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TIP 37 Addictions Treatment with Persons with HIV

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TIP 37 Addictions Treatment with Persons with HIV

  1. 1. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  2. 2.  650,000 to 900,000 in the U.S. with HIV  Many don’t know it  Most easily transmitted by exposure to contaminated blood  Drug use results › poor judgment, unprotected sex, sharing needles Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  3. 3.  Alcohol and drug use can: › Interfere with HIV medications › Inhibited immune system › Lead to poor health behaviors further compromising immunity Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  4. 4.  Medical providers  Mental health  Substance abuse  Public health  Social support groups Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  5. 5.  HIV positive, doesn’t matter what you do  Avoid HIV if you’re careful and don’t repeat risky behaviors  You can tell whether your sex (or injection) partners are infected  Treat any sexually transmitted diseases and you won’t get HIV  Washing after sex will prevent HIV  Not sharing syringes so can’t catch HIV Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  6. 6.  Ask: Unprotected in the last 3 to 6 months: › Vaginal sex? › Anal sex? › Oral sex? › Sex for money or drugs? › Sex with more than three people? › Sex with an injection drug user? › Sex with someone you think has HIV/AIDS?  Ask: When you have sex, do you sometimes or never use condoms? Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  7. 7.  Ask: Do you use drugs before or after sex?  Ask: When you use drugs, do you: › Use syringes? › Share syringes? › Clean your works? › Use crack or powder cocaine? › Use several drugs at the same time?  If client answers positively for half or more, client has a high risk of having or getting HIV Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  8. 8.  Use condoms  Don’t share syringes  Use new syringes  Disinfect drug paraphernalia  Medical care before, during, after pregnancy  Elective cesarean delivery  Avoid reinfection  Observe universal precautions as directed  If exposed, begin postexposure prophylaxis Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  9. 9.  Clinician’s goals in promoting risk-reduction: › Help and support client understanding need for behavior change › Assist client address cultural practices or beliefs that contribute to resisting change › Assist client develop skills to sustain behavior change Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  10. 10. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  11. 11.  Pre- and posttest counseling by a trained HIV clinician  Counseling should: › Explain limitations of HIV tests › Help clients assess their risks › Encourage and reinforce behavior change › Refer infected clients for medical care Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  12. 12.  ELISA (enzyme-linked immunosorbent assay) › typically used as a first test  Western blot › typically a second test  Rapid HIV tests  Home sample collection tests  Positive result › a second test is needed to confirm  Negative result › second test needed in about 6 months to rule out a false-negative Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  13. 13.  All states require reporting AIDS cases  Some states also require reporting new cases  Reports forwarded to CDC  State laws vary regarding client- identifying information Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  14. 14.  Testing needed to determine disease progression › CD4+ T cell count (More info) › Viral load count Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  15. 15. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  16. 16.  First combination of medications prescribed for patient are most effective  Adherence leads to: › healthier, longer life › prevention of developing drug-resistant strain(s) of HIV Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  17. 17.  Addiction or mental health relapse  Living in an institution  Side effects  Affordability Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  18. 18.  Write instructions  Use timer, ensuring proper dosing  Use check-sheet, notating dosage  Provide positive feedback  Empathize / Advocate regarding medication side effects  Visual cues for persons with impaired language/cognitive abilities Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  19. 19. Take all medications as prescribed Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  20. 20. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  21. 21.  Socioeconomic status › Level › Impact on client’s illness  Degree of acculturation  Heterogeneity of cultural, racial, ethnic groups Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  22. 22.  Family role in treatment  Spirituality in treatment  Trust in the health care system  Views toward injection drug use and unprotected sex  Reliance on verbal communication in medical treatment  Negotiating safer sex practices Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  23. 23.  Identity as caregiver, reluctant to seek testing  Reproductive decision making  Gay, lesbian, bisexual, transgender clients’ social stigma Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  24. 24.  Listen with empathy and understanding  Elicit cultural information  Acknowledge and discuss cultural differences and similarities  Recommend action, treatment, intervention incorporating cultural knowledge  Negotiate agreements and differences with client Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  25. 25. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  26. 26.  Events which may initiate client relapse: › Taking an HIV test › Receiving HIV test results › Experiencing first symptoms of HIV › Experiencing first AIDS-related hospitalization › Being diagnosed with AIDS › Friend or significant other dying from AIDS › Beginning medication regimen for HIV › Experiencing little or no response to various medications › Decreasing CD4+ T cell count or increasing viral load Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  27. 27.  Peer support  Medical intervention for pain  Relaxation and stress management  Recreation Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  28. 28.  Consider organizing separate groups for: › Clients newly aware of their positive HIV status › Clients asymptomatic or mildly symptomatic › Clients with more advanced disease Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  29. 29.  Issues: › Loss › Unfinished business › Pain management › Religious and cultural traditions  Clients can be encouraged to: › Make a will › Arrange for child custody › Decide about health care directives Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  30. 30.  5 stages when coping with death or loss 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance  Normalize their reactions Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  31. 31.  Acknowledge deaths › attendance at memorial services, if appropriate  Encourage expression of grief both verbally and nonverbally › art therapy  Provide grief group support › clients and significant others  Help clients leave a legacy of living memories › video or cassette recordings for others Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  32. 32.  Medical  Dental  Hospice  HIV organizations and support groups  Local health departments  Legal assistance providers  Agencies providing housing, financial assistance, medical care funding  Mental health providers  Members of the criminal justice community  Spiritual caregivers Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  33. 33.  Equal access to health care and substance abuse treatment guaranteed  State laws regulate disclosure of patient information related to HIV/AIDS; differ from other health information  If in doubt, always consult your legal counsel Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  34. 34.  HIV/AIDS as a second, third or fourth diagnosis integrated into comprehensive treatment  HIV/AIDS counseling and education available at every treatment facility or detoxification unit  Patients receiving adequate, early intervention live longer, healthier lives Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  35. 35.  The Ryan White CARE Act › HRSA Grant Application Center  (877) 477-2123  http://www.hrsa.gov › Title I Information (301) 443-9086 › Title II Information (301) 443-6745 › Title III Information (301) 443-0735 › Title IV Information (301) 443-9051 › See TIP 37 Appendix F for further information Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  36. 36.  Significantly reduces  May affect methadone methadone levels levels › • Rifampin › • Nelfinavir › • Dilantin › • Phenobarbital  No significant effect on methadone levels  Reduces methadone levels › • Clarithromycin / › • Carbamazepine Azithromycin › • Ritonavir › • Didanosine › • Rifampin › • Lamivudine › • Nevirpine › • Saquinavir › • Efavirenz › • Stavudine › • Sulfamethoxazole  May raise methadone › • Zalcitabine levels › • AZT › • Delavirdine › • Fluconazole Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

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