Primary care

Primary care measures for detecting and treating common HIV-related diseases should include diagnosis and treatment of infectious (sputum smear-positive pulmonary) TB. Primary care staff need to detect TB cases among persons presenting with, or found through screening to have, symptoms of TB.The most important symptom is prolonged cough. Detection of infectious TB cases requires access to quality-assured TB sputum microscopy. Special attention to case detection is necessary in congregate settings (e.g. prisons, health care facilities) and among people attending VCT centres.

There are two preventive treatments that should be available at primary care level for the prevention of common HIV-related diseases. Isoniazid is effective as preventive treatment of TB. Cotrimoxazole may prevent common bacterial infections.

Health care workers and HIV-infected patients are often exposed to the risk of TB in health facilities. Health services have a responsibility to implement measures to decrease nosocomial risk of TB in health facilities. They also need to protect health care workers from occupational exposure to HIV.

Information for communicable disease surveillance passes from primary care level to those responsible at district level.This includes reporting of TB cases and recording of TB treatment outcomes. Systems of surveillance of HIV-related diseases other than TB are currently lacking or poorly developed at all levels of care. TB surveillance can be a starting-point for the development of these systems.

An effective NTP ensures integration of TB diagnosis and treatment activities with general health service provider activities (see Chapter 2). So primary health care staff are in a good position to identify and treat common HIV-related problems during or after anti-TB treatment. Good communication between general health service staff and HIV/AIDS care workers is important for continuity of care of TB/HIV patients.

The IMCI strategy, developed by WHO, provides management guidelines for sick children. In outpatient settings, the aim of the strategy is to improve diagnosis and treatment of childhood illnesses. In the home setting, IMCI has several aims.These include promoting appropriate care-seeking behaviour, improved nutrition and preventive care, and ensuring the child receives the care prescribed.

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