Pharmaceutical Sciences Notes

NTA Level 6 • Semester 1 • PST06102 Situations Requiring Guidance Counselling and Guidance • Source Session/Topic 7 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. PST 06102 : Counselling and Guidance Session 7: Situations Require Guidance 1 Learning tasks By the end of this session students are expected to be able to: Define situations require guidance Explain situations require guidance List principles of direct and indirect guidance 2 Definition of the Situations Required Guidance Guidance as a process, developmental in nature, by which an individual is assisted to understand , accepts and use his/her abilities, aptitudes and interests and attitudinal patterns in relation to his/her aspirations. It is a process of helping or assisting an individual to solve their problems, it help them to identify where to go, what to do and how to do for post accomplishment of their goals. Guidance as an educational construct involves those experiences that assist each learner to understand him/herself, accept him/herself, and live effectively in his/her society, this is in addition to the learner‘s experiences in the world of work 3 Definition of the Situations Required Guidance Guidance can also be looked at as a programme or services to individuals based upon the need of each individual, an understanding of his/her immediate environment, the influence of environmental factors on the individual Guidance is designed to help each individual adjust to his/her environment, develop the ability to set realistic goals for him/herself, and improve his/her knowledge. As a process, guidance is not a simple matter, but involves a series of actions or progressive steps which move towards a goal, as a service, we can isolate four major services, those of educational , vocational, personal and social guidance . Situations that require counselling are educational guidance, vocational guidance, career guidance , avocational guidance and personal and Social Guidance 4 What are the situations required guidance ? 5 Situations Require Guidance 1. Educational Guidance Educational guidance is, essential in the counselling service, guiding and educating patients to take right treatment and adhere to the medications, guiding young people to pursue the right type of education, while ensuring that the right balance is kept in order to meet the human resource needs of a nation Helping an individual to reflect on personal educational issues and experiences and to make appropriate educational choices and appropriate treatment choice. 6 2. Vocational Guidance Vocational guidance is a process for helping individuals to choose an occupation, prepare for it, enter it and develop in it. Vocational happiness requires that a person‘s interests, aptitudes and personality, be suitable for his/her work. It plays its part by providing individuals with an understanding of the world of work and essential human needs, and familiarizing individuals with such terms as the dignity of ‘labor ‘ and ‘work value‘. It based on psychological tests and interviews to find out what career or occupation may best suit a person, it is the process of assisting a student to choose, prepare for and enter an occupation for which he or she shows aptitude. 7 3. Personal and Social Guidance Personal and social guidance is the process of helping an individual to know how to behave with consideration towards other people. Primarily , personal and social guidance helps the individual to understand himself, know how to get on with others, learn manners and etiquette, pursue leisure time activities, practice social skills, develop family and family relationships, and understand social roles and responsibilities 8 4. Career guidance Career guidance includes a wide variety of professional activities which help people deal with career-related challenges. Career counselors work with adolescents seeking to explore career options, experienced professionals contemplating a career change, parents who want to return to the world of work after taking time to raise their child, or people seeking employment. Career guidance is also offered in various settings, including in groups and individually, in person or by means of digital communication, several approaches have been undertaken to systemize the variety of professional activities related to career guidance and counseling such as: The Career Educator "supports people in developing their own career management competences" The Career Information & Assessment Expert "supports people in assessing their personal characteristics and needs, then connecting them with the labour market and education systems" The Career Counsellor "supports individuals in understanding their situations, so as to work through issues towards solutions“ The Programme & Service Manager "ensures the quality and delivery of career guidance and counselling organisations' services" 9 5. Avocational guidance An avocation is an activity that someone engages in as a hobby outside their main occupation . There are many examples of people whose professions were the ways that they made their livings, but for whom their activities outside their workplaces were their true passions in life. It assist individual with leisure attitudinal or behavior problem with choosing and effectively participating in an avocation, as a newly emerging independent profession, a vocational guidance has the task of developing theory, techniques and tools for doing the job with greater precision. 10 What are the Principles of direct and indirect guidance? 11 Principles of Direct Guidance The followings are the principles of direct guidance Use simple language Speak in a relaxed voice Be positive Offer choices with care Encourage independence and cooperation Be firm Be consistent Provide time for change Consider feelings Intervene when necessary 12 Key Point Guidance as an educational construct involves those experiences that assist each learner to understand him/herself, accept him/herself, and live effectively in his/her society, this is in addition to the learner‘s experiences in the world of work and the people found there, Guidance can also be looked at as a programme or services to individuals based Up on the need of each individual, an understanding of his/her immediate environment, the influence of environmental factors on the individual Situations require guidance are; educational guidance, vocational guidance, career guidance, a

NTA Level 6 • Semester 1 • PST06102 Counselling and Guidance Process Counselling and Guidance • Source Session/Topic 8 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. PST 06102 : Counselling and Guidance Session 8 : Counselling and Guidance Process 1 Learning Tasks By the end of this session students are expected to be able to: Define counselling and guidance process Explain stages of counselling process Identify factors that hinder effective counselling 2 What is counseling and guidance process? 3 Definition of Counselling and Guidance Process The counseling process often takes time, it is probably not realistic to expect that clients‘ problems will be solved after one or two sessions, because counseling is a process, it is wise to give it a few weeks before you decide it is not working for a client . There are time when a client may have a very specific questions or concern that can be resolved quickly in one or two sessions, something may have been troubling client for months or even for years , in that case, it may take a longer time to build a trusting relationship with counsellor and to resolve problem, client and counsellor can talk over what client‘s goals for counseling are and how long it will take client to achieve these goals 4 Definition of Counselling and Guidance Process Guidance is the process of assisting the individual to choose, to prepare, to enter upon and progress in course of action pertaining to the educational, vocational, health, recreational and community services, it is a process of helping individuals through their own efforts to discover and develop their potentialities both for personal happiness and social usefulness. Guidance as a concept guidance is concerned with the optimal development of the individual and guidance as a process guidance helps the individual in self- understanding ones strengths and limitations and in self-direction (ability to solve problems, make choices and decision on ones own. 5 What are the stages of counseling process? 6 Stages of the Counselling Process In order to counsel a patient effectively, the counsellor needs to have a variety of skills and work with the patient through different steps. Most of these steps and skills fall under the umbrella of four main stages in the counseling process. These four stages are detailed below. 1. Relationship Building Rather than telling patients about a subject, counsellors first ask patients what they know or what they have heard, and correct their misperceptions through discussion. Establishes rapport Establishing rapport should be the very first step in starting a relationship. If the patient does not trust the counsellor, s/he may be reluctant to discuss lifestyle issues or behaviours . Establishing rapport serves to open communication between the counsellor and the patient. 7 1. Relationship Building Greets the patient and makes him or her feel welcome Establishes the reason the patient has come Confirms what the counsellor can and cannot do Assures the patient of confidentiality Sets the rules for the session (e.g. time) Uses language at a level that the patient can understand 8 2. Exploration The patient shares his or her own feelings and views about the problem at hand. The counsellor listens , encouraging the patient to express his or her main concerns. The counsellor gives time for the patient to tell their stories, so the counsellor can understand the issues and see things the way the patient sees things. The counsellor listens carefully The counsellor asks questions so the patient will provide more information The patient leads the discussion, and not the counselor 9 3. Understanding The counsellor helps the patient to understand some of the concerns that patient has discussed . The counsellor helps to draw conclusions, and to interpret the information. The counsellor listens to the patient and interprets some of the information the patient has given The counsellor might help the patient to understand some of the patient‘s attitudes or actions that could be creating challenges The counsellor also sees how ready or able the patient is to change those attitudes and actions 10 3. Action Plan Counsello r uses information the patient has provided, and information about what the patient is able and willing to do about the issue of concern to talk about concrete steps the patient will take The pair collaborates in creating a plan for action The pair discusses available resources to support the plan and can plan for the next session 11 The Outcomes of Counselling The results or resolutions of a counselling process aim to enable the patient to: Make some of the changes that he/she wants in life Develop positive relationships and explore his or her potential Cope with painful situations, like death, terminal illness and disability Outcomes of Effective Counseling ; When counseling is effective, patients: Develop a greater awareness of their problems Create new responses to old issues Develop a relationship with the person providing the counselling Are more likely to return to the clinic for additional care and treatment 12 Factors that Hinder Effective Counselling Language barrier Lack of counseling skills Personality/attitude of counselor Cultural relationship and social economic differences Lack of trust and confidence between counselor and counselee Unrealistic expectations of patients/clients 13 Key points The counseling process often takes time, it is probably not realistic to expect that clients‘ problems will be solved after one or two sessions, because counseling is a process, it is wise to give it a few weeks before you decide it is not working for client. Effective Counselling , is private, confidential, and respectful, views the patient as the expert on his or her own life, respects that patients come to counselling with great, strengths and knowledge upon, which to build, doesn‘t tell the patient what to do, and never forces the patient to do something • The Outcomes of Counselling, the results or resolutions of a counselling process aim to enable

NTA Level 6 • Semester 1 • PST06102 Counselling and Guidance in Promoting Rational Use of Medicines Counselling and Guidance • Source Session/Topic 9 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. PST 06102 : Counselling and Guidance Session 9 : Counseling and Guidance in promoting Rational Use of Medicine 1 Learning tasks By the end of this session students are expected to be able to: Explain concept of counseling and guidance in promoting rational use of medicines Describe Role of counseling and guidance in promoting rational use of medicines Describe Counseling and guidance matters to improve rational use of medicines 2 How counselling and guidance promot e rational use of medicines ? 3 Introduction to Counselling and Guidance in Promoting Rational Use of Medicines Counselling and Guidance in Promoting Rational Use of Medicines is mandated since medicines are weapons used by man to fight against diseases therefore patient should be counselled and guided on the proper use of medicines. Pharmaceutical personnel can set up a different counselling space for guiding patients, he can keep up points of interest of patient history, hypersensitivities and other vital information for the treatment , and in addition, he/she encourages the patients to take the measurements in appropriate time in order to keep any antagonistic results. 4 The amount and type of counselling and guidance required to be provided to patients by pharmaceutical personnel varies depending on the patient‘s individual needs, and the individual situation in question. Pharmaceutical personnel are reminded that they have a duty of care to their patients, and must at all times act in the best interests of their patients, exercising due diligence and his/her own professional judgment to ensure rational use of medicines. 5 What are the role of counselling and guidance in promoting rational use of medicines? 6 Role of Counselling and Guidance in Promoting Rational Use of Medicines Help patients to get correct information and advice regarding their medicine therapy to improve rational use of medicines. Counselling and guidance process if properly implemented and consistently maintained result in the safe supply of prescribed medicinal products and ensure that they are used rationally and appropriately . 7 Adequate Counselling and guidance provided to patient by pharmaceutical personnel must be satisfied that, patient has sufficient information to take their medicinal product safely and as prescribed , and that they know how to store the medicinal product to ensure rational use of medicines . When pharmaceutical personnel ensure that the patients provided with appropriate counselling and guidance are the right patient, or approved representative it will avoid any unintentional breaches of patient confidentiality hence increase rational use of medicines. When medicinal product is substituted, the Pharmaceutical personnel must take the necessary steps to ensure that patient is aware of the substitution and is fully counselled and guided on the change , as is the case with the initiation of any new medication to improve rational use of medicines The Pharmaceutical personnel should ensure that patient get sufficient counselling and guidance on the active ingredient in the medicinal product and is aware of how to use their medicinal product safely to improve rational use of medicines 8 Counselling and Guidance Matters to improve rational use of medicines A im of effective patient counselling and guidance is to enable and encourage the safe and proper use of medications by patients in order to achieve the required therapeutic outcomes . To achieve such positive results, a pharmaceutical personnel may undertake to counsel and guide patient or his/ her representative on the following matters, as deemed appropriate: The nature and use of the medicinal product, the directions for use; how to take/administer it and duration of treatment The therapeutic benefit which may be expected from the use of the medicinal product and potential side effects that are likely to be experienced and how to deal with them 9 Any special precautions to be taken while using the medication; special regard for food or drink like which foods to avoid, which drinks to avoid, take with(out) food, take with(out) drink and which other medicinal products to avoid The importance of the need for compliance with the directions for use, where a medicinal product has been interchanged in line with prescriber‘s , instruction/consent, or in accordance with the HPRA interchangeable list, to avoid confusion for patients and to ensure that the risk of duplication of therapy is avoided Storage of the medicinal product, what to do if they think the medicinal product is not working , what to do in the event of a missed dose, what to do in the event of an overdose, the correct use of therapeutic devices (including demonstration, if applicable) 10 If the patient is using the medication long term, whether they are experiencing any difficulties with it, counselling and guidance on change to medication or any new medications being introduced Any other matters which may be included or referred to in the Summary of Product Characteristics ( SmPC ) for the medicinal product concerned, what to do with any previously dispensed medicinal product(s), no longer required (i.e. disposal of medicinal product) The pharmaceutical personnel should aim to confirm patient understanding at regular intervals in the counselling process, assessing whether or not the information was understood as intended. The pharmaceutical personnel should ensure that the patient understands how to use the information furnished to them in order to improve the probability of positive therapeutic outcomes . 11 Key points The main aim of effective patient counselling and guidance is to enable and encourage the safe and proper use of medications by patients in order to achieve the required therapeutic outcomes. The Pharmaceutical personnel must be satisfied that the patient has sufficient information to take their medicinal product safely and as prescribed, and that they know how to store the medicinal product . Patient counselling and guidance is a key component of

NTA Level 6 • Semester 1 • PST06102 Care and Treatment Clinic (CTC) Counselling and Guidance • Source Session/Topic 10 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 to identify an adherence/treatment assistant. This can be any person (e.g. a family member, friend, colleague, or community member)

NTA Level 6 • Semester 1 • PST06102 Types of Counselling and Guidance at VCT and PITC Counselling and Guidance • Source Session/Topic 11 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. PST 06102 : Counselling and Guidance Session 11 : Types of Counseling and Guidance provided at VCT , and PITC 1 Learning tasks By the end of this session students are expected to be able to: Describe HIV Testing and Counseling Approaches in Tanzania Explain pre and post test counseling Explain prevention and disclosure counseling Describe bereavement counseling 2 HIV Testing and Counseling Approaches in Tanzania Different approaches to HIV testing and counseling exist in Tanzania as follow; Client-Initiated Counseling and Testing (VCT); client voluntarily makes the decision to learn his/her HIV status and seeks for counseling and testing services out of his/her own will for the purpose of prevention of HIV infection and personal life decision making Provider-Initiated HIV Testing and Counseling (PITC); HIV testing and counseling which is recommended by health care provider to person attending Health Care Facilities as standard component of medical care 3 Activity: Buzzing What are the types of counselling and guidance provided at CTC? 4 Pre and Post Test Counseling There are several types of counseling in relation to HIV Counselling and guidance. The essence of the different types of counseling and guidance is to provide guidance and counseling in different stages of HIV infection that the infected person and the relations go through. The types include: Pre-test counselling, post-test counselling, prevention counseling, bereavement counseling and disclosure Counseling 5 Pre-test counseling Pre-test counselling simply refers to counseling given to an individual prior to taking an HIV test. It is given to prepare the person for the HIV test and the implications of taking the test. Post Test Counselling Post test counseling simply refers to counselling given to an individual after an HIV test is conducted and is given irrespective of what the HIV test result is. The main goal is to help the client to understand and come to terms with his/her test results and to initiate adaptation to their seropositive or seronegative status. 6 Prevention and Disclosure Counselling Prevention Counselling Prevention counselling is similar to pre-test counseling as it provides an opportunity for the counsellor/client to negotiate and reinforce a plan to reduce or eliminate the risk of HIV transmission . Prevention counseling can also be given to relatives and significant others of an infected person so as to protect them from contacting the infection in the process of caring for the PLWHA . 7 Prevention and Disclosure Counselling Disclosure Counselling; Disclosure of HIV status is advocated to reduce stigma among PLWHA. Clients prepared emotionally for the outcome of disclosing, they are helped to identify who the disclosure might be affect (e.g. spouse, children) and to be aware of potential negative consequences . Health workers must ensure that there is adequate support and preparation before and after disclosing PLWHA may need support to disclose their status to loved ones and their loved ones may need support to cope with their feelings about the information. 8 Bereavement counselling Bereavement counseling Bereavement is a term that can be used to describe any event that includes loss, so this could mean losing a job or the death of someone you know. Bereavement can also be termed as grief . Bereavement in relation to HIV/AIDS could be grief over the loss of a dear one or grief upon learning one or a partner or a friend is HIV positive 9 Normal Grief Reactions The normal grief reactions can include: Feelings : This can be expressed in the form of shock, anger, Sadness, guilt, self reproach , loneliness, helplessness, hopelessness, depression, numbness and feelings of unreality Physical symptoms: Such as tightness in throat and chest, excessive sensitivity to noise , irritability, weakness, loss of appetite, insomnia, weight loss. Behavior : This can be manifested in the form of confusion, hallucination (seeing or hearing the deceased person), tearfulness, Absentmindedness, obsession to belongings of deceased person, irrational behavior 10 Potential Danger Signs in Grief Reactions When someone feels he/she is no longer of value as a person Behavior or personality changes that are inconsistent with clients normally behavior pattern . When client makes threats of self-destruction Excessive hostility Complete withdrawal and unwillingness to interact with other people Appearance of fleeing from reality 11 Stages of bereavement are; Denial : first reaction that people have to the loss of a loved one or a diagnosis of HIV, tend to deny and may withdraw from usual social contacts. Anger ; There is the stage of anger at self, loved one, God, the world, the HIV virus and the world in general. Questions such as ―Why me?‖, ―Why did it happen to him/her ?‘ are asked over and over again. Bargaining; At this stage the grieving person may make bargains with God, asking, "If I do such and such, will you take away the loss?", ―I promise I'll be a better person if ….‖ Hoping that the loss will disappear or magically be made right. 12 Depression; At this stage the person feels numb, although anger and sadness may remain underneath but the person feels tired and doesn‘t care any longer about what happens . A sense of hopelessness and helplessness washes over the person and leaves him or her unable to muster energy to do anything and everyday functioning may also be a problem. Acceptance ; At this stage there is a sense of resignation, when anger, sadness and mourning have tapered off. The person simply accepts the reality of the loss and lets‘ go, but memories still remain . It is not a pleasant feeling but rather a feeling of being ready for whatever may come. 13 Key Points There are several types of counseling in relation to HIV Counselling and guidance, The essence of the different types

NTA Level 6 • Semester 1 • PST06102 Pharmaceutical Personnel at CTC Counselling and Guidance • Source Session/Topic 12 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. PST 06102 : Counselling and Guidance Session 12 : Pharmaceutical Personnel at CTC 1 Learning tasks By the end of this session students are expected to be able to: Explain concept of the role of pharmaceutical personnel at CTC List role of pharmaceutical personnel at CTC Explain role of pharmaceutical personnel at CTC Identify Steps for providing counselling and guidance to patients at CTC for medicinal use 2 Concept of the Role of Pharmaceutical Personnel at CTC Patient counseling and guidance about medications at CTC; involve providing medication information orally or in written form to the patients or their representative or providing proper directions of use, advice on side effects, storage, diet and life style modifications, it involves a one-to-one interaction between a pharmaceutical personnel and a patient or care giver. Pharmaceutical personnel and patient need to come to a common understanding about their respective roles and responsibilities. It may be necessary to clarify for patients that Pharmaceutical personnel have an appropriate and important role in providing education and counselling and patients should be encouraged to be active participants. Pharmaceutical personnel provide optimal management of medication for chronic diseases such as diabetes, asthma, hypertension, HIV/AIDS etc. The collaboration of healthcare professionals , such as physicians and Pharmaceutical personnel, can help to ensure that patients properly take their medications as prescribed and avoid any harmful effects 3 In addition to a current knowledge of pharmacotherapy, Pharmaceutical personnel need to have the knowledge and skills to provide Effective and accurate patient education and counseling. They should know about patients‘ cultures, especially health and illness beliefs, attitudes , and practices. They should be aware of patients‘ feelings toward the health system and views of their own roles and responsibilities for decision-making and for managing their care. 4 What are the roles of pharmaceutical personnel at CTC? 5 Role of Pharmaceutical Personnel at CTC Role of pharmaceutical personnel in the management of HIV/AIDS and related problems in the CTC are: Selecting and reviewing therapy i.e. general principles, resistance to antiretroviral drug , management of drug interaction, complementary or alternative medicines, general promotion and maintenance of health Tailoring treatment for specific populations i.e. women, pediatric patients, patients with comorbidity, patients with co-infections with hepatitis virus, marginalized patients groups, immigration and indigent population Counselling patients i.e. counseling and educating on adherence issues. Monitoring response to therapy i.e. managing adverse drug reaction and therapeutic drug monitoring and professional networking and collaborations 6 Role of Pharmaceutical Personnel at CTC 1. Selecting and reviewing therapy, General principles Pharmaceutical personnel working at CTC should be familiar with current treatment principles so that they can effectively manage and optimize pharmacotherapy for HIV infected individuals, they should also be familiar with recommendations on prophylaxis and treatment of opportunistic infections that occur in conjunction with HIV infection Resistance to Antiretroviral Drugs Resistance to antiretroviral is a major cause of treatment failure, it is therefore important for pharmaceutical personnel to understand the mechanisms of and factors contributing to development of drug resistance. 7 Pharmaceutical personnel at CTC can play an important role in preventing the development of drug resistance by ensuring selection of potent antiretroviral regimens; monitoring and reinforcing the need for strict adherence; screening for and managing drug–drug interactions; anticipating and effectively managing adverse effects, as a means to increase adherence ; providing appropriate education about the relationship between nonadherence and development of resistance aggressively managing treatment failure by switching therapy to prevent further accumulation of resistance mutations 8 Management of Drug Interactions Patients are now living longer and experiencing co-morbidities such as cardiovascular disease , hyperlipidemia, hypertension, diabetes mellitus, gastrointestinal conditions, osteoporosis , renal disease, and non–AIDS-related cancers, which may be manifestations of long-term toxic effects of the antiretroviral, increasing age, or the virus itself. Pharmaceutical personnel should be aware of the types and mechanisms of drug interactions if they are to manage such interactions effectively Interactions between antiretroviral and other drug classes have not been exhaustively elucidated , so pharmaceutical personnel at CTC need to be aware of the pharmacological and pharmacokinetic characteristics of specific agents to identify or predict potential drug interactions 9 Management of Drug Interactions Pharmaceutical personnel at CTC must utilize current sources of information to make an accurate assessment, in situations of suspected or potential drug interactions, close clinical, virological , and therapeutic drug monitoring is necessary. In some instances, dose adjustments may be beneficial in optimizing the clinical response, including viral suppression, other management options include altering dosing frequency or replacing one agent with another drug that has lower potential for interaction 10 Pharmaceutical Management cycle 11 Complementary or Alternative Medicine The concomitant use of CAM with antiretroviral is common, patients need to be reminded that , in contrast to conventional medications, the large majority of CAM products are not licensed and are not required to meet the standards for efficacy, safety, bioavailability, and stability that are required for conventional medications before they can be marketed, Herbal remedies are classified as dietary supplements, and manufacturers do not have to prove the safety and effectiveness of dietary supplements before marketing them. Pharmaceutical personnel can play a crucial role by providing reliable information about CAM to help patients who visit at CTC to understand the potential risks, benefits, and uncertainties regarding specific products of interest. When indicated, potential interventions include offering therapeutic alternatives, evaluating the risk of drug interactions, recommending therapeutic drug monitoring, and ensuring optimal adherence with combination antiretroviral therapy 12 General Promotion and Maintenance of Health With the evolution of HIV infection into a chronic manageable disease, patients who are receiving stable combination antiretroviral therapy may be seen less frequently. Pharmaceutical personnel, especially those practicing in ambulatory or community settings, can play a significant role in this aspect of

NTA Level 6 • Semester 1 • PST06102 Co-ordination of Health Workers at CTC Counselling and Guidance • Source Session/Topic 13 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. PST 06102 : Counselling and Guidance Session 13: Co-ordination of Health Workers at CTC 1 Learning tasks At the end of this session, students are expected to be able to : Explain concept of the co-ordination of health workers at CTC Identify services provided by staff within CTC Explain impact of health care workers on HIV and AIDS Programmes at CTC 2 Concept of the Co-ordination of Health Workers at CTC Caring for HIV/AIDS patients requires health care workers (HCWs) to have good knowledge of the issues, cultural differences in HCWs, combined with professional ethics and personal beliefs, could also result in conflicting attitudes, leading to difficulties related to looking after people affected by HIV/AIDS For CTC services to function well, adequate and trained staff need to have clearly outlined roles and responsibilities, since HIV and AIDS is now a manageable chronic disease, the principles of chronic disease management must be followed. 3 Team approaches involving a patient, a family care giver and a healthcare team i.e. consisting of at least a triage nurse, a doctor and a treatment/adherence pharmaceutical personnel to ensure the building of an ongoing relationship between patient and the health care team for life-long care. Regularly scheduled visits minimize drug depletion at home; this is enabled by records that are easy to retrieve, and disciplined observance of appointment schedules. 4 Weekly CTC team meetings to discuss bottlenecks and case studies will help to build team spirit, while quarterly staff meetings between heads of relevant units involved in HIV care such as CTC, TB, VCT, PRCH, STI, HBC, Pharmacy, Laboratory and In-patient units will help to build better internal cooperation and patient referrals . Council Health Management Team (CHMT) members must conduct regular at least quarterly supportive supervision visits to assess efficiency and effectiveness of service delivery, and identify where mentoring by experts from supervising hospitals or health programmes should be put in place. 5 Activity: Buzzing What are the services provided by staff within CTC? 6 The National Standard Operating Procedures manual outlines the following services to be provided by available staff within CTC: Registration and appointments management; filling of CTC1 and CTC2 basic information; height, weight, Blood Pressure (BP), (Body Mass Index(BMI)), pulse rate and temperature Triage: assessment of immediate medical needs, TB screening questionnaire, support and referring the patient to the next relevant unit or staff at the CTC 7 Clinical management Patient ART preparedness and adherence counselling All elements of PHDP Data collection and management Referral management within the hospital, and with relevant institutions and community organizations 8 9 Impact of Health Care Workers on HIV and AIDS Programmesat CTC HIV and AIDS programmes have had a direct impact on health care workers (HCW) at CTC into; Recruitment of HCW at CTC Distribution and retention of HCW at CTC; Attrition of HCW at CTC 10 a. Recruitment of health workers at CTC Recruitment in this context includes all measures and processes used to prepare and deploy HCWs into the HIV and AIDS programmes; for instance, HCW like doctors, pharmaceutical personnel, nurses etc who shifted from their normal activities to HIV and AIDS programmes, they must effectively recruited into HIV and AIDS care. HIV and AIDS programmes create greater demand for HCWs, in response to which there have been efforts to recruit additional staff, including new cadres, the additional staff may be from the existing stock of HCWs, or could be from outside the system, depending on the country involved . 11 b . Distribution and retention of HCW at CTC; Exploring impact, opportunity and lessons from, HIV/AIDS service programmes on HCW distribution and retention There is specific HCW retention strategies including financial and non-financial incentives, in scale up for HIV and AIDS services Specific workplace challenges and wider issues in retaining health workers in the context of HIV/AIDS at CTCs especially in high burden countries are solved 12 Health worker get HIV/AIDS treatment and prevention programmes including infection prevention and control measure (IPC) and post exposure prophylaxis (PEP) HIV and AIDS drive deployment policies skills mix, task shifting and their relationship to the rest of the health system to improve distribution and retention HCW 13 c. Attrition of health workers at CTC Employment impact opportunity and lessons from, HIV and AIDS programme on HCW resignation, illness ,absenteeism, premature retirement, death and emigration all cause Attrition of health care workers at CTC AIDS/HIV treatment and prevention programme to HCW mitigate attrition of health care workers at CTC 14 Strategies to address higher demand for HIV and AIDS services resulting stress, frustration, burn-out hence there is a need to mitigate attrition of HCW HIV and AIDS driven improvement in working conditions and how they mitigate HCW attrition 15 Key points For CTC services to function well, adequate and trained staff, need to have clearly outlined roles and responsibilities, since HIV and AIDS is now a manageable chronic disease, the principles of chronic disease management must be followed. The National Standard Operating Procedures manual outlines the different services to be provided by available staff within CTC 16 Review questions What are the services provided by health workers at CTC? What are the impacts of health workers on HIV/AIDS programme ? 17 References Essengue M-S (2003) ‘ Assessment of human resources for scaling up HIV/AIDS/ART country programmes, ’ Duty travel report from site visits in Rwanda. Geneva: WHO, Department of Human Resources for Health. MOHSW (2009). Provider Initiated HIV Testing and Counselling: Trainer’s Manual. Dares Salaam, Tanzania: National AIDS Control Programme . Uebel KE, Nash J and Avalos A (2007) ‘ Caring for the Caregivers: Models of HIV/AIDS Care and Treatment Provision for Health Care Workers in Southern Africa,’ Journal of Infectious Diseases 196 (Supplement) : UNAIDS (2007)

NTA Level 6 • Semester 1 • PST06102 Adherence in Treatment Counselling and Guidance • Source Session/Topic 14 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. PST 06102 : Counselling and Guidance Session 14: Adherence in the Treatment 1 Learning tasks At the end of this session, students are expected to be able to : Give Introduction to adherence in the treatment Describe difference between adherence, compliance and concordance in the treatment Describe importance of adherence in the treatment Explain reasons for non-adherence in the treatment Explain methods of improving adherence in the treatment 2 Activity: Buzzing What is adherence in the treatment? 3 Adherence in the treatment Adherence: is defined as the extent to which a patient takes medication in the way intended by a health care provider, This is include, patients taking all medications at the correct time, in the appropriate quantities and in line with additional instructions regarding food or drug interactions Medicines play an important role in medical care and effectiveness of treatment depends on both the efficacy of medication and patient adherence to the therapeutic regimen. 4 Adherence in the treatment …. Adherence to medication is essential to achieve the best possible pharmacotherapy outcomes. Evidence shows that non-adherence medications result in higher health care costs, longer hospitalization, and increased morbidity and mortality. 5 Adherence in the treatment … A medication is the most frequent intervention within healthcare systems worldwide. Achieving the best possible outcome of medication for the quality of life of patients should be the primary aim of all health professionals involved in the medication process, as well as carers and patients, depending on their abilities and capacities Adherence is a major issue for long term medication in chronic diseases, between 1/3 to ½ of medicines prescribed are not taken as intended, this affects: Patients’ health leading to decreased quality of life, complications, preventable hospitals admissions and mortality/morbidity 6 Adherence in the treatment …. Non-adherence in the society increased healthcare cost/government spending, untreated diseases expose the society to potential problems such as infectious diseases like TB/HIV, psychiatric diseases e.t.c Medication non adherence can be divided into four categories: Primary non adherence Secondary non adherence Unintentional non adherence Intentional non adherence 7 1. Primary non adherence : is when a patient does not fill an initial prescription; 2. Secondary non adherence : is when a patient does not refill a prescription on time. 3. non adherence : occurs when a patient simply forgets to take medication or is careless in some way as to miss a scheduled dose; 4. Intentional non adherence : is a decision of not taking the medication, and may be the most important aspect of non adherence that must be addressed, with some estimates showing that up to 80 percent of non adherence may be intentional 8 Differences between adherence, compliance and concordance In contrast, compliance and adherence relate to the medicine-taking behavior of the patient. Compliance and adherence can be estimated using prescription claims records, pharmacy dispensing data, validated survey instruments or electric pill counters, as well as direct measures such as serum drug levels However, the definition of concordance implied that the prescriber and patient should come to an agreement about the regimen that the patient will take 9 10 Important of Adherence in the Treatment Treatment adherence is generally regarded as an important factor in achieving optimal outcomes across many disease states. In the treatment of chronic disease like HIV, Cancer and tuberculosis, poor adherence to treatment has the potential to impact outcomes on multiple levels. The health system in where pharmaceutical personnel practices is integral to achieving the ultimate goal of improved patient health, because medication adherence is an important contributor to improved patient health, health care systems must evolve in a way that emphasizes its importance. 11 Therefore the importance of adherence in the treatment are: To decrease morbidity and mortality in the community and reduce health cost Help to improve effectiveness of medicines Strengthen relationship between patients and health workers Lessening number of hospitalities 12 Reasons for Non-adherence in the Treatment Medication non-adherence is a serious problem with possible life-threatening consequences. Patients frequently are unable to recognize their own adherence issues, especially for chronic medications Reasons for non-adherence to prescribed medicines are commonly divided into 5 intersecting categories; Patient variables. Treatment regimen. Disease characteristics. Patient provider relationship. Clinic setting 13 Patient Variables Sociodemographic factors i.e . age, gender, race/ethnicity, income, education, literacy, housing status, insurance status Psychosocial factors i.e . mental health, substance use, social climate and support, knowledge and attitudes about disease and its treatment. Common predictors of non-adherence include depression/psychiatric morbidity, active drug or alcohol use, stressful life events, lack of social support, and the inability to correctly identify the drug regimen or describe the relationship between adherence and drug resistance . 14 Treatment Regimen Factors related to the treatment regimen include: The number of pills prescribed, the complexity of the regimen ie . dosing frequency and food instructions, the specific type of medicines dispensed, the short- and long-term medication side effects. The complexity of the regimen and side effects caused by it are clearly associated with non-adherence, the impact of once-daily regimens on adherence behavior, amid great hope for a beneficial effect 15 Disease Characteristics Disease characteristics include the stage and duration of infection, associated opportunistic infections, and disease-related symptoms, there is a relationship between disease-related symptoms and non-adherence. 16 Patient-Provider Relationship Patient-provider relationship characteristics that may affect adherence include; The patient's overall satisfaction and trust in the provider and clinic staff, the patient's opinion of the provider's competence, the provider's willingness to include the patient in the decision-making processes The affective tone of the relationship ie . Warmth, openness and cooperation, the concordance of race/ethnicity between patient and provider and the adequacy of referrals . 17 Patient-Provider Relationship May affect adherence include; The patient's overall satisfaction and trust in the provider

NTA Level 6 • Semester 1 • PST06102 Compliance in Treatment Counselling and Guidance • Source Session/Topic 15 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. PST 06102 : Counselling and Guidance Session 15 : Compliance in the Treatment 1 Learning tasks At the end of this session, students are expected to be able to : Give introduction to compliance in the treatment Describe importance of compliance in treatment Explain reasons for non-compliance in the treatment Explain methods of improving compliance Explain methods of assessing compliance 2 Activity: Buzzing What is compliance in the treatment ? 3 Compliance in Treatment Is filling up and complete an action or process and fulfilling the promise to a desirable, requested conditions specific to act in conformity. Compliance can mean ‘accord agreement of amicable relations that has conformity. Poor compliance to treatment of chronic diseases is a worldwide problem of striking magnitude., average of 50% in most diseases and excessive non-compliance accounts for a significant percent of admissions in patients with heart failure 4 The consequences of poor compliance to long-term therapies are poor health outcomes and increased health care costs, Increasing the effectiveness of compliance interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments, a multidisciplinary approach towards compliance is needed 5 Types of patients based on the acceptance of diagnosis and treatment initiation, patients are categorized into four types Non compliers : those who do not accept diagnosis and need treatment. Partial compliers : those who accept diagnosis and treatment but cannot fulfill the recommended actions sufficiently to reach targeted improvements in their health. Over compliers : those who take recommended actions in excess of targeted improvements (these patients are rare). Adequate compliers : those who follow health advice adequately to improve or control their disorder 6 Importance of Compliance in Treatment Taking your medicine as prescribed or medication adherence is important for controlling chronic conditions, treating temporary conditions, and overall long-term health and well-being. A personal connection with your health-care provider or pharmaceutical personnel is an important part of medication compliance 7 F actors determined to have the most important effect on patient compliance with dispensed medications Understanding of medical directions Involvement in the Process Compliance reminders 8 Activity: Buzzing What are the reasons for non-compliance in the treatment? 9 Non-compliance in the Treatment Non-compliance, failure or refusal to comply, in medicine, the term non-compliance is commonly used in regard to a patient who does not take a prescribed medication or follow a prescribed course of treatment A person who demonstrates non-compliance is said to be non-compliant 10 Reasons for Non-compliance in the Treatment a. The nature of patient’s illness: Patients suffering from schizophrenia has high incidence of non-compliance, due to distorted reality & lack of insight do not recognize their illness and need for treatment, similarly in chronic disorders like hypertension, tuberculosis etc b. Therapeutic regime: Multiple drug therapy like 5-6 prescribed drugs taking at different timings ,taking tablets with same color, size and shape cause more confusion and skip doses also technical difficulty in using inhalers 11 c. Duration of treatment: Compliance is inversely proportional to duration of treatment, in a long term therapy, low compliance is observed as in bronchial asthma and hypertension d. Frequency : Increased frequency of drug administration causes more disruption of normal routine or work schedule, hence many patients forget or inconvenienced or embarrassed 12 E. Adverse events, Some patients are non-compliant due to adverse events. Some drugs like Anti-Hypertensive agents, Anti depressants or Anti psychotics cause sexual dysfunction which is frequently implicated for non compliance F. Taste of medication , Can be the cause for noncompliance especially in children. Failure to comprehend the importance of therapy, as patient has limited knowledge about the illness, become non compliant if beliefs and expectations are not met with, poor understanding of instructions also contributes to non compliance 13 G . Taste of medication, Can be the cause for noncompliance especially in children. Failure to comprehend the importance of therapy, as patient has limited knowledge about the illness, become non compliant if beliefs and expectations are not met with, poor understanding of instructions also contributes to non compliance 14 Other Non compliance to treatment Increased , or decreased sensitivity to drugs, Frequent change of prescriptions( prescription cascade), Living alone, Lack of social support system, Difficulty in opening the medication container that has flip off type of lid Going to pharmacist/chemist due to physical problems like (osteoarthritis) Cognitive impairment, Impaired mobility or dexterity, Swallowing problems, Financial issues like, Low income and high cost of medications, Everyday inconvenience in carrying and taking of medicines 15 Methods of Improving Compliance I nclude health education to increase retention of the regimen, self-monitoring of medication habits, tailoring medication taking to other daily habits and treatment contracts 16 O ther methods The patient can be supervised while taking the drug for example, during treatment in hospital, by parents giving medicines to their children, visitors giving drugs to relatives, and a district pharmaceutical personnel giving medicines to elderly people Single dose treatment eg syphilis, Improving the palatability of medicines by flavouring medicines for children Blister calendar packs for oral contraceptives or better blockers help p to remember to take the drug . 17 By simplifying therapeutic regimens, reducing the number of tablets and reducing the frequency of administration.. By educating the patient, patient education on the nature of their condition and the necessity and aims of treatment 18 Methods of Assessing Compliance Tablet counting Recording devices Measuring the concentration of the drug in body fluids Measuring the pharmacological effect Measuring a marker substance added to the drug 19 Key points Compliance: Is filing up and complete an action or process and fulfilling the promise to a desirable, requested conditions specific to act in conformity, Methods to improve compliance to medication include health education