How can we improve the provision of high quality care?     Join the Quality & Safety Community

Ever since HIV/AIDS was first discovered more than 30 years ago, advancements have been made to prevent the spread of the disease and help patients infected with HIV live longer and more productive lives. The development of antiretroviral drugs has significantly changed the perception of HIV/AIDS from a very fatal to a chronic and potentially manageable disease, and the availability and administration of antiretroviral therapy (ART) has significantly reduced mortality and morbidity associated with HIV and AIDS.
However, due to several factors surrounding the health of PLWH/A, there is late presentation at the HIV/AIDS treatment centers where patients present in critical health states. In Uganda, it is common practice to refer such patients to nearby health Units for "further management". Usually, this creates a gap in the continuum of care progressing to unprecedented mortality among HIV Patients. There are mixed feelings about managing emergencies since there are usually overwhelming numbers at a daily clinic attendance.
Does anyone have links to any resources that can help me design a policy for emergency HIV/AIDS care.

Emmanuel Byaruhanga
MUST Research Collaboration
Mbarara- Uganda

Moses Bateganya
Replied at 8:59 AM, 18 Jul 2013

Hi Emmanuel,
You raise a very important issue of management of HIV in the emergency department. Rather than developing a policy I would suggest you develop a series of SOPs for several steps including Testing in the ED: lots if resources to adapt from the National ED Testing consortium in the US. Other SOPs can include one on Triage of those newly identified (into emergent, urgent and non urgent), those with known status and on treatment, management, referral. So am thinking of a decision tree of sorts that will help identify those who need urgent care. Will send some links later.

Byaruhanga B Emmanuel
Replied at 9:29 AM, 18 Jul 2013

Thank you Moses, great Ideas. I Love to receive those links and will do it
right away.

Asfawesen Gebreyohannes Woldegiorgis
Replied at 9:35 AM, 18 Jul 2013

I concure with the suggestion by Moses B. The practice set up needs to be designed to include patient traiging and emergency care unit with in the HIV/AIDS care center. guideline and/or SOP ffor system creation and implementation should be available. Moreover, clinical manuals guiding the clinical intervention and treatment should be developed and avilable in the ED.

Shevin Jacob
Replied at 9:58 AM, 18 Jul 2013

Hi Emmanuel,

You bring up a very important and neglected aspect of HIV treatment and care. As you allude, guidelines like the first level WHO IMAI handbook provide minimal guidance on clinical management and instead recommend referral to higher level health centers for further management. The 2nd level IMAI program addresses this very issue and I think the recently published WHO IMAI District Clinician Manual ( might be helpful for developing SOPs in your specific clinical setting. Of note, our group has developed a 5- day training course which is complementary to the IMAI District Clinician Manual's sections focusing on the emergency management of hospitalized patients including those with HIV. Over the past 2 years, we have conducted trainings comprising over 85 health workers from 15 district and regional referral hospitals in Uganda. Currently, we are in the process of adapting the guidelines for Uganda with the Uganda Ministry of Health I'm now based in Uganda so you can feel free to get in touch with me if you'd like to discuss further ().

Best wishes,

Kenly Sikwese
Replied at 4:51 AM, 19 Jul 2013

In worked at a hospice that provided long-term care for cancer and HIV
patients during the pre-ART ara. The ART transitioned into a fully fledged
ART centre with about 7,000 patients (over 5,000 on ART including
children). The Hospice has a fairly high recovery rate of late presenters.
But there are always the occasional individual with HIV who arrive too late
to save. The answer remains in up-stream measures - testing and initiating
people into care or/and ART early. For that, there is enough evidence to
demonstrate effectiveness of keeping people alive and healthier.

Byaruhanga B Emmanuel
Replied at 5:17 AM, 19 Jul 2013

Thanks Shevin & Kenly.

I do appreciate the resources attached which I am using to make an evidence
based measure to care for emergencies at HIV care centers.
Depending on ones geographic orientation and socio-economic status, it may
be shocking to know that some communities still condemn emergencies in
terminal HIV disease. Here is a common saying; *"After all, he/she is going
to die"*
Professionally, such beliefs should be averted to ensure equitable and
accessible medical care.

I salute you all

  Sign in to reply