Care prevention and management of tuberculosis

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TB and HIV > HIV testing
  • Standard statement
  • Rationale
  • Resources
  • Professional practice
  • Outcome
  • References

Diagnostic HIV testing will be offered routinely to all patients with TB who do not know their HIV status, in a caring, consensual and confidential manner.

patients
Relationship between HIV and TB (click to view)

HIV is the strongest known risk factor for developing TB disease in individuals with TB infection. Globally, an estimated 11 % of new adult TB cases are infected with HIV. The proportion is highest in Africa, particularly in sub-Saharan Africa, where up to 75% of individuals with TB are co-infected with HIV.

On the other hand, TB is the most frequent opportunistic infection among HIV-infected individuals, and is often the first manifestation of HIV disease. Mortality during and after anti-tuberculosis treatment is also higher in HIV-infected than in non-HIV-infected TB patients.

video presentation Video: a volunteer and a patient, explains the link between HIV and TB
(video developed by the WHO, Stop TB and UNAIDS Winstone)
video presentation Documentation: Factsheet 1 – TB and HIV
summer meeting place
Benefits of early diagnosis of HIV infection (click to view)

As TB is one of the main opportunistic infections associated with HIV, all TB patients should be tested for HIV. The earlier it is found that someone is infected with HIV, the sooner he or she can be offered advice and preventive treatment that can reduce incidence of opportunistic infections, prolong life, and reduce the possibility of further transmission. It will also present an opportunity to offer diagnostic and care services to the patient’s partner, who may be at significant risk from contact with both HIV and TB.

learn more Read more: TBCTA (2006) Standard 12 in Standards for Treatment
patient
Managing patient anxiety and stigma (click to view)

The level of anxiety about HIV and TB, both heavily stigmatised and potentially fatal conditions, can lead the patient to feel very vulnerable and confused. This is especially acute when, having just been diagnosed with TB, the patient is confronted with the possibility that he or she may also be HIV-positive. It is essential to assess the patient’s thoughts, feelings and understanding about HIV/AIDS in order to respond appropriately. Just as inthe case of TB, the patient’s response to the possibility that he or she is infected with HIV will vary according to:

• Knowledge and understanding of the infection
• Any experience he or she has had either personally or through family or friends who may be infected
• Access to care and treatment for HIV/AIDS, including antiretroviral treatment (ART).

video presentation Video: Rhoda talks about stigma
reflect Reflect: Exercise and reflect - Stigma tree
young patient
Maintaining trust and patient confidentiality (click to view)

The development of a good relationship with the patient is essential to maintain the patient’s trust and confidence in the service being provided. This is underpinned by an open commitment to maintaining patient confidentiality and addressing discrimination.

 

 visiting patient
Documentation (click to view)

Clear, prompt and accurate record keeping following agreed policies and procedures is necessary to ensure that those who test positive for HIV receive appropriate care. The NTP must monitor the number of patients tested and trends in results.

 

 visiting patient

Do you have the resources required for best practice?

Best Practice Requirement

Your Current Practice

Identify Gaps in your Practice

Joint plans, guidelines and policies for the treatment and care of co-infected patients have been developed in partnership between the National AIDS Programme and the National TB Programme. These plans include guidance about documentation

We have space for privacy to be maintained during discussions with patients about their HIV status & treatment

We have a reliable supply and storage of drugs and laboratory materials for the
treatment and monitoring of TB and common HIV-related infections as well as cotrimoxazole prophylaxis

Our unit has access to a variety of local support services, which can offer additional care to patients according to their needs

TB and HIV infection control procedures in place are in line with WHO guidelines

A referral system is in place to ensure ongoing care for a HIV patient following the completion of his or her TB treatment
 

 

How is your practice?

Best Practice Requirement

Your Current Practice

Identify Gaps in your Practice

Staff have an understanding of both TB and HIV treatment and care

Nursing and medical follow-up with the appropriate expertise in both conditions

We have provision for group education covering a variety of themes associated with HIV and TB treatment, safer sex and prevention of further infection

Trained staff have access to information and guidelines from agencies including WHO, IMAI, UNAIDS

The health-care workers assess co-infected patients when the diagnosis of TB and HIV is made and on an ongoing basis during subsequent appointments. The following areas are covered:

1. The patient’s understanding of TB and HIV, how it is transmitted and how it is treated

2. The presence of HIV-related conditions that may or may not require treatment

3. The patient’s readiness to start ART and his or her ability to adhere to
4. the regimen

5. Psychosocial issues which may affect the patient’s care or treatment

6. The patient’s feelings about disclosing his or her HIV and TB status to others

7. Any adverse drug effects the patient is experiencing and what medication this is likely to be associated with

Following such assessments:

• The appropriate support information can be provided at a time when the patient is most likely to need and absorb it

• Referrals are made with the agreement of the patient according to the patient’s needs and the services available locally

• Adverse drug effects are managed appropriately whether they are related to treatment in association with TB† or HIV

If the patient is on ART, regular assessment is carried out with regard to:

• Any changes in the patient’s condition, e.g., weight gain and the resolution of opportunistic infections can indicate a good response to treatment; CD4 counts can also be used but are not always available

• The health-care worker are aware of immune reconstitution syndrome (IRIS), which can make TB worsen even while the immune system is improving

• Ensuring that the regimen and dosages prescribed are based on national guidelines

• Laboratory monitoring according to local policies

• The patient’s adherence to the regimen prescribed

All health-care workers follow local procedures for clear, accurate and prompt record keeping
 

 

Your Action Plan for improvement

Use the following box to develop an action plan on how you will improve
your practice with regards to initial assessment of the patient

Things you will change in the patient assessment form

Things you will change about the way you talk to
patients during an initial assessment/consultation

Things you will change about how others in your team talk
to patients during an initial assessment/consultation

List yours and others training needs and identify how you will address them
to enable best practice during initial consultations and assessment.
 

 

 

Tuberculosis Coalition for Technical Assistance (TBCTA, 2006) International Standards for Tuberculosis Care

WHO (2009) recommends the use of indicators to monitor and evaluate the need and effectiveness of TB and HIV collaborative activities in your own service. A range of indicators are outlined in the Guide to monitoring and evaluation for collaborative TB/HIV activities, (page 34)

Additional Online Learning Resources
HIV Testing and Counselling in TB Clinical Settings

 
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