV treatment, are strongly
encouraged to
member, friend
, colleague, or community member) to support the patient in complying to
prescribed medication
.
12
Evaluation
What is CTC?
What
are the core elements of HIV prevention, treatment and support at CTC?
13
Reference
Clift PJ, Nixon E and Fisher M (2004) ‗Patients' involvement in the development of, and access
to, HIV
clinical services, care and treatment,‘ 15th International Conference on
AIDS Bangkok
, Thailand; International Conference on AIDS 15.
MOHSW (2008). HIV and AIDS Voluntary Counselling and Testing: Participant Manual. Dar
es
Salaam
, Tanzania: National AIDS Control Programme.
World Health Organization, (2007) Guidance on provider-initiated HIV testing and counselling
in health
facilities. Geneva,
United Republic of Tanzania, MOHSW, AIDS Control Programme, ( 2007) Guidelines on
HIV Testing
and Counseling in Clinical Settings.
Dar
es
Salaam, Tanzania:
14
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