BSC SEM 4 UNIT 7 ADULT HEALTH NURSING 2

🧠	Central Lymphoid Organs
🦴	Bone Marrow – produces all blood cells including lymphocytes
🧠	Thymus – site of T-cell maturation (T for Thymus)

🌐	Peripheral Lymphoid Organs
💚	Lymph Nodes – filter lymph, site for antigen interaction
🌊	Spleen – filters blood, removes old RBCs
👅	MALT (Mucosa-Associated Lymphoid Tissue) – tonsils, Peyer’s patches, appendix

🔬 Cell Type	🌟 Function
🧪 Lymphocytes	Key players (T-cells, B-cells, NK cells)
🧲 Macrophages	Phagocytosis & Antigen presentation
🧹 Neutrophils	First responders – phagocytosis
🚨 Basophils/Mast cells	Release histamine – allergic response
🧤 Eosinophils	Defend against parasites/allergic reactions
🧬 Dendritic cells	Bridge between innate & adaptive immunity

🧠 Adaptive Immunity	📌 Description
🧬 Humoral Immunity	B-cells → produce antibodies
⚔️ Cell-mediated Immunity	T-cells → kill infected cells directly

🔬 Cell Type	⚙️ Function
Helper T cells (CD4⁺)	🧭 Direct immune response by cytokines
Cytotoxic T cells (CD8⁺)	🗡 Destroy infected/cancerous cells
B cells	🧫 Produce antibodies (IgG, IgM, etc.)
Memory cells	🧠 Retain response for faster reaction next time

💉 Type	🔍 Function
IgG	Most abundant, crosses placenta
IgA	Mucosal immunity (saliva, tears, milk)
IgM	First antibody in infection
IgE	Allergy and parasitic defense
IgD	B-cell receptor (role unclear)

🧠 Type	📘 Example
Natural Active	Infection (e.g., chickenpox)
Natural Passive	Maternal antibodies via placenta or milk
Artificial Active	Vaccination
Artificial Passive	Immunoglobulin injection (e.g., rabies IgG)

⚠️ Disorder Type	🔍 Example
Immunodeficiency	HIV/AIDS, SCID
Autoimmunity	SLE, rheumatoid arthritis
Hypersensitivity	Allergies, asthma
Transplant Rejection	Graft-versus-host disease

🩺 NURSING ASSESSMENT IN IMMUNOLOGICAL PROBLEMS

🔹 I. Purpose of Nursing Assessment in Immunological Disorders

🧭 Identify immune dysfunction (hypoactivity or hyperactivity)
📋 Collect baseline data to compare response to treatment
📌 Recognize signs of infection, autoimmune activity, or allergic reactions
⚖ Assess impact on nutrition, skin, mobility, and mental health

📖 II. Nursing History Taking

📌 A. Demographic Data

🧑‍🤝‍🧑 Age, gender (some disorders like RA or SLE are more common in women)
🌎 Residence/occupation (exposure to environmental allergens, industrial toxins)

📌 B. Chief Complaint

⛑️ Document symptoms: fatigue, fever, joint pain, skin rashes, weight loss, infections, allergies

📌 C. History of Present Illness

🕰️ Onset, duration, and progression of current symptoms
🧾 What makes it worse or better (triggers/allergens)

📌 D. Past Medical History

⚕️ Frequent infections (e.g., pneumonia, skin abscesses)
🔄 Autoimmune diseases (SLE, rheumatoid arthritis, Hashimoto’s)
💉 History of immunizations and vaccine reactions
🧬 Family history of immunodeficiency or autoimmune diseases

📌 E. Medication History

💊 Corticosteroids, immunosuppressants, chemotherapy
🚫 Adverse drug reactions or allergies

📌 F. Nutritional History

🍎 Diet deficiencies (e.g., protein, zinc) impair immunity
🍭 Food allergies or intolerance

📌 G. Psychosocial History

💔 Stress, depression, anxiety (can lower immunity)
🧑‍🍼 Support system, coping mechanisms, social withdrawal

🩻 III. Physical Examination (Head to Toe)

1️⃣ General Appearance

😔 Fatigue, pallor, weight loss
🧊 Low-grade fever or chills (suggests ongoing infection/inflammation)

2️⃣ Skin & Mucous Membranes

🔴 Rash (butterfly rash in SLE)
🟤 Hyperpigmentation
🌵 Dryness, ulcers, delayed healing wounds
🦷 Oral ulcers, white patches (candidiasis)

3️⃣ Lymphatic System

💥 Palpate for lymphadenopathy (swollen lymph nodes – neck, axilla, groin)
🔎 Tender or non-tender nodes may indicate infection or lymphoma

4️⃣ Musculoskeletal System

🦴 Joint swelling, pain, stiffness, deformities (RA, SLE)
🔁 Reduced range of motion or fatigue with activity

5️⃣ Respiratory System

😮‍💨 Cough, dyspnea, wheezing (asthma, anaphylaxis)
🫁 Auscultation for crackles or reduced breath sounds

6️⃣ Cardiovascular System

❤️ Tachycardia, hypotension (in anaphylaxis or sepsis)
👣 Edema (SLE, nephrotic syndrome due to autoimmunity)

7️⃣ Gastrointestinal System

🍽️ Nausea, vomiting, diarrhea
🧻 Abdominal pain (autoimmune hepatitis, IBD)

8️⃣ Genitourinary System

💧 Dysuria, frequency (recurrent UTIs in immunodeficiency)
⏳ Urine output & color

9️⃣ Neurological System

🧠 Confusion, depression, headache (CNS lupus, MS)
💢 Peripheral neuropathy

🔧 IV. Nursing Management Strategies

🔹 A. Based on Findings:

📊 Monitor lab values: WBC count, CD4 count (HIV), ANA, CRP, ESR, Ig levels
🧪 Assist in diagnostic tests: skin allergy test, ELISA, biopsy

🔹 B. Symptom Management:

💊 Administer medications: steroids, antihistamines, immunosuppressants
❄️ Provide comfort: pain relief, rest, skin care
🛌 Monitor for infections and implement isolation if needed

🔹 C. Education and Counseling:

🧴 Teach skin care for autoimmune rashes
🧬 Educate about medication adherence and side effects
💉 Encourage immunization where indicated
📢 Guide avoidance of allergens or known triggers

🔹 D. Nutrition & Lifestyle Support:

🥗 Promote balanced, high-protein diet
🚭 Encourage avoidance of smoking/alcohol
🧘 Promote stress management and adequate sleep

🧠 V. Key Points to Remember

Always assess risk of infection vs. risk of autoimmune flare
Monitor for medication side effects (long-term steroids can cause Cushing’s features)
Recognize early signs of anaphylaxis or immunosuppression
Build rapport for psychological support due to chronic nature of illness

🦠 HIV & AIDS:

📘 🔹DEFINITION

🔬 HIV (Human Immunodeficiency Virus):

A retrovirus that attacks the body’s immune system, specifically the CD4⁺ T-helper cells, leading to a gradual decline in immune function.

⚠️ AIDS (Acquired Immunodeficiency Syndrome):

A late stage of HIV infection where the immune system becomes severely damaged, and the body is vulnerable to opportunistic infections and certain cancers.

🧠 Important:
Not every HIV-positive individual develops AIDS if early diagnosis and antiretroviral therapy (ART) are provided.

🧫 🔹CAUSES (Mode of Transmission)

HIV is primarily spread through direct contact with certain body fluids from an infected person:

💉 Mode	📌 Details
🩸 Blood	Transfusions with infected blood or sharing needles
🍆 Sexual Contact	Unprotected vaginal, anal, or oral sex
🤱 Mother-to-Child	During pregnancy, childbirth, or breastfeeding
💉 Needle Sharing	IV drug users sharing contaminated needles
🩹 Occupational Exposure	Needle stick injuries in healthcare settings (rare)
🧬 Infected Organ Transplant	Receiving organs/tissues from an HIV+ donor

🚫 HIV is NOT spread by:

Touching or hugging
Sharing utensils or toilets
Saliva, tears, or sweat (without blood)

🧬 🔹TYPES OF HIV

There are two major types of HIV:

1️⃣ HIV-1

🔹 Most common worldwide
🔹 More virulent and easily transmitted
🔹 Subtypes: A, B, C, D, F, G, H, J, K
🔹 Subtype B common in USA/Europe; Subtype C in India/South Africa

2️⃣ HIV-2

🔹 Less common and mostly found in West Africa
🔹 Slower disease progression
🔹 Less transmissible compared to HIV-1

🧠 Quick Comparison:

Feature	HIV-1	HIV-2
Prevalence	Worldwide	Mostly West Africa
Progression	Rapid	Slower
Infectivity	High	Lower
Response to ART	Good	May be resistant to some drugs

🔬 🔹 PATHOPHYSIOLOGY OF HIV/AIDS

🧬 Stepwise Progression:

🔗 Entry of Virus (HIV)
➤ HIV enters the body via blood, semen, vaginal secretions, or breast milk.
➤ Virus targets CD4⁺ T-helper cells (essential for immune defense).
🧫 Viral Binding & Fusion
➤ HIV uses its gp120 protein to bind to CD4 receptors.
➤ Fusion allows viral RNA to enter the host cell.
🔄 Reverse Transcription
➤ HIV’s reverse transcriptase enzyme converts viral RNA into DNA.
🧬 Integration
➤ The viral DNA integrates into the host’s DNA via integrase enzyme.
➤ Now the host cell starts producing HIV proteins.
🧪 Assembly & Release
➤ New viruses are assembled and released from the host cell, destroying it.
➤ Thousands of CD4⁺ T cells die, weakening immune response.
📉 Immune System Collapse
➤ Progressive CD4 count drops
➤ Body becomes susceptible to opportunistic infections → leads to AIDS

🧠 Key Point:
The lower the CD4 count, the weaker the immune system.

🚨 🔹 STAGES WITH SIGNS & SYMPTOMS

🌟 1. Acute HIV Infection (Seroconversion phase)

🕐 Within 2–4 weeks after infection

⚠️ Symptoms	📌 Description
🌡️ Fever	Often the first sign
🤧 Sore throat	Due to immune activation
😴 Fatigue	Common and persistent
🤕 Headache	Flu-like symptoms
🤮 Nausea, rash, diarrhea	May occur together
📈 High viral load	Very infectious at this stage

🌙 2. Chronic HIV Infection (Asymptomatic or Latent Phase)

🕐 Can last for years (7–10 years or more)

✅ Features	📌 Description
😐 No major symptoms	Person feels healthy
🔻 Gradual CD4 decline	Virus replicates silently
🧬 Persistent lymphadenopathy	Swollen lymph nodes

⛔ 3. AIDS (Late-Stage HIV)

🕐 CD4 < 200 cells/mm³ or presence of AIDS-defining illness

🩸 Symptoms	📌 Examples
🔥 Recurrent infections	TB, pneumonia, fungal infections
🌿 Opportunistic diseases	Candidiasis, Kaposi’s sarcoma
💧 Chronic diarrhea	Often persistent and debilitating
🎯 Neurological signs	Confusion, memory loss, dementia
👄 Oral thrush	White patches in mouth
😔 Weight loss	“Wasting syndrome”
🦠 Herpes, shingles	Reactivation of latent viruses

🧪 🔹 DIAGNOSIS OF HIV/AIDS

1️⃣ Screening Tests (Detect antibodies or antigens):

🧪 Test	🧬 Details
ELISA (EIA)	Detects HIV antibodies; high sensitivity
Rapid Tests	Detects antibodies or antigens (results in 15–30 mins)
Home Testing Kits	Finger-prick or oral fluid kits (e.g., OraQuick)

✅ Positive ELISA should be confirmed with another test

2️⃣ Confirmatory Tests:

🔬 Test	📌 Description
Western Blot	Detects specific HIV proteins (used after ELISA)
Immunofluorescence Assay (IFA)	Detects HIV antibodies
HIV-1/HIV-2 Differentiation Test	Identifies the type of HIV

3️⃣ Monitoring Tests (For disease progression):

📊 Test	📌 Purpose
CD4 Count	Indicates immune function.
Normal = 500–1,600 cells/mm³
AIDS = < 200 cells/mm³
Viral Load Test	Measures amount of HIV RNA in blood
Goal of ART = undetectable viral load

💊 HIV & AIDS – Medical Management

🧠 🔹Goal of Treatment:

⛔ Suppress HIV viral replication
📈 Increase & preserve CD4⁺ T-cell count
✅ Delay progression to AIDS
🦠 Prevent and treat opportunistic infections
💉 Improve quality of life and reduce transmission

🧪 🔹Main Treatment: Antiretroviral Therapy (ART)

📌 ART = Combination of 3 or more antiretroviral drugs (ARVs) from different classes, also known as HAART (Highly Active Antiretroviral Therapy)

📘 🔸Classes of Antiretroviral Drugs

🔬 Drug Class	🔍 Mechanism of Action	💊 Examples
NRTIs (Nucleoside Reverse Transcriptase Inhibitors)	Block reverse transcription	Zidovudine (AZT), Lamivudine, Abacavir
NNRTIs (Non-Nucleoside RT Inhibitors)	Bind reverse transcriptase enzyme directly	Efavirenz, Nevirapine
PIs (Protease Inhibitors)	Inhibit protease → prevent virus assembly	Lopinavir, Ritonavir
INSTIs (Integrase Strand Transfer Inhibitors)	Block viral DNA integration into host DNA	Raltegravir, Dolutegravir
Fusion Inhibitors	Prevent virus from entering the host cell	Enfuvirtide
CCR5 Antagonists	Block HIV co-receptor (CCR5) on CD4 cells	Maraviroc

💊 🔸Common First-Line ART Regimen

(As per NACO/WHO Guidelines)

Tenofovir (TDF) + Lamivudine (3TC) + Dolutegravir (DTG)
Taken as a once-daily fixed-dose combination pill

🧠 This regimen is preferred for its potency, fewer side effects, and high resistance barrier

⚠️ 🔹Monitoring During ART:

📊 Test	🧪 Purpose
CD4 count	Monitor immune status (target: >500 cells/mm³)
Viral Load	Goal: Undetectable (<50 copies/mL)
LFT, KFT	Drug toxicity monitoring
Complete Blood Count	Detect anemia/neutropenia
Adherence Monitoring	Counseling to ensure compliance

📌 🔹Prevention & Management of Opportunistic Infections (OIs)

🦠 Infection	💊 Prophylaxis / Treatment
Pneumocystis pneumonia (PCP)	Cotrimoxazole
TB (if co-infected)	Anti-TB therapy (ATT)
Candidiasis	Fluconazole
CMV Retinitis	Ganciclovir
Toxoplasmosis	Pyrimethamine + Sulfadiazine
Herpes Simplex/Zoster	Acyclovir

🧘 🔹Supportive Therapies

🥗 Nutritional support: High-protein, immune-boosting foods
💉 Vaccination: Hepatitis B, influenza, pneumococcus
🧠 Psychological counseling: Reduce depression, stigma
🧬 Family planning & safe sex practices
🚭 Avoidance of smoking, alcohol, substance abuse

🧠 Key Points:

✔ ART is lifelong – stopping it can cause resistance
✔ Adherence >95% is crucial to prevent drug resistance
✔ Early diagnosis = better prognosis
✔ ART does not cure HIV, but helps lead a near-normal life

🛠️ HIV & AIDS: Surgical Management

🔍 🔹Overview

Patients with HIV/AIDS are not typically treated with surgery for the virus itself, but they may require surgical interventions for:

Treating complications (e.g., abscesses, malignancies)
Managing opportunistic infections
Addressing HIV-related tumors
Improving quality of life (e.g., cosmetic or functional restoration)

📌 Surgery in HIV-positive patients must be carefully planned due to immunosuppression, poor wound healing, and infection risk.

🔧 🔹Common Surgical Indications in HIV/AIDS Patients

🩺 Condition	🛠️ Surgical Intervention
🦠 Abscess or Infections	Incision & drainage
🧠 Tuberculous Lymphadenitis	Excision biopsy, drainage
⚫ Kaposi’s Sarcoma	Surgical excision or laser ablation
⚠️ Lymphoma	Biopsy, debulking surgery
🩸 Perianal or rectal abscesses	Incision & drainage
🔄 Persistent or resistant infections	Debridement
🧬 Biopsies	Lymph node, skin, or mucosal lesions
👅 Oral lesions or ulcers	Excision or cauterization if persistent
🧠 Neurological complications	Surgical drainage of abscesses, shunt for hydrocephalus

🧠 🔹Precautions Before Surgery in HIV Patients

⚠️ Area	🔍 Precaution
📊 CD4 Count	Ideally >200 cells/mm³ before elective surgery
🦠 Viral Load	Should be controlled with ART
🧴 Infection Control	Strict asepsis; universal precautions
💊 ART Status	Continue ART before, during, and after surgery
💉 Prophylactic Antibiotics	To prevent surgical site infections
🩹 Wound Care	Enhanced post-op care due to poor healing
🩸 Coagulation Monitoring	Especially if patient is on medications like AZT (causes anemia)

🧪 🔹Surgical Risk Factors in HIV Patients

📉 Low CD4 count (<200 cells/mm³) → ↑ Risk of infection, poor healing
🩸 Anemia or leukopenia due to ART
🧬 Delayed wound healing
🦠 Reactivation of latent infections post-op
❗ Risk of occupational exposure for surgical staff (Needlestick injury)

💡 Surgical Team Precautions (Universal Precautions)

✔ Double gloving
✔ Face shield, masks, eye protection
✔ Safe needle disposal
✔ Use of blunt surgical instruments
✔ Immediate post-exposure prophylaxis (PEP) if exposed

🌈 Recent Advances in Surgical Care for HIV Patients

🔬 Minimally invasive techniques (laparoscopy) to reduce infection risk
🧫 Robotic-assisted surgeries in high-risk immunocompromised patients
🧴 Negative-pressure wound therapy (NPWT) to improve wound healing
⚕ Enhanced Recovery After Surgery (ERAS) protocols tailored to HIV-positive patients

🧠 Key Takeaways for Nursing Practice:

🧾 Monitor vital signs, wound site, and signs of infection post-op
💊 Ensure ART adherence and antibiotic coverage
💧 Maintain fluid-electrolyte balance
🧘‍♂️ Provide psychological support and reduce stigma
🩹 Reinforce hygiene and wound care education

👩‍⚕️ HIV & AIDS – Nursing Management

🎯 🔹Objectives of Nursing Care:

🛑 Prevent opportunistic infections
📉 Reduce viral load & monitor ART effectiveness
💊 Promote adherence to ART and medication regimens
🧠 Provide emotional, psychosocial, and nutritional support
💬 Educate about transmission prevention & healthy lifestyle

🩺 🔸I. Assessment Responsibilities

📝 Health History
- Past infections, ART history, vaccination status, exposure risks
📊 Physical Assessment
- Skin: rashes, ulcers, Kaposi’s lesions
- Oral: candidiasis, ulcers
- Lymph nodes: swelling
- Respiratory: cough, dyspnea (TB, PCP)
- GI: diarrhea, weight loss
- Neuro: confusion, depression, memory loss
📋 Monitor Lab Results
- CD4 count
- Viral load
- CBC, liver & kidney function
- Drug side effects

🩹 🔸II. Nursing Diagnoses (Common)

🧠 Diagnosis	💡 Reason
🛏 Risk for infection	Due to immune suppression
💔 Imbalanced nutrition: less than body requirements	Due to GI symptoms, poor appetite
🧠 Fatigue	Due to chronic infection
😔 Disturbed body image	Due to skin lesions or weight loss
🧘 Anxiety/Fear	Related to stigma, disease outcome
🗣️ Knowledge deficit	Related to disease process and transmission

🧰 🔸III. Interventions & Responsibilities

🦠 1. Infection Prevention

🧴 Maintain strict hand hygiene and aseptic precautions
💉 Administer prophylactic antimicrobials as prescribed
🧼 Isolate as necessary for highly contagious OIs
🌡️ Monitor temperature and signs of infection

🍎 2. Nutritional Support

🥗 Provide high-protein, high-calorie diet
💧 Encourage fluid intake
🧾 Small frequent meals if nausea or fatigue present
📉 Monitor weight and BMI regularly

💊 3. Medication Management

💉 Administer ART and other prescribed drugs on time
📘 Educate about adherence (≥95% required for success)
⚠ Monitor for side effects (e.g., nausea, hepatotoxicity, anemia)

💬 4. Education & Counseling

🚫 Teach safe sex practices and needle safety
📖 Educate about disease, ART, and infection control
🧠 Help patient understand chronic nature and importance of follow-up
💬 Involve family in supportive education (with consent)

🧠 5. Psychosocial & Emotional Support

🧘 Encourage expression of feelings
🤝 Provide non-judgmental care to reduce stigma
👨‍⚕️ Refer to social worker or counselor if needed
🧍 Promote support groups or community resources

🧍 6. Skin & Mucous Membrane Care

💧 Maintain good oral hygiene
🧴 Use gentle cleansers and moisturizers for skin
💥 Monitor for pressure ulcers or Kaposi’s sarcoma lesions

🛌 7. Energy Conservation & Activity Balance

😴 Encourage rest periods
💪 Promote mild physical activity as tolerated
🧘 Monitor for signs of fatigue and adjust care plan

📚 IV. Discharge Planning

🏥 Ensure understanding of medication schedule
📞 Plan regular follow-up visits
🛡 Encourage vaccination (Hepatitis B, Influenza, Pneumococcal)
🧑‍⚕️ Refer to community-based HIV/AIDS support services

🧠 V. Key Nursing Tips:

✅ Always use gloves & standard precautions
✅ Establish trust and therapeutic communication
✅ Respect patient’s confidentiality and autonomy
✅ Tailor teaching to individual literacy and language needs
✅ Monitor mental health and reduce social isolation

🍎 🔹 NUTRITIONAL CONSIDERATIONS

🔬 HIV/AIDS increases metabolic demands, weakens the immune system, and may cause malnutrition, which further worsens immunity.

✅ Goals of Nutrition Therapy:

🛡 Boost immunity
💪 Maintain muscle mass
⚕ Prevent nutrient deficiencies
📈 Improve quality of life and treatment tolerance

🧾 🔸 Recommended Dietary Guidelines:

🍽️ Aspect	✅ Recommendations
Calories	High-calorie diet to prevent weight loss (35–45 kcal/kg/day)
Proteins	High-protein intake (1.2–2 g/kg/day) to build immune cells and repair tissue
Fats	Moderate fat intake – avoid trans fats; prefer omega-3 fatty acids
Carbohydrates	Complex carbs preferred (whole grains, fruits, vegetables)
Micronutrients	Supplement with vitamins A, C, E, B-complex, zinc, selenium, iron
Fluids	Adequate hydration – 2 to 3 liters/day unless restricted
Probiotics	May help maintain gut health, reduce diarrhea (e.g., curd, yogurt)
Avoid	Raw/undercooked meat, unpasteurized milk, alcohol, tobacco

⚠️ Special Considerations:

📉 Monitor for wasting syndrome (severe weight and muscle loss)
💊 Interactions between ART drugs and food (some require fasting)
🤢 Manage side effects of ART: nausea, vomiting, diarrhea, anorexia
🦷 Ensure good oral hygiene – mouth ulcers can affect intake

⚠️ 🔹 COMPLICATIONS OF HIV & AIDS

📌 A. Opportunistic Infections (OIs)

Pneumocystis jiroveci pneumonia (PCP)
Tuberculosis (TB)
Candidiasis (oral/esophageal)
Toxoplasmosis
Cytomegalovirus (CMV)
Herpes Zoster

📌 B. Neurological Complications

HIV-associated neurocognitive disorder (HAND)
HIV dementia
Peripheral neuropathy
Seizures

📌 C. Malignancies

Kaposi’s Sarcoma
Non-Hodgkin’s Lymphoma
Cervical cancer (women)

📌 D. Metabolic & Systemic Complications

Wasting syndrome
Lipodystrophy (fat redistribution)
Hyperlipidemia
Diabetes mellitus
Liver and renal dysfunction

📌 E. Psychosocial Complications

Depression
Anxiety
Social stigma and isolation
Non-adherence to ART

🌟 🔹 KEY POINTS (Summary for Quick Revision)

✅ HIV targets CD4⁺ T-cells, weakening the immune system
✅ AIDS is the final stage of HIV infection
✅ ART is lifelong and must be taken with ≥95% adherence
✅ Early diagnosis + proper management = prolonged survival
✅ Malnutrition is common – needs high-protein, high-calorie diet
✅ Opportunistic infections & malignancies are major complications
✅ Nurses must ensure infection control, emotional support, and education

🌍 EPIDEMIOLOGY OF HIV & AIDS

📘 🔹DEFINITION OF EPIDEMIOLOGY

Epidemiology refers to the study of the distribution, patterns, causes, and control of diseases in populations.

📌 In the context of HIV/AIDS, it includes:

Incidence & prevalence
Modes of transmission
Affected populations
Trends & geographical distribution
Risk factors and preventive measures

📊 🔸GLOBAL EPIDEMIOLOGY (As per UNAIDS & WHO)

📅 Statistical Update (Approximate)	🌍 Global Numbers
👥 People living with HIV	~39 million worldwide
🆕 New infections per year	~1.3 million (2023)
⚰️ AIDS-related deaths/year	~630,000 deaths
💉 ART coverage (globally)	~76% of diagnosed cases

🌍 High-burden regions:

Sub-Saharan Africa (accounts for ~65–70% of all global HIV cases)
South and Southeast Asia
Eastern Europe and Central Asia (rising incidence)

🇮🇳 🔸EPIDEMIOLOGY IN INDIA (According to NACO 2023-24)

📌 Parameter	🇮🇳 India’s Status
🧑‍🤝‍🧑 Estimated people living with HIV (PLHIV)	~2.4 million
🆕 New infections/year	~63,000
⚰️ AIDS-related deaths/year	~42,000
🧬 Adult HIV prevalence	~0.21%
💉 ART coverage	~75% of diagnosed individuals on ART

🗺️ High-prevalence states in India:

Maharashtra
Andhra Pradesh
Karnataka
Telangana
Tamil Nadu
Manipur & Mizoram (highest in Northeast India)

🔍 🔸MODES OF TRANSMISSION (India-Specific %)

🚻 Mode	📊 Percentage Contribution
Unprotected heterosexual sex	~88%
Injecting drug use (IDU)	~2.6%
Homosexual/bisexual transmission	~2.4%
Parent-to-child transmission	~2.3%
Blood transfusion	<0.1% (due to strict screening protocols)

🔐 🔸KEY RISK FACTORS

🔹 Unprotected sex (especially multiple partners)
🔹 Injecting drug use with shared needles
🔹 Infected mother-to-child transmission
🔹 STDs (increase susceptibility)
🔹 Lack of awareness & education
🔹 Social stigma → Delayed testing and treatment
🔹 Poor access to healthcare services

🚨 🔸VULNERABLE POPULATIONS (High-Risk Groups)

👥 Group	⚠️ Risk Reason
Female sex workers (FSWs)	Multiple partners, limited condom use
Men who have sex with men (MSM)	Higher mucosal transmission risk
Transgender persons	Social stigma, poor healthcare access
Injecting drug users (IDUs)	Needle sharing
Migrant workers	Limited awareness, high-risk behavior
Adolescents and youth	Inadequate sex education
Pregnant women (PMTCT cases)	Risk of vertical transmission

🛡️ 🔸PREVENTION STRATEGIES (National & Global)

✅ ABC Strategy – Abstinence, Be faithful, Condom use
✅ ART (Antiretroviral Therapy) for all diagnosed
✅ PrEP & PEP – Pre- and Post-Exposure Prophylaxis
✅ Safe blood transfusion practices
✅ Harm-reduction programs for IDUs
✅ Mother-to-child transmission prevention (free ART during pregnancy)
✅ Awareness campaigns through NACO, WHO, NGOs
✅ HIV testing and counseling centers (ICTCs)

🧠 🔹KEY POINTS TO REMEMBER

✔ HIV/AIDS remains a global pandemic with regional differences
✔ Highest burden in Sub-Saharan Africa & Southeast Asia
✔ In India, heterosexual transmission is the leading mode
✔ Focused interventions are essential for high-risk groups
✔ Early detection, ART access, education & de-stigmatization are crucial

🔁 TRANSMISSION & PREVENTION OF TRANSMISSION OF HIV

🦠 🔹 MODES OF HIV TRANSMISSION

HIV (Human Immunodeficiency Virus) is transmitted when infected body fluids come in direct contact with another person’s bloodstream or mucous membranes.

📌 Major Body Fluids that Transmit HIV:

🩸 Blood
🧬 Semen and pre-seminal fluid
💦 Vaginal fluids
🌬️ Rectal fluids
🍼 Breast milk

✅ Saliva, sweat, tears, or urine do NOT transmit HIV unless visibly mixed with blood.

📊 🔸 MAIN ROUTES OF TRANSMISSION

🧪 Mode	🔍 Description
🍆 Unprotected Sexual Contact	Vaginal, anal, or oral sex with an HIV-positive person without using a condom
💉 Sharing Needles/Syringes	Among IV drug users, tattooing, or piercing with unsterilized tools
🤱 Mother-to-Child (Vertical Transmission)	During pregnancy, childbirth, or breastfeeding
🩸 Transfusion of Infected Blood	Rare in modern healthcare due to strict screening
🩹 Occupational Exposure	Accidental needle-stick injuries in healthcare workers
🧬 Organ/Tissue Transplantation	If donor is HIV positive (rare with current testing protocols)

🚫 🔸 HIV is NOT spread by:

❌ Touching, hugging, or shaking hands
❌ Sharing food, utensils, or toilets
❌ Mosquito bites
❌ Coughing or sneezing
❌ Using the same swimming pool or gym

🛡️ PREVENTION OF HIV TRANSMISSION

🔸 I. General Preventive Strategies

🧭 Strategy	📌 Details
✅ Use of Condoms	Always use male or female condoms correctly during intercourse
✅ HIV Testing & Counseling	Regular testing for early detection & prevention
✅ Monogamous Relationship	Reduce number of sexual partners
✅ Education & Awareness	Promote knowledge on HIV, safe sex, and transmission routes
✅ Screening of Blood/Organs	Mandatory testing before transfusion or donation
✅ Sterile Medical Equipment	Use disposable needles, safe surgical practices

🔸 II. Prevention in Special Populations

🔹 A. Injecting Drug Users (IDUs)

🧼 Needle exchange programs
💊 Opioid substitution therapy (e.g., Methadone)
📢 Behavioral counseling

🔹 B. Mother-to-Child Transmission (MTCT)

🤰 HIV testing during pregnancy
💊 Antiretroviral therapy (ART) for mother
🍼 Avoidance of breastfeeding if safe alternatives available
👶 ART for the newborn within 72 hours
🧬 Safe delivery methods (C-section if viral load high)

🔹 C. Healthcare Workers

🧤 Use Personal Protective Equipment (PPE)
🩹 Careful needle disposal (sharps containers)
🧪 Post-Exposure Prophylaxis (PEP) within 72 hours if exposed

🔸 III. Medical Prophylaxis Strategies

💊 Strategy	📘 Description
ART (Antiretroviral Therapy)	Reduces viral load in HIV-positive persons, preventing transmission (U=U)
PrEP (Pre-Exposure Prophylaxis)	Daily pill (e.g., Tenofovir + Emtricitabine) for high-risk HIV-negative individuals
PEP (Post-Exposure Prophylaxis)	Emergency ART within 72 hours of possible exposure, continued for 28 days

🔔 Key Preventive Programs in India (Under NACO):

🚻 ICTC – Integrated Counseling and Testing Centres
💊 ART centres – Free antiretroviral drugs
🧬 PPTCT – Prevention of Parent to Child Transmission
📚 Awareness campaigns: Red Ribbon Express, school-based education
💉 Blood Safety Program: 100% screening of donated blood

📌 KEY POINTS TO REMEMBER

✔ HIV is transmitted through specific body fluids, not casual contact
✔ Sexual contact remains the most common route of transmission
✔ Consistent condom use, education, and ART adherence reduce risk
✔ Prevention of mother-to-child transmission (PMTCT) is highly successful
✔ PEP & PrEP are crucial for high-risk individuals
✔ Stigma reduction and open discussion promote prevention

👩‍⚕️ ROLE OF THE NURSE IN HIV & AIDS CARE

(Counseling, Health Education, and Home Care Considerations)

🧠 I. ROLE OF NURSE IN COUNSELING

Nursing counseling in HIV/AIDS involves emotional support, guidance, and therapeutic communication to help the patient and their family cope with the physical, psychological, and social aspects of the disease.

🔹 1. Pre-Test Counseling

📋 Explain the purpose, procedure, and implications of HIV testing
🧘 Alleviate fear or anxiety related to test results
🤐 Ensure confidentiality and informed consent
💡 Assess risk behavior and knowledge levels

🔹 2. Post-Test Counseling

✅ For HIV-negative clients: reinforce prevention, safe practices, and need for repeat testing if at risk
❗ For HIV-positive clients:
- Help them accept the diagnosis
- Provide emotional and psychological support
- Explain the chronic nature of the disease
- Discuss treatment options (ART initiation)
- Educate on transmission prevention
- Address stigma and discrimination concerns

🔹 3. Family and Partner Counseling

👨‍👩‍👧 Support disclosure of status to family or sexual partner
💑 Encourage partner testing and safe sex practices
👶 Counsel pregnant women on PMTCT (Prevention of Mother-to-Child Transmission)

🔹 4. Adherence Counseling

💊 Educate about importance of ≥95% ART adherence
⏰ Support strategies like setting alarms, using pill boxes
⚠ Help manage side effects and promote follow-up visits

📚 II. ROLE OF NURSE IN HEALTH EDUCATION

Health education empowers individuals with knowledge, attitudes, and practices to live healthier and prevent transmission.

🔹 1. Patient-Centered Education

🧬 Basic understanding of HIV/AIDS, its transmission & non-transmission routes
📉 Importance of early ART initiation and regular CD4/viral load monitoring
🍲 Nutrition advice – high-protein, high-calorie diet
📌 Importance of safe sex, condom use, and reproductive health

🔹 2. Community Education

🏘 Conduct awareness programs in schools, colleges, slums, and workplaces
📢 Use of IEC (Information, Education, Communication) materials – posters, pamphlets, Red Ribbon campaigns
🚫 Promote anti-stigma campaigns and fight discrimination
📺 Utilize media platforms – TV, radio, social media for public messages

🔹 3. Targeted Interventions

👥 Educate high-risk groups: MSM, IDUs, FSWs, truck drivers, prisoners
🧪 Promote HIV testing, safe practices, and PrEP/PEP use
👩‍⚕️ Encourage early treatment-seeking behavior and peer education

🏡 III. ROLE OF NURSE IN HOME CARE CONSIDERATIONS

As HIV is a chronic condition, home care plays a key role in maintaining quality of life and preventing complications.

🔹 1. Home Environment Assessment

🏠 Ensure hygienic living conditions
🍽 Proper storage/preparation of food to prevent infections
🧴 Safe waste disposal of bodily fluids (vomit, feces, etc.)

🔹 2. Health Monitoring

🌡 Monitor temperature, weight, oral ulcers, skin lesions
💊 Ensure ART adherence and symptom reporting
📈 Support routine lab visits (CD4 count, viral load)

🔹 3. Caregiver Education

🧼 Teach infection control measures at home (glove use, hand hygiene)
💊 ART schedule, medication side-effect management
🛏 Pressure sore prevention in bed-ridden clients
🤕 First aid for minor ailments or opportunistic infections

🔹 4. Emotional and Social Support

🤝 Encourage participation in support groups
📞 Provide contact for helplines and NGO-based care
💌 Reduce social isolation through community involvement

🔹 5. Palliative & End-of-Life Care (if needed)

🕯️ Provide comfort care in advanced cases
🌹 Pain relief, oxygen support, emotional/spiritual counseling
💬 Respect patient wishes and provide dignity in dying

🌟 KEY POINTS FOR NURSES:

✔ Maintain confidentiality at all levels
✔ Use non-judgmental and empathetic communication
✔ Be a link between the patient and other services (social, nutritional, medical)
✔ Encourage positive living with HIV – treatment, relationships, employment
✔ Address stigma, myths, and discrimination
✔ Promote ART adherence, healthy habits, and hope

National AIDS Control Programme (NACP) – India

🏛️ Overview

Established: 1992
Governing Body: National AIDS Control Organization (NACO), under the Ministry of Health & Family Welfare, Government of India
Objective: To prevent and control the spread of HIV/AIDS and provide comprehensive care and support to those affected
Implementation: Through State AIDS Control Societies (SACS) and District AIDS Prevention and Control Units (DAPCUs)Wikipedia+1Wikipedia+1

📈 Evolution of NACP

NACP Phase I (1992–1999)

Focus: Awareness generation, establishing surveillance systems, ensuring safe blood transfusion services, and initiating targeted interventions for high-risk groups
Achievements: Set up of blood safety protocols and initial HIV surveillance mechanisms naco.gov.in naco.gov.in+2Wikipedia+2Wikipedia+2

NACP Phase II (1999–2006)

Focus: Behavioral change communication, expansion of targeted interventions, and introduction of care and support services
Achievements: Launch of Prevention of Parent-to-Child Transmission (PPTCT) program and establishment of Antiretroviral Therapy (ART) centers

NACP Phase III (2007–2012)

Focus: Halting and reversing the HIV epidemic through saturation of coverage among high-risk groups and integration of services
Achievements: Scale-up of ART services, integration with National Rural Health Mission (NRHM), and enhanced focus on marginalized populations

NACP Phase IV (2012–2017)

Focus: Consolidation of gains, acceleration of response, and strengthening of systems
Achievements: Implementation of the ‘Test and Treat’ policy, expansion of community-based testing, and increased ART coverage PMC+1WHO Extranet+1 naco.gov.in+2naco.gov.in+2PrEPWatch+2

NACP Phase V (2021–2026)

Focus: Achieving Sustainable Development Goal 3.3 – ending the HIV/AIDS epidemic as a public health threat by 2030
Key Objectives:
- Reduce new HIV infections and AIDS-related deaths by 80% from 2010 baseline
- Achieve 95-95-95 targets:
  - 95% of people living with HIV know their status
  - 95% of those diagnosed receive sustained ART
  - 95% of those on ART achieve viral suppression
- Eliminate vertical transmission of HIV and syphilis
- Reduce HIV/AIDS-related stigma and discrimination
- Promote universal access to quality STI/RTI services Maharashtra State AIDS Control Society+1naco.gov.in+1 Wikipedia+3naco.gov.in+3gsacsonline.org+3

🧰 Key Strategies and Initiatives

Sampoorna Suraksha Kendras (SSK): One-stop centers providing prevention, testing, treatment, and care services for at-risk populations
Community-Based Screening: Enhancing early detection through outreach programs
Mission Sampark: Re-engaging people lost to follow-up in HIV care
Integration with Other Health Programs: Collaborating with TB, Hepatitis, and reproductive health services for comprehensive care
Legal Framework: Implementation of the HIV and AIDS (Prevention and Control) Act, 2017, ensuring the rights of people living with HIV naco.gov.in+1PrEPWatch+1

📊 Monitoring and Evaluation

Strategic Information Management System (SIMS): For data collection, analysis, and dissemination
Regular Surveillance: Conducting HIV Sentinel Surveillance and Integrated Biological and Behavioral Surveillance
Research and Evaluation: Undertaking operational research to inform policy and program decisions

🤝 Partnerships and Collaborations

International Agencies: Collaboration with UNAIDS, WHO, World Bank, and Global Fund
Non-Governmental Organizations (NGOs): Engaging NGOs for targeted interventions and community mobilization
Private Sector: Involving private healthcare providers in service delivery and awareness campaigns Wikipedia+1naco.gov.in+1

📝 Conclusion

The National AIDS Control Programme has evolved over the years to address the changing dynamics of the HIV/AIDS epidemic in India. Through its multi-pronged approach encompassing prevention, care, support, and treatment, NACP aims to achieve an AIDS-free India by 2030.

VARIOUS NATIONAL AGENCIES FOR HIV/AIDS IN INDIA

🏛️ 1. National AIDS Control Organization (NACO)

📍 Established: 1992

🏢 Under: Ministry of Health & Family Welfare, Government of India

🎯 Objective: To lead the national response to HIV/AIDS epidemic in India

✅ Key Functions:

Formulation and implementation of National AIDS Control Programme (NACP)
Monitoring and evaluating ART, blood safety, STI/RTI management, and preventive services
Setting up ART Centres, ICTCs, STI Clinics, PPTCT programs
Collaborating with NGOs, civil society, and international partners
Managing National HIV Surveillance System

🔗 naco.gov.in

🧪 2. Indian Council of Medical Research (ICMR) – Division of Epidemiology & Communicable Diseases

🧠 Role in HIV/AIDS:

Conducts biomedical research in the field of HIV/AIDS
Supports HIV vaccine development, diagnostics, and operational research
Collaborates with NACO and WHO for national HIV/AIDS research policies
Operates the National AIDS Research Institute (NARI)

🔬 Key Institute:

NARI (National AIDS Research Institute), Pune
➤ Leading research institute focused on HIV prevention, epidemiology, and treatment studies

🔗 icmr.gov.in

💉 3. National Health Mission (NHM)

🏥 Under: Ministry of Health & Family Welfare

🔄 Integration with NACP:

NHM helps integrate HIV/AIDS services (ART, counseling, STI treatment) with primary health care

✅ Key Contributions:

Strengthening rural and urban health infrastructure
Supporting Reproductive and Child Health (RCH) programs that include PMTCT services
Funding and support to District AIDS Prevention and Control Units (DAPCUs)

🔗 nhm.gov.in

💉 4. National Blood Transfusion Council (NBTC)

🩸 Role: Ensures safe blood transfusion services in India

✅ Key Responsibilities:

Enforces 100% screening of donated blood for HIV, HBV, HCV, etc.
Develops blood bank standards and protocols
Works with State Blood Transfusion Councils (SBTCs)
Partners with NACO for blood safety programs

🔗 naco.gov.in

🧬 5. State AIDS Control Societies (SACS)

🗺️ Functioning under NACO, each Indian state and union territory has its own SACS (e.g., GSACS – Gujarat State AIDS Control Society)

✅ Key Roles:

Implementing NACP at the state level
Coordinating with NGOs, hospitals, medical colleges
Managing ART centres, STI clinics, ICTCs, Blood Banks
Conducting IEC (Information Education Communication) campaigns

🧑‍⚕️ 6. Medical Colleges & Hospitals (Under DHR/MoHFW)

Act as ART Centres, Testing Sites, and STI clinics
Provide training for healthcare providers on HIV/AIDS management
Support HIV testing and counseling services through ICTCs (Integrated Counseling and Testing Centres)

📢 7. National Institute of Health & Family Welfare (NIHFW)

📚 Role:

Provides academic training and capacity-building for healthcare workers on HIV/AIDS
Develops health education materials and distance learning programs related to HIV prevention and care
Collaborates with NACO and NHM

🔗 nihfw.org

🧩 8. National Tuberculosis Elimination Program (NTEP)

🔄 Link with HIV/AIDS:

Focuses on HIV-TB co-infection management
Offers bidirectional screening: All TB patients are tested for HIV and vice versa
Integrated care model between NACO and NTEP programs

🔗 tbcindia.gov.in

👫 9. NGOs and Community-Based Organizations (CBOs)

NACO partners with more than 2000 NGOs and CBOs to reach high-risk and marginalized groups.

🧡 Roles:

Implement targeted interventions (TIs) for:
- Female sex workers (FSWs)
- Men who have sex with men (MSMs)
- Injecting drug users (IDUs)
- Transgender persons
Provide:
- Community outreach
- Peer education
- Condom distribution
- ART adherence support
- Anti-stigma education

✅ Examples: Naz Foundation, SAATHII, CARE India

🤝 Collaborative Agencies (Govt + Non-Govt):

Department of Women and Child Development – HIV+ orphans & children care
Department of Social Justice – HIV services for drug users & transgender persons
Ministry of Labour – HIV workplace policies
National Rural Livelihood Mission (NRLM) – Livelihood support for PLHIV
School Health Programs – HIV awareness among adolescents

🌟 KEY POINTS TO REMEMBER

✔ NACO is the apex national agency under the MoHFW for HIV/AIDS control
✔ SACS and DAPCUs ensure state/district-level program execution
✔ ICMR–NARI, NIHFW, and NBTC support research, training, and blood safety
✔ NHM helps integrate HIV services with mainstream healthcare
✔ NGOs and CBOs are essential for reaching vulnerable populations

🌐 VARIOUS INTERNATIONAL AGENCIES FOR HIV/AIDS:

🏛️ 1. UNAIDS (Joint United Nations Programme on HIV/AIDS)

📍 Established: 1996

🌍 Headquarters: Geneva, Switzerland

🎯 Objective: To lead and inspire the global effort to end AIDS as a public health threat by 2030.

✅ Key Functions:

Coordinating the HIV/AIDS response across 11 UN organizations
Publishing global data and strategic reports on HIV/AIDS
Supporting countries in achieving 95-95-95 targets
Advocacy for universal access to ART
Promoting rights-based and gender-sensitive HIV policies

🧭 Member Organizations Include:

WHO, UNICEF, UNDP, UNFPA, UNESCO, World Bank, ILO, UN Women, WFP, UNHCR, and UNODC

🔗 www.unaids.org

🩺 2. WHO (World Health Organization)

📍 Headquarters: Geneva, Switzerland

🎯 Role in HIV/AIDS:

Develops global HIV treatment guidelines (ART, PrEP, PEP)
Provides technical assistance to countries for prevention, testing, and care
Supports HIV surveillance and research
Promotes integrated HIV, TB, Hepatitis, and STI services
Addresses HIV as part of Universal Health Coverage (UHC)

📝 Publishes:

Global HIV reports
Treatment and prevention toolkits
Monitoring & evaluation frameworks

🔗 www.who.int/hiv

💰 3. The Global Fund to Fight AIDS, Tuberculosis and Malaria

📍 Established: 2002

🌍 HQ: Geneva, Switzerland

💸 Objective: Mobilize and invest resources to end epidemics of AIDS, TB, and malaria.

✅ Contributions:

Provides funding for ART programs, testing, and prevention
Supports countries like India through grants for national programs (e.g., NACO)
Ensures procurement of HIV test kits, medicines, and lab equipment
Promotes community health system strengthening and civil society engagement

🔗 www.theglobalfund.org

👶 4. UNICEF (United Nations Children’s Fund)

📍 Headquarters: New York, USA

👶 Role in HIV/AIDS:

Focuses on HIV prevention in children, adolescents, and pregnant women
Supports PMTCT (Prevention of Mother-to-Child Transmission)
Ensures access to HIV services for orphans and vulnerable children
Provides life skills education for adolescents to prevent new infections
Integrates HIV education into school programs and health campaigns

🔗 www.unicef.org

🏦 5. The World Bank

🎯 Role in HIV/AIDS:

Provides financial assistance, loans, and technical support to developing nations
Supports countries in health system strengthening and HIV-related poverty alleviation
Invests in impact assessment studies, capacity-building, and data-driven policy reform
Helped launch MAP (Multi-country AIDS Program) in Africa and Asia

🔗 www.worldbank.org

👨‍⚕️ 6. PEPFAR (U.S. President’s Emergency Plan for AIDS Relief)

📍 Launched: 2003 by the U.S. Government

🌐 Operates in 50+ countries

🎯 Goal: To provide emergency support for countries hardest hit by HIV/AIDS

✅ Achievements:

Largest commitment by any nation for a single disease
Has saved over 25 million lives globally
Supports free ART to over 20 million people
Implements gender-sensitive and youth-focused HIV programs

🔗 www.pepfar.gov

🧬 7. International AIDS Society (IAS)

📍 Headquarters: Geneva, Switzerland

🎓 Role:

Conducts global HIV/AIDS scientific conferences (e.g., International AIDS Conference)
Promotes HIV research, vaccine development, and policy translation
Supports clinical trials, cure research, and stigma reduction studies

🔗 www.iasociety.org

🏥 8. Médecins Sans Frontières (MSF – Doctors Without Borders)

📍 Independent, international humanitarian organization

🌍 Present in over 70 countries

✅ Contributions to HIV/AIDS:

Provides ART and care in resource-poor settings
Operates in conflict zones and refugee camps
Pioneered community-based ART distribution models
Supports viral load testing access in rural regions

🔗 www.msf.org

🤝 9. International Planned Parenthood Federation (IPPF)

📍 Global NGO working in reproductive and sexual health

🎯 Role in HIV:

Provides HIV testing, counseling, and condom distribution
Offers services to marginalized groups: sex workers, LGBTQ+, youth
Advocates for rights-based, non-discriminatory HIV policies

🔗 www.ippf.org

📚 10. GAVI – The Vaccine Alliance

Though not focused exclusively on HIV, GAVI helps:
- Strengthen immunization systems (important for HIV-affected children)
- Support the integration of HIV, TB, and immunization services

🔗 www.gavi.org

🧠 KEY POINTS TO REMEMBER

✔ International agencies play a vital role in funding, research, advocacy, and service delivery for HIV/AIDS control
✔ UNAIDS and WHO lead the global HIV strategy and policy
✔ The Global Fund and PEPFAR are the largest donors for HIV/AIDS programs worldwide
✔ UNICEF and MSF provide grassroots-level service delivery for women, children, and vulnerable populations
✔ These agencies partner with national governments, NGOs, and communities to build a comprehensive HIV response

🦠 INFECTION CONTROL PROGRAMME RELATED TO HIV/AIDS

📘 🔹Definition of Infection Control Programme

An Infection Control Programme includes policies, procedures, and practices aimed at preventing the transmission of infectious agents such as HIV in healthcare, community, and household settings. For HIV/AIDS, it focuses on universal precautions, safe practices, education, and monitoring to prevent spread.

🧭 OBJECTIVES OF HIV INFECTION CONTROL PROGRAMME

🛑 Prevent occupational exposure to HIV among healthcare workers
🔐 Minimize nosocomial (hospital-acquired) HIV transmission
🚫 Prevent community and vertical transmission
📈 Ensure safe blood and blood products
🎯 Promote universal precautions and safety culture
📚 Educate health workers, patients, and families about HIV prevention strategies

🩺 KEY COMPONENTS OF HIV INFECTION CONTROL PROGRAMME

🔸 1. Universal Precautions

Universal precautions treat all blood and body fluids as potentially infectious.

✅ Key Practices:

🧤 Wear gloves, mask, goggles for procedures with exposure risk
💉 Use disposable/single-use syringes and needles
🚮 Dispose of sharps in puncture-proof containers
🧼 Hand hygiene before/after patient contact
🧴 Disinfect surfaces and instruments
🧥 Use PPE (personal protective equipment) appropriately

🔸 2. Standard Operating Procedures (SOPs)

Healthcare institutions follow SOPs for:

Safe handling of blood, secretions, and bodily fluids
Environmental cleaning (beds, instruments, operation theatre)
Sterilization of medical equipment
Safe injection and infusion practices
Biomedical waste management as per BMW Rules, 2016

🔸 3. Post-Exposure Prophylaxis (PEP)

PEP is a key part of HIV infection control for healthcare workers.

💥 Situation	📌 Protocol
Needle-stick injury, blood splash, or mucosal exposure to HIV+ fluids	Start PEP within 72 hours
🔄 Regimen	3-drug ART (e.g., Tenofovir + Lamivudine + Dolutegravir) for 28 days
🧪 Monitoring	Baseline and follow-up HIV testing at 6 weeks, 3 months, and 6 months

🔸 4. Safe Blood Transfusion Practices

✅ Mandatory 100% screening of blood for:

HIV 1 & 2
Hepatitis B and C
Syphilis
Malaria

✅ Follow guidelines of the National Blood Transfusion Council (NBTC)

🔸 5. Infection Control in Special Populations

👶 Group	🛡 Strategy
Pregnant HIV+ Women	ART + Safe delivery practices + No breastfeeding if alternatives available
Infants Born to HIV+ Mothers	ART prophylaxis for baby + Early infant diagnosis
Sexually Active Adults	Promote condom use + STI management + Education
IDUs (Injecting Drug Users)	Needle exchange programs + Harm reduction strategies

🔸 6. Health Worker Education & Training

📚 Train healthcare workers on infection control protocols
🩺 Simulation exercises for needle stick prevention
🧠 Promote non-discriminatory care practices
💬 Counseling and awareness on stigma reduction

🔸 7. Monitoring and Surveillance

📊 Continuous reporting of needle-stick injuries
🧾 Internal audits and compliance checks
📈 National HIV surveillance via NACO and ICMR-NARI
📘 Documentation of PEP administration and ART follow-up

🔸 8. Integration with Other Programs

🧬 Link HIV infection control with TB control, STI/RTI services, and maternal health programs
🔄 Referral system for HIV+ cases identified in hospitals or community

🌍 NATIONAL SUPPORTIVE PROGRAMS

🏢 Agency	💡 Contribution
NACO	Guidelines for HIV infection control & PEP
SACS	State-level training and ART implementation
NHM	Integration with primary healthcare
National Blood Safety Programme	Ensures safe transfusions
ICTCs & ART Centers	Entry points for prevention, testing, and care

✅ KEY POINTS TO REMEMBER

✔ HIV is not spread by casual contact—focus is on blood, sexual, and vertical transmission
✔ Universal precautions must be followed in all healthcare settings
✔ PEP is effective if started within 72 hours
✔ Infection control programs reduce HIV transmission to zero in healthcare settings if strictly followed
✔ Continuous training, awareness, and monitoring are crucial

🧘‍♂️ REHABILITATION IN HIV & AIDS

📘 🔹Definition of Rehabilitation in HIV/AIDS

Rehabilitation for HIV/AIDS refers to a comprehensive and continuous process that helps restore, maintain, and improve the physical, emotional, social, and occupational functioning of individuals living with HIV/AIDS (PLHIV), especially as the disease progresses or complications arise.

🎯 OBJECTIVES OF HIV/AIDS REHABILITATION

🛡️ Maintain independence and functional capacity
🧠 Address mental and emotional well-being
💪 Strengthen physical health and reduce disability
💼 Enable return to meaningful occupation and societal participation
👨‍👩‍👧 Improve quality of life and reduce stigma

🧰 COMPONENTS OF REHABILITATION IN HIV/AIDS

🔸 I. Physical Rehabilitation

✔ Required for PLHIV experiencing:

Muscle weakness
Neuropathy
Wasting syndrome
Functional limitations due to opportunistic infections

✅ Strategies Include:

🏋️‍♂️ Physiotherapy and graded exercise programs
🧘 Yoga, breathing techniques, stretching
🩺 Pain management techniques
🧬 Nutrition rehabilitation (high-protein diet, supplements)
🚶 Mobility aids (e.g., walkers, orthotic support)

🔸 II. Psychological Rehabilitation

✔ PLHIV often face:

Depression, anxiety
Fear of stigma or death
Cognitive impairments (e.g., HIV-associated neurocognitive disorder – HAND)

✅ Approaches:

🧠 Individual or group counseling
💬 Cognitive-behavioral therapy (CBT)
🧘 Stress reduction techniques (meditation, mindfulness)
👫 Peer support groups
💊 Psychiatric referrals if needed (for major depression, psychosis)

🔸 III. Social Rehabilitation

✔ Challenges include:

Social rejection and discrimination
Family disintegration
Loss of social roles and identity

✅ Interventions:

👨‍👩‍👧 Family education & involvement
🏘 Reintegration into community & social groups
💖 Anti-stigma campaigns and awareness programs
🧑‍⚕️ Social worker interventions and follow-up visits
🔗 Linkages with NGOs and community-based organizations

🔸 IV. Vocational Rehabilitation

✔ PLHIV may suffer loss of job or income due to stigma or physical limitations.

✅ Supportive Steps:

💼 Vocational counseling and career planning
🛠️ Skill training or retraining for new professions
💻 Work-from-home or flexible job options
🤝 Job placement support through NGOs
📜 Legal aid for workplace discrimination

🔸 V. Community-Based Rehabilitation (CBR)

CBR focuses on utilizing local community resources to support PLHIV in their environment.

✅ CBR Includes:

🧑‍⚕️ Home-based care models
🛡 Local health volunteers/ASHAs trained in HIV care
📚 Awareness and education sessions in villages or slums
💊 Mobile ART distribution in remote areas
🏘 Participation in SHGs (Self Help Groups), cooperatives

🧑‍⚕️ ROLE OF NURSES IN HIV REHABILITATION

📌 Area	🧩 Role
🧠 Psychological	Provide counseling, reduce fear, encourage expression
🧴 Physical	Encourage mobility, assess fatigue, assist with rehab exercise
💬 Social	Educate family, advocate against stigma
🛠 Vocational	Motivate skill building, refer for training
📋 Follow-up	Monitor drug adherence, nutritional intake, functional status
🤝 Coordination	Collaborate with physiotherapists, psychologists, social workers

🧠 KEY CHALLENGES IN HIV REHABILITATION

❌ Stigma and discrimination from society/employers
📉 Low awareness and access to rehabilitation services in rural areas
💰 Financial constraints limiting treatment and follow-up
😷 Physical limitations due to opportunistic infections or comorbidities
⏳ Lack of trained rehab personnel for chronic HIV cases

🌟 KEY POINTS TO REMEMBER

✔ Rehabilitation must be individualized and holistic
✔ Covers physical, psychological, social, vocational, and community aspects
✔ Early rehabilitation improves quality of life and life expectancy
✔ Nurses play a central role in coordination, care, and education
✔ Involvement of family, community, and NGOs enhances success

💉 PEP – POST-EXPOSURE PROPHYLAXIS

📘 🔹DEFINITION

Post-Exposure Prophylaxis (PEP) refers to the short-term antiretroviral treatment given to a person after potential exposure to HIV to prevent seroconversion (i.e., becoming HIV-positive).

📌 It is a medical emergency, and the treatment must begin within 72 hours of exposure.

🎯 🔹OBJECTIVES OF PEP

⛔ Prevent establishment of HIV infection after accidental exposure
🧬 Inhibit viral replication during the early window period
🩺 Protect healthcare workers, victims of sexual assault, and others at risk

🦠 🔸INDICATIONS FOR PEP

PEP is recommended when there is a substantial risk of HIV transmission, such as:

📍 Situation	🔍 Details
💉 Occupational exposure	Needle-stick injury, blood splash into eyes/nose/mouth, exposure to broken skin from HIV+ source
💔 Non-occupational exposure	Unprotected sex, condom breakage, sharing of needles, sexual assault
🤰 Pregnant woman exposed	To prevent vertical transmission if recently exposed
🧑‍⚕️ Healthcare providers	Accidental injury during care of known or suspected HIV+ patients

🕒 🔸TIME FRAME

⏳ PEP must be initiated within 72 hours (3 days) of exposure.
⏱️ The sooner, the better – ideally within 2 hours.

❌ PEP is not effective if started after 72 hours.

💊 🔸PEP REGIMEN

According to NACO and WHO guidelines:

🧪 Drug	📌 Dosage
Tenofovir Disoproxil Fumarate (TDF) – 300 mg	Once daily
Lamivudine (3TC) – 300 mg	Once daily
Dolutegravir (DTG) – 50 mg	Once daily

📅 Duration: 28 days (4 weeks)
✅ Can be given as a fixed-dose combination tablet in many settings

🧪 🔸INVESTIGATIONS BEFORE AND AFTER PEP

🔬 Baseline Testing (Before Starting PEP):

HIV antibody test (ELISA or Rapid)
Liver function test (LFT)
Renal function test (RFT)
CBC
Hepatitis B & C screening
Pregnancy test (if applicable)

🧾 Follow-up HIV Testing:

At 6 weeks
At 3 months (12 weeks)
At 6 months (optional in some guidelines)

👨‍⚕️ 🔸MONITORING DURING PEP

🎯 Adherence to daily medication
💊 Side effects (nausea, headache, fatigue)
⚠ LFTs and RFTs if patient develops symptoms of toxicity
🧠 Emotional/psychological support (especially after assault or high-anxiety events)

🧠 🔸ROLE OF NURSE IN PEP MANAGEMENT

🎓 Nursing Responsibility	💡 Description
🛑 Risk assessment	Identify exposure type, HIV status of source
⏱ Immediate action	Clean wound, refer for PEP initiation
📋 Documentation	Record exposure details, consent, regimen
💊 Drug administration	Educate about ART dosage and adherence
🤝 Counseling	Reduce anxiety, stigma, promote testing
📞 Follow-up	Schedule HIV tests and monitor drug compliance

❌ WHEN PEP IS NOT REQUIRED

🤝 Casual contact (hugging, handshakes)
🧼 Exposure to intact skin
💧 Contact with non-blood body fluids (saliva, urine, sweat) unless visibly mixed with blood
🧫 Source confirmed to be HIV-negative

⚠️ PRECAUTIONS DURING PEP

Do not donate blood or body tissues
Use condoms consistently
Avoid breastfeeding (if applicable)
Monitor and report any side effects
Continue safer practices until follow-up tests are clear

🧠 KEY POINTS TO REMEMBER

✔ PEP is not 100% effective, but highly successful when started early
✔ Must be initiated within 72 hours
✔ Full 28-day course is necessary
✔ Always do follow-up HIV testing
✔ Nurses play a crucial role in counseling, administration, and support

Published April 19, 2025By mynursingapp

Categorized as Uncategorised

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