Measures applicable at secondary care level are additional to those applicable at the primary care level. Measures for detecting and treating common HIV-related diseases should include diagnosis and treatment of sputum smear-negative pulmonary TB and extrapulmonary TB. Diagnosis usually requires investigations often available only at secondary level, e.g. X-ray and biopsy.
Primary health care staff can manage many HIV-related problems in health centres and dispensaries. Sometimes TB/HIV patients develop problems requiring investigations and treatment unavailable at primary health care level.Then they need to be referred to the district hospital, either to the outpatient department or for admission. After treatment, often the district level staff can refer the patient back to the primary care or community level. Good channels of communication promote continuity of care.
The IMCI strategy includes management guidelines (see Suggestions for Further Reading) for district level care of children with HIV-related problems.
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