Tertiary care

Measures applicable at tertiary care level are additional to those applicable at the secondary care level. They include diagnosis and treatment of complications of common HIV-related diseases. Specialist management of complicated forms of TB (e.g. peritoneal and pericardial TB) is often available only at the tertiary level.

District level staff sometimes are faced with difficult problems of diagnosis or treatment. The patient may benefit from transfer to a tertiary referral hospital. It is usually wise to obtain advice on the telephone before transferring the patient. This is to ensure that the specialist agrees that the patient is likely to benefit from the referral.

The table below shows HIV/AIDS and TB care integrated at different levels of the health care system.Availability of interventions depends on whether a country is low-, middle- or high-income.

Level of care

Low-income

Middle-income

High-income

Home and

Information

As per low- income

As per middle-

community

and education

level

income level

Condoms

plus

plus

Breastfeeding

a) terminal care

a) terminal care

advice

with health

with advanced

Palliative care

professional

technology

Support groups

input

b) domiciliary

b) formula feeds for

treatment of HIV-

infant nutritional

related diseases

supplementation

Primary care

VCT for HIV

As per low-income

As per middle-

(health centre)

Prevention of

level

income level

HIV

plus

plus clinical and

transmission

a) antiretroviral

laboratory

Detection and

drugs for prevention

monitoring of

treatment of

of mother-to-child

HIV progression

common HIV-

transmission

related diseases

b) prevention of

(e.g. TB)

fungal infections

Prevention of

common HIV-

related diseases

Pain relief

Intensified TB

case-finding

Disease

surveillance

(e.g. TB)

Decreased

nosocomial

transmission

and

protection of

health workers

Secondary care

As for primary

As per low- income

As per middle-

(district

care level

level plus

income level

hospital)

plus

disease surveillance

plus

a) safe blood

of less common

a) diagnosis and

b) terminal

HIV-related

treatment of

in-patient care

diseases

uncomplicated

c) possible

HIV-related

access to ART

illness

b) access to ART

c) post-exposure

prophylaxis

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